Costa-Verdera Helena, Meneghini Vasco, Fitzpatrick Zachary, Abou Alezz Monah, Fabyanic Emily, Huang Xin, Dzhashiashvili Yulia, Ahiya Avantika, Mangiameli Elisabeth, Valeri Erika, Crivicich Giovanni, Piccolo Silvia, Cuccovillo Ivan, Caccia Roberta, Chan Ying Kai, Bertin Bérangère, Ronzitti Giuseppe, Engel Esteban A, Merelli Ivan, Mingozzi Federico, Gritti Angela, Kuranda Klaudia, Kajaste-Rudnitski Anna
San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Spark Therapeutics, Inc., Philadelphia, PA, USA.
Nat Commun. 2025 Apr 18;16(1):3694. doi: 10.1038/s41467-025-58778-3.
Adeno-associated viral (AAV) vector-based gene therapy is gaining foothold as treatment for genetic neurological diseases with encouraging clinical results. Nonetheless, dose-dependent adverse events have emerged in recent clinical trials through mechanisms that remain unclear. We have modelled here the impact of AAV transduction in cell models of the human central nervous system (CNS), taking advantage of induced pluripotent stem cells. Our work uncovers vector-induced innate immune mechanisms that contribute to cell death. While empty AAV capsids were well tolerated, the AAV genome triggered p53-dependent DNA damage responses across CNS cell types followed by the induction of inflammatory responses. In addition, transgene expression led to MAVS-dependent activation of type I interferon responses. Formation of DNA damage foci in neurons and gliosis were confirmed in murine striatum upon intraparenchymal AAV injection. Transduction-induced cell death and gliosis could be prevented by inhibiting p53 or by acting downstream on STING- or IL-1R-mediated responses. Together, our work identifies innate immune mechanisms of vector sensing in the CNS that can potentially contribute to AAV-associated neurotoxicity.
基于腺相关病毒(AAV)载体的基因疗法作为治疗遗传性神经疾病的方法正逐渐站稳脚跟,临床试验结果令人鼓舞。尽管如此,最近的临床试验中出现了剂量依赖性不良事件,其机制尚不清楚。我们在此利用诱导多能干细胞,在人类中枢神经系统(CNS)细胞模型中模拟了AAV转导的影响。我们的研究揭示了导致细胞死亡的载体诱导的先天免疫机制。虽然空的AAV衣壳耐受性良好,但AAV基因组在中枢神经系统细胞类型中引发了p53依赖性DNA损伤反应,随后诱导了炎症反应。此外,转基因表达导致了MAVS依赖性的I型干扰素反应激活。在脑实质内注射AAV后,在小鼠纹状体中证实了神经元中DNA损伤灶的形成和神经胶质增生。通过抑制p53或作用于STING或IL-1R介导的反应的下游,可以预防转导诱导的细胞死亡和神经胶质增生。总之,我们的研究确定了中枢神经系统中载体感知的先天免疫机制,这些机制可能导致AAV相关的神经毒性。
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