Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Adeno-associated virus neutralising antibodies in type 1 diabetes mellitus

Abstract

Recombinant Adeno-associated viruses (AAVs) are an attractive vector for gene therapy delivery which may be blocked by AAV neutralising antibodies (NAbs). As Type 1 Diabetes (T1DM) is an endocrine disease of immunological origin, it is likely that NAb profiles are altered in the disease. In this study NAb to AAV2, AAV5, AAV6, and AAV8 in 72 subjects with T1DM and 45 non-diabetic patients were measured over a 4-year follow-up period. AAV2 NAb titres were significantly lower in non-diabetic subjects (P = 0.036). The T1DM group had more AAV8 NAb activity at baseline (P = 0.019), whilst after 4 years follow-up the T1DM group displayed developed increased AAV 5 (P = 0.03), 6 (P = 0.03) and 8 (P = 0.002) activity relative to the control group, however, overall AAV5 and 8 NAb levels were very low in patients <40. AAV NAb titre activity and prevalence generally appears higher in T1DM, however, low levels of AAV 5 and 8, particular in younger adult age groups at which T1DM can be targeted, could make these attractive vectors to target the disease.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Association AD. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37(Supplement 1):S81–90.

    Article  Google Scholar 

  2. Gepts W. Pathologic anatomy of the pancreas in juvenile diabetes mellitus. Diabetes. 1965;14:619–33.

    Article  CAS  PubMed  Google Scholar 

  3. Dorko E, Baranova Z, Jenča A, Kizek P, Pilipčinec E. Diabetes mellitus and candidiases. Folia Microbiol (Praha). 2005;50:255.

    Article  CAS  Google Scholar 

  4. Poovazhagi V, Thangavelu S, Umadevi L, Suresh S, Kasturi K. Infections in children with type 1 diabetes mellitus. Int J Diabetes Dev Ctries. 2011;31:14–7.

    Article  Google Scholar 

  5. Bingley PJ. Clinical applications of diabetes antibody testing. J Clin Endocrinol Metab. 2010;95:25–33.

    Article  CAS  PubMed  Google Scholar 

  6. Krischer JP, Lynch KF, Schatz DA, Ilonen J, Lernmark Å, Hagopian WA, et al. The 6 year incidence of diabetes-associated autoantibodies in genetically at-risk children: the TEDDY study. Diabetologia. 2015;58:980–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ziegler A-G, Hummel M, Schenker M, Bonifacio E. Autoantibody appearance and risk for development of childhood diabetes in offspring of parents with type 1 diabetes: the 2-year analysis of the German BABYDIAB Study. Diabetes. 1999;48:460–8.

    Article  CAS  PubMed  Google Scholar 

  8. Zhao LP, Alshiekh S, Carlsson A, Elding-Larsson H, Forsander G, Ivarsson SA, et al. Next generation sequencing reveals that HLA-DRB3,-DRB4 and-DRB5 may be associated with islet autoantibodies and risk for childhood type 1 diabetes. Diabetes. 2016;65:db151115.

    Article  Google Scholar 

  9. Caillat-Zucman S, Garchon H-J, Timsit J, Assan R, Boitard C, Djilali-Saiah I, et al. Age-dependent HLA genetic heterogeneity of type 1 insulin-dependent diabetes mellitus. J Clin Invest. 1992;90:2242–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Pak C, Mcarthur R, Eun H-M, Yoon J-W. Association of cytomegalovirus infection with autoimmune type 1 diabetes. The Lancet. 1988;332:1–4.

    Article  Google Scholar 

  11. Guberski D, Thomas V, Shek W, Like A, Handler E, Rossini A, et al. Induction of type I diabetes by Kilham’s rat virus in diabetes-resistant BB/Wor rats. Science. 1991;254:1010–3.

    Article  CAS  PubMed  Google Scholar 

  12. Kasuga A, Harada R, Saruta T. Insulin-dependent diabetes mellitus associated with parvovirus B19 infection. Ann Intern Med. 1996;125:700–1.

    Article  CAS  PubMed  Google Scholar 

  13. Conrad B, Weissmahr RN, Böni J, Arcari R, Schüpbach J, Mach B. A human endogenous retroviral superantigen as candidate autoimmune gene in type I diabetes. Cell. 1997;90:303–13.

    Article  CAS  PubMed  Google Scholar 

  14. Craighead JE, McLane MF. Diabetes mellitus: induction in mice by encephalomyocarditis virus. Science. 1968;162:913–4.

