U.S. patent application number 17/222500 was filed with the patent office on 2022-03-24 for methods and pharmaceutical compositions for the treatment and the prevention of cardiomyopathy due to energy failure.
The applicant listed for this patent is Assistance Publique-Hopitaux de Paris (APHP), Centre National de la Recherche Scientifique (CNRS), Cornell University, Institut National De La Sante Et De La Recherche Medicale (INSERM), UNIVERSITE DE STRASBOURG, Universite Paris-Sud XI. Invention is credited to Patrick AUBOURG, Pierre BOUGNERES, Ronald G. CRYSTAL, Helene Monique PUCCIO.
Application Number | 20220090128 17/222500 |
Document ID | / |
Family ID | |
Filed Date | 2022-03-24 |
United States Patent
Application |
20220090128 |
Kind Code |
A1 |
PUCCIO; Helene Monique ; et
al. |
March 24, 2022 |
METHODS AND PHARMACEUTICAL COMPOSITIONS FOR THE TREATMENT AND THE
PREVENTION OF CARDIOMYOPATHY DUE TO ENERGY FAILURE
Abstract
A method for preventing or treating cardiomyopathy due to energy
failure in a subject in need thereof is provided. The method
comprises administering to the subject a therapeutically effective
amount of a vector which comprises a nucleic acid sequence encoding
a gene that can reverse energy failure. An exemplary cardiomyopathy
is that which is associated with Friedreich ataxia and an exemplary
nucleic acid sequence comprises a nucleic acid that encodes
frataxin (FXN).
Inventors: |
PUCCIO; Helene Monique;
(Illkirch, FR) ; AUBOURG; Patrick; (Le
Kremlin-Bicetre, FR) ; CRYSTAL; Ronald G.; (New York,
NY) ; BOUGNERES; Pierre; (Le Kremlin-Bicetre,
FR) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Institut National De La Sante Et De La Recherche Medicale
(INSERM)
Centre National de la Recherche Scientifique (CNRS)
UNIVERSITE DE STRASBOURG
Cornell University
Universite Paris-Sud XI
Assistance Publique-Hopitaux de Paris (APHP) |
Paris
Paris
Strasbourg
Ithaca
Orsay
Paris |
NY |
FR
FR
FR
US
FR
FR |
|
|
Appl. No.: |
17/222500 |
Filed: |
April 5, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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16411997 |
May 14, 2019 |
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17222500 |
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14718696 |
May 21, 2015 |
10337027 |
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16411997 |
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13756651 |
Feb 1, 2013 |
9066966 |
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14718696 |
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International
Class: |
C12N 15/86 20060101
C12N015/86; A61K 31/7088 20060101 A61K031/7088; A61K 38/44 20060101
A61K038/44; C12N 7/00 20060101 C12N007/00; A61K 9/00 20060101
A61K009/00; A61K 48/00 20060101 A61K048/00; C07K 14/47 20060101
C07K014/47 |
Claims
1. A method for preventing or treating cardiomyopathy due to energy
failure in a subject in need thereof, comprising administering to
said subject a therapeutically effective amount of a vector which
comprises a nucleic acid sequence of a gene that can reverse energy
failure.
2. The method according to claim 1 wherein the cardiomyopathy due
to energy failure is a cardiomyopathy associated with Friedreich
ataxia and the gene that can reverse energy failure is a frataxin
(FXN) encoding nucleic acid.
3. The method according to claim 2, wherein said FXN encoding
nucleic acid encodes for an amino acid sequence which is or
includes SEQ ID NO:2.
4. The method according to claim 1 wherein the vector of claim
comprises the nucleic acid sequence is or includes SEQ ID NO:1.
5. The method according to claim 1 wherein the vector is selected
from the group consisting of adenovirus, retrovirus, herpesvirus
and Adeno-Associated Virus (AAV) vectors.
6. The method according to claim 5 wherein the vector is an AAV
vector.
7. The method according to claim 6 wherein the AAV vector is an
AAV1, AAV2, AAV3, AAV4, AA5, AAV6, AAV7, AAV8, AAV9, AAVrh10 vector
or any AAV derived vector.
8. The method according to claim 7 wherein the AAV vector is an
AAVrh10 vector.
9. The method according to claim 1 wherein the vector is
administered intracoronary or directly into the myocardium of the
subject.
10. The method according to claim 1 wherein the vector is
administered by intravenous injection.
11. A pharmaceutical composition for preventing or treating
cardiomyopathy due to energy failure in a subject in need thereof,
comprising a therapeutically effective amount of a vector which
comprises a nucleic acid sequence of a gene that can reverse energy
failure.
12. The pharmaceutical composition according to claim 11 wherein
the cardiomyopathy due to energy failure is a cardiomyopathy
associated with Friedreich ataxia and the gene that can reverse
energy failure is the frataxin (FXN) encoding nucleic acid.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application is a Continuation of U.S. application Ser.
No. 16/411,997, filed May 14, 2019, which is a Continuation of U.S.
application Ser. No. 14/718,696 (now U.S. Pat. No. 10,337,027,
issued Jul. 2, 2019), filed May 21, 2015, which is a Continuation
of U.S. application Ser. No. 13/756,651 (now U.S. Pat. No.
9,066,966, issued Jun. 30, 2015), filed Feb. 1, 2013. The contents
of each of the above patent applications are incorporated herein by
reference in their entireties.
SUBMISSION OF SEQUENCE LISTING ON ASCII TEXT FILE
[0002] The contents of the text file named
"LEXE-001_C05US_SeqList.txt", which was created on Apr. 1, 2021 and
is 11.4 KB in size, are hereby incorporated by reference in their
entirety.
FIELD OF THE INVENTION
[0003] The present invention relates a method for preventing or
treating cardiomyopathy due to energy failure in a subject in need
thereof, comprising administering to said subject a therapeutically
effective amount of a vector which comprises a nucleic acid
sequence of a gene that can reverse energy failure.
[0004] More particularly, the invention relates to a method for
preventing or treating a cardiomyopathy associated with Friedreich
ataxia in a subject in need thereof, comprising administering to
said subject a therapeutically effective amount of a vector which
comprises a frataxin (FXN) encoding nucleic acid.
BACKGROUND OF THE INVENTION
[0005] Friedreich ataxia (FRDA), an autosomal progressive recessive
neurodegenerative disorder associated with cardiomyopathy, is
caused by reduced expression of the mitochondrial protein, frataxin
[V. Campuzano et al., 1996 and V. Campuzano et al., 1997]. The
cardiomyopathy associated with FRDA is hypertrophic. As the disease
progresses, there is a natural transition from hypertrophy to
dilation, with death of cardiomyocytes replaced by fibrotic tissue
leading to systolic and diastolic dysfunction [R. M. Payne et al.,
2012]. Impaired myocardial perfusion reserve index associated with
microvascular dysfunction and fibrosis occurs even prior to the
onset of overt cardiomyopathy. Consistent with impaired
mitochondrial respiratory chain function that leads to energy
deficit, phosphorus magnetic resonance spectroscopy shows reduced
ATP production in patient heart, which strongly correlates with the
degree of cardiac hypertrophy. Cardiac dysfunction, predisposing to
congestive heart failure and supraventricular arrhythmias, is the
primary mode of death in -60% of patients with FRDA.
[0006] Although the function of frataxin is still under
investigation, available evidence supports a role as an activator
of iron-sulfur (Fe--S) cluster biogenesis in mitochondria [C. L.
Tsai et al., 2010 and Schmucker et al., 2012]. In particular,
frataxin was recently shown to control iron delivery for de novo
Fe--S cluster biogenesis through activation of cysteine desulfurase
activity [Colin et al., 2013].
[0007] Fe--S clusters are essential prosthetic groups for many
proteins with a variety of functions and subcellular localizations.
Frataxin deficiency leads to impairment of Fe--S cluster-containing
proteins, altered cellular iron metabolism, mitochondrial
dysfunction and increased sensitivity to oxidative stress. Most
mitochondrial and biochemical defects identified in human patients
have been recapitulated in mouse models of FRDA [H. Puccio et al.,
2001 and Simon et al. et al., 2004], providing valuable models for
testing potential therapeutic interventions. Particularly, the MCK
conditional mouse model, with complete frataxin deletion in cardiac
and skeletal muscle, recapitulates the cardiomyopathy observed in
FRDA patients with a more rapidly progressive course [H. Puccio et
al., 2001 and H. Seznec et al., 2004]. Furthermore, the MCK mouse
demonstrated that hypertrophy and mitochondrial Fe--S cluster
protein defects precede mitochondrial iron accumulation and
increase sensitivity to oxidative stress.
[0008] To date, no treatment exists for stopping or slowing down
the cardiomyopathy of FRDA. Current therapeutic approaches in
clinical use or under evaluation are directed at alleviating
symptoms and maximizing quality of life [R. B. Wilson 2012]. Thus,
there is an important need for a novel therapeutic approach to
treat cardiomyopathy associated with Friedreich ataxia.
SUMMARY OF THE INVENTION
[0009] In the present invention, the therapeutic effect of an
AVVrh10 vector carrying a human frataxin cDNA on the cardiac
phenotype in a mammalian model of FRDA cardiomyopathy was
investigated. The results showed that delivery of a vector encoding
hFXN resulted in i) prevention of the development of disease
symptoms in asymptomatic individuals and ii) reversal of disease
symptoms in individuals who already exhibited cardiomyopathy,
mitochondrial dysfunction and the biochemical impairment associated
with frataxin deficiency.
[0010] More generally, the inventors show that by restoring an
essential mitochondrial function with the use of the
nuclear-encoded FXc gene, and thereby increasing the energy
production of the mitochondria, the myocardium function can be
restored and the interstitial cardiac fibrosis stopped. Considering
that inefficient energy utilization and increased energy demand by
the sarcomere have been suggested as a key consequence of many, if
not all, hypertrophic cardiomyopathy associated mutations (Sweeney
H L et al., 1998), the results demonstrate that the use of a gene
that can reverse energy failure is useful for preventing or
treating cardiomyopathy linked to or associated with energy
failure.
[0011] Thus, the invention relates to a method for preventing or
treating cardiomyopathy due to energy failure in a subject in need
thereof, comprising administering to said subject a therapeutically
effective amount of a vector which comprises a nucleic acid
sequence of a gene that can reverse energy failure.
[0012] More particularly, the invention relates to a method for
preventing or treating a cardiomyopathy associated with Friedreich
ataxia in a subject in need thereof, comprising administering to
said subject a therapeutically effective amount of a vector which
comprises a frataxin (FXN) encoding nucleic acid.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] FIG. 1 A, FIG. 1 B1, FIG. 1 B2, Administration of
AAVrh10.CAG-hXN vector at 3 weeks of age prevents the onset of
cardiac failure and rescues survival in pre-symptomatic MCK mice.
(FIG. 1 A) Survival rates of wild-type (black solid line), treated
(grey dotted line) and untreated (black dotted line) MCK mice.
n=9-10 for each group. 100% survival was observed for wild type and
treated mice up to 35 weeks and thus the two lines (i.e. the grey
dotted line and the black dotted line) are superimposed near the
top of the graph. (FIG. 1 B1 and FIG. 1 B2) Relative quantification
of atrial natriuretic peptide (ANP), brain natriuretic peptide
(BNP) and sarcoplasmic reticulum ATPase (Scrca2a) mRNA expressions
in heart at 8 and 35 weeks for wild-type (white), treated (grey)
and untreated (black) MCK mice; n=3-5 per group (*P<0.05;
***p>0.001). mRNA expression was normalized to 18S ribosomal RNA
and is presented as a fold change relative to wild-type values.
Data are represented as means.+-.SD.
