Patent Application
20210230631
The Sequence Listing associated with this application is provided in text format in lieu of a paper copy, and is hereby incorporated by reference into the specification.
The name of the text file containing the Sequence Listing is ROPA_009_01WO_ST25.txt. The text file is 254 KB, was created on Apr. 29, 2019, and is being submitted electronically via EFS-Web.
The present disclosure relates generally to gene therapy and/or gene editing for treatment of disorders associated with central nervous system degeneration, such as Parkinson's Disease. In particular, the disclosure provides compositions and methods for gene therapy or gene repair in neurons both ex vivo and in vivo.
Various genes have been implicated in disorders of central nervous system degeneration, such as Parkinson's Disease (PD). Those genes include PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. Creed et al. (2018) Mov Disord. 33:717-729; Blesa et al. (2014) Front. Neuroanat. 8:1-12; Alcalay et al. (2010) Arch Neurol. 67:1116-1122). PARK2, also known as PRKN, has been implicated in a form of PD, autosomal recessive juvenile PD. Despite widespread attempts, there have been few reports of successful gene therapy for central nervous system degeneration.
There is a great need in the art for new compositions and methods of treating and preventing central nervous system degeneration.
The present disclosure provides, in part, compositions and methods for treating, preventing, inhibiting, or delaying central nervous system degeneration. In particular, the inventors disclose various embodiments of, and methods related to, a recombinant gene therapy vector comprising a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene, or functional fragment or variant thereof.
The further inventors disclose various embodiments, and methods related to, of a gene editing system comprising a Cas protein, guide RNA, a repair template comprising a a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene, or functional fragment or variant thereof.
In a first aspect, the disclosure provides a method of inhibiting degeneration or death of a dopaminergic neuron comprising a mutation in a gene associated with a Parkinson's Disease (PD). The mutated gene can be a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene. In methods of this aspect, the method comprises contacting the neuron with a recombinant gene therapy vector comprising a polynucleotide encoding a wild-type protein expressed by a wild-type version of the mutated gene, or a functional variant or fragment thereof. Following contact with the recombinant gene therapy vector, the neuron expresses the wild-type protein, or functional variant or fragment thereof.
In some embodiments, the PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA protein comprises the amino acid sequence set forth in SEQ ID NOs: 1-9, respectively. In some embodiments, the gene is the PARK2 gene, and the wild-type PARK2 protein comprises the amino acid sequence set forth in any of SEQ ID NOs: 10-17. In some embodiments, the polynucleotide comprises a sequence having at least 70%, 75%, 80%, 85%, 95%, or 99% identity to a PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA polynucleotide sequence set forth in SEQ ID NOs: 18-26, respectively. In some embodiments, the gene is the PARK2 gene, and the polynucleotide comprises a sequence having at least 70%, 75%, 80%, 85%, 95%, or 99% identity to a PARK2 isoform polynucleotide sequence set forth in any of SEQ ID NOs: 27-34. In some embodiments, the polynucleotide is codon-optimized. In some embodiments, the polynucleotide comprises less than 40, less than 30, less than 20, or 10 or fewer CpG islands. In some embodiments, the polynucleotide comprises at least 1, at least 2, at least 3, at least 4, at least 5, at least 6, or at least 10 CpG islands. In some embodiments, it comprises between 5 and 20 CpG islands.
Various viral or non-viral vectors can be used. In some embodiments, the recombinant gene therapy vector is a recombinant adeno-associated virus (AAV). Any of the known serotypes can be used. In some embodiments, the AAV has serotype AAV1, AAV2, AAV5, AAV8, AAV9, AAVrh10, or AAVrh74. In some embodiments, the recombinant gene therapy vector comprises a self-complementary AAV. In some embodiments, the recombinant gene therapy vector comprises a single-stranded AAV. In some embodiments, the AAV is a wild-type AAV or a modified AAV. In some embodiments, the AAV comprises a capsid protein having at least 95% identity to a wild-type VP1, VP2, or VP3 capsid protein.
The recombinant gene therapy vector may include gene regulatory elements. In some embodiments, the recombinant gene therapy vector comprises a polynucleotide comprising, in the following 5′ to 3′ order, a eukaryotically active promoter sequence and the sequence encoding the wild-type protein, or functional fragment or variant thereof. The sequence encoding the wild-type protein, or functional fragment or variant thereof, is operably linked to the eukaryotically active promoter sequence.
Without being limited by examples of the disclosure, the recombinant gene therapy vector in some embodiments further comprises one or more of a neuron-specific promoter, optionally selected from the group consisting of hSYN1 (human synapsin), INA (alpha-internexin), NES (nestin), TH (tyrosine hydroxylase), FOXA2 (Forkhead box A2), CaMKII (calmodulin-dependent protein kinase II), and NSE (neuron-specific enolase) promoters; a ubiquitous promotor selected from the group consisting of CMV, CAG, UBC, PGK, EF1-alpha, GAPDH, SV40, HBV, and chicken beta-actin promoters; an enhancer; an intron; a poly-A signal; a WPRE (Woodchuck hepatitis virus posttranscriptional regulatory element); and a HPRE (Hepatitis posttranscriptional regulatory element). The WPRE may be a WPRE(r) or a WPRE(x).
In various embodiments of any of the vectors and methods disclosed herein, the vector comprises an expression cassette comprising in 5′ to 3′ order:
HuBA promoter, the transgene, WPRE(x), and pAGlobin-Oc;
CMV promoter, TPL-eMLP 5′enhancer, the transgene, WPRE(r), and pAGlobin-Oc;
Syn promoter, the transgene, WPRE(r), 3′UTR(globin), and pAGH-Bt;
CBA promoter, the transgene, and pAGH-Bt;
EF1a promoter, the transgene, and pAGlobin-Oc;
HuBA promoter, the transgene, R2V17, and pAGH-Bt;
Syn promoter, the transgene, WPRE(x), 3′UTR(globin), and pAGH-Hs;
CaMKIIa promoter, the transgene, WPRE(r), and pAGH-Hs;
CMV and TPL promoter, the transgene, WPRE(r), and pAGH-Hs;
HuBA promoter, the transgene, and pAGH-Hs;
CMV and TPL promoter, eMPL, the transgene, R2V17, 3′UTR(globin), and pAGH-Bt;
EF1α promoter, the transgene, WPRE(r), and pAGH-Bt;
Syn promoter, the transgene, R2V17, and pAGlobin-Oc;
CaMKIIa promoter, the transgene, R2V17, and pAGlobin-Oc;
CBA promoter, the transgene, WPRE(x), 3′UTR(globin), and pAGH-Hs.
CBA promoter, the transgene, 3′UTR(globin), and pAGlobin-Oc;
CaMKIIa promoter, the transgene, R2V17, and pAGH-Bt;
EF1a promoter, the transgene, R2V17, 3′aglobin, and pAGH-Hs;
CMV promoter, the transgene, R2V17, 3′UTR(globin), and pAGH-Hs; or
CMV promoter, the transgene, and pAGH-Hs,
optionally wherein the transgene encodes PARK2.
The methods of the disclosure may have various effects. In some embodiments, the neuron expresses a reduced amount of alpha-synuclein and/or comprises a reduced amount of Lewy bodies following contact with the recombinant gene therapy vector. In some embodiments, the neuron expresses a reduced amount of monoamine oxidases following contact with the recombinant gene therapy vector. In some embodiments, the neuron produces and/or releases an increased amount of dopamine following contact with the recombinant gene therapy vector. In some embodiments, the neuron undergoes increased mitophagy following contact with the recombinant gene therapy vector.
In some embodiments, the neuron expresses a lower amount of monoamine oxidases as compared to an amount of monoamine oxidases expressed in a neuron not contacted with said recombinant gene therapy vector, optionally wherein said lower amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, or at least 80% lower than the amount expressed in the neuron not contacted with said recombinant gene therapy vector. In some embodiments, the neuron produces and/or releases an increased amount of dopamine as compared to an amount of dopamine produced and/or released by a neuron not contacted with said recombinant gene therapy vector, optionally wherein said increase amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least two-fold, at least three-fold, at least four-fold, at least five-fold, or at least 10-fold greater than the amount produced and/or released by the neuron not contacted with said recombinant gene therapy vector. In some embodiments, the neuron undergoes an increased amount of autophagy as compared to an amount of autophagy undergone by a neuron not contacted with said recombinant gene therapy vector, optionally wherein the increased amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least two-fold, at least three-fold, at least four-fold, at least five-fold, or at least 10-fold greater than the amount undergone by the neuron not contacted with said recombinant gene therapy vector.
The neuron used in the methods of the disclosure may have various characteristics. In some embodiments, the neuron is a primary tyrosine hydroxylase positive neuron. In some embodiments, the neuron was produced from an induced pluripotent stem cell prepared from cells obtained from a subject diagnosed with Parkinson's disease.
In another aspect, the disclosure provides a recombinant gene therapy vector comprising a polynucleotide encoding a wild-type Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene, or a functional variant or fragment thereof; wherein the polynucleotide is operatively linked to a eukaryotically active promoter; and wherein a neuron transduced with said recombinant gene therapy vector expresses the wild-type protein, or functional variant or fragment thereof.
In some embodiments, the functional PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA protein comprises the amino acid sequence set forth in SEQ ID NOs: 1-9, respectively. In some embodiments, the gene is the PARK2 gene, and the wild-type PARK2 protein comprises the amino acid sequence set forth in any of SEQ ID NOs: 10-17. In some embodiments, the polynucleotide comprises a sequence having at least 70%, 75%, 80%, 85%, 95%, or 99% identity to a PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA polynucleotide sequence set forth in SEQ ID NOs: 18-26, respectively. In some embodiments, the gene is the PARK2 gene, and the polynucleotide comprises a sequence having at least 70%, 75%, 80%, 85%, 95%, or 99% identity to a PARK2 isoform polynucleotide sequence set forth in any of SEQ ID NOs: 27-34. In some embodiments, the vector comprises an expression cassette comprising in 5′ to 3′ order:
HuBA promoter, the transgene, WPRE(x), and pAGlobin-Oc;
CMV promoter, TPL-eMLP 5′enhancer, the transgene, WPRE(r), and pAGlobin-Oc;
Syn promoter, the transgene, WPRE(r), 3′UTR(globin), and pAGH-Bt;
CBA promoter, the transgene, and pAGH-Bt;
EF1a promoter, the transgene, and pAGlobin-Oc;
HuBA promoter, the transgene, R2V17, and pAGH-Bt;
Syn promoter, the transgene, WPRE(x), 3′UTR(globin), and pAGH-Hs;
CaMKIIa promoter, the transgene, WPRE(r), and pAGH-Hs;
CMV and TPL promoter, the transgene, WPRE(r), and pAGH-Hs;
HuBA promoter, the transgene, and pAGH-Hs;
CMV and TPL promoter, eMPL, the transgene, R2V17, 3′UTR(globin), and pAGH-Bt;
EF1a promoter, the transgene, WPRE(r), and pAGH-Bt;
Syn promoter, the transgene, R2V17, and pAGlobin-Oc;
CaMKIIa promoter, the transgene, R2V17, and pAGlobin-Oc;
CBA promoter, the transgene, WPRE(x), 3′UTR(globin), and pAGH-Hs.
CBA promoter, the transgene, 3′UTR(globin), and pAGlobin-Oc;
CaMKIIa promoter, the transgene, R2V17, and pAGH-Bt;
EF1a promoter, the transgene, R2V17, 3′UTR(globin), and pAGH-Hs;
CMV promoter, the transgene, R2V17, 3′UTR(globin), and pAGH-Hs; or
CMV promoter, the transgene, and pAGH-Hs,
optionally wherein the transgene encodes PARK2.
In some embodiments, the polynucleotide is codon-optimized. In some embodiments, the polynucleotide comprises any of SEQ ID NOs: 35-38. In some embodiments, the recombinant gene therapy vector is a recombinant adeno-associated virus (rAAV). In some embodiments, the rAAV has serotype AAV1, AAV2, AAV5, AAV8, AAV9, AAVrh10, or AAVrh74. In some embodiments, the recombinant gene therapy vector comprises a self-complementary or a single-stranded AAV genome. In some embodiments, the AAV is a wild-type AAV or a modified AAV. In some embodiments, the AAV comprises a capsid protein having at least 95% identity to wild-type VP1, VP2, or VP3 capsid protein.
In another aspect, the disclosure provides a method of treating or inhibiting onset of a Parkinson's Disease (PD) in a subject suffering from or at risk of the PD, comprising administering a recombinant gene therapy vector comprising a polynucleotide encoding a wild-type a wild-type Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene, or a functional variant or fragment thereof, to the subject; wherein administration of the recombinant gene therapy vector treats or inhibits onset of the Parkinson's Disease in the subject.
