Gene Therapy (2001) 8, 1248–1254 2001 Nature Publishing Group All rights reserved 0969-7128/01 $15.00 www.nature.com/gt RESEARCH ARTICLE Self-complementary recombinant adeno-associated virus (scAAV) vectors promote efficient transduction independently of DNA synthesis DM McCarty1,2, PE Monahan1,3 and RJ Samulski1,4 1 UNC Gene Therapy Center, 2School of Pharmacy, 3Department of Pediatrics, 4Department of Pharmacology University of North Carolina at Chapel Hill, NC, USA Adeno-associated virus (AAV) vectors package singlestranded genomes and require host-cell synthesis of the complementary strand for transduction. However, when the genome is half wild-type size, AAV can package either two copies, or dimeric inverted repeat DNA molecules. Dimeric, or self-complementary molecules (scAAV) should spontaneously reanneal, alleviating the requirement for host-cell DNA synthesis. We generated and characterized scAAV vectors in order to bypass the rate-limiting step of secondstrand synthesis. In vitro, scAAV vectors were five- to 140fold more efficient transducing agents than conventional rAAV, with a 5.9:1 particle to transducing unit ratio. This efficiency is neither greatly increased by co-infection with Ad, nor inhibited by hydroxyurea, demonstrating that transduction is independent of DNA synthesis. In vivo, scAAV expressing erythropoietin resulted in rapid and higher levels of hematocrit than a conventional single-stranded vector. These novel scAAV vectors represent a biochemical intermediate in rAAV transduction and should provide new insights into the biology of vector transduction. Gene Therapy (2001) 8, 1248–1254. Keywords: AAV; vector; dimer; double-stranded DNA Introduction Adeno-associated virus (AAV) is a nonpathogenic, helper-dependent member of the parvovirus family. One of the identifying characteristics of this group is the encapsidation of a single-stranded DNA (ssDNA) genome.1–3 In the case of AAV, the separate plus or minus polarity strands are packaged with equal frequency, and either is infectious.4,5 At each end of the ssDNA genome, a palindromic terminal repeat (TR) structure base-pairs upon itself into a hairpin configuration.6 This serves as a primer for cellular DNA polymerase to synthesize the complementary strand after uncoating in the host cell. Adeno-associated virus generally requires a helper virus for a productive infection. Although adenovirus (Ad) usually serves this purpose, treatment of AAV infected cells with UV irradiation or hydroxyurea (HU) will also allow limited replication.7–10 Recombinant AAV (rAAV) gene delivery vectors also package ssDNA of plus or minus polarity, and must rely on cellular replication factors for synthesis of the complementary strand. While it was initially expected that this step would be carried out spontaneously, by cellular DNA replication or repair pathways, this does not appear to be the case. Early work with rAAV vectors revealed that the ability to score marker gene expression was dra- Correspondence: DM McCarty, Rm 7119 Thurston Building, CB#7352, Chapel Hill, NC 27599, USA Received 24 January 2001; accepted 22 May 2001 matically enhanced when cells were co-infected with adenovirus, or transiently pretreated with genotoxic agents.11 This enhancement correlated with the formation of duplex DNA from the single-stranded virion DNA (vDNA).12,13 Similar induction of rAAV vectors has been observed in vivo following treatment with Ad, ionizing radiation, or topoisomerase inhibitors.13–15 However, the effect was highly variable between different tissues and cell types. It has more recently been suggested that reannealing of complementary vDNA from separate infecting rAAV particles may be an important pathway for rAAV transduction.16 The requirement for complementary-strand synthesis, or recruitment, is now considered to be a limiting factor in the efficiency of rAAV vectors. The transduction rate for rAAV in mouse liver has been estimated at approximately 5% of hepatocytes after portal vein infusion of 4.2 × 1010 particles.17 Subsequent experiments revealed that the rAAV vDNA had been taken up into the nuclei of virtually all of the liver hepatocytes, and that the transduction potential of these genomes could be rescued by co-infection with adenovirus.18 This is consistent with an earlier report of up to 25% of mouse hepatocytes transduced by 1010 particles of rAAV in the presence of coinfecting adenovirus.13 Expression from rAAV in liver tissue coincides with the formation of duplex DNA and the vDNA appears to be lost if not converted to duplex within 5–13 weeks.19 Further experiments suggest that a subpopulation of mouse hepatocytes is transiently permissive for rAAV tranduction in vivo.18 Rather than rely on potentially variable cellular mech- rAAV double-stranded vector DM McCarty et al anisms to provide