Long-Term Follow-Up After Unilateral Intravitreal Gene Therapy for Leber Hereditary Optic Neuropathy: The RESTORE Study

Background: RESCUE and REVERSE were 2 Phase 3 clinical trials that assessed the efficacy and safety of intravitreal gene therapy with lenadogene nolparvovec (rAAV2/2-ND4) for the treatment of Leber hereditary optic neuropathy (LHON). RESTORE is the long-term follow-up study of subjects treated in the RESCUE and REVERSE trials. Methods: In RESCUE and REVERSE, 76 subjects with LHON because of the m.11778 G>A mutation in the mitochondrial gene ND4 received a single unilateral intravitreal injection of lenadogene nolparvovec. After 96 weeks, 61 subjects were enrolled in the long-term follow-up study RESTORE. The best-corrected visual acuity (BCVA) was assessed over a period of up to 52 months after onset of vision loss. A locally estimated scatterplot smoothing regression model was used to analyze changes in BCVA over time. Vision-related quality of life was reported using the visual function questionnaire-25 (VFQ-25). Results: The population of MT-ND4 subjects enrolled in RESTORE was representative of the combined cohorts of RESCUE and REVERSE for mean age (35.1 years) and gender distribution (79% males). There was a progressive and sustained improvement of BCVA up to 52 months after the onset of vision loss. The final mean BCVA was 1.26 logarithm of the minimal angle of resolution 48 months after the onset of vision loss. The mean VFQ-25 composite score increased by 7 points compared with baseline. Conclusion: The treatment effect of lenadogene nolparvovec on BCVA and vision-related quality of life observed 96 weeks (2 years) after treatment in RESCUE and REVERSE was sustained at 3 years in RESTORE, with a maximum follow-up of 52 months (4.3 years) after the onset of vision loss

Efficacy and Safety of Intravitreal Gene Therapy for Leber Hereditary Optic Neuropathy Treated within 6 Months of Disease Onset.

PURPOSE: To evaluate the efficacy of a single intravitreal injection of rAAV2/2-ND4 in subjects with visual loss from Leber hereditary optic neuropathy (LHON). DESIGN: RESCUE is a multicenter, randomized, double-masked, sham-controlled, phase 3 clinical trial. PARTICIPANTS: Subjects with the m.11778G>A mitochondrial DNA mutation and vision loss ≤6 months from onset in 1 or both eyes were included. METHODS: Each subject's right eye was randomly assigned (1:1) to treatment with rAAV2/2-ND4 (single injection of 9 × 1010 viral genomes in 90 μl) or to sham injection. The left eye received the treatment not allocated to the right eye. MAIN OUTCOME MEASURES: The primary end point was the difference of the change from baseline in best-corrected visual acuity (BCVA) between rAAV2/2-ND4-treated and sham-treated eyes at week 48. Other outcome measures included contrast sensitivity, Humphrey visual field perimetry, retinal anatomic measures, and quality of life. Follow-up extended to week 96. RESULTS: Efficacy analysis included 38 subjects. Mean age was 36.8 years, and 82% were male. Mean duration of vision loss at time of treatment was 3.6 months and 3.9 months in the rAAV2/2-ND4-treated eyes and sham-treated eyes, respectively. Mean baseline logarithm of the minimum angle of resolution (logMAR) BCVA (standard deviation) was 1.31 (0.52) in rAAV2/2-ND4-treated eyes and 1.26 (0.62) in sham-treated eyes, with a range from -0.20 to 2.51. At week 48, the difference of the change in BCVA from baseline between rAAV2/2-ND4-treated and sham-treated eyes was -0.01 logMAR (P = 0.89); the primary end point of a -0.3 logMAR (15-letter) difference was not met. The mean BCVA for both groups deteriorated over the initial weeks, reaching the worst levels at week 24, followed by a plateau phase until week 48, and then an improvement of +10 and +9 Early Treatment Diabetic Retinopathy Study letters equivalent from the plateau level in the rAAV2/2-ND4-treated and sham-treated eyes, respectively. CONCLUSIONS: At 96 weeks after unilateral injection of rAAV2/2-ND4, LHON subjects carrying the m.11778G>A mutation treated within 6 months after vision loss achieved comparable visual outcomes in the injected and uninjected eyes