In some embodiments, the PD is an early-onset PD, optionally an early-onset autosomal recessive PD. In some embodiments, the subject comprises a mutation in a PARK2 gene, PINK1 gene, LRRK2 gene, SCNA gene, c-Rel gene, ATG7 gene, VMAT2, or GBA gene. In some embodiments, the PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA protein comprises the amino acid sequence set forth in SEQ ID NOs: 1-9, respectively. In some embodiments, the gene is the PARK2 gene, and the wild-type PARK2 protein comprises the amino acid sequence set forth in any of SEQ ID NOs: 10-17. In some embodiments, the polynucleotide comprises a sequence having at least 70%, 75%, 80%, 85%, 95%, or 99% identity to a PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA polynucleotide sequence set forth in SEQ ID NOs: 18-26, respectively. In some embodiments, the gene is the PARK2 gene, and the polynucleotide comprises a sequence having at least 70%, 75%, 80%, 85%, 95%, or 99% identity to a PARK2 isoform polynucleotide sequence set forth in any of SEQ ID NOs: 27-34. In some embodiments, the polynucleotide is codon-optimized. In some embodiments, the polynucleotide comprises a sequence having at least 70%, 75%, 80%, 85%, 95%, or 99% identity to a sequence set forth in any of SEQ ID NOs: 35-38.
In some embodiments, the recombinant gene therapy vector is a recombinant adeno-associated virus (AAV). In some embodiments, the AAV has serotype AAV1, AAV2, AAV5, AAV8, AAV9, AAVrh10, or AAVrh74. In some embodiments, the recombinant gene therapy vector comprises a self-complementary AAV genome. In some embodiments, the recombinant gene therapy vector comprises a single-stranded AAV. In some embodiments, the AAV is a wild-type AAV or a modified AAV. In some embodiments, the AAV comprises a capsid protein having at least 95% identity to wild-type VP1, VP2, or VP3 capsid protein.
In some embodiments, the recombinant gene therapy vector comprises a polynucleotide comprising in the following 5′ to 3′ order, a eukaryotically active promoter sequence; and the sequence encoding the wild-type protein, or functional fragment or variant thereof; wherein the sequence encoding the wild-type protein, or functional fragment or variant thereof, is operably linked to the eukaryotically active promoter sequence.
In some embodiments, the recombinant gene therapy vector further comprises one or more of a neuron-specific promoter, optionally selected from the group consisting of hSYN1 (human synapsin), INA (alpha-internexin), NES (nestin), TH (tyrosine hydroxylase), FOXA2 (Forkhead box A2), CaMKII (calmodulin-dependent protein kinase II), and NSE (neuron-specific enolase) promoters; a ubiquitous promotor selected from the group consisting of CMV, CAG, UBC, PGK, EF1-alpha, GAPDH, SV40, HBV, human beta-actin, and chicken beta-actin promoters; an enhancer; an intron; a poly-A signal; a WPRE (Woodchuck hepatitis virus posttranscriptional regulatory element); and a HPRE (Hepatitis posttranscriptional regulatory element).
The recombinant gene therapy vector or gene editing system can be administered in various ways. In some embodiments, the administering step comprises systemic, parenteral, intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular administration. In some embodiments, the administering step comprises intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular injection. In some embodiments, the administering step comprises intrathecal injection with Threndelenburg tilting. In some embodiments, the administering step comprises direct injection into the pars compacta of the substantia nigra of the brain. In some embodiments, the administering step comprises introducing the recombinant gene therapy vector into the subject's brain or cerebrospinal fluid (CSF).
In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject. In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject's brain. In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject's CSF. In some embodiments, 1×107-1×109 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject.
The methods of the disclosure relate to both adult and juvenile forms of disease. In some embodiments, the subject is an adult. In some embodiments, the subject is a child.
The methods of the disclosure may have various effects on the subject. In some embodiments, the number of dopaminergic neurons in the subject after the administering step is greater than the number of dopaminergic neurons in the subject before the administering step. In some embodiments, the level of dopamine in the subject after the administering step is greater than the level of dopamine in the subject before the administering step. In some embodiments, the number of dopaminergic neurons in a subject treated by the method is increased compared to the number of dopaminergic neurons in a subject not so treated. In some embodiments, the level of dopamine of a subject treated by the method is increased compared to the level of dopamine in a subject not so treated. In some embodiments, the level of dopamine in the substantia nigra of a subject treated by method is increased compared to the level of dopamine in the substantia nigra of a subject not so treated. In some embodiments, the level of PRKN in the subject's CSF after the administering step is greater than the level of PRKN in the subject's CSF before the administering step. In some embodiments, the Unified Parkinson's Disease Rating Scale (UPDRS) score of the subject before the administering step is improved compared to the UPDRS score of the subject before the administering step. In some embodiments, the level of PRKN in the CSF of a subject treated by the method is increased compared to the level of PRKN in the CSF of a subject not so treated. In some embodiments, the level of PRKN in the subject's substantia nigra after the administering step is greater than the level of PRKN in the subject's substantia nigra before the administering step. In some embodiments, the UPDRS score of a subject treated by the method is improved compared to the UPDRS score of a subject not so treated. In some embodiments, the subject's neurons express a reduced amount of alpha-synuclein and/or comprises a reduced amount of Lewy bodies following contact with the recombinant gene therapy vector.
In another aspect, the disclosure provides a method of inhibiting degeneration or death of a dopaminergic neuron having a mutated Parkin (PRKN) gene, comprising contacting the neuron with a gene editing system comprising: Cas protein or a polynucleotide encoding a Cas protein; a guide-RNA (gRNA); and a repair template comprising a functional Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene, or a functional variant or fragment thereof; wherein the gene editing system is capable of repairing an endogenous gene in the neuron or inserting a functional gene into the genome of the neuron.
In some embodiments, at least one component of the gene editing system is delivered by recombinant AAV. In some embodiments, the gene editing system is delivered by recombinant AAV.
In another aspect, the disclosure provides a gene editing system for a cell comprising: Cas protein or a polynucleotide encoding a Cas protein; a guide-RNA (gRNA); and a repair template comprising a functional Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene, or a functional variant or fragment thereof; wherein the gene editing system is capable of repairing an endogenous gene in the cell or inserting a functional gene into the genome of the cell.
In some embodiments, at least one component of the gene editing system is delivered by recombinant AAV. In some embodiments, the gene editing system is delivered by recombinant AAV. In some embodiments, the cell is an ex vivo neuron. In some embodiments, the cell is a cell of a subject.
In another aspect, the disclosure provides recombinant gene therapy vector, comprising a transgene polynucleotide encoding E3 ubiquitin protein ligase (PARK2) gene, wherein the transgene polynucleotide is operably linked to a eukaryotically active promoter sequence.
In some embodiments, the transgene polynucleotide shares at least 95% identity to one of SEQ ID NOs: 35-38.
In some embodiments, the promoter sequence is selected from Table 5.
In some embodiments, the vector further comprises a CMV enhancer.
In some embodiments, the vector further comprises a 5′ untranslated region (UTR) selected from Table 6.
In some embodiments, the vector further comprises a 3′ untranslated region selected from Table 7.
In some embodiments, the vector further comprises a polyadenylation sequence (polyA) selected from Table 8.
In some embodiments, the polynucleotide is codon-optimized.
In some embodiments, the expression cassette shares at least 95% sequence identity to any one of SEQ ID NOs: 39-58.
In some embodiments, the vector is an adeno-associated virus (AAV) vector.
In some embodiments, the vector comprises two AAV inverted terminal repeats (ITRs) flanking the expression cassette.
In some embodiments, the AAV has serotype AAV1, AAV2, AAV5, AAV8, AAV9, AAVrh10, or AAVrh74.
In some embodiments, the recombinant gene therapy vector comprises a self-complementary AAV.
In some embodiments, the recombinant gene therapy vector comprises a single-stranded AAV.
In some embodiments, the AAV is a wild-type AAV or a modified AAV.
In some embodiments, the AAV comprises a capsid protein having at least 95% identity to wild-type VP1, VP2, or VP3 capsid protein.
In another aspect, the disclosure provides host cell comprising any of the foregoing recombinant gene therapy vectors.
In another aspect, the disclosure provides method of inhibiting degeneration or death of a dopaminergic neuron comprising a mutation in a gene associated with a Parkinson's Disease (PD), wherein the mutated gene is a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, comprising contacting the neuron with the recombinant gene therapy vector of the disclosure, wherein following contact with the recombinant gene therapy vector, the neuron expresses the wild-type protein.
In some embodiments, the neuron expresses a reduced amount of alpha-synuclein and/or comprises a reduced amount of Lewy bodies following contact with the recombinant gene therapy vector.
In some embodiments, the neuron expresses a reduced amount of monoamine oxidases following contact with the recombinant gene therapy vector.
In some embodiments, the neuron produces and/or releases an increased amount of dopamine following contact with the recombinant gene therapy vector.
In some embodiments, the neuron undergoes increased mitophagy following contact with the recombinant gene therapy vector.
In some embodiments, the neuron expresses a lower amount of monoamine oxidases as compared to an amount of monoamine oxidases expressed in a neuron not contacted with said recombinant gene therapy vector, optionally wherein said lower amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, or at least 80% lower than the amount expressed in the neuron not contacted with said recombinant gene therapy vector.
In some embodiments, the neuron produces and/or releases an increased amount of dopamine as compared to an amount of dopamine produced and/or released by a neuron not contacted with said recombinant gene therapy vector, optionally wherein said increase amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least two-fold, at least three-fold, at least four-fold, at least five-fold, or at least 10-fold greater than the amount produced and/or released by the neuron not contacted with said recombinant gene therapy vector.
In some embodiments, the neuron undergoes an increased amount of autophagy as compared to an amount of autophagy undergone by a neuron not contacted with said recombinant gene therapy vector, optionally wherein the increased amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least two-fold, at least three-fold, at least four-fold, at least five-fold, or at least 10-fold greater than the amount undergone by the neuron not contacted with said recombinant gene therapy vector.
In some embodiments, the neuron is a primary tyrosine hydroxylase positive neuron.
In some embodiments, the neuron was produced from an induced pluripotent stem cell prepared from cells obtained from a subject diagnosed with Parkinson's disease.
In another aspect, the disclosure provides, a method of treating or inhibiting onset of a Parkinson's Disease (PD) in a subject suffering from or at risk of the PD, comprising administering a gene therapy vector of the disclosure, wherein administration of the recombinant gene therapy vector treats or inhibits onset of the Parkinson's Disease in the subject.
In some embodiments, the PD is an early-onset PD, optionally an early-onset autosomal recessive PD.
In some embodiments, the subject comprises a mutation in a PARK2 gene.
In some embodiments, the PARK2 comprises the amino acid sequence set forth in SEQ ID NO: 1.
In some embodiments, administering step comprises systemic, parenteral, intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular administration.
In some embodiments, the administering step comprises intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular injection.
In some embodiments, the administering step comprises intrathecal injection with Threndelenburg tilting.
In some embodiments, the administering step comprises direct injection into the pars compacta of the substantia nigra of the brain.
In some embodiments, the administering step comprises introducing the recombinant gene therapy vector into the subject's brain or cerebrospinal fluid (CSF).
In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject.
In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject's brain.
In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject's CSF.
In some embodiments, 1×107-1×109 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject.
In some embodiments, 1×107-1×1011 total vector genomes are administered to the subject, e.g., via direct injection into the putamen or substantia nigra.
In some embodiments, the subject is an adult.
In some embodiments, the subject is a child.
In some embodiments, the number of dopaminergic neurons in the subject after the administering step is greater than the number of dopaminergic neurons in the subject before the administering step.
In some embodiments, the level of dopamine in the subject after the administering step is greater than the level of dopamine in the subject before the administering step.
In some embodiments, the number of dopaminergic neurons in a subject treated by the method is increased compared to the number of dopaminergic neurons in a subject not so treated.
In some embodiments, the level of dopamine of a subject treated by the method is increased compared to the level of dopamine in a subject not so treated.
In some embodiments, the level of dopamine in the substantia nigra of a subject treated by method is increased compared to the level of dopamine in the substantia nigra of a subject not so treated.
In some embodiments, the level of PRKN in the subject's CSF after the administering step is greater than the level of PRKN in the subject's CSF before the administering step.
In some embodiments, the Unified Parkinson's Disease Rating Scale (UPDRS) score of the subject before the administering step is improved compared to the UPDRS score of the subject before the administering step.
In some embodiments, the level of PRKN in the CSF of a subject treated by the method is increased compared to the level of PRKN in the CSF of a subject not so treated.
In some embodiments, the UPDRS score of a subject treated by the method is improved compared to the UPDRS score of a subject not so treated.
In some embodiments, the subject's neurons express a reduced amount of alpha-synuclein and/or comprises a reduced amount of Lewy bodies following contact with the recombinant gene therapy vector.
Other features and advantages of the invention will be apparent from and encompassed by the following detailed description and claims.
The patent or application file contains at least one drawing executed in color. Copies of this patent or patent application publication with color drawing(s) will be provided by the Office upon request and payment of the necessary fee.
The present disclosure provides, in part, compositions and methods for treating, preventing, inhibiting, or delaying central nervous system degeneration, e.g., in the treatment of a Parkison's Disease. In particular, the inventors disclose various embodiments of a recombinant gene therapy vector comprising a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, a Synaptic vesicular amine transporter (VMAT2) gene, or a glucocerebrosidase (GBA) gene, or functional fragment or variant thereof. As used herein, the term “gene” or “transgene” are used interchangeably and refer to a polynucleotide sequence encoding a polypeptide or protein, such as any of the proteins disclosed in Table 1.
The disclosure further includes various embodiments of a gene editing system comprising a Cas protein, guide RNA, a repair template comprising a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, a Synaptic vesicular amine transporter (VMAT2) gene, or a glucocerebrosidase (GBA) gene, or functional fragment or variant thereof.
