Cited by 743Retinal Development and DisordersVirus-based gene therapy researchRetinal Diseases and Treatments

Long-Term Effect of Gene Therapy on Leber’s Congenital Amaurosis

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Bainbridge, James W.B., Mehat, Manjit S., Sundaram, Venki, Robbie, Scott J., Barker, Susie E., Ripamonti, Caterina, Georgiadis, Anastasios, Mowat, Freya M. +23 more·2015·New England Journal of Medicine

Abstract

BACKGROUND: Mutations in RPE65 cause Leber's congenital amaurosis, a progressive retinal degenerative disease that severely impairs sight in children. Gene therapy can result in modest improvements in night vision, but knowledge of its efficacy in humans is limited. METHODS: We performed a phase 1-2 open-label trial involving 12 participants to evaluate the safety and efficacy of gene therapy with a recombinant adeno-associated virus 2/2 (rAAV2/2) vector carrying the RPE65 complementary DNA, and measured visual function over the course of 3 years. Four participants were administered a lower dose of the vector, and 8 were administered a higher dose. In a parallel study in dogs, we investigated the relationship among vector dose, visual function, and electroretinography (ERG) findings. RESULTS: Improvements in retinal sensitivity were evident, to varying extents, in six participants for up to 3 years, peaking at 6 to 12 months after treatment and then declining. No associated improvement in retinal function was detected by means of ERG. Three participants had intraocular inflammation, and two had clinically significant deterioration of visual acuity. The reduction in central retinal thickness varied among participants. In dogs, RPE65 gene therapy with the same vector at lower doses improved vision-guided behavior, but only higher doses resulted in improvements in retinal function that were detectable with the use of ERG. CONCLUSIONS: Gene therapy with rAAV2/2 RPE65 vector improved retinal sensitivity, albeit modestly and temporarily. Comparison with the results obtained in the dog model indicates that there is a species difference in the amount of RPE65 required to drive the visual cycle and that the demand for RPE65 in affected persons was not met to the extent required for a durable, robust effect. (Funded by the National Institute for Health Research and others; ClinicalTrials.gov number, NCT00643747.).

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Crossref · 10.1056/nejmoa1414221

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  • Ocular AAV treatments have caused permanent visual acuity loss after intraocular inflammation.

    “ocular AAV therapies leading to a permanent reduction in visual acuity following intraocular inflammation (9–11)”

    From Engineering adeno-associated viral vectors to evade innate immune and inflammatory responses (2021) · cites this paper as [9]

    The Results (Inflammatory and Immune Responses; page unavailable) report that mild anterior uveitis in one participant was followed by a persistent 15-letter reduction in visual acuity. This supports a lasting loss after intraocular inflammation, but the paper reports persistence during follow-up, not that the loss was permanent or irreversible. (LLM, conf=0.82)

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  • Clinical trials have reported AAV dose-dependent intraocular inflammation and persistent visual acuity loss after subretinal AAV despite prophylactic immunosuppression.

    “AAV dose-dependent intraocular inflammation and a few instances of persistent loss of visual acuity have been independently reported in clinical trials following subretinal AAV administration despite prophylactic immunosuppression (9–11).”

    From Engineering adeno-associated viral vectors to evade innate immune and inflammatory responses (2021) · cites this paper as [9]

    The Results (Inflammatory and Immune Responses; page not provided) report inflammation in higher-dose recipients and a persistent 15-letter loss of visual acuity in one participant. The Adverse Events section mentions oral glucocorticoids, but the passages in our copy do not establish that immunosuppression was given prophylactically. (LLM, conf=0.86)

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  • In phase 1/2 dose-escalation trials for RPE65-associated LCA, choroideremia, and RPGR-associated X-linked retinitis pigmentosa, patients receiving higher doses of AAV presented with signs of retinal inflammation including vitritis, retinitis, and choroiditis.

    “In the phase 1/2 dose-escalation trials for RPE65-associated LCA, choroideremia, and retinitis pigmentosa GTPase regulator (RPGR)-associated X-linked retinitis pigmentosa, patients receiving higher doses of AAV have presented with various signs of retinal inflammation, including vitritis, retinitis, and choroiditis,2,6,7 implicating the presence of a cell-mediated immune response.”

    From Characterizing the cellular immune response to subretinal AAV gene therapy in the murine retina (2021) · cites this paper as [2]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Dose-dependent retinal inflammation (GTAU) has been observed in many retinal gene therapy trials, limiting vector dose and therapeutic efficacy.

    “Despite the perceived low immunogenicity of AAV and relative immune privilege of the intraocular environment,8 dose-dependent retinal inflammation, or gene therapy-associated uveitis (GTAU), has been observed in many retinal gene therapy trials, which limits the vector dose and therapeutic efficacy.”

