WO2017184463A1

WO2017184463A1 - Compositions and methods useful for prophylaxis of organophosphates

Info

Publication number: WO2017184463A1
Application number: PCT/US2017/027824
Authority: WO
Inventors: Anna P. Tretiakova; James M. Wilson
Original assignee: University of Pennsylvania Penn
Current assignee: University of Pennsylvania Penn
Priority date: 2016-04-17
Filing date: 2017-04-15
Publication date: 2017-10-26
Anticipated expiration: 2018-10-17
Also published as: US11401527B2; US20190144884A1

Abstract

rAAV compositions useful for preventing the toxicity associated with organophosphate exposure are provided herein. The rAAV co-express a human butyrylcholinesterase and a proline-rich peptide. Each the esterase and the peptide may have an exogenous signal sequence. Also provided are compositions, e.g., aqueous liquid suspensions containing the rAAV.

Description

COMPOSITIONS AND METHODS USEFUL FOR PROPHYLAXIS OF ORGANOPHOSPHATES STATEMENT OF FEDERALLY SPONSORED RESEARCH

This invention was made with government support awarded by Defense Threat Reduction Agency of the Department of Defense (DTRA) Contract # HDTRA1-15-C- 0023. The government has certain rights in the invention. INCORPORATION-BY-REFERENCE OF MATERIAL SUBMITTED IN

ELECTRONIC FORM

Applicant hereby incorporates by reference the Sequence Listing material filed in electronic form herewith. This file is labeled "UPN-16-7803PCT_ST25.txt". BACKGROUND OF THE INVENTION

Human butyrylcholinesterase (hBChE) is a widely-distributed enzyme that may play a role in nerve conduction, can hydrolyze various toxic esters (e.g., cocaine), and acts as a potent scavenger.

Organophosphates (OP) are toxic chemical compounds which are present in pesticides and chemical warfare agents. OPs produce their toxic effects by irreversibly inhibiting acetylcholinesterase, the enzyme that breaks down the neurotransmitter acetylcholine (Taylor P (1990) Anticholinesterase agents, in The Pharmacological Basis of Therapeutics (Gilman AG, Rail TW, Nies AS, and Taylor P eds) pp 131 -149, Macmillan, New York.1990). The accumulation of acetylcholine in response to OP exposure causes an overstimulation of cholinergic receptors at the neuromuscular junctions and nerve synapses (Marrs, TC, et al, (1996) Riot-control Agents, in Chemical Warfare Agents: Toxicology and Treatment, pp 221-230, John Wiley, Chi Chester 1996), which can lead to muscle weakness, increased secretions, respiratory depression, seizures, coma, and ultimately death resulting from respiratory and/or cardiovascular failure or convulsions. One approach to treating OP poisoning is the use of enzymes to sequester these compounds in the circulation before they reach their physiological target, acetylcholinesterase in the nervous system. Among these enzymes is plasma-derived human but rylcholinesterase (Hu BChE; EC 3.8.1.1 ; accession no. M16541). BChE is mostly a tetrameric glycoprotein consisting of four identical subunits with a combined molecular mass of 340 kDa. The molecular mass of each subunit is 85 kDa, of which 65 kDa is protein and 20 kDa (24-26%) is carbohydrate.

Major limitations prohibiting the development of purified hBChE as a mainstream biologic drug include: limited availability of human plasma, limited scalability of manufacturing, high cost of purified human-derived product, and the need for intravenous administration. In addition, the preventive uses of hBChE are limited by its relatively short half-life. See, e.g., M. Wandhammer et al, Chem Biol Interact. 2013 Mar 25;203(1): 19-23. doi: 10.1016/j.cbi.2012.08.005. Epub 2012 Aug 16.

In an attempt to address some of these limitations, several methods for the production of recombinant hBChE in vitro (cell lines) and in vivo (transgenic animals, plants) were developed. However, the resulting recombinant proteins presented with unfavorable pharmacokinetic profiles making them unsuitable for preventive uses.

Alternatively, adeno virus-mediated delivery of hBChE delivers suitable levels of the enzyme. See, e.g., Chilukuri N., et al., Chem Biol Interact. 2008 Sep 25;175(l-3):327- 31. doi: 10.1016/j.cbi.2008.04.009. Epub 2008 May 21; and Chilukuri N., et al., Mol Pharmacol. 2009 Sep;76(3):612-7. doi: 10.1124/mol.109.055665. Epub 2009 Jun 19. However, adenovirus is not a candidate for development due to the inherent

immunogenicity of the vector. Expression of hBChE peaks at around 4 days post IV administration of the adenoviral vector, and the peak is followed by a rapid decline, with minimal expression being detectable 10 days post-administration. See, Chilukuri (2008), (2009) cited above.

What are needed are safe and effective means for delivering therapeutically and/or prophylactically effective levels of hBChE.

SUMMARY OF THE I NVENTION

In one aspect, a replication-defective, recombinant AAV (rAAV) which comprises an AAV capsid having a vector genome packaged therein. The vector genome comprises: AAV inverted terminal repeats (ITRs); a promoter; a 5' UTR; a leader sequence operably linked to a codon optimized human butyrylcholinesterase (hBChE); a linker; a nucleic acid sequence encoding a proline rich peptide, optionally having an exogenous leader sequence; and a poly A.

In a further aspect, an aqueous liquid suspension comprising an rAAV as described herein and an aqueous suspension base is provided herein.

In another aspect, an rAAV or a liquid suspension containing same, as described herein is provided which is administrable to a patient for protection against poisoning with organophosphate chemical agents, reducing the effects of organophosphates in a patient, and/or treating cocaine and/or heroin toxicity or addiction.

In yet another aspect, use of an rAAV in preparing a medicament is provided.

The medicament may be administrable to a patient for protection against poisoning with organophosphate chemical agents, reducing the effects of organophosphates in a patient, and/or treating cocaine or heroin toxicity and/or addiction.

In still a further aspect, the invention provides a method for protecting against poisoning with organophosphate chemical agents. The method involves administering an rAAV.hBChE as provided herein.

In yet another aspect, a method for reducing the effects of organophosphates in a patient is provided. The method comprises administering an rAAV.hBChE as provided herein to the patient.

These and other aspects of the invention will be apparent from the following

Description of the Invention.

BRIEF DESCRIPTION OF THE FIGURES

FIGs 1A and IB provide the effect of variable proline rich peptide (PRIMA1 PRP vs LPDN PRP) on BChE expression (FIG 1A) and activity (FIG IB) post vector administration in RAG KO mice. Expression and activity of BChE CO post-vector administration (in context of CMV promoter, PI intron, innate leader and SV40 poly A) in the presence (PRIMA1 PRP, circles vs LPDN PRP, triangles) or absence (inverted triangles) of proline rich peptide as shown. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 xlO¹¹ GC tittered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD (n=5/group).

FIGs 2 A and 2B provide the effect of 5' UTR on BChE expression (FIG 2 A) and activity (FIG 2B) post vector administration in RAG KO mice. Expression and activity of BChE CO post-vector administration (in context of CMV promoter, IL2 leader sequence, and PRIMAl PRP) in the presence (inverted triangles connected via solid line) and absence (circles connected via dashed line) of c-myc 5 'UTR. Mice were injected IM with one 30 μΐ injection into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 xlO¹¹ GC tittered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD

(n=5/group).

FIGs 3A and 3B provide the effect of Gl 17H, E197Q mutation on BChE expression (FIG 3A) and activity (FIG 3B) post vector administration in RAG KO mice. Expression and activity of BChE CO (circles connected via dashed line, marked as Wild- type) and G117H, E197Q (mutant, inverted triangle connected via solid line, marked as G117H) post-vector administration (in context of CMV promoter, IL2 leader, and PRIMAl PRP) as shown. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 xl O¹¹ GC tittered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD (n=5/group).

FIGs 4A and 4B provide the effect of different secretion signals on BChE expression (FIG 4A) and activity (FIG 4B) post vector administration in RAG KO mice. Expression and activity of BChE CO post-vector administration (in context of CMV promoter and PRIMAl PRP) in the presence of either innate (circles connected via dashed line) or hIL2 (inverted triangles connected via solid line) leader peptide. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 x 10¹¹ GC tittered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD (n=5/group).

FIGs 5A and 5B provide the effect of 3'UTR on BChE expression (FIG 5A) and activity (FIG 5B) post vector administration in RAG KO mice. Expression and activity of BChE CO post-vector administration (in context of CMV promoter, IL2 leader, and PRIMAl PRP) in the presence (inverted triangles connected via solid line) or absence (circles connected via dashed line) of WPRE 3 'UTR as shown. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 x 10¹¹ GC tittered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD

(n=5/group).

FIGs 6A and 6B provide the effect of different promoters on BChE expression (FIG 6A) and activity (FIG 6B) post vector administration in RAG KO mice. Expression and activity of BChE CO post-vector administration (in context of CMV promoter, innate leader, and PRIMAl PRP) in the presence of different promoters CMV (circles connected via dashed line), CB7 (inverted triangles connected via solid line) and UBC (grey triangles connected via solid grey line) as shown. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 xlO¹¹ GC. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD (n=5/group). * indicates that the vector titer was quantified by QPCR (vectors with CMV or CB7 promoter) while ** indicates that the vector titer was quantified by ddPCR (vector with UBC promoter).

FIG 6C provides the effect of different promoters on BChE expression post vector administration in RAG KO mice. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on Day 3. Mice were administered with a dose of 1 xlO¹¹ GC. Expression was measured in serum by ELISA. Values are expressed as mean ± SD.

FIGs 7A and 7B provide the effect of codon variation (CO, C 1 , C2 through C8) on BChE expression (FIG 7A) and activity (FIG 7B) post vector administration in RAG KO mice. Expression and activity of BChE with different codon variations (in context of CMV promoter, IL2 leader, and PRIMA1 PRP) as shown. Mice were inj ected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days a shown. Mice were administered with a dose of 1 xl O¹¹ GC tittered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD (n=5/group).

FIGs 8A-8H illustrate test constructs in RAG KO mice. Expression (FIGs 8A, 8C, 8E and 8G) and activity (FIGs 8B, 8D, 8F and 8H) of BChE CI in the 4 constructs with most preferred elements as shown (FIGs 8A and 8B, UbC-cmyc-IL2-BChE Cl IRES-IL2-PRIMA1 -SV40; FIGs 8C and 8D, UbC-cmyc-IL2-BChE C1 -IRES-IL2-

LPDN-SV40; FIGs 8E and 8F, CB7-cmyc-IL2-BChE C l-IRES-IL2-PRIMAl -rBG; and FIGs 8G and 8H, CB7-cmyc-IL2-BChE C l-IRES-IL2-LPDN-rBG). Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 x 10¹¹ GC titered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD

(n=5/group).

FIGs 9A-9D show expression (FIGs 9A and 9C) and activity (FIGs 9B and 9D) of BChE C I in the 2 test constructs in BChE KO mice as shown (FIGs 9A and 9B, UbC- cmyc-IL2-BChE C 1-IRES-IL2-PRIMA1 -SV40; and FIGs 9C and 9D, CB7-cmyc-IL2- BChE C l-IRES-IL2-LPDN-rBG). Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days a shown. Mice were administered with a dose of 1 x 10¹¹ GC titered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD (n=3/group).

FIGs 9E-9H show comparison of BChE expression (FIGs 9E and 9G) and activity (FIGs 9F and 9H) of BChE C I in RAG KO mice (circles connected via dashed line) and BChE KO mice (inverted triangles connected via solid line) utilizing the 2 test constructs (FIGs 9A and 9B, UbC-cmyc-IL2-BChE C 1-IRES-IL2-PRIMA1 -SV40; and FIGs 9C and 9D, CB7-cmyc-IL2-BChE Cl -IRES-IL2-LPDN-rBG). Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days a shown. Mice were administered with a dose of 1 x 10¹¹ GC titered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method, values are expressed as mean ± SD (n=3- 5/group).

FIGs 10A and 10B show expression of BChE CI in the 2 test constructs in

BChE KO mice as shown (FIG 10A, UbC-cmyc-IL2-BChE C1-IRES-IL2-PRIMA1- SV40; and FIG 10B, CB7-cmyc-IL2-BChE Cl-IRES-IL2-LPDN-rBG). Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days a shown. Mice were administered with a dose of 1 x 10¹¹ GC titered by QPCR. Expression was measured in serum by ELISA. Values are expressed as mean ± SD (n=3/group).

FIGs 11 A and 11B show expression (FIG 11 A) and activity (FIG 1 IB) of BChE in RAG KO mice post injection with the UbC-cmyc-IL2-BChE C 1 -IRES-IL2-LPDN- SV40 vector. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 x 10¹¹ GC (circles connected via dashed line) or 1 x 10¹⁰ GC (inverted triangles connected via solid line) titered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method.

FIGs 12A and 12B show expression (FIG 12A) and activity (FIG 12B) of BChE in RAG KO mice post injection with the CB7-cmyc-IL2-BChE C1-IRES-IL2-PRIMA1- rBG vector. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of 1 x 10¹¹ GC (circles connected via dashed line) or 1 x 10¹⁰ GC (inverted triangles connected via solid line) titered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method.

FIGs 13 A and 13B show expression (FIG 13 A) and activity (FIG 13B) of BChE in RAG KO mice post injection with the CB7-cmyc-IL2-BChE C 1 -IRES-IL2-LPDN- rBG vector. Mice were injected IM with one 30 μΐ injections into the left gastrocnemius muscles. Orbital bleeds were collected on different days as shown. Mice were administered with a dose of (circles connected via dashed line) or 1 x 10¹⁰ GC (inverted triangles connected via solid line) titered by QPCR. Expression was measured in serum by ELISA and activity was measured by modified Ellman's method.

FIG 14 provides expression (grey bars) and activity (black bars) of BChE in mice post injection with the rAAV.CMV.BChE CI vector as described in Example 5.

FIG 15 provides a representative result of in-gel butyrylcholinesterase activity assay using serum collected on Day 0 and Day 56 from RAG KO mouse injected with 1 x 10¹¹ GC of AAV8.UbC.hIL2.BChE C 1. IRES . PRIMA 1. S V40 vector. Top band marked by letter T, tetramer; the band indicated by letter D, dimer; the band indicated by letter ma, one subunit of BChE and one of albumin; the band indicated by letter M, monomer.

