Adeno-associated virus vector as a platform for gene therapy delivery
Open accessAbstract
Adeno-associated virus (AAV) vectors are the leading platform for gene delivery for the treatment of a variety of human diseases. Recent advances in developing clinically desirable AAV capsids, optimizing genome designs and harnessing revolutionary biotechnologies have contributed substantially to the growth of the gene therapy field. Preclinical and clinical successes in AAV-mediated gene replacement, gene silencing and gene editing have helped AAV gain popularity as the ideal therapeutic vector, with two AAV-based therapeutics gaining regulatory approval in Europe or the United States. Continued study of AAV biology and increased understanding of the associated therapeutic challenges and limitations will build the foundation for future clinical success.
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A primary immune response to the treatment may be triggered by the presence of pre-existing neutralizing antibodies (NABs) against rAAV capsids, due to previous naturally-occurring exposure to AAV.
“A primary immune response to the treatment may be triggered by the presence of pre-existing neutralizing antibodies (NABs) against rAAV capsids, due to previous naturally-occurring exposure to AAV [1, 3].”
From Characterization of anti-AAV2 neutralizing antibody levels in sheep prior to and following intravitreal AAV2.7m8 injection (2024) · cites this paper as [3]
In “Immunological barriers to rAAV gene delivery,” the paper says neutralizing antibodies from natural AAV infection can be present before treatment and can block rAAV delivery. It separately says that administration of the vector capsid triggers a humoral immune response; it does not say pre-existing antibodies trigger a primary immune response to treatment. (LLM, conf=0.85)
Experimental — accuracy not yet measuredHost immune responses against AAV vectors and delivered transgene impact effective and stable transgene expression.
“However, host immune responses against AAV vectors and delivered transgene impact effective and stable transgene expression [10, 11].”
From Immunogenicity of Recombinant Adeno-Associated Virus (AAV) Vectors for Gene Transfer (2023) · cites this paper as [11]
One of the first approaches to show gene transfer in mouse retina used rAAV vectors to deliver a reporter gene by subretinal injection into an adult mouse retina.
“One of the first approaches to show gene transfer in mouse retina used rAAV vectors to deliver a reporter gene by subretinal injection into an adult mouse retina [62].”
From The Ocular Gene Delivery Landscape (2021) · cites this paper as [62]
The therapeutic payload must be under 5 kb and must include regulatory elements such as the promoter and polyadenylation signal.
“The therapeutic payload must be under 5 kb and must include the regulatory elements, such as the promoter and polyadenylation signal [61,62].”
From The Ocular Gene Delivery Landscape (2021) · cites this paper as [62]
The proteasome degradation pathway results in unsuccessful transduction, and capsid-derived peptides are presented to CTL by MHC class I molecules, provoking elimination of transduced cells and loss of transgene expression.
“The latter pathway results in unsuccessful transduction, and capsid-derived peptides are presented to CTL by MHC class I molecules, provoking elimination of transduced cells and loss of transgene expression (85).”
From Immunomodulation in Administration of RAAV: Preclinical and Clinical Adjuvant Pharmacotherapies (2021) · cites this paper as [85]
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Viral vector platforms within the gene therapy landscape
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Brain-Derived Neurotrophic Factor in Alzheimer’s Disease and Its Pharmaceutical Potential
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Manufacturing challenges and rational formulation development for AAV viral vectors
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Viral <scp>vector‐based</scp> gene therapies in the clinic
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Overcoming innate immune barriers that impede AAV gene therapy vectors
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rAAV immunogenicity, toxicity, and durability in 255 clinical trials: A meta-analysis
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Dual-AAV delivering split prime editor system for in vivo genome editing
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Rapid evolution of blood-brain-barrier-penetrating AAV capsids by RNA-driven biopanning
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Immunogenicity of Recombinant Adeno-Associated Virus (AAV) Vectors for Gene Transfer
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Rescuing AAV gene transfer from neutralizing antibodies with an IgG-degrading enzyme
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Journey to the Center of the Cell: Tracing the Path of AAV Transduction
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“46,47 To overcome these key limitations, we developed AAV9-RE GABA -eTF S CN1A , a novel gene regulation therapy, to selectively drive upregulation of endogenous WT SCN1A in GABAergic inhibitory interneurons to rescue haploinsufficiency of SCN1A in DS (Fig.”
