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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
  • A61K48/005—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the 'active' part of the composition delivered, i.e. the nucleic acid delivered
  • A61K48/0058—Nucleic acids adapted for tissue specific expression, e.g. having tissue specific promoters as part of a contruct
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
  • A61K48/0075—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the delivery route, e.g. oral, subcutaneous
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/04—Centrally acting analgesics, e.g. opioids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K14/00—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • C07K14/52—Cytokines; Lymphokines; Interferons
  • C07K14/53—Colony-stimulating factor [CSF]
  • C07K14/535—Granulocyte CSF; Granulocyte-macrophage CSF
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  • C07K14/435—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
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  • C12N15/00—Mutation or genetic engineering; DNA or RNA concerning genetic engineering, vectors, e.g. plasmids, or their isolation, preparation or purification; Use of hosts therefor
  • C12N15/09—Recombinant DNA-technology
  • C12N15/11—DNA or RNA fragments; Modified forms thereof; Non-coding nucleic acids having a biological activity
  • C12N15/113—Non-coding nucleic acids modulating the expression of genes, e.g. antisense oligonucleotides; Antisense DNA or RNA; Triplex- forming oligonucleotides; Catalytic nucleic acids, e.g. ribozymes; Nucleic acids used in co-suppression or gene silencing
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  • C12N9/00—Enzymes; Proenzymes; Compositions thereof; Processes for preparing, activating, inhibiting, separating or purifying enzymes
  • C12N9/14—Hydrolases (3)
  • C12N9/16—Hydrolases (3) acting on ester bonds (3.1)
  • C12N9/22—Ribonucleases [RNase]; Deoxyribonucleases [DNase]
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  • C12N2310/00—Structure or type of the nucleic acid
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• • C—CHEMISTRY; METALLURGY
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  • C12N2320/00—Applications; Uses
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  • C12N2799/00—Uses of viruses
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  • C12N2830/00—Vector systems having a special element relevant for transcription
  • C12N2830/008—Vector systems having a special element relevant for transcription cell type or tissue specific enhancer/promoter combination

Definitions

• the invention relates generally to compositions and methods for the treatment of neuropathic pain.
• Microglia contribute to many neurological conditions, including the mechanical hypersensitivity associated with neuropathic pain produced by peripheral nerve injury.
• DRG dorsal root ganglia
• CCL2 and CCL21 provide the connection between injured sensory neurons and microglia.
• CCR2 the primary CCL2 receptor
• CCL2 cannot provide the connection between sensory neurons and spinal cord microglia.
• CCR79 the primary CCL21 receptor
• CCL21 does target CXCR3, but this receptor is expressed in microglia, astrocytes, and even neurons. Moreover, deletion of CXCR3 has no effect on nerve injury- induced hypersensitivity.
• the present disclosure provides methods and compositions for treatment of neuropathic pain by targeted disruption of at least one CSF1-DAP12 pathway member gene (e.g., CSFl, DAP12) so as to effect a decrease in production of a CSF1-DAP12 pathway member.
• CSF1-DAP12 pathway member gene e.g., CSFl, DAP12
• a polynucleotide comprising a neuronal promoter, such as a trigeminal ganglion (TGG) or dorsal root ganglion (DRG) promoter, operably linked to a recombinant nucleic acid encoding an endonuclease that binds to a nucleotide sequence of a CSF1-DAP12 pathway member, such as a colony stimulating factor 1 (CSFl) gene (e.g., human colony stimulating factor 1 (hCSFl) gene), a DAP12 gene (e.g., a human DAP12 (hDAP12) gene).
• CSFl colony stimulating factor 1
• hCSFl human colony stimulating factor 1
• hDAP12 human DAP12
• Feature 2 The polynucleotide of feature 1, wherein binding of the
• CSF1-DAP12 pathway member e.g., hCSF and/or hDAP12
• Feature 3 The polynucleotide of features 1 or 2, wherein the neuronal promoter is a TGG or DRG promoter selected from the group consisting of: an hSYNl promoter, a TRPV1 promoter, a Navl.7 promoter, a Navl.8 promoter, a Navl.9 promoter, a CAG promoter, and an Advillin promoter.
• the neuronal promoter is a TGG or DRG promoter selected from the group consisting of: an hSYNl promoter, a TRPV1 promoter, a Navl.7 promoter, a Navl.8 promoter, a Navl.9 promoter, a CAG promoter, and an Advillin promoter.
• Feature 4 The polynucleotide of any one of features 1 -3, wherein the CSF1-
• DAP12 pathway member gene is nucleotide sequence in the hCSFl gene is selected from the group consisting of: an hCSFl gene regulatory region, an hCSFl promoter, an hCSFl transcription start site, an hCSFl exon sequence, an hCSFl intronic sequence, and an hCSFl 5' or 3 ' untranslated region.
• Feature 5 The polynucleotide of any one of features 1-4, wherein the endonuclease is an endonuclease that is engineered to bind the nucleotide sequence of the CSF1-DAP12 pathway member gene (e.g., hCSFlor hDAP12 gene).
• the endonuclease is an endonuclease that is engineered to bind the nucleotide sequence of the CSF1-DAP12 pathway member gene (e.g., hCSFlor hDAP12 gene).
• endonuclease is a homing endonuclease, a transcription activator-like effector nucleases (TALENs), a zinc finger nuclease (ZFN), a Type II clustered regularly interspaced short palindromic repeats (CRISPR) associated (Cas9) nuclease, or a megaTAL nuclease.
• TALENs transcription activator-like effector nucleases
• ZFN zinc finger nuclease
• CRISPR Type II clustered regularly interspaced short palindromic repeats associated nuclease
• megaTAL nuclease a homing endonuclease
• TALENs transcription activator-like effector nucleases
• ZFN zinc finger nuclease
• CaRISPR Type II clustered regularly interspaced short palindromic repeats associated nuclease
• megaTAL nuclease or a megaTAL nuclease.
• Feature 7 The polynucleotide of feature 6, wherein the homing endonuclease is a LAGLIDADG endonuclease, a GIY-YIG endonuclease, a His-Cys box endonuclease, or an HNH endonuclease.
• the homing endonuclease is a LAGLIDADG endonuclease, a GIY-YIG endonuclease, a His-Cys box endonuclease, or an HNH endonuclease.
• Feature 8 The polynucleotide of feature 6, wherein the homing endonuclease is I-Onu I, I HjeMI, I-CpaMI, I-Sce I, I-Chu I, I-Dmo I, I-Cre I, I-Csm I, PI-Sce I, PI-T11 I, PI-Mtu I, I-Ceu I, I-Sce II, I-Sce III, HO, Pl-Civ I, PI-Ctr I, PI-Aae I, PI-Bsu I, PI-Dha I, PI-Dra I, Pi- May I, PI-Mch I, PI-Mfu I, PI-Mfl I, PI-Mga I, PI-Mgo I, PI-Min I, PI-Mka I, PI-Mle I, PI-Mma I, PI-Msh I, PI-Msm I,
• Feature 9 The polynucleotide of feature 6, wherein the Cas9 nuclease is from Streptococcus pyogenes, Streptococcus thermophilus, Treponema denticola, and Neisseria meningitidis.
• Feature 10 The polynucleotide of feature 9, wherein the Cas9 nuclease comprises one or more mutations in a HNH or a RuvC-like endonuclease domain or the HNH and the RuvC-like endonuclease domains.
• Feature 11 The polynucleotide of feature 10, wherein the mutant Cas9 nuclease is a nickase.
• Feature 12 The polynucleotide of any one of the preceding features, wherein the polynucleotide further comprises a RNA polymerase III promoter operably linked to a crRNA and a tracrRNA, or to a single guide RNA (sgRNA).
• a RNA polymerase III promoter operably linked to a crRNA and a tracrRNA, or to a single guide RNA (sgRNA).
• RNA polymerase III promoter is the human or mouse U6 snRNA promoter, the human or mouse HI RNA promoter, or the human tRNA-val promoter.
• Feature 14 The polynucleotide of feature 12, wherein the polynucleotide comprises a pair of offset crRNAs or sgRNAs.
• Feature 15 The polynucleotide of any one of features 12-14, wherein the pair of crRNA or sgRNAs are offset by about 25 to about 100 nucleotides from each other.
• Feature 16 The polynucleotide of any of the preceding features, wherein the endonuclease comprises a TREX2 domain.
• a polynucleotide comprising a neuronal promoter, such as a promoter operable in a TGG or DRG that is operably linked to an inhibitory RNA that binds to an mRNA of a CSF1-DAP12 pathway member (e.g., an hCSFl mRNA and/or a hDAP12 mRNA).
• a neuronal promoter such as a promoter operable in a TGG or DRG that is operably linked to an inhibitory RNA that binds to an mRNA of a CSF1-DAP12 pathway member (e.g., an hCSFl mRNA and/or a hDAP12 mRNA).
• Feature 18 The polynucleotide of feature 17, wherein the neuronal promoter, e.g., TGG or DRG promoter, is an inducible promoter.
• the neuronal promoter e.g., TGG or DRG promoter
• Feature 19 The polynucleotide of feature 18, wherein the inducible promoter comprises a tetracycline inducible promoter, a LOX-stop-LOX human or mouse U6 snRNA promoter, LOX-stop-LOX human or mouse HI RNA promoter, or a LOX-stop- LOX human tRNA-val promoter.
• the inducible promoter comprises a tetracycline inducible promoter, a LOX-stop-LOX human or mouse U6 snRNA promoter, LOX-stop-LOX human or mouse HI RNA promoter, or a LOX-stop- LOX human tRNA-val promoter.
