Cited by 865Retinal Development and DisordersVirus-based gene therapy researchRetinal Diseases and Treatments

Age-dependent effects of RPE65 gene therapy for Leber's congenital amaurosis: a phase 1 dose-escalation trial

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Maguire, Albert M, High, Katherine A, Auricchio, Alberto, Wright, J Fraser, Pierce, Eric A, Testa, Francesco, Mingozzi, Federico, Bennicelli, Jeannette L +25 more·2009·The Lancet

Abstract

Background Gene therapy has the potential to reverse disease or prevent further deterioration of vision in patients with incurable inherited retinal degeneration. We therefore did a phase 1 trial to assess the effect of gene therapy on retinal and visual function in children and adults with Leber's congenital amaurosis.Methods We assessed the retinal and visual function in 12 patients (aged 8-44 years) with RPE65-associated Leber's congenital amaurosis given one subretinal injection of adeno-associated virus (AAV) containing a gene encoding a protein needed for the isomerohydrolase activity of the retinal pigment epithelium (AAV2-hRPE65v2) in the worst eye at low (1.5 x 10(10) vector genomes), medium (4.8 x 10(10) vector genomes), or high dose (1.5 x 10(11) vector genomes) for up to 2 years.Findings AAV2-hRPE65v2 was well tolerated and all patients showed sustained improvement in subjective and objective measurements of vision (ie, dark adaptometry, pupillometry, electroretinography, nystagmus, and ambulatory behaviour). Patients had at least a 2 log unit increase in pupillary light responses, and an 8-year-old child had nearly the same level of light sensitivity as that in age-matched normal-sighted individuals. The greatest improvement was noted in children, all of whom gained ambulatory vision. The study is registered with ClinicalTrials.gov, number NCT00516477.Interpretation The safety, extent, and stability of improvement in vision in all patients support the use of AAV-mediated gene therapy for treatment of inherited retinal diseases, with early intervention resulting in the best potential gain.Funding Center for Cellular and Molecular Therapeutics at the Children's Hospital of Philadelphia, Foundation Fighting Blindness, Telethon, Research to Prevent Blindness, F M Kirby Foundation, Mackall Foundation Trust, Regione Campania Convenzione, European Union, Associazione Italiana Amaurosi Congenita di Leber, Fund for Scientific Research, Fund for Research in Ophthalmology, and National Center for Research Resources.

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  • Subretinal AAV2 RPE65 trials in LCA showed sustained improvement in subjective and objective vision in over 30 patients.

    “during Phase I/II clinical trials for Leber's congenital amaurosis (LCA), over 30 patients who received a subretinal injection of AAV2 encoding RPE65, an enzyme responsible for the isomerohydrolase activity of retinal pigment epithelium, showed sustained improvement in both subjective and objective measurements of vision.8–14”

    From Antibody neutralization poses a barrier to intravitreal adeno-associated viral vector gene delivery to non-human primates (2015) · cites this paper as [12]

    The Abstract (Methods and Findings) describes subretinal AAV2-hRPE65v2 treatment and sustained improvement in subjective and objective vision measures. But this trial enrolled 12 patients, not over 30; this paper alone does not establish the citing sentence’s aggregate patient count across the cited trials. (LLM, conf=0.88)

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  • Posterior vitreous detachment induction may be difficult in cases of strong adhesion, which may be important for the paediatric population, particularly as these patients stand to benefit most from retinal gene therapy.

    “Induction of posterior vitreous detachment (PVD) is routinely performed as part of vitrectomy prior to subretinal vector administra­ tion but may be difficult in cases of strong adhesion. This may be important for the paediatric population, particularly as these patients stand to benefit most from retinal gene therapy (Maguire et al., 2009).”

    From Gene Therapy-Associated Uveitis (GTAU): Understanding and mitigating the adverse immune response in retinal gene therapy (2025) · cites this paper as Maguire et al., 2009

    The Discussion reports that young patients had the greatest overall improvement in vision after subretinal gene therapy, supporting the claim that paediatric patients may benefit most. The Methods describe vitrectomy and removal of the posterior cortical vitreous, but the paper does not say that strong adhesion makes posterior vitreous detachment difficult to induce or link that difficulty to children. Page numbers were not available in our copy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Young patients are more likely to suffer from corticosteroid adverse effects given the higher cumulative doses required over a lifetime, yet are also the most likely to benefit from retinal gene therapy.

