Cited by 188Neurogenetic and Muscular Disorders ResearchVirus-based gene therapy researchLysosomal Storage Disorders Research

Gain of toxic function by long-term AAV9-mediated SMN overexpression in the sensorimotor circuit

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Van Alstyne, Meaghan, Tattoli, Ivan, Delestrée, Nicolas, Recinos, Yocelyn, Workman, Eileen, Shihabuddin, Lamya S., Zhang, Chaolin, Mentis, George Z. +1 more·2021·Nature Neuroscience

Abstract

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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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
Venue
Nature Neuroscience
Published
2021-04-01
Volume
24
Issue
7
Pages
930-940
ISSN
  • 1097-6256 (ISSN-L)
  • 1546-1726
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
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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