Cas9-specific immune responses compromise local and systemic AAV CRISPR therapy in multiple dystrophic canine models

CH Hakim, SRP Kumar, DO Pérez-López… - Nature …, 2021 - nature.com
CH Hakim, SRP Kumar, DO Pérez-López, NB Wasala, D Zhang, Y Yue, J Teixeira, X Pan…
Nature communications, 2021nature.com
Abstract Adeno-associated virus (AAV)-mediated CRISPR-Cas9 editing holds promise to
treat many diseases. The immune response to bacterial-derived Cas9 has been speculated
as a hurdle for AAV-CRISPR therapy. However, immunological consequences of AAV-
mediated Cas9 expression have thus far not been thoroughly investigated in large
mammals. We evaluate Cas9-specific immune responses in canine models of Duchenne
muscular dystrophy (DMD) following intramuscular and intravenous AAV-CRISPR therapy …
Abstract
Adeno-associated virus (AAV)-mediated CRISPR-Cas9 editing holds promise to treat many diseases. The immune response to bacterial-derived Cas9 has been speculated as a hurdle for AAV-CRISPR therapy. However, immunological consequences of AAV-mediated Cas9 expression have thus far not been thoroughly investigated in large mammals. We evaluate Cas9-specific immune responses in canine models of Duchenne muscular dystrophy (DMD) following intramuscular and intravenous AAV-CRISPR therapy. Treatment results initially in robust dystrophin restoration in affected dogs but also induces muscle inflammation, and Cas9-specific humoral and cytotoxic T-lymphocyte (CTL) responses that are not prevented by the muscle-specific promoter and transient prednisolone immune suppression. In normal dogs, AAV-mediated Cas9 expression induces similar, though milder, immune responses. In contrast, other therapeutic (micro-dystrophin and SERCA2a) and reporter (alkaline phosphatase, AP) vectors result in persistent expression without inducing muscle inflammation. Our results suggest Cas9 immunity may represent a critical barrier for AAV-CRISPR therapy in large mammals.
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