a complementary-strand for rAAV vectors, we have found that we can circumvent the problem by packaging both strands as a single DNA molecule. Original studies on wild-type (wt) AAV determined that defective interfering particles (DI) often carried atypical genomes comprised of inverted repeats.20 Subsequent studies have also revealed that rAAV DNA of less than half the wtAAV genome length can be packaged as a dimer or a diploid monomer, mimicking a DI particle.21–23 The replication scheme of AAV suggests that the dimeric DNA molecules would be in the inverted repeat configuration.24,25 These self-complementary molecules (scAAV) should have the ability to re-fold into doublestranded DNA (dsDNA) templates for expression with pseudo-first order kinetics upon uncoating. In this study, we engineered a number of vector constructs, which packaged genomes varying in size relative to the wtAAV genome, and evaluated their ability to transduce in vitro and in vivo. We observed an increased efficiency of transduction from scAAV vectors over conventional rAAV in HeLa cells (5- to 140-fold). More importantly, unlike conventional single-stranded AAV vectors, inhibitors of DNA replication did not affect transduction from scAAV vectors. In addition, scAAV vectors displayed a rapid onset and a higher level of transgene expression in mouse hepatocytes in vivo. All of these biological attributes support the generation and characterization of a new class of AAV vectors (delivering duplex DNA) that should significantly contribute to the ongoing development of parvovirus-based gene delivery systems. 1249 Figure 1 Virion DNA content of rAAV vectors. The drawing illustrates the DNA content of the rAAV vectors used in this study and the predicted conformation that they adopt upon release from the virions. The transgenes expressed from the cytomegalovirus immediate–early promoter (CMV) are: green fluorescent protein (GFP),  galactosidase (LacZ), mouse erythropoietin (nEpo). Neomycin phosphotransferase (neo) is expressed from the SV40 early promoter (SV40). The size, in nucleotides (nt) of each packaged DNA molecule is indicated. The self-complementary (scAAV) GFP dimer and mEpo dimer vectors fold into a complete duplex DNA with one extra copy of the terminal repeat while the GFPneo, LacZ, and mEpo vectors require cell-mediated DNA synthesis of the complementary strand. Results Generation of scAAV vector A rAAV plasmid construct (pTR-CMV-GFP), with a replicon size of 2299 nucleotides, was used to generate a viral vector stock (rAAV-GFP) by conventional methods. The predicted size of the dimeric replicative form of this vector was 4474 nucleotides (Figure 1), which was 95.6% of the wt AAV genome length. The viral vectors were fractionated by isopycnic gradient centrifugation in CsCl and the vDNA content of each fraction was analyzed on alkaline agarose gels (Figure 2). PhosphoImager scans were used to quantify the vDNA-specific bands from each fraction. Under denaturing conditions, the selfcomplementary dimer DNA (Figure 2a, fractions 10–13) ran at approximately twice the length of the monomeric genome. The hybridizing material in fractions 2–4 is unpackaged replicative form DNA that sediments at the bottom of the gradient. Athough a DNase step was included in the vector purification (see Methods), the treatment was not intended to be exhaustive and this material proved to be DNase sensitive in subsequent experiments while the material in fractions 10–14 was DNase resistant (data not shown). Vectors containing mostly dimeric DNA genomes (fractions 10 and 11) were designated as ‘self-complementary rAAV’ (scAAV). The inverted repeat structure of these molecules was confirmed by restriction enzyme digestion (data not shown). Two additional rAAV vectors (Figure 1) were generated and purified in parallel, and analyzed in the same manner (Figure 2b and c). The first, rAAV-GFPneo, contained a neo gene in addition to the GFP and had a replicating genome length of 3398 nucleotides. This was Figure 2 Recombinant AAV vectors fractionated on CsCl gradients. Virion DNA (vDNA) was extracted from CsCl gradient fractionated CMV-GFP (a), GFPneo (b), and LacZ (c) rAAV vectors. Alkaline agarose gels of the vDNA were Southern blotted and hybridized with a CMVGFP DNA fragment. Markers at the left end of panel a were the excised vector sequences from the plasmids used to generate the viral vectors (see Results). The number of unit length, ssDNA, vector copies per molecule are indicated by 1×, 2×, and 4×. The viral vectors used in the experiments depicted in Figures 3 and 4 were from fractions a-11 or a-10 for scAAV CMV-GFP (as indicated in the Figure legends), fraction a-13 or a-14 for the monomer CMV-GFP, fraction b-13 for GFPneo, and fraction c-12 for LacZ. Gene Therapy rAAV double-stranded vector DM McCarty