• Feature 20 The polynucleotide of feature 17, wherein the neuronal promoter, e.g., TGG or DRG promoter, is selected from the group consisting of: an hSYNl promoter, a TRPVl promoter, a Navl.7 promoter, a Navl.8 promoter, a Navl.9 promoter, a CAG promoter, and an Advillin promoter.
• the neuronal promoter e.g., TGG or DRG promoter
• Feature 21 The polynucleotide of feature 17, wherein the polynucleotide comprises a TGG or DRG promoter operably linked to a Cre recombinase and a LOX-stop- LOX inducible RNA polymerase III promoter operably linked to the inhibitory RNA.
• Feature 22 The polynucleotide of any one of features 17-22, wherein the inhibitory RNA is an siRNA, an miRNA, an shRNA, a ribozyme, or a piRNA.
• Feature 23 A vector comprising the polynucleotide of any one of features 1-22.
• Feature 24 The vector of feature 23, wherein the vector is a plasmid-based vector or a viral vector.
• Feature 25 The vector of feature 23 or feature 24, wherein the vector is episomal or non-integrative.
• Feature 26 The vector of feature 25, wherein the viral vector is retroviral vector, an adenoviral vector, an adeno-associated viral (AAV) vector, or a herpes simplex virus (HSV) vector.
• retroviral vector an adenoviral vector, an adeno-associated viral (AAV) vector, or a herpes simplex virus (HSV) vector.
• AAV adeno-associated viral
• HSV herpes simplex virus
• Feature 27 The vector of feature 26, wherein the retroviral vector is a lentiviral vector or a gamma retroviral vector.
• Feature 28 The vector of feature 25, wherein the AAV comprises a serotype selected from the group consisting of: AAV9, AAV6, AAVrhlO, AAV7M8, and
• Feature 29 The vector of feature 25, wherein the HSV vector comprises a serotype selected from the group consisting of: JANI5, JANI7, and JANI8.
• a vector comprising a polynucleotide comprising an hSYNl promoter operably linked to a nucleic acid encoding a Cas9 nuclease and a polynucleotide comprising an U6 RNA polymerase III promoter operably linked to CSF1-DAP12 pathway member gene targeted sgRNA (e.g., an hCSFl gene targeted sgRNA or an hDAP12 gene targeted sgRNA) .
• CSF1-DAP12 pathway member gene targeted sgRNA e.g., an hCSFl gene targeted sgRNA or an hDAP12 gene targeted sgRNA
• Feature 31 A method of treating neuropathic or central pain comprising administering a subject in need thereof, a vector according to any one of features 17-30.
• a method of providing analgesia to a subject comprising
• a method of decreasing expression of at least one CSF1-DAP12 pathway member gene e.g., an hCSFl gene, an hDAP12 gene
• a neuron e.g., TGG or DGG
• administering comprising administering to the subject, a vector according to any one of features 17-30.
• hypersensitivity and microglia activation comprising administering to the subject, a vector according to any one of features 17-30.
• Feature 35 The method of any one of features 31-34, wherein the vector is administered to the subject by intrathecal bolus injection or infusion, intraganglionic injection, intraneural injection, subcutaneous injection, or intraventricular injection.
• Feature 36 The method of features 31-35, wherein the vector is administered to the subject by intrathecal bolus injection or infusion at multiple levels of the spinal column for DRG transduction.
• Feature 37 The method of features 31-35, wherein the vector is administered to the subject by intraganglionic injection directly into a single dorsal root ganglion, multiple dorsal root ganglia, or the trigeminal ganglion.
• Feature 38 The method of features 31-35, wherein the vector is administered to the subject by intraneural injection into the nerve bundle (e.g. sciatic nerve, trigeminal nerve).
• the nerve bundle e.g. sciatic nerve, trigeminal nerve.
• Feature 39 The method of features 31-35, wherein the vector is administered to the subject by subcutaneous injection at the peripheral nerve terminals (subdermal or internal organ wall).
• Feature 40 The method of features 31-35, wherein the vector is administered to the subject by intraventricular injection (for trigeminal ganglion transduction).
• Feature 41 The method of features 31-15, wherein the neuropathic pain is central neuropathic pain, and the vector is administered by intraparenchymal
• administration intracisternal administration, intracranial administration, intraspinal administration or stereotactic brain injection.
• FIG. 1A-1O depict the effect of CSF1 induction in DRG neurons after peripheral nerve injury.
• FIG. 2A-2H depict the effect of CSF1 induction in DRG neurons after peripheral nerve injury.
• FIG. 3A-3D depict the requirement of DAP12 for nerve injury- and CSFl-induced mechanical hypersensitivity.
• FIG. 4A-4E depict that in DAP 12 ko mice baseline motor and pain behaviors are intact and SNI-induced de novo CSF1 expression in DRG neurons is preserved.
• FIG. 5A-5G depict the requirement of DAP12 for nerve injury and CSFl-induced microglial gene induction, but not for microglia proliferation.
• FIG. 6 depicts the contribution of DAP12 to the autotomy phenotype.
• FIG. 7 depicts that microglia-enriched genes are induced in the dorsal cord after nerve injury; monocyte-specific genes are not.
• FIG. 8A-8E depict that peripheral nerve injury induces microglial proliferation.
• FIG. 9A-9D depict that nerve injury and CSFl-induced microglia proliferation in the dorsal horn is DAP12-independent.
• FIG. 10A-10K depict that nerve injury-induced CSF1 expression in injured motoneurons is required for ventral horn microglial activation.
• FIG. 11 depicts the coexpression of ATF3 and CSF1 in injured motoneurons.
• FIG. 12A-12C depict that CSF1 is upregulated in injured motoneurons and is required for nerve injury-induced microglia activation and proliferation in the ventral horn of the spinal cord.
• FIG. 13 depicts nerve injury-induced CSF1 in injured sensory neurons is preserved in Nestin-Cre; Csfl fl/fl mice.
• FIG. 14 depicts a schematic showing de novo expression of CSF1 in injured sensory neurons triggers a microglial, DAP12- dependent induction of genes that contribute to neuropathic pain.
• FIG. 15 depicts a schematic showing de novo CSF1 expression in injured sensory neurons triggers a DAP12-independent self-renewal of microglia and a DAP12-dependent upregulation of microglial genes that contribute to the neuropathic pain phenotype.
• FIG. 16A-16B depict the effect of minocycline on CSFl-induced hypersensitivity (FIG. 16 A), and intrathecal CSFl-induced mechanical hypersensitivity in P2X4 mutant mice (FIG. 16B).
• an element means one element or more than one element.
• the term “about” or “approximately” refers to a quantity, level, value, number, frequency, percentage, dimension, size, amount, weight or length that varies by as much as 30, 25, 20, 25, 10, 9, 8, 7, 6, 5, 4, 3, 2 or 1 % to a reference quantity, level, value, number, frequency, percentage, dimension, size, amount, weight or length.
• the terms “about” or “approximately” when preceding a numerical value indicates the value plus or minus a range of 15%, 10%, 5%, or 1%.
• targeting the CSF1-DAP12 pathway e.g., to decrease expression of a CSF1-DAP12 pathway member (e.g., at least one of CSF1, CSFRl, or DAP12) thus provides a novel approach to the pharmacological management of neuropathic pain and potentially also to a host of peripheral nerve injury-induced alterations in motoneuron function.
• a CSF1-DAP12 pathway member e.g., at least one of CSF1, CSFRl, or DAP12
• compositions and methods to effect targeted disruption of at least one CSF1-DAP12 pathway member gene e.g., CSF1, DAP12
• CSF1-DAP12 pathway member gene e.g., CSF1, DAP12
• CSF1 can play a role in recruitment of macrophages to the nerve damage (neuroma) site in the periphery.
• targeted disruption of CSF1 can also provide for a method of reducing recruitment of macrophages to a site of peripheral nerve damage by administering to a subject in need of treatment a modulator of a CSF1- DAP12 pathway member gene (e.g., CSF1 (e.g., hCSFl), DAP 12, (e.g., hDAP12).
• CSF1-DAP12 pathway member gene e.g., CSF1 (e.g., hCSFl), DAP 12, (e.g., hDAP12).
• compositions for treatment of neuropathic pain contemplate by the present disclosure include nucleic acid compositions to target at least one CSF1-DAP12 pathway member (e.g., CSF1, DAP12).
• CSF1-DAP12 pathway member e.g., CSF1, DAP12
• Such compositions can, for example, effect inhibition of expression of a target gene by, for example, genome editing (e.g., to effectively delete all or a portion of a gene encoding the target gene), inhibiting production of RNA encoding a target protein, and/or inhibiting translation of RNA encoding a target protein.
• genome editing e.g., to effectively delete all or a portion of a gene encoding the target gene
• RNA encoding a target protein e.g., to effectively delete all or a portion of a gene encoding the target gene
• translation of RNA encoding a target protein e.g., translation of RNA encoding a target protein.
• tools are available
• CSF1-DAP12 pathway member genes are available in the art (e.g., human CSF-1, human DAP12), as are methods of adapting platforms to specifically target a gene or interest.
• Compositions for use in targeting at least one CSF1-DAP12 pathway member such as disclosed below may be referred to herein as CSF1-DAP12 pathway modulators.
• polynucleotides comprising a neuronal promoter, and may be a neuron- specific promoter.
• the promoter may be selected according to the type of neuron to be treated, e.g., for use in treatment of peripheral neuropathic pain or central neuropathic pain.
• the neuronal promoter can be a trigeminal ganglion (TGG) or dorsal root ganglion (DRG) promoter operably linked to a recombinant nucleic acid encoding an endonuclease that binds to a nucleotide sequence in a CSF1- DAP12 pathyway member gene (e.g., a CSF1 gene, a human colony stimulating factor 1 (hCSFl) gene, a DAP 12 gene, a human DAP 12 gene).
