Adeno-Associated Virus Vector Delivery of Muscle Specific Micro-Dystrophin To Treat Muscular Dystrophy
20220364117 · 2022-11-17
Inventors
Cpc classification
C12N7/00
CHEMISTRY; METALLURGY
A61P21/00
HUMAN NECESSITIES
C12N2750/14143
CHEMISTRY; METALLURGY
C12N2830/008
CHEMISTRY; METALLURGY
A61K9/0029
HUMAN NECESSITIES
A61K48/00
HUMAN NECESSITIES
C12N15/86
CHEMISTRY; METALLURGY
International classification
C12N15/86
CHEMISTRY; METALLURGY
A61K9/00
HUMAN NECESSITIES
A61P21/00
HUMAN NECESSITIES
Abstract
The invention provides gene therapy vectors, such as adeno-associated virus (AAV) vectors, expressing a miniaturized human micro-dystrophin gene and method of using these vectors to express micro-dystrophin in skeletal muscles including diaphragm and cardiac muscle and to protect muscle fibers from injury, increase muscle strength and reduce and/or prevent fibrosis in subjects suffering from muscular dystrophy.
Claims
1. A recombinant AAV vector comprising a muscle specific control element nucleotide sequence and a nucleotide sequence encoding the micro-dystrophin protein.
2. The recombinant AAV vector of claim 1 wherein the nucleotide sequence encoding the micro-dystrophin protein comprises a) a nucleotide sequence that is at least 85% identical to the nucleotide sequence SEQ ID NO: 1 and encodes a functional micro-dystrophin protein, or b) the nucleotide sequences of SEQ ID NO: 1.
3. The recombinant AAV vector of claim 1 or 2, wherein the muscle specific control element is human skeletal actin gene element, cardiac actin gene element, myocyte-specific enhancer binding factor (MEF), muscle creatine kinase (MCK), truncated MCK (tMCK), myosin heavy chain (MHC), hybrid α-myosin heavy chain enhancer-/MCK enhancer-promoter (MHCK7), C5-12, murine creatine kinase enhancer element, skeletal fast-twitch troponin c gene element, slow-twitch cardiac troponin c gene element, slow-twitch troponin i gene element, an hypoxia-inducible nuclear factor, steroid-inducible element, or glucocorticoid response element (GRE).
4. The recombinant AAV vector of any one of claims 1-3, wherein the muscle specific control element is muscle creatine kinase (MCK) or hybrid α-myosin heavy chain enhancer-/MCK enhancer-promoter (MHCK7).
5. The recombinant AAV vector of any one of claims 1-4, wherein the muscle specific control element is muscle creatine kinase (MCK) comprising the nucleotide sequence SEQ ID NO: 4 or hybrid α-myosin heavy chain enhancer-/MCK enhancer-promoter (MHCK7) comprising the nucleotide sequence SEQ ID NO: 2.
6. The recombinant AAV vector of any one of claims 1-5 comprising nucleotide sequences of SEQ ID NOS: 1 and 2.
7. The recombinant AAV vector of any one of claims 1-6 comprising the nucleotide sequence of SEQ ID NO: 3.
8. A recombinant AAV vector comprising the human micro-dystrophin nucleotide sequence of SEQ ID NO: 1 and the MHCK7 promoter sequence of SEQ ID NO: 2.
9. A recombinant AAV vector comprising the pAAV.MHCK7.micro-dystrophin construct nucleotide sequence of SEQ ID NO: 3.
10. The recombinant AAV vector of any one of claims 1-5 comprising the nucleotide sequences of SEQ ID NOS: 1 and 4.
11. The recombinant AAV vector of any one of claims 1-5 or 10 comprising the nucleotide sequence of SEQ ID NO: 5.
12. The recombinant AAV vector of any one of claims 1-11, wherein the vector is of the serotype AAVrh.74, AAV1, AAV2, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12 or AAV13.
13. The recombinant AAV vector of any one of claims 1-12, wherein the muscle specific control element nucleotide sequence is operably linked to the micro-dystrophin nucleotide sequence.
14. A composition comprising the recombinant AAV vector of any one of claims 1-13 and a pharmaceutically acceptable carrier.
15. A method of increasing muscular force or muscle mass in a subject suffering from muscular dystrophy comprising administering a therapeutically effective amount of the recombinant AAV vector of any one of claims 1-13 or the composition of claim 14.
16. A method of reducing or preventing fibrosis in a subject suffering from muscular dystrophy comprising administering a therapeutically effective amount of the recombinant AAV vector of any one of claims 1-13 or the composition of claim 14.
17. A method of treating muscular dystrophy comprising administering a therapeutically effective amount of the recombinant AAV vector of any one of claims 1-13 or the composition of claim 14.
18. A method of treating muscular dystrophy comprising administering a therapeutically effective amount of a recombinant AAV vector comprising the human micro-dystrophin nucleotide sequence of SEQ ID NO: 1 and the MHCK7 promoter nucleotide sequence of SEQ ID NO: 2.
19. A method of treating muscular dystrophy comprising administering a therapeutically effective amount of a recombinant AAV vector comprising the pAAV.MHCK7.micro-dystrophin construct nucleotide sequence of SEQ ID NO: 3.
20. The method of any one of claims 15-19, wherein the muscular dystrophy is Duchenne muscular dystrophy.
21. The method of any one of claims 15-19, wherein the recombinant AAV vector or the composition is administered by intramuscular injection or intravenous injection.
22. The method of any one of claims 15-19, wherein the recombinant AAV vector or the composition is administered systemically.
23. The method of claim 22, where the recombinant AAV vector or the composition is parenterally administered by injection, infusion or implantation.
24. A composition comprising the recombinant AAV vector of any one of claims 1-13 for increasing muscular force or muscle mass in a subject suffering from muscular dystrophy.
25. A composition comprising the recombinant AAV vector of any one of claims 1-13 for the treatment of muscular dystrophy.
26. A composition comprising a recombinant AAV vector comprising the human micro-dystrophin nucleotide sequence of SEQ ID NO: 1 and the MHCK7 promoter sequence of SEQ ID NO: 2 for the treatment of muscular dystrophy.
27. A composition comprising a recombinant AAV vector comprising the pAAV.MHCK7.micro-dystrophin construct nucleotide sequence of SEQ ID NO: 3 for the treatment of muscular dystrophy.
28. The composition of any one of claims 24-27 wherein the muscular dystrophy is Duchenne muscular dystrophy.
29. The composition of any one of claims 24-28 formulated for intramuscular injection or intravenous injection.
30. The method of any one of claims 24-28 wherein the recombinant AAV vector or the composition is administered systemically.
31. The method of claim 30, where the recombinant AAV vector or the composition is parenterally administration by injection, infusion, or implantation.
32. Use of the recombinant AAV vector of any one of claims 1-13, or the composition of claim 14 for the preparation of a medicament for increasing muscular strength or muscle mass in a subject suffering from muscular dystrophy.
33. Use of the recombinant AAV vector of any one of claims 1-13, or the composition of claim 14, for the preparation of a medicament for the treatment of muscular dystrophy.
34. Use of the recombinant AAV vector of any one of claims 1-13 or the composition of claim 14, for the preparation of a medicament for reducing or preventing fibrosis in a subject suffering from muscular dystrophy.
35. Use of a recombinant AAV vector comprising the human micro-dystrophin nucleotide sequence of SEQ ID NO: 1 and the MHCK7 promoter nucleotide sequence of SEQ ID NO: 2 for preparation of a medicament for the treatment of muscular dystrophy.
