Yvonne K. Y. Lai

Adenovirus and Adeno-Associated Virus Vectors

Recombinant adenovirus (rAd) and recombinant adeno-associated virus (rAAV) are among the most extensively used vectors in gene therapy studies to date. These two vectors share some similar features such as a broad host range and ability to infect both proliferating and quiescent cells. However, they also possess their own unique set of properties that render them particularly attractive for gene therapy applications. rAd vectors can accommodate larger inserts, mediate transient but high levels of protein expression, and can be easily produced at high titers. Development of gutted rAd vectors has further increased the cloning capacity of these vectors. The gaining popularity of rAAV use in gene therapy can be attributed to its lack of pathogenicity and added safety due to its replication defectiveness, and its ability to mediate long-term expression in a variety of tissues. Site-specific integration, as occurs with wild-type AAV, will be a unique and valuable feature if incorporated into rAAV vectors, further improving their safety. This paper describes these properties of rAd and rAAV vectors, and discusses further development and vector improvements that continue to extend the utility of these vectors, such as cell retargeting by capsid modification, differential transduction by use of serotypes, and extension of the cloning capacity of rAAV vectors by dual vector heterodimerization.

Inhibition of angiogenesis by adenovirus-mediated sFlt-1 expression in a rat model of corneal neovascularization

Pathological angiogenesis, or the production of new capillary vessels from preexisting vasculature, within the eye is a serious event that often leads to blindness. Upregulation of vascular endothelial growth factor (VEGF) has been linked to neovascularization in the eye, suggesting that it could be a suitable target to inhibit angiogenic changes. This work investigated whether the presence of a proven antiangiogenic factor, the soluble variant of the VEGF receptor, sFlt-1, in the anterior chamber is sufficient to inhibit new vessel formation in the cornea in an animal model of corneal neovascularization. A recombinant adenovirus vector that can mediate efficient in vivo gene transfer and expression in ocular cells was selected as a delivery agent. We have shown that after the injection of Ad.betagal into the anterior chamber of normal and cauterized rat eyes, corneal endothelial cells and cells of the trabecular meshwork were efficiently transduced and that beta-galactosidase (beta-Gal) expression was maintained up to 10 days postinjection. Cauterization significantly increased the amount of immunoreactive VEGF in vehicle- or Ad.null-injected animals (t test, p < 0.001 and p < 0.001, respectively). However, when cauterization was combined with Ad.sflt injection there was no statistically significant increase in the amount of immunoreactive VEGF (p = 0.12). The injection of Ad.sflt into the anterior chamber slowed or inhibited VEGF-induced angiogenic changes. After cauterization, 100% of uninjected and vehicle-injected and 82% of Ad.null-injected animals developed moderate to severe corneal angiogenesis in contrast to 18% of Ad.sflt-injected animals. These in vivo results suggest that the transient presence of antiangiogenic agents in the anterior chamber can be successfully used to inhibit the development of corneal angiogenesis.

Generation of transgenic mice with mild and severe retinal neovascularisation

Aim: To generate a mouse model for slow progressive retinal neovascularisation through vascular endothelial growth factor (VEGF) upregulation. Methods: Transgenic mice were generated via microinjection of a DNA construct containing the human VEGF165 (hVEGF) gene driven by a truncated mouse rhodopsin promoter. Mouse eyes were characterised clinically and histologically and ocular hVEGF levels assayed by ELISA. Results: One transgenic line expressing low hVEGF levels showed mild clinical changes such as focal fluorescein leakage, microaneurysms, venous tortuosity, capillary non-perfusion and minor neovascularisation, which remained stable up to 3 months postnatal. Histologically, there were some disturbance and thinning of inner and outer nuclear layers, with occasional focal areas of neovascularisation. By contrast, three other lines expressing high hVEGF levels presented with concomitantly severe phenotypes. In addition to the above, clinical features included extensive neovascularisation, haemorrhage, and retinal detachment; histologically, focal to extensive areas of neovascularisation associated with retinal folds, cell loss in the inner and outer nuclear layers, and partial retinal detachment were common. Conclusions: The authors generated four hVEGF overexpressing transgenic mouse lines with phenotypes ranging from mild to severe neovascularisation. These models are a valuable research tool to study excess VEGF related molecular and cellular changes and provide additional opportunities to test anti-angiogenic therapies.

Long-term effect of therapeutic laser photocoagulation on gene expression in the eye

Microarray‐based gene expression analysis demonstrated that laser photocoagulation (LPC) of mouse eyes had a long‐term effect on the expression of genes functionally related to tissue repair, cell migration, proliferation, ion, protein and nucleic acid metabolism, cell signaling, and angiogenesis. Six structural genes, including five crystallins (Cryaa, Cryba1, Crybb2, Crygc, Crygs) and keratin 1–12 (Krt1–12), the anti‐angiogenic factor thrombospondin 1 (Tsp1), the retina‐ and brain‐specific putative transcription factor tubby‐like protein 1 (Tulp1), and transketolase (Tkt), a key enzyme in the pentose‐phosphate pathway, were all shown to be up‐regulated by real‐time PCR and/or Western blotting. Immunohistochemistry localized five of these proteins to the laser lesions and surrounding tissue within the retina and pigmented epithelium. This is the first study demonstrating long‐term changes in the expression of these genes associated with LPC. Therefore, it suggests that modulated gene expression might contribute to the long‐term inhibitory effect of LPC. In addition, these genes present novel targets for gene‐based therapies aimed at treating microangiopathies, especially diabetic retinopathy, a disease currently only treatable with LPC.