• a CSF1- DAP12 pathyway member gene e.g., a CSF1 gene, a human colony stimulating factor 1 (hCSFl) gene, a DAP 12 gene, a human DAP 12 gene.
• promoter sequences operable in a neuron include, but are not limited to, a neuron-specific enolase (NSE) promoter (see, e.g., EMBL HSEN02,
• AADC aromatic amino acid decarboxylase
• GenBank HUMSYNIB, M55301 GenBank HUMSYNIB, M55301
• a thy-1 promoter see, e.g., Chen et al. (1987) Cell 51:7- 19
• a serotonin receptor promoter see, e.g., GenBank S62283
• a tyrosine hydroxylase promoter TH
• GnRH promoter see, e.g., Radovick et al., Proc. Natl. Acad. Sci.
• polynucleotide or “nucleic acid” refer to
• DNA deoxyribonucleic acid
• RNA ribonucleic acid
• DNA/RNA hybrids DNA/RNA hybrids
• Polynucleotides may be single-stranded or double- stranded.
• Polynucleotides include, but are not limited to: pre-messenger RNA (pre-mRNA), messenger RNA (mRNA), RNA, short interfering RNA (siRNA), short hairpin RNA (shRNA), microRNA (miRNA), ribozymes, synthetic RNA, genomic RNA (gRNA), plus strand RNA (RNA(+)), minus strand RNA (RNA(-)), tracrRNA, crRNA, single guide RNA (sgRNA), synthetic RNA, genomic DNA (gDNA), PCR amplified DNA, complementary DNA (cDNA), synthetic DNA, or recombinant DNA.
• pre-mRNA pre-messenger RNA
• mRNA messenger RNA
• RNA short interfering RNA
• shRNA short hairpin RNA
• miRNA microRNA
• ribozymes synthetic RNA
• genomic RNA gRNA
• RNA(+) plus strand
• Polynucleotides refer to a polymeric form of nucleotides of at least 5, at least 10, at least 15, at least 20, at least 25, at least 30, at least 40, at least 50, at least 100, at least 200, at least 300, at least 400, at least 500, at least 1000, at least 5000, at least 10000, or at least 15000 or more nucleotides in length, either ribonucleotides or deoxynucleotides or a modified form of either type of nucleotide, as well as all intermediate lengths. It will be readily understood that “intermediate lengths, " in this context, means any length between the quoted values, such as 6, 7, 8, 9, etc., 101, 102, 103, etc.
• polynucleotides or variants have at least or about 50%, 55%, 60%, 65%, 70%, 71%, 72%, 73%, 74%, 75%,76%, 77%, 78%, 79%, 80%, 81%, 82%, 83%, 84%,85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% sequence identity to a reference sequence described herein or known in the art, typically where the variant maintains at least one biological activity of the reference sequence.
• isolated polynucleotide refers to a polynucleotide that has been purified from the sequences which flank it in a naturally- occurring state, e.g., a DNA fragment that has been removed from the sequences that are normally adjacent to the fragment.
• an isolated polynucleotide refers to a
• cDNA complementary DNA
• a recombinant DNA or other polynucleotide that does not exist in nature and that has been made by the hand of man.
• polynucleotides include: 5' (normally the end of the polynucleotide having a free phosphate group) and 3' (normally the end of the polynucleotide having a free hydroxyl (OH) group).
• Polynucleotide sequences can be annotated in the 5' to 3' orientation or the 3' to 5' orientation.
• the 5' to 3' strand is designated the "sense,” "plus,” or "coding” strand because its sequence is identical to the sequence of the premessenger (premRNA) [except for uracil (U) in RNA, instead of thymine (T) in DNA].
• the complementary 3' to 5' strand which is the strand transcribed by the RNA polymerase is designated as "template,” "antisense,” “minus,” or “non-coding” strand.
• reverse orientation refers to a 5' to 3' sequence written in the 3' to 5' orientation or a 3' to 5' sequence written in the 5' to 3' orientation.
• complementarity refers to polynucleotides (i.e., a sequence of nucleotides) related by the base-pairing rules. For example, the
• a sequence that is equal to its reverse complement is said to be a palindromic sequence.
• Complementarity can be "partial,” in which only some of the nucleic acids' bases are matched according to the base pairing rules. Or, there can be “complete” or “total” complementarity between the nucleic acids.
• the term “gene” may refer to a polynucleotide sequence comprising enhancers, promoters, introns, exons, and the like.
• the term “gene” refers to a polynucleotide sequence encoding a polypeptide, regardless of whether the polynucleotide sequence is identical to the genomic sequence encoding the polypeptide.
• a “genomic sequence regulating transcription of or a “genomic sequence that regulates transcription or” refers to a polynucleotide sequence that is associated with the transcription of a gene.
• a polynucleotide-of-interest comprises an inhibitory
• polynucleotide including, but not limited to, a crRNA, a tracrRNA, a single guide RNA (sgRNA), an siRNA, an miRNA, an shRNA, piRNA, a ribozyme or another inhibitory RNA.
• a crRNA a tracrRNA
• a single guide RNA sgRNA
• siRNA an siRNA
• miRNA miRNA
• shRNA shRNA
• piRNA a ribozyme or another inhibitory RNA.
• a polynucleotide-of-interest comprises a crRNA, a tracrRNA, or a single guide RNA (sgRNA). These RNAs are part of the CRISPR (Clustered
• the CPvISPR/Cas nuclease system can be used to introduce a double-strand break in a target polynucleotide sequence, which may be repaired by non-homologous end joining (NHEJ) in the absence of a polynucleotide template, e.g., a DNA template, or by homology directed repair (HDR), i.e., homologous recombination, in the presence of a polynucleotide repair template.
• NHEJ non-homologous end joining
• HDR homology directed repair
• Cas9 nucleases can also be engineered as nickases, which generate single- stranded DNA breaks that can be repaired using the cell's base-excision-repair (BER) machinery or homologous recombination in the presence of a repair template.
• NHEJ is an error-prone process that frequently results in the formation of small insertions and deletions that disrupt gene function. Homologous recombination requires homologous DNA as a template for repair and can be leveraged to create a limitless variety of modifications specified by the introduction of donor DNA containing the desired sequence flanked on either side by sequences bearing homology to the target.
• a crRNA or sgRNA is directed against a polynucleotide sequence encoding a polypeptide
• NHEJ of the ends of the cleaved genomic sequence may result in a normal polypeptide, a loss-of- or gain-of-function polypeptide, or knock-out of a functional polypeptide.
• a crRNA or sgRNA is directed against a polynucleotide sequence encoding a cis-acting sequence that regulates mRNA expression of a
• polynucleotide sequence encoding a polypeptide, NHEJ of the genomic sequence may result increased expression, decreased expression, or complete loss of expression of the mRNA and polypeptide.
• crRNA refers to an RNA comprising a region of partial or total complementarity referred to herein as a "spacer motif to a target polynucleotide sequence referred to herein as a protospacer motif.
• a protospacer motif is a 20 nucleotide target sequence.
• the protospacer motif is 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, or more nucleotides.
• protospacer target sequences of various lengths will be recognized by different bacterial species.
• the region of complementarity comprises a polynucleotide sequence that is at least 80%, 81%, 82%, 83%, 84%,85%, 86%, 87%, 88%, 89%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% identical to the protospacer sequence.
• at least 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, or 20 or more polynucleotides in the region of complementarity are identical to the protospacer motif.
• at least 10 of the 3' most sequence in the protospacer motif is complementary to the crRNA sequence.
• the term "tracrRNA” refers to a trans-activating RNA that associates with the crRNA sequence through a region of partial complementarity and serves to recruit a Cas9 nuclease to the protospacer motif.
• the tracrRNA is at least 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, or more nucleotides in length. In one embodiment, the tracrRNA is about 85 nucleotides in length.
• the crRNA and tracrRNA are engineered into one
• sgRNA single guide RNA
• the crRNA equivalent portion of the sgRNA is engineered to guide the Cas9 nuclease to target any desired protospacer motif.
• the tracrRNA equivalent portion of the sgRNA is engineered to be at least 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100, or more nucleotides in length.
• the protospacer motif abuts a short protospacer adjacent motif (PAM), which plays a role in recruiting a Cas9/RNA complex.
• Cas9 polypeptides recognize PAM motifs specific to the Cas9 polypeptide. Accordingly, the CRISPR/Cas9 system can be used to target and cleave either or both strands of a double- stranded polynucleotide sequence flanked by particular 3' PAM sequences specific to a particular Cas9 polypeptide.
• PAMs may be identified using bioinformatics or using experimental approaches. Esvelt et ah, 2013, Nature Methods. 10(11): 1116-1121, which is hereby incorporated by reference in its entirety.
• RNA short interfering RNA
• siRNA short polynucleotide sequence that mediates a process of sequence-specific post-transcriptional gene silencing, translational inhibition, transcriptional inhibition, or epigenetic RNAi in animals (Zamore et al, 2000, Cell, 101, 25-33; Fire et al, 1998, Nature, 391, 806;
• an siRNA comprises a first strand and a second strand that have the same number of nucleosides; however, the first and second strands are offset such that the two terminal nucleosides on the first and second strands are not paired with a residue on the complimentary strand. In certain instances, the two nucleosides that are not paired are thymidine resides.
• the siRNA should include a region of sufficient homology to the target gene, and be of sufficient length in terms of nucleotides, such that the siRNA, or a fragment thereof, can mediate down regulation of the target gene.
• an siRNA includes a region which is at least partially complementary to the target RNA. It is not necessary that there be perfect complementarity between the siRNA and the target, but the correspondence must be sufficient to enable the siRNA, or a cleavage product thereof, to direct sequence specific silencing, such as by RNAi cleavage of the target RNA.
