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Kvanta A, Rangaswamy N, Holopigian K, Watters C, Jennings N, Liew MSH, Bigelow C, Grosskreutz C, Burstedt M, Venkataraman A, Westman S, Geirsdottir A, Stasi K, André H. Interim safety and efficacy of gene therapy for RLBP1-associated retinal dystrophy: a phase 1/2 trial. Nat Commun 2024; 15:7438. [PMID: 39256350 PMCID: PMC11387776 DOI: 10.1038/s41467-024-51575-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 08/13/2024] [Indexed: 09/12/2024] Open
Abstract
Gene therapy holds promise for treatment of inherited retinal dystrophies, a group of rare genetic disorders characterized by severe loss of vision. Here, we report up to 3-year pre-specified interim safety and efficacy results of an open-label first-in-human dose-escalation phase 1/2 gene therapy clinical trial in 12 patients with retinal dystrophy caused by biallelic mutations in the retinaldehyde-binding protein 1 (RLBP1) gene of the visual cycle. The primary endpoints were systemic and ocular safety and recovery of dark adaptation. Secondary endpoints included microperimetry, visual field sensitivity, dominant eye test and patient-reported outcomes. Subretinal delivery of an adeno-associated viral vector (AAV8-RLBP1) was well tolerated with dose-dependent intraocular inflammation which responded to corticosteroid treatment, and focal atrophy of the retinal pigment epithelium as the dose limiting toxicity. Dark adaptation kinetics, the primary efficacy endpoint, improved significantly in all dose-cohorts. Treatment with AAV8-RLBP1 resulted in the resolution of disease-related retinal deposits, suggestive of successful restoration of the visual cycle. In conclusion, to date, AAV8-RLBP1 has shown preliminary safety and efficacy in patients with RLBP1-associated retinal dystrophy. Trial number: NCT03374657.
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Affiliation(s)
- Anders Kvanta
- Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
| | | | - Karen Holopigian
- Novartis Institutes for Biomedical Research, East Hanover, NJ, USA
| | | | - Nicki Jennings
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Chad Bigelow
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | - Marie Burstedt
- Department of Clinical Sciences/Ophthalmology, University of Umeå, Umeå, Sweden
| | - Abinaya Venkataraman
- Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sofie Westman
- Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Asbjörg Geirsdottir
- Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Kalliopi Stasi
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Helder André
- Department of Clinical Neuroscience, St. Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden
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Bianco L, Antropoli A, Benadji A, Condroyer C, Antonio A, Navarro J, Sahel JA, Zeitz C, Audo I. RDH5 and RLBP1-Associated Inherited Retinal Diseases: Refining the Spectrum of Stationary and Progressive Phenotypes. Am J Ophthalmol 2024; 267:160-171. [PMID: 38945349 DOI: 10.1016/j.ajo.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/11/2024] [Accepted: 06/11/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE To investigate the clinical, functional, and imaging characteristics in patients affected by inherited retinal diseases associated with RDH5 and RLBP1 gene variants, and to report novel genotype-phenotype correlations. DESIGN Retrospective single-center cohort study. METHODS Twenty-two patients with molecularly confirmed RLBP1-associated retinopathy and 5 with RDH5-associated retinopathy. Medical records were reviewed to obtain data on family history and ophthalmologic examinations, including retinal imaging and full-field electroretinography (ffERG). Genotype was determined by targeted next-generation sequencing followed by confirmation and familial segregation by Sanger sequencing. RESULTS The median (interquartile ranges) age at baseline for the RDH5 and RLBP1 cohort was 44.6 (38.2-67.9) years and 36.9 (23.1-45.2) years, respectively. Macular atrophy (MA) was found in approximately 80% of eyes from both cohorts. The RLBP1 genotype was associated with a lower macular volume by 0.28 mm3 (95% CI, -0.46 to -0.11; P = .005) compared to the RDH5 genotype. In both genotypic cohorts, we found a significant annual rate of macular volume loss, estimated at -0.007 mm3/y (95% CI, -0.012 to -0.001; P = .02), without any significant difference between the two genotypes. Three unrelated patients homozygous for the c.361C>T p.(Arg121Trp) RLBP1 variant showed minimal impairment of both the rod and cone systems function on ffERG and absence of MA. CONCLUSIONS Progressive MA in addition to congenital night blindness can be identified in adult patients with RDH5-associated retinopathy. Vice versa, hypomorphic RLBP1 variants may cause milder retinal phenotypes rather than the typical severe rod-cone dystrophy with MA. These findings could prove beneficial to improve the prognostication of patients and help in designing future interventional trials.
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Affiliation(s)
- Lorenzo Bianco
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute (Bianco and Antropoli), Milan, Italy; Università Vita-Salute San Raffaele (Bianco and Antropoli), Milan, Italy
| | - Alessio Antropoli
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute (Bianco and Antropoli), Milan, Italy; Università Vita-Salute San Raffaele (Bianco and Antropoli), Milan, Italy
| | - Amine Benadji
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Centre de Référence Maladies Rares REFERET and INSERM-DGOS CIC (Benadji, Sahel, and Audo), Paris, France
| | - Christel Condroyer
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France
| | - Aline Antonio
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France
| | - Julien Navarro
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France
| | - José-Alain Sahel
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Centre de Référence Maladies Rares REFERET and INSERM-DGOS CIC (Benadji, Sahel, and Audo), Paris, France; Department of Ophthalmology, The University of Pittsburgh School of Medicine (Sahel), Pittsburg, Pennsylvania, USA
| | - Christina Zeitz
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France
| | - Isabelle Audo
- From the Sorbonne Université, INSERM, CNRS, Institut de la Vision (Bianco, Antropoli, Condroyer, Antonio, Antonio, Navarro, Sahel, Zeitz, and Audo), Paris, France; Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Centre de Référence Maladies Rares REFERET and INSERM-DGOS CIC (Benadji, Sahel, and Audo), Paris, France.
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Sajovic J, Meglič A, Glavač D, Markelj Š, Hawlina M, Fakin A. The Role of Vitamin A in Retinal Diseases. Int J Mol Sci 2022; 23:1014. [PMID: 35162940 PMCID: PMC8835581 DOI: 10.3390/ijms23031014] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/24/2022] Open
Abstract
Vitamin A is an essential fat-soluble vitamin that occurs in various chemical forms. It is essential for several physiological processes. Either hyper- or hypovitaminosis can be harmful. One of the most important vitamin A functions is its involvement in visual phototransduction, where it serves as the crucial part of photopigment, the first molecule in the process of transforming photons of light into electrical signals. In this process, large quantities of vitamin A in the form of 11-cis-retinal are being isomerized to all-trans-retinal and then quickly recycled back to 11-cis-retinal. Complex machinery of transporters and enzymes is involved in this process (i.e., the visual cycle). Any fault in the machinery may not only reduce the efficiency of visual detection but also cause the accumulation of toxic chemicals in the retina. This review provides a comprehensive overview of diseases that are directly or indirectly connected with vitamin A pathways in the retina. It includes the pathophysiological background and clinical presentation of each disease and summarizes the already existing therapeutic and prospective interventions.
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Affiliation(s)
- Jana Sajovic
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia
| | - Andrej Meglič
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia
| | - Damjan Glavač
- Department of Molecular Genetics, Institute of Pathology, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Špela Markelj
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia
| | - Marko Hawlina
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia
| | - Ana Fakin
- Eye Hospital, University Medical Centre Ljubljana, Grablovičeva 46, 1000 Ljubljana, Slovenia
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