Effective Gene Therapy for Metachromatic Leukodystrophy Achieved with Minimal Lentiviral Genomic Integrations

Author:

Tricoli LucasORCID,Sase Sunetra,Hacker Julia,Pham Vi,Smith Sidney,Chappell Maxwell,Breda Laura,Hurwitz Stephanie,Tanaka Naoto,Castracani Carlo Castruccio,Guerra Amaliris,Hou Zhongqi,Schlotawa Lars,Radhakrishnan Karthikeyan,Kurre PeterORCID,Ahrens-Nicklas Rebecca,Adang Laura,Vanderver Adeline,Rivella StefanoORCID

Abstract

ABSTRACTMetachromatic leukodystrophy (MLD) is a fatal lysosomal storage disease (LSD) characterized by the deficient enzymatic activity of arylsulfatase A (ARSA). Combined autologous hematopoietic stem cell transplant (HSCT) with lentiviral (LV) based gene therapy has great potential to treat MLD. However, if enzyme production is inadequate, this could result in continued loss of motor function, implying a high vector copy number (VCN) requirement for optimal enzymatic output. This may place children at increased risk for genomic toxicity due to higher VCN. We increased the expression of ARSA cDNA at single integration by generating novel LVs, optimizing ARSA expression, and enhancing safety. In addition, our vectors achieved optimal transduction in mouse and human HSC with minimal multiplicity of infection (MOI). Our top-performing vector (EA1) showed at least 4X more ARSA activity than the currently EU-approved vector and a superior ability to secrete vesicle-associated ARSA, a critical modality to transfer functional enzymes from microglia to oligodendrocytes. Three-month-oldArsa-KO MLD mice transplanted withArsa-KO BM cells transduced with 0.6 VCN of EA1 demonstrated behavior and CNS histology matching WT mice. Our novel vector boosts efficacy while improving safety as a robust approach for treating early symptomatic MLD patients.

Publisher

Cold Spring Harbor Laboratory

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