Tan, M.H.; (2011) Development of gene therapy for the treatment of retinal dystrophies caused by mutations in AIPL1. Doctoral thesis , UCL (University College London).

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Abstract

Genetic defects in AIPL1 cause a heterogeneous set of clinical conditions depending on the severity of the mutant alleles. Diseases can range from Leber Congenital Amaurosis (LCA), the severest form of early-onset retinal degeneration, to milder forms such as retinitis pigmentosa (RP) and cone-rod dystrophy. There is currently no effective treatment for LCA and inherited retinal dystrophies, which are the commonest cause of childhood blindness. AIPL1 is expressed primarily in retinal photoreceptors and is required for the biosynthesis of photoreceptor phosphodiesterase (PDE). This thesis describes a programme of work that examines the potential and efficacy of gene replacement therapy in the treatment of AIPL1- associated retinal diseases. It centres on the use of recombinant adeno-associated virus for the transfer of murine and human AIPL1 cDNA into photoreceptor cells. AAV-mediated gene replacement was assessed in two genetically engineered mouse models carrying null and hypomorphic alleles, Aipl1 -/- and Aipl1 h/h mice, which simulate retinal degenerations similar to human LCA and RP respectively. Three different rates of photoreceptor degeneration were simulated using the mouse models. To treat the different rates of degeneration, two pseudotypes of AAV (serotype 2 and 8) exhibiting different transduction kinetics were used for gene transfer. Substantial and long term rescue of the disease phenotype was seen as a result of Aipl1 transgene expression mediated by AAV2/2 vector in Aipl1 h/h mice and by AAV2/8 in rapid degenerations in light accelerated Aipl1 h/h mice and in Aipl1 -/- mice. Thus, the results presented in this thesis validates the efficacy of AIPL1 gene replacement using AAV vectors in varying rates of degeneration that reflected the clinical spectrum of disease. This is the first study to report long-term rescue of a photoreceptor-specific defect and to demonstrate effective rescue of rapid photoreceptor degeneration. The development of an efficient therapy depends on the identification of patients and characterisation of disease phenotype. A panel of DNA samples from patients with LCA and early onset severe retinal dystrophy was screened for mutations in the AIPL1 gene. Patients identified with AIPL1- associated disease demonstrated varying severity of disease from LCA to milder form of rod cone dystrophy. Clinical characterisation and imaging of the patients highlighted distinctive features which will direct future identification and molecular screening of patients. Residual retinal integrity and function in young patients and patients with milder phenotype suggests that AIPL1 defects may be amenable to treatment.

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