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Occelli LM, Zobel L, Stoddard J, Wagner J, Pasmanter N, Querubin J, Renner LM, Reynaga R, Winkler PA, Sun K, Marinho LFLP, O'Riordan CR, Frederick A, Lauer A, Tsang SH, Hauswirth WW, McGill TJ, Neuringer M, Michalakis S, Petersen-Jones SM. Development of a translatable gene augmentation therapy for CNGB1-retinitis pigmentosa. Mol Ther 2023; 31:2028-2041. [PMID: 37056049 PMCID: PMC10362398 DOI: 10.1016/j.ymthe.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/07/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
In this study, we investigate a gene augmentation therapy candidate for the treatment of retinitis pigmentosa (RP) due to cyclic nucleotide-gated channel beta 1 (CNGB1) mutations. We use an adeno-associated virus serotype 5 with transgene under control of a novel short human rhodopsin promoter. The promoter/capsid combination drives efficient expression of a reporter gene (AAV5-RHO-eGFP) exclusively in rod photoreceptors in primate, dog, and mouse following subretinal delivery. The therapeutic vector (AAV5-RHO-CNGB1) delivered to the subretinal space of CNGB1 mutant dogs restores rod-mediated retinal function (electroretinographic responses and vision) for at least 12 months post treatment. Immunohistochemistry shows human CNGB1 is expressed in rod photoreceptors in the treated regions as well as restoration of expression and trafficking of the endogenous alpha subunit of the rod CNG channel required for normal channel formation. The treatment reverses abnormal accumulation of the second messenger, cyclic guanosine monophosphate, which occurs in rod photoreceptors of CNGB1 mutant dogs, confirming formation of a functional CNG channel. In vivo imaging shows long-term preservation of retinal structure. In conclusion, this study establishes the long-term efficacy of subretinal delivery of AAV5-RHO-CNGB1 to rescue the disease phenotype in a canine model of CNGB1-RP, confirming its suitability for future clinical development.
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Affiliation(s)
- Laurence M Occelli
- College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI 48864, USA
| | - Lena Zobel
- Department of Pharmacy-Center for Drug Research, Ludwig-Maximilians-Universität München, 81377 Munich, Germany; Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany
| | - Jonathan Stoddard
- Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185(th) Avenue, Beaverton, OR 97005, USA
| | - Johanna Wagner
- Department of Pharmacy-Center for Drug Research, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Nathaniel Pasmanter
- College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI 48864, USA
| | - Janice Querubin
- College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI 48864, USA
| | - Lauren M Renner
- Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185(th) Avenue, Beaverton, OR 97005, USA
| | - Rene Reynaga
- Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185(th) Avenue, Beaverton, OR 97005, USA
| | - Paige A Winkler
- College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI 48864, USA
| | - Kelian Sun
- College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI 48864, USA
| | - Luis Felipe L P Marinho
- College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI 48864, USA
| | | | - Amy Frederick
- Genomic Medicine Unit, Sanofi, 225 Second Avenue, Waltham, MA 02451, USA
| | - Andreas Lauer
- Casey Eye Institute, Oregon Health & Science University, 515 Campus Drive, Portland, OR 97239, USA
| | - Stephen H Tsang
- Jonas Children's Vision Care, Departments of Ophthalmology, Pathology and Cell Biology, Institute of Human Nutrition, Columbia Stem Cell Initiative, Vagelos College of Physicians and Surgeons, New York, NY 10032, USA
| | - William W Hauswirth
- Department of Ophthalmology, College of Medicine, University of Florida, Box 100284 HSC, Gainesville, FL 32610, USA
| | - Trevor J McGill
- Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185(th) Avenue, Beaverton, OR 97005, USA; Casey Eye Institute, Oregon Health & Science University, 515 Campus Drive, Portland, OR 97239, USA
| | - Martha Neuringer
- Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185(th) Avenue, Beaverton, OR 97005, USA; Casey Eye Institute, Oregon Health & Science University, 515 Campus Drive, Portland, OR 97239, USA
| | - Stylianos Michalakis
- Department of Pharmacy-Center for Drug Research, Ludwig-Maximilians-Universität München, 81377 Munich, Germany; Department of Ophthalmology, University Hospital, LMU Munich, 80336 Munich, Germany.
| | - Simon M Petersen-Jones
- College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI 48864, USA.
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Kuehlewein L, Straßer T, Blumenstock G, Stingl K, Fischer MD, Wilhelm B, Zrenner E, Wissinger B, Kohl S, Weisschuh N, Zobor D. Central Visual Function and Genotype-Phenotype Correlations in PDE6A-Associated Retinitis Pigmentosa. Invest Ophthalmol Vis Sci 2022; 63:9. [PMID: 35533076 PMCID: PMC9106976 DOI: 10.1167/iovs.63.5.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Autosomal recessive retinitis pigmentosa (arRP) can be caused by mutations in the phosphodiesterase 6A (PDE6A) gene. Here, we describe the natural course of disease progression with respect to central retinal function (i.e., visual acuity, contrast sensitivity, and color vision) and establish a detailed genotype-–phenotype correlation. Methods Forty-four patients (26 females; mean age ± SD, 43 ± 13 years) with a confirmed genetic diagnosis of PDE6A-associated arRP underwent comprehensive ophthalmological examinations including best-corrected visual acuity (BCVA) with Early Treatment Diabetic Retinopathy Study charts, contrast sensitivity (CS) with Pelli–Robson charts at distances of 3 m and 1 m, and color vision testing using Roth 28-Hue and Panel D-15 saturated color cups. Results The most frequently observed variants were c.998+1G>A/p.?, c.304C>A/p.R102S, and c.2053G>A/p.V685M. Central retinal function in patients homozygous for variant c.304C>A/p.R102S was better when compared to patients homozygous for variant c.998+1G>A/p.?, although the former were older at baseline. Central retinal function was similar in patients homozygous for variant c.304C>A/p.R102S and patients heterozygous for variants c.304C>A/p.R102S and c.2053G>A/p.V685M, although the latter were younger at baseline. Annual decline rates in central retinal function were small. Conclusions We conclude that the severity of the different disease-causing PDE6A mutations in humans with respect to central visual function may be ranked as follows: c.2053G>A/p.V685M in homozygous state (most severe) > c.998+1G>A/p.? in homozygous state > c.304C>A/p.R102S and c.2053G>A/p.V685M in compound-heterozygous state > c.304C>A/p.R102S in homozygous state (mildest). The assessment of treatment efficacy in interventional trials will remain challenging due to small annual decline rates in central retinal function.
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Affiliation(s)
- Laura Kuehlewein
- University Eye Hospital, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany.,Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Torsten Straßer
- University Eye Hospital, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany.,Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Gunnar Blumenstock
- Department of Clinical Epidemiology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Katarina Stingl
- University Eye Hospital, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - M Dominik Fischer
- Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Barbara Wilhelm
- STZ eyetrial at the Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Eberhart Zrenner
- Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany.,Werner Reichardt Centre for Integrative Neuroscience, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Bernd Wissinger
- Molecular Genetics Laboratory, Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Susanne Kohl
- Molecular Genetics Laboratory, Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Nicole Weisschuh
- Molecular Genetics Laboratory, Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Ditta Zobor
- Institute for Ophthalmic Research, Centre for Ophthalmology, Eberhard Karls University of Tübingen, Tübingen, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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