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- Title
Magnetic resonance imaging-guided phase 1 trial of putaminal AADC gene therapy for Parkinson's disease.
- Authors
Christine, Chadwick W.; Bankiewicz, Krystof S.; Van Laar, Amber D.; Richardson, R. Mark; Ravina, Bernard; Kells, Adrian P.; Boot, Brendon; Martin, Alastair J.; Nutt, John; Thompson, Marin E.; Larson, Paul S.
- Abstract
<bold>Objective: </bold>To understand the safety, putaminal coverage, and enzyme expression of adeno-associated viral vector serotype-2 encoding the complementary DNA for the enzyme, aromatic L-amino acid decarboxylase (VY-AADC01), delivered using novel intraoperative monitoring to optimize delivery.<bold>Methods: </bold>Fifteen subjects (three cohorts of 5) with moderately advanced Parkinson's disease and medically refractory motor fluctuations received VY-AADC01 bilaterally coadministered with gadoteridol to the putamen using intraoperative magnetic resonance imaging (MRI) guidance to visualize the anatomic spread of the infusate and calculate coverage. Cohort 1 received 8.3 × 1011 vg/ml and ≤450 μl per putamen (total dose, ≤7.5 × 1011 vg); cohort 2 received the same concentration (8.3 × 1011 vg/ml) and ≤900 μl per putamen (total dose, ≤1.5 × 1012 vg); and cohort 3 received 2.6 × 1012 vg/ml and ≤900 μl per putamen (total dose, ≤4.7 × 1012 vg). (18)F-fluoro-L-dihydroxyphenylalanine positron emission tomography (PET) at baseline and 6 months postprocedure assessed enzyme activity; standard assessments measured clinical outcomes.<bold>Results: </bold>MRI-guided administration of ascending VY-AADC01 doses resulted in putaminal coverage of 21% (cohort 1), 34% (cohort 2), and 42% (cohort 3). Cohorts 1, 2, and 3 showed corresponding increases in enzyme activity assessed by PET of 13%, 56%, and 79%, and reductions in antiparkinsonian medication of -15%, -33%, and -42%, respectively, at 6 months. At 12 months, there were dose-related improvements in clinical outcomes, including increases in patient-reported ON-time without troublesome dyskinesia (1.6, 3.3, and 1.5 hours, respectively) and quality of life.<bold>Interpretation: </bold>Novel intraoperative monitoring of administration facilitated targeted delivery of VY-AADC01 in this phase 1 study, which was well tolerated. Increases in enzyme expression and clinical improvements were dose dependent. ClinicalTrials.gov Identifier: NCT01973543 Ann Neurol 2019;85:704-714.
- Subjects
PARKINSON'S disease; GENE therapy; AROMATIC amino acid decarboxylase genes; AROMATIC amino acid decarboxylases; TARGETED drug delivery; TREATMENT effectiveness; INTRAOPERATIVE monitoring; MAGNETIC resonance imaging
- Publication
Annals of Neurology, 2019, Vol 85, Issue 5, p704
- ISSN
0364-5134
- Publication type
journal article
- DOI
10.1002/ana.25450