Patent Application
20200392516
Genetically-based hearing loss is a significant problem with few therapeutic options other than cochlear implants. Inherited hearing problems are often due to single gene defects. Prelingual deafness is diagnosed in 1/500 infants, of which about 50% have a genetic etiology. Usher syndrome, which is associated with a number of different clinical subtypes, each of which can be caused by a mutation in any of a number of different genes, is responsible for 3 to 6% of early childhood deafness. One of the more prevalent genetic defects, estimated to be 1-2% of all genetic deafness, occurs in the TMC1 gene. The most severe form of Usher Syndrome, USH1, is associated with defects in six genes: USH1, MYO7A (myosin 7a), USH1C (harmonin), CDH23 (cadherin 23), PCDH15 (protocadherin 15), SANS (sans; also known as USH1G) and CIB2 (calcium and integrin binding protein 2).
The inner ear, e.g., cochlea, particularly the inner and outer hair cells (IHCs and OHCs) in the cochlea, is an attractive target for polynucleotide therapy approaches to intervene in hearing loss and deafness of various etiologies, most immediately monogenic forms of inherited deafness. However, it has been a challenge to efficiently target and transduce IHCs and OHCs as well as other inner ear cells that may be relevant to gene therapy approaches.
The invention provides an AAV9-php.b vector comprising a transgene encoding a polypeptide of interest (e.g., TMC1, TMC2, MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, USH1C (e.g., harmonin-a, b, or c), OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B) and methods for administering the vector to the inner ear of a subject having a genetic defect in auditory and/or vestibular mechanosensation, thereby treating the subject.
The invention is based, at least in part, on the discovery that AAV9-php.b-CMV-GFP (also termed AAV-php.b-CMV-GFP) efficiently and specifically targeted the sensory cell of the inner ear, including inner and outer hair cells in vivo.
In one aspect, the invention provides a AAV9-php.b vector, where the vector contains a polynucleotide encoding myosin 7a, harmonin (e.g., harmonin-a, harmonin-b, or harmonin-c), cadherin 23, protocadherin 15, USH2A, ADGRV1/VLGR1/GPR98, WHRN, CLRN1, HARS, SANS and calcium and integrin binding protein 2, or any other polypeptide described herein.
In another aspect, the invention provides a AAV9-php.b vector, where the vector encodes a capsid having at least about 85% sequence identity to AAV9-php.b, and contains a promoter that directs expression of a human TMC1 polynucleotide.
In another aspect, the invention provides an AAV9-php.b vector, where the vector contains a promoter that is an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, or a TMHS (LHFPL5) promoter that directs expression of a downstream polynucleotide.
In another aspect, the invention provides a cell containing the AAV9-php.b vector of a previous aspect.
In another aspect, the invention provides a method of expressing a polypeptide in the inner ear of a subject, the method involving contacting a cell of the inner ear with a AAV9-php.b vector encoding a polypeptide of interest, where the AAV9-php.b vector transfects at least about 85, 90, 95 percent or more of inner and outer hair cells.
In another aspect, the invention provides a method of expressing a polypeptide in the inner ear of a subject, the method involving contacting a cell of the inner ear with a AAV9-php.b vector encoding a human polypeptide of interest.
In another aspect, the invention provides a method of treating an inner ear disorder associated with a genetic defect in a subject, the method involving contacting a cell of the subject with a AAV9-php.b vector, where the vector contains a polynucleotide encoding any one or more of myosin 7a, harmonin, cadherin 23, protocadherin 15, USH2A, ADGRV1/VLGR1/GPR98, WHRN, CLRN1, HARS, SANS and calcium and integrin binding protein 2.
In another aspect, the invention provides a method of treating an inner ear disorder associated with a genetic defect in a subject, the method involving contacting a cell of the subject with a AAV9-php.b vector, where the vector contains a promoter is any of an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter.
In another aspect, the invention provides a method of treating an inner ear disorder associated with a genetic defect in a subject, the method involving contacting a cell of the subject with a AAV9-php.b vector, where the vector encodes a capsid having at least about 85% sequence identity to AAV9-php.b, and contains a promoter operably linked to a polynucleotide encoding an USH1 polypeptide that is myosin 7a, harmonin, cadherin 23, protocadherin 15, USH2A, ADGRV1/VLGR1/GPR98, WHRN, CLRN1, HARS, SANS and calcium or integrin binding protein 2.
In various embodiments of the above-aspects or any other aspect of the invention described herein, the inner ear defect is a genetic disorder associated with a genetic alteration in a polypeptide expressed in the inner ear. In other embodiments, the genetic defect is associated with partial hearing loss, complete deafness, or partial or complete vestibular dysfunction. In other embodiments of the above aspects, the promoter is any one or more of an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter. In other embodiments of the above aspects, the vector transduces inner and outer hair cells, vestibular hair cells, spiral ganglions, or vestibular ganglions with at least about 70% or greater efficiency. In other embodiments of the above aspects, the harmonin polypeptide is harmonin-a, harmonin-b, or harmonin-c. In other embodiments of the above aspects, the cell is outer or inner hair cell, vestibular hair cell, a spiral ganglion, or a vestibular ganglion. In other embodiments of the above aspects, the vector contains a promoter directing expression of a downstream polynucleotide, and the promoter is an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, or a TMHS (LHFPL5) promoter. In other embodiments of the above aspects, the downstream polynucleotide is TMC1, TMC2 or an USH1 polypeptide that is myosin 7a, harmonin, cadherin 23, protocadherin 15, USH2A, ADGRV1/VLGR1/GPR98, WHRN, CLRN1, HARS, SANS and calcium or integrin binding protein 2. In particular embodiments of the above aspects, the harmonin polypeptide is harmonin-a, harmonin-b, or harmonin-c. In other embodiments of the above aspects, the AAV9-php.b vector targets inner and outer hair cells with at least about 70%, 80%, 90%, 95% or greater efficiency, even as high as 100% efficiency. In other embodiments of the above aspects, the human polypeptide is TMC1, TMC2, harmonin-a, harmonin-b, or harmonin-c. In other embodiments of the above aspects, the inner ear defect is a hearing disorder or vestibular disorder. In other embodiments, administering the vector improves or maintains auditory and/or vestibular function in the subject. In some embodiments, improved or maintained auditory and/or vestibular function is associated with preservation of hair bundle morphology and/or restoration of mechanotransduction. In other embodiments of the above aspects, the inner ear disorder is Usher Syndrome.
Unless defined otherwise, all technical and scientific terms used herein have the meaning commonly understood by a person skilled in the art to which this invention belongs. The following references provide one of skill with a general definition of many of the terms used in this invention: Singleton et al., Dictionary of Microbiology and Molecular Biology (2nd ed. 1994); The Cambridge Dictionary of Science and Technology (Walker ed., 1988); The Glossary of Genetics, 5th Ed., R. Rieger et al. (eds.), Springer Verlag (1991); and Hale & Marham, The Harper Collins Dictionary of Biology (1991). As used herein, the following terms have the meanings ascribed to them below, unless specified otherwise.
By “AAV9-php.b vector” is meant a viral vector comprising an AAV9-php.b polynucleotide or fragment thereof that transfects a cell of the inner ear. In one embodiment, the AAV9-php.b vector transfects at least 70% of inner hair cells and 70% of outer hair cells following administration to the inner ear of a subject or contact with a cell derived from an inner ear in vitro. In other embodiments, at least 85%, 90%, 95% or virtually 100% of inner hair cells and/or 85%, 90%, 95% or virtually 100% of outer hair cells are transfected. The transfection efficiency may be assessed using a gene encoding GFP in a mouse model. The sequence of an exemplary AAV9-php.b vector is provided below.
By “mechanosensation” is meant a response to a mechanical stimulus. Touch, hearing, and balance are examples of the conversion of a mechanical stimulus into a neuronal signal. Mechanosensory input is converted into a response to a mechanical stimulus through a process termed “mechanotransduction.”
