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Project 5: A Novel Vector for Gene Transfer
for hemophilia B.
Hemophilia B (HB) is an inherited bleeding diathesis due to absence
of functional coagulation F. IX. Gene transfer is an appealing
approach to HB since small increases in plasma F. IX levels improve
the clinical course and tight control of transgene expression
is unnecessary for clinical benefit. Efficacy and dose-finding
can be extrapolated from experiments in animal models. A human
trial assessing the safety of intramuscular (IM) administration
of adeno-associated virus (AAV) vector with a CMV promotor encoding
F. IX was developed 2-3 years ago, but new tools are now available
that will likely improve the current vector. We propose three
strategies for enhanced transgene expression and improved patient
safety in the clinical trial. First, we will make a vector with
a muscle-specific promotor to reduce the risk of immune response
against the myocyte derived F. IX. Second, we will assess if vector
injection into muscles rich in slow fibers (the soleus
of the leg) results in enhanced murine transgene expression. Third,
since AAV-1 capsid provides superior gene transfer compared to
the AAV-2 capsid of the current vector, we will test whether an
AAV-1 vector produces better gene transfer than the AAV-2 in RAG-1
mice. Those modifications that result in enhanced transgene expression
will be used to create a novel vector for a new trial of AAV-
F.IX for IM administration. We will enroll 9 adult males with
severe HB in a dose escalation safety trial. Three subjects will
be enrolled in each of 3 dose cohorts. We will monitor subjects
for local and systemic toxicity, antibody formation against the
viral capsid Ag and F. IX and body fluids for the presence of
vector sequences. Clinical endpoints will include changes in aPTTs,
F. IX levels and patterns of factor concentrate use. After safety
is demonstrated, we will establish if re-treatment with an AAV
vector is useful, by injecting the new vector into subjects previously
treated with AAV-CMV-hF.IX who have demonstrated low transgene
expression .
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