Huichalaf Claudia, Perfitt Tyler L, Kuperman Anna, Gooch Renea, Kovi Ramesh C, Brenneman Karrie A, Chen Xian, Hirenallur-Shanthappa Dinesh, Ma Tiffany, Assaf Basel T, Pardo Ingrid, Franks Tania, Monarski Laura, Cheng Ting-Wen, Le Kevin, Su Chunyan, Somanathan Suryanarayan, Whiteley Laurence O, Bulawa Christine, Pregel Marko J, Martelli Alain
Rare Disease Research Unit, Worldwide Research, Development and Medical, Pfizer Inc., 610 Main Street, Cambridge, MA 02139, USA.
Drug Safety Research and Development, Worldwide Research, Development and Medical, Pfizer Inc., Cambridge, MA 02139, USA.
Mol Ther Methods Clin Dev. 2022 Feb 7;24:367-378. doi: 10.1016/j.omtm.2022.02.002. eCollection 2022 Mar 10.
Friedreich's ataxia is a rare disorder resulting from deficiency of frataxin, a mitochondrial protein implicated in the synthesis of iron-sulfur clusters. Preclinical studies in mice have shown that gene therapy is a promising approach to treat individuals with Friedreich's ataxia. However, a recent report provided evidence that AAVrh10-mediated overexpression of frataxin could lead to cardiotoxicity associated with mitochondrial dysfunction. While evaluating an AAV9-based frataxin gene therapy using a chicken β-actin promoter, we showed that toxic overexpression of frataxin could be reached in mouse liver and heart with doses between 1 × 10 and 1 × 10 vg/kg. In a mouse model of cardiac disease, these doses only corrected cardiac dysfunction partially and transiently and led to adverse findings associated with iron-sulfur cluster deficiency in liver. We demonstrated that toxicity required frataxin's primary function by using a frataxin construct bearing the N146K mutation, which impairs binding to the iron-sulfur cluster core complex. At the lowest tested dose, we observed moderate liver toxicity that was accompanied by progressive loss of transgene expression and liver regeneration. Together, our data provide insights into the toxicity of frataxin overexpression that should be considered in the development of a gene therapy approach for Friedreich's ataxia.
弗里德赖希共济失调是一种罕见的疾病,由线粒体蛋白铁硫蛋白缺乏引起,该蛋白与铁硫簇的合成有关。小鼠的临床前研究表明,基因治疗是治疗弗里德赖希共济失调患者的一种有前景的方法。然而,最近的一份报告提供了证据,表明腺相关病毒rh10介导的铁硫蛋白过表达可能导致与线粒体功能障碍相关的心脏毒性。在使用鸡β-肌动蛋白启动子评估基于腺相关病毒9的铁硫蛋白基因治疗时,我们发现,在小鼠肝脏和心脏中,剂量在1×10至1×10病毒基因组/千克之间时,铁硫蛋白可能会出现毒性过表达。在一种心脏病小鼠模型中,这些剂量只能部分且短暂地纠正心脏功能障碍,并导致与肝脏中铁硫簇缺乏相关的不良发现。我们通过使用携带N146K突变的铁硫蛋白构建体证明,毒性需要铁硫蛋白的主要功能,该突变会损害与铁硫簇核心复合物的结合。在测试的最低剂量下,我们观察到中度肝脏毒性,同时伴随着转基因表达的逐渐丧失和肝脏再生。总之,我们的数据为铁硫蛋白过表达的毒性提供了见解,在开发弗里德赖希共济失调的基因治疗方法时应予以考虑。