[0014] FIG. 2 A1, FIG. 2 A2, FIG. 2 B, FIG. 2 C1, FIG. 2 C2, FIG. 2
D, Administration of AAVrh10.CAG-hXN vector at 7 weeks of age in
symptomatic MCK mire with severe cardiac failure reverses the
cardiac contractile dysfunction, Fe--S cluster proteins, and
cardiomyocyte and mitochondria) ultrastructure disorganization.
(FIG. 2 A1 and FIG. 2 A2) Longitudinal echocardiographic assessment
of the left ventricle macs (LVM, left) and the shortening fraction
(SF, right) for wild-type (back circles) mice, treated (light grey
squares) and untreated (grey triangle) MCK mice. Data are
represented as means.+-.SD. n=9-11 for each group. (FIG. 2 B)
Survival rates of wild-type mice (black solid line), treated (grey
dotted line) and untreated (black dotted line) MCK mice. n=9-11 for
each group. (FIG. 2 C1 and FIG. 2 C2) Relative quantification of
atrial natriuretc peptide (ANP), brain natriuretic peptide (BNP)
and sarcoplasmic reticulum Ca.sup.2+ ATPase (Serca2a) mRNA
expressions in heart at 8, 15 and 22 weeks for wild-type (white),
treated (grey) and untreated (black) MCK mice; n=3-5 per group and
per age (*P<0.05; **P<0.01; ns: statistically
non-significant), mRNA expression was normalized to 18S ribosomal
RNA and is presented as a fold change relative to wild-type values.
Data are represented as means.+-.SD. (FIG. 2 D) Biochemical
measurements of combined cytosolic and mitochondrial aconitases
(Aco) and succinate dehydrogenase (SDH, complex II) activities in
heart from wild-type (white) mice, treated (grey) and untreated
(black) MCK mice at 8, 15 and 22 weeks of age; n=3-6 per group and
per age (**P<0.01). Isocitrate dehydrogenase (IDH) activity was
used to normalized SDH and aconitase activities for total
mitochondrial content.
DETAILED DESCRIPTION OF THE INVENTION
Methods of the Invention
[0015] A first object of the invention relates to a method for
preventing or treating cardiomyopathy due to energy failure in a
subject in need thereof, comprising administering to said subject a
therapeutically effective amount of a vector which comprises a
nucleic acid sequence of a gene that can reverse energy
failure.
[0016] By "energy failure" we mean inadequate or abnormal energy
production by mitochondria, and/or lower than normal levels of ATP
production. The phrase "reverse energy failure" denotes that energy
failure is reversed and/or that energy metabolism is retuned or
restored to a normal, non-pathological state, or is at least
improved compared to the state or level that would be present if a
treatment were not administered. For example, a "reversal of energy
failure" may involve an increase in or restoration of mitochondrial
function as a result of providing a patient with a gene that can
reverse energy failure such as the exemplary FXN gene. In one
embodiment, the invention relates to a method for preventing or
treating cardiomyopathy due to energy failure in a subject in need
thereof, comprising administering to the subject a therapeutically
effective amount of a vector which comprises a nucleic acid
sequence of a gene that can reverse the pathological effects of
energy function, e.g. cardiomyopathy.
[0017] As used herein the term "cardiomyopathy due to energy
failure" denotes one or more of a deterioration of the function of
the myocardium leading to heart failure, cardiac remodelling,
long-term high blood pressure, heart valve problems, impaired
calcium cycling sensitivity, disturbed biochemical stress sensing,
altered energy homeostasis due but not limited to mitochondrial
dysfunction and fibrosis.
[0018] In a particular embodiment, the cardiomyopathy due to energy
failure may be one or more of a dilated cardiomyopathy, a
hypertrophic cardiomyopathy, a restrictive cardiomyopathy or an
ischemic cardiomyopathy.
[0019] In another particular embodiment, the cardiomyopathy due to
energy failure may be a cardiomyopathy due to a deficiency of fatty
oxidation, including but not limited to primary camitine
deficiency, long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD)
deficiency, translocase deficiency, and very long-chain acyl-CoA
dehydrogenase (VLCAD) deficiency.
[0020] In another particular embodiment, the cardiomyopathy due to
energy failure may be a cardiomyopathy associated with Friedreich
ataxia.
[0021] As used herein, the term "a gene that can reverse energy
failure" denotes a nuclear or mitochondrial gene that can reverse
energy failure and/or mitochondrial dysfunction.
[0022] In a particular embodiment, the gene that can reverse energy
failure may be a nuclear gene encoding a subunit of pyruvate
dehydrogenase complex, a nuclear or a mitochondrial gene coding for
a subunit of Complex I, III, IV or V involved in oxidative
phosphorylation; a mitochondrial gene encoding transfer RNA, a gene
involved in the biogenesis of mitochondria such as SIRT1, a gene
involved in the fusion of mitochondria such as OPA1, a gene
involved in the fission of mitochondria such as FIS1 or a gene
involved in the oxidation of fatty acid such as long-chain
3-hydroxyacyl-CoA dehydrogenase or very long-chain specific
acyl-CoA dehydrogenase.
[0023] In a particular embodiment, the gene that can reverse energy
failure is the frataxin (FXN) gene.
[0024] As used herein in its broadest meaning, the term
"preventing" or"prevention" refers to preventing the disease or
condition from occurring in a subject which has not yet been
diagnosed as having it. The subject may, however, be known to be
susceptible to developing the disease, e.g. may be known or
suspected of harbouring a genetic mutation that may lead to the
condition, even though overt clinical symptoms have not yet
appeared.
[0025] As used herein, the term "treating" or "treatment" means
reversing, alleviating, or inhibiting the progress of the disorder
or condition to which such term applies, or one or more symptoms of
such disorder or condition. A "therapeutically effective amount" is
intended for a minimal amount of active agent which is necessary to
impart therapeutic benefit to a subject. For example, a
"therapeutically effective amount" to a patient is such an amount
which induces, ameliorates, stabilises, slows down the progression
or otherwise causes an improvement in the pathological symptoms,
disease progression or physiological conditions associated with or
resistance to succumbing to a disorder.
[0026] As used herein, the term "gene" refers to a polynucleotide
containing at least one open reading frame that is capable of
encoding a particular polypeptide or protein after being
transcribed and translated.
[0027] As used herein, the terms "coding sequence". "a sequence
which encodes a particular protein" or "encoding nucleic acid",
denotes a nucleic acid sequence which is transcribed (in the case
of DNA) and translated (in the case of mRNA) into a polypeptide in
vitro or in vivo when placed under the control of (operably linked
to) appropriate regulatory sequences. The boundaries of the coding
sequence are determined by a start codon at the 5' (amino) terminus
and a translation stop codon at the 3' (carboxy) terminus. A coding
sequence can include, but is not limited to, cDNA from prokaryotic
or eukaryotic mRNA, genomic DNA sequences from prokaryotic or
eukaryotic DNA, and even synthetic DNA sequences.
[0028] In a particular embodiment, the invention relates to a
method for preventing or treating a cardiomyopathy associated with
Friedreich ataxia in a subject in need thereof, comprising
administering to said subject of a therapeutically effective amount
of a vector which comprises a frataxin (FXN) encoding nucleic
acid.
[0029] The FXN gene encodes the protein frataxin. Frataxin is a
protein localized to the mitochondrion and is involved in assembly
of iron-sulfur clusters by regulating iron entry and the activity
of cysteine desulfurase. A cDNA sequence for human FXN (transcript
variant 1) is disclosed in Genbank Access Number NM_000144 or NG
008845 (SEQ ID NO:1). The amino acid sequence of human frataxin is
shown in SEQ ID NO:2.
[0030] The sequence of the nucleic acid of the frataxin (cDNA)
is:
TABLE-US-00001 (SEQ ID NO: 1) agtctccctt gggtcagggg tcctggttgc
actccgtgct ttgcacaaag caggctctcc atttttgtta aatgcacgaa tagtgctaag
ctgggaagtt cttcctgagg tctaacctct agctgctccc ccacagaaga gtgcctgcgg
ccagtggcca ccaggggtcg ccgcagcacc cagcgctgga gggcggagcg ggcagcagac
ccggagcagc atgtggactc tcgggcgccg cgcagtagcc ggcctcctgg cgtcacccag
cccagcccag gcccagaccc tcacccgggt cccgcggccg gcagagttgg ccccactctg
cggccgccgt ggcctgcgca ccgacatcga tgcgacctgc acgccccgcc gcgcaagttc
gaaccaacgt ggcctcaacc agatttggaa tgtcaaaaag cagagtgtct atttgatgaa
tttgaggaaa tctggaactt tgggccaccc aggctctcta gatgagacca cctatgaaag
actagcagag gaaacgctgg actctttagc agagtttttt gaagaccttg cagacaaacc
atacacgttt gaggactatg atgtctcctt tgggagtggt gtcttaactg tcaaactggg
tggagatcta ggaacctatg tgatcaacaa gcagacgcca aacaagcaaa tctggctatc
ttctccatcc agtggaccta agcgttatga ctggactggg aaaaactggg tgtactccca
cgacggcgtg tccctccatg agctgctggc cgcagagctc actaaagcct taaaaaccaa
actggacttg tcttccttgg cctattccgg aaaagatgct tgatgccgag ccccgtttta
aggacattaa aagctatcag gccaagaccc cagcttcatt atgcagctga ggtctgtttt
ttgttgttgt tgttgtttat tttttttatt cctgcttttg aggacagttg ggctatgtgt
cacagctctg tagaaagaat gtgttgcctc ctaccttgcc cccaagttct gatttttaat
ttctatggaa gattttttgg attgtcggat ttcctccgtc acatgatacc ccttatcttt
tataatgtct tatgcctata cctgaatata acaaccttta aaaaagcaaa ataataagaa
ggaaaaattc caggagggaa aatgaattgt cttcactctt cattctttga aggatttact
gcaagaagta catgaagagc agctggtcaa cctgctcact gttctatctc caaatgagac
acattaaagg gtagcctaca aatgttttca ggcttctttc aaagtgtaag cacttctgag
ctctttagca ttgaagtgtc gaaagcaact cacacgggaa gatcatttct tatttgtgct
ctgtgactgc caaggtgtgg cctgcactgg gttgtccagg gagacctagt gctgtttctc
