JP2022020839A - 筋ジストロフィーを治療するためのマイクロジストロフィンのアデノ随伴ウイルスベクター送達 - Google Patents
筋ジストロフィーを治療するためのマイクロジストロフィンのアデノ随伴ウイルスベクター送達 Download PDFInfo
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Abstract
Description
技術分野
Acad Sci U S A,2007.104(43):p.17016-21)。最近、miR-29の下方調節は、心臓線維症の一因となることが示され(Cacchiarelli et al.,Cell Metab,2010.12(4):p.341-51)、miR-29の発現の減少は、ヒトDMD患者の筋肉と遺伝的に関連していた(Eisenberg et al.Proc Natl Acad Sci U S A,2007.104(43):p.17016-2)。miR-29ファミリーは、2つのバイシストロン性miRNAクラスターから発現する3つのファミリーメンバーからなる。MiR-29aは、miR-29b(miR-29b-1)と同時発現し、miR-29cは、miR-29bの第2のコピー(miR-29b-2)と同時発現する。miR-29ファミリーは保存されたシード配列を共有し、miR-29a及びmiR-29bはそれぞれmiR-29cから1塩基だけ異なる。さらに、mdxマウス筋肉へのmiR-29プラスミド(miR-29a及びmiR-29b-1のクラスター)のエレクトロポレーションは、ECM成分、コラーゲン、及びエラスチンの発現レベルを低下し、治療の25日以内に筋肉切片におけるコラーゲン沈着を大幅に減少させた(Cacchiarelli et al.,Cell Metab,2010.12(4):p.341-51)。
et al.,J Gen Virol,75:3385-3392(1994)によって修正されたSrivastava et al.,J Virol,45:555-564(1983)に提示されている。他の例としては、AAV-1の完全ゲノムは、GenBank受入番号NC_002077に提供されており、AAV-3の完全ゲノムは、GenBank受入番号NC_1829に提供されており、AAV-4の完全ゲノムは、GenBank受入番号NC_001829に提供されており、AAV-5ゲノムは、GenBank受入番号AF085716に提供されており、AAV-6の完全ゲノムは、GenBank受入番号NC_001862に提供されており、AAV-7及びAAV-8ゲノムの少なくとも一部分は、それぞれ、GenBank受入番号AX753246及びAX753249に提供されており(AAV-8に関して米国特許第7,282,199号及び第7,790,449号も参照)、AAV-9ゲノムは、Gao et al.,J.Virol.,78:6381-6388(2004)に提供されており、AAV-10ゲノムは、Mol.Ther.,13(1):67-76(2006)に提供されており、AAV-11ゲノムは、Virology,330(2):375-383(2004)に提供されている。AAVrh74血清型は、Rodino-Klapac et al.J.Trans.Med.5:45(2007)に記載されている。ウイルスDNA複製(rep)、カプシド形成/パッケージング、及び宿主細胞染色体組込みを指示するCis作用配列は、ITR内に含有される。3つのAAVプロモーター(それらの相対マップ位置に対してp5、p19、及びp40と名付けられる)は、rep及びcap遺伝子をコードする2つのAAV内部オープンリーディングフレームの発現を駆動する。単一AAVイントロンの差異的スプライシングにより(例えば、AAV2ヌクレオチド2107及び2227において)連結された2つのrepプロモーター(p5及びp19)は、rep遺伝子からの4つのrepタンパク質(rep78、rep68、rep52、及びrep40)の生成をもたらす。repタンパク質は、最終的にウイルスゲノムの複製に関与する複数の酵素特性を有する。cap遺伝子は、p40プロモーターから発現され、3つのカプシドタンパク質VP1、VP2、及びVP3をコードする。選択的スプライシング及び非コンセンサス翻訳開始部位は、3つの関連カプシドタンパク質の産生に関与する。単一コンセンサスポリアデニル化部位は、AAVゲノムのマップ位置95に位置する。AAVの生活環及び遺伝学は、Muzyczka,Current Topics in Microbiology and Immunology,158:97-129(1992)においてレビューされる。