Practical considerations of recombinant adeno-associated virus-mediated gene transfer for treatment of retinal degenerations

Photoreceptor (PR) and retinal pigment epithelium (RPE) are the principal cell targets in retinal gene therapy. Recombinant adeno‐associated virus (rAAV) has emerged as a very promising vector for gene therapy in hereditary retinal diseases. Gene transfer at different stages of the disease is a practical consideration for future clinical application.

Development and evaluation of the specificity of a cathepsin D proximal promoter in the eye

Purpose: Recombinant adeno-associated virus (rAAV)-mediated gene delivery has emerged as a valuable tool for alternative treatment of ocular diseases. Cellular specificity of transgene expression could be influenced by either the viral capsid or the choice of promoter. The use of cellular promoter, cathepsin D (CatD) proximal promoter, and its potential for application in rAAV-based gene therapy are evaluated in this study. Materials and methods: Different sizes of CatD proximal promoter fragments –769 to –1 (CD768), –366 to –1 (CD365), –253 to –1 (CD252), and –124 to –1 (CD123) were subcloned upstream of the green fluorescent protein (GFP) gene. The specificity and activity of the promoter were tested in vitro using human retinal pigment epithelium (RPE) cell lines (RPE51, D407), with the human fibroblast cell line (F2000) used as control. The promoter fragment that showed higher activity in RPE cells was chosen to generate rAAV vector based on AAV serotype 2. The ability of CatD promoter to target transgene expression to RPE in vivo was determined following subretinal delivery of rAAV particles into nonpigmented RCS/rdy+ rats. Results: In vitro studies showed that the proximal promoter fragment CD365 targeted highGFP expression in RPE cells. This fragment was then used to generate the AAV.CD365.gfp construct. It was shown in vivo that following subretinal injection, the CD365 fragment in AAV.CD365.gfp directed GFP expression preferentially into RPE cells. Relatively lower level of GFP expression was detected in the neuroretina. In contrast, injection of control virus (AAV.CMV.gfp) resulted in equal levels of transduction and fluorescence signal intensity in both the RPE and photoreceptor cells. Conclusions: The results of our study demonstrate that the promoter fragment CD365 has the potential to target preferential gene expression in the RPE following subretinal injection in rAAV-mediated gene therapy.

Impurity of recombinant adeno-associated virus type 2 affects the transduction characteristics following subretinal injection in the rat.

We recently reported that different purification methods of recombinant adeno-associated virus type 2 (rAAV2) affect the transduction characteristics following subretinal injection. In this study, we examined the roles of contaminant proteins from the HEK-293 cells and helper adenovirus, inactivation of helper adenovirus and cell stress induced by DNA-damaging agents in rAAV-mediated retinal transduction. Our results showed that contaminating factors/proteins resulting from the helper E1 deleted adenovirus are possibly responsible for efficient RPE transduction. Future studies of these factors will undoubtedly lead to development of new therapeutic approaches to PR- and RPE-specific retinal diseases.

Pathological Heterogeneity of Vasoproliferative Retinopathy in Transgenic Mice Overexpressing Vascular Endothelial Growth Factor in Photoreceptors

Retinal neovascularization is a feature shared by many disease processes including diabetic retinopathy, retinopathy of prematurity, branch retinal vein occlusion and central retinal vein occlusion, which are collectively referred to as ischemic retinopathy (Campochiaro, 2000). Retinal neovascularization is the most common cause of blindness in young diabetic patients. Investigations of the pathogenic mechanisms and therapeutic interventions for retinal neovascularization require reproducible and clinically related animal models. Currently, all diabetic models exhibit only early retinal vasculopathy after 1 or 2 years of the disease (Kondo and Kahn, 2004). The lack of retinal neovascularization in diabetic models is probably due to the natural short life span of rodents (2–3 years). In humans, DR is detected only after at least 3 years of diabetes (Dorchy et al., 2002). As angiogenesis is tightly controlled by the relative balance of stimulators and inhibitors, a shift in their balance, such as increased expression of vascular endothelial growth factor (VEGF) or decreased production of pigment epithelium-derived factor, would initiate angiogenesis (Okamoto et al., 1997; Ruberte et al., 2004; Renno et al., 2002). It is clear from literature that ischemia-induced upregulation of VEGF is a potent mediator of retinal neovascularization (Campochiaro, 2000; Miller, 1997). Animal models of retinal neovascularization have been established by oxygen-induced retinal ischemia, photodynamically-induced retinal branch vein occlusion and intravitreal implantation of VEGF sustained-release pellets (Campochiaro, 2000; Saito et al., 1997; Ozaki et al., 1997; Tolentino et al., 2002). However, retinal neovascularization in these animal models is either transient or occurs with a delayed onset.

Virus-mediated secretion gene therapy--a potential treatment for ocular neovascularization.

Ocular neovascularization (NV) is a severe and major complication of many ocular conditions such as age-related macular degeneration, diabetic retinopathy, retinopathy of prematurity and retinal vein occlusion. The uncontrolled growth of blood vessels and its associated vascular hyperpermeability are the most common pathologic causes of vision loss in developed countries. Current conventional therapies can only provide symptomatic treatment for a limited subset of patients, often induce adverse effects and disease recurrence is common. Therefore, gene therapy aimed at blocking the underlying stimuli for new vessel growth is a potentially more effective treatment.

Potential Use of Cellular Promoter(s) to Target RPE in AAV-Mediated Delivery

Gene therapy has been reported to show potential as an alternative treatment to conventional therapy. In ocular research, recombinant adeno-associated virus (rAAV) has been chosen as a vector of interest due to its low immunogenicity, its broad host range and its ability to result in long-term transduction (Ali et al., 1997; Bennett and Maguire, 2000).