36. Use of a recombinant AAV vector comprising the pAAV.MHCK7.micro-dystrophin construct nucleotide sequence of SEQ ID NO: 3 for the treatment of muscular dystrophy.
37. The use of any one of any one of claims 32-36 wherein the muscular dystrophy is Duchenne muscular dystrophy.
38. The use of any one of claims 32-37 wherein the medicament is formulated for intramuscular or intravenous administration.
39. The use of any one of claims 32-37 wherein the medicament is formulated for systemic delivery.
40. The use of claim 39, where the medicament is formulated for parenteral administration by injection, infusion or implantation.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
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DETAILED DESCRIPTION
[0085] The present invention provides for gene therapy vectors, e.g. rAAV vectors, overexpressing human micro-dystrophin and methods of reducing and preventing fibrosis in muscular dystrophy patients. Muscle biopsies taken at the earliest age of diagnosis of DMD reveal prominent connective tissue proliferation. Muscle fibrosis is deleterious in multiple ways. It reduces normal transit of endomysial nutrients through connective tissue barriers, reduces the blood flow and deprives muscle of vascular-derived nutritional constituents, and functionally contributes to early loss of ambulation through limb contractures. Over time, treatment challenges multiply as a result of marked fibrosis in muscle. This can be observed in muscle biopsies comparing connective tissue proliferation at successive time points. The process continues to exacerbate leading to loss of ambulation and accelerating out of control, especially in wheelchair-dependent patients.
[0086] Without early treatment including a parallel approach to reduce fibrosis it is unlikely that the benefits of exon skipping, stop-codon read-through, or gene replacement therapies can ever be fully achieved. Even small molecules or protein replacement strategies are likely to fail without an approach to reduce muscle fibrosis. Previous work in aged mdx mice with existing fibrosis treated with AAV.micro-dystrophin demonstrated that we could not achieve full functional restoration (Liu, M., et al., Mol Ther 11, 245-256 (2005)). It is also known that progression of DMD cardiomyopathy is accompanied by scarring and fibrosis in the ventricular wall.
[0087] As used herein, the term “AAV” is a standard abbreviation for adeno-associated virus. Adeno-associated virus is a single-stranded DNA parvovirus that grows only in cells in which certain functions are provided by a co-infecting helper virus. There are currently thirteen serotypes of AAV that have been characterized. General information and reviews of AAV can be found in, for example, Carter, 1989, Handbook of Parvoviruses, Vol. 1, pp. 169-228, and Berns, 1990, Virology, pp. 1743-1764, Raven Press, (New York). However, it is fully expected that these same principles will be applicable to additional AAV serotypes since it is well known that the various serotypes are quite closely related, both structurally and functionally, even at the genetic level. (See, for example, Blacklowe, 1988, pp. 165-174 of Parvoviruses and Human Disease, J. R. Pattison, ed.; and Rose, Comprehensive Virology 3:1-61 (1974)). For example, all AAV serotypes apparently exhibit very similar replication properties mediated by homologous rep genes; and all bear three related capsid proteins such as those expressed in AAV2. The degree of relatedness is further suggested by heteroduplex analysis which reveals extensive cross-hybridization between serotypes along the length of the genome; and the presence of analogous self-annealing segments at the termini that correspond to “inverted terminal repeat sequences” (ITRs). The similar infectivity patterns also suggest that the replication functions in each serotype are under similar regulatory control.
[0088] An “AAV vector” as used herein refers to a vector comprising one or more polynucleotides of interest (or transgenes) that are flanked by AAV terminal repeat sequences (ITRs). Such AAV vectors can be replicated and packaged into infectious viral particles when present in a host cell that has been transfected with a vector encoding and expressing rep and cap gene products.
[0089] An “AAV virion” or “AAV viral particle” or “AAV vector particle” refers to a viral particle composed of at least one AAV capsid protein and an encapsidated polynucleotide AAV vector. If the particle comprises a heterologous polynucleotide (i.e. a polynucleotide other than a wild-type AAV genome such as a transgene to be delivered to a mammalian cell), it is typically referred to as an “AAV vector particle” or simply an “AAV vector”. Thus, production of AAV vector particle necessarily includes production of AAV vector, as such a vector is contained within an AAV vector particle.
AAV
[0090] Recombinant AAV genomes of the invention comprise nucleic acid molecule of the invention and one or more AAV ITRs flanking a nucleic acid molecule. AAV DNA in the rAAV genomes may be from any AAV serotype for which a recombinant virus can be derived including, but not limited to, AAV serotypes AAVrh.74, AAV-1, AAV-2, AAV-3, AAV-4, AAV-5, AAV-6, AAV-7, AAV-8, AAV-9, AAV-10, AAV-11, AAV-12 and AAV-13. Production of pseudotyped rAAV is disclosed in, for example, WO 01/83692. Other types of rAAV variants, for example rAAV with capsid mutations, are also contemplated. See, for example, Marsic et al., Molecular Therapy, 22(11): 1900-1909 (2014). As noted in the Background section above, the nucleotide sequences of the genomes of various AAV serotypes are known in the art. To promote skeletal muscle specific expression, AAV1, AAV6, AAV8 or AAVrh.74 can be used.
[0091] DNA plasmids of the invention comprise rAAV genomes of the invention. The DNA plasmids are transferred to cells permissible for infection with a helper virus of AAV (e.g., adenovirus, E1-deleted adenovirus or herpesvirus) for assembly of the rAAV genome into infectious viral particles. Techniques to produce rAAV particles, in which an AAV genome to be packaged, rep and cap genes, and helper virus functions are provided to a cell are standard in the art. Production of rAAV requires that the following components are present within a single cell (denoted herein as a packaging cell): a rAAV genome, AAV rep and cap genes separate from (i.e., not in) the rAAV genome, and helper virus functions. The AAV rep and cap genes may be from any AAV serotype for which recombinant virus can be derived and may be from a different AAV serotype than the rAAV genome ITRs, including, but not limited to, AAV serotypes AAV-1, AAV-2, AAV-3, AAV-4, AAV-5, AAV-6, AAV-7, AAVrh.74, AAV-8, AAV-9, AAV-10, AAV-11, AAV-12 and AAV-13. Production of pseudotyped rAAV is disclosed in, for example, WO 01/83692 which is incorporated by reference herein in its entirety.
[0092] A method of generating a packaging cell is to create a cell line that stably expresses all the necessary components for AAV particle production. For example, a plasmid (or multiple plasmids) comprising a rAAV genome lacking AAV rep and cap genes, AAV rep and cap genes separate from the rAAV genome, and a selectable marker, such as a neomycin resistance gene, are integrated into the genome of a cell. AAV genomes have been introduced into bacterial plasmids by procedures such as GC tailing (Samulski et al., 1982, Proc. Natl. Acad. S6. USA, 79:2077-2081), addition of synthetic linkers containing restriction endonuclease cleavage sites (Laughlin et al., 1983, Gene, 23:65-73) or by direct, blunt-end ligation (Senapathy & Carter, 1984, J. Biol. Chem., 259:4661-4666). The packaging cell line is then infected with a helper virus such as adenovirus. The advantages of this method are that the cells are selectable and are suitable for large-scale production of rAAV. Other examples of suitable methods employ adenovirus or baculovirus rather than plasmids to introduce rAAV genomes and/or rep and cap genes into packaging cells.
