Muscle-specific CRISPR/Cas9 dystrophin gene editing ameliorates pathophysiology in a mouse model for Duchenne muscular dystrophy

TLDR

AAV gene‑replacement therapies hold promise for Duchenne muscular dystrophy, and AAV vectors can also be used to edit the DMD gene via CRISPR/Cas9. The study develops multiple AAV‑mediated strategies to edit the DMD mutation in mdx 4cv mice, employing muscle‑specific Cas9, sgRNAs, and in one case a dystrophin homology region for full correction. Muscle‑restricted Cas9 expression allows direct mutation editing, multi‑exon deletion, or homologous recombination‑mediated gene correction in myogenic cells. Intramuscular delivery yields dystrophin expression in up to 70 % of myogenic area and enhanced force, while systemic administration produces widespread dystrophin in skeletal and cardiac muscle, demonstrating the therapeutic potential of AAV‑mediated muscle‑specific gene editing.

Abstract

Abstract Gene replacement therapies utilizing adeno-associated viral (AAV) vectors hold great promise for treating Duchenne muscular dystrophy (DMD). A related approach uses AAV vectors to edit specific regions of the DMD gene using CRISPR/Cas9. Here we develop multiple approaches for editing the mutation in dystrophic mdx 4cv mice using single and dual AAV vector delivery of a muscle-specific Cas9 cassette together with single-guide RNA cassettes and, in one approach, a dystrophin homology region to fully correct the mutation. Muscle-restricted Cas9 expression enables direct editing of the mutation, multi-exon deletion or complete gene correction via homologous recombination in myogenic cells. Treated muscles express dystrophin in up to 70% of the myogenic area and increased force generation following intramuscular delivery. Furthermore, systemic administration of the vectors results in widespread expression of dystrophin in both skeletal and cardiac muscles. Our results demonstrate that AAV-mediated muscle-specific gene editing has significant potential for therapy of neuromuscular disorders.