JP2016535587A - Aav5カプシドタンパク質を含むアデノ随伴ウイルス(aav)を用いた神経学的疾患の処置 - Google Patents
Aav5カプシドタンパク質を含むアデノ随伴ウイルス(aav)を用いた神経学的疾患の処置 Download PDFInfo
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Abstract
Description
第一の態様において、本発明は、哺乳動物対象、好ましくはヒトにおける医薬としての使用のためのアデノ随伴ウイルス(AAV)遺伝子治療ベクターであって、遺伝子治療ベクターは、AAV血清型5カプシドタンパク質と、AAV ITRに隣接する目的遺伝子産物(gene product of interest)と、を含み、遺伝子治療ベクターは腰部髄腔内投与により投与される、AAV遺伝子治療ベクターに関する。
「核酸構築物」は、天然に存在する遺伝子から単離される、又はその他の点では天然に存在しない方法で組み合わされ、若しくは並置される核酸のセグメントを含むように改変されている核酸分子と規定する。核酸分子はヌクレオチド配列により表される。任意選択により、核酸構築物に存在するヌクレオチド配列は、1つ又は複数の制御配列に作動可能に連結され、制御配列は、細胞又は対象における上記ペプチド又はポリペプチドの産生又は発現を導く。
(a)疾患の素因となり得るが、それを有すると未だ診断されていない対象に疾患が生じるのを防ぐこと
(b)疾患を阻害し、すなわち疾患の発生を抑止すること
(c)疾患を軽減し、すなわち疾患の退行を引き起こすこと
遺伝子のCNSへの送達は、今まで、CNSのサイズ及び複雑さによって阻まれていた。脳実質中へ単回注射した後の導入遺伝子の発現は局所的であり、注入領域に主に制限されたままである。ウイルスベクターを送達するための方法としてCSFを用いると、より広範な領域に到達することができる。本研究により、AAV−5ベクターを用いると、CNSのより広範な領域に形質導入するというこの目的を達成できることが示される。有害な臨床徴候及び明らかなニューロンの喪失が観察されなかったため、処置は耐容性が良好であった。神経細胞及びグリア細胞の両方に、ユビキタスなCAGプロモーターを用いて形質導入し、導入遺伝子の発現はCNSの外に観察されなかった。GFAPプロモーター又はシナプシン−1プロモーターなどの細胞特異的なプロモーターを用いて、特定の集団に対して発現を導くことができる。本発明者らは、皮質、小脳、及び脳室下帯の領域は、神経細胞及びグリア細胞の両方で導入遺伝子の発現を示すことを示した。脊髄では、運動ニューロンへの形質導入及び後根神経節におけるニューロンへの形質導入が優勢だった。これらの結果は、CNS媒介性の送達方法を用いて、遺伝子治療アプローチ用に遺伝子を送達することができることを示す。これが補助となり得る適応症には、運動ニューロン疾患、感覚関連の適応症、及び他の種々の神経学的な適応症があり得る。
本実施例では、CAGプロモーターの制御下で緑色蛍光タンパク質(GFP)をコードするAAV−5ベクターを、非ヒト霊長動物のCSF中に髄腔内注入した。注入4週間後、導入遺伝子の発現を調べた。GFPの発現が、運動ニューロン及び後根神経節(DRG)に、すべての脊髄レベルで観察された。さらに、小脳では、多くのバーグマングリア、及びいくつかのプルキンエ細胞が形質導入された。脳では、皮質も、ニューロン及びグリアの両方でGFPを発現した。脳室下帯(SVZ)に沿った細胞も形質導入された。全体的に、これらの結果は、この注射経路を用いると、CNSの広範な領域が網羅され、CNSに対する遺伝子治療が現実的な選択肢になることを示す。
1.1.1. ベクターの調製