[0093] General principles of rAAV production are reviewed in, for example, Carter, 1992, Current Opinions in Biotechnology, 1533-539; and Muzyczka, 1992, Curr. Topics in Microbial. and Immunol., 158:97-129). Various approaches are described in Ratschin et al., Mol. Cell. Biol. 4:2072 (1984); Hermonat et al., Proc. Natl. Acad. Sci. USA, 81:6466 (1984); Tratschin et al., Mol. Cell. Biol. 5:3251 (1985); McLaughlin et al., J. Virol., 62:1963 (1988); and Lebkowski et al., Mol. Cell. Biol., 7:349 (1988). Samulski et al., J. Virol., 63:3822-3828 (1989); U.S. Pat. No. 5,173,414; WO 95/13365 and corresponding U.S. Pat. No. 5,658,776; WO 95/13392; WO 96/17947; PCT/US98/18600; WO 97/09441 (PCT/US96/14423); WO 97/08298 (PCT/US96/13872); WO 97/21825 (PCT/US96/20777); WO 97/06243 (PCT/FR96/01064); WO 99/11764; Perrin et al. Vaccine 13:1244-1250 (1995); Paul et al. Human Gene Therapy 4:609-615 (1993); Clark et al. Gene Therapy 3:1124-1132 (1996); U.S. Pat. Nos. 5,786,211; 5,871,982; and 6,258,595. The foregoing documents are hereby incorporated by reference in their entirety herein, with particular emphasis on those sections of the documents relating to rAAV production.
[0094] The invention thus provides packaging cells that produce infectious rAAV. In one embodiment packaging cells may be stably transformed cancer cells such as HeLa cells, 293 cells and PerC.6 cells (a cognate 293 line). In another embodiment, packaging cells are cells that are not transformed cancer cells, such as low passage 293 cells (human fetal kidney cells transformed with E1 of adenovirus), MRC-5 cells (human fetal fibroblasts), WI-38 cells (human fetal fibroblasts), Vero cells (monkey kidney cells) and FRhL-2 cells (rhesus fetal lung cells).
[0095] Recombinant AAV (i.e., infectious encapsidated rAAV particles) of the invention comprise a rAAV genome. In exemplary embodiments, the genomes of both rAAV lack AAV rep and cap DNA, that is, there is no AAV rep or cap DNA between the ITRs of the genomes. Examples of rAAV that may be constructed to comprise the nucleic acid molecules of the invention are set out in International Patent Application No. PCT/US2012/047999 (WO 2013/016352) incorporated by reference herein in its entirety.
[0096] In an exemplary embodiment, the recombinant AAV vector of the invention is produced by the triple transfection method (Xiao et al., J Virol 72, 2224-2232 (1998) using the AAV vector plasmids pAAV.MHCK7.micro-dystrophin, pNLRep2-Caprh74 and pHelp, pAAV contains the micro-dystrophin gene expression cassette flanked by AAV2 inverted terminal repeat sequences (ITR). It is this sequence that is encapsidated into AAVrh74 virions. The plasmid contains the micro-dystrophin sequence and the MHCK7 enhancer and core promoter elements of the muscle specific promoter to drive gene expression. The expression cassette also contains an SV40 intron (SD/SA) to promote high-level gene expression and the bovine growth hormone polyadenylation signal is used for efficient transcription termination.
[0097] The pNLREP2-Caprh74 is an AAV helper plasmid that encodes the 4 wild-type AAV2 rep proteins and the 3 wild-type AAV VP capsid proteins from serotype rh74. A schematic map of the pNLREP2-Caprh74 plasmid is shown in Error! Reference source not found.25.
[0098] The pHELP adenovirus helper plasmid is 11,635 bp and was obtained from Applied Viromics. The plasmid contains the regions of adenovirus genome that are important for AAV replication, namely E2A, E4ORF6, and VA RNA (the adenovirus E1 functions are provided by the 293 cells). The adenovirus sequences present in this plasmid only represents ˜40% of the adenovirus genome, and does not contain the cis elements critical for replication such as the adenovirus terminal repeats. Therefore, no infectious adenovirus is expected to be generated from such a production system. A schematic map of the pHELP plasmid is shown in
[0099] The rAAV may be purified by methods standard in the art such as by column chromatography or cesium chloride gradients. Methods for purifying rAAV vectors from helper virus are known in the art and include methods disclosed in, for example, Clark et al., Hum. Gene Ther., 10(6): 1031-1039 (1999); Schenpp and Clark, Methods Mol. Med., 69 427-443 (2002); U.S. Pat. No. 6,566,118 and WO 98/09657.
[0100] In another embodiment, the invention contemplates compositions comprising rAAV of the present invention. Compositions of the invention comprise rAAV and a pharmaceutically acceptable carrier. The compositions may also comprise other ingredients such as diluents and adjuvants. Acceptable carriers, diluents and adjuvants are nontoxic to recipients and are preferably inert at the dosages and concentrations employed and include buffers and surfactants such as pluronics.
[0101] Titers of rAAV to be administered in methods of the invention will vary depending, for example, on the particular rAAV, the mode of administration, the treatment goal, the individual, and the cell type(s) being targeted, and may be determined by methods standard in the art. Titers of rAAV may range from about 1×10.sup.6, about 1×10.sup.7, about 1×10.sup.8, about 1×10.sup.9, about 1×10.sup.10, about 1×10.sup.11, about 1×10.sup.12, about 1×10.sup.13 to about 1×10.sup.14 or more DNase resistant particles (DRP) per ml. Dosages may also be expressed in units of viral genomes (vg).
[0102] Methods of transducing a target cell with rAAV, in vivo or in vitro, are contemplated by the invention. The in vivo methods comprise the step of administering an effective dose, or effective multiple doses, of a composition comprising a rAAV of the invention to an animal (including a human being) in need thereof. If the dose is administered prior to development of a disorder/disease, the administration is prophylactic. If the dose is administered after the development of a disorder/disease, the administration is therapeutic. In embodiments of the invention, an effective dose is a dose that alleviates (eliminates or reduces) at least one symptom associated with the disorder/disease state being treated, that slows or prevents progression to a disorder/disease state, that slows or prevents progression of a disorder/disease state, that diminishes the extent of disease, that results in remission (partial or total) of disease, and/or that prolongs survival. An example of a disease contemplated for prevention or treatment with methods of the invention is DMD.
[0103] Combination therapies are also contemplated by the invention. Combination as used herein includes both simultaneous treatment and sequential treatments. Combinations of methods of the invention with standard medical treatments (e.g., corticosteroids) are specifically contemplated, as are combinations with novel therapies.
[0104] Administration of an effective dose of the compositions may be by routes standard in the art including, but not limited to, intramuscular, parenteral, intravenous, oral, buccal, nasal, pulmonary, intracranial, intraosseous, intraocular, rectal, or vaginal. Route(s) of administration and serotype(s) of AAV components of the rAAV (in particular, the AAV ITRs and capsid protein) of the invention may be chosen and/or matched by those skilled in the art taking into account the infection and/or disease state being treated and the target cells/tissue(s) that are to express the micro-dystrophin protein.
[0105] The invention provides for local administration and systemic administration of an effective dose of rAAV and compositions of the invention. For example, systemic administration is administration into the circulatory system so that the entire body is affected. Systemic administration includes enteral administration such as absorption through the gastrointestinal tract and parenteral administration through injection, infusion or implantation.
