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Free Content Efficient induction of immune tolerance to coagulation factor IX following direct intramuscular gene transfer

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Background: The formation of inhibitory anti-factor IX (anti-FIX) antibodies is a major complication of FIX protein replacement-based treatment for hemophilia B. It is difficult to treat patients with anti-FIX antibodies. Gene therapy is emerging as a potentially effective treatment for hemophilia. Direct i.m. injection of adeno-associated virus (AAV) is a safe and efficient procedure for hemophilia B gene therapy. However, the development of anti-FIX antibodies following i.m. of AAV may impede its application to patients. Objective: We aimed to investigate induction of immune tolerance to human FIX (hFIX) by i.m. of AAV1, further validating i.m. of AAV1 for hemophilia B gene therapy. Methods and results: Cohorts of hemostatically normal and hemophilia B mice with diverse genetic and MHC backgrounds received i.m. of AAV-hFIX. Human FIX antigen and anti-hFIX antibodies were examined. I.m. of 1 × 1011 vector genomes (VG) of AAV2 elicits formation of anti-hFIX antibodies comparable to those by hFIX protein replacement. I.m. of 1 × 1011 VG of AAV1 results in expression of therapeutic levels of hFIX (up to 950 ng mL−1, mean = 772 ng mL−1, SEM ± 35.7) and hFIX-specific immune tolerance in C57BL/6 mice. Conclusions: A single i.m. of AAV1 can result in efficient expression of therapeutic levels of hFIX and induction of hFIX tolerance in hemostatically normal and hemophilic B mice. Our results substantiate the prospect of i.m. of AAV1 for hemophilia B gene therapy and FIX tolerance induction.

Keywords: adeno-associated virus; factor IX; gene therapy; hemophilia B; immune tolerance

Document Type: Research Article


Publication date: 2007-06-01

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