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Preexisting maternal immunity to AAV but not Cas9 impairs in utero gene editing in mice
John S. Riley, Valerie L. Luks, Cara L. Berkowitz, Ana Maria Dumitru, Nicole J. Kus, Apeksha Dave, Pallavi Menon, Monique E. De Paepe, Rajan Jain, Li Li, Lorraine Dugoff, Christina Paidas Teefey, Mohamad-Gabriel Alameh, Philip W. Zoltick, William H. Peranteau
John S. Riley, Valerie L. Luks, Cara L. Berkowitz, Ana Maria Dumitru, Nicole J. Kus, Apeksha Dave, Pallavi Menon, Monique E. De Paepe, Rajan Jain, Li Li, Lorraine Dugoff, Christina Paidas Teefey, Mohamad-Gabriel Alameh, Philip W. Zoltick, William H. Peranteau
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Research Article Immunology

Preexisting maternal immunity to AAV but not Cas9 impairs in utero gene editing in mice

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Abstract

In utero gene editing (IUGE) is a potential treatment for inherited diseases that cause pathology before or soon after birth. Preexisting immunity to adeno-associated virus (AAV) vectors and Cas9 endonuclease may limit postnatal gene editing. The tolerogenic fetal immune system minimizes a fetal immune barrier to IUGE. However, the ability of maternal immunity to limit fetal gene editing remains a question. We investigated whether preexisting maternal immunity to AAV or Cas9 impairs IUGE. Using a combination of fluorescent reporter mice and a murine model of a metabolic liver disease, we demonstrated that maternal anti-AAV IgG antibodies were efficiently transferred from dam to fetus and impaired IUGE in a maternal titer–dependent fashion. By contrast, maternal cellular immunity was inefficiently transferred to the fetus, and neither maternal cellular nor humoral immunity to Cas9 impaired IUGE. Using human umbilical cord and maternal blood samples collected from mid- to late-gestation pregnancies, we demonstrated that maternal-fetal transmission of anti-AAV IgG was inefficient in midgestation compared with term, suggesting that the maternal immune barrier to clinical IUGE would be less relevant at midgestation. These findings support immunologic advantages for IUGE and inform maternal preprocedural testing protocols and exclusion criteria for future clinical trials.

Authors

John S. Riley, Valerie L. Luks, Cara L. Berkowitz, Ana Maria Dumitru, Nicole J. Kus, Apeksha Dave, Pallavi Menon, Monique E. De Paepe, Rajan Jain, Li Li, Lorraine Dugoff, Christina Paidas Teefey, Mohamad-Gabriel Alameh, Philip W. Zoltick, William H. Peranteau

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Figure 3

Preexisting maternal immunity to Cas9 endonuclease does not impair fetal liver gene editing.

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Preexisting maternal immunity to Cas9 endonuclease does not impair fetal...
(A) Experimental design. (B) Stereomicroscopy. Numerous mG+ cells were observed in the livers of unsensitized and SpCas9-sensitized offspring at both 2 and 12 weeks after injection. (C) Quantification of liver editing by flow cytometry. Shown is percent mG+mT–/(mG+mT– + mG–mT+) among live CD45–TER119–CD31–EpCAM–E-cadherin+ offspring hepatocytes compared by 2-tailed t test. Comparable editing was observed between the groups in the short and long term. (D) Anti-SpCas9 IgG BAbs. SpCas9-sensitized offspring demonstrated increased levels of anti-SpCas9 IgG BAbs on day of life 10 (2 weeks after injection) by 2-tailed t test, but these fell to levels comparable to those of unsensitized offspring by 12 weeks after injection. (E) T cell analysis. The prevalence of various T cell populations in the liver was assessed by flow cytometry and compared between groups by 2-tailed t test. No maternal T cells were detected in livers of SpCas9-sensitized offspring. Cytotoxic T cells were not present at increased frequency in livers of SpCas9-sensitized offspring, nor was a marker of activation (CD154) increased among them. (F) Liver histology and IHC. H&E slides were prepared and imaged at ×10 original magnification. Normal hepatocyte morphology without lymphocytic infiltration was observed in both groups in the short and long term. To assess for tissue-infiltrating T cells, IHC for CD4 and CD8 was performed and imaged at ×10 original magnification. Scant CD4+ helper T cells and CD8+ cytotoxic T cells were detected in equal frequency between the groups. Scale bars: 200 μm. (G) Serum transaminases. Serum aspartate transaminase (AST) and alanine transaminase (ALT) were measured 2 and 12 weeks after injection and compared between groups by 2-tailed t test. No elevation of AST or ALT was observed among SpCas9-sensitized offspring compared with unsensitized offspring, confirming the absence of hepatocellular injury. *P < 0.05.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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