Complexity of immune responses to AAV transgene products – Example of factor IX
Open accessAbstract
After two decades of research, in vivo gene transfer with adeno-associated viral (AAV) vectors has now resulted in successful treatments and even cures for several human diseases. However, the potential for immune responses against the therapeutic gene products remains one of the concerns as this approach is broadened to more patients, diverse diseases, and target organs. Immune responses following gene transfer of coagulation factor IX (FIX) for the treatment of the bleeding disorder hemophilia B has been extensively investigated in multiple animal models. Findings from these studies have not only influenced clinical trial design but have broader implications for other diseases. The impact of vector design and dose, as well as target organ/route of administration on humoral and cellular immune responses are reviewed. Furthermore, the potential for tolerance induction by hepatic gene transfer or combination with immune modulation is discussed.
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Upon exposure to the AAV-delivered transgene, antigen-presenting cells acquire protein product through transduction or phagocytosis and present processed antigen on either MHC I or MHC II molecules, resulting in cellular or humoral immune responses, respectively.
“Upon exposure to the AAV-delivered transgene, APCs acquire protein product through transduction or phagocytosis and present processed antigen on either MHC I or MHC II molecules, resulting in cellular or humoral immune responses, respectively [113].”
From Immunogenicity of Recombinant Adeno-Associated Virus (AAV) Vectors for Gene Transfer (2023) · cites this paper as [113]
When compared with adenoviral and lentiviral vectors, AAVs have a lower risk of inducing an immune response against the transgene due to the low transduction efficiency of antigen-presenting cells by AAVs.
“However, when compared with adenoviral and lentiviral vectors, AAVs have a lower risk of inducing an immune response against the transgene due to the low transduction efficiency of APCs by AAVs [113, 114].”
From Immunogenicity of Recombinant Adeno-Associated Virus (AAV) Vectors for Gene Transfer (2023) · cites this paper as [113]
The immunogenic i.m. route was chosen because hepatic gene transfer typically results in tolerance induction to FIX.
“The immunogenic i.m. route was chosen for these experiments, as hepatic gene transfer typically results in tolerance induction to FIX (24, 38).”
From Effect of CpG Depletion of Vector Genome on CD8+ T Cell Responses in AAV Gene Therapy (2021) · cites this paper as [38]
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MyD88 Signaling in B Cells Regulates the Production of Th1-dependent Antibodies to AAV
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Progress toward inducing immunologic tolerance to factor VIII
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Self-citationFactor VIII gene variants and inhibitor risk in African American hemophilia A patients
Gunasekera, D., Ettinger, R. A., Fletcher, S. N., James, E. A., Liu, M., Barrett, J. C., Withycombe, J. S., Matthews, D. C., Epstein, M. S., Hughes, R. J., et al. (2015) · Blood · doi:10.1182/blood-2014-09-599365 · Cited by 54 · see citing works
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Self-citationTargeted approaches to induce immune tolerance for Pompe disease therapy
Doerfler, P. A., Nayak, S., Corti, M., Morel, L. M., Herzog, R. W., & Byrne, B. J. (2016) · Molecular Therapy — Methods & Clinical Development · doi:10.1038/mtm.2015.53 · Cited by 51 · see citing works
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Liver type I regulatory T cells suppress germinal center formation in HBV-tolerant mice
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Self-citationMuscle as a Target for Supplementary Factor IX Gene Transfer
Hoffman, B. E., Dobrzynski, E., Wang, L., Hirao, L. A., Mingozzi, F., Cao, O., & Herzog, R. W. (2007) · Human Gene Therapy · doi:10.1089/hum.2007.042 · Cited by 44 · see citing works
Self-citationBoisgérault, F., & Mingozzi, F. (2015) · Current Gene Therapy · doi:10.2174/1566523215666150630121750 · Cited by 44 · see citing works
Prevention and Reversal of Antibody Responses Against Factor IX in Gene Therapy for Hemophilia B
Nayak, S., Sarkar, D., Perrin, G. Q., Moghimi, B., Hoffman, B. E., Zhou, S., Byrne, B. J., & Herzog, R. W. (2011) · Frontiers in Microbiology · doi:10.3389/fmicb.2011.00244 · Cited by 40 · see citing works
