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This study describes the findings from the targeted delivery of gene therapy to midbrain to treat a rare deadly neurodevelopmental disorder in children with a neurogenetic disease, aromatic L-amino acid decarboxylase (AADC) deficiency characterized by deficient synthesis of dopamine and serotonin.
“Remarkably, these episodes are the first symptom to disappear after gene therapy surgery, and they never return,” said study co-author Dr. Krystof Bankiewicz
, professor of neurological surgery at Ohio State College of Medicine who leads the Bankiewicz Lab
. “In the months that follow, many patients experience life-changing improvements. Not only do they begin laughing and have improved mood, but many are able to begin speaking and even walking. They are making up for the time they lost during their abnormal development.”
The directed gene therapy in seven children ages 4 to 9 who were infused with the viral vector resulted in dramatic improvement of symptoms, motor function and quality of life. Six children were treated at UCSF Benioff Children’s Hospital in San Francisco and one at Ohio State Wexner Medical Center. This therapeutic modality promises to transform the treatment of AADC deficiency and other similar disorders of the brain in the future, Bankiewicz said.
“Really, what we're doing is introducing a different code to the cell,” said Dr. James “Brad” Elder, director of neurosurgical oncology at Ohio State Wexner Medical Center’s Neurological Institute.
“And we're watching the whole thing happen live. So we continuously repeat the MRI and we can see the infusion blossom within the desired nucleus.”
Researchers believe this same method of gene therapy can be used to treat other genetic disorders as well as common neurodegenerative diseases, such as Parkinson’s and Alzheimer’s disease. Clinical trials are underway to test this procedure in others living with debilitating and incurable neurological conditions.
The directed gene therapy, in these patients, resulted in dramatic improvement of symptoms, motor function and quality of life. This therapeutic modality promises to transform the treatment of AADC deficiency and other similar disorders of the brain in the future.
The findings described in this study are the culmination of decades of work by teams from multiple academic institutions, including University of California San Francisco, Washington University in St. Louis, Medical Neurogenetics Laboratory in Atlanta, St. Louis Children’s Hospital and Nationwide Children’s Hospital in Columbus, Ohio.
“This work provides a framework for the treatment of other human nervous system genetic diseases. It’s our hope that this will be first of many ultra-rare and other neurologic disorders that will be treated with gene therapy in a similar manner,” Bankiewicz said. Reference:
Pearson TS, Gupta N, San Sebastian W, et al. Gene therapy for aromatic L-amino acid decarboxylase deficiency by MR-guided direct delivery of AAV2-AADC to midbrain dopaminergic neurons. Nat Commun
. 2021;12(1):4251. doi:10.1038/s41467-021-24524-8
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