DETAILED DESCRIPTION OF THE INVENTION

Recombinant, replication-defective AAV vectors which express hBChE are provided herein. These vectors have several advantages over prior art approaches. More particularly, rAAV are substantially non-immunogenic, thus no rapid decline in hBChE levels is expected. For example, hBChE expression from the illustrative rAAV vectors provided herein has been observed for at least two months with no decline and is expected to last for several months to several years. Further, this approach is not reliant on hBChE protein purification and has the flexibility to deliver the product into liver, lung and muscle.

As used herein, organophosphates (OP) are esters of phosphoric acid and its derivatives, having the general structure shows below, with a central phosphorus atom (P) and a characteristic (P=0) or thiophosphoric (P=S) bond. The symbol X represents the leaving group which is replaced (by nucleophilic substitution) by the oxygen of serine in an acetylcholinesterase (AcHE) active site. The rate of AcHe inhibition depends on the leaving group; higher tendency of leaving results in higher affinity of the inhibitor to the enzyme.

OP having toxicity include, e.g., chemical compounds used, e.g., as insecticides (malathion, parathion, diazinon, fenthion, dichlorvos, chlorpyrifos, ethion sulfoton, phorate, dimethoate, ciodrin, dichlorvos, dioxathion, ruelene, carbophenothion, supona, TEPP, EPN, HETP, parathion, malathion, ronnel, coumaphos, diazinon, trichlorfon, paraoxon, potasan, dimefox, mipafox, schradan, sevin, and dimetonor), nerve gases (soman, sarin, tabun, VX), ophthalmic agents (echothiophate, isoflurophate), and antihelmintics (trichlorfon). Herbicides (tribufos [DEF], merphos) are tricresyl phosphate-containing industrial chemicals.

The vectors provided herein are designed to carry a nucleic acid sequence which expresses at a minimum, leader sequences and the mature human butyrylcholinesterase enzyme. The wild-type human enzyme sequence (Human BChE, hBChE, hBuChE; UniProtKB - P06276) is reproduced in SEQ ID NO: 1, including the native leader (signal) peptide (amino acids residues 1 to 26) and the mature protein (amino acid residues 27 to 602). See, e.g., www.uniprot.org/uniprot/P06276. The nucleic acid sequence of the native human sequence (GenBank accession no. M16541.1) is reproduced in SEQ ID NO: 2. As discussed herein, while certain embodiments preferentially express the wild-type enzyme, there are indications wherein expression of hBChE mutants may be desired. In such embodiments, the vectors may be designed to express these hBChE mutants for a single therapy, or for use in a co-therapy with in combination with the vectors expressing the wild-type human enzyme, or in combination with another therapeutic. Similarly, vectors expressing the hBChE wild-type mutant [SEQ ID NO: 2] may be used alone, or in a co-therapy with another therapeutic.

Native BChE is primarily a tetrameric glycoprotein consisting of four identical subunits (typically about 98% is tetrameric form, which tetramer consists of four identical subunits corresponding to the mature enzyme). As provided herein, the vector (e.g., rAAV) expressed synthetic hBChE may be present in any form which confer a desired biological activity including, e.g., as a monomer, dimer, tetramer or a combination of two or more thereof. A variety of suitable methods are available to determine BChE activity. For example, BChE activity may be determined with a modified Ellman method (Ellman, GL., et al, Biochem Pharmacol, 1961, 7:88-95 41) in 96-well plates as described in the examples herein. Units of activity are μιηοΐ of butyrylthiocholine hydrolyzed per minute.

The activity of the BChE enzyme expressed from the rAAV vector has a specific activity similar to wild-type. Normal circulating levels of BChE enzyme are in the range of about 1 μg/mL or less. In certain embodiments, expression levels of about 10% to about 120% higher than normal wild-type BChE enzyme levels, or about 25% to about 100%, or about 50% to 100%, or about 75% to about 100%, or about 80% to about 100%, or about 90% to 95% of wild-type levels (delivered in protein form). In such embodiments, a patient may have a disorder or disease state associated with defective or null expression of the normal wild-type BChE enzyme. For example, the K variant of BChE enzyme (point mutation ntl615 GCA→ ACA resulting in the amino acid change Ala539→ Thr) has been associated with Alzheimer's disease and risk of cerebral amyloid angiopathy. In another example, patients homozygous for the A variant (point mutation at nt 209 GAT→GGT) resulting in an amino acid change Asp70→Gly), have been associated with sensitivity to mivacurium (used, e.g., as a muscle relaxant). In another example, mutant alleles at the BChE locus are associated with suxamethonium sensitivity (which is used, e.g., in surgical anesthesia) and increased risk for cocaine dependence and for crack cocaine use.

In certain embodiments, delivery of "normal" hBCheE activity levels about 5% to about 120% of the activity levels of human subjects may be therapeutically useful. Such embodiments may include, e.g., treatment of Alzheimer's disease and/or anesthesia sensitivity.

In certain other embodiments, e.g, to achieve protection against a chemical warfare agent containing an organophosphate or treatment of drug dependence, expression of human BChE at least 100 fold higher levels than normal levels are desirable, e.g. , about 100 μg/mL to about 700 μg/mL (i.e., 100,000 ng/mL to 700,000 ng/mL), or higher. For example, expression may be at least 250 μg/mL, at least about 400 μg/mL, or at least about 600 μg/mL. Suitably, expression may be observed to be sustained above a threshold amount of at least 100 μg/mL within about 24 hours and may increase to reach a steady state over a period of several days to about three weeks. In a particularly desirable embodiment, these expression levels can be provided by the vector via intramuscular dosing of vector, which is a route which typically provides lower expression levels than intravenous dosing. However, other routes of administration are permitted, including inhalation, intravenous, among others discussed herein.

In certain embodiments, BChE mutants which provide enhanced cocaine hydrolysis activity as compared to the native human BChE may be selected. Native human BChE has been reported to slowly hydrolyze cocaine with a biomolecular constant rate (kcat/Km) of about 0.28 mM^'Vmin^"1. See, e.g., P Masson and D Rochu, Acta Nature, 2009 Apr; 1(1): 68-79. Such mutants may include, A328Y (reported to have 4-fold higher catalytic efficiency), A328W/Y332A (reported to have a higher kcat/Dm activity), a 4-amino acid mutant A199S/S287G/A328W/Y332G (reported to provide an enzyme with a catalytic efficiency 456-fold greater than that of wild-type BChE) and a 5-amino acid mutant A199S/F227A/S287G/A328W7Y332G. In another embodiment, a mutant Gl 17H and a double mutant Gl 17H, E197Q are provided, which are capable of hydrolyzing toxic compounds including, e.g., paraoxon, sarin, echotiophate and VX. See, also,, M. Dwyer et al, Biochemistry, 2014, Jul 15: 453(27): 4476-4487, describing variants having Y332S, D340H, and Y332/S/D340H. These mutations are suited for use in the rAAV vectors described herein, e.g., when the function of human BChE for hydrolyzing ester-containing therapeutic and/or addictive drugs such as succinylcholine and its long-chain derivatives aspirin, irinotecan, heroin is desired and/or the function of BChE in plasma for hydrolyzing prodrugs such as isosorbide diaspirinate, bambuterol, ISDA, and/or cocaine is desired. When treating a subject having addiction or overdose (poisoning) of drugs such as cocaine, having the properties described above, the AAV.hBChE desirably is delivered in an amount which expresses about 100 fold to 1000 fold higher levels, or 500 to about 750 fold higher levels of human BChE than the "normal" about 1 μg/mL levels found in humans. For example, a suitable dose of vector may provide expression of about 1 mg/mL to about 10 mg/mL of hBCheE. However, higher or lower amounts may also provide a therapeutic effect alone, or when delivered as in a combination therapy, or as a co-therapy.

In certain embodiments, the hBChE coding sequence is modified to have a heterologous leader sequence, e.g., a leader sequence derived a source different from the native (innate) hBCheE leader sequence. In one embodiment, the leader sequence is a human IL2 leader sequence, which is reproduced in SEQ ID NO: 20. In a further embodiment, the leader sequence is a mutated human IL2 leader sequence, which is reproduced in SEQ ID NO: 21.

In one aspect, an engineered nucleic acid sequence encoding hBChE is provided. In one embodiment, the hBChE is the sequence of hBChEC2, which is provided in SEQ ID NO: 6, shown with an IL2 leader sequence. In one embodiment, the hBChE coding sequence is hBChE CO with innate leader sequence, SEQ ID NO: 3. In one

embodiment, the hBChE coding sequence is hBChE CO with an IL2 leader sequence, SEQ ID NO: 4. In one embodiment, the hBChE coding sequence is hBChE C I with an IL2 leader sequence, SEQ ID NO: 5. In one embodiment, the hBChE coding sequence is hBChE C3 with an IL2 leader sequence, SEQ ID NO: 7. In one embodiment, the hBChE coding sequence is hBChE C4 with an IL2 leader sequence, SEQ ID NO: 8.

In certain embodiments, a vector is provided which contains a nucleic acid sequence encoding a 57 nt IL2 signal peptide and the mature hBChE enzyme. In one embodiment, the hBChE coding sequence is hBChE CO with IL2 leader sequence, which is reproduced in SEQ ID NO: 4. In one embodiment, the codon optimized hBChE coding sequence is hBChE CI with IL2 leader sequence, which is reproduced in SEQ ID NO: 5. In one embodiment, the hBChE coding sequence is hBChE C2 with IL2 leader sequence, which is reproduced in SEQ ID NO: 6. In one embodiment, the codon optimized hBChE coding sequence is hBChE C3 with IL2 leader sequence, which is reproduced in SEQ ID NO: 7. In one embodiment, the codon optimized hBChE coding sequence is hBChE C4 with IL2 leader sequence, which is reproduced in SEQ ID NO: 8. In one embodiment, the codon optimized hBChE coding sequence is hBChE C5 with IL2 leader sequence, which is reproduced in SEQ ID NO: 9. In one embodiment, the codon optimized hBChE coding sequence is hBChE C6 with IL2 leader sequence, which is reproduced in SEQ ID NO: 10. In one embodiment, the codon optimized hBChE coding sequence is hBChE C7 with IL2 leader sequence, which is reproduced in SEQ ID NO: 11. In one embodiment, the codon optimized hBChE coding sequence is hBChE C8 with IL2 leader sequence, which is reproduced in SEQ ID NO: 12. In one embodiment, the codon optimized hBChE coding sequence is hBChE with mutation Gl 17H E197Q with IL2 leader sequence, which is reproduced in SEQ ID NO: 13. The following nomenclature for the hBChE coding sequences provided herein are used interchangeably.

In certain embodiments, the hBChE is co-expressed from the viral vector with a proline-rich peptide (PRP). Such PRP are derived from a sequence having the proline- rich core sequence: PSPPLPPPPPPPPPPPPPPPPPPPPLP (SEQ ID NO: 41) by vary in length at their N- and C-terminals. PRP do not contain native leader sequences.

However, for use in the vector genomes herein, the PRP are provided with a leader sequence in order to direct it to the same intracellular location as the hBChE in order to enhance tetramerization. In another embodiment, the proline-rich peptide is derived from human Proline-rich membrane anchor 1 (PRIMA1, UniProtKB - Q86XR5). In a further embodiment, the proline-rich peptide is derived from human lamellipodin (LPDN, UniProtKB - Q70E73). In one embodiment, the amino acid sequence of hPRIMAl PRP is that of SEQ ID NO: 48. In a further embodiment, the coding sequence encoding hPRIMAl PRP with an IL2 leader is reproduced in SEQ ID NO: 23. In another embodiment, the amino acid sequence of hLPDN PRP is that of SEQ ID NO: 49. In a further embodiment, the coding sequence encoding hLPDN PRP with an IL2 leader is reproduced in SEQ ID NO: 24. As used illustrated in the examples, a synthetic PRIMAl construct is provided which includes the N-terminal IL2 signal peptide, followed by a proline-rich extracellular domain. In the examples herein, a

transmembrane segment, and a cytoplasmic domain which are in the native protein are not present. The examples herein further demonstrate use of LPDN PRP or PRIMAl PRP with an N-terminal IL-2 signal peptide. In certain embodiments, the vectors provided herein contain a heterologous signal peptide, e.g., an IL2 signal peptide.

However, other signal peptides may be selected. In still other embodiments, variants on the lamellipodin, variants of the PRIMAl, or other proline-rich peptides may be selected.

Suitably, the hBChE and proline-rich peptide are co-expressed from a bicistronic expression cassette in which a linker sequence separates the two coding sequences in a manner which allow their expression to be driven by a single promoter. Suitable linkers, e.g., an IRES or F2A are discussed herein. In one embodiment, the linker is IRES with a sequence reproduced in SEQ ID NO: 22. In other embodiments, other multiple expression cassettes may be included in a vector.

Suitably, the expression cassette is designed so that a larger amount of BChE is expressed than PRP in accordance with the requirements for preferential BChE tetramer formation. In one embodiment, the ratio of BChE to PRP is at least 4 to 1 ; however, other ratios may be useful. For example, a greater excess of expressed BChE to PRP, e.g., ratios of 5-10 parts BChE : 1 PRP may be used. Still other ratios may be selected, e.g., 1 : 1.

While the present invention describes expression from an rAAV, these constructs may be engineered into other genetic elements (e.g., a plasmid useful in production or for direct delivery), or another viral vector.

These coding sequences and suitable viral vector elements are described in more detail below.

AAV CAPS ID

In the examples below, the vector is a recombinant, replication-defective adeno- associated virus.

In certain embodiments, the rAAV capsid is selected from amongst those having tropism for the liver. Any of a number of rAAV vectors with liver tropism can be used. Examples of AAV which may be selected as sources for capsids of rAAV include, e.g., rhlO, AAVrh64Rl, AAVrh64R2, rh8 [See, e.g., US Published Patent Application No. 2007-0036760-A1; US Published Patent Application No. 2009-0197338-A1; EP

1310571]. See also, WO 2003/042397 (AAV7 and other simian AAV), US Patent 7790449 and US Patent 7282199 (AAV 8), WO 2005/033321 and US 7,906,111 (AAV 9), and WO 2006/110689], and rhlO [WO 2003/042397], AAV3B; AAVdj [US

2010/0047174]. As illustrated in the examples, an AAV8 capsid may be selected.