The disclosure further includes methods of inhibiting degeneration or death of a dopaminergic neuron having a mutated PARK2 gene, and methods of treating or inhibiting onset or progression of Parkinson's Disease in a subject suffering from or at risk of Parkinson's disease. In particular embodiments, the Parkinson's disease is an early-onset or juvenile Parksinson's Disease. In certain embodiments, it is associated with or caused by an autosomal recessive mutation, e.g., in a subject's PARK2, PINK1, DJ-1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA gene. In some embodiments, a viral vector, e.g., an adeno-associated virus (AAV), is used to deliver a recombinant gene therapy construct to the body or more particularly the brain of a subject. Also provided are recombinant gene therapy vectors or gene editing systems for PARK2, PINK1, DJ-1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA. Table 1 provides protein sequences. Those genes are expressed as various isoforms. For example, and without limiting the disclosure to PARK2, the isoforms of PARK2 are provided in Table 2. Table 3 provides polynucleotide sequences. Table 4 provides polynucleotide sequences for the isoforms of PARK2. The disclosure provides compositions and methods comprising or encoding any of the isoforms as proteins or polynucleotides, including codon-optimized polynucleotides and spliced or un-spliced variants.
musculus OX = 10090 GN = Atg7 PE = 1
sapiens OX = 9606 GN = SLC18A2 PE = 1
sapiens OX = 9606 GN = PRKN
sapiens OX = 9606 GN = PRKN
sapiens OX = 9606 GN = PRKN
sapiens OX = 9606 GN = PRKN
sapiens OX = 9606 GN = PRKN
sapiens OX = 9606 GN = PRKN
sapiens OX = 9606 GN = PRKN
In particular embodiments, the compositions and methods disclosed herein contemplate the use of functional variants and functional fragments of any of these protein or polynucleotide sequences. Functional fragments and variants retain the biological properties or activities of the corresponding wild-type protein, although the properties or activities may in certain instances be reduced, e.g., to about 50%, about 60%, about 70%, or about 80% as compared to the wild-type protein, or increased, e.g., 1.1-fold, 1.2-fold, 1.3-fold, 1.4-fold, 1.5-fold, 2-fold, 3-fold, 4-fold, or 5-fold as compared to the wild-type protein. In certain embodiments, a functional fragment or variant of a protein has at least 70%, at least 80%, at least 90%, at least 95%, at least 98%, or at least 99% sequence identity to the corresponding wild-type protein. In certain embodiments, a functional fragment of a protein comprises at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, at least 98%, or at least 99% of the corresponding wild-type protein.
In another aspect, the disclosure provides recombinant gene therapy vector, comprising a transgene polynucleotide encoding E3 ubiquitin protein ligase (PARK2), wherein the transgene polynucleotide is operably linked to a eukaryotically active promoter sequence. In some embodiments, the transgene polynucleotide shares at least 95% identity to one of SEQ ID NOs: 35-38.
In some embodiments, the disclosure provides a codon-optimized polynucleotide encoding PARK2. In some cases, the entire transgene sequence is codon optimized for expression in a mammalian cell. Codon optimization refers to the discovery that the frequency of occurrence of synonymous codons (i.e., codons that code for the same amino acid) in coding DNA is biased in different species. Such codon degeneracy allows an identical polypeptide to be encoded by a variety of nucleotide sequences. A variety of codon optimization methods is known in the art, and include, e.g., methods disclosed in at least U.S. Pat. Nos. 5,786,464 and 6,114,148.
In some embodiments, the codon-optimized polynucleotide encoding PARK2 comprises fewer CpG islands than the native human polynucleotide sequence encoding human PARK2. For example, in some embodiments, the native human sequence comprises 95 CpG islands, whereas the codon-optimized polynucleotides comprise less than 95, less than 90, less than 85, less than 80, less than 75, less than 70, less than 65, less than 60, less than 55, less than 50, less than 45, less than 40, less than 35, less than 30, less than 25, less than 20, less than 15, less than 10, less than 5, or no CpG islands. In some embodiments, the codon-optimized polynucleotide sequence comprises 2-20, 5-20, about 5, or about 10 CpG islands. In some embodiments, the codon-optimized polynucleotide sequence comprises one or more CpG island. In some embodiments, the expression cassette shares at least 80%, at least 85%, at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99%, or 100% sequence identity to any one of SEQ ID NOs: 39-58. In some embodiments, the expression cassette comprises, consists essentially of, or consists of a sequence having at least 80%, at least 85%, at least 90%, at least 91%, at least 92%, at least 93%, at least 94%, at least 95%, at least 96%, at least 97%, at least 98%, at least 99%, or 100% sequence identity to any one of SEQ ID NOs: 39-58.
In some embodiments, the vector is an adeno-associated virus (AAV) vector. In some embodiments, the vector comprises two AAV inverted terminal repeats (ITRs) flanking the expression cassette. In some embodiments, the AAV has serotype AAV1, AAV2, AAV5, AAV8, AAV9, AAVrh10, or AAVrh74. In some embodiments, the recombinant gene therapy vector comprises a self-complementary AAV. In some embodiments, the recombinant gene therapy vector comprises a single-stranded AAV. In some embodiments, the AAV is a wild-type AAV or a modified AAV. In some embodiments, the AAV comprises a capsid protein having at least 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity to wild-type VP1, VP2, or VP3 capsid protein.
In another aspect, the disclosure provides host cell comprising any of the foregoing recombinant gene therapy vectors. Exemplary host cells include HEK293, 293T, HeLa, Vero, and Sf9 cells.
In another aspect, the disclosure provides a method of inhibiting, reducing, or delaying degeneration or death of a dopaminergic neuron comprising a mutation in a gene associated with a Parkinson's Disease (PD), wherein the mutated gene is a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, comprising contacting the neuron with the recombinant gene therapy vector of the disclosure, wherein following contact with the recombinant gene therapy vector, the neuron expresses the wild-type protein. The method may be practiced in vitro, or in vivo, e.g., in a subject in need thereof.
In some embodiments, the neuron expresses a reduced amount of alpha-synuclein and/or comprises a reduced amount of Lewy bodies following contact with the recombinant gene therapy vector. In some embodiments, alpha-synuclein and/or comprises a reduced amount of Lewy bodies are reduced by at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40% or more.
In some embodiments, the neuron expresses a reduced amount of monoamine oxidases following contact with the recombinant gene therapy vector. In some embodiments, the amount of monoamine oxidases is reduced by at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40% or more.
In some embodiments, the neuron produces and/or releases an increased amount of dopamine following contact with the recombinant gene therapy vector. In some embodiments, the amount of dopamine produced and/or released is increased at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40% or more.
In some embodiments, the neuron undergoes increased mitophagy following contact with the recombinant gene therapy vector. In some embodiments, mitophagy is increased at least 5%, at least 10%, at least 15%, at least 20%, at least 25%, at least 30%, at least 35%, at least 40% or more.
In some embodiments, the neuron expresses a lower amount of monoamine oxidases as compared to an amount of monoamine oxidases expressed in a neuron not contacted with said recombinant gene therapy vector, optionally wherein said lower amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, or at least 80% lower than the amount expressed in the neuron not contacted with said recombinant gene therapy vector.
In some embodiments, the neuron produces and/or releases an increased amount of dopamine as compared to an amount of dopamine produced and/or released by a neuron not contacted with said recombinant gene therapy vector, optionally wherein said increase amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least two-fold, at least three-fold, at least four-fold, at least five-fold, or at least 10-fold greater than the amount produced and/or released by the neuron not contacted with said recombinant gene therapy vector.
In some embodiments, the neuron undergoes an increased amount of autophagy as compared to an amount of autophagy undergone by a neuron not contacted with said recombinant gene therapy vector, optionally wherein the increased amount is at least 5%, at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least two-fold, at least three-fold, at least four-fold, at least five-fold, or at least 10-fold greater than the amount undergone by the neuron not contacted with said recombinant gene therapy vector.
In some embodiments, the neuron is a primary tyrosine hydroxylase positive neuron. In some embodiments, the neuron was produced from an induced pluripotent stem cell prepared from cells obtained from a subject diagnosed with Parkinson's disease.
In another aspect, the disclosure provides a method of treating or inhibiting or delaying onset or progression of a Parkinson's Disease (PD) in a subject suffering from or at risk of the PD, comprising administering a gene therapy vector of the disclosure to the subject, wherein administration of the recombinant gene therapy vector treats or inhibits or delays onset or progression of the Parkinson's Disease in the subject.
In some embodiments, the PD is an early-onset PD. In some embodiments, the PD is an early-onset autosomal recessive PD. In some embodiments, the subject comprises a mutation in a PARK2 gene.
In some embodiments, the gene therapy vector comprises an expression cassette comprising a transgene that encodes for PARK2 or a functional fragment or variant thereof. In some embodiments, the PARK2 comprises the amino acid sequence set forth in SEQ ID NO: 1 or an amino acid sequence at least about 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, 100% identical thereto. In some embodiments, the transgene polynucleotide shares at least 95% identity to one of SEQ ID NOs: 35-38.
In some embodiments, administering step comprises systemic, parenteral, intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular administration.
In some embodiments, the administering step comprises intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular injection.
In some embodiments, the administering step comprises intrathecal injection with Threndelenburg tilting.
In some embodiments, the administering step comprises direct injection into the pars compacta of the substantia nigra of the brain.
In some embodiments, the administering step comprises introducing the recombinant gene therapy vector into the subject's brain or cerebrospinal fluid (CSF).
In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject.
In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject's brain.
In some embodiments, 1×109-1×1014 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject's CSF.
In some embodiments, 1×107-1×109 vector genomes per kilogram body mass of the subject (vg/kg) of the gene therapy vector are administered to the subject.
In some embodiments, the subject is an adult or a child.
In some embodiments, the number of dopaminergic neurons in the subject after the administering step is greater than the number of dopaminergic neurons in the subject before the administering step.
In some embodiments, the level of dopamine in the subject after the administering step is greater than the level of dopamine in the subject before the administering step.
In some embodiments, the number of dopaminergic neurons in a subject treated by the method is increased compared to the number of dopaminergic neurons in a subject not so treated.
In some embodiments, the level of dopamine of a subject treated by the method is increased compared to the level of dopamine in a subject not so treated.
In some embodiments, the level of dopamine in the substantia nigra of a subject treated by method is increased compared to the level of dopamine in the substantia nigra of a subject not so treated.
In some embodiments, the level of PRKN in the subject's CSF after the administering step is greater than the level of PRKN in the subject's CSF before the administering step.
In some embodiments, the Unified Parkinson's Disease Rating Scale (UPDRS) score of the subject before the administering step is improved compared to the UPDRS score of the subject before the administering step.
In some embodiments, the level of PRKN in the CSF of a subject treated by the method is increased compared to the level of PRKN in the CSF of a subject not so treated.
In some embodiments, the UPDRS score of a subject treated by the method is improved compared to the UPDRS score of a subject not so treated.
In some embodiments, the subject's neurons express a reduced amount of alpha-synuclein and/or comprises a reduced amount of Lewy bodies following contact with the recombinant gene therapy vector.
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 this invention pertains. Although methods and materials similar or equivalent to those described herein can be used in the practice of the present invention, suitable methods and materials are described below. All publications, patent applications, patents, and other references mentioned herein are expressly incorporated by reference in their entirety. In cases of conflict, the present specification, including definitions, will control. In addition, the materials, methods, and examples described herein are illustrative only and are not intended to be limiting.
All publications and patents mentioned herein are hereby incorporated by reference in their entirety as if each individual publication or patent was specifically and individually indicated to be incorporated by reference. In case of conflict, the present application, including any definitions herein, will control. However, mention of any reference, article, publication, patent, patent publication, and patent application cited herein is not, and should not be taken as an acknowledgment, or any form of suggestion, that they constitute valid prior art or form part of the common general knowledge in any country in the world.
In the present description, any concentration range, percentage range, ratio range, or integer range is to be understood to include the value of any integer within the recited range and, when appropriate, fractions thereof (such as one tenth and one hundredth of an integer), unless otherwise indicated. The term “about”, when immediately preceding a number or numeral, means that the number or numeral ranges plus or minus 10%. It should be understood that the terms “a” and “an” as used herein refer to “one or more” of the enumerated components unless otherwise indicated. The use of the alternative (e.g., “or”) should be understood to mean either one, both, or any combination thereof of the alternatives. The term “and/or” should be understood to mean either one, or both of the alternatives. As used herein, the terms “include” and “comprise” are used synonymously.
The abbreviations PRKN and PARK2 are used interchangeably herein.
The section headings used herein are for organizational purposes only and are not to be construed as limiting the subject matter described.
Adeno-Associated Virus (AAV)
As used herein, the term “AAV” is a standard abbreviation for adeno-associated virus or a recombinant vector thereof. Adeno-associated virus is a single-stranded DNA parvovirus that grows only in cells in which certain functions are provided by a co-infecting helper virus. General information and reviews of AAV can be found in, for example, Carter, 1989, Handbook of Parvoviruses, Vol. 1, pp. 169-228, and Berns, 1990, Virology, pp. 1743-1764, Raven Press, (New York). It is fully expected that the same principles described in these reviews will be applicable to additional AAV serotypes characterized after the publication dates of the reviews because it is well known that the various serotypes are quite closely related, both structurally and functionally, even at the genetic level. (See, for example, Blacklowe, 1988, pp. 165-174 of Parvoviruses and Human Disease, J. R. Pattison, ed.; and Rose, Comprehensive Virology 3: 1-61 (1974)). For example, all AAV serotypes apparently exhibit very similar replication properties mediated by homologous rep genes; and all bear three related capsid proteins such as those expressed in AAV2. The degree of relatedness is further suggested by heteroduplex analysis which reveals extensive cross-hybridization between serotypes along the length of the genome; and the presence of analogous self-annealing segments at the termini that correspond to “inverted terminal repeat sequences” (ITRs). The similar infectivity patterns also suggest that the replication functions in each serotype are under similar regulatory control.