[0106] In particular, actual administration of rAAV of the present invention may be accomplished by using any physical method that will transport the rAAV recombinant vector into the target tissue of an animal. Administration according to the invention includes, but is not limited to, injection into muscle and injection into the bloodstream. Simply resuspending a rAAV in phosphate buffered saline has been demonstrated to be sufficient to provide a vehicle useful for muscle tissue expression, and there are no known restrictions on the carriers or other components that can be co-administered with the rAAV (although compositions that degrade DNA should be avoided in the normal manner with rAAV). Capsid proteins of a rAAV may be modified so that the rAAV is targeted to a particular target tissue of interest such as muscle. See, for example, WO 02/053703, the disclosure of which is incorporated by reference herein. Pharmaceutical compositions can be prepared as injectable formulations or as topical formulations to be delivered to the muscles by transdermal transport. Numerous formulations for both intramuscular injection and transdermal transport have been previously developed and can be used in the practice of the invention. The rAAV can be used with any pharmaceutically acceptable carrier for ease of administration and handling.
[0107] The dose of rAAV to be administered in methods disclosed herein will vary depending, for example, on the particular rAAV, the mode of administration, the treatment goal, the individual, and the cell type(s) being targeted, and may be determined by methods standard in the art. Titers of each rAAV administered may range from about 1×10.sup.6, about 1×10.sup.7, about 1×10.sup.8, about 1×10.sup.9, about 1×10.sup.10, about 1×10.sup.11, about 1×10.sup.12, about 1×10.sup.13, about 1×10.sup.14, or to about 1×10.sup.15 or more DNase resistant particles (DRP) per ml. Dosages may also be expressed in units of viral genomes (vg) (i.e., 1×10.sup.7 vg, 1×10.sup.8 vg, 1×10.sup.9 vg, 1×10.sup.10 vg 1×10.sup.11 vg, 1×10.sup.12 vg, 1×10.sup.13 vg, 1×10.sup.14 vg, 1×10.sup.15 respectively). Dosages may also be expressed in units of viral genomes (vg) per kilogram (kg) of bodyweight (i.e., 1×10.sup.10 vg/kg, 1×10.sup.11 vg/kg, 1×10.sup.12 vg/kg, 1×10.sup.13 vg/kg, 1×10.sup.14 vg/kg, 1×10.sup.15 vg/kg respectively). Methods for titering AAV are described in Clark et al., Hum. Gene Ther., 10: 1031-1039 (1999).
[0108] In particular, actual administration of rAAV of the present invention may be accomplished by using any physical method that will transport the rAAV recombinant vector into the target tissue of an animal. Administration according to the invention includes, but is not limited to, injection into muscle and injected into the bloodstream. Simply resuspending a rAAV in phosphate buffered saline has been demonstrated to be sufficient to provide a vehicle useful for muscle tissue expression, and there are no known restrictions on the carriers or other components that can be co-administered with the rAAV (although compositions that degrade DNA should be avoided in the normal manner with rAAV). Capsid proteins of a rAAV may be modified so that the rAAV is targeted to a particular target tissue of interest such as muscle. See, for example, WO 02/053703, the disclosure of which is incorporated by reference herein. Pharmaceutical compositions can be prepared as injectable formulations or as topical formulations to be delivered to the muscles by transdermal transport. Numerous formulations for both intramuscular injection and transdermal transport have been previously developed and can be used in the practice of the invention. The rAAV can be used with any pharmaceutically acceptable carrier for ease of administration and handling.
[0109] For purposes of intramuscular injection, solutions in an adjuvant such as sesame or peanut oil or in aqueous propylene glycol can be employed, as well as sterile aqueous solutions. Such aqueous solutions can be buffered, if desired, and the liquid diluent first rendered isotonic with saline or glucose. Solutions of rAAV as a free acid (DNA contains acidic phosphate groups) or a pharmacologically acceptable salt can be prepared in water suitably mixed with a surfactant such as hydroxpropylcellulose. A dispersion of rAAV can also be prepared in glycerol, liquid polyethylene glycols and mixtures thereof and in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms. In this connection, the sterile aqueous media employed are all readily obtainable by standard techniques well-known to those skilled in the art.
[0110] The pharmaceutical carriers, diluents or excipients suitable for injectable use include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In all cases the form must be sterile and must be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating actions of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, liquid polyethylene glycol and the like), suitable mixtures thereof, and vegetable oils. The proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of a dispersion and by the use of surfactants. The prevention of the action of microorganisms can be brought about by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal and the like. In many cases it will be preferable to include isotonic agents, for example, sugars or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by use of agents delaying absorption, for example, aluminum monostearate and gelatin.
[0111] Sterile injectable solutions are prepared by incorporating rAAV in the required amount in the appropriate solvent with various other ingredients enumerated above, as required, followed by filter sterilization. Generally, dispersions are prepared by incorporating the sterilized active ingredient into a sterile vehicle which contains the basic dispersion medium and the required other ingredients from those enumerated above. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying and the freeze drying technique that yield a powder of the active ingredient plus any additional desired ingredient from the previously sterile-filtered solution thereof.
[0112] Transduction with rAAV may also be carried out in vitro. In one embodiment, desired target muscle cells are removed from the subject, transduced with rAAV and reintroduced into the subject. Alternatively, syngeneic or xenogeneic muscle cells can be used where those cells will not generate an inappropriate immune response in the subject.
[0113] Suitable methods for the transduction and reintroduction of transduced cells into a subject are known in the art. In one embodiment, cells can be transduced in vitro by combining rAAV with muscle cells, e.g., in appropriate media, and screening for those cells harboring the DNA of interest using conventional techniques such as Southern blots and/or PCR, or by using selectable markers. Transduced cells can then be formulated into pharmaceutical compositions, and the composition introduced into the subject by various techniques, such as by intramuscular, intravenous, subcutaneous and intraperitoneal injection, or by injection into smooth and cardiac muscle, using e.g., a catheter.
[0114] Transduction of cells with rAAV of the invention results in sustained expression of the micro-dystrophin protein. The present invention thus provides methods of administering/delivering rAAV which express micro-dystrophin protein to an animal, preferably a human being. These methods include transducing tissues (including, but not limited to, tissues such as muscle, organs such as liver and brain, and glands such as salivary glands) with one or more rAAV of the present invention. Transduction may be carried out with gene cassettes comprising tissue specific control elements. For example, one embodiment of the invention provides methods of transducing muscle cells and muscle tissues directed by muscle specific control elements, including, but not limited to, those derived from the actin and myosin gene families, such as from the myoD gene family (See Weintraub et al., Science, 251: 761-766 (1991)), the myocyte-specific enhancer binding factor MEF-2 (Cserjesi and Olson, Mol Cell Biol 11: 4854-4862 (1991)), control elements derived from the human skeletal actin gene (Muscat et al., Mol Cell Biol, 7: 4089-4099 (1987)), the cardiac actin gene, muscle creatine kinase sequence elements (See Johnson et al., Mol Cell Biol, 9:3393-3399 (1989)) and the murine creatine kinase enhancer (mCK) element, control elements derived from the skeletal fast-twitch troponin C gene, the slow-twitch cardiac troponin C gene and the slow-twitch troponin I gene: hypoxia-inducible nuclear factors (Semenza et al., Proc Natl Acad Sci USA, 88: 5680-5684 (1991)), steroid-inducible elements and promoters including the glucocorticoid response element (GRE) (See Mader and White, Proc. Natl. Acad. Sci. USA 90: 5603-5607 (1993)), and other control elements.