As used herein, "AAV8 capsid" refers to an assembled AAV8 capsid, which contains AAV vpl, vp2 and vp3 protein, having the encoded amino acid sequence of GenBank accession: YP 077180 (SEQ ID NO: 47), which is incorporated by reference herein. Some variation from this encoded sequence is encompassed herein, which may include sequences having about 99% identity to the referenced amino acid sequence in GenBank accession: YP_077180; US Patent 7,282,199, 7,790,449; 8,319,480; 8,962,330; US 8,962,332, (i.e., less than about 1% variation from the referenced sequence). In another embodiment, the AAV8 capsid may have the VPl sequence of the AAV8 variant described in WO2014/124282 or the dj sequence described in US 2013/0059732 Al or US7588772 B2, which is incorporated by reference herein. Methods of generating the capsid, coding sequences therefore, and methods for production of rAAV viral vectors have been described. See, e.g., Gao, et al, Proc. Natl. Acad. Sci. U.S.A. 100 (10), 6081- 6086 (2003), US 2013/0045186A1, and WO 2014/124282.

In certain embodiments, an AAV capsid having tropism for muscle, and particularly, skeletal muscle may be selected. Such AAV may include, e.g., AAV8, AAV1, AAV6, amongst others. In certain embodiments, an AAV capsid having tropism for epithelial cells may be selected. Such AAV may include, e.g., AAV9, amongst others. In other embodiments, muscular tropism may not be as important a factor. In certain embodiments, intravenous delivery may be desired, e.g., for anesthesia sensitivity or drug addiction, as described herein. In still other embodiments, central nervous system tropism may be desired, e.g., for treatment of Alzheimer's Disease. Still other tropisms or routes of delivery may be selected. VECTOR GENOME ELEMENTS

A vector genome is designed which contains the expression cassette for the hBChE and protein-rich peptide. Suitably, such a genome includes AAV ITRs flanking a transgene expression cassette.

The AAV vector may contain a full-length AAV 5' inverted terminal repeat

(ITR) and a full-length 3' ITR. A shortened version of the 5' ITR, termed AITR, has been described in which the D-sequence and terminal resolution site (trs) are deleted. The abbreviation "sc" refers to self-complementary. "Self-complementary AAV" refers a construct in which a coding region carried by a recombinant AAV nucleic acid sequence has been designed to form an intra-molecular double-stranded DNA template. Upon infection, rather than waiting for cell mediated synthesis of the second strand, the two complementary halves of scAAV will associate to form one double stranded DNA (dsDNA) unit that is ready for immediate replication and transcription. See, e.g., D M McCarty et al, "Self-complementary recombinant adeno-associated virus (scAAV) vectors promote efficient transduction independently of DNA synthesis", Gene Therapy, (August 2001), Vol 8, Number 16, Pages 1248-1254. Self-complementary AAVs are described in, e.g., U.S. Patent Nos. 6,596,535; 7,125,717; and 7,456,683, each of which is incorporated herein by reference in its entirety.

Where a pseudotyped AAV is to be produced, the ITRs are selected from a source which differs from the AAV source of the capsid. For example, AAV2 ITRs may be selected for use with an AAV capsid having a particular efficiency for a selected cellular receptor, target tissue or viral target. In one embodiment, the ITR sequences from AAV2, or the deleted version thereof (AITR), are used for convenience and to accelerate regulatory approval. However, ITRs from other AAV sources may be selected. Where the source of the ITRs is from AAV2 and the AAV capsid is from another AAV source, the resulting vector may be termed pseudotyped. However, other sources of AAV ITRs may be utilized. In certain embodiment, the 5 'ITR is that of SEQ ID NO: 28. In certain embodiment, the 3'ITR is that of SEQ ID NO: 29.

As used herein, an "expression cassette" refers to a nucleic acid sequence which comprises at least a first open reading frame (ORF) and optionally a second ORF. An expression cassette may be designed to be bicistronic, i.e., to contain regulatory sequences which direct expression of the ORFs thereon from shared regulatory sequences. In this instance, the two ORFs (e.g., hBChE and PRP) are typically separated by a linker. Suitable linkers, such as an internal ribozyme binding site (IRES) and/or a furin-2a self-cleaving peptide linker (F2a), [see, e.g., Radcliffe and Mitrophanous, Gene Therapy (2004), 11, 1673-1674] are known in the art. Suitably, the ORF are operably linked to regulatory control sequences which direct expression in a target cell. Such regulatory control sequences may include a poly A, a promoter, and an enhancer. In order to facilitate co-expression from an AAV vector, at least one of the enhancer and/or polyA sequence may be shared by the first and second expression cassettes.

As discussed above, the vector contains an expression cassette in which hBChE and PRP operably linked to regulatory sequences which direct expression thereof. In certain embodiments, the PRP coding sequences include an artificial heterologous leader sequences to facilitate transport of the peptide to the same cellular compartment to which BChE is directed for more effective tetramer (dimer) assembly. In certain embodiments, the hBChE is also provided with a heterologous leader sequences.

These leader sequences may be selected from human leader sequences, e.g., interleukin 2 for the tissue to which the vector is to be targeted, e.g., liver (e.g., IL2), muscle, epithelium. These may be signal sequences from a cytokine (e.g., IL2, IL12, IL18, or the like), insulin, albumin, β-glucuronidase, alkaline protease or the fibronectin secretory signal peptides, mucin, amongst others. In certain embodiments, the PRP may be provided with a native hBChE leader sequence. See, e.g., www.signalpeptide.de [Signal Peptide Website: An information platform for Signal Sequences and Signal Peptides].

Suitable regulatory control sequences may be selected and obtained from a variety of sources. In one embodiment, a minimal promoter and/or a minimal polyA may be utilized to conserve size. The examples herein utilize CMV, or more preferably, UbC or CB7.

As used herein, the term "minimal promoter" means a short DNA sequence comprised of a TATA-box and other sequences that serve to specify the site of transcription initiation, to which regulatory elements are added for control of expression. In one embodiment, a promoter refers to a nucleotide sequence that includes a minimal promoter plus regulatory elements that is capable of controlling the expression of a coding sequence or functional RNA. This type of promoter sequence consists of proximal and more distal upstream elements, the latter elements often referred to as enhancers. In one embodiment, the minimal promoter is a Cytomegalovirus

(CMV) minimal promoter. In another embodiment, the minimal promoter is derived from human CMV (hCMV) such as the hCMV immediate early promoter

derived minimal promoter (see, US 20140127749, and Gossen and Bujard (Proc. Natl. Acad. Sci. USA, 1992, 89: 5547-5551), which are incorporated herein by reference). In another embodiment, the minimal promoter is derived from a viral source such as, for example: SV40 early or late promoters, cytomegalovirus (CMV) immediate early promoters, or Rous Sarcoma Virus (RSV) early promoters; or from eukaryotic cell promoters, for example, beta actin promoter (Ng, Nuc. Acid Res. 17:601-615, 1989; Quitsche et al., J. Biol. Chem. 264:9539-9545, 1989), GADPH promoter (Alexander, M. C. et al, Proc. Nat. Acad. Sci. USA 85:5092-5096, 1988, Ercolani, L. et al., J. Biol. Chem. 263: 15335-15341, 1988), TK-1 (thymidine kinase) promoter, HSP (heat shock protein) promoters, UbB or UbC promoter, PGK, Efl -alpha promoter or any eukaryotic promoter containing a TATA box (US Published Application No. 2014/0094392). In another embodiment, the minimal promoter includes a mini-promoter, such as the CLDN5 mini-promoter described in US Published Application No. 2014/0065666. In another embodiment, the minimal promoter is the Thymidine Kinase (TK) promoter. In one embodiment, the minimal promoter is tissue specific, such as one of the muscle-cell specific promoters minimal TnlSlow promoter, a minimal TnlFast promoter or a muscle creatine kinase promoter (US Published Application No. 2012/0282695). Each of these documents is incorporated herein by reference. In one embodiment, the promoter is a CMV promoter, which is reproduced in SEQ ID NO: 14. In one embodiment, the promoter is a CMV IE promoter, which is reproduced in SEQ ID NO: 15. In one embodiment, the promoter is a chicken beta actin (CB) promoter, which is reproduced in SEQ ID NO: 16. In one embodiment, the promoter is a UbC promoter, which is reproduced in SEQ ID NO: 18. In a further embodiment, a C4 enhancer which is reproduced in SEQ ID NO: 17, is further included in the expression cassette. In one embodiment, the promoter is a C4/UbC promoter, which is a CMV C4 enhancer in the upstream Pf-UbC promoter. In one embodiment, the promoter is a CB7 promoter, which is a hybrid between a cytomegalovirus (CMV) immediate early enhancer (C4) and the chicken beta actin promoter and intron. In a further embodiment, the promoter is a CB7 promoter, which is reproduced in SEQ ID NO: 50.

In one embodiment, the polyadenylation (poly(A)) signal is a minimal poly(A) signal, i.e., the minimum sequence required for efficient polyadenylation. In one embodiment, the minimal poly(A) is a synthetic poly(A), such as that described in Levitt et al, Genes Dev., 1989 Jul, 3(7): 1019-25; and Xia et al, Nat Biotechnol. 2002 Oct; 20(10): 1006-10. Epub 2002 Sep 16. Each of these documents is incorporated herein by reference. In another embodiment, the poly(A) is derived from the rabbit beta-globin poly(A). In a further embodiment, the poly(A) comprises the sequence reproduced in SEQ ID NO: 26. In one embodiment, the poly(A) is derived from the SV40 early poly A signal sequence. In a further embodiment, the poly(A) comprises the sequence reproduced in SEQ ID NO: 27.

In certain embodiments, the vector genome includes one or more of a 5' untranslated region (UTR), an intron, a Kozak sequence, and/or a 3' UTR. As used herein, a "5' UTR" is also known as a leader sequence or leader RNA. In the examples herein, the 5' UTR is derived from c-myc . In a further embodiment, the 5 'UTR comprises the sequence reproduced in SEQ ID NO: 19. However, other suitable sources are known to those of skill in the art. See, e.g., www.utrdb.ba.itb.cnr.it [Institute for Biomedical Technologies, UTR database]. Optionally, a 3' UTR may also be derived from, e.g., c-myc, a woodchuck post-transcription regulatory element.

In certain embodiments, the expression cassette comprises: UbC-cmyc-IL2- BChE C1-IRES-IL2-PRIMA1 [nt 14 to nt 4162 of SEQ ID NO: 30]. In other embodiments, the expression cassette comprises: UbC-cmyc-IL2-BChE C1-IRES-IL2- LPDN [nt 14 to nt 4874 of SEQ ID NO: 31]. In other embodiments, the expression cassette is CB7-cmyc-IL2-BChE C1-IRES-IL2-PRIMA1 [SEQ ID NO: 32]. In still other embodiments, the expression cassette is: CB7-cmyc-IL2-BChE C1-IRES-IL2- LPDN [SEQ ID NO: 33]. In another embodiment, the expression cassette comprises C4/UbC-hIL2-BchE Cl-IRES-LPDN [SEQ ID NO: 34]. In another embodiment, the expression cassette comprises C4/UbC-hIL2-BChE C1-IRES-PRIMA1 [SEQ ID NO: 35]. In yet another embodiment, the expression cassette comprises C4/UbC.hIL2.BChE Cl .IRES.PRIMA.RBG [SEQ ID NO: 51]. Such expression cassettes may be particularly well suited for targeting liver and/or muscle.

The expression cassette is typically engineered into a suitable genetic element, e.g., a plasmid. For a vector genomes, the expression cassette is flanked by AAV ITRs. Suitably, the plasmid may be used in production of rAAV vectors. Methods of generating the capsid, coding sequences therefore, and methods for production of rAAV viral vectors have been described. See, e.g., Gao, et al, Proc. Natl. Acad. Sci. U.S.A. 100 (10), 6081-6086 (2003), US 2013/0045186A1, and WO 2014/124282. However, the hBChE coding sequences and the vector genomes may optionally be engineered into another suitable viral vector. See, e.g., WO 2014/168953, providing chimeric

AAV/bocavirus parvovirus vectors. Still other viral systems may be selected.

VECTOR MANUFACTURE

Numerous methods are known in the art for production of rAAV vectors, including transfection, stable cell line production, and infectious hybrid virus production systems which include Adenovirus -AAV hybrids, herpesvirus -AAV hybrids and baculovirus-AAV hybrids. See, e.g., G Ye, et al, Hu Gene Ther Clin Dev, 25: 212-217 (Dec 2014); RM Kotin, Hu Mol Genet, 2011, Vol. 20, Rev Issue 1, R2-R6; M. Mietzsch, et al, Hum Gene Therapy, 25: 212-222 (Mar 2014); T Virag et al, Hu Gene Therapy, 20: 807-817 (August 2009); N. Clement et al, Hum Gene Therapy, 20: 796-806 (Aug 2009); DL Thomas et al, Hum Gene Ther, 20: 861-870 (Aug 2009). rAAV production cultures for the production of rAAV virus particles may require; 1) suitable host cells, including, for example, human-derived cell lines such as HeLa, A549, or 293 cells, or insect- derived cell lines such as SF-9, in the case of baculovirus production systems; 2) suitable helper virus function, provided by wild type or mutant adenovirus (such as temperature sensitive adenovirus), herpes virus, baculovirus, or a nucleic acid construct providing helper functions in trans or in cis; 3) functional AAV rep genes, functional cap genes and gene products; 4) a transgene (such as a therapeutic transgene) flanked by AAV ITR sequences; and 5) suitable media and media components to support rAAV production. A variety of suitable cells and cell lines have been described for use in production of AAV. The cell itself may be selected from any biological organism, including prokaryotic (e.g., bacterial) cells, and eukaryotic cells, including, insect cells, yeast cells and mammalian cells. Particularly desirable host cells are selected from among any mammalian species, including, without limitation, cells such as A549, WEHI, 3T3,

10T1/2, BHK, MDCK, COS 1 , COS 7, BSC 1, BSC 40, BMT 10, VERO, WI38, HeLa, a HEK 293 cell (which express functional adenoviral El), Saos, C2C 12, L cells, HT1080, HepG2 and primary fibroblast, hepatocyte and myoblast cells derived from mammals including human, monkey, mouse, rat, rabbit, and hamster. The selection of the mammalian species providing the cells is not a limitation of this invention; nor is the type of mammalian cell, i.e., fibroblast, hepatocyte, tumor cell, etc.

AAV sequences may be obtained from a variety of sources. For example, a suitable AAV sequence may be obtained as described in WO 2005/033321 or from known sources, e.g., the American Type Culture Collection, or a variety of academic vector core facilities. Alternatively, suitable sequences are synthetically generated using known techniques with reference to published sequences. Examples of suitable AAV sequences are provided herein.

