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Suzuki-Hatano S, Saha M, Rizzo SA, Witko RL, Gosiker BJ, Ramanathan M, Soustek MS, Jones MD, Kang PB, Byrne BJ, Cade WT, Pacak CA. AAV-Mediated TAZ Gene Replacement Restores Mitochondrial and Cardioskeletal Function in Barth Syndrome. Hum Gene Ther 2018; 30:139-154. [PMID: 30070157 DOI: 10.1089/hum.2018.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Barth syndrome (BTHS) is a rare mitochondrial disease that affects heart and skeletal muscle and has no curative treatment. It is caused by recessive mutations in the X-linked gene TAZ, which encodes tafazzin. To develop a clinically relevant gene therapy to restore tafazzin function and treat BTHS, three different adeno-associated virus serotype 9 vectors were tested and compared to identify the optimal promoter-cytomegalovirus (CMV), desmin (Des), or a native tafazzin promoter (Taz)-for TAZ expression following intravenous administration of 1 × 1013 vector genomes/kilogram to a mouse model of BTHS as either neonates (1-2 days of age) or adults (3 months of age). At 5 months of age, evaluations of biodistribution and TAZ expression levels, mouse activity assessments, fatigue in response to exercise, muscle strength, cardiac function, mitochondrial structure, oxygen consumption, and electron transport chain complex activity assays were performed to measure the extent of improvement in treated mice. Each promoter was scored for significant improvement over untreated control mice and significant improvement compared with the other two promoters for every measurement and within each age of administration. All three of the promoters resulted in significant improvements in a majority of the assessments compared with untreated BTHS controls. When scored for overall effectiveness as a gene therapy, the Des promoter was found to provide improvement in the most assessments, followed by the CMV promoter, and finally Taz regardless of injection age. This study provides substantial support for translation of an adeno-associated virus serotype 9-mediated TAZ gene replacement strategy using a Des promoter for human BTHS patients in the clinic.
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Affiliation(s)
- Silveli Suzuki-Hatano
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Madhurima Saha
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Skylar A Rizzo
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Rachael L Witko
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Bennett J Gosiker
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Manashwi Ramanathan
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Meghan S Soustek
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,2 Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida
| | - Michael D Jones
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Peter B Kang
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,2 Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida
| | - Barry J Byrne
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,2 Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida
| | - W Todd Cade
- 3 Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri
| | - Christina A Pacak
- 1 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,2 Department of Molecular Genetics and Microbiology, University of Florida College of Medicine, Gainesville, Florida
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