European Molecular Biology Laboratory (EMBL), Genome Biology Unit, Heidelberg, Germany.
Department of Genetics, Stanford University School of Medicine, Stanford, CA, USA.
Nat Commun. 2023 Jun 22;14(1):3714. doi: 10.1038/s41467-023-39352-1.
Dilated cardiomyopathy is the second most common cause for heart failure with no cure except a high-risk heart transplantation. Approximately 30% of patients harbor heritable mutations which are amenable to CRISPR-based gene therapy. However, challenges related to delivery of the editing complex and off-target concerns hamper the broad applicability of CRISPR agents in the heart. We employ a combination of the viral vector AAVMYO with superior targeting specificity of heart muscle tissue and CRISPR base editors to repair patient mutations in the cardiac splice factor Rbm20, which cause aggressive dilated cardiomyopathy. Using optimized conditions, we repair >70% of cardiomyocytes in two Rbm20 knock-in mouse models that we have generated to serve as an in vivo platform of our editing strategy. Treatment of juvenile mice restores the localization defect of RBM20 in 75% of cells and splicing of RBM20 targets including TTN. Three months after injection, cardiac dilation and ejection fraction reach wild-type levels. Single-nuclei RNA sequencing uncovers restoration of the transcriptional profile across all major cardiac cell types and whole-genome sequencing reveals no evidence for aberrant off-target editing. Our study highlights the potential of base editors combined with AAVMYO to achieve gene repair for treatment of hereditary cardiac diseases.
扩张型心肌病是心力衰竭的第二大常见病因,除了高风险的心脏移植外,尚无治愈方法。大约 30%的患者存在可遗传的突变,这些突变可以通过基于 CRISPR 的基因疗法来治疗。然而,与编辑复合物的传递和脱靶问题相关的挑战,限制了 CRISPR 试剂在心脏中的广泛适用性。我们结合使用病毒载体 AAVMYO 和对心肌组织具有更高靶向特异性的 CRISPR 碱基编辑器,来修复导致侵袭性扩张型心肌病的心脏剪接因子 Rbm20 中的患者突变。使用优化的条件,我们修复了两种 Rbm20 敲入小鼠模型中超过 70%的心肌细胞,这些模型被用作我们编辑策略的体内平台。对幼年小鼠的治疗可使 75%的细胞中 RBM20 的定位缺陷得到恢复,并使 RBM20 靶标包括 TTN 的剪接恢复正常。注射三个月后,心脏扩张和射血分数达到野生型水平。单细胞 RNA 测序揭示了所有主要心脏细胞类型的转录谱的恢复,全基因组测序未发现异常脱靶编辑的证据。我们的研究强调了碱基编辑器与 AAVMYO 相结合,为遗传性心脏疾病的治疗实现基因修复的潜力。