Publication Date

6-11-2021

Journal

Molecular Therapy Methods & Clinical Development:

DOI

10.1016/j.omtm.2021.04.011

PMID

34141821

PMCID

PMC8166646

PubMedCentral® Posted Date

4-24-2021

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

AAV, CRISPR-Cas9, gene therapy, genome editing, gene targeting, Apoa1, liver, inherited metabolic disorders

Abstract

Clinical application of somatic genome editing requires therapeutics that are generalizable to a broad range of patients. Targeted insertion of promoterless transgenes can ensure that edits are permanent and broadly applicable while minimizing risks of off-target integration. In the liver, the Albumin (Alb) locus is currently the only well-characterized site for promoterless transgene insertion. Here, we target the Apoa1 locus with adeno-associated viral (AAV) delivery of CRISPR-Cas9 and achieve rates of 6% to 16% of targeted hepatocytes, with no evidence of toxicity. We further show that the endogenous Apoa1 promoter can drive robust and sustained expression of therapeutic proteins, such as apolipoprotein E (APOE), dramatically reducing plasma lipids in a model of hypercholesterolemia. Finally, we demonstrate that Apoa1-targeted fumarylacetoacetate hydrolase (FAH) can correct and rescue the severe metabolic liver disease hereditary tyrosinemia type I. In summary, we identify and validate Apoa1 as a novel integration site that supports durable transgene expression in the liver for gene therapy applications.

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