• Complementarity, or degree of homology with the target strand is most critical in the antisense strand. While perfect complementarity, particularly in the antisense strand, is often desired, some embodiments include one or more, but preferably 10, 8, 6, 5, 4, 3, 2, or fewer mismatches with respect to the target RNA. The mismatches are most tolerated in the terminal regions, and if present are preferably in a terminal region or regions, e.g. , within 6, 5, 4, or 3 nucleotides of the 5' and/or 3' terminus.
• the sense strand need only be sufficiently complementary with the antisense strand to maintain the overall double-strand character of the molecule.
• Each strand of an siRNA can be equal to or less than 30, 25, 24, 23, 22, 21, or 20 nucleotides in length.
• the strand is preferably at least 19 nucleotides in length.
• each strand can be between 21 and 25 nucleotides in length.
• Preferred siRNAs have a duplex region of 17, 18, 19, 29, 21, 22, 23, 24, or 25 nucleotide pairs, and one or more overhangs of 2-3 nucleotides, preferably one or two 3' overhangs, of 2-3 nucleotides.
• miRNA refers to small non-coding RNAs of 20-22 nucleotides, typically excised from -70 nucleotide foldback RNA precursor structures known as pre-miRNAs. miRNAs negatively regulate their targets in one of two ways depending on the degree of complementarity between the miRNA and the target. First, miRNAs that bind with perfect or nearly perfect complementarity to protein- coding mRNA sequences induce the RNA-mediated interference (RNAi) pathway.
• RNAi RNA-mediated interference
• miRNAs that exert their regulatory effects by binding to imperfect complementary sites within the 3' untranslated regions (UTRs) of their mRNA targets, repress target-gene expression post-transcriptionally, apparently at the level of translation, through a RISC complex that is similar to, or possibly identical with, the one that is used for the RNAi pathway. Consistent with translational control, miRNAs that use this mechanism reduce the protein levels of their target genes, but the mRNA levels of these genes are only minimally affected. miRNAs encompass both naturally occurring miRNAs as well as artificially designed miRNAs that can specifically target any mRNA sequence. For example, in one embodiment, the skilled artisan can design short hairpin RNA constructs expressed as human miRNA (e.g.
• the hairpin stem consists of 22-nt of dsRNA (e.g. , antisense has perfect complementarity to desired target) and a 15- 19-nt loop from a human miR. Adding the miR loop and miR30 flanking sequences on either or both sides of the hairpin results in greater than 10-fold increase in Drosha and Dicer processing of the expressed hairpins when compared with conventional shRNA designs without microRNA. Increased Drosha and Dicer processing translates into greater siRNA/miRNA production and greater potency for expressed hairpins.
• shRNA or “short hairpin RNA” refer to double- stranded structure that is formed by a single self-complementary RNA strand.
• shRNA constructs containing a nucleotide sequence identical to a portion, of either coding or non- coding sequence, of the target gene are preferred for inhibition.
• RNA sequences with insertions, deletions, and single point mutations relative to the target sequence have also been found to be effective for inhibition. Greater than 90% sequence identity, or even 100% sequence identity, between the inhibitory RNA and the portion of the target gene is preferred.
• the length of the duplex-forming portion of an shRNA is at least 20, 21 or 22 nucleotides in length, e.g.
• the shRNA construct is at least 25, 50, 100, 200, 300 or 400 bases in length. In certain embodiments, the shRNA construct is 400-800 bases in length. shRNA constructs are highly tolerant of variation in loop sequence and loop size.
• ribozyme refers to a catalytically active RNA molecule capable of site-specific cleavage of target mRNA.
• RNA molecules capable of site-specific cleavage of target mRNA.
• subtypes e.g. , hammerhead and hairpin ribozymes.
• Ribozyme catalytic activity and stability can be improved by substituting deoxyribonucleotides for ribonucleotides at noncatalytic bases. While ribozymes that cleave mRNA at site- specific recognition sequences can be used to destroy particular mRNAs, the use of hammerhead ribozymes is preferred. Hammerhead ribozymes cleave mRNAs at locations dictated by flanking regions that form
• hammerhead ribozymes The construction and production of hammerhead ribozymes is well known in the art. Polynucleotides can be prepared, manipulated and/or expressed using any of a variety of well established techniques known and available in the art. In order to express a desired polypeptide, a nucleotide sequence encoding the polypeptide, can be inserted into appropriate vector. Examples of vectors are plasmid, autonomously replicating sequences, and transposable elements.
• Additional exemplary vectors include, without limitation, plasmids, phagemids, cosmids, artificial chromosomes such as yeast artificial chromosome (YAC), bacterial artificial chromosome (BAC), or Pl-derived artificial chromosome (PAC), bacteriophages such as lambda phage or Ml 3 phage, and animal viruses.
• animal viruses include, without limitation, retrovirus (including lentivirus), adenovirus, adeno-associated virus, herpesvirus (e.g. , herpes simplex virus), poxvirus, baculovirus, papillomavirus, and papovavirus (e.g. , SV40).
• expression vectors are pClneo vectors (Promega) for expression in mammalian cells;
• the coding sequences of the chimeric proteins disclosed herein can be ligated into such expression vectors for the expression of the chimeric protein in mammalian cells.
• “Expression control sequences,” “control elements,” or “regulatory sequences” present in an expression vector are those non-translated regions of the vector— origin of replication, selection cassettes, promoters, enhancers, translation initiation signals (Shine Dalgarno sequence or Kozak sequence) introns, a polyadenylation sequence, 5' and 3' untranslated regions— which interact with host cellular proteins to carry out transcription and translation.
• Such elements may vary in their strength and specificity.
• any number of suitable transcription and translation elements including ubiquitous promoters and inducible promoters may be used.
• operably linked refers to a juxtaposition wherein the components described are in a relationship permitting them to function in their intended manner.
• the term refers to a functional linkage between a nucleic acid expression control sequence (such as a promoter, and/or enhancer) and a second polynucleotide sequence, e.g., a polynucleotide-of-interest, wherein the expression control sequence directs transcription of the nucleic acid corresponding to the second sequence.
• a nucleic acid expression control sequence such as a promoter, and/or enhancer
• second polynucleotide sequence e.g., a polynucleotide-of-interest
• condition expression may refer to any type of conditional expression including, but not limited to, inducible expression; repressible expression; expression in cells or tissues having a particular physiological, biological, or disease state, etc. This definition is not intended to exclude cell type or tissue specific expression.
• Certain embodiments of the invention provide conditional expression of a polynucleotide- of-interest, e.g., expression is controlled by subjecting a cell, tissue, organism, etc., to a treatment or condition that causes the polynucleotide to be expressed or that causes an increase or decrease in expression of the polynucleotide encoded by the polynucleotide-of- interest.
• inducible promoters/systems include, but are not limited to, steroid-inducible promoters such as promoters for genes encoding glucocorticoid or estrogen receptors (inducible by treatment with the corresponding hormone),
• metallothionein promoter inducible by treatment with various heavy metals
• MX-1 promoter inducible by interferon
• the "GeneS witch” mifepristone-regulatable system Sirin et al, 2003, Gene, 323:67
• the cumate inducible gene switch WO 2002/088346
• tetracycline-dependent regulatory systems etc.
• polynucleotides comprise at least one (typically two) site(s) for recombination mediated by a site specific recombinase.
• recombinase or "site specific recombinase” include excisive or integrative proteins, enzymes, co-factors or associated proteins that are involved in recombination reactions involving one or more recombination sites (e.g., two, three, four, five, six, seven, eight, nine, ten or more.), which may be wild-type proteins (see Landy, Current Opinion in Biotechnology 3:699-707 (1993)), or mutants, derivatives (e.g., fusion proteins containing the recombination protein sequences or fragments thereof), fragments, and variants thereof.
• Illustrative examples of recombinases suitable for use in particular embodiments of the present invention include, but are not limited to: Cre, Int, IHF, Xis, Flp, Fis, Hin, Gin, OC31, Cin, Tn3 resolvase, TndX, XerC, XerD, TnpX, Hjc, Gin, SpCCEl, and ParA.
• polynucleotides comprise a polyadenylation sequence 3' of a polynucleotide encoding a polypeptide to be expressed.
• Polyadenylation sequences can promote mRNA stability by addition of a polyA tail to the 3' end of the coding sequence and thus, contribute to increased translational efficiency. Recognized
• polyadenylation sites include an ideal polyA sequence (e.g., AATAAA, ATTAAA
• BGHpA a rabbit ⁇ -globin polyA sequence
• rPgpA a rabbit ⁇ -globin polyA sequence
• the endonuclease is a Cas9 polypeptide obtained from the following illustrative list of bacterial species: Enterococcus faecium, Enterococcus italicus, Listeria innocua, Listeria monocytogenes, Listeria seeligeri, Listeria ivanovii, Streptococcus agalactiae, Streptococcus anginosus, Streptococcus bovis, Streptococcus dysgalactiae, Streptococcus equinus, Streptococcus gallolyticus, Streptococcus macacae, Streptococcus mutans, Streptococcus pseudoporcinus, Streptococcus pyogenes,
• Streptococcus thermophilus Streptococcus gordonii, Streptococcus infantarius,
• Streptococcus macedonicus Streptococcus mitis, Streptococcus pasteurianus,
• Streptococcus suis Streptococcus vestibularis, Streptococcus sanguinis, Streptococcus downei, Neisseria bacilliformis, Neisseria cinerea, Neisseria flavescens, Neisseria lactamica, Neisseria meningitidis, Neisseria subflava, Lactobacillus brevis, Lactobacillus buchneri, Lactobacillus casei, Lactobacillus paracasei, Lactobacillus fermentum,
• Lactobacillus gasseri Lactobacillus jensenii, Lactobacillus johnsonii, Lactobacillus rhamnosus, Lactobacillus ruminis, Lactobacillus salivarius, Lactobacillus
• Cas9 polypeptides target double-stranded polynucleotide sequences flanked by particular 3' PAM sequences specific to a particular Cas9 polypeptide. Each Cas9 nuclease domain cleaves one DNA strand. Cas9 polypeptides naturally contain domains
• the HNH and RuvC-like domains are each responsible for cleaving one strand of the double-stranded DNA target sequence.