As used herein, an “AAV vector” or “rAAV vector” refers to a recombinant vector comprising one or more polynucleotides of interest (or transgenes) that are flanked by AAV terminal repeat sequences (ITRs). Such AAV vectors can be replicated and packaged into infectious viral particles when present in a host cell that has been transfected with a plasmid encoding and expressing rep and cap gene products. Alternatively, AAV vectors can be packaged into infectious particles using a host cell that has been stably engineered to express rep and cap genes.
As used herein, an “AAV virion” or “AAV viral particle” or “AAV vector particle” refers to a viral particle composed of at least one AAV capsid protein and an encapsidated polynucleotide AAV vector. As used herein, if the particle comprises a heterologous polynucleotide (i.e. a polynucleotide other than a wild-type AAV genome such as a transgene to be delivered to a mammalian cell), it is typically referred to as an “AAV vector particle” or simply an “AAV vector.” Thus, production of AAV vector particle necessarily includes production of AAV vector, as such a vector is contained within an AAV vector particle.
Adeno-associated virus (AAV) is a replication-deficient parvovirus, the single-stranded DNA genome of which is about 4.7 kb in length including two 145-nucleotide inverted terminal repeat (ITRs). There are multiple known variants of AAV, also sometimes called serotypes when classified by antigenic epitopes. The nucleotide sequences of the genomes of the AAV serotypes are known. For example, the complete genome of AAV-1 is provided in GenBank Accession No. NC_002077; the complete genome of AAV-2 is provided in GenBank Accession No. NC_001401 and Srivastava et al., J. Virol., 45: 555-564 {1983); the complete genome of AAV-3 is provided in GenBank Accession No. NC_1829; the complete genome of AAV-4 is provided in GenBank Accession No. NC_001829; the AAV-5 genome is provided in GenBank Accession No. AF085716; the complete genome of AAV-6 is provided in GenBank Accession No. NC_00 1862; at least portions of AAV-7 and AAV-8 genomes are provided in GenBank Accession Nos. AX753246 and AX753249, respectively; the AAV-9 genome is provided in Gao et al., J. Virol., 78: 6381-6388 (2004); the AAV-10 genome is provided in Mol. Ther., 13(1): 67-76 (2006); and the AAV-11 genome is provided in Virology, 330(2): 375-383 (2004). The sequence of the AAVrh.74 genome is provided in U.S. Pat. No. 9,434,928, incorporated herein by reference. Cis-acting sequences directing viral DNA replication (rep), encapsidation/packaging and host cell chromosome integration are contained within the AAV ITRs. Three AAV promoters (named p5, p19, and p40 for their relative map locations) drive the expression of the two AAV internal open reading frames encoding rep and cap genes. The two rep promoters (p5 and p19), coupled with the differential splicing of the single AAV intron (at nucleotides 2107 and 2227), result in the production of four rep proteins (rep78, rep68, rep52, and rep40) from the rep gene. Rep proteins possess multiple enzymatic properties that are ultimately responsible for replicating the viral genome. The cap gene is expressed from the p40 promoter and it encodes the three capsid proteins VP1, VP2, and VP3. Alternative splicing and non-consensus translational start sites are responsible for the production of the three related capsid proteins. A single consensus polyadenylation site is located at map position 95 of the AAV genome. The life cycle and genetics of AAV are reviewed in Muzyczka, Current Topics in Microbiology and Immunology, 158: 97-129 (1992).
AAV possesses unique features that make it attractive as a vector for delivering foreign DNA to cells, for example, in gene therapy. AAV infection of cells in culture is noncytopathic, and natural infection of humans and other animals is silent and asymptomatic. Moreover, AAV infects many mammalian cells allowing the possibility of targeting many different tissues in vivo. Moreover, AAV transduces slowly dividing and non-dividing cells, and can persist essentially for the lifetime of those cells as a transcriptionally active nuclear episome (extrachromosomal element). The AAV proviral genome is inserted as cloned DNA in plasmids, which makes construction of recombinant genomes feasible. Furthermore, because the signals directing AAV replication and genome encapsidation are contained within the ITRs of the AAV genome, some or all of the internal approximately 4.3 kb of the genome (encoding replication and structural capsid proteins, rep-cap) may be replaced with foreign DNA. To generate AAV vectors, the rep and cap proteins may be provided in trans. Another significant feature of AAV is that it is an extremely stable and hearty virus. It easily withstands the conditions used to inactivate adenovirus (56° to 65° C. for several hours), making cold preservation of AAV less critical. AAV may even be lyophilized. Finally, AAV-infected cells are not resistant to superinfection.
AAV DNA in the rAAV genomes may be from any AAV variant or serotype for which a recombinant virus can be derived including, but not limited to, AAV variants or serotypes AAV-1, AAV-2, AAV-3, AAV-4, AAV-5, AAV-6, AAV-7, AAV-8, AAV-9, AAV-10, AAV-11, AAV-12, AAV-13 and AAVrh10. Production of pseudotyped rAAV is disclosed in, for example, WO 01/83692. Other types of rAAV variants, for example rAAV with capsid mutations, are also contemplated. See, for example, Marsic et al., Molecular Therapy, 22(11): 1900-1909 (2014). The nucleotide sequences of the genomes of various AAV serotypes are known in the art. To promote eye-specific expression, AAV6, AAV8 or AAV9 may be used.
In some cases, the rAAV comprises a self-complementary genome. As defined herein, an rAAV comprising a “self-complementary” or “double stranded” genome refers to an rAAV which has been engineered such that the coding region of the rAAV is configured to form an intra-molecular double-stranded DNA template, as described in McCarty et al. Self-complementary recombinant adeno-associated virus (scAAV) vectors promote efficient transduction independently of DNA synthesis. Gene Therapy. 8 (16): 1248-54 (2001). The present disclosure contemplates the use, in some cases, of an rAAV comprising a self-complementary genome because upon infection (such transduction), rather than waiting for cell mediated synthesis of the second strand of the rAAV genome, the two complementary halves of scAAV will associate to form one double stranded DNA (dsDNA) unit that is ready for immediate replication and transcription. It will be understood that instead of the full coding capacity found in rAAV (4.7-6 kb), rAAV comprising a self-complementary genome can only hold about half of that amount (≈2.4 kb).
In other cases, the rAAV vector comprises a single stranded genome. As defined herein, a “single standard” genome refers to a genome that is not self-complementary. In most cases, non-recombinant AAVs are have singled stranded DNA genomes. There have been some indications that rAAVs should be scAAVs to achieve efficient transduction of cells, such as ocular cells. The present disclosure contemplates, however, rAAV vectors that maybe have singled stranded genomes, rather than self-complementary genomes, with the understanding that other genetic modifications of the rAAV vector may be beneficial to obtain optimal gene transcription in target cells. In some cases, the present disclosure relates to single-stranded rAAV vectors capable of achieving efficient gene transfer to anterior segment in the mouse eye. See Wang et al. Single stranded adeno-associated virus achieves efficient gene transfer to anterior segment in the mouse eye. PLoS ONE 12(8): e0182473 (2017).
In some cases, the rAAV vector is of the serotype AAV1, AAV2, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAV11, AAV12, AAV13, or AAVrh10. Production of pseudotyped rAAV is disclosed in, for example, WO 01/83692. Other types of rAAV variants, for example rAAV with capsid mutations, are also contemplated. See, for example, Marsic et al., Molecular Therapy, 22(11): 1900-1909 (2014). In some cases, the rAAV vector is of the serotype AAV9. In some embodiments, said rAAV vector is of serotype AAV9 and comprises a single stranded genome. In some embodiments, said rAAV vector is of serotype AAV9 and comprises a self-complementary genome. In some embodiments, a rAAV vector comprises the inverted terminal repeat (ITR) sequences of AAV2. In some embodiments, the rAAV vector comprises an AAV2 genome, such that the rAAV vector is an AAV-2/9 vector, an AAV-2/6 vector, or an AAV-2/8 vector.
Full-length sequences and sequences for capsid genes for most known AAVs are provided in U.S. Pat. No. 8,524,446, which is incorporated herein in its entirety.
AAV vectors may comprise wild-type AAV sequence or they may comprise one or more modifications to a wild-type AAV sequence. In certain embodiments, an AAV vector comprises one or more amino acid modifications, e.g., substitutions, deletions, or insertions, within a capsid protein, e.g., VP1, VP2 and/or VP3. In particular embodiments, the modification provides for reduced immunogenicity when the AAV vector is provided to a subject.
Promoters
In some embodiments, the polynucleotide sequence encoding wild-type PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA protein, or functional variant or fragment thereof is operably linked to a CMV promoter. The present disclosure further contemplates the use of other promoter sequences. Promoters useful in embodiments of the present disclosure include, without limitation, a cytomegalovirus (CMV) promoterphosphoglycerate kinase (PGK) promoter, or a promoter sequence comprised of the CMV enhancer and portions of the chicken beta-actin promoter and the rabbit beta-globin gene (CAG). In some cases, the promoter may be a synthetic promoter. Exemplary synthetic promoters are provided by Schlabach et al. Synthetic design of strong promoters. Proc Natl Acad Sci USA. 2010 Feb. 9; 107(6): 2538-2543.
In some cases, a polynucleotide sequence encoding a therapeutic protein or a wild-type PARK2, PINK1, LRRK2, SCNA, c-Rel, ATG7, VMAT2, or GBA protein, or functional variant or fragment thereof, is operatively linked to an inducible promoter. A polynucleotide sequence operatively linked to an inducible promoter may be configured to cause the polynucleotide sequence to be transcriptionally expressed or not transcriptionally expressed in response to addition or accumulation of an agent or in response to removal, degradation, or dilution of an agent. The agent may be a drug. The agent may be tetracycline or one of its derivatives, including, without limitation, doxycycline. In some cases, the inducible promoter is a tet-on promoter, a tet-off promoter, a chemically-regulated promoter, a physically-regulated promoter (i.e. a promoter that responds to presence or absence of light or to low or high temperature). This list of inducible promoters is non-limiting.
As used herein, “eukaryotically active promoter” or “promoter” are used interchangeably and refer to promoter capable of promoting initiation of RNA transcription from a polynucleotide in a eukaryotic cell. In some cases, the promoter is a tissue-specific promoter, such as a promoter capable of driving expression in a neuron to a greater extent than in a non-neuronal cell. In some embodiments, tissue-specific promoter is a selected from a list of neuron-specific promoters consisting of: hSYN1 (human synapsin), INA (alpha-internexin), NES (nestin), TH (tyrosine hydroxylase), FOXA2 (Forkhead box A2), CaMKII (calmodulin-dependent protein kinase II), and NSE (neuron-specific enolase). In some cases, the promoter is a ubiquitous promoter. A “ubiquitous promoter” refers to a promoter that is not tissue-specific under experimental or clinical conditions. In some cases, the ubiquitous promoter is selected from the group consisting of: CMV, CAG, UBC, PGK, EF1-alpha, GAPDH, SV40, HBV, chicken beta-actin, and human beta-actin.
In some embodiments, the promoter sequence is selected from Table 5, and sequences having at least 95%, at least 98%, or least 99% identity thereto.
Further illustrative examples of promoters are the SV40 late promoter from simian virus 40, the Baculovirus polyhedron enhancer/promoter element, Herpes Simplex Virus thymidine kinase (HSV tk), the immediate early promoter from cytomegalovirus (CMV) and various retroviral promoters including LTR elements. Inducible promoters include heavy metal ion inducible promoters (such as the mouse mammary tumor virus (mMTV) promoter or various growth hormone promoters), and the promoters from T7 phage which are active in the presence of T7 RNA polymerase. By way of illustration, examples of tissue-specific promoters include various surfactin promoters (for expression in the lung), myosin promoters (for expression in muscle), and albumin promoters (for expression in the liver). A large variety of other promoters are known and generally available in the art, and the sequences of many such promoters are available in sequence databases such as the GenBank database.
In some embodiments, the vector further comprises a CMV enhancer.
Other Regulatory Elements
In some cases, vectors of the present disclosure further comprise one or more regulatory elements selected from the group consisting of an enhancer, an intron, a poly-A signal, a 2A peptide encoding sequence, a WPRE (Woodchuck hepatitis virus posttranscriptional regulatory element), and a HPRE (Hepatitis B posttranscriptional regulatory element).
In certain embodiments, the vectors comprise one or more enhancers. In particular embodiments, the enhancer is a CMV enhancer sequence, a GAPDH enhancer sequence, a β-actin enhancer sequence, or an EF1-α enhancer sequence. Sequences of the foregoing are known in the art. For example, the sequence of the CMV immediate early (IE) enhancer is:
In certain embodiments, the vectors comprise one or more introns. In particular embodiments, the intron is a rabbit globin intron sequence, a chicken β-actin intron sequence, a synthetic intron sequence, or an EF1-α intron sequence.