DMD及び他の筋ジストロフィーに罹患している患者における機能改善には、遺伝子回復及び線維症の軽減の両方が必要である。DMD及び他の筋ジストロフィーのより効果的な治療のための遺伝子回復法で修復され得る線維症を軽減する方法が必要とされている。miR29は、筋線維症を軽減するための潜在的な遺伝子調節因子であり、理想的な候補である。
「併用療法」及び「併用治療」という用語は、miR-29を発現する本発明のrAAVベクター及びマイクロジストロフィンを発現するrAAVベクターの投与を指す。
本発明は、例えば、以下の項目を提供する。
(項目1)
a)配列番号7のヌクレオチド配列と少なくとも85%の同一性を有し、機能性マイクロジストロフィンタンパク質をコードするヌクレオチド配列、
b)配列番号7のヌクレオチド配列、または
c)配列番号9のヌクレオチド配列を含む、組換えAAVベクター。
(項目2)
前記ベクターが、血清型AAV1、AAV2、AAV4、AAV5、AAV6、AAV7、AAVrh74、AAV8、AAV9、AAV10、AAV11、AAV12、またはAAV13である、項目1に記載の組換えAAVベクター。
(項目3)
前記ポリヌクレオチド配列が、筋特異的制御要素に作動可能に連結される、項目1または2に記載の組換えAAVベクター。
(項目4)
前記筋特異的制御要素が、ヒト骨格アクチン遺伝子要素、心臓アクチン遺伝子要素、筋細胞特異的エンハンサー結合因子mef、筋クレアチンキナーゼ(MCK)、短縮MCK(tMCK)、ミオシン重鎖(MHC)、C5-12、マウスクレアチンキナーゼエンハンサー要素、骨格速筋トロポニンC遺伝子要素、遅筋心臓トロポニンC遺伝子要素、遅筋トロポニンI遺伝子要素、低酸素誘発性核因子、ステロイド誘発性要素、またはグルココルチコイド応答要素(gre)である、項目3に記載の組換えAAVベクター。
(項目5)
前記筋特異的制御要素が、配列番号10または配列番号11のヌクレオチド配列を含む、項目3または4に記載の組換えAAVベクター。
(項目6)
項目1~5のいずれか一項に記載の組換えAAVベクターを含む、組成物。
(項目7)
治療有効量の項目1~5のいずれか一項に記載の組換えAAVベクターまたは項目6に記載の組成物を投与することを含む、筋ジストロフィーまたはジストロフィン異常症を治療する方法。
(項目8)
治療有効量の項目1~5のいずれか一項に記載の組換えAAVベクターまたは項目6に記載の組成物を投与することを含む、筋ジストロフィーまたはジストロフィン異常症に罹患している対象における線維症を軽減または予防する方法。
(項目9)
治療有効量の項目1~5のいずれか一項に記載の組換えAAVベクターまたは項目6に記載の組成物を投与することを含む、筋ジストロフィーまたはジストロフィン異常症に罹患している対象における筋力または筋肉量を増加する方法。
(項目10)
前記組換えAAVベクターまたは前記組成物が、筋肉内注射、静脈内注射、非経口投与、または全身投与により投与される、項目7~9のいずれか一項に記載の方法。
(項目11)
前記組換えAAVが、前記対象において線維症が観察される前に、または前記対象において筋力が減少する前に、または前記対象において筋肉量が減少する前に投与される、項目7~10のいずれか一項に記載の方法。
(項目12)
前記筋ジストロフィーが、デュシェンヌ型筋ジストロフィーまたはベッカー型筋ジストロフィーである、項目7~11のいずれか一項に記載の方法。
(項目13)
筋ジストロフィーの治療のための、項目1~5のいずれか一項に記載の組換えAAVベクターを含む組成物。
(項目14)
筋ジストロフィーに罹患している対象における線維症を軽減または予防するための、項目1~5のいずれか一項に記載の組換えAAVベクターを含む組成物。
(項目15)
筋ジストロフィーに罹患している対象における筋力を増加するための、項目1~5のいずれか一項に記載の組換えAAVベクターを含む組成物。
(項目16)
前記組成物が、前記対象において線維症が観察される前に、または前記対象において筋力が減少する前に、または前記対象において筋肉量が減少する前に投与される、項目13~15のいずれか一項に記載の組成物。
(項目17)
前記対象が、デュシェンヌ型筋ジストロフィーまたはベッカー型筋ジストロフィーに罹患している、項目13~16のいずれか一項に記載の組成物。
(項目18)
筋ジストロフィーの治療用の薬剤の調製のための、項目1~5のいずれか一項に記載の組換えAAVベクターまたは項目6に記載の組成物の使用。
(項目19)
筋ジストロフィーに罹患している対象における線維症の軽減または予防用の薬剤の調製のための、項目1~5のいずれか一項に記載の組換えAAVベクターまたは項目6に記載の組成物の使用。