• the HNH domain of the Cas9 polypeptide cleaves the DNA strand complementary to the tracrRNA:crRNA or sgRNA.
• the RuvC-like domain of the Cas9 polypeptide cleaves the DNA strand that is not-complementary to the tracrRNA:crRNA or sgRNA.
• the endonuclease is a TALENs comprising one or more TALE domains.
• Transcription activator like effectors are natural type III effector proteins secreted by nutmerous species of Xanthomonas to modulate gene expression in host plants and to facilitate bacterial colonization and survival (Boch et al., Annu Rev Phytopathol 2010; Bogdanove et al., Curr Opin Plant Biol 2010). Recent studies of TALEs have revealed an elegant code linking the repetitive region of TALEs with their target DNA-binding site (Boch et al., Science 2009; Moscou et al., Science 2009).
• TALEs are highly conserved and repetitive region within the middle of the protein, consisting of tandem repeats of mostly 33 or 34 amino acid segments. Repeat monomers differ from each other mainly in amino acid positions 12 and 13 (repeat variable di -residues), and recent computational and functional analyses have revealed a strong correlation between unique pairs of amino acids at positions 12 and 13 and the corresponding nucleotide in the TALE-binding site: NI to A, HD to C, NG to T, NN to G (and to a lesser degree A) (Boch et al., Science 2009; Moscou et al., Science 2009; Miller et al., Nat. Biotech 2011; Zhang et al., Nat. Biotech 2011).
• the endonuclease is homing endonuclease designed or engineered with one or more amino acid substitutions, additions, or deletions to enable the endonuclease to bind to a desired nucleic acid target sequence.
• Illustrative examples of homing endonucleases that may be engineered include, but are not limited to I-Onu I, I HjeMI, I-CpaMI, I-Sce I, I-Chu I, I-Dmo I, I-Cre I, I-Csm I, PI-Sce I, PI-T11 I, PI-Mtu I, I- Ceu I, I-Sce II, I-Sce III, HO, Pl-Civ I, PI-Ctr I, PI-Aae I, PI-Bsu I, PI-Dha I, PI-Dra I, PI- May I, PI-Mch I, PI-Mfu I, PI-Mfl I, PI-Mga I, PI-Mgo I, PI-Min I, PI-Mka I, PI-Mle I, PI- Mma I, PI-Msh I, PI-Msm I,
• the endonuclease is a ZFN.
• ZFN comprise one or more zinc finger DNA binding domains and an endonuclease domain, e.g., Fok I.
• a number of methods are known in the art that can then be used to engineer one or more zinc finger proteins that have a high affinity for its target (e.g., preferably with a Kd of less than about 25 nM).
• a ZFP DNA binding domain can be designed or selected to bind to any suitable target site in the genetic locus with high affinity.
• WO 00/42219 comprehensively describes methods for design, construction, and expression of ATPs comprising zinc finger DNA binding domains for selected target sites. Each zinc finger recognizes approximately 3 bp of DNA.
• zinc finger DNA binding domains can be designed to recognize 3, 6, 9, 12, 15, 18, 21, or 24 or more bp of DNA.
• Candidate zinc finger DNA binding domains for a given 3 bp DNA target sequence have been identified and modular assembly strategies have ben devised for linking a plurality of the domains into a multifinger peptide targeted to the corresponding composite DNA target sequence.
• Other suitable method sknown in the art can also be used to design and construct nucleic acids encoding zinc finger DNA binding domains, e.g., phage display, random mutagenesis, combinatorial libraries, computer/rational design, affinity selection, PCR, cloning from cDNA or genomic libraries, synthetic construction and the like, (see, e.g., U.S. Pat.
• Illustrative retroviruses suitable for use in particular embodiments include, but are not limited to: Moloney murine leukemia virus (M-MuLV), Moloney murine sarcoma virus (MoMSV), Harvey murine sarcoma virus (HaMuSV), murine mammary tumor virus (MuMTV), gibbon ape leukemia virus (GaLV), feline leukemia virus (FLV), spumavirus, Friend murine leukemia virus, Murine Stem Cell Virus (MSCV) and Rous Sarcoma Virus (RSV)) and lentivirus.
• M-MuLV Moloney murine leukemia virus
• MoMSV Moloney murine sarcoma virus
• HaMuSV Harvey murine sarcoma virus
• MuMTV murine mammary tumor virus
• GaLV gibbon ape leukemia virus
• FLV feline leukemia virus
• RSV Rous Sarcoma Virus
• lentivirus refers to a group (or genus) of complex retroviruses.
• Illustrative lenti viruses include, but are not limited to: HIV (human immunodeficiency virus; including HIV type 1, and HIV type 2); visna-maedi virus (VMV) virus; the caprine arthritis-encephalitis virus (CAEV); equine infectious anemia virus (EIAV); feline immunodeficiency virus (FIV); bovine immune deficiency virus (BIV); and simian immunodeficiency virus (SIV).
• HIV based vector backbones i.e. , HIV cis-acting sequence elements
• HIV based vector backbones i.e. , HIV cis-acting sequence elements
• Retroviral vectors and more particularly lentiviral vectors may be used in practicing particular embodiments of the present invention. Accordingly, the term “retrovirus” or “retroviral vector”, as used herein is meant to include “lentivirus” and “lentiviral vectors” respectively.
• viral vector is widely used to refer either to a nucleic acid molecule (e.g. , a transfer plasmid) that includes virus-derived nucleic acid elements that typically facilitate transfer of the nucleic acid molecule or integration into the genome of a cell or to a viral particle that mediates nucleic acid transfer.
• Viral particles will typically include various viral components and sometimes also host cell components in addition to nucleic acid(s).
• vectors contemplated herein comprise non-integrating or integration defective retrovirus.
• an "integration defective" retrovirus or lentivirus refers to retrovirus or lentivirus having an integrase that lacks the capacity to integrate the viral genome into the genome of the host cells.
• the integrase protein is mutated to specifically decrease its integrase activity.
• Integration- incompetent lentiviral vectors are obtained by modifying the pol gene encoding the integrase protein, resulting in a mutated pol gene encoding an integrative deficient integrase.
• Such integration-incompetent viral vectors have been described in patent application WO 2006/010834, which is herein incorporated by reference in its entirety.
• HIV-1 pol gene suitable to reduce integrase activity include, but are not limited to: H12N, H12C, H16C, H16V, S81 R, D41A, K42A, H51A, Q53C, D55V, D64E, D64V, E69A, K71A, E85A, E87A, D116N, D1161, D116A, N120G, N1201, N120E, E152G, E152A, D35E, K156E, K156A, E157A, K159E, K159A, K160A, R166A, D167A, E170A, H171A, K173A, K186Q, K186T, K188T, E198A, R199c, R199T, R199A, D202A, K211A, Q214L, Q216L, Q221 L, W235F, W235E, K236S, K236A, K246A, G247W, D253
• Adeno-associated virus is a small (.about.26 nm) replication-defective, nonenveloped virus, that depends on the presence of a second virus, such as adenovirus or herpes virus, for its growth in cells.
• AAV is not known to cause disease and induces a very mild immune response.
• AAV can infect both dividing and non-dividing cells and may incorporate its genome into that of the host cell.
• rAAV recombinant AAV
• the AAV comprises serotype that is effective in infecting cells of the nervous system.
• the AAV comprises a serotype selected from the group consisting of: AAV9, AAV6, AAVrhlO, AAV7M8, and AAV24YF.
• Recombinant AAV (rAAV) vectors are typically composed of, at a minimum, a transgene and its regulatory sequences, and 5' and 3' AAV inverted terminal repeats (ITRs). It is this recombinant AAV vector which is packaged into a capsid protein and delivered to a selected target cell.
• the transgene is a nucleic acid sequence, heterologous to the vector sequences, which encodes a polypeptide, protein, functional RNA molecule (e.g., miRNA, miRNA inhibitor) or other gene product, of interest.
• the nucleic acid coding sequence is operatively linked to regulatory components in a manner which permits transgene transcription, translation, and/or expression in a cell of a target tissue.
• the AAV sequences of the vector typically comprise the cis-acting 5' and 3' inverted terminal repeat sequences (See, e.g., B. J. Carter, in "Handbook of Parvoviruses", ed., P. Tijsser, CRC Press, pp. 155 168 (1990)).
• the ITR sequences are about 145 bp in length. Preferably, substantially the entire sequences encoding the ITRs are used in the molecule, although some degree of minor modification of these sequences is permissible.
• the ability to modify these ITR sequences is within the skill of the art. (See, e.g., texts such as Sambrook et al, "Molecular Cloning. A Laboratory Manual", 2d ed., Cold Spring Harbor Laboratory, New York (1989); and K. Fisher et al., J Virol., 70:520 532 (1996)).
• An example of such a molecule employed in the present invention is a "cis-acting" plasmid containing the transgene, in which the selected transgene sequence and associated regulatory elements are flanked by the 5' and 3' AAV ITR sequences.
• the AAV ITR sequences may be obtained from any known AAV, including presently identified mammalian AAV types.
• an AAV comprising a Cas9 cDNA is packaged as a single- stranded AAV vector.
• a dual AAV vector system is used in which the Cas9 cDNA is split into two halves and the two AAV vectors reconstitute the Cas9 gene by either splicing (trans-splicing), homologous recombination (overlapping), or a combination of the two (hybrid).