By “myosin 6 (Myo6) promoter” is meant a regulatory polynucleotide sequence comprising or consisting of a nucleic acid sequence sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, a vestibular hair cell, a spiral ganglion, or a vestibular ganglion and having at least about 85% sequencing identity to the following nucleotide sequence:
By “myosin 7A (Myo7A) promoter” is meant a regulatory polynucleotide sequence comprising or consisting of a nucleic acid sequence sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, a vestibular hair cell, a spiral ganglion, or a vestibular ganglion and having at least about 85% sequence identity to the following nucleotide sequence:
By “TMC1 polypeptide” is meant a polypeptide having at least about 85% or greater amino acid sequence identity to NCBI Reference Sequence: NP 619636.2 or a fragment thereof having mechanotransduction channel activity. An exemplary amino acid sequence of TMC1 is provided below:
By “TMC1 polynucleotide” is meant a polynucleotide encoding a TMC1 polypeptide. The sequence of an exemplary TMC1 polynucleotide is provided at NCBI Reference Sequence: NM_138691.2, which is reproduced below:
By “TMC2 polypeptide” is meant a polypeptide having at least about 85% or greater amino acid sequence identity to NCBI Reference Sequence: NP_542789 or a fragment thereof that functions in mechanosensation. An exemplary amino acid sequence of TMC2 is provided below:
By “TMC2 polynucleotide” is meant a polynucleotide encoding a TMC2 polypeptide. An exemplary polynucleotide sequence is provided below:
By “harmonin” polypeptide is meant a polypeptide having at least about 85% amino acid sequence identity to Q9Y6N9-1 (isoform 1), Q9Y6N9-2, Q9Y6N9-3, Q9Y6N9-4, Q9Y6N9-5 or a fragment thereof that functions in mechanosensation or that interacts with any one or more of USH1C, USH1G, CDH23 and MYO7A. The sequence of an exemplary harmonin-a polypeptide (isoform 1) is provided below:
By “Ush1C polynucleotide” is meant a nucleic acid molecule encoding a harmonin polypeptide. The sequence of exemplary Ush1C polynucleotide NM_005709 is provided below:
Other Exemplary harmonin sequences are provided below:
By “KCNQ4 polypeptide” is meant a polypeptide having at least about 85% identity to NP_004691.2 or a fragment thereof and having potassium voltage-gated channel activity. An exemplary amino acid sequence is provided at NP_004691.2, the sequence of which follows:
By KCNQ4 polynucleotide is meant a polynucleotide encoding a KCNQ4 polypeptide. An exemplary KCNQ4 polynucleotide sequence is provided at NM_004700, which is reproduced below.
By “KCNQ4 promoter” is meant a regulatory polynucleotide sequence comprising or consisting of a nucleic acid sequence sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, a vestibular hair cell, a spiral ganglion, or a vestibular ganglion and having at least about 85% nucleotide sequence identity to the following nucleotide sequence:
By “TMPRSS3 polypeptide” is meant a protein having at least about 85% amino acid sequence identify to NP_001243246 or a fragment thereof having protease activity. An exemplary TMPRSS3 sequence follows:
Transmembrane Protease Serine 3 Isoform 4 [Homo sapiens]
By “TMPRSS3 polynucleotide” is meant a polynucleotide encoding a TMPRSS3 polypeptide. An exemplary TMPRSS3 sequence is provided at NCBI NM_001256317, which is reproduced below:
By “STRC polypeptide” is meant a protein having at least about 85% amino acid sequence identity to NP_714544 or a fragment thereof that associates with a hair bundle in the inner ear. An exemplary STRC amino acid sequence follows:
By “STRC polynucleotide” is meant a nucleic acid molecule encoding an STRC polypeptide. An exemplary STRC polynucleotide sequence follows:
By “EYA4 polypeptide” is meant a protein having at least about 85% identity to NP_001287941.1 or a fragment thereof having transcriptional regulatory activity.
By “EYA4 polynucleotide” is meant a nucleic acid molecule that encodes an EYA4 polypeptide. An exemplary EYA4 polynucleotide sequence is provided at NCBI Ref: NM_001301012.1, which is reproduced below:
By “Espin promoter” is meant a regulatory polynucleotide sequence derived from NCBI Reference Sequence: NG 015866.1 that is sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, vestibular hair cell, a spiral ganglion, or a vestibular ganglion. In one embodiment, the Espin promoter comprises or consists of at least about 350, 500, 1000, 2000, 3000, 4000, 5000, or more base pairs upstream of an Espin coding sequence.
By “protocadherin related 15 (PCDH15) promoter” is meant a regulatory polynucleotide sequence derived from NCBI Reference Sequence: NG 009191 that is sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, vestibular hair cell, a spiral ganglion, or a vestibular ganglion. In one embodiment, the PCDH15 promoter comprises at least about 350, 500, 1000, 2000, 3000, 4000, 5000, or more base pairs upstream of an PCDH15 coding sequence. In some embodiments, the PCDH15 promoter comprises or consists of a nucleic acid sequence having at least about 85% sequence identity to the following nucleotide sequence:
By “protein tyrosine phosphatase, receptor type Q (PTPRQ) promoter” is meant a regulatory polynucleotide sequence derived from GeneID: 374462 that is sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, vestibular hair cell, a spiral ganglion, or a vestibular ganglion. In one embodiment, the PTPRQ promoter comprises at least about 350, 500, 1000, 2000, 3000, 4000, 5000, or more base pairs upstream of an PTPRQ coding sequence. In some embodiments, the PTPRQ promoter comprises or consists of a nucleic acid sequence having at least about 85% sequence identity to the following nucleotide sequence:
By “lipoma HMGIC fusion partner-like 5 (LHFPL5) promoter” also termed “TMHS promoter” is meant a regulatory polynucleotide sequence derived from NCBI Reference Sequence: GeneID: 222662 that is sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, vestibular hair cell, a spiral ganglion, or a vestibular ganglion. In one embodiment, the TMHS promoter comprises at least about 350, 500, 1000, 2000, 3000, 4000, 5000, or more base pairs upstream of an PCDH15 coding sequence. In some embodiments, the TMHS promoter comprises or consists of a nucleic acid sequence having at least about 85% sequence identity to the following nucleotide sequence:
By “synapsin promoter” also termed “Syn promoter” is meant a regulatory polynucleotide sequence comprising or consisting of a nucleic acid sequence sufficient to direct expression of a downstream polynucleotide in an outer or inner hair cell, a vestibular hair cell, a spiral ganglion, or a vestibular ganglion and having at least about 85% sequence identity to the following nucleotide sequence:
By “agent” is meant a polypeptide, polynucleotide, or small compound.
By “ameliorate” is meant decrease, suppress, attenuate, diminish, arrest, or stabilize the development or progression of a disease or disorder.
By “alteration” is meant a change (increase or decrease) in the expression levels or activity of a gene or polypeptide as detected by standard art known methods such as those described herein. As used herein, an alteration includes a 10% change in expression levels, preferably a 25% change, more preferably a 40% change, and most preferably a 50% or greater change in expression levels.”
In this disclosure, “comprises,” “comprising,” “containing” and “having” and the like can have the meaning ascribed to them in U.S. patent law and can mean “includes,” “including,” and the like; “consisting essentially of” or “consists essentially” likewise has the meaning ascribed in U.S. patent law and the term is open-ended, allowing for the presence of more than that which is recited so long as basic or novel characteristics of that which is recited is not changed by the presence of more than that which is recited, but excludes prior art embodiments.
“Detect” refers to identifying the presence, absence or amount of the analyte to be detected.
By “disease” is meant any condition or disorder that damages or interferes with the normal function of a cell, tissue, or organ. Examples of diseases include genetic disorders characterized by a loss of function in a protein that functions in mechanosensory transduction that is expressed, for example, in the inner ear of a subject. In another embodiment, the disease is Usher Syndrome (e.g., USH1) or age-related hearing loss. In one embodiment, a disease is an auditory disorder associated with a genetic defect, such as a defect in TMC1, TMC2, MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, USH1C (e.g., harmonin-a, b, or c), OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B.
By “effective amount” is meant the amount of an agent required to ameliorate the symptoms of a disease relative to an untreated patient. The effective amount of active agent(s) used to practice the present invention for therapeutic treatment of a disease varies depending upon the manner of administration, the age, body weight, and general health of the subject. Ultimately, the attending physician or veterinarian will decide the appropriate amount and dosage regimen. Such amount is referred to as an “effective” amount.
By “fragment” is meant a portion of a polypeptide or nucleic acid molecule. This portion contains, preferably, at least 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, or 90% of the entire length of the reference nucleic acid molecule or polypeptide. A fragment may contain 10, 20, 30, 40, 50, 60, 70, 80, 90, or 100, 200, 300, 400, 500, 600, 700, 800, 900, or 1000 nucleotides or amino acids.
“Hybridization” means hydrogen bonding, which may be Watson-Crick, Hoogsteen or reversed Hoogsteen hydrogen bonding, between complementary nucleobases. For example, adenine and thymine are complementary nucleobases that pair through the formation of hydrogen bonds.