ccacatattc acatacgtgt ctgtgtgtat atatattttt tcaatttaaa ggttagtatg
gaatcagctg ctacaagaat gcaaaaaaat ttccaaagac aagaaaagag gaaaaaaagc
cgttttcatg agctgagtga tgtagcgtaa caaacaaaat catggagctg aggaggtgcc
ttgtaaacat gaaggggcag ataaaggaag gagatactca tgttgataaa gagagccctg
gtcctagaca tagttcagcc acaaagtagt tgtccctttg tggacaagtt tcccaaattc
cctggacctc tgcttcccca tctgttaaat gagagaatag agtatggttg attcccagca
ttcagtggtc ctgtcaagca acctaacag ctagttctaa ttccctattg ggtagatgag
gggatgacaa agaacagttt ttaagctata taggaaacat tgttattggt gttgccctat
cgtgatttca gttgaattca tgtgaaaata atagccatcc ttggcctggc gcggtggctc
acacctgtaa tcccagcact tttcgaggcc aaggtgggtg gatcacctga ggtcaggagt
tcaagaccag cctggccaac atgatgaaa cccgtctcta ctaaaaatac aaaaaattag
ccgggcatga tggcaggtgc ctgtaatccc agctacttgg gaggctgaag cggaagaatc
gcttgaaccc agaggtggag gttgcagtga gccgagatcg tgccattgca ctgtaacctg
ggtgactgag caaaactctg tctcaaaata ataataacaa tataataata ataatagcca
tcctttattg tacccttact gggttaatcg tattatacca cattacctca ttttaatttt
tactgacctg cactttatac aaagcaacaa gcctccagga cattaaaatt catgcaaagt
tatgctcatg ttatattatt ttcttactta aagaaggatt tattagtggc tgggcatggt
ggcgtgcacc tgtaatccca ggtactcagg aggctgagag gggagaattg cttgacccca
ggcggaggag gttacagtga gtcgagatcg tacctgagcg acagagcgag actccgtctc
aaaaaaaaaa aaaaggaggg tttattaatg agaagtttgt attaatatgt agcaaaggct
tttccaatgg gtgaataaaa acacattcca ttaagtcaag ctgggagcag tggcatatac
ctatagtccc agctgcacag gaggctgaga caggaggatt gcttgaagcc aggaattgga
gatcagcctg ggcaacacag caagatccta tctcttaaaa aaagaaaaaa aaacctatta
ataataaaac agtataaaca aaagctaaat aggtaaaata ttttttctga aataaaatta
ttttttgagt ctgatggaaa tgtttaagtg cagtaggcca gtgccagtga gaaaataaat
aacatcatac atgtttgtat gtgtttgcat cttgcttcta ctgaaagttt cagtgcaccc
cacttactta gaactcggtg acatgatgta ctcctttatc tgggacacag cacaaaagag
gtatgcagtg gggctgctct gacatgaaag tggaagttaa ggaatctggg ctcttatggg
gtccttgtgg gccagccctt caggcctatt ttactttcat tttacatata gctctaattg
gtttgattat ctcgttccca aggcagtggg agatccccat ttaaggaaag aaaaggggcc
tggcacagtg gctcatgcct gtaatcccag cactttggga ggctgaggca agtgtatcac
ctgaggtcag gagttcaaga ccagcctggc caacatggca aaatcccgtc tctactaaaa
atattaaaaa attggctggg cgtggtggtt cgtgcctata atttcagcta ctcaggaggc
tgaggcagga gaatcgctgt aacctggggg gtggaggttg cagtgagacg agatcatgcc
acttcactcc agcctggcca acagagcca actccgtctc aaataaataa ataaataaat
aaagggactt caaacacatg aacagcagcc aggggaagaa tcaaaatcat attctgtcaa
gcaaactgga aaagtaccac tgtgtgtacc aatagcctcc ccaccacaga ccctgggagc
atcgcctcat ttatggtgtg gtccagtcat ccatgtgaag gatgagtttc caggaaaagg
ttattaaata ttcactgtaa catactggag gaggtgagga attgcataat acaatcttag
aaaacttttt tttccccttt ctattttttg agacaggatc tcactttggc actcaggctg
gaggacagtg gtacaatcaa agctcatgac agcctcgacc tccctgggct tgggcaatcc
tcccacaggt gtgcacctcc atagctggct aatttgtgta ttttttgtag agatggggtt
tcaccatgtt gcccaggctg gtctctaaca cttaggctca agtgatccac ctgcctcgtc
ctcccaagat gctgggatta caggtgtgtg ccacaggtgt tcatcagaaa gctttttcta
ttatttttac cttcttgagt gggtagaacc tcagccacat agaaaataaa atattctggc
atgacttatt tagctctctg gaattacaaa gaaggaatga ggtgtgtaaa agagaacctg
ggtttttgaa tcacaaattt agaatttaat cgaaactctg cctcttactt gtttgtagac
actgacagtg gcctcatgtt tttttttttt ttaatctata aaatggagat atctaacatg
ttgagcctgg gcccacaggc aaagcacaat cctgatgtga gaagtactca gttcatgaca
actgttgttc tcacatgcat agcataattt catattcaca ttggaggact tctcccaaaa
tatggatgac gttccctact caaccttgaa cttaatcaaa atactcagtt tacttaactt
cgtattagat tctgattccc tggaaccatt tatcgtgtgc cttaccatgc ttatatttta
cttgatcttt tgcatacctt ctaaaactat tttagccaat ttaaaatttg acagtttgca
ttaaattata ggtttacaat atgctttatc cagctatacc tgccccaaat tctgacagat
gcttttgcca cctctaaagg aagacccatg ttcatagtga tggagtttgt gtggactaac
catgcaaggt tgccaaggaa aaatcgcttt acgcttccaa ggtacacact aagatgaaag
taattttagt ccgtgtccag ttggattctt ggcacatagt tatcttctgc tagaacaaac
taaaacagct acatgccagc aagggagaaa ggggaaggag gggcaaagtt ttgaaatttc
atgtaaattt atgctgttca aaacgacgag ttcatgactt tgtgtataga gtaagaaatg
ccttttcttt tttgagacag agtcttgctc tgtcacccag gctggagtgc agtggcacga
tctgggctca ctacaacctc cgcctcctgg gttcaagcaa ttctctgcct cagcctcccg
agtagctggg attacaggtg cctgccacca cacccggcta atttttgtat ttttagtaga
gacggggttt caccatcatg gccaggctgg tcttgaactc ctgacctagt aatccacctg
cctccgcctc ccaaagtgct gggattacag gcgtgagcca ctgcacccag ccagaaatgc
cttctaatct ttggtttatc ttaattagcc aggacacttg gagtgcatcc cgaagtacct
gatcagtggc ccctttggaa tgtgtaaaac tcagctcact tatatccctg catccgctac
agagacagaa tccaagctca tatgttccat cttctctggc tgtatagttt aaggaatgga
aggcaccaga acagatttat tgaaatgttt attagctgaa gatttattta gacagttgag
gaaaacatca gcacccagca gtaaaattgg ctctcaaaga ttttcttctc ctgtggaaag
tcagacctct gaggccccat ccaggtagaa gtactagtgc aagaagggcc tctgctgtcc
acttgtgttt ctatgatctg tgggaacatt gttaacgcca catcttgacc tcaaattgtt
tagctcctgg ccagacacgg tggctcacac ctgtaatccc agcactttga gaggctgagg
caggtggatc acctgaggtt aggagttcga ggccagcctg gtcaacatgg taaaaccccg
cctctactaa aaatacaaaa attagctggc cgtagtggcg cacgcctgtt atcccagcta
ctcgggaggc tgaggcagga gaattgcttg aacctgggtg gtggaggttg cagtgagccg
agattacacc actgcactcc agcctgggtg acaagaggga aactccatta aaaaaatgta
attcccgtgt ctgccatctt aagtgtaaag gtggctaaat tatatagaaa aataagacaa
tatcatttcc caattacatt cctttcctac cgcactctat gatgctagct gagatttttc
caaaagaaaa tggcttaaat aaaacccta gagaaagaaa aactttaaat ccctccaaag
ctcaaaagta atagaaacag atgagtttgg agtcaggatt tctctgtaag attgcctagg
ctgtgtactg cacatctcca ggtgccactg ttgacagaga ttataactac aatgtgaagt
gaatggtgcc actgacagtt atgcaaaccg tccagagcat agccacctga tcctgctggg
attcctcttg ccagtccatc agcagttccc cttgaaagtt tcaccaaaca tcccttaaat
ctgccctctc ctgcccgtcc ccagtggagg tcctcatcat ttttcacctg catttttgca
ggagctttct tatatccacc ttcctccttt tctctcagcc catcatctag ctacacagtc
tccagggtaa gctttcagaa aggcaatctc ttgtctgtaa aacctaagca ggaccaaggc
caagtttctt agcctgaaaa atgtgctttt ctgactgaac tgttcaggca ctgactctac
atataattat gcttttctac cccctcacac tcaacacttt gactccagca
atcccaaatc
cccagatccc taagtgtgct gtgctatttt cacgtggctc tcagacttgg ccagtgctgt
ttccattttg gtctttattc cccacatctc tgcctggggg gtagattcta ccctgaaaaa
tgttcttggc acagccttgc aaactcctcc tccactcagc ctctgcctgg atgcccttga
ttgttccatg tcctcagcat accatgtttg tctttcccag cactgaccta ccatgtgtca
cccctgcttg gctgtacctt ccatgaggct aggactatgt gtctcctttg ttgactgctg
ttgccctagc atcttgcaca gttccttgca cacaattaga gctctataaa tgtcaaataa
atgtgttata attatatgtt taagatagtt gttcaaataa actctaaata accccaac.
The sequence of the frataxin protein is (SEQ ID NO: 2):
MWTLGRRAVAGLLASPSPAQAQTLTRVPRPAELAPLCGRRGLRTDIDATCTPRRASS
NQRGLNQIWNVKKQSVYLMNLRKSGTLGHPGSLDETTYERLAEETLDSLAEFFEDLA
DKPYTFEDYDVSFGSGVLTVKLGGDLGTYVINKQTPNKQIWLSSPSSGPKRYDWTGK
NWVYSHDGVSLHELLAAELTKALKTKLDLSSLAYSGKDA.
[0031] In a particular embodiment, the invention provides a nucleic
acid construct comprising a sequence that is or includes SEQ ID
NO:1 or a variant thereof for treating cardiomyopathy associated
with Friedreich ataxia.
[0032] The variants include, for instance, naturally-occurring
variants due to allelic variations between individuals (e.g.,
polymorphisms), alternative splicing forms, in particular
transcript variants 2 and 3 (GenBank accession numbers NM-001161706
and NM_181425), etc. The term variant also includes FXN gene
sequences from other sources or organisms. Variants are preferably
substantially homologous to SEQ ID NO: 1, i.e., exhibit a
nucleotide sequence identity of typically at least about 75%,
preferably at least about 85%, more preferably at least about 90%,
more preferably at least about 95%, 96%, 97%, 98%, or 99% with SEQ
ID NO: 1. Variants of a FXN gene also include nucleic acid
sequences, which hybridize to a sequence as defined above (or a
complementary strand thereof) under stringent hybridization
conditions. Typical stringent hybridisation conditions include
temperatures above 30.degree. C., preferably above 35.degree. C.,
more preferably in excess of 42.degree. C., and/or salinity of less
than about 500 mM, preferably less than 200 mM. Hybridization
conditions may be adjusted by the skilled person by modifying the
temperature, salinity and/or the concentration of other reagents
such as SDS, SSC, etc.
[0033] In a particular embodiment, the variant may be a variant of
the SEQ ID NO:1 which encodes for the amino acid sequence 81-210 of
the SEQ ID NO:1 (named variant "81-210").
[0034] In a another particular embodiment, a sequence known as the
"mitochondrion-targeting signal" or "mitochondrial targeting
signal" may be added to a variant of the invention, for example to
the variant "81-210". Sequences known as "mitochondrion-targeting
signal" or "mitochondrial targeting signal" are referred to as MTS
by the skilled person.
[0035] A MTS sequence can be identified within a protein or nucleic
acid sequence by a person of ordinary skill in the art.
[0036] Most mitochondrion-targeting peptides consist of an
N-terminal pre-sequence of about 15 to 100 residues, preferably of
about 20 to 80 residues. They are enriched in arginine, leucine,
serine and alanine. Mitochondrial pre-sequences show a statistical
bias of positively charged amino acid residues, provided mostly
through arginine residues; very few sequences contain negatively
charged amino acids. Mitochondrion-targeting peptides also share an
ability to form an amphilic alpha-helix.
[0037] A complete description of a method to identify a MTS is
available in: M. G. Claros, P. Vincens, 1996 (Eur. J. Biochem. 241,
779-786 (1996), "Computational method to predict mitochondrially
imported proteins and their targeting sequences"), the complete
content of which is herein incorporated by reference.
[0038] In another embodiment, the invention relates to a method for
treating or preventing diseases associated with frataxin deficiency
in a subject in need therefore, comprising administering to said
subject a therapeutically effective amount of a vector which
comprises a nucleic acid encoding frataxin.
