Forelimb treatment in a large cohort of dystrophic dogs supports delivery of a recombinant AAV for exon skipping in Duchenne patients.

Duchenne muscular dystrophy (DMD) is a severe muscle-wasting disorder caused by mutations in the dystrophin gene, without curative treatment yet available. Our study provides, for the first time, the overall safety profile and therapeutic dose of a recombinant adeno-associated virus vector, serotype 8 (rAAV8) carrying a modified U7snRNA sequence promoting exon skipping to restore a functional in-frame dystrophin transcript, and injected by locoregional transvenous perfusion of the forelimb. Eighteen Golden Retriever Muscular Dystrophy (GRMD) dogs were exposed to increasing doses of GMP-manufactured vector. Treatment was well tolerated in all, and no acute nor delayed adverse effect, including systemic and immune toxicity was detected. There was a dose relationship for the amount of exon skipping with up to 80% of myofibers expressing dystrophin at the highest dose. Similarly, histological, nuclear magnetic resonance pathological indices and strength improvement responded in a dose-dependent manner. The systematic comparison of effects using different independent methods, allowed to define a minimum threshold of dystrophin expressing fibers (>33% for structural measures and >40% for strength) under which there was no clear-cut therapeutic effect. Altogether, these results support the concept of a phase 1/2 trial of locoregional delivery into upper limbs of nonambulatory DMD patients.

Capsid-specific removal of circulating antibodies to adeno-associated virus vectors.

Neutralizing antibodies directed against adeno-associated virus (AAV) are commonly found in humans. In seropositive subjects, vector administration is not feasible as antibodies neutralize AAV vectors even at low titers. Consequently, a relatively large proportion of humans is excluded from enrollment in clinical trials and, similarly, vector redosing is not feasible because of development of high-titer antibodies following AAV vector administration. Plasmapheresis has been proposed as strategy to remove anti-AAV antibodies from the bloodstream. Although safe and relatively effective, the technology has some limitations mainly related to the nonspecific removal of all circulating IgG. Here we developed an AAV-specific plasmapheresis column which was shown to efficiently and selectively deplete anti-AAV antibodies without depleting the total immunoglobulin pool from plasma. We showed the nearly complete removal of anti-AAV antibodies from high titer purified human IgG pools and plasma samples, decreasing titers to levels that allow AAV vector administration in mice. These results provide proof-of-concept of a method for the AAV-specific depletion of neutralizing antibodies in the setting of in vivo gene transfer.

Vascular Delivery of Allogeneic MuStem Cells in Dystrophic Dogs Requires Only Short-Term Immunosuppression to Avoid Host Immunity and Generate Clinical/Tissue Benefits.

Growing demonstrations of regenerative potential for some stem cells led recently to promising therapeutic proposals for neuromuscular diseases. We have shown that allogeneic MuStem cell transplantation into Golden Retriever muscular dystrophy (GRMD) dogs under continuous immunosuppression (IS) leads to persistent clinical stabilization and muscle repair. However, long-term IS in medical practice is associated with adverse effects raising safety concerns. Here, we investigate whether the IS removal or its restriction to the transplantation period could be considered. Dogs aged 4-5 months old received vascular infusions of allogeneic MuStem cells without IS (GRMDMU/no-IS) or under transient IS (GRMDMU/tr-IS). At 5 months post-infusion, persisting clinical status improvement of the GRMDMU/tr-IS dogs was observed while GRMDMU/no-IS dogs exhibited no benefit. Histologically, only 9-month-old GRMDMU/tr-IS dogs showed an increased muscle regenerative activity. A mixed cell reaction with the host peripheral blood mononucleated cells (PBMCs) and corresponding donor cells revealed undetectable to weak lymphocyte proliferation in GRMDMU/tr-IS dogs compared with a significant proliferation in GRMDMU/no-IS dogs. Importantly, any dog group showed neither cellular nor humoral anti-dystrophin responses. Our results show that transient IS is necessary and sufficient to sustain allogeneic MuStem cell transplantation benefits and prevent host immunity. These findings provide useful critical insight to designing therapeutic strategies.

Extraction of alkyl methylphosphonic acids from aqueous samples using a conventional polymeric solid-phase extraction sorbent and a molecularly imprinted polymer.

The analysis of alkyl methylphosphonic acids (AMPAs) constitutes an important subject for verifying the compliance to the Chemical Weapons Convention (CWC). Indeed, alkyl methylphosphonic acids are the degradation products of V and G nerve agents such as VX, sarin or soman. Lowering the limits of detection of analytical methods for complex aqueous matrices implies the introduction of concentration and clean-up steps in the whole analytical process. Therefore a molecular imprinted polymer (MIP) has been previously developed for the selective extraction and the concentration of the alkyl methylphosphonic acids. Unfortunately, the selective retention process on this MIP has involved the development of hydrogen bonds and so does not allow the direct percolation of aqueous samples. A change of solvent is then necessary and can be performed using solid-phase extraction (SPE) with conventional non selective hydrophobic sorbents. Two polymeric sorbents, Oasis HLB and HR-P resins, were selected for their high specific surface area. The extraction recoveries obtained on both sorbents were compared and the Oasis HLB sorbent was further selected and used for the percolation of acidified aqueous samples. An optimised SPE procedure was then applied to concentrate an aqueous soil extract spiked with isobutyl methylphosphonic acid (iBMPA) and cyclopentyl methylphosphonic acid (cPMPA) that was further cleaned-up by passing through the MIP. The resulting LC-MS full scan chromatograms highlight the clean-up effect of the SPE-MIP association by the removal of the matrix substances and the preservation of 95% of the compounds of interest.