rAAV血清型5(rAAV−5)の発現カセットは、ヒトのcDNA、増強された緑色蛍光タンパク質(EGFP)のcDNA遺伝子を含む。発現は、CAGプロモーター、サイトメガロウイルス(CMV)初期エンハンサーエレメント及びニワトリベータ−アクチンプロモーターの組合せの制御下にある。GFPは、Kozak配列の下流に位置し、またウシ成長ホルモンポリアデニル化(BGHpA)シグナルによってポリアデニル化される。カセット全体が、AAV−2の2つの非コード末端逆位配列に隣接する(図1を参照されたい)。先に記載したものと同様のバキュロウイルス発現系を使用して、組換えAAV−5ベクターを調製した(Urabe et al., 2002, Unzu et al., 2011(Kotin, 2011において概説))。簡潔に述べると、1つは複製及びパッケージング用にREPをコードし、1つはAAV−5のカプシド用にCAP−5をコードし、1つは発現カセットを有する、3つの組換えバキュロウイルスを使用して、SF9昆虫細胞に感染させた。AVBセファロース高速アフィニティーメディア(GE Healthcare,Piscataway,NJ)を使用して精製を行った。導入遺伝子に対するプライマー−プローブの組合せでQ−PCR法を用いてベクターを滴定し、力価を、1ml当たりのゲノムコピーとして表した(GC/ml)。ベクターの力価は1.4E14GC/mlであった。
本研究では、およそ4kgの雄カニクイザル(Cynolmolgus monkey)(Macaca fascicularis)を使用した。動物愛護を評価するために、毎日の健康観察及び周期的な体重測定を記録した。獣医師は研究期間を通じて異常症状を報告しなかった。手順はすべて、Valley Biosystemsの動物実験委員会(Institutional Animal Care and Use Committee)(Sacramento,CA,USA)によって認可された。手順開始前、AAVに対する中和抗体の存在に対して動物を試験し、陰性であった(以下を参照されたい)。手順を行うために、動物を、ケタミン(Ketaset,7mg/kg)及び塩酸デクスメデトミジン(Dexdomitor,0.015mg/kg)の混合物で麻酔した。手術後、全動物に筋肉内用量の塩酸アチパメゾール(Antisedan,0.15mg/kg)を投与して麻酔を解除した。AAV−5投与1か月後、動物を深麻酔し、リン酸緩衝食塩水(PBS)及びPBS中4%パラホルムアルデヒド(PFA)を経心的に潅流した。脳及び器官を収集し、組織学的分析用に加工した。
麻酔を導入した後、動物の頭部を定位フレーム(stereotactic frame)に配置し、腹臥位に曲げ、頸部の背部をポビドン−ヨウ素及びアルコールで清浄にした。1インチの23ゲージニードルを装着した3mlシリンジをマイクロマニピュレータ上に搭載し、手操作でニードルを大槽中に導いた。腰椎部の嚢(lumbar sac)を、脊髄レベルL4〜5の間に同様に接近させた。小体積の脳脊髄液(CSF)をシリンジ中に吸引し、次いでシリンジをマイクロマニピュレータに固定することによって浸透を検証した。次いで、シリンジ上の三方ストップコックを調整して、0.5ml/分のポンプ(3500 Medfusion; Strategic Applications,Libertyville,IL)でベクター3mlを注入した。注入が完了した後、ラインを食塩水0.2mlでフラッシュした。最後に、小体積のCSFを吸引して、ニードルが依然としてCMにあることを検証した。検証後、ニードルをゆっくりと抜いた。こうして、各動物の大槽中に3ml、及び腰椎注射により3mlを投与した。1.4E14GC/mlのAAV−5−CAG−GFPを合計6ml注入した。
発色及び免疫蛍光染色を、前頭前野から小脳及び脊髄まで交互に4つの6mmブロックにわたって40−lmの冠状切片に対して行った。発色GFP染色は、以前に記載されている通りに行った(Hadaczek et al., 2009)。簡潔に述べると、切片をPBS中で洗浄し、PBS中1%H2O2−30%エタノール中で内因性ペルオキシダーゼ活性に対してブロックし、PBST(PBSプラス0.1%Tween20)中ですすいだ。次いで、切片をBackground Sniperブロック溶液(BS966G; Biocare Medical, Concord, CA)中でインキュベートし、Da Vinci Green希釈液(PD900; Biocare Medical)中でGFP(ウサギ抗GFP,1:3000希釈;Millipore,Bedford,MA)に対する一次抗体と4℃で最高24時間、インキュベートした。