et al 1250 72.6% of the wtAAV genome size, and was too large to be packaged as a dimer. The second was a 4898 nucleotide rAAV-CMV-LacZ construct, which was slightly larger (104.7%) than wtAAV genome size, but within the limit for efficient packaging.22 The lower density, higher mobility hybridizing material in fractions 14 and 15 (Figure 2, panel c) comprised genomes which had undergone deletions and these fractions were not used in subsequent experiments. Transduction with dimeric versus monomeric rAAV vectors and effects of Ad co-infection The transducing efficiency of the scAAV-GFP (Figure 2a, fraction 11) was compared with the homologous monomer (fraction 13), as well as the GFPneo and LacZ vectors (Figure 2b and c, fractions 13 and 12, respectively), in HeLa cells infected at low multiplicity (Figure 3). The particle numbers were calculated from the specific, fulllength vDNA PhosphorImager signals in each fraction on the Southern blot, after correction for monomeric versus dimeric DNA copy number. Thus, each scAAV contains two copies of the transgene as a single molecule, in the inverted repeat orientation, while each monomeric particle contains one single-stranded copy. The scAAV CMV-GFP vector (fraction 11), containing approximately 90% dimer virus, yielded a 5.9:1 ratio of physical particles to transducing units, thus bearing out our prediction of high transducing efficiency. Fraction 13, from the same gradient, conversely containing approximately 80–90% monomer virus, had a 24.6:1 particle to transducing unit ratio. This four-fold difference in efficiency represented a minimum difference when it was considered that the dimer contamination in the monomer fraction would have a greater impact on its transducing potential than the monomer component would contribute Figure 3 Transduction efficiency of scAAV versus conventional rAAV vectors in the absence and presence of co-infecting adenovirus. The efficiencies of the three CsCl fractionated vectors (Figure 1) were compared in rapidly dividing HeLa cells infected with scAAV-GFP fraction 11 (0.5 particles per cell), monomer CMV-GFP fraction 13 (0.5 particles per cell), rAAV-GFPneo fraction 13 (2 particles per cell), or rAAV-LacZ fraction 12 (0.5 particles per cell). Transduction was quantified at 24 h after infection by counting GFP-positive cells using fluorescence microscopy, or by fixing the cells and X-gal staining. The transducing efficiency was graphed as the number of physical particles per transducing unit, as determined by the number of cells scoring positive for GFP or LacZ expression. Dark grey bars indicate transducing efficiency in the presence of Ad co-infection at 5 p.f.u. per cell. Gene Therapy to the dimer fraction. In contrast, the monomeric ssDNA GFPneo and LacZ vectors had particle to transducing unit ratios of 125:1 and 828:1, respectively, comparable to previously reported efficiencies for these vectors.13,26 The transducing efficiency of conventional rAAV vectors can be greatly enhanced (up to 100-fold) by co-infection with Ad, or by treatment with DNA damaging agents or other types of cell stress. This enhancement had been associated with the cell-mediated transformation of the ssDNA genome into active ds-DNA transcription templates. Because the dimeric rAAV contains the two complementary strands packaged as a single molecule, we predicted that transduction would be independent of enhancement by adenovirus. This was largely the case when HeLa cells were co-infected with the scAAV vectors and 5 infectious units per cell of adenovirus (Figure 3). The number of GFP-positive cells in the scAAV infected cultures was increased by only 1.6-fold, an effect which could be attributed to the transcriptional effects of adenovirus infection on the activity of the CMV promoter as previously reported.27,28 The monomer vector transduction rate was increased 2.4-fold by Ad coinfection, while the GFPneo and LacZ vectors were induced 6.0-fold and 12.8-fold, respectively. Transduction with dimeric rAAV vectors in the absence of host-cell DNA synthesis Because the vDNA of the scAAV vectors contained both DNA strands on a single molecule, allowing efficient renaturation upon uncoating, we predicted that these vectors would obviate the role of host-cell DNA synthesis in transduction. We compared the scAAV-GFP vector with the homologous monomer, and the GFPneo vector, in HeLa cells pretreated with hydroxyurea (HU) 24 h before infection to inhibit host cell DNA synthesis. Hydroxyurea treatment was continued, uninterrupted, at the same concentrations following infection and maintained on the cells for the following 24 h, until GFP transduction was scored. Transduction from the scAAV-GFP was stimulated by up to 1.9-fold in response to increasing concentrations of HU (Figure 4a). This stimulation, similar in