    Article  CAS  PubMed  Google Scholar 

  15. Lin H-C, Wang C-H, Tsai F-J, Hwang K-P, Chen W, Lin C-C, et al. Enterovirus infection is associated with an increased risk of childhood type 1 diabetes in Taiwan: a nationwide population-based cohort study. Diabetologia. 2015;58:79–86.

    Article  CAS  PubMed  Google Scholar 

  16. Oikarinen S, Tauriainen S, Hober D, Lucas B, Vazeou A, Sioofy-Khojine A, et al. Virus antibody survey in different European populations indicates risk association between coxsackievirus B1 and type 1 diabetes. Diabetes. 2014;63:655–62.

    Article  CAS  PubMed  Google Scholar 

  17. Muller L, Gorter K, Hak E, Goudzwaard W, Schellevis F, Hoepelman A, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005;41:281–8.

    Article  CAS  PubMed  Google Scholar 

  18. Tanaka Y. Immunosuppressive mechanisms in diabetes mellitus. Nihon rinsho. Jpn J Clin Med. 2008;66:2233–7.

    Google Scholar 

  19. Joshi N, Caputo GM, Weitekamp MR, Karchmer A. Infections in patients with diabetes mellitus. N Engl J Med. 1999;341:1906–12.

    Article  CAS  PubMed  Google Scholar 

  20. Peleg AY, Weerarathna T, McCarthy JS, Davis TM. Common infections in diabetes: pathogenesis, management and relationship to glycaemic control. Diabetes Metab Res Rev. 2007;23:3–13.

    Article  CAS  PubMed  Google Scholar 

  21. Bainbridge JW, Mehat MS, Sundaram V, Robbie SJ, Barker SE, Ripamonti C, et al. Long-term effect of gene therapy on Leber’s congenital amaurosis. N Engl J Med. 2015;372:1887–97.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Li W, Kong F, Li X, Dai X, Liu X, Zheng Q, et al. Gene therapy following subretinal AAV5 vector delivery is not affected by a previous intravitreal AAV5 vector administration in the partner eye. Mol Vis. 2009;15:267.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Dinculescu A, Estreicher J, Zenteno JC, Aleman TS, Schwartz SB, Huang WC, et al. Gene therapy for retinitis pigmentosa caused by MFRP mutations: human phenotype and preliminary proof of concept. Hum Gene Ther. 2011;23:367–76.

    Article  PubMed Central  Google Scholar 

  24. Klimczak RR, Koerber JT, Dalkara D, Flannery JG, Schaffer DV. A novel adeno-associated viral variant for efficient and selective intravitreal transduction of rat Müller cells. PLoS ONE. 2009;4:e7467.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hellström M, Ruitenberg M, Pollett M, Ehlert E, Twisk J, Verhaagen J, et al. Cellular tropism and transduction properties of seven adeno-associated viral vector serotypes in adult retina after intravitreal injection. Gene Ther. 2009;16:521.

    Article  PubMed  Google Scholar 

  26. Srivastava A. In vivo tissue-tropism of adeno-associated viral vectors. Curr Opin Virol. 2016;21:75–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Wang D, Zhong L, Nahid MA, Gao G. The potential of adeno-associated viral vectors for gene delivery to muscle tissue. Expert Opin Drug Deliv. 2014;11:345–64.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Mallol C, Casana E, Jimenez V, Casellas A, Haurigot V, Jambrina C, et al. AAV-mediated pancreatic overexpression of Igf1 counteracts progression to autoimmune diabetes in mice. Mol Metab. 2017;6:664–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Shu Uin G, Maria N, Ying FZ, Kok Onn L, Kian Chuan S, Amit Chunilal N, et al. Correction of murine diabetic hyperglycaemia with a single systemic administration of an AAV2/8 vector containing a novel codon optimized human insulin gene. Curr Gene Ther. 2016;16:65–72.

    Article  Google Scholar 

  30. Samulski RJ, Muzyczka N. AAV-mediated gene therapy for research and therapeutic purposes. Ann Rev Virol. 2014;1:427–51.

    Article  Google Scholar 

  31. Asokan A, Conway JC, Phillips JL, Li C, Hegge J, Sinnott R, et al. Reengineering a receptor footprint of adeno-associated virus enables selective and systemic gene transfer to muscle. Nat Biotechnol. 2010;28:79.

