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Gene-replacement therapy in neurodevelopmental disorders: progress and challenges
Holger Lerche, … , Ulrike B.S. Hedrich, Thomas V. Wuttke
Holger Lerche, … , Ulrike B.S. Hedrich, Thomas V. Wuttke
Published February 3, 2025
Citation Information: J Clin Invest. 2025;135(3):e188703. https://doi.org/10.1172/JCI188703.
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Commentary

Gene-replacement therapy in neurodevelopmental disorders: progress and challenges

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Abstract

Heterozygous loss-of-function variants in the SLC6A1 gene, encoding GAT1, which is the main GABA transporter in the brain, lead to a broad spectrum of neuropsychiatric and neurodevelopmental disorders including epilepsy, developmental delay, intellectual disability, and autism. Gene-replacement strategies involving adeno-associated viruses (AAV) require the delivery of genes to specific types of neurons or areas in the brain, likely during certain developmental time points. In this issue of the JCI, Guo and colleagues from the Gray lab evaluated two promoters, three injection modalities, and various timing strategies for replacement of GAT1 via AAV type 9 in heterozygous and homozygous knockout mouse models. Intrathecal administration of vectors containing either promoter at postnatal day 5 achieved high expression and was the best tolerated approach. Notably, gene-replacement therapy failed at later disease stages, suggesting the importance of early gene reconstitution and confirming the importance of GABA metabolism in early brain development.

Authors

Holger Lerche, Ulrike B.S. Hedrich, Thomas V. Wuttke

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Figure 1

GAT1 is responsible for GABA reuptake after release from presynaptic nerve terminals and was replaced at different developmental time points.

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GAT1 is responsible for GABA reuptake after release from presynaptic ner...
(A) In the presynaptic neuron, vesicles are packed with GABA and GABA is released into the synaptic cleft upon membrane depolarization and activation of the presynaptic release machinery. At the postsynaptic membrane, it binds to and activates ionotropic GABAA receptors mediating synaptic inhibition. Released GABA is cleared by the GABA transporter GAT1, which is primarily expressed in neurons, but also in glial cells (astrocytes and microglia). (B) Evaluation of GAT1 restoration to Slc6a1 knockout mice using AAV vector-based gene therapy involved different injection sites and developmental time points (ICV at P1, intrathecal at P5, P10, and P28, and intravenously [tail vein] at P23). Intrathecal injection at P5 was adopted to balance the risk for mortality, which occurred at earlier time points with the therapeutic effect that diminished with development (3).

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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