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Combined Effect of Cyclosporine and Sirolimus on Improving the Longevity of Recombinant AdenovirusMediated Transgene Expression in the Retina
Wei-Yong Shen, MD;
May C. Lai, PhD;
John Beilby, MD;
Nigel L. Barnett, PhD;
Jie Liu, MD;
Ian J. Constable, MD;
Piroska E. Rakoczy, PhD
Arch Ophthalmol. 2001;119:1033-1043.
Objectives To reevaluate the longevity and intraocular safety of recombinant adenovirus
(rAd)mediated gene delivery after subretinal injection, and to prolong
transgene expression through the combination of 2 synergistic immunosuppressants.
Methods An rAd vector carrying green fluorescent protein (GFP) gene was delivered subretinally in the rat eye. The GFP expression
was monitored in real time by fundus fluorescent photography. Intraocular
safety was examined by observation of changes of retinal pigmentation, cell
infiltration in virus-contacted area, immunophenotyping for CD4+
and CD8+ cytotoxic T lymphocytes, and CD68+ macrophages,
histologic findings, and dark-adapted electroretinography. Two synergistic
immunosuppressants, cyclosporine and sirolimus, were used alone or in combination
to prolong transgene expression by temporary immunosuppression.
Results The GFP expression peaked on day 4, dramatically decreased on day 10,
and was not detectable on day 14. The decreased GFP expression was coincident
with cell infiltration in virus-contacted area. Immunostaining showed that
the infiltrating cells were CD4+ and CD8+ cytotoxic
T lymphocytes and CD68+ macrophages. Clumped retinal pigmentation
and decreased b wave of dark-adapted electroretinogram were observed at 3
to 4 weeks after injection. Histologic examination confirmed rAd-induced retinal
degeneration. Transient immunosuppression by cyclosporine and sirolimus, either
alone or in combination, improved transgene expression, with the combination
being the most efficient. The combined immunosuppression attenuated but did
not retard the rAd-induced retinal damage.
Conclusions Transgene expression mediated by rAd after subretinal delivery is short-term
and toxic to the retina. Combination of cyclosporine and sirolimus may act
as an immunosuppressive adjunct to prolong rAd-mediated gene transfer.
Clinical Relevance The intraocular safety of rAd should be carefully considered before
clinical trials are performed.
From the Centre for Ophthalmology and Visual Science, University of
Western Australia, Perth (Drs Shen, Lai, Liu, Constable, and Rakoczy); Centre
for Pathology and Medical Research, Queen Elizabeth II Medical Centre, Perth
(Dr Beilby); and Vision, Touch & Hearing Research Center, Department of
Physiology and Pharmacology, University of Queensland, Brisbane, Australia
(Dr Barnett).
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