翌日、PBST中で洗浄した後、切片を、GFP染色に、Rabbit Mach 3 Polymer HRP(RP531L; Biocare Medical)中、周囲温度でインキュベートし、着色を3,3c−ジアミノベンチジン(DAB)(DABペルオキシダーゼ基質キット,SK−4100;Vector Laboratories,Burlingame,CA)で発色させた。次いで、切片をスライド上に搭載し、脱水し、Shandon−Mount(カタログ番号1900333;Thermo Fisher Scientific)と一緒にカバーガラスを被せた。
AAVカプシドに対する抗体の力価を、ベクター投与前の血液試料に対してELISAによって決定した。簡潔に述べると、1mM炭酸バッファー中AAV5カプシド2E10GC/ml溶液を96ウェルタイタープレートに分注し、4℃で一夜インキュベートした。翌日、プレートを洗浄し、PBST中5%無脂肪ミルク溶液でブロックした。血清を、1:50〜1:6400の範囲にわたって希釈し、室温で1時間インキュベートした。次いで、ウェルをPBSTで洗浄し、セイヨウワサビペルオキシダーゼ(HRP)をコンジュゲートさせた抗サル二次抗体(Sigma−Aldrich,St.Louis,MO)と室温で1時間インキュベートした。ウェルをPBST中で再び洗浄し、次いで3,3−5,5−テトラメチルベンチジン(TMB)で発色させた。塩酸を加えることによって反応を停止させ、プレートリーダー上で450nmの吸光度を読み取った(Bevan et al., 2011)。
投薬前:
成年カニクイザル(Cynolmolgus macaque)(Macaca fascicularis)から血液試料をスクリーニング用に採取し、血清抗AAV−5抗体力価、血清臨床化学、及び血液学的評価について分析した。
動物をケタミン(10mg/kg)IM及びメデトミジン(15μg/kg)IMで固定した。脊椎用針(spinal needle)を腰椎領域に配置し、動物のCSF中に(5分にわたり5mLからなる)単回用量のAAV5−CAG−GFPを注射した。これらの動物に異なる3つの用量を投与した(GC合計5E14、5E13、及び5E12)。
CSF注入した動物を、注入8週間後に安楽死させた。各動物を、ケタミン(10〜15mg/kg,IM)及びメデトミジン(15μg/kg)で深麻酔した。動物に安楽死溶液を投薬した。麻酔の深さ(deep plane)(すなわち、爪先つまみ応答(toe pinch response)、角膜反射、及び顎の緊張(jaw tone)の喪失)を検証した後、胸郭切開術を行い、肝臓の一断片を試料採取した。脳及び脊髄を収集し、組織パンチを分子(Q−PCR)分析用に採取した。組織の残りを、組織学的評価用にパラホルムアルデヒド中に貯蔵した。
動物は、手順を良好に耐容した。体重減少は観察されず、また獣医は臨床徴候を認めなかった。
遺伝子のCNSへの送達は、今まで、CNSのサイズ及び複雑さによって阻まれていた。脳中に単回注射した後の導入遺伝子の発現は局所的であり、注入領域に主に制限されたままである。ウイルスベクターを送達するための方法としてCSFを用いると、より広範な領域に到達することができる。本研究により、1E14GC/kgを超える比較的高用量のAAV−5ベクターを用いると、CNSの広範な領域に形質導入するというこの目標を達成ができることが示される。臨床徴候及び明らかなニューロンの喪失が観察されなかったため、処置は耐容性が良好であった。神経細胞及びグリア細胞の両方が、この特異的なCAGプロモーターを用いて形質導入された。GFAPプロモーター又はシナプシン−1プロモーターなどの細胞特異的なプロモーターを用いて、特定の集団に対して発現を導いてもよい。本発明者らは、皮質、小脳、及び脳室下帯の領域は、神経細胞及びグリア細胞の両方で導入遺伝子の発現を示すことを示した。脊髄では、運動ニューロンへの形質導入及び後根神経節におけるニューロンへの形質導入が優勢だった。