151. BEST1 gene therapy corrects a diffuse retina-wide microdetachment modulated by light exposure.
- Author
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Guziewicz KE, Cideciyan AV, Beltran WA, Komáromy AM, Dufour VL, Swider M, Iwabe S, Sumaroka A, Kendrick BT, Ruthel G, Chiodo VA, Héon E, Hauswirth WW, Jacobson SG, and Aguirre GD
- Subjects
- Animals, Dog Diseases therapy, Dogs, Eye Diseases, Hereditary diagnostic imaging, Eye Diseases, Hereditary pathology, Eye Diseases, Hereditary veterinary, Female, Genetic Vectors pharmacology, Humans, Light, Male, Mutation, Retinal Detachment diagnostic imaging, Retinal Detachment pathology, Retinal Detachment therapy, Retinal Diseases diagnostic imaging, Retinal Diseases pathology, Retinal Diseases veterinary, Retinal Pigment Epithelium pathology, Tomography, Optical Coherence, Bestrophins genetics, Eye Diseases, Hereditary therapy, Genetic Therapy methods, Retinal Diseases therapy
- Abstract
Mutations in the BEST1 gene cause detachment of the retina and degeneration of photoreceptor (PR) cells due to a primary channelopathy in the neighboring retinal pigment epithelium (RPE) cells. The pathophysiology of the interaction between RPE and PR cells preceding the formation of retinal detachment remains not well-understood. Our studies of molecular pathology in the canine BEST1 disease model revealed retina-wide abnormalities at the RPE-PR interface associated with defects in the RPE microvillar ensheathment and a cone PR-associated insoluble interphotoreceptor matrix. In vivo imaging demonstrated a retina-wide RPE-PR microdetachment, which contracted with dark adaptation and expanded upon exposure to a moderate intensity of light. Subretinal BEST1 gene augmentation therapy using adeno-associated virus 2 reversed not only clinically detectable subretinal lesions but also the diffuse microdetachments. Immunohistochemical analyses showed correction of the structural alterations at the RPE-PR interface in areas with BEST1 transgene expression. Successful treatment effects were demonstrated in three different canine BEST1 genotypes with vector titers in the 0.1-to-5E11 vector genomes per mL range. Patients with biallelic BEST1 mutations exhibited large regions of retinal lamination defects, severe PR sensitivity loss, and slowing of the retinoid cycle. Human translation of canine BEST1 gene therapy success in reversal of macro- and microdetachments through restoration of cytoarchitecture at the RPE-PR interface has promise to result in improved visual function and prevent disease progression in patients affected with bestrophinopathies., Competing Interests: Conflict of interest statement: W.W.H. and the University of Florida have a financial interest in the use of AAV therapies, and own equity in a company (AGTC, Inc.) that might, in the future, commercialize some aspects of this work., (Copyright © 2018 the Author(s). Published by PNAS.)
- Published
- 2018
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