Treatment of a metabolic liver disease by in vivo genome base editing in adult mice

Nat Med. 2018 Oct;24(10):1519-1525. doi: 10.1038/s41591-018-0209-1. Epub 2018 Oct 8.

Abstract

CRISPR-Cas-based genome editing holds great promise for targeting genetic disorders, including inborn errors of hepatocyte metabolism. Precise correction of disease-causing mutations in adult tissues in vivo, however, is challenging. It requires repair of Cas9-induced double-stranded DNA (dsDNA) breaks by homology-directed mechanisms, which are highly inefficient in nondividing cells. Here we corrected the disease phenotype of adult phenylalanine hydroxylase (Pah)enu2 mice, a model for the human autosomal recessive liver disease phenylketonuria (PKU)1, using recently developed CRISPR-Cas-associated base editors2-4. These systems enable conversion of C∙G to T∙A base pairs and vice versa, independent of dsDNA break formation and homology-directed repair (HDR). We engineered and validated an intein-split base editor, which allows splitting of the fusion protein into two parts, thereby circumventing the limited cargo capacity of adeno-associated virus (AAV) vectors. Intravenous injection of AAV-base editor systems resulted in Pahenu2 gene correction rates that restored physiological blood phenylalanine (L-Phe) levels below 120 µmol/l [5]. We observed mRNA correction rates up to 63%, restoration of phenylalanine hydroxylase (PAH) enzyme activity, and reversion of the light fur phenotype in Pahenu2 mice. Our findings suggest that targeting genetic diseases in vivo using AAV-mediated delivery of base-editing agents is feasible, demonstrating potential for therapeutic application.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • CRISPR-Cas Systems / genetics*
  • DNA / genetics
  • DNA / therapeutic use
  • Dependovirus / genetics
  • Disease Models, Animal
  • Gene Editing
  • Genetic Therapy / methods
  • Humans
  • Liver / metabolism
  • Liver / pathology
  • Liver Diseases / genetics
  • Liver Diseases / metabolism
  • Liver Diseases / pathology
  • Liver Diseases / therapy*
  • Mice
  • Phenylalanine / blood
  • Phenylalanine Hydroxylase / genetics*
  • Phenylalanine Hydroxylase / therapeutic use
  • Phenylketonurias / genetics
  • Phenylketonurias / metabolism
  • Phenylketonurias / pathology
  • Phenylketonurias / therapy*
  • Recombinational DNA Repair / genetics

Substances

  • Phenylalanine
  • DNA
  • Phenylalanine Hydroxylase