Self-citationPerrin, G. Q., Zolotukhin, I., Sherman, A., Biswas, M., de Jong, Y. P., Terhorst, C., Davidoff, A. M., & Herzog, R. W. (2016) · Molecular Therapy — Methods & Clinical Development · doi:10.1038/mtm.2016.83 · Cited by 40 · see citing works
Self-citationIn vivo induction of regulatory T cells for immune tolerance in hemophilia
Wang, X., Terhorst, C., & Herzog, R. W. (2015) · Cellular Immunology · doi:10.1016/j.cellimm.2015.10.001 · Cited by 37 · see citing works
Self-citationTranslational Data from Adeno-Associated Virus-Mediated Gene Therapy of Hemophilia B in Dogs
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Combination therapy for inhibitor reversal in haemophilia A using monoclonal anti-CD20 and rapamycin
Sherman, A., Byrne, B. J., Markusic, D. M., Jiang, H., Biswas, M., Rogers, G. L., & Herzog, R. W. (2016) · Thrombosis and Haemostasis · doi:10.1160/th16-05-0404 · Cited by 30 · see citing works
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The Role of Apoptosis in Immune Hyporesponsiveness Following AAV8 Liver Gene Transfer
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Early clinical data raise the bar for hemophilia gene therapies
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A Cure For Hemophilia: the Promise Becomes a Reality
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Innovating immune tolerance induction for haemophilia
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Tilt balance towards regulation: evolving new strategy for treatment of hemophilia inhibitors
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Oral Tolerance: Another Reason to Eat Your Veggies!
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- [78]Nienhuis AW Nathwani AC Davidoff AM Gene Therapy for Hemophilia Mol Ther 2017 PMC5417837 28411016
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Update on clinical gene therapy for hemophilia
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Self-citationAdeno-associated viral vector-mediated immune responses: Understanding barriers to gene delivery
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“Using coagulation factor IX as an example of transgenes, Herzog recently discussed the complexity of immune responses to rAAV-encoded transgene products (Herzog, 2019).”
MethodImmunogenicity of Recombinant Adeno-Associated Virus (AAV) Vectors for Gene Transfer
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“transgene due to the low transduction efficiency of APCs by AAVs [113, 114].”
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Immunogenicity assessment of AAV-based gene therapies: An IQ consortium industry white paper
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Immune Response Mechanisms against AAV Vectors in Animal Models
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Modulation of immune responses in lentiviral vector-mediated gene transfer
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Effect of CpG Depletion of Vector Genome on CD8+ T Cell Responses in AAV Gene Therapy
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“route was chosen for these experiments, as hepatic gene transfer typically results in tolerance induction to FIX (24, 38).”
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Adeno-Associated Viruses (AAV) and Host Immunity – A Race Between the Hare and the Hedgehog
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Plant cell-made protein antigens for induction of Oral tolerance
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Self-citationEx vivo editing of human hematopoietic stem cells for erythroid expression of therapeutic proteins
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Long-Term Delivery of an Anti-SIV Monoclonal Antibody With AAV
Martinez-Navío, J. M., Fuchs, S. P., Mendes, D. E., Rakasz, E. G., Gao, G., Lifson, J. D., & Desrosiers, R. C. (2020) · Frontiers in Immunology · doi:10.3389/fimmu.2020.00449 · Cited by 47 · see citing works
The curious case of AAV immunology
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Development challenges associated with rAAV-based gene therapies
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Gene therapy with regulatory T cells: A beneficial alliance
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Self-citationAdeno-associated virus vectors and neurotoxicity—lessons from preclinical and human studies