In certain embodiments, the vectors comprise a polyA sequence. In particular embodiments, the polyA sequence is a rabbit globin polyA sequence, a human growth hormone polyA sequence, a bovine growth hormone polyA sequence, a PGK polyA sequence, an SV40 polyA sequence, or a TK polyA sequence. In some embodiments, the poly-A signal may be a bovine growth hormone polyadenylation signal (bGHpA).
In certain embodiments, the vectors comprise one or more transcript stabilizing element. In particular embodiments, the transcript stabilizing element is a WPRE sequence, a HPRE sequence, a scaffold-attachment region, a 3′ UTR, or a 5′ UTR. In particular embodiments, the vectors comprise both a 5′ UTR and a 3′ UTR.
In some embodiments, the vector comprises a 5′ untranslated region (UTR) selected from Table 6.
In some embodiments, the vector comprises a 3′ untranslated region selected from Table 7.
In some embodiments, the vector comprises a polyadenylation sequence (polyA) selected from Table 8.
Illustrative expression cassettes are depicted in
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, HuBA promoter, the transgene, WPRE(x), and pAGlobin-Oc. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CMV promoter, TPL-eMLP enhancer, the transgene, WPRE(r), and pAGlobin-Oc. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, Syn promoter, the transgene, WPRE(r), 3′UTR (globin), and pAGH-Bt. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CBA promoter, the transgene, and pAGH-Bt. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, EF1α promoter, the transgene, and pAGlobin-Oc. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, HuBA promoter, the transgene, R2V17, and pAGH-Bt. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, Syn promoter, the transgene, WPRE(x), 3′UTR (globin), and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CaMKIIa promoter, the transgene, WPRE(r), and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, a-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CMV promoter, TPL-eMLP enhancer, the transgene, WPRE(r), and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, HuBA promoter, the transgene, and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CMV promoter, TPL/eMLP enhancer, the transgene, R2V17, 3′UTR (globin), and pAGH-Bt. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, EF1α promoter, the transgene, WPRE(r), and pAGH-Bt. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, Syn promoter, the transgene, R2V17, and pAGlobin-Oc. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CaMKIIa promoter, the transgene, R2V17, and pAGlobin-Oc. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CBA promoter, the transgene, WPRE(x), 3′UTR (globin), and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CBA promoter, the transgene, 3′UTR (globin), and pAGlobin-Oc. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, a-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CaMKIIa promoter, the transgene, R2V17, and pAGH-Bt. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, a-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, EF1α promoter, the transgene, R2V17, 3′UTR (globin), and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CMV promoter, the transgene, R2V17, 3′UTR (globin), and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In an embodiment, the expression cassette comprises, in 5′ to 3′ order, CMV promoter, the transgene, and pAGH-Hs. In certain embodiments, the transgene encodes PARK2, PINK1 (PARK6), DJ-1 (PARK7), LRRK2, α-synuclein, and DJ-1. In particular embodiments, it encodes PARK2, and in certain embodiments, in comprises a sequence set forth in any of SEQ ID NOs: 27 or 35-38.
In embodiments of the foregoing, the order of the elements 5′ to the transgene are reversed so that the promoter precedes the enhancer elements or the enhancer element precedes the promoter element.
Therapeutic Compositions and Methods
As used herein, the term “patient in need” or “subject in need” refers to a patient or subject at risk of, or suffering from, a disease, disorder or condition that is amenable to treatment or amelioration with a recombinant gene therapy vector or gene editing system disclosed herein. A patient or subject in need may, for instance, be a patient or subject diagnosed with a disorder associated with central nervous system degradation. A subject may have a mutation or a malfunction in a PARK2, PARK6, PARK7, LRRK2, or α-synuclein, gene or protein. “Subject” and “patient” are used interchangeably herein. The subject treated by the methods described herein may be an adult or a child. Subjects may range in age. The subject may be a person identified as at risk for a Parkinson's Disease, e.g., an early-onset Parkinson's Disease.
Combination therapies are also contemplated by the invention. Combination as used herein includes simultaneous treatment or sequential treatment. Combinations of methods of the invention with standard medical treatments (e.g., corticosteroids or topical pressure reducing medications) are specifically contemplated, as are combinations with novel therapies. In some cases, a subject may be treated with a steroid to prevent or to reduce an immune response to administration of a rAAV described herein. In certain cases, a subject may receive topical pressure reducing medications before, during, or after administrating of a rAAV described herein.
A therapeutically effective amount of the rAAV vector is a dose of rAAV ranging from about 1e7 vg/kg to about 5e15 vg/kg, or about 1e7 vg/kg to about 1e14 vg/kg, or about 1e8 vg/kg to about 1e14 vg/kg, or about 1e9 vg/kg to about 1e13 vg/kg, or about 1e9 vg/kg to about 1e12 vg/kg, or about 1e7 vg/kg to about 5e7 vg/kg, or about 1e8 vg/kg to about 5e8 vg/kg, or about 1e9 vg/kg to about 5e9 vg/kg, or about 1e10 vg/kg to about 5e10 vg/kg, or about 1e11 vg/kg to about 5e11 vg/kg, or about 1e12 vg/kg to about 5e12 vg/kg, or about 1e13 vg/kg to about 5e13 vg/kg, or about 1e14 vg/kg to about 5e14 vg/kg, or about 1e15 vg/kg to about 5e15 vg/kg. The invention also comprises compositions comprising these ranges of rAAV vector.
For example, in particular embodiments, a therapeutically effective amount of rAAV vector is a dose of about 1e10 vg/kg, about 2e10 vg/kg, about 3e10 vg/kg, about 4e10 vg/kg, about 5e10 vg/kg, about 6e10 vg/kg, about 7e10 vg/kg, about 8e10 vg/kg, about 9e10 vg/kg, about 1e12 vg/kg, about 2e12 vg/kg, about 3e12 vg/kg, about 4e12 vg/kg and 5e12 vg/kg. The invention also comprises compositions comprising these doses of rAAV vector.
In some embodiments, for example where direct injection into substantia nigra is performed, a therapeutically effective amount of rAAV vector is a dose in the range of 1e7 vg to 1e11 vg, or about 1e7 vg, about 1e8 vg, about 1e9 vg, about 1e10 vg, or about 1e11 vg.
In some embodiments, for example where direct injection into intraputaminal is performed, a therapeutically effective amount of rAAV vector is a dose in the range of 1e7 vg to 1e11 vg, or about 1e7 vg, about 1e8 vg, about 1e9 vg, about 1e10 vg, or about 1e11 vg.
In some cases, the therapeutic composition comprises more than about 1e9, 1e10, or 1e11 genomes of the rAAV vector per volume of therapeutic composition injected. In some cases, the therapeutic composition comprises more than about 1e9, 1e10, or 1e11 genomes of the rAAV vector per volume of therapeutic composition injected. In some cases, the therapeutic composition comprises more than approximately 1e10, 1e11, 1e12, or 1e13 genomes of the rAAV vector per mL. In certain embodiments, the therapeutic composition comprises less than about 1e14, 1e13 or le1e12 genomes of the rAAV vector per mL.
Administration of Compositions
Administration of an effective dose of the compositions may be by routes standard in the art including, but not limited to, systemic, local, direct injection, parenteral, intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular administration. In some cases, administration comprises intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular injection. Administration may be performed by intrathecal injection with Threndelenberg tilting. Route(s) of administration and serotype(s) of AAV components of the rAAV (in particular, the AAV ITRs and capsid protein) of the invention may be chosen and/or matched by those skilled in the art taking into account the disorder being treated and the target cells/tissue(s) that are to express the repaired and/or exogenously provided gene.
In certain embodiment, the disclosure provides for local administration and systemic administration of an effective dose of rAAV and compositions of the invention. For example, systemic administration may be administration into the circulatory system so that the entire body is affected. Systemic administration includes enteral administration such as absorption through the gastrointestinal tract and parental administration through injection, infusion or implantation.
In particular, actual administration of rAAV of the present invention may be accomplished by using any physical method that will transport the rAAV recombinant vector into the target tissue of an animal. Administration according to the invention includes, but is not limited to, injection into the central nervous system (CNS) or cerebrospinal fluid (CSF) and/or directly into the brain.
Capsid proteins of a rAAV may be modified so that the rAAV is targeted to a particular target tissue of interest such as neurons or more particularly a dopaminergic neuron. See, for example, Albert et al. AAV Vector-Mediated Gene Delivery to Substantia Nigra Dopamine Neurons: Implications for Gene Therapy and Disease Models. Genes. 2017 Feb. 8; see also U.S. Pat. No. 6,180,613 and U.S. Patent Pub. No. US20120082650A1, the disclosures of both of which are incorporated by reference herein. In some embodiments, the rAAV is directly injected into the substantia nigra of the subject.
For purposes of administration, e.g., by injection, various solutions can be employed, such as sterile aqueous solutions. Such aqueous solutions can be buffered, if desired, and the liquid diluent first rendered isotonic with saline or glucose. Solutions of rAAV as a free acid (DNA contains acidic phosphate groups) or a pharmacologically acceptable salt can be prepared in water suitably mixed with a surfactant such as hydroxpropylcellulose. A dispersion of rAAV can also be prepared in glycerol, liquid polyethylene glycols and mixtures thereof and in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms. In this connection, the sterile aqueous media employed are all readily obtainable by standard techniques well-known to those skilled in the art.
The pharmaceutical forms suitable for injectable use include but are not limited to sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In all cases the form is sterile and must be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating actions of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, liquid polyethylene glycol and the like), suitable mixtures thereof, and vegetable oils. The proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of a dispersion and by the use of surfactants. The prevention of the action of microorganisms can be brought about by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal and the like. In many cases it will be preferable to include isotonic agents, for example, sugars or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by use of agents delaying absorption, for example, aluminum monostearate and gelatin.
Sterile injectable solutions may be prepared by incorporating rAAV in the required amount in the appropriate solvent with various other ingredients enumerated above, as required, followed by filter sterilization. Generally, dispersions are prepared by incorporating the sterilized active ingredient into a sterile vehicle which contains the basic dispersion medium and the required other ingredients from those enumerated above. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying and the freeze-drying technique that yield a powder of the active ingredient plus any additional desired ingredient from the previously sterile-filtered solution thereof.
Transduction with rAAV may also be carried out in vitro. In one embodiment, desired target cells are removed from the subject, transduced with rAAV and reintroduced into the subject.
Suitable methods for the transduction and reintroduction of transduced cells into a subject are known in the art. In one embodiment, cells can be transduced in vitro by combining rAAV with cells, e.g., in appropriate media, and screening for those cells harboring the DNA of interest using conventional techniques such as Southern blots and/or PCR, or by using selectable markers. Transduced cells can then be formulated into pharmaceutical compositions, and the composition introduced into the subject by various techniques, such as by systemic, local, direct injection, parenteral, intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular administration. In some cases, administration comprises intravenous, cerebral, cerebrospinal, intrathecal, intracisternal, intraputaminal, intrahippocampal, intra-striatal, or intra-cerebroventricular injection. Administration may be performed by intrathecal injection with Threndelenburg tilting.
Transduction of cells with rAAV of the invention results in sustained expression of a gene of interest, such as PARK2, PARK6, PARK7, LRRK2, or a-synuclein. The present invention thus provides methods of administering or delivering recombinant gene therapy vectors (e.g. rAAV vectors) which express a gene related to a CNS degeneration to a mammalian subject, preferably a human being. These methods include transducing tissues (including, but not limited to, the tissues of the brain) with one or more rAAV of the present invention. Transduction may be carried out with gene cassettes comprising tissue specific control elements. For example, one embodiment of the invention provides methods of transducing neuronal cells and brain tissues directed by neuron-specific control elements, including, but not limited to, those derived from neuron-enriched promoters, and other control elements.
Gene-Editing System
As used herein, a gene-editing system is a system comprising one or more proteins or polynucleotides capable of editing an endogenous target gene or locus in a sequence specific manner. In some embodiments, the gene-editing system is a protein-based gene regulating system comprising a protein comprising one or more zinc-finger binding domains and an enzymatic domain. In some embodiments, the protein-based gene regulating system comprises a protein comprising a Transcription activator-like effector nuclease (TALEN) domain and an enzymatic domain. Such embodiments are referred to herein as “TALENs”.
1. Zinc Finger-Based Systems
Zinc finger-based systems comprise a fusion protein comprising two protein domains: a zinc finger DNA binding domain and an enzymatic domain. A “zinc finger DNA binding domain”, “zinc finger protein”, or “ZFP” is a protein, or a domain within a larger protein, that binds DNA in a sequence-specific manner through one or more zinc fingers, which are regions of amino acid sequence within the binding domain whose structure is stabilized through coordination of a zinc ion. The zinc finger domain, by binding to a target DNA sequence, directs the activity of the enzymatic domain to the vicinity of the sequence and, hence, induces modification of the endogenous target gene in the vicinity of the target sequence. A zinc finger domain can be engineered to bind to virtually any desired sequence. Accordingly, after identifying a target genetic locus containing a target DNA sequence at which cleavage or recombination is desired (e.g., a target locus in a target gene referenced in Table 1), one or more zinc finger binding domains can be engineered to bind to one or more target DNA sequences in the target genetic locus. Expression of a fusion protein comprising a zinc finger binding domain and an enzymatic domain in a cell, effects modification in the target genetic locus.