[0115] Muscle tissue is an attractive target for in vivo DNA delivery, because it is not a vital organ and is easy to access. The invention contemplates sustained expression of microdystrophin from transduced myofibers.
[0116] By “muscle cell” or “muscle tissue” is meant a cell or group of cells derived from muscle of any kind (for example, skeletal muscle and smooth muscle, e.g. from the digestive tract, urinary bladder, blood vessels or cardiac tissue). Such muscle cells may be differentiated or undifferentiated, such as myoblasts, myocytes, myotubes, cardiomyocytes and cardiomyoblasts.
[0117] The term “transduction” is used to refer to the administration/delivery of the coding region of the micro-dystrophin to a recipient cell either in vivo or in vitro, via a replication-deficient rAAV of the invention resulting in expression of micro-dystrophin by the recipient cell.
[0118] Thus, the invention provides methods of administering an effective dose (or doses, administered essentially simultaneously or doses given at intervals) of rAAV that encode micro-dystrophin to a patient in need thereof.
EXAMPLES
Example 1
Generation of the pAAV.MHCK7.Micro-Dystrophin Construct
[0119] The pAAV.MHCK7.micro-dystrophin plasmid contains a human micro-dystrophin cDNA expression cassette flanked by AAV2 inverted terminal repeat sequences (ITR) (see
[0120] Previous studies have validated cardiac expression using MHCK7 promoter (Salva et al. Mol Ther 15, 320-329 (2007) and AAVrh74 achieving skeletal, diaphragm, and cardiac muscle expression (Sondergaard et al. Annals of clinical and Transl Neurology 2, 256-270 (2015)), The sequence of construct of
Table 1 shows the molecular features of the plasmid pAAV.MHCK7.micro-dystrophin (SEQ ID NO: 3)
TABLE-US-00001 TABLE 1 Molecular Features of plasmid pAAV.MHCK7.micro-dystrophin TYPE START END NAME DESCRIPTION REGION 7 116 5′ ITR Wild-type AAV2 inverted terminal repeat REGION 236 1036 MHCK7 Mouse myosin heavy chain complex - E box muscle creatine kinase fusion enhancer/promoter REGION 1046 1195 Chimeric 5′ donor site from human β-globin gene intron and the branchpoint and 3′ splice acceptor site from IgG heavy chain variable region GENE 1206 4786 huDys cDNA Human micro-dystrophin cDNA REGION 4787 4842 PolyA Synthetic PolyA REGION 4933 5042 3′ ITR Wild-type AAV2 inverted terminal repeat GENE 6808 7668 AmpR β-lactamase gene REGION 7823 8442 Ori Plasmid origin of replication
Example 2
Intramuscular Expression Studies Using rAAV.MHCK7.Micro-Dystrophin
[0121] Expression studies were conducted with the human micro-dystrophin construct (rAAVrh74.MHCK7. micro-dystrophin; described in Example 1) by intramuscular injection. The tibialis anterior muscle of mdx mice (spontaneous Dmd.sup.mdx (mutant mice that do not express dystrophin) were injected with 1×10.sup.11 vg of the cassette (n=5 per group). Six weeks later the muscles were harvested and stained for dystrophin (Dys3) expression with an N-terminal antibody for dystrophin and hematoxylin and eosin (HE) staining.
[0122] In addition to measuring micro-dystrophin localization and expression levels, skeletal muscle force was measured following intramuscular injection of the cassette. Intramuscular expression of pAAV.MHCK7.micro-dystrophin construct resulted in significantly greater absolute and specific force production compared with untreated controls (
Example 3
Systemic Delivery of rAAVrh.74.MHCK7.Micro-Dystrophin to Mdx Mice
[0123] Cohorts of mdx mice were injected via tail vein with either 2×10.sup.12 vg (8×10.sup.13 vg/kg) or high dose (planned clinical dose) 6×10.sup.12 vg (2×10.sup.14 vg/kg) of rAAVrh.74.MHCK7.micro-dystrophin at 6 weeks of age. Following 12 weeks of treatment, all muscles were harvested and stained for dystrophin and restoration of DAPC components. Systemically injected (tail vein) mice showed high levels of staining of dystrophin throughout all muscles.
[0124] The toxicology/safety of AAVrh.74.MHCK7.micro-dystrophin are were evaluated by administering the vector via intravenous (i.v.) injection to the tail vein of mdx mice per Table 2. There was no evidence of toxicity in any of the muscle tissues analyzed including: Tibialis anterior (TA), Gastrocnemius (GAS), Quadriceps (QD), Psoas (PSO), Triceps (TRI), and Diaphragm (DIA) (
TABLE-US-00002 TABLE 2 Outline of toxicology/safety study of rAAVrh.74.MHCK7.micro-dystrophin in mice. Sacrificial End- Cohort Dose Treatment Follow-up Point Number Study Agent (vg/kg) Day 0 Day 1 Week 6 Extra (1) Low AAVrh.74.MH 8.0 × 10.sup.13 Single i.v. injection 24 h Weight, 5M +2 Dose CK7.Micro-dys to the tail vein of Clinical (2) High AAVrh.74.MH 2.0 × 10.sup.14 mdx mice Observations 5M +2 Dose CK7.Micro-dys (3) Control Vehicle (LRS) 0 5M +2 TOTAL MICE N = 21
Example 4
Generation of the pAAV.MCK.Micro-Dystrophin Construct
[0125] The pAAV.MCK.micro-dystrophin plasmid was constructed by inserting the MCK expression cassette driving a codon optimized human micro-dystrophin cDNA sequence into the AAV cloning vector psub201 (Samulski et al., J. Virol. 61(10):3096-3101). A muscle-specific regulatory element was included in the construct to drive muscle-specific gene expression. This regulatory element comprised the mouse MCK core enhancer (206 bp) fused to the 351 bp MCK core promoter (proximal). After the core promoter, the construct comprises the 53 bp endogenous mouse MCK Exon1 (untranslated) for efficient transcription initiation, followed by the SV40 late 16S/19S splice signals (97 bp) and a small 5′UTR (61 bp). The intron and 5′ UTR was derived from plasmid pCMVß (Clontech). The micro-dystrophin cassette has a consensus Kozak immediately in front of the ATG start and a small 53 bp synthetic polyA signal for mRNA termination. The human micro-dystrophin cassette contains the (R4-R23/Δ71-78) domains as previously described by Harper et al. Nat. Med. 8(3):253-61, 2002
[0126] The pAAV.MCK.micro-dystrophin plasmid contained the human micro-dystrophin cDNA expression cassette flanked by AAV2 inverted terminal repeat sequences (ITR) (see
Example 5
Potency and Dose Analysis Using rAAV.MCK.Micro-Dystrophin
[0127] Expression studies were conducted with the human micro-dystrophin construct (rAAV.MCK.micro-dystrophin; described in Example 1) by intramuscular injection. The tibialis anterior (TA) muscle of mdx mice (spontaneous Dmd.sup.mdx (mutant mice that do not express dystrophin) were injected with 3×10.sup.9, 3×10.sup.10, or 1×10.sup.11 vg (n=3 per group). Four weeks later the muscles were harvested and stained for dystrophin expression using an antibody specific for the N-terminal Dys3 and hematoxylin and eosin (HE) staining.