これらの結果は、CNS媒介性の送達方法を用いて、遺伝子治療アプローチ用に遺伝子を送達することができることを示す。これが補助となり得る適応症には、運動ニューロン疾患、例えば、筋萎縮性側索硬化症(ALS)、脊髄性筋萎縮症(SMA)、又は感覚関連の適応症、例えば疼痛があり得る。このようなアプローチが補助となり得る他の神経学的な適応症には、例えば、ハンチントン病、アルツハイマー病、テイ−セイズ病、フリードライヒ失調症、毛細血管拡張性運動失調症、脊髄小脳失調症(1型、2型、及び3型)、ニーマン・ピック病(A型、B型、及びC型)、ドーパ反応性ジストニア、脆弱X染色体症候群、クラッベ病、糖原病2型(ポンペ)、原発性側索硬化症、ペリツェウス−メルツバッハー病、X連鎖性副腎白質ジストロフィー、巨大軸索ニューロパチー、多系統萎縮症(MSA)、近位型筋緊張性ミオパチー、及び神経セロイドリポフスチン症(バッテン病)がある。
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Claims (15)
- 哺乳動物対象における医薬としての使用のためのアデノ随伴ウイルス(AAV)遺伝子治療ベクターであって、該遺伝子治療ベクターは、AAV血清型5カプシドタンパク質と、AAV ITRに隣接する目的遺伝子産物と、を含み、該遺伝子治療ベクターは腰部髄腔内投与により投与される、AAV遺伝子治療ベクター。
- 腰部髄腔内投与は、L4〜L5、L3〜L4、L1〜L2、及びL2〜L3からなる群から選択される位置におけるものである、請求項1に記載のAAV遺伝子治療ベクター。
- 一本鎖AAV遺伝子治療ベクター又はモノマーの二本鎖ベクターである、請求項1又は請求項2に記載のAAV遺伝子治療ベクター。
- 目的遺伝子産物は、筋萎縮性側索硬化症(ALS)、脊髄性筋萎縮症(SMA)、疼痛、ハンチントン病、アルツハイマー病、テイ−セイズ病、フリードライヒ失調症、毛細血管拡張性運動失調症、脊髄小脳失調症1型、2型、及び3型、ニーマン・ピック病A型、B型、及びC型、ドーパ反応性ジストニア、脆弱X染色体症候群、クラッベ病、糖原病2型(ポンペ)、原発性側索硬化症、ペリツェウス−メルツバッハー病、X連鎖性副腎白質ジストロフィー、巨大軸索ニューロパチー、多系統萎縮症(MSA)、近位型筋緊張性ミオパチー、神経セロイドリポフスチン症(バッテン病)、及び癌からなる群から選択される状態の処置又は予防における使用のためのものである、請求項1〜3のいずれか一項に記載のAAV遺伝子治療ベクター。
- AAV ITRはAAV血清型2 ITRである、請求項1〜4のいずれか一項に記載のAAV遺伝子治療ベクター。
- 目的遺伝子産物は、アスパルチルグルコサミニダーゼ、α−ガラクトシダーゼA、パルミトイルタンパク質チオエステラーゼ、トリペプチジルペプチダーゼ、リソソーム膜貫通タンパク質、複数の遺伝子産物、システイントランスポーター、酸性セラミダーゼ、酸性α−L−フコシダーゼ、保護タンパク質/カテプシンA、酸性β−グルコシダーゼ又はグルコセレブロシダーゼ、酸性β−ガラクトシダーゼ、イズロン酸−2−スルファターゼ、α−L−イズロニダーゼ、ガラクトセレブロシダーゼ、酸性α−マンノシダーゼ、酸性β−マンノシダーゼ、アリールスルファターゼB、アリールスルファターゼA、N−アセチルガラクトサミン−6−硫酸スルファターゼ、酸性β−ガラクトシダーゼ、N−アセチルグルコサミン−1−ホスホトランスフェラーゼ、酸性スフィンゴミエリナーゼ、NPC−1、酸性α−グルコシダーゼ、β−ヘキソサミニダーゼB、ヘパランN−スルファターゼ、α−N−アセチルグルコサミニダーゼ、アセチル−CoA:α−グルコサミニドN−アセチルトランスフェラーゼ、N−アセチルグルコサミン−6−硫酸スルファターゼ、α−N−アセチルガラクトサミニダーゼ、α−N−アセチルガラクトサミニダーゼ、α−ノイラミダーゼ、β−グルクロニダーゼ、β−ヘキソサミニダーゼA、酸性リパーゼ、神経栄養因子、例えば、神経成長因子(NGF)、ニューロトロフィン−3(NT−3)、ニューロトロフィン−4/5(NT−4/5)、脳由来神経栄養因子(BDNF)、脳ドーパミン神経栄養因子(CDNF)、グリア細胞株由来神経栄養因子(GDNF)、繊毛様神経栄養因子(CNTF)、成長因子インスリン様成長因子(IGF−1)、及び欠陥遺伝子のダウンレギュレーションのためのmiRNAからなる群から選択される、請求項1〜5のいずれか一項に記載のAAV遺伝子治療ベクター。
