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Beneficial effects on vision in patients undergoing retinal gene therapy for choroideremia

Abstract

Retinal gene therapy is increasingly recognized as a novel molecular intervention that has huge potential in treating common causes of blindness, the majority of which have a genetic aetiology1,2,3,4,5. Choroideremia is a chronic X-linked retinal degeneration that was first described in 18726. It leads to progressive blindness due to deficiency of Rab-escort protein 1 (REP1). We designed an adeno-associated viral vector to express REP1 and assessed it in a gene therapy clinical trial by subretinal injection in 14 patients with choroideremia. The primary endpoint was vision change in treated eyes 2 years after surgery compared to unoperated fellow eyes. Despite complications in two patients, visual acuity improved in the 14 treated eyes over controls (median 4.5 letter gain, versus 1.5 letter loss, P = 0.04), with 6 treated eyes gaining more than one line of vision (>5 letters). The results suggest that retinal gene therapy can sustain and improve visual acuity in a cohort of predominantly late-stage choroideremia patients in whom rapid visual acuity loss would ordinarily be predicted.

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Fig. 1: Validation of the AAV2.REP1 gene therapy vector.
Fig. 2: Visual acuity changes in the 12 patients who received retinal gene therapy for choroideremia without complications as per protocol.
Fig. 3: Retinal structural and visual acuity changes in participants C1 and C2.
Fig. 4: Preferred retinal locus shift is maintained in the treated area after 5 years.

Data availability

The authors declare that all of the data supporting the findings of this study are available within the paper and the Supplementary Information and are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank all trial participants for their commitment to attending extensive follow-up visits, K. M. Jasani for helping with collection of the OCT and adverse events data, M. Hassall for helping with analysis of the AF data, and staff members of the Eye Research Group Oxford (ERGO) for their support throughout the study. This work was supported primarily by a grant (HICF-1009-006) from the Health Innovation Challenge Fund, a funding partnership between the UK Department of Health and the Wellcome Trust. Additional funding support was from the Health Foundation; Fight for Sight; the Lanvern Foundation; the Special Trustees of Moorfields Eye Hospital; the Royal College of Surgeons of Edinburgh and the National Institute for Health Research (NIHR) Biomedical Research Centres (BRC) at the Oxford University Hospitals NHS Foundation Trust (which includes the University of Oxford) and Moorfields Eye Hospital NHS Foundation Trust (which includes the University College London Institute of Ophthalmology).

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Authors

Contributions

K.X., J.K.J., A.R.B., A.R., A.P.S., M.I.P. and T.L.E. collected the data and performed data analysis. K.X. and M.G. assisted with surgery. T.T., A.R.B., M.I.P. and H.O.O. tested the vector. G.C.B., A.R.W., A.J.L., S.M.D. and R.E.M. were clinical trial investigators, who designed the trial protocol, managed patient recruitment and interpreted the data. G.E.H. performed electrophysiology, data analysis and helped with trial design. R.E.M. and M.C.S. obtained funding and designed the study. R.E.M. and K.X. wrote the manuscript. All authors provided scientific input and read and approved the manuscript.

Corresponding author

Correspondence to Robert E. MacLaren.

Ethics declarations

Competing interests

R.E.M.: scientific cofounder of Nightstar Therapeutics Inc.—a gene therapy company established by the University of Oxford and originally funded by the Wellcome Trust through Syncona Partners Ltd. A.R.B., G.C.B., A.J.L., G.C.B. and M.C.S.: consulting or on advisory board for Nightstar Therapeutics Inc. M.I.P., M.C.S. and R.E.M.: named inventors on patents relating to choroideremia gene therapy owned by the University of Oxford and Nightstar Therapeutics Inc. R.E.M., A.J.L. and G.C.B.: scientific advisory board to Spark Therapeutics Inc. The companies had no role in the conduct of this university-sponsored clinical trial, nor in the interpretation of the data, nor in the writing of the results. The views expressed are those of the authors and not necessarily those of the Wellcome Trust, the National Health Service, the NIHR or the UK Department of Health.

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Supplementary Figures 1–7, Supplementary Tables 1–7 and Supplementary Methods

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Xue, K., Jolly, J.K., Barnard, A.R. et al. Beneficial effects on vision in patients undergoing retinal gene therapy for choroideremia. Nat Med 24, 1507–1512 (2018). https://doi.org/10.1038/s41591-018-0185-5

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