Example 6
Vascular Delivery of rAAV.MCK.Micro-Dystrophin to Mdx Mice
[0128] Using an isolated limb perfusion model (Rodino-Klapac et al., J. Trans. Med. 5(45): 1-11, 2007), mdx mice (n=10) were injected with 1×10.sup.11 vg of rAAVrh.74.MCK.micro-dystrophin via the femoral artery and performed outcomes analysis was carried out. Three months post gene transfer, lower limb muscles were harvested and efficacy studies demonstrated significant improvement in both force and resistance to eccentric contraction induced injury (
[0129] Dystrophin protein immunostaining in the extensor digitorum longus (EDL) muscle and TA muscle shows expression in a mdx myofibers following rAAVrh.74-MCK-micro-dystrophin treatment (
Example 7
Primate Studies
[0130] In order to apply pre-clinical finds in mice to a clinical paradigm, a non-human primate (NHP) was dosed systemically in order to evaluate safety and efficacy for future clinical trials. The effect of 2×10.sup.14 vg total dose of AAVrh74.MHCK7.micro-dystrophin.FLAG delivered intravenously through the cephalic vein was studied in a non-human primate. This dose was proportional (based on animal weight) to the systemic dose given to mice and corresponded to the mid-dose (6.0×10.sup.12 vg Total Dose) given to mice.
[0131] Baseline chemistries and immunological studies including enzyme-linked immunosorbent spot assay (ELISpot) analysis were carried out to measure T cells against AAVrh.74 capsid and micro-dystrophin as well as anti-AAV antibody titers. Three peptide pools were used for the AAVrh.74 capsid protein (Genemed Synthesis, San Antonio, Tex.) containing 34-36 peptides, each 18 amino acids long and overlapping by 11 residues. Four peptide pools encompassing the micro-dystrophin.FLAG protein (Genemed Synthesis) each 18 amino acids long and overlapping by 11 residues. Concanavalin A (ConA) (Sigma, 1 μg/mL) served as a positive control and 0.25% dimethylsulfoxide (DMSO) as a negative control. These studies were repeated every two weeks for the entire study. At 3 months following treatment, animals were euthanized to obtain a full tissue necropsy. Immunological assays did not show any unexpected responses to the capsid or transgene by ELISpot (
[0132] In addition full complete blood count and chemistry panels showed slight elevation of liver enzymes which were normalized back to baseline with no intervention or treatment necessary, as shown in Table 3 below.
TABLE-US-00003 TABLE 3 Blood Chemistry 24 2 4 6 8 12 13-176 Baseline hours week week week week week Total Protein 7 7 6.7 6.6 6.6 6.6 6.7 (6.4-7 mg/dL) Billirubin, Total 0.2 0.4 0.3 0.2 0.3 0.4 0.4 (0.15-0.23 mg/dL) ALT (31-50 U/L) 39 38 75 104 182 172 65 AST (19-38 U/L) 35 63 50 92 98 121 64 Alkaline 417 396 332 383 598 608 578 Phosphatease (504-821 U/L) GGT 77 77 120 106 131 156 134 CK 109 504 164 183 137 126 123
[0133] There were no other unexpected chemistry values throughout the duration of the study. Finally, a full analysis of all skeletal muscles demonstrated widespread expression in muscle fibers through immunofluorescence staining with a FLAG specific antibody and western blot detection using a mouse monoclonal antibody to dystrophin (
[0134] The data together demonstrates that systemic delivery of AAVrh74.MHCK7.micro-dystrophin.FLAG established safety and efficacy with widespread expression across all skeletal muscles in a non-human primate.
Example 8
Pre-Clinical Study to Demonstrate Efficacy
[0135] A pre-clinical study was carried out to demonstrate efficacy of systemic delivery of rAAVrh74.MHCK7.micro-dystrophin in treating skeletal and cardiac muscle deficits in mdx mice. The AAVrh74 vector containing a codon optimized human micro dystrophin transgene driven by a muscle and cardiac specific promoter, MHCK7 as described in Example 1 was used for this study.
[0136] Systemic injections of the rAAVrh74.MHCK7.micro-dystrophin via the tail vein in mdx (dystrophin null) mice were used for a dose response study. The results of this study demonstrated that systemic injections in mdx mice was effective in normalizing histologic and functional outcomes measured in limb and diaphragm in a dose dependent manner. Additionally, no significant vector-associated toxicity was reported following formal histopathology review by a board-certified veterinary pathologist.
[0137] The vector for this study was produced by the Nationwide Children's Hospital Viral Vector Core utilizing a triple-transfection method of HEK293 cells, under research grade conditions. Characterization of the vector following production included titer determination by qPCR with a supercoiled standard, endotoxin level determination (EU/mL) and a sterility assessment. The produced vector was analyzed by SDS-PAGE to verify banding pattern consistency with expected rAAV. The vector was produced using plasmid containing the microdystrophin construct, a muscle specific MHCK7 promoter to drive expression, a consensus Kozak sequence (CCACC), an SV40 chimeric intron, synthetic polyadenylation site (53 bp) (Error! Reference source not found). The microdystrophin expression cassette was cloned between AAV2 ITRs packaged into an AAVrh74 vector for enhanced transduction of skeletal and cardiac tissue.
[0138] Potency determination of the rAAVrh74.MHCK7.micro-dystrophin test article was achieved by performing intramuscular injections of the vector into mdx mice. Wild type mice serve as a positive control and injection of sterile lactated ringers into mdx mice serve as a negative control.
TABLE-US-00004 TABLE 4 Overview of rAAVrh74.MHCK7.micro-dystrophin Study Design Delivery Animal Total Treatment Route Strain Dose (vg) # Mice Endpoint Analysis IM (Potency) mdx 1E+11 3 1 mo IF. H&E IV (Efficacy) mdx 2E+12 5 3 mo IF, H&E, Diaph Phys IV (Efficacy) mdx 6E+12 8 3 mo IF, H&E, Diaph Phys, TA Phys, Path, Biodistribution, Western Blot IV (Efficacy) mdx 1.2E+13.sup. 8 3 mo IF, H&E, Diaph Phys, TA Phys, Path, Biodistribution, Western Blot IV (Efficacy) C57BL/6 6E+12 5 3 mo IF, H&E, Diaph Phys, TA Phys, Path IV (Efficacy) mdx 6E+12 5 6 mo IF, H&E, Diaph Phys, TA Phys, Path IV (Efficacy) mdx — 8 3 mo IF, H&E, Diaph Phys, Path, IV (Efficacy) C57BL/6 — 6 3 mo IF, H&E, Diaph Phys, Path, IF: immunofluoresence; H&E: hematoxylin & eosin staining; Diaph/TA Phys: specific force measurements in the diaphragm and TA muscle; Path: formal histopathology; ‘—’: uninjected All injected animals were treated at 4-5 weeks of age and necropsied 3 or 6 months post-injection. Control mice were necropsied at 4 months of age and 7 months of age.
[0139] The animals indicated in Table 4 were dosed at the age indicated (4-5 weeks of age) with a tail vein injection for systemic delivery. To perform accurate dosing with an intramuscular injection, animals were briefly anesthetized by isoflurane inhalation. Doses were administered by direct injection into the tibialis anterior muscle of the lower hind limb. No anesthesia was required for accurate dosing with systemic delivery. Doses were administered by the vasculature through the tail vein. Care was taken to accurately deposit the entire vector dose into the vessel. After the dosing was performed, animals were placed on a heating pad until spontaneous movement was regained, and then returned to the cage. Observations of each animal were performed weekly for the whole duration of the study.