(項目20)
筋ジストロフィーに罹患している対象における筋力または筋肉量の増加用の薬剤の調製のための、項目1~5のいずれか一項に記載の組換えAAVベクターまたは項目6に記載の組成物の使用。
(項目21)
前記薬剤が、前記対象において線維症が観察される前に、または前記対象において筋力が減少する前に、または前記対象において筋肉量が減少する前に投与される、項目16~18のいずれか一項に記載の使用。
(項目22)
前記対象が、デュシェンヌ型筋ジストロフィーまたはベッカー型筋ジストロフィーに罹患している、項目18~21のいずれか一項に記載の使用。
(項目23)
前記組成物または薬剤が、筋肉内投与、静脈内注射、非経口投与、または全身投与用に製剤化される、項目13~22のいずれか一項に記載の組成物または使用。
(項目21)
宿主細胞を項目1~5のいずれか一項に記載の組換えAAVベクターで感染させることと、前記宿主細胞中に機能性マイクロジストロフィンタンパク質を発現させることとを含む、機能性マイクロジストロフィンタンパク質の産生方法。
本発明の組換えAAVゲノムは、本発明の核酸分子及び核酸分子に隣接する1つ以上のAAV ITRを含む。rAAVゲノム内のAAV DNAは、組換えウイルスが由来し得る任意のAAV血清型からであり得、AAV血清型 AAV-1、AAV-2、AAV-3、AAV-4、AAV-5、AAV-6、AAV-7、AAV-8、AAV-9、AAV-10、AAV-11、AAV-12、及びAAV-13が挙げられるが、これらに限定されない。偽型rAAVの生成は、例えば、国際公開第01/83692号に開示される。他のタイプのrAAV変異体、例えば、カプシド変異を有するrAAVも企図される。例えば、Marsic et al.,Molecular Therapy,22(11):1900-1909(2014)を参照されたい。上記の背景部分に記載されるように、様々なAAV血清型のゲノムのヌクレオチド配列が、当該技術分野において既知である。骨格筋特異的発現を促進するために、AAV1、AAV6、AAV8、またはAAVrh.74を使用することができる。
デュシェンヌ型筋ジストロフィーモデルの確認
mdxマウスは、DMD病因を研究するための、便利だがまだ不完全な、動物モデルを提供する。このモデルは、mdxマウスとユートロフィン遺伝子のヘテロ接合型ノックアウトとの交配(mdx:utrn+/-)であり、増加した線維症を呈し、ヒトDMDの病理をより忠実に再現する。Mdxマウスは、比較的軽度の表現型及びほぼ正常な寿命をもたらすDMDのエクソン23にナンセンス突然変異を有する。3週齢までに、mdxマウスの横隔膜及び四肢筋は、筋内膜炎症の徴候を発現する。これらの症状は、マウスが成体期に達した後の四肢筋では鎮静するが、横隔膜筋における炎症は徐々に悪化し続ける。テロメラーゼを欠くmdxマウスでは、筋ジストロフィーは齢と共に次第に悪化し、ユートロフィンを欠くmdxマウス(DKO)は、早期発症筋力低下、重度線維症、及び早期死亡を伴うヒトDMDにより特徴的な表現型を有する。ジストロフィンの常染色体パラログであるユートロフィンは、二重KO(ジストロフィン+ユートロフィン)のmdxマウスにおけるジストロフィンの欠如を補い得る高度の配列相同性を共有し、早期死亡を伴う重度の表現型が観察される。DKOマウスにおける早期死亡は炎症及び線維症の進行を排除するが、mdx:utrn+/-マウスは、顕著な程度の線維症、及びDKOよりも長い生存期間を示す、ヒト疾患との類似性を有するモデルを提示し、提案する変換研究のためのより良好なモデルを提供する。最近の報告では、mdx:utrn+/-マウスの使用は、DMDとの関連で線維症を研究するのに理想的なモデルとして確認されている。本研究では、シリウスレッド染色により測定される線維症の増加は、コラーゲン転写物レベルの増加及びmir29cレベルの減少を伴った。
DMDマウスへのmiR29の送達は線維症を軽減する
予備研究は、ヒトDMD患者及びmdx/utrn+/-マウスにおいて、コラーゲンについてのシリウスレッド染色の有意な増加及びmiR-29cレベルの減少があることを実証している。筋特異的AAVベクターを用いたmiR-29の遺伝子送達は、潜在的に安全かつ効率的である。本明細書においてrAAVrh.74.CMV.miR29cと称されるrAAVベクターを生成するために、22ヌクレオチドmiR29c配列(標的鎖配列番号3及びガイド鎖配列番号4)を、CMVプロモーターによって駆動されるmiR-30スカフォールドにクローニングした。発現カセット(配列番号2)を自己相補的AAVプラスミドにクローニングし、筋肉中でよく発現することが知られている血清型AAVrh.74を用いてパッケージングした。miR-29c cDNAは、miR-30骨格にmiR-30c標的(センス)鎖、miR-30ステムループ、及びmiR-29cガイド(アンチセンス)鎖を含むカスタムプライマーを用いて合成した。miR-29c配列の3つの塩基を改変した。次いで、この配列を、CMVプロモーター及びポリA配列によって駆動される自己相補的AAV ITR含有プラスミドにクローニングした。
