Safety and Tolerability of Magnetic Resonance Imaging-Guided Convection-Enhanced Delivery of AAV2-hAADC with a Novel Delivery Platform in Nonhuman Primate Striatum

Sebastián, Waldy San; Richardson, R. Mark; Kells, Adrian P.; Lamarre, Clementine; Bringas, John; Pivirotto, Philip; Salegio, Ernesto A.; DeArmond, Stephen J.; Forsayeth, John; Bankiewicz, Krystof S.

doi:10.1089/hum.2011.162

Cited by 45 publications

(25 citation statements)

References 33 publications

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“…In our LINCL trial we administered vector exclusively to the white matter underlying the cortex, using small-bore catheters directed to predetermined locations with guide needles, with two injection levels through each of six symmetrically located burr holes. We compared delivery to the white matter with delivery to alternative locations chosen on the basis of well-described connected afferent and efferent neuronal pathways (Gould, 2013), and assessed the impact of gradually ramping up the infusion speed by convection-enhanced delivery to these alternative locations (Krauze et al, 2005;Sebastian et al, 2012). In addition to direct cerebral delivery, we assessed intraventricular delivery of AAV, a method commonly used for drug delivery, and a nonsurgical route, in which the cerebral vasculature is used to deliver the vector via the intraarterial route with mannitol to assist in translocating the vector across the bloodbrain barrier.…”

Section: Aav Vector Direct Cns Therapy Of Mldmentioning

confidence: 99%

Comparative Efficacy and Safety of Multiple Routes of Direct CNS Administration of Adeno-Associated Virus Gene Transfer Vector Serotype rh.10 Expressing the Human Arylsulfatase A cDNA to Nonhuman Primates

Rosenberg

Sondhi

Rubin

et al. 2014

Human Gene Therapy Clinical Development

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Metachromatic leukodystrophy (MLD), a fatal disorder caused by deficiency of the lysosomal enzyme arylsulfatase A (ARSA), is associated with an accumulation of sulfatides, causing widespread demyelination in both central and peripheral nervous systems. On the basis of prior studies demonstrating that adeno-associated virus AAVrh.10 can mediate widespread distribution in the CNS of a secreted lysosomal transgene, and as a prelude to human trials, we comparatively assessed the optimal CNS delivery route of an AAVrh.10 vector encoding human ARSA in a large animal model for broadest distribution of ARSA enzyme. Five routes were tested (each total dose, 1.5 · 10 12 genome copies of AAVrh.10hARSA-FLAG): (1) delivery to white matter centrum ovale; (2) deep gray matter delivery (putamen, thalamus, and caudate) plus overlying white matter; (3) convection-enhanced delivery to same deep gray matter locations; (4) lateral cerebral ventricle; and (5) intraarterial delivery with hyperosmotic mannitol to the middle cerebral artery. After 13 weeks, the distribution of ARSA activity subsequent to each of the three direct intraparenchymal administration routes was significantly higher than in phosphate-buffered saline-administered controls, but administration by the intraventricular and intraarterial routes failed to demonstrate measurable levels above controls. Immunohistochemical staining in the cortex, white matter, deep gray matter of the striatum, thalamus, choroid plexus, and spinal cord dorsal root ganglions confirmed these results. Of the five routes studied, administration to the white matter generated the broadest distribution of ARSA, with 80% of the brain displaying more than a therapeutic (10%) increase in ARSA activity above PBS controls. No significant toxicity was observed with any delivery route as measured by safety parameters, although some inflammatory changes were seen by histopathology. We conclude that AAVrh.10-mediated delivery of ARSA via CNS administration into the white matter is likely to be safe and yields the widest distribution of ARSA, making it the most suitable route of vector delivery.

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Section: Aav Vector Direct Cns Therapy Of Mldmentioning

confidence: 99%

Comparative Efficacy and Safety of Multiple Routes of Direct CNS Administration of Adeno-Associated Virus Gene Transfer Vector Serotype rh.10 Expressing the Human Arylsulfatase A cDNA to Nonhuman Primates

Rosenberg

Sondhi

Rubin

et al. 2014

Human Gene Therapy Clinical Development

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“…CED combined with Intraoperative Magnetic Resonance Imaging (IMRI) increases targeting accuracy and allows monitoring of the infusion cloud [3–5]. These new technologies are particularly attractive for intracerebral gene therapy, as its efficacy and safety depends on appropriate vector distribution and, ultimately, gene expression.…”

Section: Introductionmentioning

confidence: 99%

Titer and Product Affect the Distribution of Gene Expression after Intraputaminal Convection-Enhanced Delivery