The terms “isolated,” “purified,” or “biologically pure” refer to material that is free to varying degrees from components which normally accompany it as found in its native state. “Isolate” denotes a degree of separation from original source or surroundings. “Purify” denotes a degree of separation that is higher than isolation. A “purified” or “biologically pure” protein is sufficiently free of other materials such that any impurities do not materially affect the biological properties of the protein or cause other adverse consequences. That is, a nucleic acid or peptide of this invention is purified if it is substantially free of cellular material, viral material, or culture medium when produced by recombinant DNA techniques, or chemical precursors or other chemicals when chemically synthesized. Purity and homogeneity are typically determined using analytical chemistry techniques, for example, polyacrylamide gel electrophoresis or high performance liquid chromatography. The term “purified” can denote that a nucleic acid or protein gives rise to essentially one band in an electrophoretic gel. For a protein that can be subjected to modifications, for example, phosphorylation or glycosylation, different modifications may give rise to different isolated proteins, which can be separately purified.
By “isolated polynucleotide” is meant a nucleic acid (e.g., a DNA) that is free of the genes which, in the naturally-occurring genome of the organism from which the nucleic acid molecule of the invention is derived, flank the gene. The term therefore includes, for example, a recombinant DNA that is incorporated into a vector; into an autonomously replicating plasmid or virus; or into the genomic DNA of a prokaryote or eukaryote; or that exists as a separate molecule (for example, a cDNA or a genomic or cDNA fragment produced by PCR or restriction endonuclease digestion) independent of other sequences. In addition, the term includes an RNA molecule that is transcribed from a DNA molecule, as well as a recombinant DNA that is part of a hybrid gene encoding additional polypeptide sequence.
By an “isolated polypeptide” is meant a polypeptide of the invention that has been separated from components that naturally accompany it. Typically, the polypeptide is isolated when it is at least 60%, by weight, free from the proteins and naturally-occurring organic molecules with which it is naturally associated. Preferably, the preparation is at least 75%, more preferably at least 90%, and most preferably at least 99%, by weight, a polypeptide of the invention. An isolated polypeptide of the invention may be obtained, for example, by extraction from a natural source, by expression of a recombinant nucleic acid encoding such a polypeptide; or by chemically synthesizing the protein. Purity can be measured by any appropriate method, for example, column chromatography, polyacrylamide gel electrophoresis, or by HPLC analysis.
By “marker” is meant any protein or polynucleotide having an alteration in expression level or activity that is associated with a disease or disorder.
As used herein, “obtaining” as in “obtaining an agent” includes synthesizing, purchasing, or otherwise acquiring the agent.
By “promoter” is meant a polynucleotide sufficient to direct transcription of a downstream polynucleotide.
By “reduces” or “increases” is meant a negative or positive alteration of at least 10%, 25%, 50%, 75%, or 100%.
By “reference” is meant a standard or control condition.
A “reference sequence” is a defined sequence used as a basis for sequence comparison. A reference sequence may be a subset of or the entirety of a specified sequence; for example, a segment of a full-length cDNA or gene sequence, or the complete cDNA or gene sequence. For polypeptides, the length of the reference polypeptide sequence will generally be at least about 16 amino acids, preferably at least about 20 amino acids, more preferably at least about 25 amino acids, and even more preferably about 35 amino acids, about 50 amino acids, or about 100 amino acids. For nucleic acids, the length of the reference nucleic acid sequence will generally be at least about 50 nucleotides, preferably at least about 60 nucleotides, more preferably at least about 75 nucleotides, and even more preferably about 100 nucleotides or about 300 nucleotides or any integer thereabout or therebetween.
Nucleic acid molecules useful in the methods of the invention include any nucleic acid molecule that encodes a polypeptide of the invention or a fragment thereof. Such nucleic acid molecules need not be 100% identical with an endogenous nucleic acid sequence, but will typically exhibit substantial identity. Polynucleotides having “substantial identity” to an endogenous sequence are typically capable of hybridizing with at least one strand of a double-stranded nucleic acid molecule. Nucleic acid molecules useful in the methods of the invention include any nucleic acid molecule that encodes a polypeptide of the invention or a fragment thereof. Such nucleic acid molecules need not be 100% identical with an endogenous nucleic acid sequence, but will typically exhibit substantial identity. Polynucleotides having “substantial identity” to an endogenous sequence are typically capable of hybridizing with at least one strand of a double-stranded nucleic acid molecule.
By “hybridize” is meant pair to form a double-stranded molecule between complementary polynucleotide sequences (e.g., a gene described herein), or portions thereof, under various conditions of stringency. (See, e.g., Wahl, G. M. and S. L. Berger (1987) Methods Enzymol. 152:399; Kimmel, A. R. (1987) Methods Enzymol. 152:507).
For example, stringent salt concentration will ordinarily be less than about 750 mM NaCl and 75 mM trisodium citrate, preferably less than about 500 mM NaCl and 50 mM trisodium citrate, and more preferably less than about 250 mM NaCl and 25 mM trisodium citrate. Low stringency hybridization can be obtained in the absence of organic solvent, e.g., formamide, while high stringency hybridization can be obtained in the presence of at least about 35% formamide, and more preferably at least about 50% formamide. Stringent temperature conditions will ordinarily include temperatures of at least about 30° C., more preferably of at least about 37° C., and most preferably of at least about 42° C. Varying additional parameters, such as hybridization time, the concentration of detergent, e.g., sodium dodecyl sulfate (SDS), and the inclusion or exclusion of carrier DNA, are well known to those skilled in the art. Various levels of stringency are accomplished by combining these various conditions as needed. In a preferred: embodiment, hybridization will occur at 30° C. in 750 mM NaCl, 75 mM trisodium citrate, and 1% SDS. In a more preferred embodiment, hybridization will occur at 37° C. in 500 mM NaCl, 50 mM trisodium citrate, 1% SDS, 35% formamide, and 100 μg/ml denatured salmon sperm DNA (ssDNA). In a most preferred embodiment, hybridization will occur at 42° C. in 250 mM NaCl, 25 mM trisodium citrate, 1% SDS, 50% formamide, and 200 μg/ml ssDNA. Useful variations on these conditions will be readily apparent to those skilled in the art.
For most applications, washing steps that follow hybridization will also vary in stringency. Wash stringency conditions can be defined by salt concentration and by temperature. As above, wash stringency can be increased by decreasing salt concentration or by increasing temperature. For example, stringent salt concentration for the wash steps will preferably be less than about 30 mM NaCl and 3 mM trisodium citrate, and most preferably less than about 15 mM NaCl and 1.5 mM trisodium citrate. Stringent temperature conditions for the wash steps will ordinarily include a temperature of at least about 25° C., more preferably of at least about 42° C., and even more preferably of at least about 68° C. In a preferred embodiment, wash steps will occur at 25° C. in 30 mM NaCl, 3 mM trisodium citrate, and 0.1% SDS. In a more preferred embodiment, wash steps will occur at 42 C in 15 mM NaCl, 1.5 mM trisodium citrate, and 0.1% SDS. In a more preferred embodiment, wash steps will occur at 68° C. in 15 mM NaCl, 1.5 mM trisodium citrate, and 0.1% SDS. Additional variations on these conditions will be readily apparent to those skilled in the art. Hybridization techniques are well known to those skilled in the art and are described, for example, in Benton and Davis (Science 196:180, 1977); Grunstein and Hogness (Proc. Natl. Acad. Sci., USA 72:3961, 1975); Ausubel et al. (Current Protocols in Molecular Biology, Wiley Interscience, New York, 2001); Berger and Kimmel (Guide to Molecular Cloning Techniques, 1987, Academic Press, New York); and Sambrook et al., Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Laboratory Press, New York.
By “substantially identical” is meant a polypeptide or nucleic acid molecule exhibiting at least 50% identity to a reference amino acid sequence (for example, any one of the amino acid sequences described herein) or nucleic acid sequence (for example, any one of the nucleic acid sequences described herein). Preferably, such a sequence is at least 60%, more preferably 80% or 85%, and more preferably 90%, 95% or even 99% identical at the amino acid level or nucleic acid to the sequence used for comparison.
Sequence identity is typically measured using sequence analysis software (for example, Sequence Analysis Software Package of the Genetics Computer Group, University of Wisconsin Biotechnology Center, 1710 University Avenue, Madison, Wis. 53705, BLAST, BESTFIT, GAP, or PILEUP/PRETTYBOX programs). Such software matches identical or similar sequences by assigning degrees of homology to various substitutions, deletions, and/or other modifications. Conservative substitutions typically include substitutions within the following groups: glycine, alanine; valine, isoleucine, leucine; aspartic acid, glutamic acid, asparagine, glutamine; serine, threonine; lysine, arginine; and phenylalanine, tyrosine. In an exemplary approach to determining the degree of identity, a BLAST program may be used, with a probability score between e−3 and e−100 indicating a closely related sequence.
