Treatment of anti-myeloperoxidase glomerulonephritis using recombinant deoxyribonuclease I is enhanced by adeno-associated virus gene therapy

Anne Cao Le, Poh-Yi Gan, Daniel Koo Yuk Cheong, Virginie Oudin, Jonathan Dick, Maliha Alikhan, Mawj Mandwie, Ian Alexander, A. Richard Kitching, Grant J Logan, Kim Maree O'Sullivan
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Abstract

Extracellular DNA (ecDNA) released from injured and dying cells powerfully induces injurious inflammation. In this study we show ecDNA renal presence in patients and experimental mice with myeloperoxidase anti-neutrophil cytoplasmic antibody-associated glomerulonephritis (MPO-ANCA GN). Twice daily administration of intravenous DNase I (ivDNase I) in two models of anti-MPO GN was effective at reducing glomerular deposition of ecDNA, histological injury, leukocyte infiltration and NETosis. Comprehensive investigation into DNase I modes of action revealed the enzyme reduced lymph node DC numbers and their activation status, resulting in decreased frequency of MPO-specific CD4 effector T cells (IFN-gamma and IL17A producing), reductions in dermal anti-MPO delayed type hypersensitivity responses and increased frequency of MPO-specific T regulatory cells. Renal expression of inflammatory chemokines were also decreased. To overcome the translational obstacle of the short half-life of DNase I (<5 hours), we tested an adeno-associated viral vector encoding DNase I in one of the models. Along with the endpoint changes described above, a single vector treatment also enhanced therapeutic benefit as seen by reductions in MPO-ANCA and albuminuria. These results indicate ecDNA is a potent driver of anti-MPO GN and that DNase I is a potential therapeutic that can be delivered using gene technology.
腺相关病毒基因疗法增强了使用重组脱氧核糖核酸酶 I 治疗抗髓过氧化物酶肾小球肾炎的效果
受伤和死亡细胞释放的细胞外 DNA(ecDNA)可强力诱发损伤性炎症。在这项研究中,我们发现在髓过氧化物酶抗中性粒细胞胞浆抗体相关性肾小球肾炎(MPO-ANCA GN)患者和实验小鼠肾脏中存在 ecDNA。在两种抗 MPO GN 模型中,每天两次静脉注射 DNase I(ivDNase I)可有效减少肾小球的 ecDNA 沉积、组织学损伤、白细胞浸润和 NETosis。对 DNase I 作用模式的全面研究表明,该酶能减少淋巴结 DC 的数量及其活化状态,从而降低 MPO 特异性 CD4 效应 T 细胞(产生 IFN-gamma 和 IL17A)的频率,减少真皮抗 MPO 迟发型超敏反应,增加 MPO 特异性 T 调节细胞的频率。肾脏中炎症趋化因子的表达也有所减少。为了克服 DNase I 半衰期短(5 小时)这一转化障碍,我们在其中一个模型中测试了编码 DNase I 的腺相关病毒载体。除了上述终点变化外,单一载体治疗还能提高治疗效果,这体现在 MPO-ANCA 和白蛋白尿的减少上。这些结果表明,ecDNA 是抗 MPO GN 的强大驱动力,而且 DNase I 是一种可利用基因技术提供的潜在疗法。
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