Bilateral Visual Improvement with Unilateral Gene Therapy Injection for Leber Hereditary Optic Neuropathy

REVERSE is a randomized, double-masked, sham-controlled, multicenter, phase III clinical trial that evaluated the efficacy of a single intravitreal injection of rAAV2/2 ND4 in subjects with visual loss from Leber hereditary optic neuropathy (LHON). A total of 37 subjects carrying the m.11778G>A (MT-ND4) mutation and with duration of vision loss between 6 to 12 months were treated. Each subject’s right eye was randomly assigned in a 1:1 ratio to treatment with rAAV2/2 ND4 (GS010) or sham injection. The left eye received the treatment not allocated to the right eye. Unexpectedly, sustained visual improvement was observed in both eyes over the 96-week follow-up period. At Week 96, rAAV2/2 ND4-treated eyes showed a mean improvement in best-corrected visual acuity (BCVA) of -0.308 LogMAR (+15 ETDRS letters). A mean improvement of 0.259 (0.068) LogMAR (+13 ETDRS letters) was observed in the sham treated eyes. Consequently, the primary endpoint, defined as the difference in the change in BCVA from baseline to Week 48 between the two treatment groups, was not met (p = 0.894, ANCOVA). At Week 96, 25 subjects (68%) had a clinically relevant recovery in BCVA from baseline in at least one eye and 29 subjects (78%) had an improvement in vision in both eyes. A non-human primate study was conducted to investigate this bilateral improvement. Evidence of transfer of viral vector DNA from the injected eye to the anterior segment, retina and optic nerve of the contralateral non-injected eye supports a plausible mechanistic explanation for the unexpected bilateral improvement in visual function after unilateral injection

Fractal analyses reveal independent complexity and predictability of gait

Locomotion is a natural task that has been assessed for decades and used as a proxy to highlight impairments of various origins. So far, most studies adopted classical linear analyses of spatio-temporal gait parameters. Here, we use more advanced, yet not less practical, non-linear techniques to analyse gait time series of healthy subjects. We aimed at finding more sensitive indexes related to spatio-temporal gait parameters than those previously used, with the hope to better identify abnormal locomotion. We analysed large-scale stride interval time series and mean step width in 34 participants while altering walking direction (forward vs. backward walking) and with or without galvanic vestibular stimulation. The Hurst exponent α and the Minkowski fractal dimension D were computed and interpreted as indexes expressing predictability and complexity of stride interval time series, respectively. These holistic indexes can easily be interpreted in the framework of optimal movement complexity. We show that α and D accurately capture stride interval changes in function of the experimental condition. Walking forward exhibited maximal complexity (D) and hence, adaptability. In contrast, walking backward and/or stimulation of the vestibular system decreased D. Furthermore, walking backward increased predictability (α) through a more stereotyped pattern of the stride interval and galvanic vestibular stimulation reduced predictability. The present study demonstrates the complementary power of the Hurst exponent and the fractal dimension to improve walking classification. Our developments may have immediate applications in rehabilitation, diagnosis, and classification procedures

Neuropathie optique héréditaire de Leber

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Review of the last two decades experiences of technosols construction for urban greening