By “subject” is meant a mammal, including, but not limited to, a human or non-human mammal, such as a bovine, equine, canine, ovine, or feline.
By “transgene” is meant any piece of DNA that is inserted by artifice into a cell and becomes part of the genome of the organism that develops from that cell. Such a transgene may include a gene which is partly or entirely heterologous (i.e., foreign) to the transgenic organism, or may represent a gene homologous to an endogenous gene of the organism.
Ranges provided herein are understood to be shorthand for all of the values within the range. For example, a range of 1 to 50 is understood to include any number, combination of numbers, or sub-range from the group consisting 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, or 50.
As used herein, the terms “treat,” treating,” “treatment,” and the like refer to reducing or ameliorating a disorder and/or symptoms associated therewith. It will be appreciated that, although not precluded, treating a disorder or condition does not require that the disorder, condition or symptoms associated therewith be completely eliminated.
Unless specifically stated or obvious from context, as used herein, the term “or” is understood to be inclusive. Unless specifically stated or obvious from context, as used herein, the terms “a”, “an”, and “the” are understood to be singular or plural.
Unless specifically stated or obvious from context, as used herein, the term “about” is understood as within a range of normal tolerance in the art, for example within 2 standard deviations of the mean. About can be understood as within 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, 0.1%, 0.05%, or 0.01% of the stated value. Unless otherwise clear from context, all numerical values provided herein are modified by the term about.
The recitation of a listing of chemical groups in any definition of a variable herein includes definitions of that variable as any single group or combination of listed groups. The recitation of an embodiment for a variable or aspect herein includes that embodiment as any single embodiment or in combination with any other embodiments or portions thereof.
Any compositions or methods provided herein can be combined with one or more of any of the other compositions and methods provided herein.
Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the methods and compositions of matter belong. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of the methods and compositions of matter, suitable methods and materials are described below. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting. All publications, patent applications, patents, and other references mentioned herein are incorporated by reference in their entirety.
The invention provides compositions and methods for delivering and expressing a protein (e.g., TMC1, TMC2, MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, USH1C (e.g., harmonin-a, b, or c), OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B) required for mechanosensation, including hearing, and/or vestibular function, in a cell of the inner ear of a subject, such as a cochlear cell (e.g., inner or outer hair cell), wherein the subject has a loss or reduction in the level or activity of that protein.
The invention is based, at least in part, on the discoveries that an adeno-associated viral vector AAV-PHP.B, which encodes a capsid comprising the 7-mer sequence TLAVPFK is extremely efficient and specific for expressing a protein of interest in inner and outer hair cells of the inner ear.
The AAV-PHP.B vector was generated using a Cre recombination-dependent approach to selectively recover capsids that transduce a predefined Cre expressing target cell population (also termed CREATE). This approach and vectors useful in the methods of the invention are described by Deverman et al., entitled “Cre-dependent selection yields AAV variants for widespread gene transfer to the adult brain,” Nat Biotechnol. 2016 February; 34(2): 204-209) and in US Patent Publication No. 20170166926, each of which is incorporated herein by reference in their entirety. A library of AAV variants was generated by inserting 7 amino acids (AA) of randomized sequence (7-mer) between AA588-589 (VP1 position) of the AAV9 capsid. AAV-PHP.B encodes the 7-mer sequence TLAVPFK and was tested for efficient transgene delivery to the cochlea, where it showed remarkably specific and robust expression in the inner and outer hair cells.
Human Usher syndrome (USH) is a rare genetic condition responsible for combined deafness and blindness. Inherited as an autosomal recessive trait, it affects 16,000 to 20,000 people in the United States and is responsible for 3 to 6% of early childhood deafness. Usher syndrome is classified under three clinical subtypes (USH-1, -2 and -3) according to the severity of the symptoms. USH1 is the most severe form. Patients who are affected by USH1 suffer congenital bilateral profound sensorineural hearing loss, vestibular areflexia and pre-pubertal retinitis pigmentosa (a progressive, bilateral, symmetric degeneration of rod and cone function of the retina). Unless fitted with a cochlear implant, individuals do not typically develop the ability to generate speech. While no biological treatments currently exist for Usher patients, early reintroduction of the wild-type form of the defective gene may allow for reversal of the disease.
Six Usher genes are associated with USH1: MYO7A (myosin 7a), USH1C (harmonin), CDH23 (cadherin 23), PCDH15 (protocadherin 15), SANS (sans) and CIB2 (calcium and integrin binding protein 2). These genes encode proteins that are involved in hair bundle morphogenesis in the inner ear and are part of an interactome (see, for example, Mathur & Yang, 2015, Biochim. Biophys. Acta, 1852:406-20). Harmonin resides at the center of the USH1 interactome where it binds to other Usher 1 proteins. Because of its PDZ (PSD-59 95/Dlg/ZO-1) interaction domains, harmonin has been proposed to function as a scaffolding protein. In vitro binding studies have shown that all other known USH1 proteins bind to PDZ domains of harmonin as do two of the USH2 proteins, usherin, and VLGR1. The USH1C gene consists of 28 exons, which code for 10 alternative splice forms of harmonin, grouped into three different subclasses (a, b and c) depending on the domain composition of the protein. The three isoforms differ in the number of PDZ protein-protein interaction domains, coiled-coiled (CC) domains, and proline-serine-threonine (PST) rich domains.
USH1 proteins are localized to the apex of hair cells in mechanosensory hair bundles, which are composed of hundreds of stereocilia interconnected by numerous extracellular links. Cadherin 23 and Protocadherin 15, products of Usher genes (USH1D and USH1E, respectively) form tip-links located at the distal end of the stereocilia. Harmonin-b binds to CDH23, PCDH15, F-actin and itself. It is found at the tips of the stereocilia near the tip-link insertion point in hair cells where it is thought to play a functional role in transduction and adaptation in hair cells. Harmonin-b is expressed during early postnatal stages but its expression diminishes around postnatal day 30 (P30) in both the cochlea and vestibule. Harmonin-a also binds to cadherin 23 and is found in the stereocilia. Recent reports reveal an additional role for harmonin-a at the synapse where it associates with Cav1.3 Ca2+ channels to limit channel availability through an ubiquitin-dependent pathway.
Several mouse models for Usher syndrome have been identified or engineered over the past decade, seven of which affect harmonin. Of these, only one model, the Ush1c c.216G>A model, reproduces both auditory and retinal deficits that characterize human Usher Syndrome. Ush1c c.216G>A is a knock-in mouse model that affects expression of all conventional harmonin isoforms due a point mutation similar to the one found in a cohort of French-Acadian USH1C patients. The mutation introduces a cryptic splice site at the end of exon three of the Ush1c gene. Use of this cryptic splice site produces a frame-shifted transcript with a 35 bp deletion and results in translation of a severely truncated protein lacking PDZ, PST and CC domains. Homozygous c.216AA knock-in mice suffer from severe hearing loss at 1 month of age while heterozygous c.216GA mice do not present any abnormal phenotype. Cochlear histology in c.216AA mice shows disorganized hair bundles, abnormal cell rows and loss of both inner and outer hair cells in middle and basal turns at P30.
It is demonstrated herein that a AAV9-PHP.B vector successfully transduced hair cells and drove expression of a protein of interest (i.e., GFP) in hair cells. Accordingly, this vector can be used to deliver other proteins of interest to hair cells for the treatment of Usher syndrome, as well as other auditory disorders.
Over 40 distinct mutations have been identified in TMC1 that cause deafness. These are subdivided into 35 recessive mutations and 5 dominant mutations. Most of the recessive mutations cause profound, congenital hearing loss (e.g., DFNB7/11) though a few cause later onset, moderate to severe hearing loss. All of the dominant mutations cause progressive hearing loss (e.g., DFNA36), with onset in the mid-teen years. In particular, a AAV9-PHP.B vector as described herein can be used to deliver a non-mutant (e.g., wild-type) TMC1 sequence or TMC2 sequence, thereby preventing hearing loss (e.g., further hearing loss) and/or restoring hearing function.
Since the sensory cells of the adult mammalian cochlea lack the capacity for self-repair, current therapeutic strategies (depending on the level and exact position of impairment) rely on amplification (hearing aids), better transmission of sound (middle ear prostheses/active implants), or direct neuronal stimulation (cochlear implants) to compensate for permanent damage to primary sensory hair cells or spiral ganglion neurons which form the auditory nerve and relay acoustic information to the brain. While these approaches have been transformative, they remain far from optimal in restoring complex human hearing function important for modern life. Specifically, major problems still include limited frequency sensitivity, unnatural sound perception, and limited speech discrimination in noisy environments.
