Group Title: Genetic Vaccines and Therapy 2008, 6:14
Title: Relative persistence of AAV serotype 1 vector genomes in dystrophic muscle
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Title: Relative persistence of AAV serotype 1 vector genomes in dystrophic muscle
Series Title: Genetic Vaccines and Therapy 2008, 6:14
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Creator: Pacak CA
Conlon T
Mah CS
Byrne BJ
Publication Date: 39736
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Genetic Vaccines and Therapy

Short paper

Relative persistence of AAV serotype I vector genomes in
dystrophic muscle
Christina A Pacak1,2, Thomas Conlon1,2, Cathryn S Mah*1,3 and
Barry J Byrne*1,2,3

Bioled Central

Address: 'Powell Gene Therapy Center, University of Florida, Gainesville, FL, USA, 2Department of Pediatrics, University of Florida, Gainesville,
FL, USA and 3Division of Cellular and Molecular Therapy, Department of Pediatrics, University of Florida, Gainesville, FL, USA
Email: Christina A Pacak; Thomas Conlon; Cathryn S Mah*;
Barry J Byme*
* Corresponding authors

Published: 15 October 2008
Genetic Voccines and Therapy 2008, 6:14 doi:10. 1186/1479-0556-6-14

Received: 10 June 2008
Accepted: 15 October 2008

This article is available from:
2008 Pacak et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The purpose of this study was to assess the behavior of pseudotyped recombinant adeno-
associated virus type I (rAAV2/1I) vector genomes in dystrophic skeletal muscle. A comparison was
made between a therapeutic vector and a reporter vector by injecting the hindlimb in a mouse
model of Limb Girdle Muscular Dystrophy Type 2D (LGMD-2D) prior to disease onset. We
hypothesized that the therapeutic vector would establish long-term persistence through
prevention of myofiber turnover. In contrast, the reporter vector genome copy number would
diminish over time due to disease-associated muscle degradation.
One day old alpha sarcoglycan knockout mice (sgca-'-) were injected with I x I01' vector genomes
of rAAV2/1-tMCK-sgca in one hindlimb and the same dose of rAAV2/I-tMCK-LacZ in the contra
lateral hindlimb. Newborn mice are tolerant of the foreign transgene allowing for long-term
expression of both the marker and the therapeutic gene in the null background. At 2 time-points
following vector administration, hindlimb muscles were harvested and analyzed for LacZ or
sarcoglycan expression. Our data demonstrate prolonged vector genome persistence in skeletal
muscle from the hindlimbs injected with the therapeutic transgene as compared to hindlimbs
injected with the reporter gene. We observed loss of vector genomes in skeletal muscles that were
there were not protected by the benefits of therapeutic gene transfer. In comparison, the
therapeutic vector expressing sarcoglycan led to reduction or elimination of myofiber loss.
Mitigating the membrane instability inherent in dystrophic muscle was able to prolong the life of
individual myofibers.

Limb Girdle Muscular Dystrophy Type 2D (LGMD-2D) is
an autosomal recessive disorder caused by mutations in
the alpha sarcoglycan gene (sgca) and is the most preva-
lent of the sarcoglycanopathies; a class of dystrophies in
which one of 6 transmembrane sarcoglycan proteins is

deficient [1]. LGMD-2D affects both genders equally with
onset typically occurring in the first decade of life [2]. The
degree of severity in disease phenotype correlates with the
amount of sgca protein present in the affected individual
[3]. Presently, there is no definitive treatment available for
this disease and care is aimed at minimizing disease pro-

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Genetic Vaccines and Therapy 2008, 6:14

gression. A clinically applicable gene delivery technique
for LGMD-2D is being pursued by various investigators as
a method for halting the debilitating consequences of sar-
coglycan deficiency and similar diseases [4,5].

Adeno-associated virus (AAV) is a useful vehicle for gene
transfer to skeletal muscle where it has been shown to per-
sist as an episome [6,7]. Here we sought to examine the
persistence of AAV genomes in dystrophic muscle over
time. To do so, we injected the skeletal muscles of 4 one-
day old alpha-sarcoglycan knockout (sgca-i-) mouse hind-
limbs with 1 x 1011 vector genomes of a vector we have
previously shown to be therapeutic: rAAV2/1-tMCK-sgca
[4]. This vector contains the human alpha sarcoglycan
(sgca) gene and a previously described truncated murine
creatine kinase (tMCK) promoter [4]. The skeletal muscles
of the contra-lateral hindlimb were injected with 1 x 1011
vector genomes of a reporter-gene containing vector:
rAAV2/1-tMCK-LacZ which contains the same promoter
driving the beta galactosidase (LacZ) gene. Neonatal mice
were anesthetized by induced hypothermia and a 29.5-G
tuberculin syringe was used to perform single intra-mus-
cular (IM) injections of each vector formulated in phos-
phate-buffered saline (total volume of 35 tiL per
injection). The bevel of the needle was inserted facing up
near the tendons of the anterior compartment at the ankle
and pointing up into the tibialis anterior along the tibia
into the upper hindlimb area. The virus solution was
injected while withdrawing the needle to maximize area
over which the vector was distributed.