    From Characterizing the cellular immune response to subretinal AAV gene therapy in the murine retina (2021) · cites this paper as [2]

    The Results (Inflammatory and Immune Responses) report inflammation or immune responses in five of eight higher-dose participants and none of four lower-dose participants; the Discussion describes these as dose-limiting toxic effects. The paper reports one trial, however, and does not establish that inflammation occurred in many retinal gene therapy trials or generally limited therapeutic efficacy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Despite a 28-day oral corticosteroid therapy started 2 days before the first IVT, 70.7% of lenadogene nolparvovec-treated eyes developed some degree of intraocular inflammation versus 10.2% of placebo-treated eyes.

    “Despite a 28-day oral corticosteroid therapy started 2 days before the first IVT, a regimen similar to that provided in several other clinical studies using IVT or sub-retinal AAV-based gene therapies,41–45 70.7% of lenadogene nolparvovec-treated eyes developed some degree of intraocular inflammation versus 10.2% of placebo-treated eyes.”

    From Randomized trial of bilateral gene therapy injection for m.11778G&amp;gt;A <i>MT-ND4</i> Leber optic neuropathy (2023) · cites this paper as [45]

    The Methods—Intervention section describes subretinal AAV-based gene therapy, and the Results—Adverse Events section refers to oral glucocorticoid use. Those passages support citing this paper as an example of a related study, but our copy does not establish that its corticosteroid regimen was similar in duration or timing. The 70.7% and 10.2% figures appear after the citation and are not attributed to this source. (LLM, conf=0.82)

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Authors
Bainbridge, J. W. B., Mehat, M. S., Sundaram, V., Robbie, S. J., Barker, S. E., Ripamonti, C., Georgiadis, A., Mowat, F. M., Beattie, S. G., Gardner, P. J., Feathers, K. L., Luong, V. A., Yzer, S., Balaggan, K., Viswanathan, A., de Ravel, T. J. L., Casteels, I., Holder, G. E., Tyler, N., Fitzke, F. W., Weleber, R. G., Nardini, M., Moore, A. T., Thompson, D. A., Petersen-Jones, S. M., Michaelides, M., van den Born, L. I., Stockman, A., Smith, A. J., Rubin, G., & Ali, R. R.
Affiliations
  • Moorfields Eye Hospital (GB)
  • Michigan State University (US)
  • University of Michigan (US)
  • Rotterdam Eye Hospital (NL)
  • Universitair Ziekenhuis Leuven (BE)
  • Oregon Health & Science University (US)
Venue
New England Journal of Medicine
Published
2015-05-14
Volume
372
Issue
20
Pages
1887-1897
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W265142245
Cited by
743
References
29
Citations by year
2026: 36 · 2025: 36 · 2024: 46 · 2023: 44 · 2022: 63 · 2021: 92 · 2020: 81 · 2019: 68 · 2018: 79 · 2017: 97 · 2016: 72 · 2015: 27 · 2014: 1
FWCI
39.82
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Durham Research Online (Durham University) (acceptedVersion)
  • Durham Research Online (Durham University) (submittedVersion, cc-by)
  • Lirias (KU Leuven) (submittedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders
  • Research to Prevent Blindness
  • Wellcome Trust
  • Massachusetts Medical Society
  • National Institute for Health and Care Research (NF-SI-0507-10204, NF-SI-0513-10074, NIHR-RP-011-003)
  • Sir Jules Thorn Charitable Trust
  • University College London
  • European Commission
  • Ulverscroft Foundation
  • Durham University
  • KU Leuven
  • Moorfields Eye Hospital NHS Foundation Trust
  • Directorate for Biological Sciences
  • Medical Research Council (MR/K024000/1, MR/M015815/1, MR/J005215/1)
  • Engineering and Physical Sciences Research Council (EP/J017698/1, EP/J005193/1)
  • Biotechnology and Biological Sciences Research Council (BB/M00211X/1)
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, RPE65, gene therapy, retinal degeneration, visual function, retinal sensitivity, electroretinogram, vector dose, intraocular inflammation, visual acuity, canine model, species differences, long-term efficacy and safety
MeSH terms
Retinoid Isomerohydrolase, Dependovirus, Adolescent, Animals, Child, Disease Models, Animal, Dogs, Genetic Vectors, Humans, Mutation, Retina, Vision, Ocular, Genetic Therapy, DNA, Complementary, Disease Progression, cis-trans-Isomerases, Photoreceptor Cells, Vertebrate, Young Adult, Leber Congenital Amaurosis

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