    Article  CAS  PubMed  Google Scholar 

  32. Xiao X, Guo P, Shiota C, Zhang T, Coudriet GM, Fischbach S, et al. Endogenous reprogramming of alpha cells into beta cells, induced by viral gene therapy, reverses autoimmune diabetes. Cell Stem Cell. 2018;22:78–90. e4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Li C, Narkbunnam N, Samulski R, Asokan A, Hu G, Jacobson L, et al. Neutralizing antibodies against adeno-associated virus examined prospectively in pediatric patients with hemophilia. Gene Ther. 2012;19:288.

    Article  CAS  PubMed  Google Scholar 

  34. Colella P, Ronzitti G, Mingozzi F. Emerging issues in AAV-mediated in vivo gene therapy. Mol Ther Methods Clin Dev. 2018;8:87–104.

    Article  CAS  PubMed  Google Scholar 

  35. Rapti K, Louis-Jeune V, Kohlbrenner E, Ishikawa K, Ladage D, Zolotukhin S, et al. Neutralizing antibodies against AAV serotypes 1, 2, 6, and 9 in sera of commonly used animal models. Mol Ther. 2012;20:73–83.

    Article  CAS  PubMed  Google Scholar 

  36. Jiang H, Couto LB, Patarroyo-White S, Liu T, Nagy D, Vargas JA, et al. Effects of transient immunosuppression on adenoassociated, virus-mediated, liver-directed gene transfer in rhesus macaques and implications for human gene therapy. Blood. 2006;108:3321–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Mathis A, Malecaze F, Bessieres M, Arne J, Seguela J, Bec P. Immunological analysis of the aqueous humour in candida endophthalmitis. II: clinical study. Br J Ophthalmol. 1988;72:313–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kotterman MA, Yin L, Strazzeri JM, Flannery JG, Merigan WH, Schaffer DV. Antibody neutralization poses a barrier to intravitreal adeno-associated viral vector gene delivery to non-human primates. Gene Ther. 2015;22:116.

    Article  CAS  PubMed  Google Scholar 

  39. Boye SE, Alexander JJ, Witherspoon CD, Boye SL, Peterson JJ, Clark ME, et al. Highly efficient delivery of adeno-associated viral vectors to the primate retina. Hum Gene Ther. 2016;27:580–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Barker SE, Broderick CA, Robbie SJ, Duran Y, Natkunarajah M, Buch P, et al. Subretinal delivery of adeno‐associated virus serotype 2 results in minimal immune responses that allow repeat vector administration in immunocompetent mice. J Gene Med. 2009;11:486–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Pritchard N, Edwards K, Dehghani C, Fadavi H, Jeziorska M, Marshall A, et al. Longitudinal assessment of neuropathy in type 1 diabetes using novel ophthalmic markers (LANDMark): study design and baseline characteristics. Diabetes Res Clin Pract. 2014;104:248–56.

    Article  PubMed  Google Scholar 

  42. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285–93.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Xiao X, Li J, Samulski RJ. Production of high-titer recombinant adeno-associated virus vectors in the absence of helper adenovirus. J Virol. 1998;72:2224–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Association AD. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010;33(Suppl 1):S62.

    Article  Google Scholar 

  45. Moraes G, Layton CJ. Therapeutic targeting of diabetic retinal neuropathy as a strategy in preventing diabetic retinopathy. Clin Exp Ophthalmol. 2016;44:838–52.

    Article  PubMed  Google Scholar 

  46. Layton CJ, Chidlow G, Casson RJ, Wood JP, Graham M, Osborne NN. Monocarboxylate transporter expression remains unchanged during the development of diabetic retinal neuropathy in the rat. Invest Ophthalmol Vis Sci. 2005;46:2878–85.

    Article  PubMed  Google Scholar 

  47. Boutin S, Monteilhet V, Veron P, Leborgne C, Benveniste O, Montus MF, et al. Prevalence of serum IgG and neutralizing factors against adeno-associated virus (AAV) types 1, 2, 5, 6, 8, and 9 in the healthy population: implications for gene therapy using AAV vectors. Hum Gene Ther. 2010;21:704–12.

    Article  CAS  PubMed  Google Scholar 

  48. Halbert CL, Miller AD, McNamara S, Emerson J, Gibson RL, Ramsey B, et al. Prevalence of neutralizing antibodies against adeno-associated virus (AAV) types 2, 5, and 6 in cystic fibrosis and normal populations: Implications for gene therapy using AAV vectors. Hum Gene Ther. 2006;17:440–7.

    Article  CAS  PubMed  Google Scholar 

  49. Liu Q, Huang W, Zhang H, Wang Y, Zhao J, Song A, et al. Neutralizing antibodies against AAV2, AAV5 and AAV8 in healthy and HIV-1-infected subjects in China: implications for gene therapy using AAV vectors. Gene Ther. 2014;21:732.