Long-term microdystrophin gene therapy is effective in a canine model of Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is an incurable X-linked muscle-wasting disease caused by mutations in the dystrophin gene. Gene therapy using highly functional microdystrophin genes and recombinant adeno-associated virus (rAAV) vectors is an attractive strategy to treat DMD. Here we show that locoregional and systemic delivery of a rAAV2/8 vector expressing a canine microdystrophin (cMD1) is effective in restoring dystrophin expression and stabilizing clinical symptoms in studies performed on a total of 12 treated golden retriever muscular dystrophy (GRMD) dogs. Locoregional delivery induces high levels of microdystrophin expression in limb musculature and significant amelioration of histological and functional parameters. Systemic intravenous administration without immunosuppression results in significant and sustained levels of microdystrophin in skeletal muscles and reduces dystrophic symptoms for over 2 years. No toxicity or adverse immune consequences of vector administration are observed. These studies indicate safety and efficacy of systemic rAAV-cMD1 delivery in a large animal model of DMD, and pave the way towards clinical trials of rAAV-microdystrophin gene therapy in DMD patients.

Selective extraction of organophosphorus nerve agent degradation products by molecularly imprinted solid-phase extraction.

The analysis of alkyl alkylphosphonic acids, the degradation products of V and G nerve agents as VX, Sarin or Soman, is an important task for the verification of compliance to the Chemical Weapons Convention. The detection of these contaminants at low concentration levels is often difficult in complex matrices due to the amount of interfering substances. Molecularly imprinted solid-phase extraction technique should allow a selective extraction of these compounds from complex samples, and thus make their detection easier. Two molecularly imprinted polymers (MIPs) prepared with methacrylic acid (MAA) as monomer and pinacolyl methylphosphonic acid (PMPA) as template molecule were synthesised and tested. The first polymer, MIP A, was prepared with ethylene glycol dimethacrylate (EGDMA) in dichloromethane. The second polymer, MIP B, was synthesised using trimethylolpropane trimethacrylate (TRIM) in acetonitrile. To evaluate the selectivity provided by these MIPs, the retention of the ethyl methylphosphonic acid (EMPA) target molecule was studied in parallel on a non-imprinted polymer (NIP). While MIP A does not show any difference compared to NIP A, a good selectivity was obtained for MIP B. After the optimisation of the extraction process, 60% of EMPA can be removed from the NIP B without affecting the retention on the MIP B. A recovery of extraction of 93% was then obtained on the MIP B. Its capacity was then measured and corresponds to 97 microg of EMPA per gram of MIP. Finally, the selectivity of MIP B was clearly demonstrated by applying it to the clean-up of a soil extract spiked with EMPA.

Applications of deactivated GC columns for analysis of nitrogen-containing chemicals related to the chemical weapons convention.

Nitrogen-containing chemicals are one of the important families of compounds relevant to the purposes of the Chemical Weapons Convention (CWC). Several applications, using various injection modes, of new deactivated columns specially designed for basic compounds are presented. These columns prove remarkably well-suited to the gas chromatographic (GC) analysis of the chemicals of interest, even to underivatized amino-alcohols, whose analysis on conventional GC columns is often difficult and hindered by poor resolution and high detection limits. Such a deactivated phase can even replace the typical GC phases used for CWC verification purposes.

Optimisation of sorbent trapping and thermal desorption-gas chromatography-mass spectrometric conditions for sampling and analysis of hydrogen cyanide in air.

Among the chemicals belonging to the schedules of the Chemical Weapons Convention (CWC), sampling and analysis of highly volatile compounds such as hydrogen cyanide (HCN) require special consideration. The latter is present in numerous old chemical weapons that are stockpiled awaiting destruction in Northeastern France: thus, sampling on stockpile area and subsequent verification of HCN levels is compulsory to ensure safety of workers on these areas. The ability of several commercial sorbents to trap hydrogen cyanide at various concentration levels and in various humidity conditions, was evaluated. Furthermore, thermal desorption of the corresponding samples, followed by analysis by gas chromatography-mass spectrometry was also optimised. Carbosieve S-III, a molecular sieve possessing a very high specific area, proved the most efficient sorbent for HCN sampling in all conditions tested. Conversely, the presented results show that Tenax, albeit generally considered as the reference sorbent for air monitoring and analysis of CWC-related chemicals, is not suitable for HCN trapping.