In addition to the expression cassette, the cell contains the sequences which drive expression of an AAV capsid in the cell (cap sequences) and rep sequences of the same source as the source of the AAV ITRs found in the expression cassette, or a cross- complementing source. The AAV cap and rep sequences may be independently selected from different AAV parental sequences and be introduced into the host cell in a suitable manner known to one in the art. While the full-length rep gene may be utilized, it has been found that smaller fragments thereof, i.e., the rep78/68 and the rep52/40 are sufficient to permit replication and packaging of the AAV.

In one embodiment, the host cell contains at least the minimum adenovirus DNA sequences necessary to express an El a gene product, an Elb gene product, an E2a gene product, and/or an E4 ORF6 gene product. In embodiments in which the host cell carries only El , the E2a gene product and/or E4 ORF6 gene product may be introduced via helper plasmid or by adenovirus co-infection. In another embodiment, the E2a gene product and/or E4 ORF6 may be substituted by herpesvirus helper functions. The host cell may contain other adenoviral genes such as VAI RNA, but these genes are not required. In one embodiment, the cell used does not carry any adenovirus gene other than El, E2a and/or E4 ORF6; does not contain any other virus gene which could result in homologous recombination of a contaminating virus during the production of rAAV; and it is capable of infection or transfection by DNA and expresses the transfected gene (s).

One cell type useful in the methods and systems described herein is a host cell stably transformed with the sequences encoding rep and cap, and which is transfected with the adenovirus El , E2a, and E40RF6 DNA and a construct carrying the expression cassette as described above. Stable rep and/or cap expressing cell lines, such as B-50 (International Patent Application Publication No. WO 99/15685), or those described in US Patent No. 5,658,785, may also be similarly employed. Another desirable host cell contains the minimum adenoviral DNA which is sufficient to express E4 ORF6. Yet other cell lines can be constructed using the novel modified cap sequences.

The preparation of a host cell involves techniques such as assembly of selected

DNA sequences. This assembly may be accomplished utilizing conventional techniques. Such techniques include cDNA and genomic cloning, which are well known and are described in Sambrook et al, Molecular Cloning: A Laboratory Manual, Cold Spring Harbor Press, Cold Spring Harbor, NY., including polymerase chain reaction, synthetic methods, and any other suitable methods which provide the desired nucleotide sequence.

The required components for AAV production (e.g., adenovirus El a, Elb, E2a, and/or E40RF6 gene products, rep or a fragment(s) thereof, cap, the expression cassette, as well as any other desired helper functions), may be delivered to the packaging host cell separately, or in combination, in the form of any genetic element which transfer the sequences carried thereon.

Alternatively, one or more of the components required to be cultured in the host cell to package an expression cassette in an AAV capsid may be provided to the host cell in trans using a suitable genetic element.

Suitable media known in the art may be used for the production of rAAV vectors. These media include, without limitation, media produced by Hy clone Laboratories and JRH including Modified Eagle Medium (MEM), Dulbecco's Modified Eagle Medium (DMEM), custom formulations such as those described in U.S. Pat. No. 6,566, 1 18, and Sf-900 II SFM media as described in U. S. Pat. No. 6,723,551, each of which is incorporated herein by reference in its entirety, particularly with respect to custom media formulations for use in production of recombinant AAV vectors.

rAAV production culture media may be supplemented with serum or serum- derived recombinant proteins at a level of 0.5%-20% (v/v or w/v). Alternatively, as is known in the art, rAAV vectors may be produced in serum-free conditions which may also be referred to as media with no animal-derived products. One of ordinary skill in the art may appreciate that commercial or custom media designed to support production of rAAV vectors may also be supplemented with one or more cell culture components know in the art, including without limitation glucose, vitamins, amino acids, and or growth factors, in order to increase the titer of rAAV in production cultures.

rAAV production cultures can be grown under a variety of conditions (over a wide temperature range, for varying lengths of time, and the like) suitable to the particular host cell being utilized. As is known in the art, rAAV production cultures include attachment-dependent cultures which can be cultured in suitable attachment- dependent vessels such as, for example, roller bottles, hollow fiber filters, microcarriers, and packed-bed or fluidized-bed bioreactors. rAAV vector production cultures may also include suspension-adapted host cells such as HeLa, 293, and SF-9 cells which can be cultured in a variety of ways including, for example, spinner flasks, stirred tank bioreactors, and disposable systems such as the Wave bag system.

rAAV vector particles may be harvested from rAAV production cultures by lysis of the host cells of the production culture or by harvest of the spent media from the production culture, provided the cells are cultured under conditions known in the art to cause release of rAAV particles into the media from intact cells, as described more fully in US Patent No. 6,566, 118). Suitable methods of ly sing cells are also known in the art and include for example multiple freeze/thaw cycles, sonication, microfluidization, and treatment with chemicals, such as detergents and/or proteases.

In order to ensure that empty capsids are removed from the dose of AAV.hBChE that is administered to patients, empty capsids are separated from vector particles during the vector purification process, e.g., using cesium chloride gradient ultracentrifugation. In one embodiment, the vector particles containing packaged genomes are purified from empty capsids using the process described in US Patent Appln No. 62/266,341 , filed on December 1 1 , 2015, and entitled "Scalable Purification Method for AAV8"; and PCT Application No. PCT/US 16/65976, filed December 9, 2016, which are incorporated by reference herein. Briefly, a two-step purification scheme is described which selectively captures and isolates the genome-containing rAAV vector particles from the clarified, concentrated supernatant of a rAAV production cell culture. The process utilizes an affinity capture method performed at a high salt concentration followed by an anion exchange resin method performed at high pH to provide rAAV vector particles which are substantially free of rAAV intermediates.

In one embodiment, the pH used is from 10 to 10.4 (about 10.2) and the rAAV particles are at least about 50% to about 90% purified from AAV8 intermediates, or a pH of 10.2 and about 90% to about 99% purified from AAV8 intermediates. In one embodiment, this is determined by genome copies. A stock or preparation of rAAV8 particles (packaged genomes) is "substantially free" of AAV empty capsids (and other intermediates) when the rAAV8 particles in the stock are at least about 75% to about 100%, at least about 80%, at least about 85%, at least about 90%, at least about 95%, or at least 99% of the rAAV8 in the stock and "empty capsids" are less than about 1%, less than about 5%, less than about 10%, less than about 15% of the rAAV8 in the stock or preparation.

In one embodiment, the formulation is be characterized by an rAAV stock having a ratio of "empty" to "full" of 1 or less, preferably less than 0.75, more preferably, 0.5, preferably less than 0.3.

In a further embodiment, the average yield of rAAV particles is at least about 70%. This may be calculated by determining titer (genome copies) in the mixture loaded onto the column and the amount presence in the final elutions. Further, these may be determined based on q-PCR analysis and/or SDS-PAGE techniques such as those described herein or those which have been described in the art.

For example, to calculate empty and full particle content, VP3 band volumes for a selected sample (e.g., an iodixanol gradient-purified preparation where numbers of GC equals numbers of particles) are plotted against GC particles loaded. The resulting linear equation (y = mx+c) is used to calculate the number of particles in the band volumes of the test article peaks. The number of particles (pt) per 20 loaded is then multiplied by 50 to give particles (pt) /mL. Pt/mL divided by GC/mL gives the ratio of particles to genome copies (pt/GC). Pt/mL-GC/mL gives empty pt/mL. Empty pt/mL divided by pt/mL and x 100 gives the percentage of empty particles.

Generally, methods for assaying for empty capsids and AAV vector particles with packaged genomes have been known in the art. See, e.g., Grimm et al, Gene Therapy (1999) 6: 1322-1330; and Sommer et al, Molec. Ther. (2003) 7: 122-128. To test for denatured capsid, the methods include subjecting the treated AAV stock to SDS- polyacrylamide gel electrophoresis, consisting of any gel capable of separating the three capsid proteins, for example, a gradient gel containing 3-8% Tris-acetate in the buffer, then running the gel until sample material is separated, and blotting the gel onto nylon or nitrocellulose membranes, preferably nylon. Anti-AAV capsid antibodies are then used as the primary antibodies that bind to denatured capsid proteins, preferably an anti-AAV capsid monoclonal antibody, most preferably the Bl anti-AAV-2 monoclonal antibody (Wobus et al.,J. Virol. (2000) 74:9281 -9293). A secondary antibody is then used, one that binds to the primary antibody and contains a means for detecting binding with the primary antibody, more preferably an anti-IgG antibody containing a detection molecule covalently bound to it, most preferably a sheep anti-mouse IgG antibody covalently linked to horseradish peroxidase. A method for detecting binding is used to semi- quantitatively determine binding between the primary and secondary antibodies, preferably a detection method capable of detecting radioactive isotope emissions, electromagnetic radiation, or colorimetric changes, most preferably a chemiluminescence detection kit. For example, for SDS-PAGE, samples from column fractions can be taken and heated in SDS-PAGE loading buffer containing reducing agent (e.g., DTT), and capsid proteins were resolved on pre-cast gradient polyacrylamide gels (e.g., Novex). Silver staining may be performed using SilverXpress (Invitrogen, CA) according to the manufacturer's instructions. In one embodiment, the concentration of AAV vector genomes (vg) in column fractions can be measured by quantitative real time PCR (Q- PCR). Samples are diluted and digested with DNase I (or another suitable nuclease) to remove exogenous DNA. After inactivation of the nuclease, the samples are further diluted and amplified using primers and a TaqMan™ fiuorogenic probe specific for the DNA sequence between the primers. The number of cycles required to reach a defined level of fluorescence (threshold cycle, Ct) is measured for each sample on an Applied Biosystems Prism 7700 Sequence Detection System. Plasmid DNA containing identical sequences to that contained in the AAV vector is employed to generate a standard curve in the Q-PCR reaction. The cycle threshold (Ct) values obtained from the samples are used to determine vector genome titer by normalizing it to the Ct value of the plasmid standard curve. End-point assays based on the digital PCR can also be used.

In one aspect, an optimized q-PCR method is provided herein which utilizes a broad spectrum serine protease, e.g., proteinase K (such as is commercially available from Qiagen). More particularly, the optimized qPCR genome titer assay is similar to a standard assay, except that after the DNase I digestion, samples are diluted with proteinase K buffer and treated with proteinase K followed by heat inactivation.

Suitably samples are diluted with proteinase K buffer in an amount equal to the sample size. The proteinase K buffer may be concentrated to 2 fold or higher. Typically, proteinase K treatment is about 0.2 mg/mL, but may be varied from 0.1 mg/mL to about 1 mg/mL. The treatment step is generally conducted at about 55 °C for about 15 minutes, but may be performed at a lower temperature (e.g., about 37 °C to about 50 °C) over a longer time period (e.g., about 20 minutes to about 30 minutes), or a higher temperature (e.g., up to about 60 °C) for a shorter time period (e.g., about 5 to 10 minutes). Similarly, heat inactivation is generally at about 95 °C for about 15 minutes, but the temperature may be lowered (e.g., about 70 to about 90 °C) and the time extended (e.g., about 20 minutes to about 30 minutes). Samples are then diluted (e.g., 1000 fold) and subjected to TaqMan analysis as described in the standard assay.

Additionally, or alternatively, droplet digital PCR (ddPCR) may be used. For example, methods for determining single-stranded and self-complementary AAV vector genome titers by ddPCR have been described. See, e.g., M. Lock et al, Hu Gene Therapy Methods, Hum Gene Ther Methods. 2014 Apr;25(2): 115-25. doi:

10.1089/hgtb.2013.131. Epub 2014 Feb 14. FORMULATIONS

The rAAV and other constructs described herein may be used in preparing a medicament for delivering an liBChE to a subject. Typically, such a medicament is a suspension containing the viral vector carrying the hBChE enzyme coding sequences (e.g., an rAAV.hBChE). S uch a replication-defective rAAV includes the vector having an AAV capsid as described herein and a vector genome packaged therein. The vector genome preferably contains an AAV 5' ITR, a promoter, a 5' UTR, a leader sequence operably linked to a hBChE coding sequence, a linker, a leader sequence operably linked to a codon. optimized nucleic acid sequence encoding a proline rich peptide, an optional 3 'UTR, a poly A, and an AAV3 ' ITR. Examples of suitable hBChE coding sequences include those of SEQ ID NOs: 3, 4, 5, 6, 7, 8, 9, 10, 1 1, 12 or 13. Examples of suitable vector genomes include those of: C4/UbC-hIL2-BchE Cl-IRES-LPD [ SEQ ID NO: 34], UbC-cmyc-IL2-BChE C 1 -IRE S-1L2-.PRTM A I [nt 14 to nt 4162 of SEQ ID NO: 30]: UbC-cmyc-IL2-BChE C 1-IRES-1L2-LPDN [nt 14 to nt 4874 of SEQ ID NO: 31]: CB7-cmyc-IL2-BChE C l -TRES-IL2-PRIMA l [SEQ ID NO: 32], CB7-cmyc-IL2- BChE C l -IRES-iL2-LPDN [SEQ ID NO: 33] : or C4/UbC-hlL2-BChE C 1 -1RES~ PRI M A i [SEQ ID NO: 35] .

The rAAV.hBChE compositions can be formulated in dosage units to contain an amount of replication-defective virus that is in the range of about 1.0 x 10⁹ GC to about 1.0 x 10¹⁵ GC. In certain embodiments, this amount of viral genome may be delivered in multiple injections. Doses will vary based on the indication being treated and may also vary based on the route of delivery. For example, intravenous delivery may provide higher expression levels than intramuscular delivery routes; thus, a formulation for intravenous delivery may require a lower amount of rAAV.hBChE. In one embodiment, the dosage is about 1 x 10¹¹ GC to about 5 x 10¹³ GC. In one embodiment, the dosage is about 1 x 10¹² GC to about 1 x 10¹⁴ GC for an average In one embodiment, the dosage is about 1 x 10¹¹ GC to 1 x 10¹⁴ GC for a subject. In another embodiment, the dose about 1 x 10¹³ GC. For example, the dose of AAV virus may be about 1 x 10¹² GC, about 5 X 10¹² GC, about 1 X 10¹³ GC, about 5 X 10¹³ GC, or about 1 X 10¹⁴ GC. In another example, the rAAV.hBChE may be delivered in an amount of about 0.001 mg to about 10 mg per mL. As used herein, the term "dosage" can refer to the total dosage delivered to the subj ect in the course of treatment, or the amount delivered in a single (or multiple) administration.

