Customized and Modular Control of Gene Expression for Precision Gene Therapies

Citation

Mayfield, Acacia Michelle Hori (2024) Customized and Modular Control of Gene Expression for Precision Gene Therapies. Dissertation (Ph.D.), California Institute of Technology. doi:10.7907/d05v-0t68. https://resolver.caltech.edu/CaltechTHESIS:05312024-185303498

Abstract

Genetic disorders are caused by mutations in essential genes that disturb the abundance or function of proteins, tipping cells and tissues from homeostatic harmony into disorder. Developing treatment for genetic diseases involves precision approaches, as gene therapies target the root causes of highly specific pathologic processes at the level of gene replacement, editing, or downstream compensation for a harmful genetic change. Safe access to these cell populations, and the ability to control the behavior of therapeutic cargo after delivery to target tissues, will enable the field to develop safe and effective therapies with the potential to be curative. Systemically delivered AAVs can noninvasively target therapeutic genetic cargo to diverse disease loci throughout the body, but at high doses required for therapeutic penetrance of naturally occurring serotypes, these vectors can cause severe toxicity, emphasizing the need for both targeted, efficient gene delivery vectors, and other means of transgene expression control. This work describes three examples of AAV capsid and cargo design strategies that seek to control where, when, and at what level therapeutic transgene expression can be achieved in a preclinical context. First, we utilize native putative regulatory elements to encourage physiologic level of ectopic frataxin expression in a mouse model of Friedreich’s Ataxia, finding that when delivered to both the brain and peripheral nervous system, treatment prevents progression of motor and coordination deficits. Next, we utilize the genetic incoherent feedforward loop circuit motif at the RNA level to decouple vector delivery level from transgene expression level of MeCP2 in a mouse model of Rett Syndrome, finding that when regulated to near endogenous healthy levels of RNA, AAV-MeCP2-IFFL enables behavioral rescue without overexpression toxicity. Lastly, we employ the mechanism for AAV-genome stability in vivo to modulate expression using a post-hoc AAV administration. Together, these methods and applications demonstrate that modular and custom approaches can improve the precision, safety and efficacy problems that the gene therapy field needs in order to advance more treatments for rare disorders.

Thesis Files