In some embodiments, a zinc finger binding domain comprises one or more zinc fingers. Miller et al. (1985) EMBO J. 4:16010-1714; Rhodes (1993) Scientific American February:56-65; U.S. Pat. No. 6,453,242. Typically, a single zinc finger domain is about 30 amino acids in length. An individual zinc finger binds to a three-nucleotide (i.e., triplet) sequence (or a four-nucleotide sequence which can overlap, by one nucleotide, with the four-nucleotide binding site of an adjacent zinc finger). Therefore, the length of a sequence to which a zinc finger binding domain is engineered to bind (e.g., a target sequence) will determine the number of zinc fingers in an engineered zinc finger binding domain. For example, for ZFPs in which the finger motifs do not bind to overlapping subsites, a six-nucleotide target sequence is bound by a two-finger binding domain; a nine-nucleotide target sequence is bound by a three-finger binding domain, etc. Binding sites for individual zinc fingers (i.e., subsites) in a target site need not be contiguous, but can be separated by one or several nucleotides, depending on the length and nature of the amino acid sequences between the zinc fingers (i.e., the inter-finger linkers) in a multi-finger binding domain. In some embodiments, the DNA-binding domains of individual ZFNs comprise between three and six individual zinc finger repeats and can each recognize between 9 and 18 basepairs.
Zinc finger binding domains can be engineered to bind to a sequence of choice. See, for example, Beerli et al. (2002) Nature Biotechnol. 20:135-141; Pabo et al. (2001) Ann. Rev. Biochem. 70:313-340; Isalan et al. (2001) Nature Biotechnol. 19:656-660; Segal et al. (2001) Curr. Opin. Biotechnol. 12:632-637; Choo et al. (2000) Curr. Opin. Struct. Biol. 10:411-416. An engineered zinc finger binding domain can have a novel binding specificity, compared to a naturally-occurring zinc finger protein. Engineering methods include, but are not limited to, rational design and various types of selection.
Selection of a target DNA sequence for binding by a zinc finger domain can be accomplished, for example, according to the methods disclosed in U.S. Pat. No. 6,453,242. It will be clear to those skilled in the art that simple visual inspection of a nucleotide sequence can also be used for selection of a target DNA sequence. Accordingly, any means for target DNA sequence selection can be used in the methods described herein. A target site generally has a length of at least 9 nucleotides and, accordingly, is bound by a zinc finger binding domain comprising at least three zinc fingers. However binding of, for example, a 4-finger binding domain to a 12-nucleotide target site, a 5-finger binding domain to a 15-nucleotide target site or a 6-finger binding domain to an 18-nucleotide target site, is also possible. As will be apparent, binding of larger binding domains (e.g., 7-, 8-, 9-finger and more) to longer target sites is also possible.
In some embodiments, the zinc finger binding domains bind to a target DNA sequence that is at least 90% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1. In some embodiments, the zinc finger binding domains bind to a target DNA sequence that is at least 95%, 96%, 97%, 98%, or 99% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1. In some embodiments, the zinc finger binding domains bind to a target DNA sequence that is 100% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1. The enzymatic domain portion of the zinc finger fusion proteins can be obtained from any endo- or exonuclease. Exemplary endonucleases from which an enzymatic domain can be derived include, but are not limited to, restriction endonucleases and homing endonucleases. See, for example, 2002-2003 Catalogue, New England Biolabs, Beverly, Mass.; and Belfort et al. (1997) Nucleic Acids Res. 25:3379-3388. Additional enzymes which cleave DNA are known (e.g., 51 Nuclease; mung bean nuclease; pancreatic DNase I; micrococcal nuclease; yeast HO endonuclease; see also Linn et al. (eds.) Nucleases, Cold Spring Harbor Laboratory Press, 1993). One or more of these enzymes (or functional fragments thereof) can be used as a source of cleavage domains.
Exemplary restriction endonucleases (restriction enzymes) suitable for use as an enzymatic domain of the ZFPs described herein are present in many species and are capable of sequence-specific binding to DNA (at a recognition site), and cleaving DNA at or near the site of binding. Certain restriction enzymes (e.g., Type IIS) cleave DNA at sites removed from the recognition site and have separable binding and cleavage domains. For example, the Type IIS enzyme Fok I catalyzes double-stranded cleavage of DNA, at 9 nucleotides from its recognition site on one strand and 13 nucleotides from its recognition site on the other. See, for example, U.S. Pat. Nos. 5,356,802; 5,436,150 and 5,487,994; as well as Li et al. (1992) Proc. Natl. Acad. Sci. USA 89:4275-4279; Li et al. (1993) Proc. Natl. Acad. Sci. USA 90:2764-2768; Kim et al. (1994a) Proc. Natl. Acad. Sci. USA 91:883-887; Kim et al. (1994b) J. Biol. Chem. 269:31,978-31,982. Thus, in one embodiment, fusion proteins comprise the enzymatic domain from at least one Type IIS restriction enzyme and one or more zinc finger binding domains.
An exemplary Type IIS restriction enzyme, whose cleavage domain is separable from the binding domain, is Fok I. This particular enzyme is active as a dimer. Bitinaite et al. (1998) Proc. Natl. Acad. Sci. USA 95: 10,570-10,575. Thus, for targeted double-stranded DNA cleavage using zinc finger-Fok I fusions, two fusion proteins, each comprising a FokI enzymatic domain, can be used to reconstitute a catalytically active cleavage domain. Alternatively, a single polypeptide molecule containing a zinc finger binding domain and two FokI enzymatic domains can also be used. Exemplary ZFPs comprising FokI enzymatic domains are described in U.S. Pat. No. 9,782,437.
2. TALEN-Based Systems
TALEN-based systems comprise a protein comprising a TAL effector DNA binding domain and an enzymatic domain. They are made by fusing a TAL effector DNA-binding domain to a DNA cleavage domain (a nuclease which cuts DNA strands). The FokI restriction enzyme described above is an exemplary enzymatic domain suitable for use in TALEN-based gene regulating systems.
TAL effectors are proteins that are secreted by Xanthomonas bacteria via their type III secretion system when they infect plants. The DNA binding domain contains a repeated, highly conserved, 33-34 amino acid sequence with divergent 12th and 13th amino acids. These two positions, referred to as the Repeat Variable Diresidue (RVD), are highly variable and strongly correlated with specific nucleotide recognition. Therefore, the TAL effector domains can be engineered to bind specific target DNA sequences by selecting a combination of repeat segments containing the appropriate RVDs. The nucleic acid specificity for RVD combinations is as follows: HD targets cytosine, NI targets adenine, NG targets thymine, and NN targets guanine (though, in some embodiments, NN can also bind adenine with lower specificity).
In some embodiments, the TAL effector domains bind to a target DNA sequence that is at least 90% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1. In some embodiments, the TAL effector domains bind to a target DNA sequence that is at least 95%, 96%, 97%, 98%, or 99% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1. In some embodiments, the TAL effector domains bind to a target DNA sequence that is 100% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1.
Methods and compositions for assembling the TAL-effector repeats are known in the art. See e.g., Cermak et al, Nucleic Acids Research, 39:12, 2011, e82. Plasmids for constructions of the TAL-effector repeats are commercially available from Addgene.
In some embodiments, the gene-editing system is a combination gene-regulating system comprising a site-directed modifying polypeptide and a nucleic acid guide molecule. Herein, a “site-directed modifying polypeptide” refers to a polypeptide that binds to a nucleic acid guide molecule, is targeted to a target nucleic acid sequence, such as, for example, a DNA sequence, by the nucleic acid guide molecule to which it is bound, and modifies the target DNA sequence (e.g., cleavage, mutation, or methylation of target DNA). A site-directed modifying polypeptide comprises two portions, a portion that binds the nucleic acid guide and an activity portion. In some embodiments, a site-directed modifying polypeptide comprises an activity portion that exhibits site-directed enzymatic activity (e.g., DNA methylation, DNA cleavage, histone acetylation, histone methylation, etc.), wherein the site of enzymatic activity is determined by the guide nucleic acid.
The nucleic acid guide comprises two portions: a first portion that is complementary to, and capable of binding with, an endogenous target DNA sequence (referred to herein as a “DNA-binding segment”), and a second portion that is capable of interacting with the site-directed modifying polypeptide (referred to herein as a “protein-binding segment”). In some embodiments, the DNA-binding segment and protein-binding segment of a nucleic acid guide are comprised within a single polynucleotide molecule. In some embodiments, the DNA-binding segment and protein-binding segment of a nucleic acid guide are each comprised within separate polynucleotide molecules, such that the nucleic acid guide comprises two polynucleotide molecules that associate with each other to form the functional guide.
The nucleic acid guide mediates the target specificity of the combined protein/nucleic gene regulating systems by specifically hybridizing with a target DNA sequence comprised within the DNA sequence of a target gene. Reference herein to a target gene encompasses the full-length DNA sequence for that particular gene and a full-length DNA sequence for a particular target gene will comprise a plurality of target genetic loci, which refer to portions of a particular target gene sequence (e.g., an exon or an intron). Within each target genetic loci are shorter stretches of DNA sequences referred to herein as “target DNA sequences” or “target sequences” that can be modified by the gene-regulating systems described herein. Further, each target genetic loci comprises a “target modification site,” which refers to the precise location of the modification induced by the gene-regulating system (e.g., the location of an insertion, a deletion, or mutation, the location of a DNA break, or the location of an epigenetic modification). The gene-regulating systems described herein may comprise a single nucleic acid guide, or may comprise a plurality of nucleic acid guides (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10, or more nucleic acid guides).
The CRISPR/Cas systems described below are exemplary embodiments of a combination protein/nucleic acid system.
3. CRISPR/Cas Gene Regulating Systems
In some embodiments, the gene editing systems described herein are CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats)/Cas (CRISPR Associated) nuclease systems. In such embodiments, the site-directed modifying polypeptide is a CRISPR-associated endonuclease (a “Cas “endonuclease) and the nucleic acid guide molecule is a guide RNA (gRNA).
A Cas polypeptide refers to a polypeptide that can interact with a gRNA molecule and, in concert with the gRNA molecule, homes or localizes to a target DNA sequence and includes naturally occurring Cas proteins and engineered, altered, or otherwise modified Cas proteins that differ by one or more amino acid residues from a naturally-occurring Cas sequence.
In some embodiments, the Cas protein is a Cas9 protein. Cas9 is a multi-domain enzyme that uses an HNH nuclease domain to cleave the target strand of DNA and a RuvC-like domain to cleave the non-target strand. In some embodiments, mutants of Cas9 can be generated by selective domain inactivation enabling the conversion of WT Cas9 into an enzymatically inactive mutant (e.g., dCas9), which is unable to cleave DNA, or a nickase mutant, which is able to produce single-stranded DNA breaks by cleaving one or the other of the target or non-target strand.
A guide RNA (gRNA) comprises two segments, a DNA-binding segment and a protein-binding segment. In some embodiments, the protein-binding segment of a gRNA is comprised in one RNA molecule and the DNA-binding segment is comprised in another separate RNA molecule. Such embodiments are referred to herein as “double-molecule gRNAs” or “two-molecule gRNA” or “dual gRNAs.” In some embodiments, the gRNA is a single RNA molecule and is referred to herein as a “single-guide RNA” or an “sgRNA.” The term “guide RNA” or “gRNA” is inclusive, referring both to two-molecule guide RNAs and sgRNAs.
The protein-binding segment of a gRNA comprises, in part, two complementary stretches of nucleotides that hybridize to one another to form a double stranded RNA duplex (dsRNA duplex), which facilitates binding to the Cas protein.
The DNA-binding segment (or “DNA-binding sequence”) of a gRNA comprises a nucleotide sequence that is complementary to and capable of binding to a specific sequence target DNA sequence. The protein-binding segment of the gRNA interacts with a Cas polypeptide and the interaction of the gRNA molecule and site-directed modifying polypeptide results in Cas binding to the endogenous DNA and produces one or more modifications within or around the target DNA sequence. The precise location of the target modification site is determined by both (i) base-pairing complementarity between the gRNA and the target DNA sequence; and (ii) the location of a short motif, referred to as the protospacer adjacent motif (PAM), in the target DNA sequence. The PAM sequence is required for Cas binding to the target DNA sequence. A variety of PAM sequences are known in the art and are suitable for use with a particular Cas endonuclease (e.g., a Cas9 endonuclease) are known in the art (See e.g., Nat Methods. 2013 November; 10(11): 1116-1121 and Sci Rep. 2014; 4: 5405). In some embodiments, the PAM sequence is located within 50 base pairs of the target modification site. In some embodiments, the PAM sequence is located within 10 base pairs of the target modification site. The DNA sequences that can be targeted by this method are limited only by the relative distance of the PAM sequence to the target modification site and the presence of a unique 20 base pair sequence to mediate sequence-specific, gRNA-mediated Cas binding. In some embodiments, the target modification site is located at the 5′ terminus of the target locus. In some embodiments, the target modification site is located at the 3′ end of the target locus. In some embodiments, the target modification site is located within an intron or an exon of the target locus.