magnitude to that observed with Ad co-infection, was probably affected through a combination of transcriptional transactivation of the CMV promoter brought about by cell stress, and the accumulation of GFP in the nondividing cells. In contrast, transduction from the homologous monomer vector fraction was stimulated at the lowest HU concentration and inhibited at higher concentrations. The residual transducing activity from the monomer vector at higher HU concentrations, at a level approximately fivefold lower than that of the scAAV fraction, is consistent with the 10–20% contamination of the monomer fractions with dimer containing particles (Figure 2a). The rAAVGFPneo vector transduction was inhibited greater than 10-fold under the same conditions. Similar results were obtained by treatment with aphidicolin, a polymerase ␣/␦ specific inhibitor (Figure 4b). This confirmed our hypothesis that scAAV transduction was independent of host-cell DNA synthesis. Transduction by scAAV in vivo A different reporter was used for the comparison of scAAV and conventional single-stranded rAAV efficiency in vivo. The dimer-producing construct con- rAAV double-stranded vector DM McCarty et al 1251 Figure 5 In vivo transduction of mouse liver tissue with scAAV or singlestranded rAAV vectors. Ten-week-old Balb-c ByJ mice were infused with 2 × 1010 particles of either scAAV-CMV-mEpo, (䉬) (n = 4), or full-length single-stranded rAAV-CMV-mEpo, (왖) (n = 5), in 200 l normal saline by portal vein injection. One group of control mice was infused with normal saline, (䊐) (n = 4), and a single mouse, (䊊) was phlebotomized at the same 7-day intervals without prior surgery. Blood hematocrit was used as a functional measure of mEpo expression. Figure 4 Transduction with scAAV and conventional rAAV in the presence of DNA synthesis inhibitor. (a) HeLa cell cultures at 30% confluence were treated with the indicated concentrations of hydroxyurea 24 h before infecting with 3.8 × 106 particles of the scAAV-GFP, (䉬), (Figure 2a, fraction 10), the homologous monomer, (䊉) (Figure 2a, fraction 14), or rAAV-GFPneo, (왖), (Figure 2b, fraction 13). The HU treatment was maintained until transduction was assayed at 24 h after infection. Each data point was calculated from the mean of the number of GFP-positive cells in 10 random fields independently of the total cell number, which was variable due to the effect of hydroxyurea on cell division. (b) The same procedure was used to evaluate transduction in the presence of the indicated concentrations of aphidicolin. Only the scAAV and homologous monomer (fractions 10 and 14) were compared. tained only the mouse erythropoietin gene (mEpo) transcribed from the CMV promoter. The size of the replicating element of this minimal vector was 2248 nucleotides. The dimeric form of this molecule, 4372 nucleotides in length (Figure 1), was 93% of the wtAAV genome size, and was readily packaged. A second construct contained the identical transgene, with the addition of a downstream heterologous sequence ( phage) to bring the size of the recombinant vector to 4570 nucleotides, or 98% of the wtAAV genome size. Previous studies have used lambda phage DNA as a stuffer without deleterious effects on the vector.21 Both vectors were purified by heparin-agarose chromotography. The smaller vector was additionally purified on a CsCl gradient to isolate dimeric DNA-containing virions (not shown). The two vector stocks were quantified using Southern blots from alkaline agarose gels to determine the number of DNA-containing particles. In this case, approximately 25% of the particles in the dimer fraction contained two separate monomer genomes. Because they could not be separated from true dimer by density, and because their behavior has not been characterized, we counted these as dimer particles, for the purpose of comparison to the fulllength vector, such that the dimer effect might only be underestimated rather than overestimated. Equal numbers of physical rAAV particles (2 × 1010 per animal in 200 l normal saline) were administered to mice by portal vein injection. The expression of the mEpo gene was evaluated by observing changes in hematocrit at 7-day intervals. Control mice received either intraportal saline injections or were not operated, but phlebotomized at 7-day intervals. Mice receiving the dimeric vector responded with a rapid increase in hematocrit (Figure 5), and with continuing increases over the following 2 weeks. Considering the lag time between expression of erythropoietin and the production of red blood cells, this suggested that the scAAV vector was expressed at high levels within the first week. Mice which received the fulllength, ssDNA vector did not show a significant increase in hematocrit until 21 days after injection, and did not reach levels comparable to the