    Article  CAS  PubMed  Google Scholar 

  50. Calcedo R, Vandenberghe LH, Gao G, Lin J, Wilson JM. Worldwide epidemiology of neutralizing antibodies to adeno-associated viruses. J Infect Dis. 2009;199:381–90.

    Article  PubMed  Google Scholar 

  51. Krause I, Anaya JM, Fraser A, Barzilai O, Ram M, Abad V, et al. Anti‐infectious antibodies and autoimmune‐associated autoantibodies in patients with Type I diabetes mellitus and their close family members. Ann N Y Acad Sci. 2009;1173:633–9.

    Article  CAS  PubMed  Google Scholar 

  52. Heymann A, Chodick G, Karpati T, Kamer L, Kremer E, Green M, et al. Diabetes as a risk factor for herpes zoster infection: results of a population-based study in Israel. Infection. 2008;36:226–30.

    Article  CAS  PubMed  Google Scholar 

  53. Sun Y, Pei W, Wu Y, Yang Y. An association of herpes simplex virus type 1 infection with type 2 diabetes. Diabetes Care. 2005;28:435–6.

    Article  PubMed  Google Scholar 

  54. Hüser D, Khalid D, Lutter T, Hammer E-M, Weger S, Heßler M, et al. High prevalence of infectious adeno-associated virus (AAV) in human peripheral blood mononuclear cells indicative of T lymphocytes as sites of AAV persistence. J Virol. 2017;91:e02137–16.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Gonzalez‐Quintela A, Alende R, Gude F, Campos J, Rey J, Meijide L, et al. Serum levels of immunoglobulins (IgG, IgA, IgM) in a general adult population and their relationship with alcohol consumption, smoking and common metabolic abnormalities. Clin Exp Immunol. 2008;151:42–50.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Erles K, Sebökovà P, Schlehofer JR. Update on the prevalence of serum antibodies (IgG and IgM) to adeno‐associated virus (AAV). J Med Virol. 1999;59:406–11.

    Article  CAS  PubMed  Google Scholar 

  57. Di Pasquale G, Davidson BL, Stein CS, Martins I, Scudiero D, Monks A, et al. Identification of PDGFR as a receptor for AAV-5 transduction. Nat Med. 2003;9:1306.

    Article  PubMed  Google Scholar 

  58. Parzych EM, Li H, Yin X, Liu Q, Wu T-L, Podsakoff GM, et al. Effects of immunosuppression on circulating adeno-associated virus capsid-specific T cells in humans. Hum Gene Ther. 2013;24:431–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Sun J, Shao W, Chen X, Merricks EP, Wimsey L, Abajas YL. et al. An observational study from long-term AAV re-administration in two hemophilia dogs. Ther Methods Clin Dev. 2018;10:257–67.

    Article  CAS  Google Scholar 

  60. Kruzik A, Koppensteiner H, Fetahagic D, Hartlieb B, Dorn S, Romeder-Finger S et al. The detection of biologically relevant low-titer neutralizing antibodies against AAV require sensitive in vitro assays. Human Gene Ther. 2019;1–9. [Epub ahead of print].

  61. Wang M, Sun J, Crosby A, Woodard K, Hirsch ML, Samulski RJ, et al. Direct interaction of human serum proteins with AAV virions to enhance AAV transduction: immediate impact on clinical applications. Gene Ther. 2017;24:49.

    Article  CAS  PubMed  Google Scholar 

  62. Ellis BL, Hirsch ML, Barker JC, Connelly JP, Steininger RJ, Porteus MH. A survey of ex vivo/in vitro transduction efficiency of mammalian primary cells and cell lines with Nine natural adeno-associated virus (AAV1-9) and one engineered adeno-associated virus serotype. Virol J. 2013;10:74.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Aparna Murali and Charmaine Ramlogan-Steel were supported by fellowships from the Layton Vision Foundation. Slawomir Andrzejewski was supported by a fellowship from the Gallipoli Medical Research Foundation. The LANDMark study was funded by the Juvenile Diabetes Research Foundation (JDRFI 8-2008-362).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher J. Layton.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Andrzejewski, S., Murali, A., Ramlogan-Steel, C. et al. Adeno-associated virus neutralising antibodies in type 1 diabetes mellitus. Gene Ther 26, 250–263 (2019). https://doi.org/10.1038/s41434-019-0076-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41434-019-0076-5

This article is cited by

Search

Quick links