• a splice donor (SD) signal is placed at the 3' end of the 5 '-half vector and a splice acceptor (SA) signal is placed at the 5' end of the 3 '-half vector.
• SD splice donor
• SA splice acceptor
• trans-splicing results in the production of a mature mRNA and full-size protein (Yan et al, 2000). Trans- splicing has been successfully used to express large genes in muscle and retina (Reich et al, 2003; Lai et al, 2005).
• the two halves of a large transgene expression cassette contained in dual AAV vectors may contain
• homologous overlapping sequences at the 3' end of the 5 '-half vector and at the 5' end of the 3 '-half vector, dual AAV overlapping
• T his strategy depends on the recombinogenic properties of the transgene overlapping sequences (Ghosh et al, 2006).
• a third dual AAV strategy is based on adding a highly recombinogenic region from an exogenous gene [i.e. alkaline phosphatase, AP (Ghosh et al, 2008, 2011)] to the trans-splicing vectors. The added region is placed downstream of the SD signal in the 5'- half vector and upstream of the SA signal in the 3 '-half vector in order to increase recombination between the dual AAVs.
• the vector is an HSV based viral vector.
• mature HSV virion consists of an enveloped icosahedral capsid with a viral genome consisting of a linear double- stranded DNA molecule that is 152 kb.
• the HSV based viral vector is deficient in at least one essential HSV gene.
• the vector can alternatively or in addition be deleted for non-essential genes.
• the HSV based viral vector that is deficient in at least one essential HSV gene is replication deficient.
• Most replication deficient HSV vectors contain a deletion to remove one or more intermediate-early, early, or late HSV genes to prevent replication.
• the HSV vector may be deficient in an immediate early gene selected from the group consisting of: ICP4, ICP22, ICP27, ICP47, and a combination thereof.
• Advantages of the HSV vector are its ability to enter a latent stage that can result in long-term DNA expression and its large viral DNA genome that can accommodate exogenous DNA inserts of up to 25 kb.
• HSV-based vectors are described in, for example, U.S. Pat. Nos.
• the HSV vector is "multiply deficient,” meaning that the HSV vector is deficient in more than one gene function required for viral replication.
• the HSV vector comprises a serotype selected from the group consisting of: JANI5, JANI7, and JANI8.
• compositions disclosed herein can be formulated for delivery to a subject according to a variety of factors, e.g., the site and route of administration, that composition to be delivered, and the like.
• compositions comprising for use in targeting at least one CSF1-DAP12 pathway member are also provided.
• Such compositions typically comprise a CSF1-DAP12 pathway member modulator and a pharmaceutically acceptable carrier.
• compositions can include a therapeutically effective amount of a CSF1-
• the term "therapeutically effective amount” or “effective amount” refers to an amount of a CSF1-DAP12 pathway member modulator that when administered alone or in combination with another therapeutic agent to a cell, tissue, or subject (e.g., a mammal such as a human or a non-human animal such as a primate, rodent, cow, horse, pig, sheep, etc.) is effective to prevent or ameliorate neuropathic pain in a subject in need of treatment, e.g., at risk or having neuropathic pain.
• a therapeutically effective dose further refers to that amount of the CSF1-DAP12 pathway member modulator sufficient to result in full or partial amelioration of symptoms of neuropathic pain.
• a therapeutically effective dose further refers to that amount of the CSF1-DAP12 pathway member modulator sufficient to provide for analgesia in a subject, e.g., local and/or systemic analgesia in subject in need of treatment.
• a therapeutically effective dose further refers to that amount of the CSF1-DAP12 pathway member modulator sufficient to provide for reduction of nerve injury induced mechanical hypersensitivity and microglia activation in the subject, e.g., as compared to prior to therapy with a CSF1-DAP12 pathway member modulator.
• compositions and techniques for their preparation and use are known to those of skill in the art in light of the present disclosure.
• suitable pharmacological compositions and techniques for their administration one may refer to the detailed teachings herein, which may be further supplemented by texts such as Remington's Pharmaceutical Sciences, 17th ed. 1985; Brunton et al., "Goodman and
• compositions or vehicle further include pharmaceutically acceptable materials, compositions or vehicle, such as a liquid or solid filler, diluent, excipient, solvent or encapsulating material, i.e., carriers.
• a liquid or solid filler such as a liquid or solid filler, diluent, excipient, solvent or encapsulating material, i.e., carriers.
• carriers are involved in transporting the subject modulator from one organ, or region of the body, to another organ, or region of the body.
• Each carrier should be "acceptable” in the sense of being compatible with the other ingredients of the formulation and not injurious to the patient.
• kits for carrying out the administration of a CSF1-DAP12 pathway member modulator are provided.
• the present disclosure also provides methods of treating neuropathic pain in a subject, as well as formulation a CSF1-DAP12 pathway member modulator as disclosed herein for use in such a method.
• Such methods generally involve administering to a subject in need with a CSF1-DAP12 pathway member modulator as disclosed above, e.g., a polynucleotide comprising a neuron specific promoter (e.g., a trigeminal ganglion (TGG) or dorsal root ganglion (DRG) promoter) operably linked to a recombinant nucleic acid encoding an endonuclease that binds to a nucleotide sequence in a human colony stimulating factor 1 (hCSFl) gene or to a nucleotide sequence in another CSF1-DAP12 pathway member gene.
• a neuron specific promoter e.g., a trigeminal ganglion (TGG) or dorsal root ganglion (
• Subjects suitable for therapy include any subject having or at risk of neuropathic pain.
• Subjects include mammals, including both human and non-human mammals, e.g., primates, rodents, cows, horses, pigs, sheep, etc.
• the methods of the present disclosure involve administration of a CSF1-DAP12 pathway member modulator in an amount effective to prevent or ameliorate neuropathic pain in a subject in need of treatment, e.g., at risk or having neuropathic pain. Such methods can provide full or partial amelioration of symptoms of neuropathic pain. Such methods can provide for analgesia in a subject in need of treatment, e.g., local and/or systemic analgesia. The present methods can provide for reduction of nerve injury induced mechanical hypersensitivity and microglia activation in the subject, e.g., as compared to prior to therapy with a CSF1-DAP12 pathway member modulator.
• the CSF1-DAP12 pathway member modulators can be administered by any suitable route, e.g., by intrathecal bolus injection or infusion, intraganglionic injection, intraneural injection, subcutaneous injection, or intraventricular injection.
• the CSF1- DAP12 pathway member modulator can be administered to a subject by, for example, intrathecal bolus injection or infusion at multiple levels of the spinal column.
• CSF1-DAP12 pathway member modulators can be administered to the subject by intraganglionic injection directly into a single dorsal root ganglion, multiple dorsal root ganglia, or the trigeminal ganglion.
• the CSF1-DAP12 pathway member can be administered to the subject by intraneural injection into the nerve bundle (e.g. sciatic nerve, trigeminal nerve).
• the CSF1-DAP12 pathway member modulator is administered to the subject by subcutaneous injection at the peripheral nerve terminals (subdermal or internal organ wall).
• the CSF1-DAP12 pathway member modulator is administered to the subject by intraventricular injection (for trigeminal ganglion transduction).
• the CSF1-DAP12 pathway member modulators may be administered to a subject in need by delivery to the central nervous system, e.g., intraparenchymal administration, intracisternal administration, intracranial administration, intraspinal administration, stereotactic brain injection, and the like.
• neuropathic pain is the result of an injury, disorder or malfunction affecting the peripheral or central nervous system.
• Neuropathic pain may result from disorders of the peripheral nervous system or the central nervous system (brain and spinal cord). Neuropathic pain may be divided into peripheral neuropathic pain, central neuropathic pain, or mixed (peripheral and central) neuropathic pain.
• the pain can be triggered by an injury, but this injury may or may not involve actual damage to the nervous system.
• nerves can be infiltrated or compressed by tumors, strangulated by scar tissue, or inflamed by infection. The pain frequently has burning, lancinating, or electric shock qualities.
• Persistent allodynia pain resulting from a nonpainful stimulus such as a light touch, is also a common characteristic of neuropathic pain.
• neuropathic pain examples include post herpetic (or post-shingles) neuralgia, reflex sympathetic dystrophy, components of cancer pain, phantom limb pain, entrapment neuropathy (e.g., carpal tunnel syndrome), and peripheral neuropathy (widespread nerve damage).
• Neuropathic pain can also be associated with diabetes, as well as chronic alcohol use, exposure to toxins (including many chemotherapeutic agents), and vitamin
• neuropathic pain examples include but are not limited to autoimmune disease, e.g. multiple sclerosis, metabolic diseases e.g. diabetic neuropathy (including peripheral, focal, proximal and autonomic), infection e.g. shingles, postherpetic neuralgia, vascular disease, trauma, pain resulting from chemotherapy, HIV infection/AIDS, spine or back surgery, post- amputation pain, central pain syndrome, postherpetic neuralgia, phantom limb, trigeminal neuralgia, reflex sympathetic dystrophy syndrome, nerve compression, stroke, spinal cord injury and cancer.
• autoimmune disease e.g. multiple sclerosis
• metabolic diseases e.g. diabetic neuropathy (including peripheral, focal, proximal and autonomic)
• infection e.g. shingles
• postherpetic neuralgia vascular disease
• trauma including peripheral, focal, proximal and autonomic
• pain resulting from chemotherapy HIV infection/AIDS, spine or back surgery
• post- amputation pain central pain syndrome
• the spared nerve injury (SNI) model of neuropathic pain was used.
• SNI spared nerve injury
• the sural and superficial peroneal branches of the sciatic nerve were tightly ligated with 8-0 silk sutures and then transected distal to the ligature, leaving the tibial nerve intact.
