Fludarabine increases nuclease-free AAV-and CRISPR/Cas9-mediated homologous recombination in mice

S Tsuji, CJ Stephens, G Bortolussi, F Zhang… - Nature …, 2022 - nature.com
S Tsuji, CJ Stephens, G Bortolussi, F Zhang, G Baj, H Jang, G de Alencastro, AF Muro
Nature biotechnology, 2022nature.com
Homologous recombination (HR)-based gene therapy using adeno-associated viruses (AAV-
HR) without nucleases has several advantages over classic gene therapy, especially the
potential for permanent transgene expression. However, the low efficiency of AAV-HR
remains a major limitation. Here, we tested a series of small-molecule compounds and
found that ribonucleotide reductase (RNR) inhibitors substantially enhance AAV-HR
efficiency in mouse and human liver cell lines approximately threefold. Short-term …
Abstract
Homologous recombination (HR)-based gene therapy using adeno-associated viruses (AAV-HR) without nucleases has several advantages over classic gene therapy, especially the potential for permanent transgene expression. However, the low efficiency of AAV-HR remains a major limitation. Here, we tested a series of small-molecule compounds and found that ribonucleotide reductase (RNR) inhibitors substantially enhance AAV-HR efficiency in mouse and human liver cell lines approximately threefold. Short-term administration of the RNR inhibitor fludarabine increased the in vivo efficiency of both non-nuclease- and CRISPR/Cas9-mediated AAV-HR two- to sevenfold in the murine liver, without causing overt toxicity. Fludarabine administration induced transient DNA damage signaling in both proliferating and quiescent hepatocytes. Notably, the majority of AAV-HR events occurred in non-proliferating hepatocytes in both fludarabine-treated and control mice, suggesting that the induction of transient DNA repair signaling in non-dividing hepatocytes was responsible for enhancing AAV-HR efficiency in mice. These results suggest that use of a clinically approved RNR inhibitor can potentiate AAV-HR-based genome-editing therapeutics.
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