The above-described recombinant vectors may be delivered to host cells according to published methods. The rAAV, preferably suspended in a physiologically compatible carrier, may be administered to a desired subject including without limitation, a cat, dog, or other non-human mammalian subject. Suitable carriers may be readily selected by one of skill in the art in view of the indication for which the transfer virus is directed. For example, one suitable carrier includes saline, which may be formulated with a variety of buffering solutions (e.g., phosphate buffered saline). Other exemplary carriers include sterile saline, lactose, sucrose, calcium phosphate, gelatin, dextran, agar, pectin, peanut oil, sesame oil, and water. The selection of the carrier is not a limitation of the present invention.

Optionally, the compositions of the invention may contain, in addition to the rAAV and/or variants and carrier(s), other conventional pharmaceutical ingredients, such as preservatives, or chemical stabilizers. Suitable exemplary preservatives include chlorobutanol, potassium sorbate, sorbic acid, sulfur dioxide, propyl gallate, the parabens, ethyl vanillin, glycerin, phenol, and parachlorophenol. Suitable chemical stabilizers include gelatin and albumin.

The rAAV, preferably suspended in a physiologically compatible carrier, may be administered to a human or non-human mammalian patient. Suitable carriers may be readily selected by one of skill in the art in view of the indication for which the transfer virus is directed. For example, one suitable carrier includes an aqueous suspension base, e.g., saline, which may be formulated with a variety of buffering solutions (e.g. , phosphate buffered saline). Other exemplary carriers include sterile saline, lactose, sucrose, maltose, and water. The selection of the carrier is not a limitation of the present invention. Optionally, the compositions of the invention may contain, in addition to the rAAV and carrier(s), other conventional pharmaceutical ingredients, such as

preservatives, or chemical stabilizers.

Any suitable method or route can be used to administer AAV-containing compositions as described herein, and optionally, to co-administer other active drugs or therapies in conjunction with the AAV-mediated antibodies described herein. Routes of administration include, for example, systemic, oral, intravenous, intraperitoneal, subcutaneous, or intramuscular administration.

For administration by inhalation, the vectors are delivered in the form of an aerosol spray from a pressurized container or dispenser that contains a suitable propellant, e.g., a gas such as carbon dioxide or a nebulizer.

The compounds also can be prepared in the form of suppositories (e.g., with conventional suppository bases such as cocoa butter and other glycerides) or retention enemas for rectal delivery. USES

The rAAV provided herein will express a therapeutically effective amount of BChE polypeptide. The phrase "therapeutically effective amount" is used herein to mean an amount sufficient to reduce by at least about 15 percent, preferably by at least 50 percent, more preferably by at least 90 percent, and still more preferably prevent, a clinically significant deficit in the activity, function and response of the host.

Alternatively, a therapeutically effective amount is sufficient to cause an improvement in a clinically significant condition in the host.

In certain embodiments, AAV-hBChE expresses at 100 units/ml of serum at 24 hours post vector administration into muscle, with steady-state expression levels of up to 30,000 units/ml of serum at 1 month. In other embodiments, steady-state expression levels are about 1000 units/mL to about 20,000 units/mL of serum at 1 month, or about 5000 units/mL to about 15,000 units/mL of serum at 1 month, or about 10,000 units/mL at 1 month.

In the context of detoxifying agents, often the level of effectiveness is defined in terms of protecting/scavenging/ detoxifying a certain amount of toxic agent. A useful metric is LD50, which is the amount of chemical that is lethal to one half of the animals exposed to the chemical. Thus, a therapeutically effective amount also is one which is sufficient to protect at least 2x LD50 of toxic agent. In certain embodiments, the vector delivers amounts of detoxifying agent that protect against 5x and up to 5 Ox or more during repeat exposures of LD50 of toxic agent. In one aspect, a method for protecting against poisoning with organophosphate chemical agents is provided which involves administering an rAAV to the patient. In one embodiment, the rAAV is administered prior to exposure to the organophosphate. In certain embodiments, the rAAV is administered about 24 hours to 6 months, or about 3 days to 1 month, prior to exposure.

In certain embodiments, the compositions are administered intramuscularly. In other embodiments, the compositions are administered by inhalation. In still other embodiments, the compositions are administered for delivery to the liver. In yet further embodiments, the compositions are administered intravenously. Other suitable routes of delivery may be readily selected.

In one aspect, a method for protecting against poisoning with organophosphate chemical agents is provided which involves administering an rAAV to the patient.

In certain embodiments, the compositions are useful in a method for reducing the effects of organophosphates in a patient.

In still other embodiments, the compositions are useful in treating a patient with one or more of dementia, Alzheimer's disease, pseudocholinesterase deficiency, cocaine addiction, chronic exposures to pesticides or insecticides, increased sensitivity to muscle relaxant drugs, complications during medical procedures requiring emergency treatments, prolonged recovery time due to paralyses and inability to breath, increased sensitivity to anesthetics, and/or increased sensitivity to environmental exposures.

In certain embodiments, the BChE enzyme expressed from the rAAV vector has an activity level within about 10% to about 500% of the activity of the wild-type BChE bioscavenger and/or enzyme activity, or about 25% to about 400%, or about 50% to 100%, or about 75% to about 100%, or about 80% to about 100%, or about 90% to 95% of wild-type levels (delivered in protein form).

In certain embodiments, the rAAV express BChE mutants which provide enhanced hydrolysis activity as compared to the native human BChE for certain toxic compounds, including e.g., heroin and/or cocaine. In another embodiment, a mutant is is used which has enhanced hydrolysis activity for certain toxic compounds including, e.g., paraoxon, sarin, echotiophate and VX. Thus, the rAAV.hBChE provided herein may be used to counteract addiction with certain toxic drugs, such heroin and/or cocaine. The rAAV may be combined with other therapies which are the current state of the art treatment, but offer the advantage of reducing the amount of such treatment which is required and/or improving the patients' condition beyond which can be achieved with such current therapies.

Optionally, an rAAV vector as described herein may be used in combination with pharmacologic agents. This may be particularly useful where the rAAV is administered post-OP exposure. Such agents may include e.g., atropine or pralidoxime, or combinations thereof. For atropine, one may start with a 1-2 mg IV bolus, repeat q3- 5min pm for desire effects (drying of pulmonary secretions and adequate oxygenation). Each subsequent dose may be doubled for rapid control of patients in severe respiratory distress. An atropine drip titrated to the above endpoints can be initiated until the patient's condition is stabilized.

Kits for Administering Vectors

Therapeutic kits are provided herein. Such kits will generally contain, in suitable container means, a pharmaceutically acceptable formulation of an rAAV vector as described herein in a form suitable for administration to a subject. The kits may also contain other pharmaceutically acceptable formulations, such as buffers for

reconstitution, suspension or dilution, surfactants, or agents that adjust pH, improve suspension, or the like.

The kits may have a single container means that contains the expression construct in a form suitable for administration. Other kits of the present invention include the expression construct in a storage stable form, along with buffers or diluents in separate and distinct containers. For example, when the components of the kit are provided in one or more liquid solutions, the liquid solution is an aqueous solution, with a sterile aqueous solution being particularly preferred. However, the components of the kit may be provided as dried powder(s). When reagents or components are provided as a dry powder, the powder can be reconstituted by the addition of a suitable aqueous suspending agent. It is envisioned that the suspension agent may also be provided in another container means. The container means of the kit may also include at least device for administration of the expression construct. For example, a syringe or inhaler may be included. In some embodiments, the expression construct may be pre-mixed and aliquoted into a unit dosage form and loaded into such a device. The kits may contain multiple devices for repeat administration or administration to more than one subject.

The kits may include a means for containing the vials, devices or such in close confinement for shipment, storage or commercial sale, such as, e.g., injection or blow- molded plastic containers into which the desired vials and other apparatus are placed and retained. The kits also may contain instructions for administration, including self- administration.

The terms "percent (%) identity", "sequence identity", "percent sequence identity", or "percent identical" in the context of amino acid sequences refers to the residues in the two sequences which are the same when aligned for correspondence. Percent identity may be readily determined for amino acid sequences over the full-length of a protein, polypeptide, about 32 amino acids, about 330 amino acids, or a peptide fragment thereof or the corresponding nucleic acid sequence coding sequencers. A suitable amino acid fragment may be at least about 8 amino acids in length, and may be up to about 700 amino acids. Generally, when referring to "identity", "homology", or "similarity" between two different sequences, "identity", "homology" or "similarity" is determined in reference to "aligned" sequences. "Aligned" sequences or "alignments" refer to multiple nucleic acid sequences or protein (amino acids) sequences, often containing corrections for missing or additional bases or amino acids as compared to a reference sequence. Alignments are performed using any of a variety of publicly or commercially available Multiple Sequence Alignment Programs. Sequence alignment programs are available for amino acid sequences, e.g., the "Clustal Omega", "Clustal X", "MAP", "PIMA", "MSA", "BLOCKMAKER", "MEME", and "Match-Box" programs. Generally, any of these programs are used at default settings, although one of skill in the art can alter these settings as needed. Alternatively, one of skill in the art can utilize another algorithm or computer program which provides at least the level of identity or alignment as that provided by the referenced algorithms and programs. See, e.g., J. D. Thomson et al, Nucl. Acids. Res., "A comprehensive comparison of multiple sequence alignments", 27(13):2682-2690 (1999).

As used herein, the term "operably linked" refers to both expression control sequences that are contiguous with the gene of interest and expression control sequences that act in trans or at a distance to control the gene of interest.

A "replication-defective virus" or "viral vector" refers to a synthetic or artificial viral particle in which an expression cassette containing a gene of interest is packaged in a viral capsid or envelope, where any viral genomic sequences also packaged within the viral capsid or envelope are replication-deficient; i.e., they cannot generate progeny virions but retain the ability to infect target cells. In one embodiment, the genome of the viral vector does not include genes encoding the enzymes required to replicate (the genome can be engineered to be "gutless" - containing only the transgene of interest flanked by the signals required for amplification and packaging of the artificial genome), but these genes may be supplied during production. Therefore, it is deemed safe for use in gene therapy since replication and infection by progeny virions cannot occur except in the presence of the viral enzyme required for replication.

It is to be noted that the term "a" or "an" refers to one or more. As such, the terms "a" (or "an"), "one or more," and "at least one" are used interchangeably herein.

The words "comprise", "comprises", and "comprising" are to be interpreted inclusively rather than exclusively. The words "consist", "consisting", and its variants, are to be interpreted exclusively, rather than inclusively. While various embodiments in the specification are presented using "comprising" language, under other circumstances, a related embodiment is also intended to be interpreted and described using "consisting of or "consisting essentially of language.

As described above, the term "about" when used to modify a numerical value means a variation of ±10%, unless otherwise specified.

The terms "identical" or percent "identity," in the context of two or more nucleic acids or polypeptide sequences, refer to two or more sequences or subsequences that are the same or have a specified percentage of amino acid residues or nucleotides that are the same (i.e., about 70% identity, preferably 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or higher identity over a specified region (e.g. , any one of the modified ORFs provided herein when compared and aligned for maximum correspondence over a comparison window or designated region) as measured using a BLAST or BLAST 2.0 sequence comparison algorithms with default parameters described below, or by manual alignment and visual inspection (see, e.g. , NCBI web site or the like). As another example, polynucleotide sequences can be compared using Fasta, a program in GCG Version 6.1. Fasta provides alignments and percent sequence identity of the regions of the best overlap between the query and search sequences. For instance, percent sequence identity between nucleic acid sequences can be determined using Fasta with its default parameters (a word size of 6 and the NOP AM factor for the scoring matrix) as provided in GCG Version 6.1, herein incorporated by reference. Generally, these programs are used at default settings, although one skilled in the art can alter these settings as needed. Alternatively, one of skill in the art can utilize another algorithm or computer program that provides at least the level of identity or alignment as that provided by the referenced algorithms and programs. This definition also refers to, or can be applied to, the compliment of a sequence. The definition also includes sequences that have deletions and/or additions, as well as those that have substitutions. As described below, the preferred algorithms can account for gaps and the like. Preferably, identity exists over a region that is at least about 25, 50, 75, 100, 150, 200 amino acids or nucleotides in length, and oftentimes over a region that is 225, 250, 300, 350, 400, 450, 500 amino acids or nucleotides in length or over the full-length of an amino acid or nucleic acid sequences.

Typically, when an alignment is prepared based upon an amino acid sequence, the alignment contains insertions and deletions which are so identified with respect to a reference AAV sequence and the numbering of the amino acid residues is based upon a reference scale provided for the alignment. However, any given AAV sequence may have fewer amino acid residues than the reference scale. In the present invention, when discussing the parental sequence, the term "the same position" or the "corresponding position" refers to the amino acid located at the same residue number in each of the sequences, with respect to the reference scale for the aligned sequences. However, when taken out of the alignment, each of the proteins may have these amino acids located at different residue numbers. Alignments are performed using any of a variety of publicly or commercially available Multiple Sequence Alignment Programs. Sequence alignment programs are available for amino acid sequences, e.g. , the "Clustal Omega", "Clustal X", "MAP", "PIMA", "MSA", "BLOCKMAKER", "MEME", and "Match-Box" programs. Generally, any of these programs are used at default settings, although one of skill in the art can alter these settings as needed. Alternatively, one of skill in the art can utilize another algorithm or computer program which provides at least the level of identity or alignment as that provided by the referenced algorithms and programs. See, e.g. , J. D. Thomson et al, Nucl. Acids. Res. , "A comprehensive comparison of multiple sequence alignments", 27(13):2682-2690 (1999).

Unless defined otherwise in this specification, technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art and by reference to published texts, which provide one skilled in the art with a general guide to many of the terms used in the present application. The following examples are illustrative only and are not intended to limit the present invention.

EXAMPLES

As illustrated in the following studies, the approach provided herein achieved not only rapid onset of hBuChE expression in mice, but also sustainable, long-term expression for at least 2 months with no decline. AAV-hBChE expressed at over 100 ng/mL of serum at 24 hours post vector administration into mouse muscle, with steady- state expression levels of up to 300 ng/mL of serum at 1 month. Based on previous findings regarding required hBuChE levels, the levels of hBuChE expressed by the rAAV provided herein are expected to be protective in OP challenges. These compositions can be expanded to include populations that are occupationally exposed to pesticides. These compositions and methods may also be used for the delivery of other protective human enzymes, such as the use of rhodanase to protect against cyanides or glutathione against 2-chloro-acetophenone, which is present in tear gas and chemical mace.