• the overlying muscle and skin were sutured, and the animals allowed to recover and then returned to their home cages.
• the L4 and L5 dorsal root were ligated with 8-0 silk sutures at the time of the peripheral nerve injury. Intrathecal injection was performed as previously described.
• CSFl Ten microliters of 3 ng/ ml CSFl (total of 30 ng) or 40 ng/ ml CSFl neutralizing antibody (total of 400 ng) were intrathecally injected.
• CSFl was injected daily for three days.
• CSFl-induced microglial gene induction CSFl was injected twice within 24 hours; spinal cord tissue was collected 24 hours after the first injection.
• ATF3 (Santa Cruz, rabbit, 1:2000), BrdU (Abeam, rat, 1:400), CSFl (R&D, goat, 1: 1000), CSF1R (Millipore), CDl lb (Abeam), NeuN (Millipore), BrdU (Abeam), GFP (Abeam, chicken, 1:2000), Ibal (Wako, rabbit, 1 : 1000), NPY (gift from J. Allen, rabbit, 1:5000), PKCy (Strategic Bio, guinea pig, 1: 10,000).
• Invitrogen Alexa Fluor 488, 555, 594, 647) were used.
• a bridge immuno staining protocol was used to detect the primary antiserum: anti-goat biotin IgG (Vector Laboratories, 1:500) and streptavidin coupled to an Alexa Fluor 488 or 594 (Invitrogen, 1: 1000).
• mice were anesthetized with Avertin (250mg/kg; 2, 2, 2-Tribromoethanol, Sigma) and perfused transcardially with phosphate-buffered saline (PBS) followed by 10% formalin in PBS (Fisher Scientific) at room temperature (RT).
• PBS phosphate-buffered saline
• RT room temperature
• Spinal cord and DRG were dissected, postfixed in the same fixative for 3 hours at RT, and then cryoprotected in 30% sucrose PBS overnight at 4°C.
• mice were injected with BrdU (100 mg/g body weight, i.p.) 2 hours prior to perfusion.
• Spinal cord sections were collected as described above.
• tissue sections were treated with 1M HCl (10 min, on ice), 2M HCl (10 min, RT) and 2M HCl (20 min, 37°C). Tissue sections were washed 5 times in PBS and then immunostained following the protocol described above.
• PKCy immuno staining was used to define the ventral border of the superficial dorsal horn and thresholding was used to measure signal intensity. 3 mice/group and 3 images/mouse were analyzed. Images were processed automatically. Results are normalized to values obtained in mice that were injected with vehicle (PBS). BrdU immunoreactive cells in the dorsal horn were also counted automatically using thresholding and the particle analyzer (Fiji/ImageJ). To quantify BrdU expression over time after SNI, the superficial dorsal horn was outlined with NeuN and analyzed 4 mice/time point, 3 images/mouse ipsilateral to the injury. To quantify BrdU labeled cells in response to intrathecal vehicle (PBS) or CSF1, BrdU labeled cells in the gray matter dorsal to the central canal were counted (3-4 mice/group and at least 3 images/mouse).
• mice were anesthetized with Avertin and perfused transcardially with PBS.
• mice with a peripheral nerve injury the investigators collected L4-6 DRGs and dorsal spinal cord ipsilateral and contralateral to the injury.
• mice that received an intrathecal CSF1 injection the investigators collected the entire lumbar spinal cord.
• Total RNA was purified with Trizol-chloroform (Ambion) and treated with DNase (Ambion).
• cDNA was synthesized with Superscript III First Strand Supermix or First-Strand Synthesis System (Invitrogen). Quantitative RT-PCR was performed using Bio-Rad CFX Connect and Maxima SYBR Green/ROX qPCR Mastermix (Thermo Scientific).
• ISH In situ hybridization
• NM_001113529.1 The signal was detected using an alkaline phosphatase reaction with a fluorescent Fast Red substrate.
• the following protocol was used to combine ISH with immunohistochemistry for ATF3.
• the mice were deeply anesthetized and transcardially perfused with 10% formalin as above. Twelve ⁇ cryostat sections collected on glass slides were immersed in 10% formalin for 10 minutes and then processed according to the manufacturer's ISH protocol. Protease treatment for 12 minutes was optimal for combining ISH with immunohistochemistry. Following the ISH steps, the slides were blocked in 5% normal goat serum/0.1M PBS (without Triton X-100) for one hour at RT and then processed for immuno staining as above.
• CSFl colony stimulating factor 1
• CSF1R microglial CSFl receptor
• Cre-mediated deletion of Csfl from sensory neurons completely prevented the hypersensitivity and significantly reduced the microglia activation produced by nerve injury.
• intrathecal (spinal) injection of CSFl not only activates microglia, but also induces mechanical hypersensitivity comparable to that produced by nerve injury.
• DAP12 an adaptor protein that is central to microglial signaling.
• DAP12 deletion abrogates both nerve injury and CSFl-induced mechanical hypersensitivity. DAP12 is also required for the nerve injury and CSFl-induced early upregulation of brain-derived neurotrophic factor (BDNF) and cathepsin S, microglial genes implicated in the development of neuropathic pain, but not for nerve injury or CSF1- induced microglial proliferation.
• BDNF brain-derived neurotrophic factor
• cathepsin S cathepsin S
• the cytokine CSF1 plays a role in the differentiation and maintenance of the myeloid lineage population, including microglia, and the CSF1 receptor, CSFIR, is also required for microglia development. Moreover, in the adult CNS, CSFIR is only expressed in microglia.
• a partial sciatic nerve injury (SNI) model of neuropathic pain was used to monitor the behavioral changes as well as the molecular consequences of injury in sensory neurons of the DRG and in the lumbar spinal cord (FIG. 1A).
• SNI sciatic nerve injury
• CSFIR is indeed exclusively expressed in microglia in the spinal cord and, as for Ibal, is upregulated in activated microglia after SNI (FIG. IB).
• a significant induction of Csfl mRNA in the L4-L6 DRG ipsilateral to the nerve injury (FIG. 1C) was recorded.
• No DRG induction of a second CSFIR ligand, IL-34 which is also required for microglial development, was observed (FIG. 2A).
• FIG. 1 (FIG. 1A) Schematic illustrating key neuroanatomical structures: sciatic nerve afferent fibers; sensory neurons in DRG; GABAergic inhibitory interneurons and microglia that regulate dorsal horn pain transmission (PT) neurons; X: sciatic nerve injury; arrow: dorsal root ligature site.
• FIG. IB Increased dorsal spinal cord Ibal and GFP labeling in CSF1R-GFP reporter mouse ipsilateral to SNI. Inset: morphology of resting (left; control) and activated (right; injured) microglia.
• FIG. 1C Rapid induction of Csfl mRNA in DRG after SNI.
• FIG. IE Co-expression of ATF3 and CSF1 in DRG neurons ipsilateral to injury (1 day).
• FIG. IE Accumulation of CSF1 at the dorsal root ligature.
• FIG. 1G Csfl deletion from sensory neurons greatly reduces microglia activation ipsilateral to the SNI.
• FIG. II Intrathecal CSF1 also activates dorsal horn microglia.
• FIG. 1J qRT-PCR shows that there is no induction of IL- 34;
• CSF1R (immunostaining) co-localizes with the microglial marker CD1 lb and both markers are induced in the dorsal horn after nerve injury (3d post injury). Scale bar equals 100 ⁇ ; (FIG. 1M) At 3 days after nerve injury there is complete CSF1R-GFP co-localization with the microglial marker Ibal, and none with the neuronal marker, NeuN. White square shows enlarged region. Scale bar equals 100 ⁇ ; (FIG. IN) Quantification of CSF1R
• FIG. 2B Combined in situ hybridization and immunocytochemistry illustrates de novo expression of Csfl mRNA in injured DRG neurons that co-express ATF3. Scale bar: 10 ⁇ .
• FIG. 2C Neither CSF1 nor ATF3 protein are expressed in DRG neurons contralateral to the nerve injury (4d post injury).
• Example 2 CSF1 is de novo induced in injured sensory neurons and transported to the spinal cord, where it engages CSF1 receptor (CSFlR)-expressing microglia
• RNA-Seq analysis was first performed after nerve injury (FIG. 1A). Although many studies have reported transcriptional changes after nerve injury, few examined both DRG and spinal cord and most were performed using microarray (LaCroix-Fralish et al., Pain. 2011, 152: 1888-1898; Perkins et al., Mol. Pain. 2014, 10:7). A dramatic upregulation of colony- stimulating factor 1 (Csfl) in the ipsilateral DRG and of its receptor (Csflr) was found in the ipsilateral dorsal cord after nerve injury (TABLE 2).
• Csfl colony- stimulating factor 1
• CSF1 is an essential factor added to culture medium to expand microglia in vitro (Suzumura et al., J. Neuwimmunol. 1990, 30: 111- 120; Smith et al., J. Neuroinflammation. 2013, 10:85), and CSF1R is required in vivo for microglia development (Elmore et al., Neuron. 2014, 82:380-397).
• Csflr is among the earliest genes expressed in microglia progenitors in yolk sac during microglia development (Ginhoux et al., Science. 2010, 330:841-845; Schulz et al., Science. 2012, 336:86-90).