    “Young patients are more likely to suffer given the higher cumulative doses of cortico­ steroids that will be required over a lifetime, yet are also the most likely to benefit from retinal gene therapy (Maguire et al., 2009).”

    From Gene Therapy-Associated Uveitis (GTAU): Understanding and mitigating the adverse immune response in retinal gene therapy (2025) · cites this paper as Maguire et al., 2009

    The Discussion (page not provided) says young patients had the greatest overall improvement in vision after subretinal gene therapy. The paper does not address whether younger patients face greater corticosteroid adverse effects because of higher cumulative lifetime doses; searches for corticosteroids and cumulative doses found no supporting passage. (LLM, conf=0.90)

    Experimental — accuracy not yet measured
  • AAV clinical successes to date have involved delivery either to immune privileged regions or to subjects lacking apparent AAV immunological memory.

    “As a result, AAV clinical successes to date have involved delivery either to immune privileged regions or to subjects lacking apparent AAV immunological memory.8–14,30,42”
  • AAV has been successful in clinical gene therapy trials for LCA, hemophilia, familial lipoprotein lipase deficiency, and choroideremia.

    “Adeno-associated virus has been successful in clinical gene therapy trials for Leber's congenital amaurosis, hemophilia, familial lipoprotein lipase deficiency, and choroideremia.8–15,26,27,60,61”

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Research works printed but not linked: 1

  1. [26]Lorenz B Gyurus P Preising M Bremser DG Early-onset severe rod-cone dystrophy in young children with RPE65 mutations Invest Ophthalmol Vis Sci 2003 44 1546 1554 10937591

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Authors
Maguire, A. M., High, K. A., Auricchio, A., Wright, J. F., Pierce, E. A., Testa, F., Mingozzi, F., Bennicelli, J. L., Ying, G.-S., Rossi, S., Fulton, A., Marshall, K. A., Banfi, S., Chung, D. C., Morgan, J. I., Hauck, B., Zelenaia, O., Zhu, X., Raffini, L., Coppieters, F., De Baere, E., Shindler, K. S., Volpe, N. J., Surace, E. M., Acerra, C., Lyubarsky, A., Redmond, T. M., Stone, E., Sun, J., McDonnell, J. W., Leroy, B. P., Simonelli, F., & Bennett, J.
Affiliations
  • Children's Hospital of Philadelphia (US)
  • Boston Children's Hospital (US)
  • National Institutes of Health (US)
  • University of Iowa (US)
Venue
The Lancet
Publisher
Elsevier BV
Published
2009-11
Volume
374
Issue
9701
Pages
1597-1605
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2162290849
Cited by
865
References
30
Citations by year
2026: 14 · 2025: 24 · 2024: 38 · 2023: 33 · 2022: 34 · 2021: 46 · 2020: 50 · 2019: 31 · 2018: 47 · 2017: 64 · 2016: 49 · 2015: 77 · 2014: 71 · 2013: 58 · 2012: 76
FWCI
30.30
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli" (submittedVersion)
Funders
  • Howard Hughes Medical Institute
  • National Eye Institute (U10EY013729, R01EY010820)
  • National Center for Research Resources (UL1RR024134)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Retinal Development and Disorders
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Virus-based gene therapy research
  • Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
Keywords
Leber congenital amaurosis, adeno-associated virus, subretinal injection, inherited retinal degeneration, visual function, pupillometry, electroretinogram, nystagmus, children, dose escalation, retinal pigment epithelium
MeSH terms
Retinoid Isomerohydrolase, Dependovirus, Adolescent, Adult, Age Factors, Blindness, Carrier Proteins, Child, Dark Adaptation, Dose-Response Relationship, Drug, Electroretinography, Eye Proteins, Female, Genetic Vectors, Humans, Injections, Male, Mutation, Nystagmus, Physiologic, Safety, Visual Acuity, Genetic Therapy, Treatment Outcome, Disease Progression, cis-trans-Isomerases, Optic Atrophy, Hereditary, Leber, Young Adult

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