BChE is one example of a human carbonic anhydrase (hCA) isoenzyme; others include hCA I, ΙΙ,ΙΧ, and XII, AChE, LPO, and glutathione S -transferases (GST). GST (GST, EC 2.5.1.18) belong to the superfamily of phase II detoxification enzymes. They are multifunctional enzymes for the cellular defense against xeno- biotics and provide protection for organism. The subfamily of GSTs is further distinguished into at least 14 classes (a-,b-,d-,e-,z-,y-,k-,-,m-,-, s-,-,u-, and-GST). This classification is based on the substrate specificity, sensitivity to inhibitors, N- terminal amino acid sequence and antibody cross-reactivity. Each GST contains a G- site, which is the glutathione substrate binding site and an H-site, which is hydrophobic substrate binding site. The G-site is conserved in the N-terminal region among the different enzyme classes.

In one embodiment, the GST enzyme has the sequence shows in [GenBank

AAA35934.1], reproduced in SEQ ID NO: 42. In another embodiment, the GST enzyme has the sequence [GenBank AAA70226.1], reproduced in SEQ ID NO: 43 :

Rhodanese (also rhodanase, also thiosulfate sulfurtransf erase) is a mitochondrial enzyme which detoxifies cyanide. See, R. Pallini et al, Biochem Biophys Res Commun, 180(2): 887-893 (1991 Oct) for the human sequence. In one embodiment, the enzyme has the sequence: [EC 2.8.1.1.1/GenBank BAA13327.1], which is reproduced in SEQ ID NO: 44. In another embodiment, the rhodanese enzyme has the sequence CAA42060.1 , which is reproduced in SEQ ID NO: 45. In still another embodiment, the rhodanese enzyme has the sequence: UniProtKB/Swiss-Prot: P25325, which is reproduced in SEQ ID NO: 46.

Example 1 - Mouse Models, Methods and Materials

A. Materials used

BALB/c Male Rag and BChE knockout mice, 6-8 weeks old, were sourced from Jackson laboratories. For BChE activity assay DTNB and substrate S-Butyrylthiocholine iodide and other chemicals were procured from Sigma Aldrich. For BChE expression in serum, ELISA kit was procured from R&D systems. 4-12% precast native gel was purchased from Novex Wedge well. Rabbit poly clonal anti-BChE antibody was bought from Abeam (ab82307).

B. Vector construction strategy & viral production

All AAV8 vectors were sourced by the Perm Vector Core at the University of

Pennsylvania as described previously (Gao G, et al. (2006) Biology of AAV serotype vectors in liver-directed gene transfer to nonhuman primates. Mol Ther 13 : 77-87). Different open reading frames (ORFs) were designed. These were assessed with codon optimized BChE sequences. Also assessed were promoters (CMV, UbC, CB7 or C4/UbC), leader sequences from hIL2 and the innate BChE leader sequence, presence and absence of Proline rich peptide (PRIMA1 , LPDN, or no peptide), presence and absence of 5 'UTR (c-myc), 3'UTR (WPRE, SEQ ID NO: 25) and polyA (RBG polyA or SV40 polyA). Different constructs were further packaged in the AAV8 viral capsid and titered later by Vector Core facility at University of Pennsylvania.

C. Animal Studies (Mice)

All mice were housed under controlled conditions in the animal facility of the Translational Research Laboratories at the University of Pennsylvania. Experimental protocols were approved by and performed in agreement with the guidelines of the IACUC (Institutional Animal Care and Use Committee) of the University of

Pennsylvania. Each vector was diluted in sterile PBS into two doses, 1 x 10¹⁰ and 1 x 10¹¹ (representing genome copies), each was injected into the left gastrocnemius muscle of five mice /experiment. Orbital bleeds were collected every 24 hours for the first three days and every week thereafter. Terminal cardiac bleeds were obtained upon termination of study on day 56. For challenge study, animals were challenged by providing a single dose of butyrylcholine (500 mg/kg i.p) to BChE WT, heterozygous (+/-), or KO mice (n=5/group), or BChE KO mice pre-treated with AAV. BChE vector via intramuscular injection. Mice were monitored for signs of toxicity (such as tonic-clonic convulsions, muscle fasciculation, body tremor, myoclonic jerks, piloerection, heaving respiration, lacrimation, and salivation) for 30 minutes following the challenge.

D. Sample Collection and storage

Blood samples were obtained from animals via orbital bleeds and serum was separated by allowing sample to clot for 15 minutes before centrifuging in gel lock tubes for 5 minutes at 5000 rpm. Samples were then aliquoted into Eppendorf tube and stored at -20 °C. Serum was also obtained from terminal cardiac bleeds upon termination of study.

E. Protein Expression

Butrylcholinestrase expression was quantified via commercially available Human BChE Quantikine ELISA kit. 100 Assay Diluent per well was added to plate 96 well polystyrene plate percolated with monoclonal antibody specific for human BChE.

Samples and standard were diluted in Calibrator Diluent RD5P and 50 was transferred to the plate according to plate layout and incubated at room temp for two hours. Plates were then washed with wash Buffer 4 times, and 200 of human BChE conjugated HRP was added and incubated for two hours at room temperature. Plates were washed 4 times with wash buffer and 200 μΐ. of substrate solution consisting of a 1 : 1 solution of stabilized hydrogen peroxide and stabilized tetramethylbenzidine was added. Plates were incubated at room temperature in the dark for 30 minutes and stop solution, 2 N sulfuric acid, was added. Absorbance was measured immediately within 30 minutes at 450 and 540 nm using Sepectramax M3 from Molecular Devices.

Concentration of BChE in serum was determined by a linear regression curve from the standards via excel. F. Enzymatic Activity Assay

Enzymatic activity of BChE was measured using a modified Ellman procedure [Ellman G.L, et al (1961) A new and rapid colorimetric determination of

acetylcholinesterase activity. Biochem Pharmacol 7: 88-95]. Serum samples were diluted in 0.1 M pH 7.6 NaP04 buffer and 50 transferred to 96 well high binding polystyrene plates from Costar. Substrate was prepared by dissolving S- Butyrylthiocholine Iodide in 0.1 M NaPC>4 buffer to concentration of 0.1 M and pH 7.5 and 101.3 was added to each well and incubated for 30 minutes at room temperature. Stop solution was prepared by dissolving DTNB in 0.1 M pH 7.6 NaP04 buffer and ethanol for 0.006 M concentration. 50 stop solution added per well and absorbance was measured immediately at 412 nm and 540 nm using Spectramax M3 plate reader. Optical imperfections of the plate were corrected for by subtracting the reading at 540 nm from the 412 nm read. Background was corrected for by using PBS as negative control in four duplicates on each plate; absorbance of this blank was averaged and subtracted from all samples.

Enzyme activity was calculated as the appearance of product (μΜ/min) using the Beer-Lambert equation. Absorbance reading from pre-injection serum was used as initial absorbance when calculating change in absorbance and reading from wells with sample was used as final absorbance. The coefficient of extinction used was 14500 M^cm^"1 and the length of path of light was 0.596 cm.

G. Western blot and in gel activity assay:

1.5 μΐ of serum sample was diluted to 15 μΐ in native gel loading buffer and was passed through Novex WedgeWell 4-20% Tris-Glycine gel for 1.5 hours at 150 Volts at 4 °C. Gel was rinsed with 0.1M Phosphate buffer pH 7.6. For butyrylcholinesterase activity assay, gel was stained with 2 mM butyrylthiocholine using Roots Karnovsky staining method. Butyrylthiocholine iodide was added to 0.1 M phosphate buffer pH 6.0 for final concentration of 2 mM Butyrylthiocholine iodide. The following were added to 32.5 mL of this solution in order with stirring in between: 0.5 mL 0.1 M sodium citrate, 1 mL 30 mM CUSO4, 1 mL water, and 1 mL 5 mM potassium ferricyanide. Gel was incubated in this 50 mL solution at room temperature for 30 minutes (until brown precipitate formed in the gel). On the appearance of bands as shown, gel was washed with water and image was taken on ChemiDoc apparatus. A representative result is shown in FIG 15.

For western blot, the native gel was blotted to PVDF membrane at 25 Volts 2.5 A for 16 minutes using Tras-blot Turbo from Biorad. The blot was blocked for 1 hour at room temperature in blocking buffer (TBS +0.3% Tween-20 + 5 % (w/v) non-fat dry milk). The blot was incubated overnight with rabbit poly clonal anti-BChE antibody (1 : 100) at 4 °C in blocking buffer. Blot was further washed with TBS+0.3% Tween-20, 3 times 10 minutes each, and incubated with HRP conjugated goat anti-rabbit antibody in blocking buffer at RT for 1 hour (1 :5000 dilution). Blot was further washed using same scheme and developed using the Pierce Chemilunilol Super Signal System as recommended. Image captured with ChemiDoc apparatus.

Example 2 - Vector Optimization

A. Proline-Rich Peptide

To evaluate the effects of proline-rich peptide/domain on the expression of BChE using the viral vector deliver system in vivo, AAV.hBChE vectors in the absence or presence of IRES (SEQ ID NO: 22) followed by a proline-rich peptide of PRIMAl (SEQ ID NO: 23) or LPDN (SEQ ID NO: 24) were constructed. The hBChE expression cassette described herein is a transgene flanked by inverted terminal repeats (ITRs). The transgene includes cytomegalovirus (CMV) promoter, a commercially available

Promega® intron (PI), hBChE CO with innate leader peptide (SEQ ID NO: 3) and an SV40 polyadenylation (poly A) signal. The IRES followed by PRP was inserted immediately after the hBChE coding sequence 0 (CO) if present. Different AAV.hBChE vector sequences were then packaged in the AAV8 viral capsid and further diluted in sterile PBS.

Studies were performed as described in Example 1. hBChE expressions and enzyme activity using the vectors described herein were assessed and the results were plotted in FIG 1A and FIG IB respectively. The hBChE vector co-expressed with the PRIMAl PRP demonstrated an increase in hBChE expression from Day 7 to Day 28 post injection during the observation period (FIG 1A) as well as an increase in enzyme activity starting Day 7 (FIG IB) compared to the hBChE only vector. The hBChE vector co-expressed with the LPDN PRP also showed an increase in hBChE expression on Day 14 post injection compared to the hBChE only vector (FIG 1 A), however, no obvious change in enzyme activity was observed. These result indicates that co-expression with PRP, especially PRIMAl PRP, benefit expression and enzyme activity in vivo.

B. 5'UTR

To evaluate the effects of 5'UTR on the expression of BChE using the viral vector deliver system in vivo, AAV.hBChE vectors in the presence or absence of c-myc (SEQ ID NO: 19) were constructed. The hBChE expression cassette described herein is a transgene flanked by inverted terminal repeats (ITRs). The transgene includes cytomegalovirus (CMV) promoter, a commercially available Promega® intron (PI), hBChE CO with IL2 leader peptide (SEQ ID NO: 4), IRES, PRIMAl PRP and an SV40 polyadenylation (poly A) signal, c-myc was inserted between PRIMAl PRP and SV40 polyA if present. Different AAV.hBChE vector sequences were then packaged in the AAV8 viral capsid and further diluted in sterile PBS.

Studies were performed as described in Example 1. hBChE expressions and enzyme activity using the vectors described herein were assessed and the results were plotted in FIG 2A and FIG 2B respectively. Although no difference in expression of hBChE was detected between the two tested vectors, the vector with c-myc demonstrated a higher enzyme activity starting on Day 7 and further increasing on Day 14 post injection. This result indicates that c-myc benefits the enzyme activity of hBChE expressed in vivo.

C. Mutated hBChE (Gl 17H E197Q)

Wildtype hBChE was mutated at aa 117 from G to H and aa 197 from E to Q. Innate hBChE sequence was then replaced with IL2 leader sequence. The expression and enzyme activity of hBChE (Gl 17H E197Q) was evaluated in vivo. The hBChE expression cassette described herein is a transgene flanked by inverted terminal repeats (ITRs). The transgene includes cytomegalovirus (CMV) promoter, a commercially available Promega® intron (PI), hBChE CO with IL2 leader peptide (SEQ ID NO: 4) or hBChE (G117H E197Q) with IL2 leader peptide (SEQ ID NO: 13), IRES, PRIMAl PRP and an SV40 polyadenylation (poly A) signal. Different AAV.hBChE vector sequences were then packaged in the AAV8 viral capsid and further diluted in sterile PBS. Studies were performed as described in Example 1. hBChE expressions and enzyme activity using the vectors described herein were assessed and the results were plotted in FIG 3A and FIG 3B respectively. No statistical significance in hBChE expression as well as enzyme activity was observed between the two tested vectors, indicating no advantages of the double mutations (Gl 17H E197Q).

D. Leader Sequence

To evaluate the effects of different leader sequences on the expression of BChE using the viral vector deliver system in vivo, AAV.hBChE vectors with innate leader or IL2 leader peptide were constructed. The hBChE expression cassette described herein is a transgene flanked by inverted terminal repeats (ITRs). The transgene includes cytomegalovirus (CMV) promoter, a commercially available Promega® intron (PI), hBChE CO with innate leader peptide (SEQ ID NO: 3) or hBChE CO with IL2 leader peptide (SEQ ID NO: 4), IRES, PRIMA1 PRP and an SV40 polyadenylation (poly A) signal. Different AAV.hBChE vector sequences were then packaged in the AAV8 viral capsid and further diluted in sterile PBS.

Studies were performed as described in Example 1. hBChE expressions and enzyme activity using the vectors described herein were assessed and the results were plotted in FIG 4 A and FIG 4B respectively. The result demonstrated that the vector with innate leader sequence exhibited a higher expression level but a lower enzyme activity compared to the one with IL2 leader sequence in vivo.