scAAV-treated animals over the course of the experiment. Discussion We have set out to circumvent the requirement for target cell-mediated complementary-strand synthesis for rAAV transduction. In doing so we expected to achieve higher rates of transduction and to identify additional parameters, which might effect these rates. The means of providing cells with a duplex rAAV virion DNA was to take advantage of the AAV rolling-hairpin mode of replication in which monomeric vDNA is generated from dimeric inverted repeat intermediates.24,25 When the genGene Therapy rAAV double-stranded vector DM McCarty et al 1252 ome is sufficiently small, the dimeric inverted repeats themselves can be encapsidated as a self-complementary DNA molecule (scAAV). In cultured HeLa cells, the scAAV vector was greater than four-fold more efficient than the homologous vector containing only a monomeric ss-DNA genome. We expect that this difference would be greater if not for the approximately 10–20% contamination of monomer fractions with dimer vectors. Consistent with this interpretation, the scAAV was 20-fold more efficient than a conventional rAAV-GFPneo vector and 140-fold more efficient than a rAAV-LacZ vector, although we cannot rule out the possibility of additional inhibition of the latter vectors due to specific cis or trans effects of the different marker genes. We have further demonstrated the increased efficiency of the scAAV in vivo by transducing mouse hepatocytes. While the CMV promoter is not known to be particularly active in liver tissue,28 we chose to target liver in this experiment because it is feasible to achieve a relatively homogeneous distribution of vector particles over a large tissue. Infecting mice with scAAVmEpo leads to a faster response, and a greater rise in hematocrit, than the fulllength ssDNA vector carrying the same gene. This supports our observations in cultured cells and is consistent with the view that the dimeric vectors are ready to express the transgene immediately upon uncoating and entry into the nucleus. The higher levels of expression ultimately achieved might reflect either the inability of many infected cells to form dsDNA from conventional rAAV, or the loss or degradation of ss vDNA before the formation of duplex.19 Our indirect assessment of transduction in vivo, through increase in hematocrit, provides only a limited range of response to increasing levels of erythropoitin. It therefore remains possible that the differences that we observed between the two vectors represents a minimum difference in the number of transduced hepatocytes. If indeed it is only complementary-strand synthesis that is limiting rAAV in these cells, we would expect to achieve near 100% transduction, based on previous observations of rAAV delivery to hepatocytes at similar doses.18 Future experiments using heterologous marker genes in liver and other potential target tissues in vivo will provide a more accurate assessment of the potential of the scAAV vectors in cells which appear to be refractory to rAAV transduction. As we have demonstrated by pre-treatment of cells with HU, transduction with the scAAV vector is independent of host-cell DNA synthesis. The ability to transduce cells in the absence of DNA synthesis represents a fundamental departure in the biology of the scAAV vectors from the parent virus, allowing them to function under circumstances where conventional rAAV vectors would normally fail. Certain cell types are extremely inefficient for rAAV transduction, ostensibly due to the inability to synthesize or recruit a complementary strand.13,14,19 The scAAV will suffer no such limitation and can be used with marker genes to directly determine whether a cell is permissive for rAAV transduction in all other steps irrespective of DNA synthesis. In light of the drastic treatments which have been proposed to promote rAAV transduction efficiency in vivo (ie gamma radiation, HU, topoisomerase inhibitors)14,29 it will be prudent to evaluate whether such lengths would be either necessary Gene Therapy or effectual using scAAV in preliminary studies. Regardless of the ability of the target cell to make the rAAV complementary strand, it is clear that these reagents provide an alternative AAV delivery system for genes that may require rapid onset. More importantly, our data suggest that scAAV vectors achieve overall higher levels of therapeutic product when identical number of particles are administered. Thus, scAAV vectors will prove most useful where a more timely, robust, or quantitative response to vector dose is required, ie in endostatin delivery for anti-cancer therapy. This potential for attaining critical levels of transgene expression at a minimal dose is important considering the level of vector production required for clinical trials. Apart from the potential