“…16,41 Although it is recognized that GAA expressed from the desmin promoter would similarly be unable to cross the blood-brain barrier, evidence of crossing the blood-brain barrier by AAV9 would confer cell autonomous correction of the CNS. 59,76 Building on success with AAV9-DES-GAA to attenuate functional decline of cardiac, respiratory, and skeletal muscle pathology in Pompe disease, we have applied a new paradigm to address both the immunological and neuromuscular complications using a copackaged, dual-AAV9 vector system that addresses the multisystem disease progression simultaneous with overcoming immune-related complications, which is likely to have the most persistent therapeutic benefit and increase survival rates. 11,37,46,47 The induction of immune tolerance enhances the success of gene therapy.…”