Therapeutic gene transfer to the cochlea has been considered to further improve upon the current standard of care ranging from age-related and environmentally induced hearing loss to genetic forms of deafness. More than 300 genetic loci have been linked to hereditary hearing loss with over 70 causative genes described (Parker & Bitner-Glindzicz, 2015, Arch. Dis. Childhood, 100:271-8). Therapeutic success in these approaches relies significantly on the safe and efficient delivery of exogenous gene constructs to the relevant therapeutic cell targets in the organ of Corti in the cochlea.
The organ of Corti includes two classes of sensory hair cells: inner hair cells, which convert mechanical information carried by sound into electrical signals transmitted to neuronal structures and outer hair cells which serve to amplify and tune the cochlear response, a process required for complex hearing function. Other potential targets in the inner ear include spiral ganglion neurons, columnar cells of the spiral limbus, which are important for the maintenance of the adjacent tectorial membrane or supporting cells, which have protective functions and can be triggered to trans-differentiate into hair cells up to an early neonatal stage.
Injection to the cochlear duct, which is filled with high potassium endolymph fluid, could provide direct access to hair cells. However, alterations to this delicate fluid environment may disrupt the endocochlear potential, heightening the risk for injection-related toxicity. The perilymph-filled spaces surrounding the cochlear duct, scala tympani and scala vestibuli, can be accessed from the middle ear, either through the oval or round window membrane. The round window membrane, which is the only non-bony opening into the inner ear, is relatively easily accessible in many animal models and administration of viral vector using this route is well tolerated. In humans, cochlear implant placement routinely relies on surgical electrode insertion through the RWM.
Previous studies evaluating AAV serotypes in organotypic cochlear explant and in vivo inner ear injection have resulted in only partial rescue of hearing in mouse models of inherited deafness. Unexpectedly, an AAV9-PHP.B vector transduced hair cells with high efficiency. This finding overcomes the low transduction rates that have limited successful development of cochlear gene therapy using conventional AAV serotypes. An AAV9-PHP.B vector as described herein provides a valuable platform for inner ear gene delivery to inner and outer hair cells, as well as an array of other inner ear cell types that are compromised by genetic hearing and balance disorders.
The AAV9-PHP.B vector provides for the highly efficient delivery of nucleic acids encoding proteins of interest. In particular, the invention provides a AAV9-PHP.B vector comprising one of the following promoters: an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, or a TMHS (LHFPL5) promoter). In particular embodiments, the promoter directs expression of a polynucleotide encoding one or more of TMC1, TMC2, MYO7A, USCH1C, CDH23, PCDH15, SANS, C1132, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, USH1C (e.g., harmonin-a, b, or c) OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B to cells, particularly cells within the inner ear, e.g., in the cochlea (or cells of the cochlea or cochlear cells). As used herein, inner ear cells refer to, without limitation, inner hair cells (IHCs), outer hair cells (OHCs), spiral ganglion neurons, stria vascularis, vestibular hair cells, vestibular ganglion neurons, and supporting cells. Supporting cells refer to cells in the ear that are not excitable, e.g., cells that are not hair cells or neurons. An example of a supporting cell is a Schwann cell.
Delivery of one or more of the nucleic acids described herein to inner ear cells can be used to treat any number of inherited or acquired hearing disorders, which are typically defined by partial hearing loss or complete deafness. The methods described herein can be used to treat a hearing disorder such as, without limitation, recessive deafness, dominant deafness, Usher syndrome, and other syndromic deafness, as well as hearing loss due to trauma or aging.
As described herein, AAV-PHP.B vectors are particularly efficient at delivering nucleic acids (e.g., transgenes, including but not limited to a polynucleotide encoding one or more of TMC1, TMC2, MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, USH1C (e.g., harmonin-a, b, or c)) to inner ear cells. The AAV-PHP.B vector advantageously transduced greater than about 60%, 70%, 80%, 90%, 95%, or even 100% of inner or outer hair cells.
In particular embodiments the AAV-PHP.B vector has a natural or engineered tropism for hair cells. In some embodiments, AAV9-php.b delivers a transgene (e.g., a polynucleotide encoding one or more of TMC1, TMC2, MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, USH1C (e.g., harmonin-a, b, or c), OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B) to the inner ear in a subject.
In one embodiment, a AAV-PHP.B vector comprising a promoter (e.g., an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter) directing expression of a polynucleotide encoding one or more of TMC1, TMC2, MYO7A, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, USH1C (e.g., harmonin-a, b, or c), OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B is used to treat a hearing disorder. A nucleic acid sequence delivered to a cell for the purpose of expression oftentimes is referred to as a transgene. Representative transgenes that can be delivered to, and expressed in, inner ear cells include, without limitation, a transgene encoding a polypeptide that functions in auditory and/or vestibular mechanosensation (e.g., TMC1, TMC2, MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7 (e.g., harmonin-a, b, or c), OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B), KCNQ4, TMPRSS3, STRC, EYA4, a transgene that encodes a neurotrophic factor (e.g., GDNV, BDNF, or HSP70).
Expression of a transgene may be directed by the transgene's natural promoter (i.e., the promoter found naturally with the transgenic coding sequence) or expression of a transgene may be directed by a heterologous promoter (e.g., an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter). For example, any of the transgenes described herein can be used with its natural promoter. Alternatively, any of the transgenes described herein can be used with a heterologous promoter. As used herein, a heterologous promoter refers to a promoter that does not naturally direct expression of that sequence (i.e., is not found with that sequence in nature). Representative heterologous promoters that can be used to direct expression of any of the transgenes indicated herein include, for example, a CMV promoter, a CBA promoter, a CASI promoter, a P promoter, and a EF-1 promoter, an alpha9 nicotinic receptor promoter, a prestin promoter, a Gfi1 promoter, and a Vglut3 promoter. In addition, a promoter that naturally directs expression of one of the above-referenced transgenes (e.g., a KCNQ4 promoter, a Myo7a promoter, a Myo6 promoter or an Atoh1 promoter) can be used as a heterologous promoter to direct expression of a transgene. In other embodiments, the promoter is an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, or a TMHS (LHFPL5) promoter.
Methods of making a transgene (e.g., TMC1, TMC2, USH1C (e.g., harmonin-a, b, or c), MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4) for packaging into a AAV-PHP.B vector are known in the art, and utilize conventional molecular biology and recombinant nucleic acid techniques.
The transgene can be packaged into an AAV-PHP.B vector using, for example, a packaging host cell. The components of a virus particle (e.g., rep sequences, cap sequences, inverted terminal repeat (ITR) sequences) can be introduced, transiently or stably, into a packaging host cell using one or more constructs as described herein.
In general, as used herein, “nucleic acids,” can include DNA and RNA, and also can include nucleic acids that contain one or more nucleotide analogs or backbone modifications. Nucleic acids can be single-stranded or double-stranded, which usually depends upon its intended use. Nucleic acids that can be used in the methods described herein can be identical to a known nucleic acid sequence, or nucleic acids that can be used in the methods described herein can differ in sequence from such known sequences. Simply by way of example, nucleic acids (or the encoded polypeptides) can have at least 75% sequence identity (e.g., at least 80%, 81%, 82%, 83%, 84%, 85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequence identity) to a known sequence.
In calculating percent sequence identity, two sequences are aligned and the number of identical matches of nucleotides or amino acid residues between the two sequences is determined. The number of identical matches is divided by the length of the aligned region (i.e., the number of aligned nucleotides or amino acid residues) and multiplied by 100 to arrive at a percent sequence identity value. It will be appreciated that the length of the aligned region can be a portion of one or both sequences up to the full-length size of the shortest sequence. It also will be appreciated that a single sequence can align with more than one other sequence and hence, can have different percent sequence identity values over each aligned region.