In some embodiments, the present disclosure provides a polynucleotide encoding a gRNA. In some embodiments, a gRNA-encoding nucleic acid is comprised in an expression vector, e.g., a recombinant expression vector. In some embodiments, the present disclosure provides a polynucleotide encoding a site-directed modifying polypeptide. In some embodiments, the polynucleotide encoding a site-directed modifying polypeptide is comprised in an expression vector, e.g., a recombinant expression vector.
a. Cas Proteins
In some embodiments, the site-directed modifying polypeptide is a Cas protein. Cas molecules of a variety of species can be used in the methods and compositions described herein, including Cas molecules derived from S. pyogenes, S. aureus, N. meningitidis, S. thermophiles, Acidovorax avenae, Actinobacillus pleuro pneumoniae, Actinobacillus succinogenes, Actinobacillus suis, Actinomyces sp., Cycliphilusdenitrificans, Aminomonas paucivorans, Bacillus cereus, Bacillus smithii, Bacillus thuringiensis, Bacteroides sp., Blastopirellula marina, Bradyrhizobium sp., Brevibacillus laterospoxus, Campylobacter coli, Campylobacter jejuni, Campylobacter lari, Candidatus puniceispirillum, Clostridium cellulolyticum, Clostridium perfringens, Corynebacterium accolens, Corynebacterium diphtheria, Corynebacterium matruchotii, Dinoroseobacter shibae, Eubacterium dolichum, Gammaproteobacterium, Gluconacetobacter diazotrophicus, Haemophilus parainfluenzae, Haemophilus sputomm, Helicobacter canadensis, Helicobacter cinaedi, Helicobacter mustelae, Ilyobacter polytropus, Kingella kingae, Lactobacillus crispatus, Listeria ivanovii, Listeria monocytogenes, Listeriaceae bacterium, Methylocystis sp., Methylosinus trichosporium, Mobiluncus mulieris, Neisseria bacilliformis, Neisseria cinerea, Neisseria flavescens, Neisseria lactamica, Neisseria meningitidis, Neisseria sp., Neisseria wadsworthii, Nitrosomonas sp., Parvibaculum lavamentivorans, Pasteurella multocida, Phascolarctobacterium succinatutens, Ralstonia syzygii, Rhodopseudomonas palustris, Rhodovulum sp., Simonsiella muelleri, Sphingomonas sp., Sporolactobacillus vineae, Staphylococcus aureus, Staphylococcus lugdunensis, Streptococcus sp., Subdoligranulum sp., Tistrella mobilis, Treponema sp., or Verminephrobacter eiseniae.
In some embodiments, the Cas protein is a Cas9 protein or a Cas9 ortholog and is selected from the group consisting of SpCas9, SpCas9-HF1, SpCas9-HF2, SpCas9-HF3, SpCas9-HF4, SaCas9, FnCpf, FnCas9, eSpCas9, and NmeCas9. In some embodiments, the endonuclease is selected from the group consisting of C2C1, C2C3, Cpf1 (also referred to as Cas12a), CasI, CasIB, Cas2, Cas3, Cas4, Cas5, Cas6, Cas7, Cas8, Cas9 (also known as CsnI and Csx12), Cas10, CsyI, Csy2, Csy3, CseI, Cse2, CscI, Csc2, Csa5, Csn2, Csm2, Csm3, Csm4, Csm5, Csm6, CmrI, Cmr3, Cmr4, Cmr5, Cmr6, CsbI, Csb2, Csb3, Csx17, Csx14, Csx10, Csx16, CsaX, Csx3, Csxl, Csx15, CsfI, Csf2, Csf3, and Csf4. Additional Cas9 orthologs are described in International PCT Publication No. WO 2015/071474.
In some embodiments, the Cas9 protein is a naturally-occurring Cas9 protein. Exemplary naturally occurring Cas9 molecules are described in Chylinski et al., RNA Biology 2013 10:5, 727-737. Such Cas9 molecules include Cas9 molecules of a cluster 1 bacterial family, cluster 2 bacterial family, cluster 3 bacterial family, cluster 4 bacterial family, cluster 5 bacterial family, cluster 6 bacterial family, a cluster 7 bacterial family, a cluster 8 bacterial family, a cluster 9 bacterial family, a cluster 10 bacterial family, a cluster 11 bacterial family, a cluster 12 bacterial family, a cluster 13 bacterial family, a cluster 14 bacterial family, a cluster 15 bacterial family, a cluster 16 bacterial family, a cluster 17 bacterial family, a cluster 18 bacterial family, a cluster 19 bacterial family, a cluster 20 bacterial family, a cluster 21 bacterial family, a cluster 22 bacterial family, a cluster 23 bacterial family, a cluster 24 bacterial family, a cluster 25 bacterial family, a cluster 26 bacterial family, a cluster 27 bacterial family, a cluster 28 bacterial family, a cluster 29 bacterial family, a cluster 30 bacterial family, a cluster 31 bacterial family, a cluster 32 bacterial family, a cluster 33 bacterial family, a cluster 34 bacterial family, a cluster 35 bacterial family, a cluster 36 bacterial family, a cluster 37 bacterial family, a cluster 38 bacterial family, a cluster 39 bacterial family, a cluster 40 bacterial family, a cluster 41 bacterial family, a cluster 42 bacterial family, a cluster 43 bacterial family, a cluster 44 bacterial family, a cluster 45 bacterial family, a cluster 46 bacterial family, a cluster 47 bacterial family, a cluster 48 bacterial family, a cluster 49 bacterial family, a cluster 50 bacterial family, a cluster 51 bacterial family, a cluster 52 bacterial family, a cluster 53 bacterial family, a cluster 54 bacterial family, a cluster 55 bacterial family, a cluster 56 bacterial family, a cluster 57 bacterial family, a cluster 58 bacterial family, a cluster 59 bacterial family, a cluster 60 bacterial family, a cluster 61 bacterial family, a cluster 62 bacterial family, a cluster 63 bacterial family, a cluster 64 bacterial family, a cluster 65 bacterial family, a cluster 66 bacterial family, a cluster 67 bacterial family, a cluster 68 bacterial family, a cluster 69 bacterial family, a cluster 70 bacterial family, a cluster 71 bacterial family, a cluster 72 bacterial family, a cluster 73 bacterial family, a cluster 74 bacterial family, a cluster 75 bacterial family, a cluster 76 bacterial family, a cluster 77 bacterial family, or a cluster 78 bacterial family.
In some embodiments, a Cas9 protein comprises an amino acid sequence having at least 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 96%, 97%, 98%, 99%, or 100% sequence identity to a Cas9 amino acid sequence described in Chylinski et al., RNA Biology 2013 10:5, 727-737; Hou et al., PNAS Early Edition 2013, 1-6).
In some embodiments, a Cas polypeptide comprises one or more of the following activities:
In some embodiments, the Cas9 is a wildtype (WT) Cas9 protein or ortholog. WT Cas9 comprises two catalytically active domains (HNH and RuvC). Binding of WT Cas9 to DNA based on gRNA specificity results in double-stranded DNA breaks that can be repaired by non-homologous end joining (NHEJ) or homology-directed repair (HDR). In some embodiments, Cas9 is fused to heterologous proteins that recruit DNA-damage signaling proteins, exonucleases, or phosphatases to further increase the likelihood or the rate of repair of the target sequence by one repair mechanism or another. In some embodiments, a WT Cas9 is co-expressed with a nucleic acid repair template to facilitate the incorporation of an exogenous nucleic acid sequence by homology-directed repair.
In some embodiments, different Cas9 proteins (i.e., Cas9 proteins from various species) may be advantageous to use in the various provided methods in order to capitalize on various enzymatic characteristics of the different Cas9 proteins (e.g., for different PAM sequence preferences; for increased or decreased enzymatic activity; for an increased or decreased level of cellular toxicity; to change the balance between NHEJ, homology-directed repair, single strand breaks, double strand breaks, etc.).
In some embodiments, the Cas protein is a Cas9 protein derived from S. pyogenes and recognizes the PAM sequence motif NGG, NAG, NGA (Mali et al, Science 2013; 339(6121): 823-826). In some embodiments, the Cas protein is a Cas9 protein derived from S. thermophiles and recognizes the PAM sequence motif NGGNG and/or NNAGAAW (W=A or T) (See, e.g., Horvath et al, Science, 2010; 327(5962): 167-170, and Deveau et al, J BACTERIOL 2008; 190(4): 1390-1400). In some embodiments, the Cas protein is a Cas9 protein derived from S. mutans and recognizes the PAM sequence motif NGG and/or NAAR (R=A or G) (See, e.g., Deveau et al, J BACTERIOL 2008; 190(4): 1390-1400). In some embodiments, the Cas protein is a Cas9 protein derived from S. aureus and recognizes the PAM sequence motif NNGRR (R=A or G). In some embodiments, the Cas protein is a Cas9 protein derived from S. aureus and recognizes the PAM sequence motif N GRRT (R=A or G). In some embodiments, the Cas protein is a Cas9 protein derived from S. aureus and recognizes the PAM sequence motif N GRRV (R=A or G). In some embodiments, the Cas protein is a Cas9 protein derived from N. meningitidis and recognizes the PAM sequence motif N GATT or N GCTT (R=A or G, V=A, G or C) (See, e.g., Hou et ah, PNAS 2013, 1-6). In the aforementioned embodiments, N can be any nucleotide residue, e.g., any of A, G, C or T.
In some embodiments, a polynucleotide encoding a Cas protein is provided. In some embodiments, the polynucleotide encodes a Cas protein that is at least 90% identical to a Cas protein described in International PCT Publication No. WO 2015/071474 or Chylinski et al., RNA Biology 2013 10:5, 727-737. In some embodiments, the polynucleotide encodes a Cas protein that is at least 95%, 96%, 97%, 98%, 99% or 99% identical to a Cas protein described in International PCT Publication No. WO 2015/071474 or Chylinski et al., RNA Biology 2013 10:5, 727-737. In some embodiments, the polynucleotide encodes a Cas protein that is 100% identical to a Cas protein described in International PCT Publication No. WO 2015/071474 or Chylinski et al., RNA Biology 2013 10:5, 727-737.
i. Cas Mutants
In some embodiments, the Cas polypeptides are engineered to alter one or more properties of the Cas polypeptide. For example, in some embodiments, the Cas polypeptide comprises altered enzymatic properties, e.g., altered nuclease activity, (as compared with a naturally occurring or other reference Cas molecule) or altered helicase activity. In some embodiments, an engineered Cas polypeptide can have an alteration that alters its size, e.g., a deletion of amino acid sequence that reduces its size without significant effect on another property of the Cas polypeptide. In some embodiments, an engineered Cas polypeptide comprises an alteration that affects PAM recognition. For example, an engineered Cas polypeptide can be altered to recognize a PAM sequence other than the PAM sequence recognized by the corresponding wild-type Cas protein.
Cas polypeptides with desired properties can be made in a number of ways, including alteration of a naturally occurring Cas polypeptide or parental Cas polypeptide, to provide a mutant or altered Cas polypeptide having a desired property. For example, one or more mutations can be introduced into the sequence of a parental Cas polypeptide (e.g., a naturally occurring or engineered Cas polypeptide). Such mutations and differences may comprise substitutions (e.g., conservative substitutions or substitutions of non-essential amino acids); insertions; or deletions. In some embodiments, a mutant Cas polypeptide comprises one or more mutations (e.g., at least 1, 2, 3, 4, 5, 10, 15, 20, 30, 40 or 50 mutations) relative to a parental Cas polypeptide.
In an embodiment, a mutant Cas polypeptide comprises a cleavage property that differs from a naturally occurring Cas polypeptide. In some embodiments, the Cas is a Cas nickase mutant. Cas nickase mutants comprise only one catalytically active domain (either the HNH domain or the RuvC domain). The Cas nickase mutants retain DNA binding based on gRNA specificity, but are capable of cutting only one strand of DNA resulting in a single-strand break (e.g. a “nick”). In some embodiments, two complementary Cas nickase mutants (e.g., one Cas nickase mutant with an inactivated RuvC domain, and one Cas nickase mutant with an inactivated HNH domain) are expressed in the same cell with two gRNAs corresponding to two respective target sequences; one target sequence on the sense DNA strand, and one on the antisense DNA strand. This dual-nickase system results in staggered double stranded breaks and can increase target specificity, as it is unlikely that two off-target nicks will be generated close enough to generate a double stranded break. In some embodiments, a Cas nickase mutant is co-expressed with a nucleic acid repair template to facilitate the incorporation of an exogenous nucleic acid sequence by homology-directed repair.
In some embodiments, the Cas polypeptides described herein can be engineered to alter the PAM specificity of the Cas polypeptide. In some embodiments, a mutant Cas polypeptide has a PAM specificity that is different from the PAM specificity of the parental Cas polypeptide. For example, a naturally occurring Cas protein can be modified to alter the PAM sequence that the mutant Cas polypeptide recognizes to decrease off target sites, improve specificity, or eliminate a PAM recognition requirement. In some embodiments, a Cas protein can be modified to increase the length of the PAM recognition sequence. In some embodiments, the length of the PAM recognition sequence is at least 4, 5, 6, 7, 8, 9, 10 or 15 amino acids in length. Cas polypeptides that recognize different PAM sequences and/or have reduced off-target activity can be generated using directed evolution. Exemplary methods and systems that can be used for directed evolution of Cas polypeptides are described, e.g., in Esvelt et al. Nature 2011, 472(7344): 499-503.
Exemplary Cas mutants are described in International PCT Publication No. WO 2015/161276, which is incorporated herein by reference in its entirety.