[0140] At the appropriate age as listed in Table 4, mice were overdosed with Ketamine/Xylazine mixture (200 mg/kg/20 mg/kg). Blood was collected via heart puncture and whole blood was sent for complete blood count (CBC) analysis and serum was stored at −80° C. till serum chemistries were analyzed by Charles Rivers Laboratory. Tissues were then collected and sent for analysis by an independent veterinary histopathologist and in house.
[0141] Intramuscular delivery of rAAVrh74.MHCK7.micro-dystrophin to dystrophin null mice at 1×10.sup.11 vg total dose resulted in ˜70% expression of dystrophin in the injected TA muscles. Immunofluorescence imaging of the vector dosed mouse confirmed expression of the micro-dystrophin gene.
Restoration of Dystrophin Expression Following Systemic Treatment with rAAVrh74.MHCK7.Micro-Dystrophin
[0142] Efficacy determination of the rAAVrh74.MHCK7.micro-dystrophin test article was achieved by performing systemic injections in mdx mice (genotype: C57BL/10ScSn-Dmd.sup.mdx/J) using dose escalation at low, mid and high dose (2.0×10.sup.12 vg Total Dose; 6.0×10.sup.12 vg Total Dose; 1.2×10.sup.13 vg Total Dose) to assess transgene expression and efficacy of the vector when delivered systemically at the time points of 3 and 6 months post injection. Mice were injected at 4-5 weeks of age and a full necropsy was performed at both 3 and 6 months post-injection. Based on mean animal weights per group, these doses equal: 8×10.sup.13 vg/kg, 2×10.sup.14 vg/kg and 6×10.sup.14 vg/kg. Injection of an equal volume of lactated ringers served as a negative control. Injection of an equal volume of lactated ringers into C57BL/6 mice served as a positive control. Safety was determined by performing systemic injections in WT mice at a dose of 6.0×10.sup.12 vg Total Dose (denoted as WT TX-mid Dose group). Immunofluorescence stain of skeletal muscles tibialis anterior (TA), gastrocnemius (GAS), quadriceps (QUAD), gluteus (GLUT), psoas, tricep (TRI), diaphragm (DIA), and heart was carried out to determine restoration of dystrophin and to ensure efficacy of viral vector of rAAVrh74.MHCK7.micro-dystrophin.
[0143] The skeletal muscles (TA, QUAD, GLUT, TRI) were extracted, along with the heart and diaphragm, for analysis. Organs were also removed for toxicology and biodistribution studies. Micro-dystrophin transgene expression remained high following 3-6 months treatment. This was accompanied by improved muscle histopathology and improved function with no adverse effects in off target organs.
Reversal of Dystrophic Phenotype in rAAVrh74.MHCK7.Micro-Dystrophin Systemically Treated Mdx Mice
[0144] Hematoxylin & Eosin (H&E) stain of skeletal muscles, diaphragm and heart was carried out to determine reversal and improvement of dystrophic pathology following systemic injection of rAAVrh74.MHCK7.micro-dystrophin at 2×10.sup.12 vg total dose (Low Dose; n=1), 6×10.sup.12 vg total dose (Mid Dose; n=8), and 1.2×10.sup.13 vg total dose (High Dose; n=8) for each dose with euthanasia 12 weeks post-injection. At 24 weeks post-injection, a second cohort of animals treated with mid dose (6×10.sup.12 vg total dose) were evaluated for reversal and improvement of dystrophin pathology (n=5).
[0145] Immunofluorescence staining for the human micro-dystrophin protein was used to determine micro-dystrophin transgene expression in both left and right sides of six skeletal muscles (TA, GAS, QUAD, GLUT, psoas, TRI), as well as the diaphragm and the heart in all dystrophin null mice injected with the micro-dystrophin vector. This was carried out to determine restoration of dystrophin and to ensure efficacy of viral vector of rAAVrh74.MHCK7.micro-dystrophin at 2×10.sup.12 vg total dose (Low Dose; n=2), 6×10.sup.12 vg total dose (Mid Dose; n=8), and 1.2×10.sup.13 vg total dose (High Dose; n=8) for each dose with euthanasia 12 weeks post-injection.
[0146] In order to evaluate expression and transduction efficiency, images from all three dosing cohorts and both left and right sides of each muscle were utilized for quantification. Four 20× images were taken of each muscle and the percent of micro-dystrophin positive fibers was determined for each image resulting in the average percent transduction for each muscle.
[0147] The muscles from untreated animals exhibited widespread myopathy including fatty infiltration, central nucleation, fibrosis and focal areas of necrosis. H&E staining in Error! Reference source not found.16 and Error! Reference source not found.17 illustrates this dystrophic phenotype in dystrophin null mice when compared to normal WT mice and the improvement of muscle pathology following treatment at either the mid dose (6×10.sup.12 vg; 2×10.sup.14 vg/kg) or the high dose (1.2×10.sup.13 vg; 6×10.sup.14 vg/kg). Quantification of histological parameters showed a reduction in central nucleation (
Functional Assessment of Systemic Treatment with rAAVrh74.MHCK7.Micro-Dystrophin
[0148] To determine whether micro-dystrophin gene transfer provided a functional strength benefit to diseased muscle, the functional properties of both the diaphragm and the tibialis anterior from mdx mice, WT mice, and vector dosed mice at three dose levels were assessed. The dose escalation included low dose (8×10.sup.13 vg/kg), mid dose (2×10.sup.14 vg/kg), and high dose (6×10.sup.14 vg/kg). Functional assessment of systemic treatment with rAAVrh74.MHCK7.micro-dystrophin using ex-vivo assessment of specific force and decrease in force output following eccentric contractions in the TA was utilized 24 weeks post-injection in animals systemically injected with rAAVrh74.MHCK7.micro-dystrophin at 6×10.sup.12 vg total dose (Mid Dose). Additionally, specific force output in the diaphragm was assessed in the same animals.
[0149] As outlined in the previous figures, histopathology exhibited a more normalized environment with improvements in central nucleation, collagen deposition, and fiber size in the mid and high doses. Tail vein delivery of rAAVrh74.MHCK7.micro-dystrophin led to a stepwise improvement in specific force output in the diaphragm (176.9 mN/mm.sup.2 in the mid dose group versus 227.78 mN/mm.sup.2 in the high dose group). Additionally, the long-term treated cohort represents mice 6 months post injection (mid dose 2×10.sup.14 vg/kg) and there was no deviation in diaphragm force output long-term (176.9 mN/mm.sup.2 vs 194.9 mN/mm.sup.2) (Error! Reference source not found.20).
[0150] Furthermore, functional deficits in tibialis anterior muscle in mdx mice were observed compared to WT mice. Mdx mice demonstrated 50% decrease in force output compared to WT mice (171.3 mN/mm.sup.2 vs. 291.65 mN/mm.sup.2) and greater loss of force following eccentric contractions (32% loss in mdx; 5% loss in WT). Systemic delivery of the mid dose level of rAAVrh74.MHCK7.micro-dystrophin resulted in 65.5% dystrophin in the tibialis anterior muscle and restoration of specific force output which improved to 235.4 mN/mm2 and protected the muscle from repeated eccentric contraction damage with only a 25% decrease in force (
SUMMARY
[0151] After the initial demonstration of biopotency by intramuscular injection, comparable or increased restoration of micro-dystrophin was achieved with vascular delivery while transducing skeletal muscles, diaphragm and the heart. The efficacy demonstrated reversal of dystrophic features in a dose dependent manner by reduction of inflammation, fewer degenerating fibers, and improved functional recovery by protecting against eccentric contractions in the tibialis anterior and diaphragm. The functional benefits of the vector include a stepwise improvement to wild-type levels in force generation of the diaphragm and the TA.
