Thrombocytopenia has been consistently reported following the administration of adenoviral gene transfer vectors. The mechanism underlying this phenomenon is currently unknown. In this study, we have assessed the influence of von Willebrand Factor (VWF) and P-selectin on the clearance of platelets following adenovirus administration. In mice, thrombocytopenia occurs between 5 and 24 hours after adenovirus delivery. The virus activates platelets and induces platelet-leukocyte aggregate formation. There is an associated increase in platelet and leukocyte-derived microparticles. Adenovirus-induced endothelial cell activation was shown by VCAM-1 expression on virus-treated, cultured endothelial cells and by the release of ultra-large molecular weight multimers of VWF within 1 to 2 hours of virus administration with an accompanying elevation of endothelial microparticles. In contrast, VWF knockout (KO) mice did not show significant thrombocytopenia after adenovirus administration. We have also shown that adenovirus interferes with adhesion of platelets to a fibronectincoated surface and flow cytometry revealed the presence of the Coxsackie adenovirus receptor on the platelet surface. We conclude that VWF and P-selectin are critically involved in a complex platelet-leukocyteendothelial interplay, resulting in platelet activation and accelerated platelet clearance following adenovirus administration. IntroductionAcute thrombocytopenia has been consistently reported following intravenous administration of adenovirus. [1][2][3] Thrombocytopenia is transient and vector dose-dependent but the mechanism underlying this adverse event currently remains unclear.P-selectin is a member of the selectin family of cell adhesion molecules that mediate binding to specific carbohydrate-containing ligands. The protein is localized in the ␣ granules of platelets and the Weibel-Palade bodies of endothelial cells. 4,5 The most clearly identified ligand for P-selectin is PSGL-1, which is detected on the majority of leukocytes and also present in small amounts on platelets. 6,7 P-selectin supports initial tethering of leukocytes to activated endothelial cells and to activated platelets and mediates leukocyte rolling on the endothelial cell surface. 8 A soluble form of P-selectin resulting from proteolytic shedding of the extracellular domain has been detected in human 9 and mouse 10 plasma and was found to maintain the requirements for ligand binding. 11 Elevated levels of plasma P-selectin are seen in a variety of inflammatory, autoimmune, and thrombotic disorders. 12,13 A critical step in the response to vascular injury is the interaction between platelets and the adhesive protein von Willebrand factor (VWF), which mediates platelet translocation and adhesion to the exposed subendothelium. 14 VWF binding to platelets is mediated through platelet GPIb and this interaction acts as a complementary binding event to the tethering of leukocytes to platelets through a Mac1-P-selectin interaction. 15 Furthermore, activation of the endothelium is...

IntroductionHemophilia A, a congenital deficiency or dysfunction of factor VIII (FVIII), is the most common severe inherited bleeding disorder in humans. Severe hemophilia A patients have less than 1% of normal FVIII activity, and suffer from spontaneous or traumatic joint and muscle hemorrhage, leading to a chronic painful and disabling arthropathy. Bleeding into body cavities or the brain can result in significant morbidity and mortality if not treated aggressively. 1 Current treatment in the developed world, FVIII protein replacement, has established that restoring circulating FVIII levels above 1% of normal prevents most spontaneous bleeding, and levels above 5% are sufficient to improve the disease from a severe to a mild form. However, the limited worldwide supplies of both plasma-derived and recombinant FVIII, its short half-life in vivo (ϳ 12 hours), and the high cost of treatment (Ͼ $150 000 per year) make gene therapy an attractive alternative to better manage and cure the disease.Previously, we have shown that gene therapy with an AAV2 vector encoding a B-domain-deleted (BDD) canine FVIII (cFVIII) cDNA under the control of a liver-specific promoter resulted in an average of 2% to 3% of normal canine FVIII activity in 2 hemophilia A dogs, 2 providing preliminary support for the feasibility of this approach in humans. In order to further improve the efficacy of liver-targeted AAV-cFVIII, we explored the possibility of using alternative serotypes of AAV. We also assessed the duration of therapeutic benefit following a single injection of AAV-cFVIII in hemophilia A dogs.Since the isolation of AAV2, many different AAV serotypes have been isolated from human and nonhuman primate tissues. 3 In comparison with the prototypic AAV2, AAV vectors pseudotyped with other serotypes show superior transduction efficiency in various tissues: AAV1 in muscle, 4 pancreatic islets, 5 heart, 6 vascular endothelium, 7 brain and central nervous system (CNS), 8,9 and liver 10 ; AAV3 in Cochlear inner hair cells 11 ; AAV4 in brain 12 ; AAV5 in brain and CNS, 8,13 lung, 14-16 eye, 17,18 arthritic joints, 19 and liver 20 ; AAV6 in muscle, 21,22 heart, 23 and airway epithelium 24 ; AAV7 in muscle 4 ; and AAV8 in muscle, 4,25 pancreas, 26 heart, 25 and liver. [27][28][29][30][31] The tissue tropism of different AAV serotypes may permit targeting of AAV vectors to human disease. However, as most of these tissue-specific tropisms have been reported in the rodent, it is important to evaluate cross-species fidelity of differential targeting among serotypes in larger animal modelsIn this report, we have compared the efficacy, gene transfer efficiency, and biodistribution of AAV-cFVIII vectors of serotypes 2, 5, 6, and 8 delivered by portal-vein injection in hemophilia A mice. Furthermore, since prior studies have demonstrated that the hemophilia dog model, compared with the mouse model, more accurately predicts the therapeutic outcomes in humans and other primates, 32,33 we have determined the long-term efficacy and safety of AAV2-cFVI...

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