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Zhu W, Shen F, Mao L, Zhan L, Kang S, Sun Z, Nelson J, Zhang R, Zou D, McDougall CM, Lawton MT, Vu TH, Wu Z, Scaria A, Colosi P, Forsayeth J, Su H. Soluble FLT1 Gene Therapy Alleviates Brain Arteriovenous Malformation Severity. Stroke 2017; 48:1420-1423. [PMID: 28325846 DOI: 10.1161/strokeaha.116.015713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Brain arteriovenous malformation (bAVM) is an important risk factor for intracranial hemorrhage. Current therapies are associated with high morbidities. Excessive vascular endothelial growth factor has been implicated in bAVM pathophysiology. Because soluble FLT1 binds to vascular endothelial growth factor with high affinity, we tested intravenous delivery of an adeno-associated viral vector serotype-9 expressing soluble FLT1 (AAV9-sFLT1) to alleviate the bAVM phenotype. METHODS Two mouse models were used. In model 1, bAVM was induced in R26CreER;Eng2f/2f mice through global Eng gene deletion and brain focal angiogenic stimulation; AAV2-sFLT02 (an AAV expressing a shorter form of sFLT1) was injected into the brain at the time of model induction, and AAV9-sFLT1, intravenously injected 8 weeks after. In model 2, SM22αCre;Eng2f/2f mice had a 90% occurrence of spontaneous bAVM at 5 weeks of age and 50% mortality at 6 weeks; AAV9-sFLT1 was intravenously delivered into 4- to 5-week-old mice. Tissue samples were collected 4 weeks after AAV9-sFLT1 delivery. RESULTS AAV2-sFLT02 inhibited bAVM formation, and AAV9-sFLT1 reduced abnormal vessels in model 1 (GFP versus sFLT1: 3.66±1.58/200 vessels versus 1.98±1.29, P<0.05). AAV9-sFLT1 reduced the occurrence of bAVM (GFP versus sFLT1: 100% versus 36%) and mortality (GFP versus sFLT1: 57% [12/22 mice] versus 24% [4/19 mice], P<0.05) in model 2. Kidney and liver function did not change significantly. Minor liver inflammation was found in 56% of AAV9-sFLT1-treated model 1 mice. CONCLUSIONS By applying a regulated mechanism to restrict sFLT1 expression to bAVM, AAV9-sFLT1 can potentially be developed into a safer therapy to reduce the bAVM severity.
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Affiliation(s)
- Wan Zhu
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Fanxia Shen
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Lei Mao
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Lei Zhan
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Shuai Kang
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Zhengda Sun
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Jeffrey Nelson
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Rui Zhang
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Dingquan Zou
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Cameron M McDougall
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Michael T Lawton
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Thiennu H Vu
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Zhijian Wu
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Abraham Scaria
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Peter Colosi
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - John Forsayeth
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.)
| | - Hua Su
- From the Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care (W.Z., F.S., L.Z., S.K., J.N., R.Z., D.Z., H.S.), Department of Neurological Surgery (L.M., C.M.M., M.T.L., J.F.), Department of Radiology (Z.S.), and Department of Medicine (T.H.V.), University of California, San Francisco; Ocular Gene Therapy Core, National Eye Institute, National Institutes of Health, Bethesda, MD (Z.W.); Sanofi-Genzyme R&D Center, Framingham, MA (A.S.); and BioMarin Pharmaceutical Inc, Novato, CA (P.C.).
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