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AAV-Mediated Gene Delivery to the Liver: Overview of Current Technologies and Methods
Palaschak, B., Herzog, R. W., & Markusic, D. M. (2019) · Methods in molecular biology · doi:10.1007/978-1-4939-9139-6_20 · Cited by 37 · see citing works
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Fuchs, S. P., Martinez-Navio, J. M., Rakasz, E. G., Gao, G., & Desrosiers, R. C. (2020) · Molecular Therapy - Methods & Clinical Development · doi:10.1016/j.omtm.2019.11.010 · Cited by 32 · see citing works
Innovative Approaches for Immune Tolerance to Factor VIII in the Treatment of Hemophilia A
Sherman, A., Biswas, M., & Herzog, R. W. (2017) · Frontiers in Immunology · doi:10.3389/fimmu.2017.01604 · Cited by 33 · see citing works
Self-citationXiang, Z., Kuranda, K., Quinn, W. J., Chekaoui, A., Ambrose, R., Hasanpourghadi, M., Novikov, M., Newman, D., Cole, C., Zhou, X., et al. (2022) · Human Gene Therapy · doi:10.1089/hum.2021.258 · Cited by 34 · see citing works
Immune Responses to Muscle-Directed Adeno-Associated Viral Gene Transfer in Clinical Studies
Kumar, S. R. P., Duan, D., & Herzog, R. W. (2023) · Human Gene Therapy · doi:10.1089/hum.2023.056 · Cited by 28 · see citing works
Self-citationAdeno-associated virus (AAV) capsid engineering in liver-directed gene therapy
Rodríguez-Márquez, E., Meumann, N., & Büning, H. (2020) · Expert Opinion on Biological Therapy · doi:10.1080/14712598.2021.1865303 · Cited by 27 · see citing works
Progress in Pseudotyping Lentiviral Vectors Towards Cell-Specific Gene Delivery In Vivo
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Prospects for gene replacement therapies in amyotrophic lateral sclerosis
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Tolerance induction in hemophilia: innovation and accomplishments
Sherman, A., Biswas, M., & Herzog, R. W. (2018) · Current Opinion in Hematology · doi:10.1097/moh.0000000000000446 · Cited by 17 · see citing works
Self-citationElkouby, L., Armour, S. M., Toso, R., DiPietro, M. A., Davidson, R. J., Nguyen, G. N., Willet, M., Kutza, S., Silverberg, J., Frick, J. E., et al. (2021) · Molecular Therapy — Methods & Clinical Development · doi:10.1016/j.omtm.2021.11.005 · Cited by 17 · see citing works
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Alpha 1 Antitrypsin Gene Therapy Extends the Lifespan of Lupus-Prone Mice
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Evading the AAV Immune Response in Mucopolysaccharidoses
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Focal lesions following intracerebral gene therapy for mucopolysaccharidosis IIIA
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Delivery of genome editors with engineered virus-like particles
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Adeno-associated virus-induced neurotoxicity is prevented by CpG depletion
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Journou, M. (2021) · theses.fr (ABES) · doi:10.70675/9a618ac2za0a4z4e90zbdb3ze14482ffa655
- Authors
- Herzog, R. W.
- Affiliations
- University of Florida (US)
- Corresponding author
- Herzog, Roland W.
- ORCID
- Herzog, Roland W.
- Venue
- Cellular Immunology
- Publisher
- Elsevier BV
- Published
- 2019-08
- Volume
- 342
- Pages
- 103658
- ISSN
- 0008-8749 (ISSN-L)
- PMC
- PMC5708148
- OpenAlex
- W2618968334
- Cited by
- 60
- References
- 116
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 13 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 5 · 2019: 7 · 2018: 8 · 2017: 2
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cellular Immunology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIH (R01 AI51390, R01 HL131093)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Virus-based gene therapy research
- Health Sciences › Medicine › Hematology › Hemophilia Treatment and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › RNA Interference and Gene Delivery
- Keywords
- adeno-associated virus vectors, coagulation factor IX, hemophilia B, in vivo gene delivery, humoral immune response, cell-mediated immunity, vector design, dosage effect, route of administration, target organs, immune tolerance induction, hepatic gene transfer, immunomodulation
- MeSH terms
- Dependovirus, Hemophilia B, Factor IX, Humans, Immune Tolerance, Genetic Therapy, Gene Transfer Techniques, Transgenes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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