IgG-cleaving endopeptidase enables in vivo gene therapy in the presence of anti-AAV neutralizing antibodies

Christian Leborgne (1) , Elena Barbon (1) , Jeffrey M Alexander (2) , Hayley Hanby (2) , Sandrine Delignat (3) , Daniel M Cohen (2) , Fanny Collaud (1) , Saghana Muraleetharan (2) , Dan Lupo (2) , Joseph Silverberg (2) , Karen Huang (2) , Laetitia van Wittengerghe (1) , Béatrice Marolleau (1) , Adeline Miranda (1) , Anna Fabiano (1) , Victoria Daventure (3) , Heena Beck (2) , Xavier M Anguela (2) , Giuseppe Ronzitti (1) , Sean M Armour (2) , Sébastien Lacroix-Desmazes (3) , Federico Mingozzi (1)

1 INTEGRARE - Approches génétiques intégrées et nouvelles thérapies pour les maladies rares
2 Spark Therapeutics [Philadelphia, PA, USA]
3 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers

Neutralizing antibodies to adeno-associated virus (AAV) vectors are highly prevalent in humans1,2, and block liver transduction3,4,5 and vector readministration6; thus, they represent a major limitation to in vivo gene therapy. Strategies aimed at overcoming anti-AAV antibodies are being studied7, which often involve immunosuppression and are not efficient in removing pre-existing antibodies. Imlifidase (IdeS) is an endopeptidase able to degrade circulating IgG that is currently being tested in transplant patients8. Here, we studied if IdeS could eliminate anti-AAV antibodies in the context of gene therapy. We showed efficient cleavage of pooled human IgG (intravenous Ig) in vitro upon endopeptidase treatment. In mice passively immunized with intravenous Ig, IdeS administration decreased anti-AAV antibodies and enabled efficient liver gene transfer. The approach was scaled up to nonhuman primates, a natural host for wild-type AAV. IdeS treatment before AAV vector infusion was safe and resulted in enhanced liver transduction, even in the setting of vector readministration. Finally, IdeS reduced anti-AAV antibody levels from human plasma samples in vitro, including plasma from prospective gene therapy trial participants. These results provide a potential solution to overcome pre-existing antibodies to AAV-based gene therapy

Domaines: Immunologie

Christian Leborgne, Elena Barbon, Jeffrey M Alexander, Hayley Hanby, Sandrine Delignat, et al.. IgG-cleaving endopeptidase enables in vivo gene therapy in the presence of anti-AAV neutralizing antibodies. Nature Medicine, 2020, 26 (7), pp.1096-1101. ⟨10.1038/s41591-020-0911-7⟩. ⟨hal-03031762⟩