2. gRNAs
The present disclosure provides guide RNAs (gRNAs) that direct a site-directed modifying polypeptide to a specific target DNA sequence. A gRNA comprises a DNA-targeting segment and protein-binding segment. The DNA-targeting segment of a gRNA comprises a nucleotide sequence that is complementary to a sequence in the target DNA sequence. As such, the DNA-targeting segment of a gRNA interacts with a target DNA in a sequence-specific manner via hybridization (i.e., base pairing), and the nucleotide sequence of the DNA-targeting segment determines the location within the target DNA that the gRNA will bind. The DNA-targeting segment of a gRNA can be modified (e.g., by genetic engineering) to hybridize to any desired sequence within a target DNA sequence.
The protein-binding segment of a guide RNA interacts with a site-directed modifying polypeptide (e.g. a Cas9 protein) to form a complex. The guide RNA guides the bound polypeptide to a specific nucleotide sequence within target DNA via the above-described DNA-targeting segment. The protein-binding segment of a guide RNA comprises two stretches of nucleotides that are complementary to one another and which form a double stranded RNA duplex.
In some embodiments, a gRNA comprises two separate RNA molecules. In such embodiments, each of the two RNA molecules comprises a stretch of nucleotides that are complementary to one another such that the complementary nucleotides of the two RNA molecules hybridize to form the double-stranded RNA duplex of the protein-binding segment. In some embodiments, a gRNA comprises a single RNA molecule (sgRNA).
The specificity of a gRNA for a target loci is mediated by the sequence of the DNA-binding segment, which comprises about 20 nucleotides that are complementary to a target DNA sequence within the target locus. In some embodiments, the corresponding target DNA sequence is approximately 20 nucleotides in length. In some embodiments, the DNA-binding segments of the gRNA sequences of the present invention are at least 90% complementary to a target DNA sequence within a target locus. In some embodiments, the DNA-binding segments of the gRNA sequences of the present invention are at least 95%, 96%, 97%, 98%, or 99% complementary to a target DNA sequence within a target locus. In some embodiments, the DNA-binding segments of the gRNA sequences of the present invention are 100% complementary to a target DNA sequence within a target locus.
In some embodiments, the DNA-binding segments of the gRNA sequences bind to a target DNA sequence that is at least 90% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1. In some embodiments, the DNA-binding segments of the gRNA sequences bind to a target DNA sequence that is at least 95%, 96%, 97%, 98%, or 99% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1. In some embodiments, the DNA-binding segments of the gRNA sequences bind to a target DNA sequence that is 100% identical to a target DNA sequence within a target locus of a target gene selected those listed in Table 1.
In some embodiments, the DNA-binding segments of the gRNA sequences described herein are designed to minimize off-target binding using algorithms known in the art (e.g., Cas-OFF finder) to identify target sequences that are unique to a particular target locus or target gene.
In some embodiments, the gRNAs described herein can comprise one or more modified nucleosides or nucleotides which introduce stability toward nucleases. In such embodiments, these modified gRNAs may elicit a reduced innate immune as compared to a non-modified gRNA. The term “innate immune response” includes a cellular response to exogenous nucleic acids, including single stranded nucleic acids, generally of viral or bacterial origin, which involves the induction of cytokine expression and release, particularly the interferons, and cell death.
In some embodiments, the gRNAs described herein are modified at or near the 5′ end (e.g., within 1-10, 1-5, or 1-2 nucleotides of their 5′ end). In some embodiments, the 5′ end of a gRNA is modified by the inclusion of a eukaryotic mRNA cap structure or cap analog (e.g., a G(5′)ppp(5′)G cap analog, a m7G(5′)ppp(5′)G cap analog, or a 3′0-Me-m7G(5′)ppp(5′)G anti reverse cap analog (ARCA)). In some embodiments, an in vitro transcribed gRNA is modified by treatment with a phosphatase (e.g., calf intestinal alkaline phosphatase) to remove the 5′ triphosphate group. In some embodiments, a gRNA comprises a modification at or near its 3′ end (e.g., within 1-10, 1-5, or 1-2 nucleotides of its 3′ end). For example, in some embodiments, the 3′ end of a gRNA is modified by the addition of one or more (e.g., 25-200) adenine (A) residues.
In some embodiments, modified nucleosides and modified nucleotides can be present in a gRNA, but also may be present in other gene-regulating systems, e.g., mRNA, RNAi, or siRNA-based systems. In some embodiments, modified nucleosides and nucleotides can include one or more of:
In some embodiments, the modifications listed above can be combined to provide modified nucleosides and nucleotides that can have two, three, four, or more modifications. For example, in some embodiments, a modified nucleoside or nucleotide can have a modified sugar and a modified nucleobase. In some embodiments, every base of a gRNA is modified. In some embodiments, each of the phosphate groups of a gRNA molecule are replaced with phosphorothioate groups.
In some embodiments, a software tool can be used to optimize the choice of gRNA within a user's target sequence, e.g., to minimize total off-target activity across the genome. Off target activity may be other than cleavage. For example, for each possible gRNA choice using S. pyogenes Cas9, software tools can identify all potential off-target sequences (preceding either NAG or NGG PAMs) across the genome that contain up to a certain number (e.g., 1, 2, 3, 4, 5, 6, 7, 8, 9, or 10) of mismatched base-pairs. The cleavage efficiency at each off-target sequence can be predicted, e.g., using an experimentally-derived weighting scheme. Each possible gRNA can then be ranked according to its total predicted off-target cleavage; the top-ranked gRNAs represent those that are likely to have the greatest on-target and the least off-target cleavage. Other functions, e.g., automated reagent design for gRNA vector construction, primer design for the on-target Surveyor assay, and primer design for high-throughput detection and quantification of off-target cleavage via next-generation sequencing, can also be included in the tool.
The invention is further described in the following Examples, which do not limit the scope of the invention described in the claims.
A series of plasmid vectors were generated to evaluate expression of Parkin transgene variants. The expression cassette (
One consideration in design of codon-optimized CO1 to CO4 was the number of CpG sites. CpG islands are regions of DNA where a cytosine nucleotide is followed by a guanine nucleotide in the linear sequence of bases along its 5′ 4 3′ direction. CpG islands (which are typically defined as a polynucleotide sequence of at least 200 bp, a GC percentage greater than 50%, and an observed-to-expected CpG ratio greater than 60%) are known to be associated with vector immunogenicity. Therefore, it was expected that decreasing the number of CpG sites would improve vector performance by decreasing immunogenicity. The number of CpG sites (5′-C-G-3′) in each Parkin codon variant is given in Table 9.
SH-SY5Y cells. A human neuroblastoma cell line, SH-SY5Y, was used to evaluate gene expression in neuronal lineage cells. SH-SY5Y cells were cultured on 96-well plates at a seeding density of 10,000 cells per well. After 24 hours, the cells were transfected with 0.10 pg of WT, CO1, CO2, or CO3 plasmid complexed with 4 μL Fugene HD per pg plasmid. Cells were cultured for an additional 48 hours and then assayed for eGFP expression by fluorescence microscopy.
Representative micrographs are shown in
Codon variant CO4 was then tested against WT and CO1. Fluorescence micrographs of SH-SY5Y cells for untransfected negative control (
iPSC-derived, Parkin knockout dopaminergic precursor cells. Human induced pluripotent stem cell (iPSC)-derived, Parkin knockout dopaminergic precursor cells were cultured in 96-well plates at a seeding density of 10,000 cells per well. After 7 days, the cells were transfected with 0.15 pg WT, CO1, and CO4 plasmid complexed with 4 μL ViaFect per pg plasmid). Transgene expression was evaluated 7 days after transfection in untransfected wells (
To evaluate other regulatory elements, a variety of AAV expression cassettes were constructed in the form of transfer plasmids for use in a helper-free AAV packaging system. The AAV expression cassettes (
SH-SY5Y cells. SH-SY5Y cells were cultured on 24-well plates at a seeding density of 50,000 cells per well. After 24 hours, the cells were transfected with 0.75 pg of plasmid complexed with 4 μL Fugene6 per pg plasmid. Cells were cultured for an additional 48 hours, and Parkin expression was assayed by performing an ELISA on cell lysates with an anti-Parkin primary antibody. Results for each construct are shown in Table 10 and graphed in
iPSC-derived, Parkin knockout dopaminergic precursor cells. iPSC-derived, Parkin knockout dopaminergic precursors cells were cultured in 96-well plates at a seeding density of 10,000 cells per well. After 15 days, the cells were transfected with 0.15 pg plasmid complexed with 4 μL ViaFect per pg plasmid). Parkin expression was assayed 2 days after by performing an ELISA on cell lysates with an anti-Parkin primary antibody. Results for each construct are shown in Table 11 and graphed in
For fluorescence microscopy, transfected cells were fixed 8 days after transfection, stained, and imaged in brightfield (
AAV vectors are generated by packaging of AAV vector genomes from constructs 1 to 20 in Example 2, in particular constructs 1, 7, 11, and 15 from Table 11. Testing is performed in rats and one or more constructs are selected for testing in non-human primates (NHPs). Dose finding studies are performed and a starting dose for clinical trials is determined by measurement of protein expression and toxicity observed.
Clinical trials are performed in subjects identified has having recessive mutations in the PRKN gene (also known as PRK2). Protein expression and observed toxicity is used to determine an optimal dose. Efficacy is evaluated using improvement on the Unified Parkinson's Disease Rating Scale (UPDRS).
Recombinant cassettes are tested in a human neuroblastoma cell line (SH-SY5Y). (See Jiang et al. Extracellular dopamine induces the oxidative toxicity of SH-SY5Y cells. Synapse. 2008 November; 62(11):797-803. doi: 10.1002/syn.20554.) The genes of interest tested are a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, a Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene.
Each cell line is treated with a recombinant gene therapy vector for each gene of interest. Expression of the gene of interest is increased. Function of the gene of interest is improved. In some cases, improved mitophagy, reduced cellular toxicity, and/or reduced oxidative stress is observed.
A rodent or non-human primate having a combination of one or more known mutations in a gene of interest is treated with a recombinant gene therapy vector for that gene of interest. The genes of interest tested are a Parkinson protein 2, E3 ubiquitin protein ligase (PARK2) gene, a PTEN-induced putative kinase 1 (PINK1) gene, a protein deglycase DJ-1 (DJ-1) gene, a Leucine Rich Repeat Kinase 2 (LRRK2) gene, an alpha-synuclein (SCNA) gene, a Proto-oncogene c-Rel (c-Rel) gene, an Ubiquitin-like modifier-activating enzyme (ATG7) gene, Synaptic vesicular amine transporter (VMAT2) gene, or glucocerebrosidase (GBA) gene
The test subject has one or more of the following features: Loss of dopamine (DA), ≥20%, nigral cell loss, dyskinesia, Lewy bodies, indications of mitochondrial dysfunction, ROS, inflammation, other locomotor behavioral deficits, and neurodegenerative symptoms.
Animals in which the methods of the present disclosure are tested include non-diseased and diseased animals and mutation-carrier and non-carrier animals. Animal models and illustrative motor behavior readouts in which the methods of the present disclosure are tested are provided in Table 12.
The test subject exhibits improvement in any of the motor behavior readouts or one or more of the following features: Gain of DA in the striatum, nigral cell gain, reduced lewy bodies, improved behavioral or other locomotor deficits, improved mitochondrial function, reduced inflammatory markers, improved life span.
The diagnosis of parkin type of early-onset Parkinson disease is considered primarily in individuals with early-onset parkinsonism (age <40 years), particularly if autosomal recessive inheritance is suspected. PRKN (formerly termed PARK2), the gene encoding the protein parkin, is the primary gene in which pathogenic variants are known to cause parkin type of early-onset Parkinson disease. The diagnosis of parkin type of early-onset Parkinson disease can only be confirmed when pathogenic variants are identified on both alleles of PRKN (i.e., the individual is homozygous for the same pathogenic allele or compound heterozygous for two different pathogenic alleles). The variant detection frequency varies by family history and age of onset.
Other mutants related to Parkinson's Disease are provided in Table 13.
Human subjects having one or more mutations associated with Parkinson's Disease are treated with recombinant gene therapy vectors encoding wild-type or functional variants of the mutated gene. The subjects exhibit improvement in any of the motor behavior readouts listed in Table 12, or any of the following features: increased dopamine in the brain, especially the substantia nigra, increased numbers of dopaminergic neurons, increased expression of genes of interesting, including PRKN, or improvement on the Unified Parkinson's Disease Rating Scale (UPDRS).
All of the above U.S. patents, U.S. patent application publications, U.S. patent applications, foreign patents, foreign patent applications and non-patent publications referred to in this specification and/or listed in the Application Data Sheet, are incorporated herein by reference, in their entirety.
The present invention may be embodied in other specific forms without departing from its structures, methods, or other essential characteristics as broadly described herein and claimed hereinafter. The described embodiments are to be considered in all respects only as illustrative, and not restrictive. The scope of the invention is, therefore, indicated by the appended claims, rather than by the foregoing description. All changes that come within the meaning and range of equivalency of the claims are to be embraced within their scope.
This application claims benefit of priority to U.S. Provisional Patent Application No. 62/664,006, filed Apr. 27, 2018, the disclosure of which is incorporated herein by reference in its entirety for all purposes.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/US2019/029744 | 4/29/2019 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62664006 | Apr 2018 | US |