International audienceWith the rise in urban population and the urban sprawl come demand for solutions to offset the environmental burden in cities. Green infrastructures are interconnected urban spaces that provide multi-ecological functions and that mainly rely on their soils component. However, because of either the consumption of such natural resources as neighboring topsoil or the poor design and implementation of soil materials, actual approaches are questionable.Constructed Technosols, consisting of rational associations of organic and mineral wastes, are artificial soils designed to meet specific requirements. Such innovative solution based on circular economy may appear as valuable contribution to sustainable urban design. This presentation has two objectives: 1) to present the methods to create Constructed Technosols adapted for various greening purposes and 2) to present and discuss the various existing published experiences about Constructed Technosols for different land-uses (i.e. parks, street-side trees, stormwater management, urban farming, and derelict land reclamation).Our work aims at answering to the following questions: What are the main steps for the construction of Technosols? What materials and which formula should be used to design functional Constructed Technosols? What are the technical constraints to consider when using Constructed Technosols? What are the levels of ecosystem functions provided by Constructed Technosols? How fast and intense is the pedogenesis of Constructed Technosols and what are the consequences in terms of sustainability?Even though there is no optimal formula, this review provides key elements to both scientists, green spaces departments and actors involved in the management of urban soils. This review also confirms that Constructed Technosols are promising solutions for greening cities and producing potential interdisciplinary benefits for urbanites.Disclosure of Interest: None declare

Review of the last two decades experiences of technosols construction for urban greening

International audienceWith the rise in urban population and the urban sprawl come demand for solutions to offset the environmental burden in cities. Green infrastructures are interconnected urban spaces that provide multi-ecological functions and that mainly rely on their soils component. However, because of either the consumption of such natural resources as neighboring topsoil or the poor design and implementation of soil materials, actual approaches are questionable.Constructed Technosols, consisting of rational associations of organic and mineral wastes, are artificial soils designed to meet specific requirements. Such innovative solution based on circular economy may appear as valuable contribution to sustainable urban design. This presentation has two objectives: 1) to present the methods to create Constructed Technosols adapted for various greening purposes and 2) to present and discuss the various existing published experiences about Constructed Technosols for different land-uses (i.e. parks, street-side trees, stormwater management, urban farming, and derelict land reclamation).Our work aims at answering to the following questions: What are the main steps for the construction of Technosols? What materials and which formula should be used to design functional Constructed Technosols? What are the technical constraints to consider when using Constructed Technosols? What are the levels of ecosystem functions provided by Constructed Technosols? How fast and intense is the pedogenesis of Constructed Technosols and what are the consequences in terms of sustainability?Even though there is no optimal formula, this review provides key elements to both scientists, green spaces departments and actors involved in the management of urban soils. This review also confirms that Constructed Technosols are promising solutions for greening cities and producing potential interdisciplinary benefits for urbanites.Disclosure of Interest: None declare

Review of the last two decades experiences of technosols construction for urban greening

International audienceWith the rise in urban population and the urban sprawl come demand for solutions to offset the environmental burden in cities. Green infrastructures are interconnected urban spaces that provide multi-ecological functions and that mainly rely on their soils component. However, because of either the consumption of such natural resources as neighboring topsoil or the poor design and implementation of soil materials, actual approaches are questionable.Constructed Technosols, consisting of rational associations of organic and mineral wastes, are artificial soils designed to meet specific requirements. Such innovative solution based on circular economy may appear as valuable contribution to sustainable urban design. This presentation has two objectives: 1) to present the methods to create Constructed Technosols adapted for various greening purposes and 2) to present and discuss the various existing published experiences about Constructed Technosols for different land-uses (i.e. parks, street-side trees, stormwater management, urban farming, and derelict land reclamation).Our work aims at answering to the following questions: What are the main steps for the construction of Technosols? What materials and which formula should be used to design functional Constructed Technosols? What are the technical constraints to consider when using Constructed Technosols? What are the levels of ecosystem functions provided by Constructed Technosols? How fast and intense is the pedogenesis of Constructed Technosols and what are the consequences in terms of sustainability?Even though there is no optimal formula, this review provides key elements to both scientists, green spaces departments and actors involved in the management of urban soils. This review also confirms that Constructed Technosols are promising solutions for greening cities and producing potential interdisciplinary benefits for urbanites.Disclosure of Interest: None declare