[0039] In another embodiment, the invention relates a method for
preventing or treating cardiomyopathy due but not limited to a
cause such as energy failure in a subject in need thereof,
comprising administering to said subject a therapeutically
effective amount of a vector which comprises a nucleic acid
sequence of a gene that can reverse energy failure.
[0040] In another particular embodiment, the invention relates a
method for preventing or treating cardiomyopathy due but not
limited to a cause such as energy failure in a subject in need
thereof, comprising administering to said subject a therapeutically
effective amount of a vector which comprises a frataxin (FXN)
encoding nucleic acid.
Non Viral Vectors
[0041] In a particular embodiment, the vector use according to the
invention is a non viral vector. Typically, the non viral vector
may be a plasmid which includes nucleic acid sequences encoding FXN
gene, or variants thereof, as described above.
The Viral Vectors
[0042] Gene delivery viral vectors useful in the practice of the
present invention can be constructed utilizing methodologies well
known in the art of molecular biology. Typically, viral vectors
carrying transgenes are assembled from polynucleotides encoding the
transgene, suitable regulatory elements and elements necessary for
production of viral proteins which mediate cell transduction.
[0043] The terms "gene transfer" or "gene delivery" refer to
methods or systems for reliably inserting foreign DNA into host
cells. Such methods can result in transient expression of
non-integrated transferred DNA, extrachromosomal replication and
expression of transferred replicons (e.g. episomes), or integration
of transferred genetic material into the genomic DNA of host
cells.
[0044] Examples of viral vector include but are not limited to
adenoviral, retroviral, lentiviral, herpesvirus and
adeno-associated virus (AAV) vectors.
[0045] Such recombinant viruses may be produced by techniques known
in the art, such as by transfecting packaging cells or by transient
transfection with helper plasmids or viruses. Typical examples of
virus packaging cells include but are not limited to PA317 cells,
PsiCRIP cells, GPenv+ cells, 293 cells, etc. Detailed protocols for
producing such replication-defective recombinant viruses may be
found for instance in WO95/14785, WO96/22378, U.S. Pat. Nos.
5,882,877, 6,013,516, 4,861,719, 5,278,056 and WO94/19478, the
complete contents of each of which is hereby incorporated by
reference.
[0046] In one embodiment, adeno-associated viral (AAV) vectors are
employed.
[0047] In other embodiments, the AAV vector is AAV1, AAV2, AAV3,
AAV4, AA5, AAV6, AAV7, AAV8, AAV9, AAVrh10 or any other serotypes
of AAV that can infect humans, monkeys or other species.
[0048] In an exemplary embodiment, the AAV vector is an
AAVrh10.
[0049] By an "AAV vector" is meant a vector derived from an
adeno-associated virus serotype, including without limitation,
AAV-1, AAV-2, AAV-3, AAV-4, AAV-5, AAV6, etc. AAV vectors can have
one or more of the AAV wild-type genes deleted in whole or part,
preferably the rep and/or cap genes, but retain functional flanking
inverted terminal repeat (ITR) sequences. Functional ITR sequences
are necessary for the rescue, replication and packaging of the AAV
virion. Thus, an AAV vector is defined herein to include at least
those sequences required in cis for replication and packaging (e.
g., functional ITRs) of the virus. The ITRs need not be the
wild-type nucleotide sequences, and may be altered, e. g by the
insertion, deletion or substitution of nucleotides, as long as the
sequences provide for functional rescue, replication and packaging.
AAV expression vectors are constructed using known techniques to at
least provide as operatively linked components in the direction of
transcription, control elements including a transcriptional
initiation region, the DNA of interest (i.e. the FXN gene) and a
transcriptional termination region.
[0050] The control elements are selected to be functional in a
mammalian cell. The resulting construct which contains the
operatively linked components is bounded (5' and 3') with
functional AAV ITR sequences. By "adeno-associated virus inverted
terminal repeats" or "AAVITRs" is meant the art-recognized regions
found at each end of the AAV genome which function together in cis
as origins of DNA replication and as packaging signals for the
virus. AAV ITRs, together with the AAV rep coding region, provide
for the efficient excision and rescue from, and integration of a
nucleotide sequence interposed between two flanking ITRs into a
mammalian cell genome. The nucleotide sequences of AAV ITR regions
are known. See, e.g., Kotin, 1994; Berns, KI "Parvoviridae and
their Replication" in Fundamental Virology, 2nd Edition, (B. N.
Fields and D. M. Knipe, eds., the complete contents of which is
hereby incorporated by reference) for the AAV-2 sequence. As used
herein, an "AAV ITR" does not necessarily comprise the wild-type
nucleotide sequence, but may be altered, e.g., by the insertion,
deletion or substitution of nucleotides. Additionally, the AAV ITR
may be derived from any of several AAV serotypes, including without
limitation, AAV-1, AAV-2, AAV-3, AAV-4, AAV-5, AAV-6, etc.
Furthermore, 5' and 3' ITRs which flank a selected nucleotide
sequence in an AAV vector need not necessarily be identical or
derived from the same AAV serotype or isolate, so long as they
function as intended, i.e., to allow for excision and rescue of the
sequence of interest from a host cell genome or vector, and to
allow integration of the heterologous sequence into the recipient
cell genome when AAV Rep gene products are present in the cell.
Additionally, AAV ITRs may be derived from any of several AAV
serotypes, including without limitation, AAV-1, AAV-2, AAV-3.
AAV-4, AAV 5, AAV-6, etc. Furthermore, 5' and 3' ITRs which flank a
selected nucleotide sequence in an AAV expression vector need not
necessarily be identical or derived from the same AAV serotype or
isolate, so long as they function as intended, i. e., to allow for
excision and rescue of the sequence of interest from a host cell
genome or vector, and to allow integration of the DNA molecule into
the recipient cell genome when AAV Rep gene products are present in
the cell.
[0051] Particularly preferred are vectors derived from AAV
serotypes having tropism for and high transduction efficiencies in
cells of the mammalian myocardium, particularly cardiomyocytes and
cardiomyocyte progenitors. A review and comparison of transduction
efficiencies of different serotypes is provided in Cearley C N et
al., Molecular Therapy 16(10); 1710-1718, 2008, the complete
contents of which is hereby incorporated by reference. In other
non-limiting examples, preferred vectors include vectors derived
from any serotypes like AAV1, AAV2, AAV3, AAV4, AA5, AAV6, AAV7,
AAVB, AAV9, or AAVrh10, which have also been shown to transduce
cells of cardiomyocytes.
[0052] The selected nucleotide sequence is operably linked to
control elements that direct the transcription or expression
thereof in the subject in vivo. Such control elements can comprise
control sequences normally associated with the selected gene.
[0053] Alternatively, heterologous control sequences can be
employed. Useful heterologous control sequences generally include
those derived from sequences encoding mammalian or viral genes.
Examples include, but are not limited to, the phophoglycerate
kinase (PKG) promoter, CAG (chicken beta-actin promoter with CMV
enhancer) promoter, MCK (muscle creatine kinase) promoter, the SV40
early promoter, mouse mammary tumor virus LTR promoter; adenovirus
major late promoter (Ad MLP); a herpes simplex virus (HSV)
promoter, a cytomegalovirus (CMV) promoter such as the CMV
immediate early promoter region (CMVIE), rous sarcoma virus (RSV)
promoter, synthetic promoters, hybrid promoters, and the like. The
promoters can be of human origin or from other species, including
from mice. In addition, sequences derived from nonviral genes, such
as the murine metallothionein gene, will also find use herein. Such
promoter sequences are commercially available from, e. g.
Stratagene (San Diego, Calif.).
[0054] Examples of heterologous promoters include but are not
limited to the CMV promoter.
[0055] Examples of inducible promoters include but are not limited
to DNA responsive elements for ecdysone, tetracycline, and hypoxia
andaufin.
[0056] The AAV expression vector which harbors the DNA molecule of
interest bounded by AAV ITRs, can be constructed by directly
inserting the selected sequence (s) into an AAV genome which has
had the major AAV open reading frames ("ORFs") excised therefrom.
Other portions of the AAV genome can also be deleted, so long as a
sufficient portion of the ITRs remain to allow for replication and
packaging functions. Such constructs can be designed using
techniques well known in the art. See, e. g. U. S. Pat. Nos.
5,173,414 and 5,139,941; International Publications Nos. WO
92/01070 (published 23 Jan. 1992) and WO 93/103769 (published 4
Mar. 1993); Lebkowski et al., 1988; Vincent et al., 1990; Carter,
1992; Muzyczka, 1992; Kotin, 1994; Shelling and Smith, 1994; and
Zhou et al., 1994, the complete contents of each of which is hereby
incorporated by reference. Alternatively, AAV ITRs can be excised
from the viral genome or from an AAV vector containing the same and
fused 5' and 3' of a selected nucleic acid construct that is
present in another vector using standard ligation techniques. AAV
vectors which contain ITRs have been described in, e. g. U.S. Pat.
No. 5,139,941, the complete contents of which is hereby
incorporated by reference. In particular, several AAV vectors are
described therein which are available from the American Type
Culture Collection ("ATCC") under Accession Numbers 53222, 53223,
53224, 53225 and 53226. Additionally, chimeric genes can be
produced synthetically to include AAV ITR sequences arranged 5' and
3' of one or more selected nucleic acid sequences. Preferred codons
for expression of the chimeric gene sequence in mammalian CNS cells
can be used. The complete chimeric sequence is assembled from
overlapping oligonucleotides prepared by standard methods. See, e.
g., Edge Nature, vol. 292, 1981, page 756; Nambair et al., Science,
vol. 223, 1984, page 1299; Jay et al., J. Biol. Chem. vol. 259,
1984, page 6311, the complete contents of each of which is hereby
incorporated by reference. In order to produce AAV virions, an AAV
expression vector is introduced into a suitable host cell using
known techniques, such as by transfection. A number of transfection
techniques are generally known in the art. See, e. g. Graham et al,
Virology, 52, 456-467, (1973); Sambrook et al. (1989) Molecular
Cloning, a laboratory manual, Cold Spring Harbor Laboratories, New
York, Davis etal. (1986) Basic Methods in Molecular Biology,
Elsevier, and Chu et a). (1981) Gene 13:197. Particularly suitable
transfection methods include calcium phosphate co-precipitation
(Graham et al., 1973), direct microinjection into cultured cells
(Capecchi, 1980), electroporation (Shigekawa et al., 1988),
liposome mediated gene transfer (Mannino et al., 1988),
lipid-mediated transduction (Felgner et al., 1987, PNAS USA, 84,
21, 7413-17), and nucleic acid delivery using high-velocity
microprojectiles (Klein et al., 1987,m Endocrinology 120:2339-45).
The complete contents of each of the foregoing references are
hereby incorporated by reference in entirety.
[0057] For instance, a preferred viral vector, such as the AAVrh10,
comprises, in addition to a FXN encoding nucleic acid sequence, the
backbone of AAV vector with ITR derived from AAV-2, the promoter,
such as the mouse PGK (phosphoglycerate kinase) gene or the
cytomegalovirus/f-actin hybrid promoter (CAG) consisting of the
enhancer from the cytomegalovirus immediate gene, the promoter,
splice donor and intron from the chicken .beta.-actin gene, the
splice acceptor from rabbit .beta.-globin, or any promoter such as
PGK, CAG, MCK.
Delivery of the Vectors
[0058] It is herein provided a method for treating cardiomyopathy
due to energy failure in a subject, said method comprising:
[0059] (a) providing a vector as defined above, which comprises a
nucleic acid sequence of a gene that can reverse energy failure;
and
[0060] (b) delivering the vector to the subject in need thereof and
whereby the gene is expressed by the transduced cells at a
therapeutically effective level.