E. 3'UTR

To evaluate the effects of 3'UTR on the expression of BChE using the viral vector deliver system in vivo, AAV.hBChE vectors in the presence or absence of WPRE (Woodchuck Hepatitis Virus (WHP) Posttranscriptional Regulatory Element, SEQ ID NO: 25) were constructed. The hBChE expression cassette described herein is a transgene flanked by inverted terminal repeats (ITRs). The transgene includes cytomegalovirus (CMV) promoter, a commercially available Promega® intron (PI), hBChE CO with IL2 leader peptide (SEQ ID NO: 4), IRES, PRIMA1 PRP, and an SV40 polyadenylation (poly A) signal. WPRE was inserted immediately after PRIMA1 PRP if present. Different AAV.hBChE vector sequences were then packaged in the AAV8 viral capsid and further diluted in sterile PBS. Studies were performed as described in Example 1. hBChE expressions and enzyme activity using the vectors described herein were assessed and the results were plotted in FIG 5A and FIG 5B respectively. No difference in the activity of hBChE was detected between the two tested vectors while the vector without WPRE revealed a higher hBChE expression on Day 2 and Day 3 post injection indicating that WPRE does not benefit the AAV. hBChE expression in vivo.

F. Promoter

To evaluate the effects of various promotors on the expression of BChE using the viral vector deliver system in vivo, AAV.hBChE vectors with CMV, UBC, C4/UbC (CMV C4 enhancer in the upstream Pf-UbC promoter), and CB7 (a hybrid between a cytomegalovirus (CMV) immediate early enhancer (C4) and the chicken beta actin promoter ) were constructed. The hBChE expression cassette described herein is a transgene flanked by inverted terminal repeats (ITRs). The transgene includes the indicated promoter, an intron (PI or chicken beta-actin intron), hBChE CO with innate leader peptide (SEQ ID NO: 3), IRES, PRIMA1 PRP, and a polyadenylation (poly A, SV40 polyA or rBG poly A) signal. Different AAV.hBChE vector sequences were then packaged in the AAV8 viral capsid and further diluted in sterile PBS.

Studies were performed as described in Example 1. hBChE expressions and enzyme activity using the vectors described herein were assessed and the results were plotted in FIG 6A and FIG 5B respectively. The vectors with CB7 and UBC promoter displayed a higher expression level as well as an increased activity compared to the one with CMV promoter. A further promoter, C4/UbC was constructed and compared to UbC and CB7. RAG KO mice injected i.m. with 1 x 10¹¹ GC of the tested vectors. Samples were collected on Day 3 post injection and processed as described in Example 1. The hBChE expression acquired was plotted in FIG 6C. The result demonstrated a better expression utilizing C4/UbC promoter than UbC and CB7.

G. Codon Optimized Coding Sequences of BChE

Nine codon-optimized coding sequences of hBChE (hBChE CO, hBChE CI, hBChE C2, hBChE C3, hBChE C4, hBChE C5, hBChE C6, hBChE C7, and hBChE C8) were designed and generated. The effects thereof were tested as described in Example 1 and above. hBChE expressions and enzyme activity were assessed and the results were plotted in FIG 7A and FIG 7B respectively. All tested vectors displayed a comparably similar activity of the hBChE expressed (FIG 7B). However, the hBChE expression level varied. An about 2000 ng/ml of hBChE was detected in the samples from mice injected with AAV.hBChE CI. An about 500 ng/ml of hBChE was detected in the samples from mice injected with AAV.hBChE C5 while an about 200 ng/ml of hBChE was found from mice injected with AAV.hBChE CO, AAV.hBChE C6 and AAV.hBChE C8.

AAV.hBChE C4 showed about 6 ng/ml of hBChE in the tested sample. In contrast, AAV vectors with hBChE C2, C3 and C7 showed an undetectable expression of hBChE.

H. Constructed with Preferred Elements in Mice

Based on the results described in Example 2, Sections A through G, four AAV.hBChE vectors listed below as promoter-5'UTR-leader-BChE-IRES-leader-PRP- polyA were constructed and further tested in mice as described in Example 1. The results were plotted in FIGs 8A-8H.

(i) UbC-cmyc-IL2-BChE C1-IRES-IL2-PRIMA1-SV40 [nt 14 to nt 4162 of SEQ ID NO: 30]

On Day 2 post injection, about 6000 ng/ml of hBChE was detected in RAG KO mice. The hBChE expression kept increasing and reached -700,000 ng/ml on Day 28 (FIG 8A). In the activity assay, an about 70μΜ/ηύη was detected on Day 1 post injection. A sustained increase of activity was observed during Day 1 to Day 14. On Day 14 till the end of the observation period (Day 28), the enzyme activity reached plateau at -30,000 μΜ/min (FIG 8B).

The vector described herein is further tested in BChE KO mice as described in Example 1. The results are shown in FIGs 9A, 10A and 9B. On Day 1 post injection, about 50 ng/ml of hBChE was detected. Expression onset is early and becomes steady state after day 21.

Overlays of the data acquired in RAG KO (triangle) and BChE KO (circle) mice were generated and plotted in FIG 9E (expression) and FIG 9F (enzyme activity).

Furthermore, in-gel butyrylcholinesterase activity assay was performed as described in Example 1. A representative result is shown in FIG 15. Serum collected on Day 0 and Day 56 from RAG KO mouse injected with 1 x 10¹¹ GC of

AAV8.UbC.hIL2.BChE C 1. IRES . PRIMAl . S V40 vector was assessed. A low level of BChE tetramer was observed on Day 0 while an increased tetramer as well as monomer, dimer and BChE with albumin were observed on Day 36, indicating a successful expression of functional BChE.

(ii) UbC-cmyc-IL2-BChE C 1 -IRES-IL2-LPDN-SV40 [nt 14 to nt 4874 of SEQ ID NO: 31]

On Day 2 post injection, an about 200 ng/ml of hBChE was detected in RAG KO mice. The hBChE expression kept increasing and reached -10,000 ng/ml on Day 28 (FIG 8C). In the activity assay, an about 9 μΜ/min was detected on Day 1 post injection. A sustained increase of activity was observed during Day 1 to Day 14. On Day 14 till the end of the observation period (Day 28), the enzyme activity reached plateau at -1,000 μΜ/min (FIG 8D).

(iii) CB7-cmyc-IL2-BChE C l-IRES-IL2-PRIMAl -rBG [SEQ ID NO: 32] On Day 2 post injection, an about 600 ng/ml of hBChE was detected in RAG KO mice. The hBChE expression kept increasing and reached -50,000 ng/ml on Day 28 (FIG 8E). In the activity assay, an about 30 μΜ/min was detected on Day 1 post injection. A sustained increase of activity was observed during Day 1 to Day 21. On Day 21 till the end of the observation period (Day 28), the enzyme activity reached plateau at -3,000 μΜ/min (FIG 8F).

(iv) CB7-cmyc-IL2-BChE Cl -IRES-IL2-LPDN-rBG [SEQ ID NO: 33]

On Day 1 post injection, an about 20 ng/ml of hBChE was detected in RAG KO mice. The hBChE expression kept increasing and reached plateau at -300,000 ng/ml on Day 14 (FIG 8G). In the activity assay, an about 100 μΜ/min of activity was detected on Day 1 post injection. A sustained increase of activity was observed during Day 1 to Day 7. On Day 7 till the end of the observation period (Day 28), the enzyme activity reached plateau at -20,000 μΜ/min (FIG 8H).

The vector described herein is further tested in BChE KO mice as described in Example 1. The results are shown in FIGs 9C, 10B and 9D. On Day 1 post injection, an about 17 ng/ml of hBChE was detected. The hBChE expression kept increasing and reached -40,000 ng/ml on Day 7. On Day 14, the hBChE expression was detected as -10,000 ng/ml (FIGs 9C and 10B). Another slow growth phase was observed starting Day 14 and the expression reached -160,000 ng/ml on Day 35 post injection(FIG 10B). In the activity assay, an about 700 μΜ/min was detected on Day 1 post injection. A sustained increase of activity was observed and reached -9,000 μΜ/min on Day 7. On Day 14, the activity was decreased to 2,000 μΜ/min (FIG 9B).

Overlays of the data acquired in RAG KO (triangle) and BChE KO (circle) mice were generated and plotted in FIG 9G (expression) and FIG 9H (enzyme activity).

Example 3 - Dosage Comparison

To investigate the dosage-dependent effects of the four vectors described in

Example 2, Section H, two doses of the vectors were utilized in vivo and evaluated as described below as well as in Example 1 : 1 x 10¹⁰ GC and 1 x 10¹¹ GC. The results were plotted in FIGs HA to 13B.

hBChE expression and activity is evaluated using samples collected from the RAG KO mice injected with 1 x 10¹⁰ GC of the vector. The result is compared to the data described in Example 2, Section H (i).

hBChE expression was evaluated using samples collected from the RAG KO mice injected with 1 x 10¹⁰ GC and 1 x 10¹¹ of the vector. The result was plotted in FIG 11 A and 1 IB. A sudden peak in hBChE expression for low dosage group was observed on Day 7 (FIG 11 A). However, this data was not statistically significant thus did not represent the average data as only one out of five mice showed an expression while all of the rest do not. Activity of the samples acquired in the low dosage group is under investigation.

(iii) CB7-cmyc-IL2-BChE Cl-IRES-IL2-PRIMAl-rBG [SEQ ID NO: 32] hBChE expression and activity was evaluated using samples collected from the RAG KO mice injected with 1 x 10¹⁰ GC and 1 x 10¹¹ of the vector. The result was plotted in FIG 12A and 12B. hBChE expression was observed starting Day 3 post injection at about 300 ng/ml in the low dosage group while in the high dosage group, an about 1,000 ng/ml of hBChE was detected in RAG KO mice on Day 2. The hBChE expression of both groups kept increasing until Day 14. An about 10,000 ng/ml of expression was observed during Day 14 to Day 28 in the low dosage group while an about 100,000 ng/ml in the high dosage group (FIG 12A). A steady increase in the enzyme activity was detected in both groups from Day 1 to Day 28 while the high dosage group demonstrated a higher activity during the observation period (FIG 12B).

(iv) CB7-cmyc-IL2-BChE Cl -IRES-IL2-LPDN-rBG [SEQ ID NO: 33] hBChE expression and activity was evaluated using samples collected from the

RAG KO mice injected with 1 x 10¹⁰ GC and 1 x 10¹¹ of the vector. The result was plotted in FIG 13A and 13B.

hBChE expression was observed starting Day 2 post injection at about 200 ng/ml in the low dosage group while in the high dosage group, an about 100 ng/ml of hBChE was detected in RAG KO mice on Day 1. The hBChE expression of both groups kept increasing until Day 14. An about 50,000 ng/ml of expression was observed during Day 14 to Day 28 in the low dosage group while an about 300,000 ng/ml in the high dosage group (FIG 13 A). An increase of enzyme activity was observed in both groups while both groups demonstrated an about 100 μΜ/min of activity on Day 1 and an about 20,000 μΜ/min on Day 14 and Day 28. However, on Day 2, Day 3 and Day 7, an elevated activity was observed in the high dosage group compared to the low dosage group.

Example 4 - Dose-dependent Protection against Butyrylcholine (BCh) challenge in BChE KO Mice

1 x 10¹¹ GC, 3 x 10¹⁰ GC, 1 x 10¹⁰ GC, 3 x 10⁹ GC per mouse of CB7-cmyc-IL2- BChE C l-IRES-IL2-LPDN-rBG vectors inj ected to BChE KO mice on Day 1 as described in Example 1. On Day 8, butyrylcholine (BCh) challenge was performed as an intraperitoneal injection of BCh at 500 mg/kg body weight (> 5x LD50, more than five times of the dose lethal to 50% of tested samples). Blood samples were collected, processed and evaluated as described in Example 1. BChE KO mice without vector injection and wild type mice were served as control. The Result is shown in the table below. A dose dependent protection effect was observed.

Example 5 - AAV.hBChE in mice

The CB7-cmyc-IL2-BChE Cl-IRES-IL2-LPDN-rBG vector were further evaluated in mice. i.m. injection of the vectors was performed and followed by an OP Challenge with two times of the MLD50 (minimal lethal dose that is lethal to 50% of animals tested). Blood samples were collected and evaluated to determine the expression and activity of hBChE. The result was plotted in FIG 14. A reduction in the enzyme activity was observed 24 hours post challenge and a steady recovery was observed 168 hours and 360 hours post challenge (grey bars in FIG 14). The BChE expression peaked at 24 hours post challenge and fell back to the baseline afterwards (black bars in FIG 14). These data suggests a protection effect of AAV.hBChE vectors over the OP challenge in mice.

(Sequence Listing Free Text)

The following information is provided for sequences containing free text under numeric identifier <223>.

<222> (1)..(26)

<223> Innate leader/signal peptide/sequence

<220>

<221> mat_peptide

<222> (27).. (602)

3 <223> human BChE CO with innate leader

peptide.

4 <223> human BChE CO with IL2 leader peptide.

5 <223> human BChE CI with IL2 leader peptide.

<220>

<221> sig_peptide

<222> (11).. (67)

<223> IL2

6 <223> human BChE C2 with IL2 leader peptide.

7 <223> human BChE C3 with IL2 leader peptide.

8 <223> human BChE C4 with IL2 leader peptide.

9 <223> human BChE C5 with IL2 leader peptide.

10 <223> human BChE C6 with IL2 leader peptide.

11 <223> human BChE C7 with IL2 leader peptide.

12 <223> human BChE C8 with IL2 leader peptide.