utility of the scAAV as a vector, we can also regard these new reagents as a biochemical intermediate in the rAAV transduction pathway. This allows the dissection of events taking place before and after DNA synthesis, such as the CMV promoter activation that we observed in the presence of Ad co-infection. This kind of effect would otherwise have been masked by the enhancement of transduction due to the promotion of complementary-strand synthesis. We anticipate that use of these vectors in specific cell types will help determine the impact of promoter choice independently of the efficiency of vector complementary-strand recruitment. Finally, the scAAV vectors are ideally suited to the transfer of small transgenes, which might include blood clotting factor IX and X, erythropoietin, superoxide dismutase, lysosomal enzymes, and most antisense RNA or ribozyme strategies. For therapies demanding larger genes, the scAAV may have an important role in pilot studies for target cell permissiveness for AAV vectors. Considering that cell cycling per se has not been an accurate predictor of rAAV permissivity,18 the direct comparison of transduction with scAAV versus the homologous monomer may be the best predictor of target cell potential for rAAV DNA synthesis. Materials and methods Plasmids The rAAV plasmids expressing green fluorescent protein (GFP) were constructed from the previously described pTRBSUF-2 (a gift from Nick Muzyczka, University of Florida, Gainesville, FL USA). First, the humanized GFP coding sequence was replaced with the enhanced GFP (eGFP) (Clonetech, Palo Alto, CA, USA) to create the plasmid, pTR-CMV-GFPneo. This plasmid generated the rAAV-GFPneo vector. Second, the SalI fragment containing the neo coding region and SV40 promoter was deleted to create pTR-CMV-GFP. The vector from this plasmid was referred to as rAAV-GFP in this report. The plasmid, p43mEpo, a gift from Barry Byrne (University of Florida, Gainesville, FL, USA) contained the mouse erythropoietin gene under the control of the CMV promoter and generated a rAAV replicon (rAAVmEpo) of less than half the wtAAV length. A longer version of this construct (pmEpo-) was made by inserting the 2.3 kb HindIII fragment from phage into a ClaI site between the polyadenylation signal and the downstream AAV terminal repeat. The rAAV-LacZ vector was generated from pDX11-LacZ, which has been described elsewhere.30 rAAV double-stranded vector DM McCarty et al Viral vectors These were generated in 293 cells (108–109 cells per preparation) by co-transfecting three plasmids containing: (1) the specific rAAV construct, (2) the AAV rep and cap genes (pACG), or (3) the essential adenovirus helper genes (pXX-6).31 At 40 h after transfection, the cells were scraped into the media and lysed by three freeze–thaw cycles. The lysates were incubated at 37°C with 2 g/ml DNase I until flocculent debris was dispersed. The lysates were cleared by centrifugation and rAAV was precipitated using amonium sulfate.32 The virus precipitate was resuspended with 8 ml 10 mm Tris pH 8.0, 1 mm MgCl2 and cesium chloride was added to reach a final density of 1.4 g/cm3 and a final volume 12.5 ml. The solution was centrifuged for 36 h at 38 k r.p.m. in an SW41 rotor. Fractions (0.75 ml) were collected by puncturing with a hypodermic needle at the bottom of each tube and pumping the liquid to a fraction collector. The vectors were stored at 4°C in cesium chloride. Virion DNA (vDNA) was extracted from 10 l of each fraction by digestion in 50 l reactions containing 0.4 mg/ml protease K, 1% sarkosyl and 10 mm EDTA at 50°C for 1 h, followed by phenol/choroform extraction. The samples were diluted three-fold with water and precipitated with ethanol for analysis by alkaline agarose gel electrophoresis and Southern blot hybridization. Cells and infections HeLa and HEK 293 cells were grown in DMEM media containing 10% FBS and penicillin/streptomycin. Viral vector stocks were diluted in media before adding to subconfluent cultures and left on the cells until GFP transduction was observed by fluorescence microscopy at 24 h after infection. For expression of erythropoietin from rAAV in mouse livers, 200 l normal saline, containing 2 × 1010 physical particles of either conventional rAAV or scAAV, was injected directly into the portal veins of 10-week-old Balb-c ByJ mice (Jackson Laboratory, Bar Harbor, ME, USA). Blood samples were collected by retro-orbital phlebotomy at the time of infection and at 7-day intervals for determination of hematocrit. Acknowledgements We acknowledge the technical assistance of Jennifer Naspinski with scAAV studies in vivo, and Xiaohuai Zhou from the UNC Vector Core for construction of rAAV/epo/lambda vector. This work was supported in part by NIH grants HL 48347, 51818. 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