Gene replacement ameliorates deficits in mouse and human models of cyclin-dependent kinase-like 5 disorder
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Accepted version
Author(s)
Yunan Gao, Yunan
Irvine, Elaine
Eleftheriadou, Ioanna
Naranjo, Carlos Jimenez
Hearn-Yeats, Francesca
Type
Journal Article
Abstract
Cyclin-dependent kinase-like 5 disorder is a severe neurodevelopmental disorder caused by mutations in the X-linked cyclin-dependent kinase-like 5 (CDKL5) gene. It predominantly affects females who typically present with severe early epileptic encephalopathy, global developmental delay, motor dysfunction, autistic features and sleep disturbances. To develop a gene replacement therapy, we initially characterized the human CDKL5 transcript isoforms expressed in the brain, neuroblastoma cell lines, primary astrocytes and embryonic stem cell-derived cortical interneurons. We found that the isoform 1 and to a lesser extent the isoform 2 were expressed in human brain, and both neuronal and glial cell types. These isoforms were subsequently cloned into recombinant adeno-associated viral (AAV) vector genome and high-titre viral vectors were produced. Intrajugular delivery of green fluorescence protein via AAV vector serotype PHP.B in adult wild-type male mice transduced neurons and astrocytes throughout the brain more efficiently than serotype 9. Cdkl5 knockout male mice treated with isoform 1 via intrajugular injection at age 28–30 days exhibited significant behavioural improvements compared to green fluorescence protein-treated controls (1012 vg per animal, n = 10 per group) with PHP.B vectors. Brain expression of the isoform 1 transgene was more abundant in hindbrain than forebrain and midbrain. Transgene brain expression was sporadic at the cellular level and most prominent in hippocampal neurons and cerebellar Purkinje cells. Correction of postsynaptic density protein 95 cerebellar misexpression, a major fine cerebellar structural abnormality in Cdkl5 knockout mice, was found in regions of high transgene expression within the cerebellum. AAV vector serotype DJ efficiently transduced CDKL5-mutant human induced pluripotent stem cell-derived neural progenitors, which were subsequently differentiated into mature neurons. When treating CDKL5-mutant neurons, isoform 1 expression led to an increased density of synaptic puncta, while isoform 2 ameliorated the calcium signalling defect compared to green fluorescence protein control, implying distinct functions of these isoforms in neurons. This study provides the first evidence that gene therapy mediated by AAV vectors can be used for treating CDKL5 disorder.
Date Issued
2020-03-03
Date Acceptance
2019-12-13
Citation
Brain: a journal of neurology, 2020, 143 (3), pp.811-832
ISSN
0006-8950
Publisher
Oxford University Press (OUP)
Start Page
811
End Page
832
Journal / Book Title
Brain: a journal of neurology
Volume
143
Issue
3
Copyright Statement
© The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please email: journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in Brain following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/brain/advance-article/doi/10.1093/brain/awaa028/5775569
Identifier
https://academic.oup.com/brain/article/143/3/811/5775569
Subjects
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences
Neurosciences & Neurology
AAV gene therapy
autism
CDKL5
hiPSC
motor deficits
CENTRAL-NERVOUS-SYSTEM
EPILEPTIC ENCEPHALOPATHY
TRANSDUCTION EFFICIENCY
NEUROLOGICAL DISEASE
INFANTILE SPASMS
DELIVERY
THERAPY
EXPRESSION
BRAIN
AAV gene therapy
CDKL5
autism
hiPSC
motor deficits
Neurology & Neurosurgery
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Publication Status
Published
Date Publish Online
2020-03-03