[0061] In a particular embodiment, a method for treating
cardiomyopathy associated with Friedreich ataxia in a subject is
herein provided, said method comprising:
[0062] (a) providing a vector as defined above, which comprises a
FXN encoding nucleic acid; and
[0063] (b) delivering the vector to the subject in need thereof and
whereby FXN is expressed by the transduced cells at a
therapeutically effective level.
[0064] In a particular method, the vector is delivered directly
into the myocardium by epicardiac injection followed by
minithoracotomy, by intracoronary injection, by endomyocardic
injection or by another type of injection useful in the heart.
[0065] Additional routes of administration may also comprise local
application of the vector under direct visualization, e.g.,
superficial cortical application, or other nonstereotactic
application. The vector may also be delivered, for example,
intrathecally, into the ventricules or by intravenous
injection.
[0066] The target cells of the vectors of the present invention are
cells of the myocardium of a subject afflicted with a
cardiomyopathy associated with Friedreich ataxia. Preferably the
subject is a human being, adult or child. However, veterinary
applications are also contemplated.
[0067] However the invention encompasses delivering the vector to
biological models of the disease. In that case, the biological
model may be any mammal at any stage of development at the time of
delivery, e.g., embryonic, fetal, infantile, juvenile or adult.
Furthermore, the target myocardium cells may be essentially from
any source, especially any cells derived from hiPS from FRDA
patients, nonhuman primates and mammals of the orders Rodenta
(mice, rats, rabbit, hamsters), Camivora (cats, dogs), and
Arteriodactyla (cows, pigs, sheep, goats, horses) as well as any
other non-human system (e. g. zebrafish model system).
[0068] The vectors used herein may be formulated in any suitable
vehicle for delivery. For instance they may be placed into a
pharmaceutically acceptable suspension, solution or emulsion.
Suitable mediums include saline and liposomal preparations. More
specifically, pharmaceutically acceptable carriers may include
sterile aqueous of non-aqueous solutions, suspensions, and
emulsions. Examples of non-aqueous solvents are propylene glycol,
polyethylene glycol, vegetable oils such as olive oil, and
injectable organic esters such as ethyl oleate. Aqueous carriers
include but are not limited to water, alcoholic/aqueous solutions,
emulsions or suspensions, including saline and buffered media.
Intravenous vehicles include fluid and nutrient replenishers,
electrolyte replenishers (such as those based on Ringer's
dextrose), and the like.
[0069] Preservatives and other additives may also be present such
as, for example, antimicrobials, antioxidants, chelating agents,
and inert gases and the like.
[0070] A colloidal dispersion system may also be used for targeted
gene delivery. Colloidal dispersion systems include macromolecule
complexes, nanocapsules, microspheres, beads, and lipid-based
systems including oil-in-water emulsions, micelles, mixed micelles,
and liposomes.
[0071] The preferred doses and regimen may be determined by a
physician, and depend on the age, sex, weight, of the subject, and
the stage of the disease. As an example, for delivery of a nucleic
acid sequence encoding an FXN polypeptide using a viral expression
vector, each unit dosage of FXN polypeptide expressing vector may
comprise 2.5 to 100 .mu.l of a composition including a viral
expression vector in a pharmaceutically acceptable fluid at a
concentration ranging from 10.sup.11 to 10.sup.16 viral genome per
ml, for example.
Pharmaceutical Composition
[0072] A second object of the invention concerns a pharmaceutical
composition for preventing or treating cardiomyopathy due to energy
failure in a subject in need thereof, which comprises a
therapeutically effective amount of a vector which comprises a
nucleic acid sequence of a gene that can reverse energy
failure.
[0073] In a particular embodiment, the invention concerns a
pharmaceutical composition for preventing or treating
cardiomyopathy associated with Friedreich ataxia in a subject in
need thereof, which comprises a therapeutically effective amount of
a vector which comprises a FXN encoding nucleic acid.
[0074] By a "therapeutically effective amount" is meant a
sufficient amount of the vector of the invention to treat a
cardiomyopathy associated with Friedreich ataxia at a reasonable
benefit/risk ratio applicable to any medical treatment.
[0075] It will be understood that the single dosage or the total
daily dosage of the compounds and compositions of the present
invention will be decided by the attending physician within the
scope of sound medical judgment. The specific therapeutically
effective dose level for any particular patient will depend upon a
variety of factors including the disorder being treated and the
severity of the disorder; activity of the specific compound
employed; the specific composition employed, the age, body weight,
general health, sex and diet of the patient; the time of
administration, route of administration, and rate of excretion of
the specific compound employed; the duration of the treatment;
drugs used in combination or coincidental with the specific nucleic
acid or polypeptide employed; and like factors well known in the
medical arts. For example, it is well within the skill of the art
to start doses of the compound at levels lower than those required
to achieve the desired therapeutic effect and to gradually increase
the dosage until the desired effect is achieved. However, the daily
dosage of the products may be varied over a wide range per adult
per day. The therapeutically effective amount of the vector
according to the invention that should be administered, as well as
the dosage for the treatment of a pathological condition with the
number of viral or non-viral particles and/or pharmaceutical
compositions of the invention, will depend on numerous factors,
including the age and condition of the patient, the severity of the
disturbance or disorder, the method and frequency of administration
and the particular peptide to be used.
[0076] The presentation of the pharmaceutical compositions that
contain the vector according to the invention may be in any form
that is suitable for the selected mode of administration, for
example, for intraventricular, intramyocardium, intracoronary or
intravenous administration.
[0077] In the pharmaceutical compositions of the present invention
for intramuscular, intravenous, intramyocardium, intracoronary or
intraventricular administration, the active principle, alone or in
combination with one or more other active principles, can be
administered in a unit administration form, as a mixture with
conventional pharmaceutical supports, to animals and human
beings.
[0078] Preferably, the pharmaceutical compositions contain vehicles
which are pharmaceutically acceptable for a formulation capable of
being injected. These may be in particular isotonic, sterile,
saline solutions (monosodium or disodium phosphate, sodium,
potassium, calcium or magnesium chloride and the like or mixtures
of such salts), or dry, especially freeze-dried compositions which
upon addition, depending on the case, of sterilized water or
physiological saline, permit the constitution of injectable
solutions.
[0079] The pharmaceutical forms suitable for injectable use include
sterile aqueous solutions or dispersions; formulations including
sesame oil, peanut oil or aqueous propylene glycol; and sterile
powders for the extemporaneous preparation of sterile injectable
solutions or dispersions. In all cases, the form must be sterile
and must be fluid. It must be stable under the conditions of
manufacture and storage and must be preserved against the
contaminating action of microorganisms, such as bacteria and
fungi.
[0080] Solutions comprising compounds of the invention as free base
or pharmacologically acceptable salts can be prepared in water
suitably mixed with a surfactant, such as hydroxypropylcellulose.
Dispersions can also be prepared in glycerol, liquid polyethylene
glycols, and mixtures thereof and in oils. Under ordinary
conditions of storage and use, these preparations contain a
preservative to prevent the growth of microorganisms.
[0081] The vector according to the invention can be formulated into
a composition in a neutral or salt form. Pharmaceutically
acceptable salts include the acid addition salts (formed with the
free amino groups of the protein) and which are formed with
inorganic acids such as, for example, hydrochloric or phosphoric
acids, or such organic acids as acetic, oxalic, tartaric, mandelic,
and the like. Salts formed with the free carboxyl groups can also
be derived from inorganic bases such as, for example, sodium,
potassium, ammonium, calcium, or ferric hydroxides, and such
organic bases as isopropylamine, trimethylamine, histidine,
procaine and the like.
[0082] The carrier can also be a solvent or dispersion medium
containing, for example, water, ethanol, polyol (for example,
glycerol, propylene glycol, and liquid polyethylene glycol, and the
like), suitable mixtures thereof, and vegetables oils. The proper
fluidity can be maintained, for example, by the use of a coating,
such as lecithin, by the maintenance of the required particle size
in the case of dispersion and by the use of surfactants. The
prevention of the action of microorganisms can be brought about by
various antibacterial and antifungal agents, for example, parabens,
chlorobutanol, phenol, sorbic acid, thimerosal, and the like. In
many cases, it will be preferable to include isotonic agents, for
example, sugars or sodium chloride. Prolonged absorption of the
injectable compositions can be brought about by the use in the
compositions of agents delaying absorption, for example, aluminium
monostearate and gelatin.
[0083] Sterile injectable solutions are prepared by incorporating
the active polypeptides in the required amount in the appropriate
solvent with several of the other ingredients enumerated above, as
required, followed by filtered sterilization. Generally,
dispersions are prepared by incorporating the various sterilized
active ingredients into a sterile vehicle which contains the basic
dispersion medium and the required other ingredients from those
enumerated above. In the case of sterile powders for the
preparation of sterile injectable solutions, the preferred methods
of preparation are vacuum-drying and freeze-drying techniques which
yield a powder of the active ingredient plus any additional desired
ingredient from a previously sterile-filtered solution thereof.
[0084] Upon formulation, solutions will be administered in a manner
compatible with the dosage formulation and in such amount as is
therapeutically effective. The formulations are easily administered
in a variety of dosage forms, such as the type of injectable
solutions described above, but drug release capsules and the like
can also be employed.
[0085] Multiple doses can also be administered.
[0086] In another embodiment, the invention relates to a
pharmaceutical composition for treating or preventing diseases
associated with frataxin deficiency in a subject in need therefore,
comprising administering to said subject a therapeutically
effective amount of a vector which comprises a nucleic acid
encoding frataxin.
[0087] The invention will be further illustrated by the following
figures and examples.
[0088] However, these examples and figures should not be
interpreted in any way as limiting the scope of the present
invention.
EXAMPLES
[0089] Material & Methods
[0090] Adeno-Associated Viral Vector Construction and
Production
[0091] Human frataxin (hFXN) cDNA, including the mitochondrial
targeting sequence, fused to a HA tag was subcloned in a pAAV2-CAG
plasmid (Sondhi, Hackett et al. 2007) to produce pAAV2-CAG-hFXN
that included the viral inverted terminal repeat (ITR) from AAV2;
the cytomegalovirus/.beta.-actin hybrid promoter, consisting of the
enhancer from the cytomegalo-virus immediate-early gene, the
promoter, splice donor, and intron from the chicken .beta.-actin
gene, and the splice acceptor from rabbit .beta.-globin. The
AAVrh10.CAG-hFXN-HA vector was produced as described earlier
(Rabinowitz, Rolling et al. 2002) in the Vector Core at the
University Hospital of Nantes
(http://www.vectors.nantes.inserm.fr). The final titers of the two
batches used were 5.4.times.10.sup.12 vg/ml and
2.15.times.10.sup.13 vg/ml, respectively.