At either 4 or 12 months post-administration, muscles
were harvested and vector genomes were quantified and
compared. Genomic DNA was isolated from frozen tissue
samples as previously described [8]. The persistence of
vector genomes was determined using the following PCR
primer/probe set against the murine creatine kinase
(tMCK) promoter. Forward Primer: 5'-GGCACCTATT-

Our results show that at both 4 and 12 months post virus
administration there were a statistically significantly
higher number of vector genomes present in those hind-
limb muscles injected with rAAV2/1-tMCK-sgca than
those injected with rAAV2/1-tMCK-LacZ (Figure 1A). At 2
months post administration differences in the number of
transduced myofibers between each hindlimb (as demon-
strated by immunohistochemistry and LacZ staining of
frozen skeletal muscle cryosections to identify alpha sar-
coglycan [green] and 3-galactosidase [blue]) were subtle
(Figure 1E-F) but increased over time (Figure 1G-J). Vec-
tor genome assessment of extensor digitorum longus (EDL),
and the tibialis anterior (TA) were combined as they are

both composed of predominately fast-twitch myofibers
(Figure 1B). At 4 months post virus administration a sig-
nificant difference in the ability of the two vectors to per-
sist over time in dystrophic muscle became evident. This
difference was still present but was not as profound at 12
months post injection since the total number of vector
genomes in rAAV2/1-tMCK-sgca injected EDL, and TA
muscles decreased over time.

In contrast, vector genome assessment of muscles com-
posed of either primarily slow-twitch or mixed amounts
of each fiber type gastrocnemiuss [Ga], soleus [So], and
quadriceps [Qu]) showed a significant difference between
the two vector's relative persistence at both time points
(Figure 1C). Specifically, the number of vector genomes
detected in the Ga muscles decreased only slightly and
those detected in the So muscles of the same hindlimbs
did not decrease over time.

The difference or spread in the numbers of detectable
genomes in each muscle as compared to those in the same
muscle of the contra lateral hindlimb revealed an interest-
ing pattern. The mean number of genomes detected for
each LacZ muscle at both time points was subtracted from
the mean number of genomes detected for each sgca mus-
cle at both time points to allow for a comparison of differ-
ences (or range in mean genome number) between
individual muscles in hindlimbs over time. Of those mus-
cles assessed in this study the So is composed of the high-
est percentage of slow twitch myofibers and it was the
only muscle that demonstrated a larger spread between
numbers of vector genomes at the 12 month time point
than at the 4 month. The EDL however, is composed of
predominately fast twitch myofibers. When compared to
the other muscles in this study it showed the greatest
decrease in spread between persistent vector genomes in
muscles from each leg. Our results suggest a greater overall
amount of muscle turnover in the EDL than in the other
individual muscles we analyzed regardless of which vector
was administered. This may suggest that fast-twitch (type
II) fibers (of which the EDL is primarily composed of [>
97%][9]) have a tendency to turnover more rapidly than
muscles composed of either a mixture of fiber types or of
primarily slow twitch fibers (type I).

To our knowledge, an explanation for the random devel-
opment of dystrophic lesions in both mouse models of
muscular dystrophy as well as the humans suffering from
this disease has not yet been presented. Our data provides
further evidence that individual muscles in this disease
model may not all have the same rate of myofiber turn-
over leading to tissue fibrosis/necrosis.

The IM delivery method used in this study does not suffi-
ciently deliver vector to every muscle fiber in an equal