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Compartmentalized ocular lymphatic system mediates eye–brain immunity
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Capsid-specific removal of circulating antibodies to adeno-associated virus vectors
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T Cell-Mediated Immune Responses to AAV and AAV Vectors
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Enhancing autophagy in Alzheimer's disease through drug repositioning
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Self-citationAdeno-Associated Viral Vectors as a Tool for Large Gene Delivery to the Retina
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Self-citationImmunomodulation in Administration of RAAV: Preclinical and Clinical Adjuvant Pharmacotherapies
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A versatile toolkit for overcoming AAV immunity
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“adenovirus preparations in the 1960s [8], AAVs were soon taken into consideration as potential vehicles for gene therapeutic applications [9].”
BackgroundChan, Y. K., Dick, A. D., Hall, S. M., Langmann, T., Scribner, C. L., Mansfield, B. C., & for the Ocular Gene Therapy Inflammation Working Group (2021) · Translational Vision Science & Technology · doi:10.1167/tvst.10.4.3 · Cited by 56 · see citing works
Host immune responses after suprachoroidal delivery of AAV8 in nonhuman primate eyes
Chung, S. H., Mollhoff, I. N., Mishra, A., Sin, T.-N., Ngo, T., Ciulla, T., Sieving, P., Thomasy, S. M., & Yiu, G. (2021) · Human Gene Therapy · doi:10.1089/hum.2020.281 · Cited by 57 · see citing works
Rational engineering of a functional CpG-free ITR for AAV gene therapy
Pan, X., Yue, Y., Boftsi, M., Wasala, L. P., Tran, N. T., Zhang, K., Pintel, D. J., Tai, P. W. L., & Duan, D. (2022) · Gene Therapy · doi:10.1038/s41434-021-00296-0 · Cited by 53 · see citing works
Self-citationHigh-efficiency base editing in the retina in primates and human tissues
Muller, A., Sullivan, J., Schwarzer, W., Wang, M., Park-Windhol, C., Hasler, P. W., Janeschitz-Kriegl, L., Duman, M., Klingler, B., Matsell, J., et al. (2025) · Nature Medicine · doi:10.1038/s41591-024-03422-8 · Cited by 52 · see citing works
Optimization of AAV vectors to target persistent viral reservoirs
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Self-citationDay, J. W., Finkel, R. S., Mercuri, E., Swoboda, K. J., Menier, M., van Olden, R., Tauscher-Wisniewski, S., & Mendell, J. R. (2021) · Molecular Therapy - Methods & Clinical Development · doi:10.1016/j.omtm.2021.02.014 · Cited by 48 · see citing works
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Kinetics and durability of transgene expression after intrastriatal injection of AAV9 vectors
Hollidge, B. S., Carroll, H. B., Qian, R., Fuller, M. L., Giles, A. R., Mercer, A. C., Danos, O., Liu, Y., Bruder, J. T., & Smith, J. B. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.1051559 · Cited by 45 · see citing works
Genome-editing strategies for treating human retinal degenerations
Quinn, J., Musa, A., Kantor, A., McClements, M. E., Cehajic-Kapetanovic, J., MacLaren, R. E., & Xue, K. (2021) · Human Gene Therapy · doi:10.1089/hum.2020.231 · Cited by 41 · see citing works
Advances in ophthalmic optogenetics: approaches and applications
Prosseda, P. P., Tran, M., Kowal, T., Wang, B., & Sun, Y. (2022) · Biomolecules · doi:10.3390/biom12020269 · Cited by 41 · see citing works
The concept of gene therapy for glaucoma: the dream that has not come true yet
Sulak, R., Liu, X., & Smedowski, A. (2024) · Neural Regeneration Research · doi:10.4103/1673-5374.375319 · Cited by 40 · see citing works
An adeno-associated virus variant enabling efficient ocular-directed gene delivery across species
Luo, S., Jiang, H., Li, Q., Qin, Y., Yang, S., Li, J., Xu, L., Gou, Y., Zhang, Y., Liu, F., et al. (2024) · Nature Communications · doi:10.1038/s41467-024-48221-4 · Cited by 39 · see citing works
Focused Update on AAV-Based Gene Therapy Clinical Trials for Inherited Retinal Degeneration
Fuller-Carter, P. I., Basiri, H., Harvey, A. R., & Carvalho, L. S. (2020) · BioDrugs · doi:10.1007/s40259-020-00453-8 · Cited by 41 · see citing works
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Approaches to gene modulation therapy for ALS
Meijboom, K. E., & Brown, R. H. (2022) · Neurotherapeutics · doi:10.1007/s13311-022-01285-w · Cited by 38 · see citing works
Structure comparison of the chimeric AAV2.7m8 vector with parental AAV2
Bennett, A., Keravala, A., Makal, V., Kurian, J., Belbellaa, B., Aeran, R., Tseng, Y.-S., Sousa, D., Spear, J., Gasmi, M., et al. (2020) · Journal of Structural Biology · doi:10.1016/j.jsb.2019.107433 · Cited by 33 · see citing works
“This capsid diversity results in a large variety of cell tropisms, which makes the AAV vector a very attractive gene delivery vehicle, as most organs and cell-types can be targeted with one or several of these naturally occurring AAV serotypes (Wang et al., 2019).”