Animal Procedures
[0092] Mice with a specific deletion of Fxn gene in cardiac and
skeletal muscle (MCK-Cre-FxnL3/L-) (MCK mice) in 100% C57BL6J
background were generated and genotyped as previously described
(Puccio, Simon et al. 2001). Mice were maintained in a temperature
and humidity controlled animal facility, with a 12 hours light/dark
cycle and free access to water and a standard rodent chow (D03,
SAFE, Villemoisson-sur-Orge, France). All animal procedures and
experiments were approved by the local ethical committee for Animal
Care and Use (Com'Eth 2011-07), and were performed in accordance
with the Guide for the Care and Use of Laboratory Animals (National
Institutes of Health). For biodistribution studies, three weeks old
wild-type mice were anesthetized by intraperitoneal injection of
ketamine/xylazine (75/10 mg/kg) to allow intravenous administration
by retro-orbital injection of AAVrh10.CAG-FXN at a dose of
510.sup.13 vg/kg, and sacrificed at 7 weeks of age (4 weeks
post-injection). For gene therapy studies, three or seven weeks old
MCK mice were anesthetized by intraperitoneal injection of
ketamine/xylazine (75/10 mg/kg or 608 mg/kg, respectively) to allow
intravenous administration by retro-orbital injection of
AAVrh10.CAG-FXN at a dose of 510.sup.13 vg/kg. Untreated MCK and WT
mice littermates were injected with equivalent volume of saline
solution. Survival was evaluated daily and mice weight weekly. The
mice cardiac function was evaluated under isofluorane anesthesia
(1-2%) by echocardiography by an experimenter blinded to mice
genotype and treatment regimen, as previously described (Seznec,
Simon et al. 2004). Animals were killed by CO.sub.2 inhalation at
8, 15, 22 or 35 weeks, and tissues samples for biochemical and
molecular analysis were immediately frozen in liquid nitrogen. For
histological analysis, mice were anesthetized by intraperitoneal
injection of ketamine/xylazine and perfused with cooled saline
solution. For histological analysis of dorsal root ganglia, spinal
cord and cardiac tissue was embedded in OCT Tissue Tek (Sakura
Finetechnical, Torrance, Calif.) and snap-frozen in isopentane
chilled in liquid nitrogen. Samples of skeletal muscles were
directly snap-frozen in isopentane chilled in liquid nitrogen. For
electron microscopy analysis, small samples from the middle of left
ventricle and its apex were collected, then fixed and embedded in
Epon as previously described (Puccio, Simon et al. 2001).
[0093] Histopathology, Enzyme Histochemistry and Electron
Microscopy
[0094] For histochemical analysis, 10 .mu.m cryosections were
stained either with hematoxylin and eosin (H&E), Sirius red and
Fast green to label extracellular collagen, or DAB enhanced Perls
to label iron (Fe3+) deposits (Puccio, Simon et al. 2001).
[0095] Sirius red and fast green staining: Tissue sections were
fixed with 10% paraformaldehyde in 0.1 M phosphate buffer (PBS), pH
7.4 for 10 min and then incubated with a saturated solution of
picric acid containing 0.1% Direct red 80 (Sigma) for 2 min, washed
with 0.5% glacial acetic acid solution followed by deionized water,
and subsequently incubated in 0.05% Fast Green solution for 5 min,
and then washed with 0.5% glacial acetic acid solution. Finally,
sections were dehydrated in graded alcohols, cleared in Histosol
Plus (Shandom) for 5 min and mounted using Pertex mounting medium
(Histolab Products AB).
[0096] DAB-enhanced Perls iron staining: Tissue sections were fixed
with 10% paraformaldehyde in 0.1 M phosphate buffer (PBS), pH 7.4
for 20 min and incubated in Perls solution (1% HCl, 1% Potassium
Ferrocyanide) for 30 min. Staining was enhanced by incubation in
0.025% 3'-3'-diaminobenzidine tetrahydrochloride (Sigma-Aldrich),
0.005% H2O2 in PBS buffer for 30 min, and then developed in the
same buffer. Finally, sections were dehydrated in graded alcohols,
cleared in Histosol Plus (Shandom) for 5 min and mounted using
Pertex mounting medium (Histolab Products AB).
[0097] Enzyme histochemical analyses: Succinate dehydrogenase (SDH)
and Cytochrome C Oxydase (COX) activities were performed on 10
.mu.m cryostat sections of tissues, as previously described
(Puccio, Simon et al. 2001).
[0098] Electron microscopy analysis: Ultrathin sections (70 nm) of
cardiac tissue were contrasted with uranyl acetate and lead citrate
and examined with a Morgagni 268D electron microscope, as described
previously (Puccio, Simon et al. 2001).
[0099] Immunofluorescence and Image Acquisition
[0100] Cardiac and spinal cord tissue cryosections were fixed in 4%
PFA for 10 min, washed and then permeabilized in methanol at
-20.degree. C. for 20 min. Sections were blocked and permeabilized
at the same time with PBS, 1% NOS, 5% BSA, 0.3% Triton X-100 for 1
h at room temperature (RT) and then washed in PBS, 0.2% Tween 1%
BSA 1% NGS (PBS-TBN). Subsequently, tissues were incubated
overnight (O/N) at 4.degree. C. with the rabbit polyclonal antibody
against frataxin (FXN935)(1/250) diluted in PBS-TBN (Puccio, Simon
et al. 2001). The Alexa fluor-594 goat anti-rabbit antibody (I
%500) (Molecular Probes) was incubated for 2 h at RT. Sections were
stained with Hoechst and mounted using Aqua-Polymount mounting
medium (Polysciences, Inc.). For co-immunolabeling of HA-tag and
prohibition, the tissue section were washed in PBS, 0.05% Tween and
then blocked O/N at 4.degree. C. in M.O.M..TM. Mouse Ig Blocking
Reagent (Vector Laboratories). Section were then incubated O/N at
4.degree. C. with the mouse monoclonal antibody to HA tag (1.150)
(Covence) diluted in M.O.M..TM. diluent (Vector Laboratories).
After washing, sections were incubated for 1 h at RT with the goat
anti-mouse antibody conjugated to Alexa Fluor-594 nm (1/500)
(Molecular Probes) diluted in M.O.M..TM. diluent. Subsequently,
sections were washed and blocked in PBS, 0.3% Triton, 2% NGS for 1
h 30 at RT, washed and incubated for 2 h at RT with the rabbit
polyclonal antibody to prohibition (11150) (Abcam) diluted in
PBS-BTN. The Alexa Fluor-488 nm goat anti-rabbit antibody
(1/500)(Molecular Probes) was incubated 1 h 30 at RT with the goat
anti-rabbit antibody conjugated to Alexa Fluor-488 nm (Molecular
Probes) diluted at 1/500 in PBS-BTN. Sections were stained with
Hoechst and mounted using Aqua-Polymount mounting medium
(Polysciences, Inc).
[0101] Confocal analysis was performed on a Leica TCS SP2 upright
confocal microsystem with a Plan Apo CS (numerical aperture 1.4)
63.times. objective. Observation of whole cardiac cryosections was
performed on a Leica Z16 APO A microsystem fitted with a
QuanteM-S12SC camera and combined with a 2.times. objective (39 mm
working distance).
[0102] Quantitative Real-Time PCR Total
[0103] Total RNA was extracted from frozen heart pulverized with
the Precellys24 homogeniser (Bertin Technologies) and using TRI
Reagent (MRC) according to the manufacturer's protocol and was
treated with DNAse I treatment (Roche Biosciences). cDNA was
generated by reverse transcription using the Transcriptor Fist
strand cDNA synthesis kit (Roche biosciences). Quantitative RT-PCR
was performed using the SYBR Green I Master (Roche biosciences) and
light Cycler 480 (Roche biosciences) with primers described in
Supplementary Table S3. 18S ribosomal RNA was used as internal
standard.
[0104] Enzyme Activities
[0105] Tissues were immediately frozen in liquid nitrogen. The
activities of the respiratory chain enzyme SDH (complex 11), the
citric acid cycle enzymes isocitrate dehydrogenase, and
mitochondrial and cytosolic aconitases were determined as described
(Puccio, Simon et al. 2001).
[0106] Immunoblot Analysis
[0107] Extracts of tissues were frozen in liquid nitrogen, and then
homogenized in lysis buffer containing Tris-HCl (280 mM, pH 6.8),
10% SDS, 50% glycerol. Total protein extract (10 .mu.g or 50 .mu.g)
was analyzed on SDS-glycine polyacrylamide gels. Proteins were
transferred to nitrocellulose membranes blocked with 5% non-fat
milk and then incubated with the different primary antibodies,
polyclonal anti-frataxin (R1250 purified sera IGBMC, 1/1,000),
anti-HA (Covance, 1/500), anti-mitochondrial aconitase (R2377
purified sera IGBMC, 1/20,000), anti-Ndufs3 (Invitrogen, 1/4,000),
anti-SDH (Invitrogen, 14,000), anti-Rieske (Abcam, 115,000),
anti-lipoic acid (Calbiochem, 115,000), anti-GAPDH (Millipore,
1/10,000) and monoclonal anti-beta-tubulin (2A2, IGBMC 1/1,000).
Secondary antibody (goat anti-rabbit or anti-mouse IgG,
respectively) coupled to peroxidase was diluted at 1'5,000 and used
for detection of the reaction with Supersignal Substrate Western
blotting (Pierce), according to the manufacturer's
instructions.
[0108] Statistical Analysis
[0109] All data are presented as mean & standard deviation of
the mean (SD). Statistical analysis was carried out using Statview
software (SAS Institute Inc). For statistical comparison of three
experimental groups, one-way ANOVA followed by Scheffe's post-hoc
test was used. A value of P<0.05 was considered significant. For
statistical comparison of two experimental groups, the bilateral
Student's t-test was used. P<0.05 was considered
significant.
[0110] Quantitative PCR on Genomic DNA
[0111] Genomic DNA was extracted from heart by using a
phenol-chloroform method. AAVrh10.CAG-FXN vector genome copy
numbers were measured by quantitative PCR using the SYBR Green I
Master (Roche Biosciences) and light Cycler 480 (Roche
Biosciences). The vector genome copy number per cell (VGC) was
evaluated as described (Piguet, Sondhi et al. 2012). The mouse
genomic Adck3 sequence was used as internal control.
[0112] Results
[0113] Three week-old MCK mice that do not exhibit yet any
clinical, echocardiographic nor biochemical signs of cardiac
disease, received a single intravenous injection of
AAVrh10-CAG-hFXN at the dose of 5.4.1013 vg/kg (n=9). Serial
echocardiographic measurements identified that the treatment
efficiently prevented the development of the cardiac disease
associated with frataxin deficiency. While untreated MCK mice
developed a rapidly progressing left ventricle hypertrophy
associated with a massive geometric remodeling characterized by
increased left-ventricular diastolic diameter, the treated MCK mice
were indistinguishable from wild-type (WT) littermate animals (data
not shown). In parallel, systolic function evaluated by the
left-ventricular shortening fraction (SF) and the cardiac output
gradually decreased in untreated mice, while the treated MCK mice
showed no sign of altered ventricular contractility (data not
shown). The absence of echocardiographic phenotype in the treated
MCK mice led to normal growth (data not shown) and survival (35
weeks with no sign of disease), in contrast to untreated mice which
die at 65*10 days (FIG. 1A). To assess the cellular and molecular
state of the cardiomyocytes, treated MCK mice were sacrificed at 35
weeks of age i.e. more than triple lifespan of untreated mice.
Consistent with the evolution towards heart failure, the expression
of atrial natriuretic peptide (ANP) and the brain natriuretic
peptide (BNP), two markers of pathology-induced stress program
induced by hemodynamic overload was markedly increased in the heart
from untreated mice at 8 weeks compared to WT (19 and 7 times,
respectively, p<0.001) (FIG. 18). In contrast, no difference
could be detected in the expression level of these two markers
between the treated MCK mice and the WT littermates, supporting the
absence of pathology-induced stress programme due to hemodynamic
overload (FIG. 1B). Furthermore, while the expression of
sarcoplasmic reticulum Ca2+ ATPase (Serca2a), a critical
determinant of cardiac relaxation responsible for diastolic Ca2+
reuptake from cytosol was reduced in untreated mice (3.3 fold,
p<0.01), treated MCK mice had normal Serca2a levels (FIG. 1C).
Histological analysis confirmed a preserved overall heart
organization in 35 week-old treated MCK mice, compared to the
myocardial degeneration with cytoplasmic vacuolization in the
necrotic cardiomyocytes observed in untreated mice at 8 weeks of
age (data not shown). Furthermore, Sirius-red staining (data not
shown) and collagen type I and III mRNA expression (data not shown)
indicated the absence of myocardial post-necrotic fibrosis in
treated animals, in comparison to the massive interstitial fibrosis
present in untreated MCK mice at 8 weeks (data not shown).
