1. Leber Hereditary Optic Neuropathy Gene Therapy: Adverse Events and Visual Acuity Results of All Patient Groups
- Author
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Byron L. Lam, William J. Feuer, Janet L. Davis, Vittorio Porciatti, Hong Yu, Robert B. Levy, Elizabeth Vanner, and John Guy
- Subjects
Retinal Ganglion Cells ,Genetic Vectors ,Vision Disorders ,Visual Acuity ,NADH Dehydrogenase ,Genetic Therapy ,Optic Atrophy, Hereditary, Leber ,Dependovirus ,DNA, Mitochondrial ,Ophthalmology ,Electroretinography ,Humans ,Prospective Studies ,Visual Fields ,Tomography, Optical Coherence - Abstract
To assess safety of gene therapy in G11778A Leber hereditary optic neuropathy (LHON).Phase 1 clinical trial.Setting: single institution.Patients with G11778A LHON and chronic bilateral visual loss12 months (group 1, n = 11), acute bilateral visual loss12 months (group 2, n = 9), or unilateral visual loss (group 3, n = 8).unilateral intravitreal AAV2(Y444,500,730F)-P1ND4v2 injection with low, medium, high, and higher doses to worse eye for groups 1 and 2 and better eye for group 3.Best-corrected visual acuity (BCVA), adverse events, and vector antibody responses. Mean follow-up was 24 months (range, 12-36 months); BCVAs were compared with a published prospective natural history cohort with designated surrogate study and fellow eyes.Incident uveitis (8 of 28, 29%), the only vector-related adverse event, resulted in no attributable vision sequelae and was related to vector dose: 5 of 7 (71%) higher-dose eyes vs 3 of 21 (14%) low-, medium-, or high-dose eyes (P.001). Incident uveitis requiring treatment was associated with increased serum AAV2 neutralizing antibody titers (p=0.007) but not serum AAV2 polymerase chain reaction. Improvements of ≥15-letter BCVA occurred in some treated and fellow eyes of groups 1 and 2 and some surrogate study and fellow eyes of natural history subjects. All study eyes (BCVA ≥20/40) in group 3 lost ≥15 letters within the first year despite treatment.G11778A LHON gene therapy has a favorable safety profile. Our results suggest that if there is an efficacy effect, it is likely small and not dose related. Demonstration of efficacy requires randomization of patients to a group not receiving vector in either eye.
- Published
- 2022