MiR-29cの注射はコラーゲンを減少させ、miR-29cを回復させる
rAAVrh.74.CMV.MiR-29cが線維症を軽減することができるかを決定するために、12週齢のmdx/utrn+¥-マウスは、左腓腹(GAS)筋に5x1011vgのrAAVrh.74.CMV.MiR-29cの筋肉内注射を受けた。注射の12週間後にマウスを分析した。ピクロシリウスレッド染色は、未治療反対側mdx/utrn+/-GAS筋と比較して、GAS筋(図2a)全体にわたるコラーゲン染色の有意な減少を明らかにした。ピクロシリウスレッド染色の定量化は、被治療筋肉が未治療筋肉と比較してコラーゲンの18.3%減少を有したことを示す(被治療-23.3%±1.3対未治療-29.5%±0.7)(図2b)。被治療筋肉におけるmiR-29cの過剰発現を確認するために、24週齢のWT、miR-29c治療マウス、及びmdx/utrn+/-マウスからのGAS筋から全RNAを抽出し、miR-29c発現についての定量逆転写PCR(qRT-PCR)分析に供した。結果は、未治療マウスと比較して、被治療マウスのGAS筋においてmiR-29cが有意に増加したことを示した(図2d)。
MiR-29cは絶対及び比筋力を改善するが、収縮誘発性損傷に対して保護しない
線維症が筋機能に影響を与え得ることは分かっているので、MiR-29cの発現を増加させることによる線維症の軽減が収縮誘発性損傷からmdx/utrn+/-筋肉を保護し、全体的な力を増加させるかを試験したかった。rAAVrh.74.CMV.MiR-29cで治療されたmdx/utrn+/-マウスからの腓腹筋の機能特性を評価した。注射の12週間後、GASを単離してインビボ力測定を行った。
マイクロジストロフィンとの同時送達は線維症をさらに軽減する
miR-29c/マイクロジストロフィン併用遺伝子療法アプローチが線維症を軽減するのにより有益であるかを決定するために、12週齢のmdx/utrn+¥-マウスは、左腓腹筋に5x1011vgのrAAVrh.74.CMV.MiR-29cの筋肉内注射を受けた。以下の遺伝子療法ベクター:scAAVrh.74.CMV.miR-29c単独、rAAVrh.74.MCK.マイクロジストロフィンとの同時送達、及びrAAVrh.74.MCK.マイクロジストロフィン単独を、3ヶ月齢のmdx/utrn+/-マウス、DMDマウスモデルの左腓腹筋(GAS)筋への筋肉内注射(IM)によって投与した。
絶対力のさらなる増加及び収縮誘発性損傷からの保護の追加
miR-29治療筋肉が絶対力及び比力の控えめだが有意な増加を有したことがわかったので、miR-29c過剰発現及びマイクロジストロフィン遺伝子置換の併用療法の筋機能への影響を調べた。注射の12週間後、GASを単離し、インビボ力測定を行った。実施例2で上記したrAAVrh.74.MiR-29cベクター及びrAAV
併用療法は筋肥大及び過形成を増加させる
マイクロジストロフィンと同時送達されたMiR-29cは、3ヶ月齢で単独で注射されたいずれか一方と比較して、被注射腓腹筋の全重量を増加させた(図8、図9a)。筋肉量の増加の原因を調べるために、筋線維直径を測定する。miR-29c/μ-dys併用治療は、平均線維サイズの増加を示した。mdx/utrn+/-対照をmiR-29c/μ-dys治療mdx/utrn+/-と比較して、平均直径は25.96から30.97μmに増加した(図9b)。同時送達は野生型線維サイズ分布へのシフトをもたらした(図9c)。平均線維サイズは増加したが、総筋肉重量の~30%増加は説明されない。筋肉の総断面積も測定した。すべての群からの腓腹筋をフルスライドスキャンし、総面積を測定した。マイクロジス/miR-29cで併用治療された筋肉は、未治療及びいずれかの単剤治療と比較して断面積の有意な増加を有した(未注射:24.6対miR-29c:26.3対マイクロジス:26.6対マイクロジス/miR-29c:33.1)(図8、図9d)。
早期併用治療は線維症を予防する