The alignment of two or more sequences to determine percent sequence identity is performed using the computer program ClustalW and default parameters, which allows alignments of nucleic acid or polypeptide sequences to be carried out across their entire length (global alignment). Chenna et al., 2003, Nucleic Acids Res., 31(13):3497-500. ClustalW calculates the best match between a query and one or more subject sequences, and aligns them so that identities, similarities and differences are determined. Gaps of one or more residues can be inserted into a query sequence, a subject sequence, or both, to maximize sequence alignments. For pairwise alignment of nucleic acid sequences, the default parameters are used (i.e., word size: 2; window size: 4; scoring method: percentage; number of top diagonals: 4; and gap penalty: 5); for an alignment of multiple nucleic acid sequences, the following parameters are used: gap opening penalty: 10.0; gap extension penalty: 5.0; and weight transitions: yes. For pairwise alignment of polypeptide sequences, the following parameters are used: word size: 1; window size: 5; scoring method: percentage; number of top diagonals: 5; and gap penalty: 3. For multiple alignment of polypeptide sequences, the following parameters are used: weight matrix: BLOSUM (blocks substitution matrix); gap opening penalty: 10.0; gap extension penalty: 0.05; hydrophilic gaps: on; hydrophilic residues: Gly, Pro, Ser, Asn, Asp, Gln, Glu, Arg, and Lys; and residue-specific gap penalties: on. ClustalW can be run, for example, at the Baylor College of Medicine Search Launcher website or at the European Bioinformatics Institute website on the World Wide Web.
Changes can be introduced into a nucleic acid sequence, which can lead to changes in the amino acid sequence of the encoded polypeptide if the nucleic acid sequence is a coding sequence. For example, changes can be introduced into nucleic acid coding sequences using mutagenesis (e.g., site-directed mutagenesis, PCR-mediated mutagenesis) or by chemically synthesizing a nucleic acid molecule having such changes. Such nucleic acid changes can lead to conservative and/or non-conservative amino acid substitutions at one or more amino acid residues. A “conservative amino acid substitution” is one in which one amino acid residue is replaced with a different amino acid residue having a similar side chain (see, for example, Dayhoff et al. (1978, in Atlas of Protein Sequence and Structure, 5 (Suppl. 3):345-352), which provides frequency tables for amino acid substitutions), and a non-conservative substitution is one in which an amino acid residue is replaced with an amino acid residue that does not have a similar side chain.
A nucleic acid can be contained within a construct, which also can be referred to as a vector or a plasmid. Constructs are commercially available or can be produced by recombinant techniques routine in the art. A construct containing a nucleic acid can have expression elements that direct and/or regulate expression of such a nucleic acid, and also can include sequences such as those for maintaining the construct (e.g., origin of replication, a selectable marker). Expression elements are known in the art and include, for example, promoters, introns, enhancer sequences, response elements, or inducible elements.
A AAV-PHP.B vector comprising a promoter (e.g., an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter) and a polynucleotide that is one or more of USH1, MYO7A, USH1C (harmonin-a, b, c), CDH23, PCDH15, SANS and CIB2, usually suspended in a physiologically compatible excipient, can be administered to a subject (e.g., a human or non-human mammal) by injection to the inner ear of a subject through the round window or utricle. Suitable carriers include saline, which may be formulated with a variety of buffering solutions (e.g., phosphate buffered saline), lactose, sucrose, calcium phosphate, gelatin, dextran, agar, pectin, and water. The AAV-PHP.B vector is administered in sufficient amounts to transduce or infect the cells and to provide sufficient levels of gene transfer and expression to provide a therapeutic benefit without undue adverse effects.
The dose of the AAV-PHP.B vector administered to a subject will depend primarily on factors such as the condition being treated, and the age, weight, and health of the subject. For example, a therapeutically effective dosage of a AAV-PHP.B vector to be administered to a human subject generally is in the range of from about 0.1 ml to about 10 ml of a solution containing concentrations of from about 1×10′ to 1×1012 genome copies (GCs) of AAVs (e.g., about 1×103 to 1×109 GCs).
Methods of delivering nucleic acids to cells generally are known in the art, and methods of delivering viruses (which also can be referred to as viral particles) containing a transgene to inner ear cells in vivo are described herein. As described herein, about 108 to about 1012 viral particles can be administered to a subject, and the virus can be suspended within a suitable volume (e.g., 10 μL, 50 μL, 100 μL, 500 μL, or 1000 μL) of, for example, artificial perilymph solution.
A virus containing a promoter (e.g., an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter) and a transgene (e.g., TMC1, TMC2, USH1C (e.g., harmonin-a, b, or c), MYO7A, USCH1C, CDH23, PCDH15, SANS, CIB2, USH2A, VLGR1, WHRN, CLRN1, PDZD7, KCNQ4, TMPRSS3, STRC, EYA4, OTOF, GPR98, MYO6, MYO15A, LOXHD1, POU3F4, EYA1, WFS1, ACTG1, TMIE, PJVK, SYNE4, and FAM65B) as described herein can be delivered to inner ear cells (e.g., cells in the cochlea) using any number of means. For example, a therapeutically effective amount of a composition including virus particles containing one or more different types of transgenes as described herein can be injected through the round window or the oval window, or the utricle, typically in a relatively simple (e.g., outpatient) procedure. In some embodiments, a composition comprising a therapeutically effective number of virus particles containing a transgene, or containing one or more sets of different virus particles, wherein each particle in a set can contain the same type of transgene, but wherein each set of particles contains a different type of transgene than in the other sets, as described herein can be delivered to the appropriate position within the ear during surgery (e.g., a cochleostomy or a canalostomy).
In one embodiment, an AAV-PHP.B vector comprising a promoter (e.g., an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, or a TMHS (LHFPL5) promoter) and a polynucleotide that is one or more of USH1, MYO7A, USH1C (harmonin-a, b, c), CDH23, PCDH15, SANS and CIB2 is injected through the round window or utricle of a subject in need thereof.
In addition, delivery vehicles (e.g., polymers) are available that facilitate the transfer of agents across the tympanic membrane and/or through the round window or utricle, and any such delivery vehicles can be used to deliver the viruses described herein. See, for example, Arnold et al., 2005, Audiol. Neurootol., 10:53-63.
The compositions and methods described herein enable the highly efficient delivery of nucleic acids to inner ear cells, e.g., cochlear cells. For example, the compositions and methods described herein enable the delivery to, and expression of, a transgene in at least 80% (e.g., at least 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, or 99%) of inner hair cells or delivery to, and expression in, at least 80% (e.g., at least 85, 90, 91, 92, 93, 94, 95, 96, 97, 98, or 99) of outer hair cells.
As demonstrated herein, expression of a transgene delivered using an AAV-PHP.B vector can result in regeneration of inner hair cells (IHCs), outer hair cells (OHCs), spiral ganglion neurons, stria vascularis, vestibular hair cells, and/or vestibular ganglion neurons (e.g. Atoh1, NF2) such that hearing or vestibular function is restored for an extended period of time (e.g., months, years, decades, a life time).
The invention also provides a pharmaceutical pack or kit comprising one or more containers filled with one or more of the ingredients of the pharmaceutical compositions of the invention including a AAV-PHP.B vector comprising a promoter (e.g., an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter) and a polynucleotide that is one or more of USH1, MYO7A, USH1C (harmonin-a, b, c), CDH23, PCDH15, SANS and CIB2). Associated with such container(s) can be a notice in the form prescribed by a governmental agency regulating the manufacture, use or sale of pharmaceuticals or biological products, which notice reflects approval by the agency of manufacture, use or sale for human administration.
The invention also provides kits for treatment or prevention of a disease or disorder (or symptoms) thereof associated with a defect in auditory and/or vestibular mechanosensation. In one embodiment, the kit includes an effective amount of a AAV-PHP.B vector comprising a promoter (e.g., an Espin promoter, a PCDH15 promoter, a PTPRQ promoter, a Myo6 promoter, a KCNQ4 promoter, a Myo7a promoter, a synapsin promoter, a GFAP promoter, a CMV promoter, a CAG promoter, a CBH promoter, a CBA promoter, a U6 promoter, and a TMHS (LHFPL5) promoter) and a polynucleotide that is one or more of USH1, MYO7A, USH1C (harmonin-a, b, c), CDH23, PCDH15, SANS and CIB2 in unit dosage form, together with instructions for administering the AAV-PHP.B vector to a subject suffering from or susceptible to a disease or disorder or symptoms thereof associated with a hearing disorder. In preferred embodiments, the kit comprises a sterile container which contains the AAV-PHP.B vector; such containers can be boxes, ampules, bottles, vials, tubes, bags, pouches, blister-packs, or other suitable container form known in the art. Such containers can be made of plastic, glass, laminated paper, metal foil, or other materials suitable for holding medicaments. The instructions will generally include information about the use of the AAV-PHP.B vector for treatment of a disease or disorder or symptoms thereof associated with a hearing disorder. The instructions may be printed directly on the container (when present), or as a label applied to the container, or as a separate sheet, pamphlet, card, or folder supplied in or with the container.
Conventional molecular biology, microbiology, biochemical, and recombinant DNA techniques within the skill of the art can be used in accordance with the present disclosure. Such techniques are explained fully in the literature. The invention will be further described in the following examples, which do not limit the scope of the methods and compositions of matter described in the claims.