[0114] Intravenous injection of AAVrh10-FXN led to robust viral
transduction of the heart (20.85.+-.6.3 vg/cell) and liver, but
also of skeletal muscle and dorsal root ganglia (data not shown).
Western blot analysis using an anti-FXN antibody, which equally
detects human and mouse frataxins, demonstrated a significant
overexpression (>10 fold) of AAVrh10-encoded frataxin compared
to endogenous frataxin of WT mice (data not shown). Sustained
expression of the AAVrh10-encoded frataxin was seen over 35 weeks
(data not shown). Mitochondrial import and maturation of frataxin
was complete and non-saturated, as only the cleaved mature form of
human frataxin was detected (data not shown). Immunohistochemistry
analysis using both anti-FXN and anti-HA antibodies showed a broad
expression of human frataxin throughout the heart of the AAV
treated MCK mice, with close to 100% of transduced cardiomyocytes
in the LV, RV and septum, with some cardiomyocytes expressing
higher levels (data not shown). Co-localization with prohibition
demonstrated the expected mitochondrial localization of human
frataxin (data not shown).
[0115] In line with the essential function of frataxin in
regulating cellular Fe--S cluster biogenesis, it is now commonly
accepted that frataxin deficiency leads to a primary Fe--S cluster
deficit followed by secondary mitochondrial iron accumulation.
Indeed, while untreated MCK mice showed a strong deficit in the
Fe--S mitochondrial aconitase (mAco) and succinate dehydrogenase
(SDH) (41.3% and 79.8%, respectively) (data not shown), treated
mice presented levels of activities similar to WT littermates.
Consistent with the widespread expression of hFXN in the heart
after AAVrh10-CAG-hFXN injection, colorimetric staining of SDH
activity confirmed the correction of Fe--S biogenesis in over 95%
of cardiomyocytes (data not shown). While a substantial decrease in
the levels of all analysed mitochondrial Fe--S proteins, was
detected in untreated mice, as a result of the instability of the
respective Fe--S apo-proteins, treated mutants had levels
equivalent to WT (data not shown). Similarly, expression of human
frataxin prevented the decrease in activity of the Fe--S enzyme
lipoic acid synthase, indirectly demonstrated by normal levels of
lipoic acid bound .alpha.-ketoglutarate dehydrogenase (KGDH) and
pyruvate dehydrogenase (PDH) in treated animals in comparison to
untreated animals (data not shown). Consistent with the absence of
Fe--S cluster deficit, no cellular iron accumulation was observed
in the cardiac tissue of treated mice (data not shown).
Furthermore, we did not detect any sign of cellular iron
homeostasis perturbation in treated animals (data not shown).
Finally, electron microscopy analysis demonstrated a normal
sarcomere organization of the cardiomyocytes and mitochondria
ultrastructure in treated mice. Untreated animals showed sparse
atrophied myofibrils and massive mitochondrial proliferation with
abnormal collapsed or swollen cristae and iron accumulation (data
not shown). All together, these data indicate that human frataxin
gene transfer using AAVrh10 in pre-symptomatic MCK mice prevented
the development of the mitochondrial FRDA cardiomyopathy at the
molecular, cellular and physiological level.
[0116] While preventing the onset of the cardiomyopathy is an
important step, at a clinical point of view it appears crucial to
determine the therapeutic potential of this gene therapy approach
when cardiac dysfunction is already present. Mutant MCK mice were
intravenously injected with AAVrh10-CAG-hFXN at the dose of
5.4.1013 vg/kg (n=9) at 7 weeks, when the ventricular remodeling
and left ventricular systolic dysfunction are established, with a
major decrease in cardiac output (60.+-.9% versus control values),
attesting of cardiac failure. One week after injection at 8 weeks
of age, the LV function was already significantly improved, with a
49.+-.5% ejection fraction and a decrease in LV hypertrophy and
dilation in the treated mutant mice, whereas untreated animals
presented typical signs of heart failure (FIG. 2A).
Echocardiographic parameters regarding cardiac function
progressively improved to reach WT values at 11-12 weeks of age,
demonstrating a complete recovery of the ventricular systolic
function and anatomy. The survival of the mice was significantly
prolonged until at least 18 weeks of age (FIG. 2B). In accordance
with the rapid reversion observed by echocardiography, human FXN
was already strongly expressed one week after injection in heart of
treated mutant mice and sustained over 22 weeks, with a
mitochondrial localization (data not shown). Similarly, the
pathology-induced stress program induced by hemodynamic overload,
reflected by the expression of ANP and BNP, was significantly
decreased one week after injection (8 weeks) in treated mice (FIG.
2C). By 22 weeks, the expression level of ANP and BNP of treated
MCK mice was close to the expression level of WT animals,
suggesting a normalization of the hemodynamic load. Furthermore,
the expression of Serca2a progressively increased in treated mice
between 8 and 22 weeks, indicating that diastolic Ca2+ transport
was likely restored (FIG. 2C). The reversal and correction of the
cardiac phenotype correlated with a progressive increased in Fe--S
proteins activities, mAco and SDH, in levels of the Fe--S proteins
Ndufs3, SDH, Rieske, as well as in the lipoic acid bound PDH and
KGDH (FIG. 2D). At 22 weeks, some rare patches with low SDH
activity were detected in the cardiac tissue of treated mice (data
not shown), corresponding to fibrotic scar probably already present
at the time of treated. Interestingly, collagen staining and
expression (type I and Ill) showed that interstitial cardiac
fibrosis stopped one week post injection (data not shown).
Strikingly, a rapid correction of the ultrastructure of the cardiac
muscle was also observed one week after injection, with normal
sarcomere organization and with a massive decrease in mitochondria
(data not shown). In correlation with a still incomplete recovery
of the biochemical phenotype one week after treatment, the
mitochondria in the treated animals showed some signs of pathology,
with the presence of some swollen mitochondria presenting parallel
stacks of cristae membranes (data not shown). However, by 22 weeks,
sarcomeres and mitochondria organizations completely recovered with
no sign of pathological change. All together, these data indicate
that AAVrh10.CAG-hFXN treatment in symptomatic MCK mice resulted in
a rapid clinical, echocardiographic and biochemical improvement
with a complete correction of the FRDA cardiomyopathy.
CONCLUSION
[0117] Our data demonstrates that AAVrh10-mediated transfer of hFXN
gene in the myocardium of a mouse model of severe FRDA
cardiomyopathy not only prevents the onset of the disease for a
sustained period, but also can reverse heart failure and cardiac
remodelling. The correction is extremely rapid and efficient, with
a striking reversal of the mitochondrial abnormalities and
biochemical Fe--S proteins deficit one week after treatment.
Despite the severity of cardiac insufficiency at the time of
treatment, the cardiac recovery is rapidly progressive, reaching
normality within 4-5 weeks of treatment.
[0118] Indeed, the correction of mitochondrial dysfunction in the
mouse was associated with a progressive increase of sarcoplasmic
reticulum Ca2+-ATPase (Serca2a) gene expression involved in
sarcoplasmic reticulum calcium uptake from cytosol. Interestingly,
a decrease in the expression and activity of Serca2a has been
identified in cardiomyocytes from failing human hearts. A rapid
correction of the ultrastructure of the cardiac muscle was also
observed and interstitial cardiac fibrosis was stopped one week
after treatment, preventing the dilation and massive remodelling of
the cardiac tissue. Fibrosis is an early manifestation of FRDA
cardiomyopathy and its importance in organ pathology and
dysfunction is relevant to a wide variety of diseases, including
heart diseases.
[0119] In conclusion, delivery of a vector encoding hFXN in a
mammalian model of FRDA cardiomyopathy resulted in i) prevention of
the development of disease symptoms in asymptomatic individuals and
ii) reversal of disease symptoms in individuals who already
exhibited cardiomyopathy, biochemical Fe--S cluster impairment,
mitochondrial dysfunction and interstitial cardiac fibrosis.
[0120] Thus, a gene that can reverse energy failure may be used for
the treatment and the prevention of a cardiomyopathy due to energy
failure (like the use of FXN gene in the case of cardiomyopathy
associated with Friedreich ataxia as explained in the
examples).