BackgroundInfluentialOcular Inflammation and Treatment Emergent Adverse Events in Retinal Gene Therapy
Mehta, N., Robbins, D. A., & Yiu, G. (2021) · International Ophthalmology Clinics · doi:10.1097/iio.0000000000000366 · Cited by 33 · see citing works
The Ocular Gene Delivery Landscape
Sahu, B., Chug, I., & Khanna, H. (2021) · Biomolecules · doi:10.3390/biom11081135 · Cited by 28 · see citing works
Quantification of Adeno-Associated Virus with Safe Nucleic Acid Dyes
Xu, J., DeVries, S. H., & Zhu, Y. (2020) · Human Gene Therapy · doi:10.1089/hum.2020.063 · Cited by 25 · see citing works
The AAV2.7m8 capsid packages a higher degree of heterogeneous vector genomes than AAV2
Cui, M., Su, Q., Yip, M., McGowan, J., Punzo, C., Gao, G., & Tai, P. W. L. (2024) · Gene Therapy · doi:10.1038/s41434-024-00477-7 · Cited by 20 · see citing works
“These features have made rAAVs the most widely used vehicles in the gene therapy fi eld, especially for treating ocular disease [2, 3]. rAAVs have demonstrated ef fi cacy in clinical trials for inherited retinal dystrophies, including Leber ’ s congenital amaurosis (LCA), chor-oideremia, and X-linked…”
BackgroundSelf-citationCheng, S.-Y., Luo, Y., Malachi, A., Ko, J., Su, Q., Xie, J., Tian, B., Lin, H., Ke, X., Zheng, Q., et al. (2021) · Human Gene Therapy · doi:10.1089/hum.2021.132 · Cited by 14 · see citing works
Self-citationStolte, B., Schreiber-Katz, O., Günther, R., Wurster, C. D., Petri, S., Osmanovic, A., Freigang, M., Uzelac, Z., Leo, M., von Velsen, O., et al. (2022) · Human Gene Therapy · doi:10.1089/hum.2022.054 · Cited by 15 · see citing works
van der Veen, I., Heredero Berzal, A., Koster, C., ten Asbroek, A. L. M. A., Bergen, A. A., & Boon, C. J. F. (2024) · International Journal of Molecular Sciences · doi:10.3390/ijms25021267 · Cited by 14 · see citing works
Özgür-Günes, Y., Chedik, M., Le Stunff, C., Fovet, C.-M., & Bougnères, P. (2022) · Human Gene Therapy · doi:10.1089/hum.2021.293 · Cited by 10 · see citing works
Ross, M., Sade, K., Obolensky, A., Averbukh, E., Desrosiers, M., Rosov, A., Dvir, H., Gootwine, E., Banin, E., Dalkara, D., et al. (2024) · Gene Therapy · doi:10.1038/s41434-024-00495-5 · Cited by 3 · see citing works
- Authors
- Wang, D., Tai, P. W. L., & Gao, G.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Corresponding author
- Gao, Guangping
- Venue
- Nature Reviews Drug Discovery
- Published
- 2019-02-01
- Volume
- 18
- Issue
- 5
- Pages
- 358-378
- ISSN
- 1474-1776 (ISSN-L)
- 1474-1784
- PMC
- PMC6927556
- OpenAlex
- W2913212173
- Cited by
- 2,444
- References
- 319
- Citations by year
- 2026: 314 · 2025: 431 · 2024: 469 · 2023: 385 · 2022: 342 · 2021: 295 · 2020: 168 · 2019: 39
- FWCI
- 27.96
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Drug Discovery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (P01HL131471, UG3HL147367)
- National Institute of Neurological Disorders and Stroke (R01NS076991)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Virus-based gene therapy research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › RNA Interference and Gene Delivery
- Health Sciences › Medicine › Genetics › Neurogenetic and Muscular Disorders Research
- Keywords
- adeno-associated virus vectors, gene therapy, gene delivery, AAV capsid, gene replacement, gene silencing, genome editing, clinical gene therapy
- MeSH terms
- Dependovirus, Animals, Genetic Vectors, Humans, Genetic Therapy, Gene Transfer Techniques
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