• RNA-Seq analysis of DRG and dorsal cord after peripheral nerve injury Relative expression levels (Fragments Per Kilobase of exon per Million mapped fragments: FPKM) for selected genes in the DRG and dorsal spinal cord 7d after nerve injury. "Genes not upregulated in DRG after nerve injury; ⁇ Genes predominately expressed in microglia; c Genes exclusively expressed in monocytes; ⁇ CCL ⁇ l receptors; e Genes encoding neuronal membrane proteins that reportedly counteract microglia activation
• FIG. 2E illustrates double labeling for CSFl and neuropeptide Y, which is also expressed in DRG neurons only after peripheral nerve injury. Co-expression in DRG neurons and at the ligature site of CSFl and NPY (FIG. 2D-2E), a peptide that is upregulated in injured sensory neurons (Hokfelt et al.,
• Example 3 CSFl is necessary and sufficient for nerve injury-induced microglia activation in the spinal dorsal horn
• the functional impact of CSF1 was addressed by selectively deleting Csfl from DRG neurons by crossing a floxed Csfl mouse with another (Advillin-Cre) in which Cre- recombinase is expressed only in sensory neurons (FIG. 2F).
• the ATF3 response of injured sensory neurons was not altered in these mice (FIG. 2F).
• Csfl deletion prevented the hypersensitivity produced by nerve injury (FIG. IF) and greatly reduced microglia activation (FIG. 1G).
• intrathecal injection of a CSF1 neutralizing antibody significantly reduced the hypersensitivity produced by nerve injury (FIG. 2G).
• FIG. 3A shows that peripheral nerve injury increased the level of DAP 12 mPvNA in the dorsal spinal cord. The increase was significant within 1 day of injury and lasted for at least 7 days (FIG. 4A).
• Intrathecal CSF1 also induced DAP 12 expression (FIG. 3B).
• Deletion of DAP12 prevented both nerve injury- and intrathecal CSFl-induced mechanical hypersensitivity (FIG. 3C-3D).
• FIG. 4B-4D As DAP12 ko mice have normal baseline pain and motor behavior (FIG. 4B-4D), the failure to develop hypersensitivity did not result from a general pain processing or motor deficit.
• the mild hypersensitivity observed in the DAP12 ko mice is comparable to that produced by PBS in wt mice in Fig. 1, Panel h. Student's t-test or 2- way ANOVA, Tukey' s posthoc analysis, p ⁇ 0.05, ** p ⁇ 0.01, *** p ⁇ 0.001, **** p ⁇ 0.0001
• FIG. 5E Intrathecal CSF1 induced microglial proliferation. Inset: BrdU and Ibal colocalization in microglia.
• RNA-Seq analysis of the dorsal spinal cord ipsilateral to the nerve injury found a significant upregulation of Tyrobp, the gene that encodes DAP12 (TABLE 2).
• DAP12 was focused on because it is central to adult microglial functionality (Salter and Beggs, Cell. 2014, 158: 15-24; Hickman et al., Nat. Neurosci. 2013, 16: 1896-1905) and is induced in microglia in the Xllth nucleus after hypoglossal nerve injury (Kobayashi et al., Glia. 2015, 1073-1082).
• DAP12 lies downstream of CSF1R and is necessary for the CSF1-CSFR1 triggered upregulation of pain-related microglial genes and of the consequent neuropathic pain condition.
• DAP12 is also required for hypoglossal nerve injury-induced expression of pro-inflammatory cytokines, including Ml- phenotype markers (Kobayashi et al., Glia. 2015, 1073-1082).
• DAP 12 mechanisms also contribute to ongoing neuropathic pain. Autotomy (self-mutilation of a denervated limb) is presumed to be driven by a persistent pain comparable to phantom limb pain after amputation.
• Basal levels of spinal cord DAP12 mRNA were found to be significantly higher in a strain of rats with high autotomy (HA) scores (Devor and Raber, Pain. 1990, 42:51-67) than are DAP12 levels in rats that rarely develop this condition (low autotomy; LA). These DAP 12 differences were present both before and after nerve injury (FIG. 6).
• FIG. 6 Rats with a predisposition for developing nerve injury-induced autotomy
• HA strain have elevated DAP 12 mRNA levels in the spinal cord compared a low autotomy (LA) strain.
• Example 5 Microglia self -renewal, rather than monocyte infiltration, underlies microglial expansion in the spinal cord after nerve injury
• RNA-Seq analysis showed that although the microglia- enriched genes are upregulated, the monocyte specific genes remained undetectable after nerve injury (TABLE 2). These RNA-Seq findings were confirmed by qRT-PCR (FIG. 7).
• Example 6 CSF1 is both necessary and sufficient for nerve injury-induced microglia proliferation/self-renewal in the dorsal horn
• FIG. 8 Double labeling for BrdU and GFP in the CSF1R-GFP mouse shows that BrdU incorporation 2 days after nerve injury is limited to CSFlR-expressing microglia.
• FIG. 8B Time course of BrdU incorporation after nerve injury. Proliferation begins 2 days after injury and returns to
• FIG. 8C Preserved nerve injury-induced microglial proliferation in DAP 12 ko mice (2 days post SNI).
• Example 7 DAP12 is not required for nerve injury- or CSFl-induced microglia proliferation in vivo
• FIG. 8A-8B show that nerve injury also triggers microglia proliferation, demonstrated by BrdU incorporation into CSF1R expressing microglia, but only beginning 2 days post SNI. It was found that intrathecal CSFl induced microglia proliferation comparable to that provoked by nerve injury (FIG. 5E). However, neither the microglial proliferation produced by nerve injury nor that produced by intrathecal CSFl was altered in the DAP 12 mutant mice (FIG. 5F-5G; FIG. 8C-8D). Thus, both CSFl and DAP 12 contribute to the rapid neuropathic pain-related gene induction in microglia produced following nerve injury, but only CSFl contributes to microglia proliferation.
• peripheral nerve injury induces microglial activation in the ventral horn (around motoneurons; FIG. 10F).
• microglial activation ipsilateral to the injury occurred in close association with de novo CSFl induction in injured motoneurons (FIG. 10B; FIG. 10F).
• CSFl was induced only in injured motoneurons that expressed ATF3.
• advillin-Cre-mediated sensory neuron deletion of Csfl greatly reduced nerve injury-induced microglial activation in the dorsal horn (FIG. IOC)
• the ventral horn microglial activation and the CSFl induction in motoneurons was only slightly reduced (FIG. IOC; FIG. 10G).
• FIG. 10 CSFl induction in ventral cord and microglial activation (Ibal) in ventral and dorsal horn 8 days post SNI (control mice)
• FIG. 10E-10F CSFl expressing motoneurons attract microglia, enlargement of (FIG. 10A-10B);
• FIG. IOC Although specific deletion of CSFl in DRG neurons prevents microglia activation (Ibal) in the dorsal horn, CSFl induction in motoneurons is intact and microglial activation around CSFl expressing motoneurons is preserved (FIG. 10G) Enlargement of ventral cord of (FIG. IOC); (FIG.
• FIG. 10D CSFl deletion in the majority of CNS neurons greatly reduces nerve injuryinduced ventral horn microglia activation, while dorsal horn microglia activation is preserved.
• FIG. 10H Note that remaining CSFl expressing motoneurons attract microglia.
• FIG. 11 In control, Csfl fl/fl mice, all ATF3-expressing (injured) ventral horn motoneurons coexpress CSF1 after peripheral nerve injury. This pattern does not change significantly in Adv-Cre; Csfl fl/fl mice. However, in nestin-Cre; Csfl fl/fl mice, in which Csfl is deleted from the majority of CNS neurons, -30% of ATF3-expressing motoneurons co-express CSF1 after nerve injury. Scale bar: 50 ⁇ .
• CSF1 appears to contribute to the microglial invasion of motoneuron pools after injury and presumably also to the pathophysiological stripping of their synaptic inputs.
• FIG. 14 schematizes the present inventors' findings that link nerve injury-induced changes in sensory neurons with the microglial signaling pathway that influences spinal cord pain transmission circuits. The process begins with the de novo expression of CSFl in injured sensory neurons. CSFl, in turn, triggers a DAP12-dependent induction of microglial genes, the products of which contribute to the neuropathic pain phenotype, in part by decreasing GABAergic inhibitory controls.
• FIG. 13 CSFl induction in DRG neurons ipsilateral to the nerve injury is preserved in Nestin-Cre; Cs 7 fl/fl mice (8d post injury), indicating that Nestin-Cre is not expressed in DRG neurons. Scale bar: 50 ⁇ .
• FIG. 14 Within one day of sciatic nerve injury, there is de novo expression of CSFl in injured (ATF3 -positive) DRG sensory neurons.
• the CSFl is transported to the spinal cord, where it interacts with microglial CSF1R.
• Stimulated microglia in turn, undergo a relatively rapid neuropathic pain-associated gene induction phase (1 day after injury) and a delayed proliferation phase (2 days after injury).
• CSFl stimulates microglia to upregulate genes that result in the mechanical hypersensitivity characteristic of neuropathic pain.
• This DAP12-dependent microglial gene induction likely starts with the upregulation of transcription factors Irf8 and Irf5, which in turn induce the expression of downstream genes, including cathepsin S, BDNF and P2X4.
• cathepsin S cleaves fractalkine (CX3CL1), which subsequently binds its receptor (CX3CR1) on microglia to amplify the activation of microglia.
• CX3CL1 fractalkine
• CX3CR1 receptor
• FIG. 15 CSFl is induced in injured (ATF3-positive) sensory neurons within 1 d of injury and is transported to the spinal cord, where it interacts with microglial CSF1R.
• Stimulated microglia undergo a DAP 12-independent proliferation/self-renewal and a DAP12-dependent neuropathic pain-associated gene induction, including BDNF and cathepsin S (CatS).
• the microglial-derived BDNF contributes to reduced GABAergic inhibitory control and a consequent hyperexcitability of dorsal horn pain transmission neurons.
• cathepsin S amplifies the activation of microglia. Whether the neuropathic pain phenotype is exacerbated by the concurrent CSFl-induced microglia self -renewal/proliferation and whether DAP12 contributes to that process remains to be determined.
• Example 9 CSFl-induced hypersensitivity involves microglial activation and does not require P2X4.

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