Immune Response and Intraocular Inflammation in Patients With Leber Hereditary Optic Neuropathy Treated With Intravitreal Injection of Recombinant Adeno-Associated Virus 2 Carrying the ND4 Gene

International audienceImportance: Intravitreal gene therapy is regarded as generally safe with limited mild adverse events, but its systemic effects remain to be investigated.Objective: To examine the association between immune response and intraocular inflammation after ocular gene therapy with recombinant adeno-associated virus 2 carrying the ND4 gene (rAAV2/2-ND4).Design, Setting, and Participants:This secondary analysis of an open-label, dose-escalation phase 1/2 randomized clinical trial of rAAV2/2-ND4 included data from February 13, 2014 (first patient visit), to March 30, 2017 (last patient visit at week 96), the first 2 years after injection. Patients older than 15 years with diagnosed ND4 Leber hereditary optic neuropathy (LHON) and visual acuity of at least counting fingers were enrolled in 1 of 5 cohorts. Four dose cohorts of 3 patients each were treated sequentially. An extension cohort of 3 patients received the dose of 9 × 1010 viral genomes per eye.Interventions: Patients received increasing doses of rAAV2/2-ND4 (9 × 109, 3 × 1010, 9 × 1010, and 1.8 × 1011 viral genomes per eye) as a single unilateral intravitreal injection. Patients were monitored for 96 weeks after injection; ocular examinations were performed regularly, and blood samples were collected for immunologic testing.Main Outcomes and Measures: A composite ocular inflammation score (OIS) was calculated based on grades of anterior chamber cells and flare, vitreous cells, and haze according to the Standardization of Uveitis Nomenclature. The systemic immune response was quantified by enzyme-linked immunospot (cellular immune response), enzyme-linked immunosorbent assay (IgG titers), and luciferase assay (neutralizing antibody [NAb] titers).Results: The present analysis included 15 patients (mean [SD] age, 47.9 [17.2] years; 13 men and 2 women) enrolled in the 5 cohorts of the clinical trial. Thirteen patients experienced intraocular inflammation after rAAV2/2-ND4 administration. Mild anterior chamber inflammation and vitritis were reported at all doses, and all cases were responsive to treatment. A maximum OIS of 9.5 was observed in a patient with history of idiopathic uveitis. Overall, OIS was not associated with the viral dose administered. No NAbs against AAV2 were detected in aqueous humor before treatment. Two patients tested positive for cellular immune response against AAV2 at baseline and after treatment. Humoral immune response was not apparently associated with the dose administered or with the immune status of patients at baseline. No association was found between OISs and serum NAb titers.Conclusions and Relevance: In this study, intravitreal administration of rAAV2/2-ND4 in patients with LHON was safe and well tolerated. Further investigations may shed light into the local immune response to rAAV2/2-ND4 as a potential explanation for the observed intraocular inflammation

Systematic identification of barriers to human iPSC generation.

Reprogramming of somatic cells to induced pluripotent stem cells (iPSCs) holds enormous promise for regenerative medicine. To elucidate endogenous barriers limiting this process, we systematically dissected human cellular reprogramming by combining a genome-wide RNAi screen, innovative computational methods, extensive single-hit validation, and mechanistic investigation of relevant pathways and networks. We identify reprogramming barriers, including genes involved in transcription, chromatin regulation, ubiquitination, dephosphorylation, vesicular transport, and cell adhesion. Specific a disintegrin and metalloproteinase (ADAM) proteins inhibit reprogramming, and the disintegrin domain of ADAM29 is necessary and sufficient for this function. Clathrin-mediated endocytosis can be targeted with small molecules and opposes reprogramming by positively regulating TGF-β signaling. Genetic interaction studies of endocytosis or ubiquitination reveal that barrier pathways can act in linear, parallel, or feedforward loop architectures to antagonize reprogramming. These results provide a global view of barriers to human cellular reprogramming