13 <223> human BChE mutated at Gl 17H and

E197Q with IL2

14 <223> CMV promoter

15 <223> CMV IE promoter

16 <223> CB promoter

17 <223> C4 enhancer

18 <223> UbC promoter

19 <223> c-myc

20 <223> IL2 leader sequence 21 <223> Mutated IL2 leader sequence

22 <223> IRES

23 <223> PRIMA1 PRP

24 <223> lamelledipodin (LDPN) PRP

25 <223> WPRE

26 <223> Rabbit beta-globin (rBG) polyA

27 <223> SV40 polyA

28 <223> AAV2 5'ITR

29 <223> AAV2 3'ITR

30 <223> UbC-cmyc-IL2-BChE C1 -IRES-IL2-

PRIMA1 -SV40

<220>

<221> repeat_region

<222> (14)..(143)

<223> 5'ITR

<220>

<221> promoter

<222> (204).. (1430)

<223> UbC promoter

<220>

<221> Intron

<222> (1524).. (1656)

<223> Promega chimeric intron (PI)

<220>

<221> misc_feature

<222> (1771).. (3572)

<223> BChE coding sequence CI <220>

<221> misc_feature

<222> (1782)..(1838)

<223> human IL2 leader sequence

<220>

<221> misc_feature

<222> (3572)..(4162)

<223> IRES

<220>

<221> misc_feature

<222> (4167)..(4407)

<223> PRIMAl PRP

<220>

<221> poly A

<222> (4410)..(4641)

<223> SV40 late PolyA

<220>

<221> repeat_region

<222> (4706).. (4835)

<223> 3'ITR

31 <223> UbC-cmyc-IL2-BChE C 1-IRES-IL2- LPDN-SV40

<220>

<221> repeat_region

<222> (14)..(143) <223> 5'ITR

<220>

<221> promoter

<222> (204).. (1430)

<223> UbC promoter

<220>

<221> Intron

<222> (1524).. (1656)

<223> Promega chimeric intron

<220>

<221> misc_feature

<222> (1770).. (3574)

<223> BChE coding sequence CI

<220>

<221> misc_feature

<222> (1782)..(1838)

<223> human IL2 leader sequence

<220>

<221> misc_feature

<222> (3572)..(4162)

<223> IRES

<220>

<221> misc_feature

<222> (4167)..(4446)

<223> LPDN PRP <220>

<221> polyA_signal

<222> (4449).. (4680)

<223> SV40 late polyadem ation signal

<220>

<221> repeat_region

<222> (4745).. (4874)

<223> 5'ITR

32 <223> CB7-cmyc-IL2-BChE C1-IRES-IL2-

PRIMAl-rBG

<220>

<221> repeat_region

<222> (1)..(130)

<223> 5'ITR

<220>

<221> promoter

<222> (198).. (579)

<223> CMV IE promoter

<220>

<221> enhancer

<222> (279).. (538)

<223> C4 enhancer with 2 mismatches

<220>

<221> promoter

<222> (582).. (862) <223> CB promoter

<220>

<221> TATA_signal

<222> (836).. (839)

<220>

<221> Intron

<222> (956).. (1928)

<223> Chicken beta-actin intron

<220>

<221> misc_feature

<222> (1941)..(3742)

<223> BChE coding sequence CI

<220>

<221> misc_feature

<222> (1950).. (2006)

<223> human IL2 leader sequence

<220>

<221> misc feature

<222> (3740).. (4330)

<223> IRES

<220>

<221> misc_feature

<222> (4335).. (4560)

<223> PRIMAl PRP <220>

<221> polyA_signal

<222> (4621)..(4747)

<223> Rabbit beta globin polyA

<220>

<221> repeat_region

<222> (4836).. (4965)

<223> 3'ITR

33 <223> CB7-cmyc-IL2-BChE C1-IRES-IL2-

LPDN-rBG

<220>

<221> repeat_region

<222> (1)..(130)

<223> 5'ITR

<220>

<221> enhancer

<222> (279).. (538)

<223> C4 enhancer with 2 mismatches

<220>

<221> promoter

<222> (582).. (862)

<223> CB promoter

<220>

<221> TATA_signal

<222> (836).. (839) <220>

<221> Intron

<222> (956).. (1928)

<223> Chicken beta-actin intron

<220>

<221> misc_feature

<222> (1941)..(3739)

<223> BChE conding sequence CI

<220>

<221> misc_feature

<222> (3740).. (4330)

<223> IRES

<220>

<221> misc_feature

<222> (4335)..(4614)

<223> LPDN PRP

<220>

<221> polyA_signal

<222> (4675)..(4801)

<223> Rabbit beta globin polyA

<220>

<221> repeat_region

<222> (4890).. (5019)

34 <223> C4/Ubc hIL2 BChE CI IRES LPDN

<220> <221> repeat_region

<222> (1)..(130)

<223> 5'ITR

<220>

<221> enhancer

<222> (279).. (538)

<223> C4 enhancer with 2 mismatches

<220>

<221> promoter

<222> (565).. (1791)

<223> UbC promoter

<220>

<221> misc_feature

<222> (1826).. (3624)

<223> BChE coding sequence CI

<220>

<221> misc_feature

<222> (3625).. (4215)

<223> IRES

<220>

<221> misc_feature

<222> (4220).. (4499)

<223> LPDN PRP

<220>

<221> polyA_signal <222> (4560).. (4686)

<223> Rabbit beta globin polyA

<220>

<221> repeat_region

<222> (4775).. (4904)

<223> 3'ITR

35 <223> C4/UbC hIL2 BuChEl l IRES PRIMA

<220>

<221> repeat_region

<222> (1)..(130)

<223> 5'ITR

<220>

<221> enhancer

<222> (279).. (538)

<223> C4 enhancer with 2 mismatches

<220>

<221> promoter

<222> (565).. (1791)

<223> UbC promoter

<220>

<221> misc_feature

<222> (1826).. (3624)

<223> hBChE coding sequence C 1

<220>

<221> misc_signal <222> (1835)..(1891)

<223> human IL2 leader sequence

<220>

<221> misc_feature

<222> (3625).. (4215)

<223> IRES

<220>

<221> misc_feature

<222> (4220).. (4460)

<223> PRIMA1 PRP

<220>

<221> polyA_signal

<222> (4521)..(4647)

<223> Rabbit beta globin poly A

<220>

<221> repeat_region

<222> (4736).. (4865)

<223> 3'ITR

36 <223> hBChE C4

<220>

<221> misc_feature

<222> (1)..(25)

<223> ITR

<220>

<221> misc_feature <222> (87).. (828)

<223> human CMV IE enhancer and promoter

<220>

<221> TATA_signal

<222> (793).. (797)

<220>

<221> Intron

<222> (943).. (1075)

<223> Promega chimeric intron

<220>

<221> misc_feature

<222> (1189).. (2993)

<223> hBChE C4

<220>

<221> misc_feature

<222> (2991)..(3581)

<223> IRES

<220>

<221> misc_feature

<222> (3586)..(3826)

<223> PRIMA 1 PRP

<220>

<221> poly A

<222> (3829).. (4060)

<223> SV40 late poly A <220>

<221> misc_feature

<222> (4125)..(4254)

<223> ITR

37 <223> CMV.hBChE C5.IRES.PRIMA1.

<220>

<221> misc feature

<222> (87).. (828)

<223> human CMV IE enahncer promoter

<220>

<221> TATA_signal

<222> (793).. (797)

<220>

<221> Intron

<222> (943).. (1075)

<223> promoga chimeric intron

<220>

<221> misc_feature

<222> (1189).. (2993)

<223> hBChE C5

<220>

<221> misc_feature

<222> (2991)..(3581)

<223> IRES <220>

<221> misc_feature

<222> (3586)..(3826)

<223> PRIMA1 PRP

<220>

<221> polyA_signal

<222> (3829)..(4060)

<223> SV40 late poly A

<220>

<221> misc_feature

<222> (4125)..(4254)

<223> ITR

38 <223> CMV.hBChE C7.IRES.PRIMA1

<220>

<221> misc feature

<222> (87).. (828)

<223> human CMV IE enhancer/promoter

<220>

<221> TATA_signal

<222> (793).. (797)

<220>

<221> Intron

<222> (943).. (1075)

<223> Promega chimeric intron <220>

<221> misc_feature

<222> (1 189)..(2993)

<223> hBChE C7

<220>

<221> misc_feature

<222> (2991)..(3581)

<223> IRES

<220>

<221> misc_feature

<222> (3586)..(3826)

<223> PRIMAl PRP

<220>

<221> polyA_signal

<222> (3829)..(4060)

<223> SV40 late polyA signal

<220>

<221> misc_feature

<222> (4125)..(4254)

<223> ITR

39 <223> hBChE plasmid

<220>

<221> misc_feature

<222> (87).. (828)

<223> human CMV IE enhancer/promoter <220>

<221> TATA_signal

<222> (793).. (797)

<220>

<221> Intron

<222> (943).. (1075)

<223> Promega chimeric intron

<220>

<221> misc_feature

<222> (1144)..(1189)

<223> c-myc mini-IRES

<220>

<221> misc_feature

<222> (1190)..(2991)

<223> hBChE CI 17H E197Q with human IL2 leader sequence

<220>

<221> misc_feature

<222> (2992).. (3581)

<223> IRES

<220>

<221> polyA_signal

<222> (3829)..(4060)

<223> SV40 late poly A

<220> <221> misc_feature

<222> (4125)..(4254)

<223> ITR

40 <223> CMV.hBChE C2.IRES.PRIMA1

<220>

<221> misc_feature

<222> (1)..(130)

<223> 5'ITR

<220>

<221> misc_feature

<222> (191).. (932)

<223> human CMV IE enhancer/promoer

<220>

<221> TATA_signal

<222> (897).. (901)

<220>

<221> Intron

<222> (1047)..(1179)

<223> Promega chimeric intron (PI)

<220>

<221> misc_feature

<222> (1293)..(3097)

<223> BuChE C2

<220> <221> misc_feature

<222> (3095).. (3685)

<223> IRES

<220>

<221> misc_feature

<222> (3690).. (3930)

<223> PRIMA1 PRP

<220>

<221> polyA_signal

<222> (3933)..(4164)

<223> SV40 polyA

<220>

<221> misc_feature

<222> (4229)..(4358)

<223> 3'ITR

41 <223> Proline-rich peptide domain

47 <223> AAV8 capsid

50 <223> CB7 promoter

51 <223> C4/UbC.hIL2.BChE

C l .IRES.PRIMA.RBG

<220>

<221> repeat_region

<222> (1)..( 130)

<223> 5'ITR

<220> <221> enhancer

<222> (279).. (538)

<223> C4 enhancer with 2 mismatches

<220>

<221> promoter

<222> (565)..(1793)

<223> UbC promoter

<220>

<221> misc_feature

<222> (1828).. (3626)

<223> BChE CI with human IL2 leader

<220>

<221> misc_feature

<222> (1837)..(1893)

<223> human IL2 leader

<220>

<221> misc feature

<222> (3627).. (4217)

<223> IRES

<220>

<221 > misc_feature

<222> (4222).. (4447)

<223> PRIMAl

<220>

<221 > polyA_signal <222> (4508).. (4634)

<223> Rabbit beta globin polyA

<220>

<221> repeat_region

<222> (4723).. (4852)

All publications cited in this specification and the appended Sequence Listing are incorporated herein by reference. Also incorporated by reference are US Provisional Patent Application No. 62/323,781, filed April 17, 2016 and US Provisional Patent Application No. 62/331,262, filed May 3, 2016. While the invention has been described with reference to particular embodiments, it will be appreciated that modifications can be made without departing from the spirit of the invention. Such modifications are intended to fall within the scope of the appended claims.

Claims

CLAIMS:

1. A replication-defective, recombinant AAV (rAAV) which comprises an AAV capsid having a vector genome packaged therein, said vector genome comprising:

(a) an AAV 5' ITR;

(b) a promoter;

(c) a 5' UTR;

(d) a leader sequence operably linked to a codon optimized human butyrlcholinesterase (hBChE) coding sequence;

(e) a linker;

(f) a leader sequence operably linked to a codon optimized nucleic acid sequence encoding a proline rich peptide;

(g) an optional 3 'UTR ;

(h) a poly A; and

(i) an AAV3' ITR.

2. The rAAV according to claim 1, wherein the leader sequences for expression of hBChE and PRP are selected from a human interleukin-2 leader or a native hBChE leader sequence.

3. The rAAV according to claim 1, wherein the origin of the proline rich peptide is from Proline-rich membrane anchor 1 (Primal) and lamellipodin (LPDN).

4. The rAAV according to claim 1, further comprising a second leader sequence operably linked to the proline rich peptide.

5. The rAAV according to claim 4, wherein the second leader sequence is the same is the leader sequence as is operably linked to the BChE coding sequence.

6. The rAAV according to claim 1 , wherein the linker is an F2A.

7. The rAAV according to claim 1, wherein the linker is an IRES.

8. The rAAV according to claim 1, wherein the vector genome further comprises a 3' UTR sequence.

9. The rAAV according to claim 8, wherein the 3' UTR is a woodchuck post-transcription regulatory element.

10. The rAAV according to claim 1, wherein the poly A is SV40 or rabbit beta globin.

11. The rAAV according to claim 1, wherein the codon optimized BChE coding sequence is selected from SEQ ID NOs: 6, 7, 8, 9, 3, 4, 5, 10, 11, 12 or 13.

12. The rAAV according to claim 1, wherein the vector genome comprises an expression cassette comprising one of:

(a) C4/UbC-hIL2-BchE Cl-IRES-LPDN [SEQ ID NO: 34];

(b) UbC-cmyc-IL2-BChE C1-IRES-IL2-PRIMA1 [nt 14 to nt 4162 of SEQ ID NO: 30];

(c) UbC-cmyc-IL2-BChE C1-IRES-IL2-LPDN [nt 14 to nt 4874 of SEQ

ID NO: 31];

(d) CB7-cmyc-IL2-BChE Cl-IRES-IL2-PRIMAl [SEQ ID NO: 32];

(e) CB7-cmyc-IL2-BChE C1-IRES-IL2-LPDN [SEQ ID NO: 33] ; or

(f) C4/UbC-hIL2-BChE Cl-IRES-PRIMAl [SEQ ID NO: 35].

13. The rAAV according to any one of claims 1 to 12, wherein the AAV capsid has tropism for skeletal muscle.

14. The rAAV according to any one of claims 1 to 12, wherein the AAV capsid is AAV8.

15. An aqueous liquid suspension comprising an rAAV according to any one of claims 1 to 14 and an aqueous suspension base.

16. An rAAV according to any one of claims 1 to 14 or a liquid suspension according to claim 15 administrable to a patient for protection against poisoning with organophosphate chemical agents, reducing the effects of organophosphates in a patient, and/or treating cocaine and/or heroin toxicity or addiction.

17. Use of an rAAV according to any one of claims 1 to 14 in preparing a medicament.

18. Use according to claim 17, wherein the medicament is administrable to a patient for protection against poisoning with organophosphate chemical agents, reducing the effects of organophosphates in a patient, and/or treating cocaine or heroin toxicity and/or addiction.

19. A method for protecting against poisoning with organophosphate chemical agents, said method comprising administering an rAAV according to any one of claims 1 to 14 or a suspension according to claim 15 to the patient.

20. The method according to claim 19, wherein the patient is administered the rAAV prior to exposure to the organophosphate.

21. The method according to claim 20, wherein the rAAV is administered intramuscularly.

22. The method according to claim 20, wherein the rAAV is administered by inhalation.

23. A method reducing the effects of organophosphates in a patient, said method comprising administering an rAAV according to any one of claims 1 to 14 or a suspension according to claim 15 to the patient.

24. A method for treating cocaine and/or heroin toxicity or addiction, said method comprising administering an rAAV according to claim 1 to the patient.