Emborg¹,

Hurley

Joers³

et al. 2014

Stereotact Funct Neurosurg

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Background: The efficacy and safety of intracerebral gene therapy for brain disorders like Parkinson's disease depends on the appropriate distribution of gene expression. Objectives: To assess whether the distribution of gene expression is affected by vector titer and protein type. Methods: Four adult macaque monkeys seronegative for adeno-associated virus 5 (AAV5) received a 30-µl inoculation of a high- or a low-titer suspension of AAV5 encoding glial cell line-derived neurotrophic factor (GDNF) or green fluorescent protein (GFP) in the right and left ventral postcommissural putamen. The inoculations were conducted using convection-enhanced delivery and intraoperative MRI (IMRI). Results: IMRI confirmed targeting and infusion cloud irradiation from the catheter tip into the surrounding area. A postmortem analysis 6 weeks after surgery revealed GFP and GDNF expression ipsilateral to the injection site that had a titer-dependent distribution. GFP and GDNF expression was also observed in fibers in the substantia nigra (SN) pars reticulata (pr), demonstrating anterograde transport. Few GFP-positive neurons were present in the SN pars compacta (pc), possibly by direct retrograde transport of the vector. GDNF was present in many neurons of the SNpc and SNpr. Conclusions: After controlling for target and infusate volume, the intracerebral distribution of the gene product was affected by the vector titer and product biology.

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“…24 A connected thresholding technique for growing a region of interest (ROI) was used to determine Vd. 29 T1-weighted sequences were used for calculating Vd by placing a seed voxel within the infused region near the catheter tip and growing the region of infusion based on a specified threshold. Specifically, the seed voxel was placed after identifying the local maximum intensity voxels, and the ROI was grown to include the entire contrast-enhancing region by modulating the interval threshold.…”

Section: Methodsmentioning

confidence: 99%

Magnetic resonance imaging properties of convective delivery in diffuse intrinsic pontine gliomas

Chittiboina

Heiss

Warren

et al. 2014

PED

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Object Coinfused surrogate imaging tracers can provide direct insight into the properties of convection-enhanced delivery (CED) in the nervous system. To better understand the distributive properties of CED in a clinical circumstance, the authors analyzed the imaging findings in pediatric diffuse intrinsic pontine glioma (DIPG) patients undergoing coinfusion of Gd-DTPA and interleukin-13–Pseudomonas exotoxin (IL13-PE). Methods Consecutive patients undergoing CED (maximal rates of 5 or 10 μl/minute) of Gd-DTPA (1 or 5 mM) and IL13-PE (0.125 μg/ml or 0.25 μg/ml) for DIPG were included. Real-time MRI was performed during infusions, and imaging results were analyzed. Results Four patients (2 males, 2 females; mean age at initial infusion 13.0 ± 5.3 years; range 5–17 years) underwent 5 infusions into DIPGs. Brainstem infusions were clearly identified on T1-weighted MR images at 1-mM (1 infusion) and 5-mM (4 infusions) coinfused Gd-DTPA concentrations. While the volume of distribution (Vd) increased progressively with volume of infusion (Vi) (mean volume 2.5 ± 0.9 ml; range 1.1–3.7 ml), final Vd:Vi ratios were significantly reduced with lower Gd-DTPA concentration (Vd:Vi for 1 mM of 1.6 compared with a mean Vd:Vi ratio for 5 mM of 3.3 ± 1.0) (p = 0.04). Similarly, anatomical distribution patterns were affected by preferential flow along parallel axial fiber tracts, into prior infusion cannula tracts and intraparenchymal air pockets, and leak back around the infusion cannula at the highest rate of infusion. Conclusions Magnetic resonance imaging of a coinfused Gd-DTPA surrogate tracer provided direct insight into the properties of CED in a clinical application. While clinically relevant Vds can be achieved by convective delivery, specific tissue properties can affect distribution volume and pattern, including Gd-DTPA concentration, preferential flow patterns, and infusion rate. Understanding of these properties of CED can enhance its clinical application. Part of clinical trial no. NCT00880061 (ClinicalTrials.gov).

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Safety and Tolerability of Magnetic Resonance Imaging-Guided Convection-Enhanced Delivery of AAV2-hAADC with a Novel Delivery Platform in Nonhuman Primate Striatum

Cited by 45 publications

References 33 publications

Comparative Efficacy and Safety of Multiple Routes of Direct CNS Administration of Adeno-Associated Virus Gene Transfer Vector Serotype rh.10 Expressing the Human Arylsulfatase A cDNA to Nonhuman Primates

Comparative Efficacy and Safety of Multiple Routes of Direct CNS Administration of Adeno-Associated Virus Gene Transfer Vector Serotype rh.10 Expressing the Human Arylsulfatase A cDNA to Nonhuman Primates

Titer and Product Affect the Distribution of Gene Expression after Intraputaminal Convection-Enhanced Delivery

Magnetic resonance imaging properties of convective delivery in diffuse intrinsic pontine gliomas

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