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Genetic Vaccines and Therapy 2008, 6:14








p =0.39

4 Months 12 Monthr 4 Months 12 Months

4 Months 12 Months ED so TA Ga

Hf -
ra l M

Figure I
Vector genome persistence. (A-C) Log graphs showing vector genome amounts in individual muscles of the lower sgca-'-
mouse hindlimb at 4 or 12 months post administration of either rAAV2/1-tMCK-sgca (black bars) or rAAV2/I -tMCK-LacZ
(grey bars). Greater persistence of vector genomes is observed in the sgca injected muscles (* indicates statistical significance
[p-value < 0.05], ** indicates p-value = 0.29). (A) Data for all muscles combined from the right (sgca injected) and the left (LacZ
injected) hindlimbs at 4 or 12 months post injection. Muscles analyzed include: extensor digitorum longus (ED), gastrocnemius
(Ga), soleus (So), tibialis anterior (TA), and quadriceps (Qu). (B) Combined (primarily) fast-twitch muscle data (ED and TA) at 4
and 12 months post injection. (C) Combined mixed/slow-twitch muscle data (Ga, So, and Qu) at 4 and 12 months post injec-
tion. (D) Bar graph depicting the differences in vector genome copy numbers in individual muscles at either 4 months (black) or
12 months (grey) post injection. Differences in expression levels between the two constructs were greater at 4 than at 12
months post administration. (E) Immunofluorescence image of a quadriceps muscle cryosection (2 months post rAAV2/ I -
tMCK-sgca administration) showing alpha-sarcoglycan located at the cell membrane (green) and nuclei maintained in the cell
periphery (DAPI stain-blue). (F) P-galactosidase stained quadriceps muscle cryosection (2 months post rAAV2/I-tMCK-LacZ
administration) showing staining in transduced myofibers (blue). (G-H) Images of extensor digitorum longus muscles (4 months
post delivery of sgca or LacZ [respectively]). (I-J) Images of soleus muscles (4 months post delivery of sgca or LacZ [respec-

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Genetic Vaccines and Therapy 2008, 6:14

manner. Therefore, there are likely areas of protected mus-
cle that do contain the therapeutic transgene as well as
unprotected muscle areas that deteriorate over time and
could eventually overwhelm the treated myofibers and
could be another explanation for higher-level turnover in
the EDL. Additionally, the sgca protein is membrane
bound and not secreted, so transduction of one cell will
not be a sufficient way to provide therapy to the surround-
ing area. Because our delivery method is simple and
allows for a single injection to transduce multiple muscles
to a high degree, it is a useful proof of concept technique.
Use of alternative IV delivery methods could provide a
more even biodistribution and may be more clinically
applicable [5,10].

Our data demonstrate the ability of a therapeutic vector to
maintain the integrity of transduced muscle fibers, and
thereby lead to improved myofiber survival. Our results
derived from muscles transduced with a reporter gene vec-
tor serve as a model for determination of the amount of
muscle fiber turnover between various muscles in this dis-
ease model. Future studies demonstrating protection of
muscle from a degenerative disease could incorporate a
cell proliferation assay such as that developed by Salic et
al to further uncover the [11]. While the body's natural
muscle regeneration machinery attempts to restore dam-
aged tissue, the non-therapeutic (reporter gene) AAV
genomes that would persist in normal muscle as episomes
are lost in proportion to the diseased myofiber number.
The ability of the rAAV2/1-tMCK-sgca vector to prevent
myofibers from membrane damage has the potential to
serve as an important therapeutic strategy in the future.
Further studies of the potential for this vector to promote
repair in muscle with existing dystrophy will be needed.

AAV: adeno-associated virus; ED: extensor digitorum longus;
Ga: gastronemius; IM: intra-muscular; LacZ: beta galactosi-
dase; LGMD-2D: limb girdle muscular dystrophy type 2D;
PCR: polymerase chain reaction; Qu: quadriceps; sgca:
alpha-sarcoglycan; So: soleus; TA: tibialis anterior; tMCK:
truncated murine creatine kinase.

Competing interests
The Johns Hopkins University, the University of Florida,
and B.J.B. could be entitled to patent royalties for inven-
tions related to the findings in this article.

Authors' contributions
CAP participated in the design of the study, performed the
injections, harvested the tissues, performed the immuno-
histochemistry analysis and drafted the manuscript. CSM
participated in the design of the study and helped to draft
the manuscript. TJC participated in the design of the study
and performed vector genome analysis and helped to

draft the manuscript. BJB participated in the design of the
study. All authors read and approved the final manuscript.

We would like to express our gratitude to Dr. Kevin P. Campbell from the
University of Iowa for providing the sgca-- mouse model used in these stud-
ies. We would also like to acknowledge the University of Florida Powell
Gene Therapy Center Toxicology staff for vector genome quantification
and the Powell Gene Therapy Center Viral Vector Core for making the
AAV used in these experiments. This work was supported in part by an
American Heart Association Pre-doctoral Fellowship Award-Florida and
Puerto Rico Affiliate (to CAP), the NIH National Heart, Lung, and Blood
Institute grant PO I HL59412; National Institute of Diabetes and Digestive
and Kidney Diseases grant PO I DK58327; AT-NHLBI-U01 HL69748; and
the AHA National Center (to C.S.M.).

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