In Vivo Injections
Mouse pups (P0 to P2) were injected with AAV-PHP.B vector CMV GFP via the round window membrane (RWM) using beveled glass microinjection pipettes. Pipettes were pulled from capillary glass (WPI) on a P-2000 pipette puller (Sutter Instrument, Novato, Calif.) and were beveled (˜20 μm tip diameter at a 28° angle) using a micropipette beveler (Sutter Instrument, Novato, Calif.). EMLA cream (lidocaine 2.5% and prilocaine 2.5%) was applied externally for analgesia using sterile swabs to cover the surgical site (left mastoid prominence). Body temperature was maintained on a 38° C. warming pad prior to surgery. Pups were anesthetized by rapid induction of hypothermia into ice/water for 2-3 minutes until loss of consciousness, and this state was maintained on a cooling platform for 5-10 minutes during the surgery. The surgical site was disinfected by scrubbing with Betadine and wiping with 70% Ethanol in repetition three times. A post-auricular incision was made to expose the transparent otic bulla, a micropipette was advanced manually through the bulla and overlying fascia, and the RWM was penetrated by the tip of the micropipette. Approximately 1 μL of virus was injected unilaterally within 1 min into the left ear manually in C57BL/6 animals. After the injection, the skin incision was closed using a 6-0 black monofilament suture (Surgical Specialties, Wyomissing, Pa.). Pups were subsequently returned to the 38° C. warming pad for 5-10 min and then put back to their mother for breeding.
AAV-PHP.B vector transduced nearly 100% of IHCs and 100% of OHCs (
The AAV-PHP.B CMV GFP vector-transduced samples were subsequently fixed, stained with phalloidin or Myo7 and imaged by confocal microscopy. The outer and inner hair cell targeting illustrates efficient transduction.
Following transduction of an AAV-PHP.B vector comprising a transgene encoding a gene of interest, the electrophysiology of the hair cell is assayed. Cochleae are excised, mounted on glass coverslips and viewed on an Axio Examiner.A1 upright microscope (Carl Zeiss, Oberkochen, Germany) equipped with a 63× water-immersion objective and differential interference contrast optics. Electrophysiological recordings are performed at room temperature (22° C.-24° C.) in standard solutions containing (in mM): 137 NaCl, 5.8 KCl, 10 HEPES, 0.7 NaH2PO4, 1.3 CaCl2, 0.9 MgCl2, and 5.6 D-glucose, vitamins (1:100), and amino acids (1:50) as in MEM (Life Technologies, Carlsbad, Calif.) (pH 7.4; ˜310 mOsm/kg). Recording electrodes (3-4 MΩ) are pulled from R-6 glass (King Precision Glass, Claremont, Calif.) and filled with intracellular solution containing (in mM): 140 CsCl, 5 EGTA-KOH, 5 HEPES, 2.5 Na2ATP, 3.5 MgCl2, and 0.1 CaCl2 (pH 7.4; ˜280 mOsm/kg). The whole-cell, tight-seal technique is used to record mechanotransduction currents using an Axopatch 200B (Molecular Devices, Sunnyvale, Calif.). Hair cells were held at −84 mV. Currents were filtered at 5 kHz with a low-pass Bessel filter, digitized at ≥20 kHz with a 12-bit acquisition board (Digidata 1440A, Molecular Devices, Sunnyvale, Calif.), and recorded using pCLAMP 10 software (Molecular Devices, Sunnyvale, Calif.). Hair bundles from IHCs and OHCs were deflected using stiff glass probes mounted on a PICMA chip piezo actuator (Physik Instrumente, Karlsruhe, Germany) driven by an LVPZT amplifier (E-500.00, Physik Instrumente, Karlsruhe, Germany) and filtered with an 8-pole Bessel filter (Model 3384 filter, Krohn-Hite Corporation, Brockton, Mass.) at 40 kHz to eliminate residual pipette resonance. Stiff glass probes are designed to fit into the concave aspect of the array of hair cell stereocilia for whole-bundle recordings (3-4 μm diameter for OHCs and 4-5 μm diameter for IHCs). For the whole cell electrophysiology recording at >P10, cochlea tissues are dissected at P5-7 and incubated in MEM(1×)+GlutaMAXTM-I medium with 1% FBS at 37° C., 5% CO2 for up to 30 days.
Hearing is also assayed following transduction in mice having a genetic auditory defect. Auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE) data are collected. DPOAE is an assay for proper cochlear amplification and tuning and is a sensitive measure of outer hair cell viability. Stimuli tested in anesthetized mice varied between 10 and 90 dB sound pressure level at frequencies of 5.6, 8, 11.3, 16, 22.6, and 32 kHz. Minimal sound thresholds required to evoke ABRs are plotted.
Mice are tested for balance behavior on the rotarod device. Mice with impaired vestibular function are known to perform poorly on the rotarod device. Previous studies highlighted the ability of this rotarod test to detect balance dysfunction when only one ear is affected. Mice are injected at P1 and tested at P36 and uninjected control mice at P79. All mice are tested using the following rotarod protocol. On day one, mice are trained to balance on a rod that is rotating at four RPM for five minutes. On day two, the mice are tested in five trials with each trial separated by five minutes. For each trial, the rod accelerated one RPM from a starting rate of two RPM. The time (in seconds) is recorded until the mice fell off the device.
Since the perilymphatic solutions of the cochlea is continuous with those of the vestibular labyrinth, it is evaluated whether AAV-PHP.B vector expressing a protein of interest injected via the cochlear RWM would transduce vestibular sensory organs. Thus, to address the safety concern that AAV-PHP.B vector transduction may affect balance, injected mice with confirmed vestibular expression perform the rotarod test for vestibular function relative to uninjected controls.
Tissue Preparation
Utricle and organ of Corti from Ush1c c.216G>A heterozygous or homozygous mutant mice are harvested from postnatal day 0 to 8 (P0 to P8) for electrophysiological studies. Postnatal mouse pups are killed by rapid decapitation. The temporal bones are excised and bathed in MEM (Invitrogen, Carlsbad, Calif.) supplemented with 10 mM HEPES (pH 7.4). The organ of Corti is dissected away without the use of enzyme as described previously (53). Utricles are removed after 10 min protease treatment (Protease XXIV, Sigma) at 0.1 mg/ml. The excised organs are mounted on round glass coverslips. A pair of thin glass fibers previously glued to the coverslip is placed on the edge of the tissue to stabilize it in a flat position. Tissues are either used acutely or kept in culture in presence of 1% Fetal Bovine Serum. Cultures are maintained for 7 to 8 days and the media is replaced every 2 to 3 days for experiments that involve viral vectors infection in vitro.
Animals
Ush1c c.216G>A knock-in mice were obtained from Louisiana State University Health Science Center. The imported strain while on a C57BL6 background were previously bred out of the Cdh23 (Ahl) mutation causing age related hearing loss (48, 49). Mice str genotyped using toe clip (before P8) or ear punch (after P8) and PCR is performed as described previously (32). For all studies, both male and female mice are used in approximately equal proportions. No randomization paradigm was otherwise applied.
Round Window Membrane (RWM) Injection
AAV-PHP.B vectors expressing a gene of interest under a selected promoter are generated. 0.8 μl-1 μl of vector is injected in neonatal mice P0-P1 and P10-P12. P0-P1 mice are first anesthetized using hypothermia exposure while P10-P12 mice are anesthetized with isoflurane. Upon anesthesia, post-auricular incision is made to expose the otic bulla and visualize the cochlea. Injections are done through the RWM with a glass micropipette controlled by a micromanipulator (Askew et al. 2015). The volume of the injected materials is controlled at an approximately 0.02 μl/min for 10 min. Standard post-operative care is applied. Sample size for in vivo studies were determined on a continuing basis to optimize the sample size and decrease the variance.
Electrophysiological Recording
Recordings are performed in standard artificial perilymph solution containing (in mM): 144 NaCl, 0.7 NaH2PO4, 5.8 KCl, 1.3 CaCl2, 0.9 MgCl2, 5.6 D-glucose, and 10 HEPES-NaOH, adjusted to pH 7.4 and 320 mOsmol/kg. Vitamins (1:50) and amino acids (1:100) were added from concentrates (Invitrogen, Carlsbad, Calif.). Hair cells were viewed from the apical surface using an upright Axioskop FS microscope (Zeiss, Oberkochen, Germany) equipped with a 63× water immersion objective with differential interference contrast optics. Recording pipettes (3-5 MΩ) were pulled from borosilicate capillary glass (Garner Glass, Claremont, Calif.) and filled with intracellular solution containing (in mM): 135 KCl, 5 EGTA-KOH, 10 HEPES, 2.5 K2ATP, 3.5 MgCl2, 0.1 CaCl2, pH 7.4. Currents were recorded under whole-cell voltage-clamp at a holding potential of −64 mV at room temperature. Data were acquired using an Axopatch Multiclamp 700A or Axopatch 200A (Molecular devices, Palo Alto, Calif.) filtered at 10 kHz with a low pass Bessel filter, digitized at ≥20 kHz with a 12-bit acquisition board (Digidata 1322) and pClamp 8.2 and 10.5 (Molecular Devices, Palo Alto, Calif.). Data were analyzed offline with OriginLab software and are presented as means±standard deviations unless otherwise noted.
