Treatment of a metabolic liver disease by in vivo genome base editing in adult mice

L Villiger, HM Grisch-Chan, H Lindsay, F Ringnalda… - Nature medicine, 2018 - nature.com
L Villiger, HM Grisch-Chan, H Lindsay, F Ringnalda, CB Pogliano, G Allegri, R Fingerhut…
Nature medicine, 2018nature.com
CRISPR–Cas-based genome editing holds great promise for targeting genetic disorders,
including inborn errors of hepatocyte metabolism. Precise correction of disease-causing
mutations in adult tissues in vivo, however, is challenging. It requires repair of Cas9-induced
double-stranded DNA (dsDNA) breaks by homology-directed mechanisms, which are highly
inefficient in nondividing cells. Here we corrected the disease phenotype of adult
phenylalanine hydroxylase (Pah) enu2 mice, a model for the human autosomal recessive …
Abstract
CRISPR–Cas-based genome editing holds great promise for targeting genetic disorders, including inborn errors of hepatocyte metabolism. Precise correction of disease-causing mutations in adult tissues in vivo, however, is challenging. It requires repair of Cas9-induced double-stranded DNA (dsDNA) breaks by homology-directed mechanisms, which are highly inefficient in nondividing cells. Here we corrected the disease phenotype of adult phenylalanine hydroxylase (Pah)enu2 mice, a model for the human autosomal recessive liver disease phenylketonuria (PKU), using recently developed CRISPR–Cas-associated base editors, –. These systems enable conversion of C∙G to T∙A base pairs and vice versa, independent of dsDNA break formation and homology-directed repair (HDR). We engineered and validated an intein-split base editor, which allows splitting of the fusion protein into two parts, thereby circumventing the limited cargo capacity of adeno-associated virus (AAV) vectors. Intravenous injection of AAV-base editor systems resulted in Pahenu2 gene correction rates that restored physiological blood phenylalanine (l-Phe) levels below 120 µmol/l . We observed mRNA correction rates up to 63%, restoration of phenylalanine hydroxylase (PAH) enzyme activity, and reversion of the light fur phenotype in Pahenu2 mice. Our findings suggest that targeting genetic diseases in vivo using AAV-mediated delivery of base-editing agents is feasible, demonstrating potential for therapeutic application.
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