Cited by 141Virus-based gene therapy researchRNA Interference and Gene DeliveryViral Infectious Diseases and Gene Expression in Insects

The DOI matches its Crossref record; 77 of the 77 references it cites were found in a registry or an index; 53 of the 110 sources its claims cite were checked for support.

Expressing Transgenes That Exceed the Packaging Capacity of Adeno-Associated Virus Capsids

Open access
Chamberlain, Kyle, Riyad, Jalish Mahmud, Weber, Thomas·2016·Human Gene Therapy Methods

Abstract

Recombinant adeno-associated virus vectors (rAAV) are being explored as gene delivery vehicles for the treatment of various inherited and acquired disorders. rAAVs are attractive vectors for several reasons: wild-type AAVs are nonpathogenic, and rAAVs can trigger long-term transgene expression even in the absence of genome integration-at least in postmitotic tissues. Moreover, rAAVs have a low immunogenic profile, and the various AAV serotypes and variants display broad but distinct tropisms. One limitation of rAAVs is that their genome-packaging capacity is only ∼5 kb. For most applications this is not of major concern because the median human protein size is 375 amino acids. Excluding the ITRs, for a protein of typical length, this allows the incorporation of ∼3.5 kb of DNA for the promoter, polyadenylation sequence, and other regulatory elements into a single AAV vector. Nonetheless, for certain diseases the packaging limit of AAV does not allow the delivery of a full-length therapeutic protein by a single AAV vector. Hence, approaches to overcome this limitation have become an important area of research for AAV gene therapy. Among the most promising approaches to overcome the limitation imposed by the packaging capacity of AAV is the use of dual-vector approaches, whereby a transgene is split across two separate AAV vectors. Coinfection of a cell with these two rAAVs will then-through a variety of mechanisms-result in the transcription of an assembled mRNA that could not be encoded by a single AAV vector because of the DNA packaging limits of AAV. The main purpose of this review is to assess the current literature with respect to dual-AAV-vector design, to highlight the effectiveness of the different methodologies and to briefly discuss future areas of research to improve the efficiency of dual-AAV-vector transduction.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review assesses strategies for expressing transgenes that exceed the ~5 kb packaging capacity of recombinant AAV vectors, focusing on dual-vector designs (fragmented/oversized, overlapping, trans-splicing, and hybrid). It concludes that hybrid dual-vector systems are currently the most promising in most instances, but that no single system is optimal across all transgenes and tissues.

Key findings

  • AAV packaging capacity is limited to roughly 5 kb: wtAAV genomes average ~4.7 kb, Hermonat et al. found ~5.6 kb as the maximum for recovery of significant infectious virus, and Dong et al. reported optimal packaging between 4.1 and 4.9 kb, with vectors >5.2 kb packaged very inefficiently. Claims that AAV5 could package up to 8.9 kb were not supported by later studies, which found such genomes truncated (packaged genomes never exceeded 5.2 kb).
  • Because ~6% of human proteins have coding sequences exceeding 4 kb (median human protein is 375 amino acids), some therapeutic cDNAs (e.g., ABCA4 ~7.3 kb, dystrophin, dysferlin, CFTR, MYO7A, factor VIII) cannot fit in a single AAV vector.
  • In a direct comparison (Ghosh et al.), hybrid vectors achieved LacZ expression equal to a single intact vector at MOI 20,000 vg/cell, and 71% at 1,000 vg/cell, outperforming overlapping (~25%) and trans-splicing (~50%) variants; in mouse tibialis anterior muscle, hybrid vectors yielded 81% of single-vector β-galactosidase activity versus 34% (overlapping) and 62% (trans-splicing).
  • Hybrid systems are not universally superior: Zhang and Duan found a dual overlapping vector system gave ~3-fold higher muscle transduction than three hybrid systems, and Pryadkina et al. obtained similar results for dysferlin. Minimized AP bridging sequences (0.27/0.26 kb vs. 0.87 kb) expand payload by ~1.2 kb; a 77 bp F1 phage-derived homology region has also been used.

Methods

  • Narrative literature review; no primary experimental data reported.
  • Synthesizes published studies on AAV biology, packaging capacity limits, and dual/triple-vector strategies (fragmented/oversized, overlapping, trans-splicing, hybrid), including in vitro (e.g., HEK293, MO59K, C2C12) and in vivo (mouse models including mdx, mdx4cv, A/J, ABCA4−/−, sh1) comparisons.
  • Discusses mechanistic hypotheses (homologous recombination, ITR-mediated concatamerization, Rad51C-dependent repair) and design variables (recombinogenic sequences, splice donor/acceptor sites, ITR heterology).

Limitations

  • Stated by the paper: the literature on dual-vector efficacy is "broad and often conflicting"; the mechanism of transduction by fragmented and overlapping vectors is "as yet not fully understood"; efficiency of transgene expression from dual-vector systems has been inconsistent and is currently insufficient for many clinical applications; hybrid systems are not always the most efficient; and optimization must be done empirically per transgene and tissue.
  • Evident from the text: as a narrative review it provides no new experimental data, and several cited comparisons rely on different transgenes, serotypes, cell/tissue types, and titration methods, which the authors note can themselves influence results.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1089/hgtb.2015.140

Cites

77 of 77 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

35 No full text of the sources · 21 Supported · 18 Own interpretation · 14 Partly supported · 6 Supported so far · 3 No basis given · 2 Couldn’t confirm · 1 Not checked yet · accuracy not yet measured

Show all 71 claims

  • It may state two separate claims as one. 26
  • Probably not a substantial claim. 8
29 of 29

Citations

Cites

Research works printed but not linked: 2

  1. Hoggan MD, 1970, Prog Med Virol, 12, 211
  2. Wong FC, 1985, Can J Comp Med, 49, 50

Cited by

Sorted by citations

See all 141

Metadata

Authors
Chamberlain, K., Riyad, J. M., & Weber, T.
Affiliations
Icahn School of Medicine at Mount Sinai (US)
Corresponding author
Weber, Thomas
Venue
Human Gene Therapy Methods
Published
2016-02
Volume
27
Issue
1
Pages
1-12
ISSN
  • 1946-6536 (ISSN-L)
  • 1946-6544
OpenAlex
W2280525353
Cited by
141
References
74
Citations by year
2026: 10 · 2025: 10 · 2024: 8 · 2023: 13 · 2022: 17 · 2021: 22 · 2020: 20 · 2019: 12 · 2018: 13 · 2017: 12 · 2016: 4
FWCI
1.83
Type
journal article
Language
en
Open access
Locations
  • Human Gene Therapy Methods (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Fondation Leducq (14CVD03)
  • National Institutes of Health (HL112324)
  • National Heart, Lung, and Blood Institute (P50HL 112324, HL117505, R01HL117505, HL112324)
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
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Viral Infectious Diseases and Gene Expression in Insects
Keywords
recombinant adeno-associated virus vectors, co-infection, transgene expression, gene therapy vectors, transduction efficiency
MeSH terms
Dependovirus, Animals, DNA, Viral, Genetic Vectors, Humans, Genetic Therapy, Gene Expression, Genome, Viral, Gene Transfer Techniques, Virus Assembly, Transgenes, Capsid Proteins, Genome Size

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