The acoustic startle responses (ASR) is measured using the Startle Monitor (Kinder Scientific). Mice are placed in a small-sized, nonrestrictive, cubical Plexiglas recording chamber (27 cm×10 cm×652 12.5 cm) fixed on a piezo/plexiglass sensing assembly and allowed to acclimate for 5 min with a 60 dB SPL background white noise. Each session consists of 35 trials, during which a single noise pulse ranging in 10 dB SPL intensities from 60-120 db SPL was delivered with an inter-trial interval averaging 30 s (25-35 s range). Pulses are arranged in a pseudorandom order, on a constant 60 dB SPL background noise to limit external noise interference. The Startle Monitor system reduced the response to each pulse into measurements of first N, max N, and max time of the response (ms), for calculations of peak startle response (ASR amplitude) and time from stimulus to peak startle response (ASR latency). ASR were all conducted blind.
To assess whether the ABR/DPOAE recovery yielded behaviorally relevant recovery of auditory function, acoustic startle responses are measured in mice injected with AAV-PHP.B vector alone and expressing a protein of interest and those injected with both vectors. Analysis of the startle response to white noise is assessed for rescue of the response in 6 weeks old mice.
Immunostaining is performed to determine the distribution of expression of a transgene delivered by a AAV-PHP.B vector. To do so, immunostaining is performed on freshly dissected organs of Corti, immersion fixed for 1 h at room temperature with 4% paraformaldehyde diluted in PBS. The tissue is then rinsed in PBS, permeabilized in 0.01-0.1% Triton X-100 for 30 minutes, and counterstained for 1 h with AlexaFluor546-phalloidin (Molecular Probes, 1:200 dilution) to label filamentous actin.
For localization of exogenously expressed TMC::FLAG fusion proteins, the tissue is blocked for 1 hour using 2% BSA and 5% Normal Goat Serum, and is incubated overnight at 4° C. with an antibody to the FLAG motif (BD Biosciences, 1:200 dilution). For hair cell counts, tissue is blocked in Normal Goat Serum for 1 hour, stained with a rabbit anti-Myosin VIIa primary antibody (Proteus Biosciences, 1:1000 dilution) at 4° C. overnight, and labeled with goat anti-rabbit antibody conjugated to AlexaFluor488 (Life Technologies, 1:200 dilution) for 1 h. Samples are mounted on glass coverslips with Vectashield mounting medium (Vector Laboratories), and imaged at 10×-63× magnification using a Zeiss LSM700 confocal microscope.
A novel injection method was developed to deliver therapeutic vectors to the inner ear. Previous injection methods delivered vectors through the round window membrane, the oval window, or the posterior semicircular canal. While somewhat effective, these methods all suffer significant draw backs, including targets that are difficult to access surgically, uneven viral distribution, and significant variability in targeting perilymphatic or endolymphatic spaces. To circumvent these limitations, a novel method was designed that allows for efficient delivery to inner ear spaces without causing auditory or vestibular dysfunction.
This method comprises targeting the utricle, one of the vestibular organs, for injection. Injection is into the endolymphatic space. Two different routes were used for delivery depending on age of the mice. As illustrated below, between P0 and P5, the utricle was approached between the lateral and posterior semicircular canals. At stages later than P5, the utricle was injected between the round and oval windows (
To compare this new method to an existing method of injecting into the round window membrane (RWM), P1 mice were injected in either the utricle or the RWM with AAV2-Anc80L65-GFP. Temporal bones were harvested at 4 weeks of age for imaging. Hair cells were stained with anti-Myosin VIIa antibody. Referring to
To determine if PHB.B-Cmv-eGFP efficiently and specifically transduced mice via utricle or RWM injection, mice were injected with the AAV9.PHP.B-Cmv-eGFP at P1 in either the utricle or the RWM. Referring to
The AAV9-PHP.B vector transduces mice at higher rates than the Anc80 vector. Mice were administered utricle injections of AAV9.PHP.B-Cmv-eGFP or AAV-Anc80-Cmv-eGFP at P1. Temporal bones were harvested at P14, and increased rates of transduction were observed for PHP.B relative to Anc80 as determined by fluorescence detected in the cochlea (
To determine if PHP.B has a higher specificity than Anc80, P1 mice were administered utricle injections of Anc80-Cmv-eGFP-EPRE or PHP.B-Cmv-eGFP. Cochleas were harvested at P15 mice, and cross sections were prepared. Referring to
To determine the developmental stages at which PHP.B-Cmv-eGFP targets inner and outer hair cells, mice were administered utricle injections of the PHP.B vector at P7 and P16. Referring to
The effect of AAV9-PHP.B-Cmv-GFP injection on hair cell transduction in wildtype mice was assessed. Mice were administered utricle injections at P1 of the vector.
Auditory brainstem recording (ABR) and distortion product otoacoustic emissions (DPOAE) thresholds were assessed.
The effects of injection timing on PHP.B and Anc80 transduction were compared. Mice were injected in the utricle at P1, P7, and P16 with either AAV9.PHP.B-Cmv-eGFP or with Anc80-Cmv-eGFP. Referring to
Viral vectors prepared by different entities were assessed. C57 mice were administered utricle injections at P1 of Anc80-Cmv-eGFP, PHP.B-Cmv-eGFP prepared at BCH, or PHP.B-Cmv-eGFP prepared at EPFL. Tissue was harvested at P15. Referring to
To determine if cochlear and vestibular neurons could be effectively transduced, the AAV9-PHP.B vector was modified to comprise the synapsin promoter. C57 mice were administered utricle injections of PHP.B-Syn-eGFP at P1. Tissue was harvested at P15 and cross sections and whole mount dissections were prepared. Referring to
The ability of the PHP.B vector to drive the expression of a therapeutic polypeptide was assessed in homozygous Tmc1 mutant mice. Mice were injected at P1 and auditory function was measured at P30.] As measured by ABR and DPOAE thresholds, the AAV9-PHP.B-Cmv-Tmc1 vector restored auditory function in the mutant mice (
Promoters that drive expression in specific cells or tissues are particularly valuable for targeted delivery of therapeutic transgenes and minimizing off-target expression. The abilities of several promoters that drive expression specifically in vestibular cells was investigated. Referring to
It is to be understood that, while the methods and compositions of matter have been described herein in conjunction with a number of different aspects, the foregoing description of the various aspects is intended to illustrate and not limit the scope of the methods and compositions of matter. Other aspects, advantages, and modifications are within the scope of the following claims.
The recitation of a listing of elements in any definition of a variable herein includes definitions of that variable as any single element or combination (or subcombination) of listed elements. The recitation of an embodiment herein includes that embodiment as any single embodiment or in combination with any other embodiments or portions thereof. All patents and publications mentioned in this specification are herein incorporated by reference to the same extent as if each independent patent and publication was specifically and individually indicated to be incorporated by reference.
Disclosed are methods and compositions that can be used for, can be used in conjunction with, can be used in preparation for, or are products of the disclosed methods and compositions. These and other materials are disclosed herein, and it is understood that combinations, subsets, interactions, groups, etc. of these methods and compositions are disclosed. That is, while specific reference to each various individual and collective combinations and permutations of these compositions and methods may not be explicitly disclosed, each is specifically contemplated and described herein. For example, if a particular composition of matter or a particular method is disclosed and discussed and a number of compositions or methods are discussed, each and every combination and permutation of the compositions and the methods are specifically contemplated unless specifically indicated to the contrary. Likewise, any subset or combination of these is also specifically contemplated and disclosed.
This application is a U.S. National Stage filed under 35 U.S.C. § 111(a), which is a continuation of and claims priority to PCT/US2019/020794, filed Mar. 5, 2019, which claims the benefit of and priority to U.S. Provisional Application No. 62/638,697, filed Mar. 5, 2018, the entire contents of each of which are incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2019/020794 | Mar 2019 | US |
| Child | 17010556 | US |
