title: Challenges and Prospects for Alpha-1 Antitrypsin Deficiency Gene Therapy.
abstract: Alpha-1 antitrypsin (AAT) is a protease inhibitor belonging to the serpin family. A number of identified mutations in the SERPINA1 gene encoding this protein result in alpha-1 antitrypsin deficiency (AATD). A decrease in AAT serum concentration or reduced biological activity causes considerable risk of chronic respiratory and liver disorders. As a monogenic disease, AATD appears to be an attractive target for gene therapy, particularly for patients with pulmonary dysfunction, where augmentation of functional AAT levels in plasma might slow down respiratory disease development. The short AAT coding sequence and its activity in the extracellular matrix would enable an increase in systemic serum AAT production by cellular secretion. In vitro and in vivo experimental AAT gene transfer with gamma-retroviral, lentiviral, adenoviral, and adeno-associated viral (AAV) vectors has resulted in enhanced AAT serum levels and a promising safety profile. Human clinical trials using intramuscular viral transfer with AAV1 and AAV2 vectors of the AAT gene demonstrated its safety, but did not achieve a protective level of AAT >11 μM in serum. This review provides an in-depth critical analysis of current progress in AATD gene therapy based on viral gene transfer. The factors affecting transgene expression levels, such as site of administration, dose and type of vector, and activity of the immune system, are discussed further as crucial variables for optimizing the clinical effectiveness of gene therapy in AATD subjects.
authors.affiliation: 1 Department of Gene Therapy, Faculty of Medicine, Nicolaus Copernicus University in Torun , Bydgoszcz, Poland .
authors.forename: Joanna
authors.initials: J
authors.lastname: Wozniak
authors.affiliation: 1 Department of Gene Therapy, Faculty of Medicine, Nicolaus Copernicus University in Torun , Bydgoszcz, Poland .
authors.forename: Tomasz
authors.initials: T
authors.lastname: Wandtke
authors.affiliation: 1 Department of Gene Therapy, Faculty of Medicine, Nicolaus Copernicus University in Torun , Bydgoszcz, Poland .
authors.forename: Piotr
authors.initials: P
authors.lastname: Kopinski
authors.affiliation: 2 Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases , Warsaw, Poland .
authors.forename: Joanna
authors.initials: J
authors.lastname: Chorostowska-Wynimko
mesh_terms: D000818:Animals; D002986:Clinical Trials as Topic; D015316:Genetic Therapy / Q000009:adverse effects; D005822:Genetic Vectors; D006801:Humans; D014780:Viruses / Q000145:classification / Q000235:genetics; D019896:alpha 1-Antitrypsin Deficiency / Q000097:blood / Q000235:genetics* / Q000503:physiopathology / Q000628:therapy*