DMDの予防療法としてのコンビナトリアルmiR-29c及びマイクロジストロフィンの潜在的重要性を考慮して、より若齢のmdx/utrn+/-マウスのコホートを4週齢で治療した。本明細書に記載の他の群と同じパラダイムを用いて、以下の治療:同じ用量のscAAVrh.74.CMV.miR-29c単独、ssAAVrh74.MCK.マイクロジストロフィン+scAAVrh74.CMV.miR-29c併用療法、またはssAAVrh74.MCK.マイクロジストロフィン単独を、GASの筋肉内注射による線維症予防の有効性について比較した。注射の12週間後にマウスを剖検した。未治療反対側mdx/utrn+/-GAS筋と比較して、すべての被治療群においてGAS筋全体にわたるコラーゲン染色の有意な減少が観察された(図10A)。ピクロシリウスレッド染色の定量化は、マイクロジストロフィン/miR-29cで併用治療された筋肉が未治療筋肉と比較してコラーゲンの51%減少を有したことを示し(被治療-11.32%±1.18対未治療-23.15%±0.90)(p<0.0001)(図10)、pRT-PCRは、コンビナトリアル療法後にCol1A、Col3A、Fbn、及びTGF-β1の減少を確認した(図10D及びE)。
早期併用療法は後期治療よりも良好に力を回復し、収縮誘発性損傷から保護する
インビボ力測定を、実施例8に記載されているように併用療法で早期に治療されたマウスのGASについて行った。4週齢のmdx/utrn+/-マウスにおいて、miR-29c/マイクロジストロフィンを用いた併用療法は、未治療mdx/utrn+/-マウスと比較した場合、絶対力の有意な改善を示し、野生型との差はなかった(併用治療:2908±129.5mN対未治療:1639.4±116.9mN対野生型:3369.73±154.1mN)。比力もまた、コンビナトリアル療法後に野生型レベルまで正常化した(併用治療338.9±22.34mN/mm2対未治療184.3±13.42mN/mm2対WT364.3±7.79mN/mm2)(図11A及びBならびに12)。
miR-29及びマイクロジストロフィンの筋特異的発現による治療は線維症及びECM発現を減少させた
miR29c配列及び筋特異的プロモーターMCKを含むAAVベクターも生成し、マイクロジストロフィンを発現するAAVベクターとの併用療法として試験した。本明細書においてrAAV.MCK.miR29cと称されるrAAVベクターを生成するために、22ヌクレオチドmiR29c配列(標的鎖配列番号3及びガイド鎖配列番号4)を、MCKプロモーターによって駆動されるmiR-30スカフォールド(配列番号11)にクローニングした。発現カセット(配列番号12)を一本鎖AAVプラスミドにクローニングし、筋肉中でよく発現することが知られている血清型AAVrh74を用いてパッケージングした。miR-29c cDNAは、miR-30骨格にmiR-30c標的(センス)鎖、miR-30ステムループ、及びmiR-29cガイド(アンチセンス)鎖を含むカスタムプライマーを用いて合成した。miR-29c配列の3つの塩基を改変した。次いで、この配列を、MCKプロモーター及びポリA配列によって駆動される一本鎖AAV ITR含有プラスミドにクローニングした。
早期併用療法は後期治療よりも良好に力を回復し、収縮誘発性損傷から保護する
インビボ力測定を、実施例8及び9に記載されているように、miR-29及びマイクロジストロフィンの筋特異的発現で早期に治療されたマウスのGASについて行った。4週齢のmdx/utrn+/-マウスにおいて、rAAV.MCK.miR-29c/及びマイクロジストロフィンを発現するrAAVを用いた併用療法は、未治療mdx/utrn+/-マウスと比較した場合、絶対力の有意な改善を示し、野生型との差はなかった(図15a)。比力もまた、併用療法後に野生型レベルまで正常化した(図15b)。
早期併用治療は筋肥大及び過形成を増加させる
マイクロジストロフィンを発現するrAAVとのrAAV.MCK.miR-29の同時送達は、注射の3ヶ月後、単独で注射されたいずれか一方と比較して、被注射腓腹筋の全重量を増加させなかった(図17a)。筋線維直径も測定した。miR-29c/マイクロジストロフィン併用治療は、平均線維サイズの増加を示した。mdx/utrn+/-対照をmiR-29c/マイクロジストロフィン治療mdx/utrn+/-と比較し、平均直径は28.96から36.03μmに増加した(図17b)。同時送達は野生型線維サイズ分布へのシフトをもたらした(図17c)。miR-29c/マイクロジストロフィン併用治療における1mm2当たりの筋線維の数は、未治療マウス及び野生型より有意に少なかった(図17d、***p<0.01、****p<0.0001)。
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