As adeno-associated virus (AAV)-based gene therapies are being increasingly approved for use in humans, it is important that we understand vector-host interactions in detail. With the advances in genome-wide genetic screening tools, a clear picture of AAV-host interactions is beginning to emerge. Understanding these interactions can provide insights into the viral life cycle. Accordingly, novel strategies to circumvent the current limitations of AAV-based vectors may be explored. Here, we summarize our current understanding of the various stages in the journey of the vector from the cell surface to the nucleus and contextualize the roles of recently identified host factors.
AAV: A Defective Virus but Effective VectorGene delivery vectors derived from adeno-associated virus (AAV) are the most widely used vectors for in vivo gene therapy. AAV possesses features that are attractive for clinical gene therapy and can be readily vectorized in a controlled fashion. In this review, we focus on the mechanisms of cellular transduction (see Glossary) of these vectors. Herein, 'AAV' is used to refer to wild-type virus, whereas recombinant vectors derived from AAV are referred to as 'rAAV'. AAV, first discovered in adenovirus preparations over 50 years ago, is a helperdependent, single-stranded DNA virus of the parvovirus family [1,2]. AAV infection of a cell commences with the engagement of the viral capsid with cell-surface receptors. This is followed by its cellular internalization via multiple routes and subsequent sorting in the endosomal and Golgi compartments. AAV particles then escape into the cytoplasm where they accumulate around the perinuclear space and eventually enter the nucleus for genome release and replication.The AAV genome comprises coding sequences for rep (replication), cap (capsid), and aap [assembly-activating protein (AAP)] genes. The rep-encoded proteins are required for genome replication and packaging, while proteins that constitute the capsid are produced by the cap gene [3]. AAP is required for capsid assembly of certain serotypes [4]. The viral genome is flanked by inverted terminal repeats (ITRs), which are the only recognition sequence required for the encapsidation of the genome and act as an origin of genome replication. Replication of the virus and the production of viral progeny can occur only in the presence of helper functions provided by superinfection with other viruses such as adenovirus or herpes virus. In the absence of helper functions, latency can be established. rAAVs are generated by replacing the entire viral genome except ITRs with the desired genetic payload. The genetic payload is flanked by ITRs, which is essential for genome encapsidation and subsequent vector production [5]. Early observations that an excess of 100 000 rAAV particles can be produced per cell indicated the nonpathogenic nature of the vector and its possible use for gene therapy. This spurred decades of research, which have brought this helperdependent virus to the center of the field of gene therapy [6]. r...