Gain of toxic function by long-term AAV9-mediated SMN overexpression in the sensorimotor circuit
Open accessAbstract
The neurodegenerative disease spinal muscular atrophy (SMA) is caused by deficiency in the survival motor neuron (SMN) protein. Currently approved SMA treatments aim to restore SMN, but the potential for SMN expression beyond physiological levels is a unique feature of adeno-associated virus serotype 9 (AAV9)-SMN gene therapy. Here, we show that long-term AAV9-mediated SMN overexpression in mouse models induces dose-dependent, late-onset motor dysfunction associated with loss of proprioceptive synapses and neurodegeneration. Mechanistically, aggregation of overexpressed SMN in the cytoplasm of motor circuit neurons sequesters components of small nuclear ribonucleoproteins, leading to splicing dysregulation and widespread transcriptome abnormalities with prominent signatures of neuroinflammation and the innate immune response. Thus, long-term SMN overexpression interferes with RNA regulation and triggers SMA-like pathogenic events through toxic gain-of-function mechanisms. These unanticipated, SMN-dependent and neuron-specific liabilities warrant caution on the long-term safety of treating individuals with SMA with AAV9-SMN and the risks of uncontrolled protein expression by gene therapy.
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Supraphysiological expression of target proteins could be hazardous, as shown in Rett syndrome, GM2 gangliosidosis, and Spinal Muscular Atrophy.
“In fact, supraphysiological expression of target proteins could be hazardous, as previously shown in the context of Rett syndrome [83], GM2 gangliosidosis [84], and Spinal Muscular Atrophy [85].”
From Circumventing the packaging limit of AAV-mediated gene replacement therapy for neurological disorders (2022) · cites this paper as [85]
AAV-mediated gene delivery has been associated with neurotoxicity in specific cell populations, some of which can be attributed to the overexpressed transgene.
“Despite an overall strong safety profile, AAV-mediated gene delivery has been associated with neurotoxicity in specific cell populations, some of which can be attributed to the overexpressed transgene.”
From An innate immune response to adeno-associated virus genomes decreases cortical dendritic complexity and disrupts synaptic transmission (2024) · cites this paper as [67]
Overexpression of SMN1 in a spinal muscular atrophy mouse model causes a toxic gain of function.
“Additionally, overexpression of SMN1 in a spinal muscular atrophy mouse model causes a toxic gain of function.67”
From An innate immune response to adeno-associated virus genomes decreases cortical dendritic complexity and disrupts synaptic transmission (2024) · cites this paper as [67]
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- Authors
- Van Alstyne, M., Tattoli, I., Delestrée, N., Recinos, Y., Workman, E., Shihabuddin, L. S., Zhang, C., Mentis, G. Z., & Pellizzoni, L.
- Affiliations
- Columbia University (US)
- Sanofi (United States) (US)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Pellizzoni, Livio
- ORCID
- Venue
- Nature Neuroscience
- Published
- 2021-04-01
- Volume
- 24
- Issue
- 7
- Pages
- 930-940
- ISSN
- 1097-6256 (ISSN-L)
- 1546-1726
- PMC
- PMC8254787
- OpenAlex
- W3151198053
- Cited by
- 188
- References
- 50
- Citations by year
- 2026: 19 · 2025: 32 · 2024: 55 · 2023: 26 · 2022: 32 · 2021: 23
- FWCI
- 19.10
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Licence
- Locations
- Nature Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute of Neurological Disorders and Stroke (R01NS078375, R01NS102451, R21NS099977)
- U.S. Department of Health & Human Services | NIH | National Institute on Alcohol Abuse and Alcoholism (R01AA027079)
- Topics
- Health Sciences › Medicine › Genetics › Neurogenetic and Muscular Disorders Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Virus-based gene therapy research
- Health Sciences › Medicine › Physiology › Lysosomal Storage Disorders Research
- Keywords
- spinal muscular atrophy, gain-of-function toxicity, small nuclear ribonucleoproteins, splicing dysregulation, neuroinflammation, innate immune response, motor neuron degeneration, sensorimotor circuits
- MeSH terms
- Motor Disorders, Dependovirus, Animals, Ganglia, Spinal, Genetic Vectors, Injections, Intraventricular, Motor Neurons, Nerve Degeneration, Genetic Therapy, Gene Transfer Techniques, Mice, Survival of Motor Neuron 1 Protein
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