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AV8 gene therapy and environmental exposure precipitate cholestatic liver disease in a mouse model of X-linked myotubular myopathy

ABSTRACT: AAV-associated hepatotoxicity has been observed in patients, with poor concordance between preclinical studies and clinical outcomes. Gene therapy for X-linked myotubular myopathy (XLMTM) has epitomized this therapeutic dilemma, as an AAV8-MTM1 clinical trial has shown efficacy but also fatal liver failure in a subset of individuals. In the present study, we address this conundrum, and demonstrate for the first time in mice that early-life nutrition and AAV exposure can promote liver injury. Specifically, XLMTM mice fed a purified-diet manifest liver dysfunction that mirrors what is seen in patients. AAV8-therapy increases this susceptibility, and additionally promotes liver injury in wild-type mice. Notably, non-viral lipid nanoparticle delivery of MTM1 rescues the XLMTM liver phenotype, offering a potential treatment strategy to mitigate liver consequences in patients. Together, these data provide critical insight into the adverse events seen in viral-gene therapy studies and set the stage for defining their pathomechanisms and identifying potential therapies.

ORGANISM(S): Mus musculus

PROVIDER: GSE264209 | GEO | 2025/06/01

REPOSITORIES: GEO

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Project description:Purpose: The goal of this study was to investigate the transcriptional profile of genes expressed in the quadriceps muscle of myotubularin deficient (Mtm1-/-) mice, and determine whether improvements in the pathophysiology of tamoxifen treated Mtm1-/- mice are a consequence of ER-dependent transcriptional modulation. Methods: Muscle mRNA profiles from quadriceps of 36-day-old wild-type (WT), myotubularin deficient (Mtm1-/-) mice, and tamoxifen treated WT and Mtm1-/- mice were generated by deep sequencing, in triplicate or quadruplicate, using Illumina HiSeq 2500. Read sets from each of the 14 samples across the four conditions were aligned to the reference genome (GRCm38/MM10 version of the Mus musculus genome) and transcriptome using STAR (Dobin et al. Bioinformatics 2013 PMID: 23104886) two-step alignment to generate a Binary Alignment Map file (BAM file). Coordinate sorted BAM files were used to quantify transcript abundance (count data) using HTSeq (Anders et al. Bioinformatics 2014, PMID: 25260700). Raw read counts generated were used as input for differential gene expression analysis, carried out using both DESeq (Anders and Huber 2010) and edgeR (Robinson, McCarthy, and Smyth 2010) R/Bioconductor packages. This was carried out in a pair-wise manner between any two conditions that were considered. FDR adjusted p-values from both edgeR and DESeq was used to determine genes that are significantly differentially expressed between the conditions tested. Finally, we used the GoSeq R/Bioconductor package (Young MD, et al Genome Biology, 11, pp. R14) to identify pathways that were significantly enriched for differentially expressed genes between any two conditions. Results: Using an established data analysis workflow, 65 million reads were aligned per sample (>90% exonic). We observed 849 differentially expressed transcripts in untreated mtm1-/-mice (p< 0.01) in comparison to wild-type (WT) controls. Furthermore, we identified 29 differentially expressed genes (p<0.01) between mtm1-/- mice and their TAM-treated mtm1-/- mice. In particular, we observed that the transcriptional profiles of mtm1 -/- mice and tamoxifen-treated mtm1-/- mice cluster together and are distinct from wild-type contros. Moreover, no significant changes were observed in the expression of estrogen-response genes that are known gene targets of tamoxifen; no significant transcriptional changes were observed in well-known MTM-related genes.This strongly indicates that, contrary to its well-established function as a transcriptional modulator, tamoxifen improves the pathophysiology of myotubular myopathy in a post-transcriptional manner. Concusions: Our study represents the first comprehensive analysis of the whole transcriptome of the Mtm1-/- and tamoxifen treated Mtm1-/- mouse, generated by RNA-seq technology. The data reported here provides a framework a comparative investigation of the expression profiles in Mtm1-/- mice and tamoxifen treated Mtm1-/- mice. Importantly, our results demonstrate that in our MTM murine model, tamoxifen does not appear to alter the transcriptional profile of many estrogen-receptor (ER) related genes, and moreover does not appear to alter the transcriptional profile of genes that are abnormally expressed in Mtm1-/- mice alone. This suggests that tamoxifen is acting to improve the pathophysiology of the MTM mouse model in a transcriptionally-indepedent manner.

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AV8 gene therapy and environmental exposure precipitate cholestatic liver disease in a mouse model of X-linked myotubular myopathy

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