- 目的遺伝子産物は、運動ニューロン及び/又はDRGにおけるニューロンに関連する状態の処置又は予防における使用のためのものである、請求項1〜6のいずれか一項に記載のAAV遺伝子治療ベクター。
- 目的遺伝子産物は、治療効果を得るのに十分な目的遺伝子産物の発現を生じさせるプロモーターを含む発現制御エレメントに作動可能に連結しており、プロモーターは、好ましくは、サイトメガロウイルス(CMV)プロモーター、ホスホグリセリン酸キナーゼ(PGK)、CAGプロモーター(サイトメガロウイルス初期エンハンサーエレメント及びニワトリベータ−アクチンプロモーターの組合せ)、グリア線維性酸性タンパク質(GFAP)プロモーター、シナプシン−1プロモーター、ニューロン特異的エノラーゼ(NSE)、及びGene Switch若しくはtet−オペロン由来プロモーターなどの誘導プロモーターからなる群から選択される、請求項1〜7のいずれか一項に記載のAAV遺伝子治療ベクター。
- 腰部髄腔内投与の前に、同時に、又は後に大槽中にさらに投与される、請求項1〜8のいずれか一項に記載のAAV遺伝子治療ベクター。
- 体重1キログラム当たり2×1013〜2×1015ゲノムコピーが対象に投与される、請求項1〜9のいずれか一項に記載のAAV遺伝子治療ベクター。
- 体重1キログラム当たり8×1013〜6×1014ゲノムコピーが対象に投与される、請求項10に記載のAAV遺伝子治療ベクター。
- 前記対象は、頭蓋内圧を制御する、及び/又はCNS微小血管系の内皮細胞間の細胞間タイトジャンクションを破壊し得る、及び/又は化学療法薬などの薬物のCNSへの送達を促進する物質による前処置を受けていない、請求項1〜11のいずれか一項に記載のAAV遺伝子治療ベクター。
- 前記対象は、AAV遺伝子治療ベクターの腰部髄腔内投与前に静脈内マンニトール前処置を受けていない、請求項1〜12のいずれか一項に記載のAAV遺伝子治療ベクター。
- 哺乳動物対象はヒトである、請求項1〜13のいずれか一項に記載のAAV遺伝子治療ベクター。
- 自己相補的遺伝子ベクターではない、請求項1〜14のいずれか一項に記載のAAV遺伝子治療ベクター。
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JP2021531044A (ja) * | 2018-07-27 | 2021-11-18 | レジェンクスバイオ インコーポレーテッド | ムコ多糖症iva型の治療 |
JP2022513034A (ja) * | 2018-11-14 | 2022-02-07 | レジェンクスバイオ インコーポレーテッド | 神経セロイドリポフスチン症の遺伝子治療 |
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CN105745326A (zh) | 2016-07-06 |
JP6873699B2 (ja) | 2021-05-19 |
AU2014337783A1 (en) | 2016-05-05 |
EA201690842A1 (ru) | 2016-10-31 |
US20160243260A1 (en) | 2016-08-25 |
JP2019216724A (ja) | 2019-12-26 |
EP3060669A1 (en) | 2016-08-31 |
CA2927366A1 (en) | 2015-04-30 |
AU2014337783B2 (en) | 2020-07-02 |
EA036394B1 (ru) | 2020-11-05 |
WO2015060722A1 (en) | 2015-04-30 |
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