Publications
The American Journal of Human GeneticsNov 2023 DOI:
10.1016/j.ajhg.2023.10.005

Efficient in vivo prime editing corrects the most frequent phenylketonuria variant, associated with high unmet medical need

Brooks, Dominique L.; Whittaker, Madelynn N.; Qu, Ping; Musunuru, Kiran; Ahrens-Nicklas, Rebecca C.; Wang, Xiao
Abstract
The c.1222C>T (p.Arg408Trp) variant in the phenylalanine hydroxylase gene (PAH) is the most frequent cause of phenylketonuria (PKU), the most common inborn error of metabolism. This autosomal-recessive disorder is characterized by accumulation of blood phenylalanine (Phe) to neurotoxic levels. Using real-world data, we observed that despite dietary and medical interventions, most PKU individuals harboring at least one c.1222C>T variant experience chronic, severe Phe elevations and do not comply with Phe monitoring guidelines. Motivated by these findings, we generated an edited c.1222C>T hepatocyte cell line and humanized c.1222C>T mouse models, with which we demonstrated efficient in vitro and in vivo correction of the variant with prime editing. Delivery via adeno-associated viral (AAV) vectors reproducibly achieved complete normalization of blood Phe levels in PKU mice, with up to 52% whole-liver corrective PAH editing. These studies validate a strategy involving prime editing as a potential treatment for a large proportion of individuals with PKU.

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