REFERENCES
[0121] Throughout this application, various references, including
United States patents and patent applications, describe the state
of the art to which this invention pertains. The disclosures of
these references are hereby incorporated by reference in entirety
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[0123] D. Simon, Seznec H, Gansmuller A, Carelle N, Weber P,
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Sequence CWU 1
1
217168DNAHomo sapiens 1agtctccctt gggtcagggg tcctggttgc actccgtgct
ttgcacaaag caggctctcc 60atttttgtta aatgcacgaa tagtgctaag ctgggaagtt
cttcctgagg tctaacctct 120agctgctccc ccacagaaga gtgcctgcgg
ccagtggcca ccaggggtcg ccgcagcacc 180cagcgctgga gggcggagcg
ggcggcagac ccggagcagc atgtggactc tcgggcgccg 240cgcagtagcc
ggcctcctgg cgtcacccag cccagcccag gcccagaccc tcacccgggt
300cccgcggccg gcagagttgg ccccactctg cggccgccgt ggcctgcgca
ccgacatcga 360tgcgacctgc acgccccgcc gcgcaagttc gaaccaacgt
ggcctcaacc agatttggaa 420tgtcaaaaag cagagtgtct atttgatgaa
tttgaggaaa tctggaactt tgggccaccc 480aggctctcta gatgagacca
cctatgaaag actagcagag gaaacgctgg actctttagc 540agagtttttt
gaagaccttg cagacaagcc atacacgttt gaggactatg atgtctcctt
600tgggagtggt gtcttaactg tcaaactggg tggagatcta ggaacctatg
tgatcaacaa 660gcagacgcca aacaagcaaa tctggctatc ttctccatcc
agtggaccta agcgttatga 720ctggactggg aaaaactggg tgtactccca
cgacggcgtg tccctccatg agctgctggc 780cgcagagctc actaaagcct
taaaaaccaa actggacttg tcttccttgg cctattccgg 840aaaagatgct
tgatgcccag ccccgtttta aggacattaa aagctatcag gccaagaccc
900cagcttcatt atgcagctga ggtctgtttt ttgttgttgt tgttgtttat
tttttttatt 960cctgcttttg aggacagttg ggctatgtgt cacagctctg
tagaaagaat gtgttgcctc 1020ctaccttgcc cccaagttct gatttttaat
ttctatggaa gattttttgg attgtcggat 1080ttcctccctc acatgatacc
ccttatcttt tataatgtct tatgcctata cctgaatata 1140acaaccttta
aaaaagcaaa ataataagaa ggaaaaattc caggagggaa aatgaattgt
1200cttcactctt cattctttga aggatttact gcaagaagta catgaagagc
agctggtcaa 1260cctgctcact gttctatctc caaatgagac acattaaagg
gtagcctaca aatgttttca 1320ggcttctttc aaagtgtaag cacttctgag
ctctttagca ttgaagtgtc gaaagcaact 1380cacacgggaa gatcatttct
tatttgtgct ctgtgactgc caaggtgtgg cctgcactgg 1440gttgtccagg
gagacctagt gctgtttctc ccacatattc acatacgtgt ctgtgtgtat
1500atatattttt tcaatttaaa ggttagtatg gaatcagctg ctacaagaat
gcaaaaaatc 1560ttccaaagac aagaaaagag gaaaaaaagc cgttttcatg
agctgagtga tgtagcgtaa 1620caaacaaaat catggagctg aggaggtgcc
ttgtaaacat gaaggggcag ataaaggaag 1680gagatactca tgttgataaa
gagagccctg gtcctagaca tagttcagcc acaaagtagt 1740tgtccctttg
tggacaagtt tcccaaattc cctggacctc tgcttcccca tctgttaaat
1800gagagaatag agtatggttg attcccagca ttcagtggtc ctgtcaagca
acctaacagg 1860ctagttctaa ttccctattg ggtagatgag gggatgacaa
agaacagttt ttaagctata 1920taggaaacat tgttattggt gttgccctat
cgtgatttca gttgaattca tgtgaaaata 1980atagccatcc ttggcctggc
gcggtggctc acacctgtaa tcccagcact tttggaggcc 2040aaggtgggtg
gatcacctga ggtcaggagt tcaagaccag cctggccaac atgatgaaac
2100cccgtctcta ctaaaaatac aaaaaattag ccgggcatga tggcaggtgc
ctgtaatccc 2160agctacttgg gaggctgaag cggaagaatc gcttgaaccc
agaggtggag gttgcagtga 2220gccgagatcg tgccattgca ctgtaacctg
ggtgactgag caaaactctg tctcaaaata 2280ataataacaa tataataata
ataatagcca tcctttattg tacccttact gggttaatcg 2340tattatacca
cattacctca ttttaatttt tactgacctg cactttatac aaagcaacaa
2400gcctccagga cattaaaatt catgcaaagt tatgctcatg ttatattatt
ttcttactta 2460aagaaggatt tattagtggc tgggcatggt ggcgtgcacc
tgtaatccca ggtactcagg 2520aggctgagac gggagaattg cttgacccca
ggcggaggag gttacagtga gtcgagatcg 2580tacctgagcg acagagcgag
actccgtctc aaaaaaaaaa aaaaggaggg tttattaatg 2640agaagtttgt
attaatatgt agcaaaggct tttccaatgg gtgaataaaa acacattcca
2700ttaagtcaag ctgggagcag tggcatatac ctatagtccc agctgcacag
gaggctgaga 2760caggaggatt gcttgaagcc aggaattgga gatcagcctg
ggcaacacag caagatccta 2820tctcttaaaa aaagaaaaaa aaacctatta
ataataaaac agtataaaca aaagctaaat 2880aggtaaaata ttttttctga
aataaaatta ttttttgagt ctgatggaaa tgtttaagtg 2940cagtaggcca
gtgccagtga gaaaataaat aacatcatac atgtttgtat gtgtttgcat
3000cttgcttcta ctgaaagttt cagtgcaccc cacttactta gaactcggtg
acatgatgta 3060ctcctttatc tgggacacag cacaaaagag gtatgcagtg
gggctgctct gacatgaaag 3120tggaagttaa ggaatctggg ctcttatggg
gtccttgtgg gccagccctt caggcctatt 3180ttactttcat tttacatata
gctctaattg gtttgattat ctcgttccca aggcagtggg 3240agatccccat
ttaaggaaag aaaaggggcc tggcacagtg gctcatgcct gtaatcccag
3300cactttggga ggctgaggca agtgtatcac ctgaggtcag gagttcaaga
ccagcctggc 3360caacatggca aaatcccgtc tctactaaaa atattaaaaa
attggctggg cgtggtggtt 3420cgtgcctata atttcagcta ctcaggaggc
tgaggcagga gaatcgctgt aacctggggg 3480gtggaggttg cagtgagacg
agatcatgcc acttcactcc agcctggcca acagagccat 3540actccgtctc
aaataaataa ataaataaat aaagggactt caaacacatg aacagcagcc
3600aggggaagaa tcaaaatcat attctgtcaa gcaaactgga aaagtaccac
tgtgtgtacc 3660aatagcctcc ccaccacaga ccctgggagc atcgcctcat
ttatggtgtg gtccagtcat 3720ccatgtgaag gatgagtttc caggaaaagg
ttattaaata ttcactgtaa catactggag 3780gaggtgagga attgcataat
acaatcttag aaaacttttt tttccccttt ctattttttg 3840agacaggatc
tcactttggc actcaggctg gaggacagtg gtacaatcaa agctcatggc
3900agcctcgacc tccctgggct tgggcaatcc tcccacaggt gtgcacctcc
atagctggct 3960aatttgtgta ttttttgtag agatggggtt tcaccatgtt
gcccaggctg gtctctaaca 4020cttaggctca agtgatccac ctgcctcgtc
ctcccaagat gctgggatta caggtgtgtg 4080ccacaggtgt tcatcagaaa
gctttttcta ttatttttac cttcttgagt gggtagaacc 4140tcagccacat
agaaaataaa atgttctggc atgacttatt tagctctctg gaattacaaa
4200gaaggaatga ggtgtgtaaa agagaacctg ggtttttgaa tcacaaattt
agaatttaat 4260cgaaactctg cctcttactt gtttgtagac actgacagtg
gcctcatgtt tttttttttt 4320ttaatctata aaatggagat atctaacatg
ttgagcctgg gcccacaggc aaagcacaat 4380cctgatgtga gaagtactca
gttcatgaca actgttgttc tcacatgcat agcataattt 4440catattcaca
ttggaggact tctcccaaaa tatggatgac gttccctact caaccttgaa
4500cttaatcaaa atactcagtt tacttaactt cgtattagat tctgattccc
tggaaccatt 4560tatcgtgtgc cttaccatgc ttatatttta cttgatcttt
tgcatacctt ctaaaactat 4620tttagccaat ttaaaatttg acagtttgca
ttaaattata ggtttacaat atgctttatc 4680cagctatacc tgccccaaat
tctgacagat gcttttgcca cctctaaagg aagacccatg 4740ttcatagtga
tggagtttgt gtggactaac catgcaaggt tgccaaggaa aaatcgcttt
4800acgcttccaa ggtacacact aagatgaaag taattttagt ccgtgtccag
ttggattctt 4860ggcacatagt tatcttctgc tagaacaaac taaaacagct
acatgccagc aagggagaaa 4920ggggaaggag gggcaaagtt ttgaaatttc
atgtaaattt atgctgttca aaacgacgag 4980ttcatgactt tgtgtataga
gtaagaaatg ccttttcttt tttgagacag agtcttgctc 5040tgtcacccag
gctggagtgc agtggcacga tctgggctca ctacaacctc cgcctcctgg
5100gttcaagcaa ttctctgcct cagcctcccg agtagctggg attacaggtg
cctgccacca 5160cacccggcta atttttgtat ttttagtaga gacggggttt
caccatcatg gccaggctgg 5220tcttgaactc ctgacctagt aatccacctg
cctccgcctc ccaaagtgct gggattacag 5280gcgtgagcca ctgcacccag
ccagaaatgc cttctaatct ttggtttatc ttaattagcc 5340aggacacttg
gagtgcatcc cgaagtacct gatcagtggc ccctttggaa tgtgtaaaac
5400tcagctcact tatatccctg catccgctac agagacagaa tccaagctca
tatgttccat 5460cttctctggc tgtatagttt aaggaatgga aggcaccaga
acagatttat tgaaatgttt 5520attagctgaa gatttattta gacagttgag
gaaaacatca gcacccagca gtaaaattgg 5580ctctcaaaga ttttcttctc
ctgtggaaag tcagacctct gaggccccat ccaggtagaa 5640gtactagtgc
aagaagggcc tctgctgtcc acttgtgttt ctgtgatctg tgggaacatt
5700gttaacgcca catcttgacc tcaaattgtt tagctcctgg ccagacacgg
tggctcacac 5760ctgtaatccc agcactttga gaggctgagg caggtggatc
acctgaggtt aggagttcga 5820ggccagcctg gtcaacatgg taaaaccccg
cctctactaa aaatacaaaa attagctggc 5880cgtagtggcg cacgcctgtt
atcccagcta ctcgggaggc tgaggcagga gaattgcttg 5940aacctgggtg
gtggaggttg cagtgagccg agattacacc actgcactcc agcctgggtg
6000acaagaggga aactccatta aaaaaatgta attcccgtgt ctgccatctt
aagtgtaaag 6060gtggctaaat tatatagaaa aataagacaa tatcatttcc
caattacatt cctttcctac 6120cgcactctat gatgctagct gagatttttc
caaaagaaaa tggcttaaat aaaaccctaa 6180gagaaagaaa aactttaaat
ccctccaaag ctcaaaagta atagaaacag atgagtttgg 6240agtcaggatt
tctctgtaag attgcctagg ctgtgtactg cacatctcca ggtgccactg
6300ttgacagaga ttataactac aatgtgaagt gaatggtgcc actgacagtt
atgcaaaccg 6360tccagagcat agccacctga tcctgctggg attcctcttg
ccagtccatc agcagttccc 6420cttgaaagtt tcaccaaaca tcccttaaat
ctgccctctc ctgcccgtcc ccagtggagg 6480tcctcatcat ttttcacctg
catttttgca ggagctttct tatatccacc ttcctccttt 6540tctctcagcc
catcatctag ctacacagtc tccagggtaa gctttcagaa aggcaatctc
6600ttgtctgtaa aacctaagca ggaccaaggc caagtttctt agcctgaaaa
atgtgctttt 6660ctgactgaac tgttcaggca ctgactctac atataattat
gcttttctac cccctcacac 6720tcaacacttt gactccagca atcccaaatc
cccagatccc taagtgtgct gtgctatttt 6780cacgtggctc tcagacttgg
ccagtgctgt ttccattttg gtctttattc cccacatctc 6840tgcctggggg
gtagattcta ccctgaaaaa tgttcttggc acagccttgc aaactcctcc
6900tccactcagc ctctgcctgg atgcccttga ttgttccatg tcctcagcat
accatgtttg 6960tctttcccag cactgaccta ccatgtgtca cccctgcttg
gctgtacctt ccatgaggct 7020aggactatgt gtctcctttg ttgactgctg
ttgccctagc atcttgcaca gttccttgca 7080cacaattaga gctctataaa
tgtcaaataa atgtgttata attatatgtt taagatagtt 7140gttcaaataa
actctaaata accccaac 71682210PRTHomo sapiens 2Met Trp Thr Leu Gly
Arg Arg Ala Val Ala Gly Leu Leu Ala Ser Pro1 5 10 15Ser Pro Ala Gln
Ala Gln Thr Leu Thr Arg Val Pro Arg Pro Ala Glu 20 25 30Leu Ala Pro
Leu Cys Gly Arg Arg Gly Leu Arg Thr Asp Ile Asp Ala 35 40 45Thr Cys
Thr Pro Arg Arg Ala Ser Ser Asn Gln Arg Gly Leu Asn Gln 50 55 60Ile
Trp Asn Val Lys Lys Gln Ser Val Tyr Leu Met Asn Leu Arg Lys65 70 75
80Ser Gly Thr Leu Gly His Pro Gly Ser Leu Asp Glu Thr Thr Tyr Glu
85 90 95Arg Leu Ala Glu Glu Thr Leu Asp Ser Leu Ala Glu Phe Phe Glu
Asp 100 105 110Leu Ala Asp Lys Pro Tyr Thr Phe Glu Asp Tyr Asp Val
Ser Phe Gly 115 120 125Ser Gly Val Leu Thr Val Lys Leu Gly Gly Asp
Leu Gly Thr Tyr Val 130 135 140Ile Asn Lys Gln Thr Pro Asn Lys Gln
Ile Trp Leu Ser Ser Pro Ser145 150 155 160Ser Gly Pro Lys Arg Tyr
Asp Trp Thr Gly Lys Asn Trp Val Tyr Ser 165 170 175His Asp Gly Val
Ser Leu His Glu Leu Leu Ala Ala Glu Leu Thr Lys 180 185 190Ala Leu
Lys Thr Lys Leu Asp Leu Ser Ser Leu Ala Tyr Ser Gly Lys 195 200
205Asp Ala 210
* * * * *
References