Example 9
Toxicology and Biodistribution of Systemic Treatment with rAAVrh74.MHCK7.Micro-Dystrophin
[0152] Organs and tissues from mdx mice given systemic injection of rAAVrh74.MHCK7.micro-dystrophin were collected for real-time quantitative PCR to detect specific sequences of vector DNA. Protein extracted from all collected organs and tissues were run on Western blot to detect micro-dystrophin in off-target organs.
[0153] Test article was given at three dose levels: low (2×10.sup.12 vg; 8×10.sup.13 vg/kg), mid (6×10.sup.12 vg; 8×10.sup.14 vg/kg) and high dose (1.2×10.sup.13 vg; 6×10.sup.14 vg/kg) by intravenous route at 4-5 weeks of age. To assess the safety of the vector, H&E staining was performed on cryosections of muscle tissue and all major organs harvested from the same cohorts of mice previously described. Also included were organs and muscles from C57BL6 WT mice treated systemically with the vector at the mid dose. Lactated ringers treated mdx and WT mice were also included for histopathology analysis. These sections were formally reviewed for toxicity by a third-party, board-certified, veterinary pathologist and no adverse effects were detected in any sample from any of the mice; results are summarized below.
[0154] Group details and study design are shown in 4 below.
TABLE-US-00005 TABLE 5 rAAVrh74.MHCK7.micro-dystrophin Safety Study Design Delivery Animal No. of Treatment Pathology Report Route Strain Total Dose (vg) Mice Endpoint Number IV mdx 2 × 10.sup.12 5 3 mo AAVrh74-mdx- MOUSE-001.1 IV mdx 6 × 10.sup.12 7 3 mo AAVrh74-mdx- MOUSE-001.1/001.2 IV mdx 1.2 × 10.sup.13 8 3 mo AAVrh74-mdx- MOUSE-001.2 IV C57BL/6 6 × 10.sup.12 5 3 mo AAVrh74-mdx- MOUSE-001.2 IV mdx 6 × 10.sup.12 5 6 mo AAVrh74-mdx- MOUSE-001.3 IV mdx — 8 3 mo AAVrh74-mdx- MOUSE-001.2 IV C57BL/6 — 6 3 mo AAVrh74-mdx- MOUSE-001.2
Histopathological Review of Vector Transduced Tissue
[0155] IV injection of rAAVrh74.MHCK7.micro-dystrophin did not elicit any microscopic changes in myofibers of any skeletal muscles examined. In addition, no treatment-related lesions were seen in any of the tissues evaluated histologically. Any changes noted were seen in both treated and control mice and were considered incidental findings. Taken together, these data indicate that this test article was well tolerated by the test subjects. Furthermore, relative to reference specimens from age-matched, untreated mdx mice, administration of rAAVrh74.MHCK7.micro-dystrophin decreased myofiber atrophy in treated mdx mice, thus showing that the test article can ameliorate the degree of myopathy associated with deficiencies of mdx.
[0156] In addition to review of diseased mdx mice systemically treated with vector, rAAVrh74.MHCK7.micro-dystrophin was delivered systemically to five C57BL/6 WT mice at a dose identical to the minimally efficacious dose (MED) established in the studies above in mdx mice, 6×10.sup.12 vg total dose (2×10.sup.14 vg/kg). This allowed for the study of intravenous delivery of the test article in healthy WT mice to determine more definitively if any adverse effects result solely due to the treatment. Here again a variety of skeletal muscles including the diaphragm, along with heart, and five other organs were harvested and H&E sections of each tissue were formally reviewed by an independent veterinary pathologist.
Vector Genome Biodistribution
[0157] The presence of test article-specific DNA sequences was examined using a real time, quantitative PCR assay (qPCR). Biodistribution analysis was performed on tissue samples collected from three vector dosed mdx animals per dose level. A positive signal was anything equal to or greater than 100 single-stranded DNA copies/μg genomic DNA detected. Tissues were harvested at necropsy and vector specific primer probe sets specific for sequences of the MHCK7 promoter were utilized.
TABLE-US-00006 TABLE 6 Vector Genome copy numbers in organs and muscles from three vector dosed mdx mice per dose level. Values are shown in vg/pg genomic DNA. 2.00E+12 6.00E+12 1.20E+13 (average vg (average vg (average vg Tissue copies/ug) copies/ug) copies/ug) Hrt 2.84E+04 7.65E+05 5.35E+06 Lng 3.14E+04 2.52E+05 1.49E+06 Liv 4.36E+04 1.11E+07 1.80E+07 Kid 1.96E+04 3.27E+05 1.06E+06 Spl 5.69E+04 5.27E+05 5.78E+05 Gon 5.74E+04 3.68E+04 3.50E+05 Dia 2.22E+04 3.55E+05 2.32E+06 Pso 1.28E+05 1.60E+05 1.57E+06 Tri 1.60E+05 5.45E+05 2.50E+06 Qd 2.66E+06 6.57E+05 2.29E+06 Gas 1.69E+05 5.80E+05 2.93E+06 TA 5.86E+05 1.25E+05 1.32E+06
[0158] rAAVrh74.MHCK7.micro-dystrophin transcript was detected at varying levels in all collected tissues. As expected, the highest levels were seen in skeletal muscle and the heart. The lowest levels were detected in gonad, lung, kidney, and spleen. These data indicate that the test article was efficiently delivered into all investigated tissues of vector dosed mice.
[0159] As the qPCR results above indicate, intravenous delivery of rAAVrh74.MHCK7.micro-dystrophin resulted in distribution of vector transcript to varying levels in most tissues, with the highest levels occurring in the liver, heart, and quadriceps muscle (mid dose) and the liver, heart and gastrocnemius muscle (high dose). Therefore, the objective of this portion of the study was to determine the protein expression of the human micro-dystrophin transgene in these tissues to ensure the functionality of the muscle specific MHCK7 promoter. Western blotting was used to detect micro-dystrophin expression in the tissue samples.
[0160] Protein expression and vector biodistribution were also assessed using qPCR and western blotting (
[0161] Micro-dystrophin protein expression was observed in varying amounts in all skeletal muscle samples as well as heart samples (
SUMMARY
[0162] Histopathology review concluded that the mdx-LR cohort exhibited widespread myopathy affecting all seven skeletal muscles evaluated as well as the right ventricular wall of the heart. The principal findings of the histopathology review included pronounced and widespread myofiber atrophy (30-75% of normal myofiber size), minimal to mild mononuclear cell inflammations, increased interstitial space, and increased cytoplasmic mineral deposits. The diaphragm exhibited the most marked changes in mononuclear cell infiltration and myofiber atrophy. The heart exhibited a few small foci of minimal mononuclear cell accumulation in the ventricular myocardium. Vector dosed cohorts had substantially reduced myopathy in all skeletal tissues and the heart. The reductions in histopathologic findings were in a dose dependent manner with the high dose group having substantially less degeneration and inflammation. There were no adverse effects due to vector treatment with rAAVrh74.MHCK7.micro-dystrophin as was documented in the WT treated cohort and the vector dosed mdx cohorts. There were incidental findings in the liver and lung of mdx and WT mice, regardless of treatment, in which the mice exhibited mild vacuolation of hepatocyte cytoplasm. Therefore, the test article was safe, efficacious and the protective effect was dose-dependent.
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