Abstract
Helper-dependent adenoviral vectors (HDAd) are attractive vectors for liver-directed gene therapy because they can mediate long-term, high level transgene expression with no long-term toxicity. However, as a consequence of a threshold effect, high vector doses are required to achieve efficient hepatic transduction by peripheral intravenous injection which unfortunately results in a dose-dependent activation of the innate inflammatory response. Clearly strategies to overcome the threshold to efficient hepatic transduction are needed to improve the therapeutic index of HDAd. We hypothesized that this obstacle could be surmounted by delivering the vector exclusively to the liver. To test this hypothesis, we have injected HDAd directly into the surgically isolated liver via the portal vein in nonhuman primates. Total hepatic isolation was achieved by occluding hepatic inflow from the portal vein and hepatic artery and by occluding hepatic venous outflow at the inferior vena cava. Prior to total hepatic isolation, saline was infused into the portal vein to flush blood out of the liver. The vector was then injected directly into the liver via the portal vein and allowed to dwell for 30 minutes, following which unabsorbed vector was flushed out via a catheter placed in the vena cava to minimize systemic vector dissemination. Our results revealed that significantly higher hepatic transduction efficiencies can be achieved with relatively low vector doses compared to peripheral intravenous injection. Importantly, stable, high levels of transgene expression were observed for up to one year with no long-term toxicity. This approach may increase the safety and efficacy of HDAd-mediated, liver-directed gene therapy by minimizing the dose required to achieve efficient hepatic transduction and by minimizing systemic vector dissemination.
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