Salmeterol with Liver Depot Gene Therapy Enhances the Skeletal Muscle Response in Murine Pompe Disease

Hum Gene Ther. 2019 Jul;30(7):855-864. doi: 10.1089/hum.2018.197. Epub 2019 Apr 5.


Gene therapy for Pompe disease with adeno-associated virus (AAV) vectors has advanced into early phase clinical trials; however, the paucity of cation-independent mannose-6-phosphate receptor (CI-MPR) in skeletal muscle, where it is needed to take up acid α-glucosidase (GAA), has impeded the efficacy of Pompe disease gene therapy. Long-acting selective β2 receptor agonists previously enhanced the CI-MPR expression in muscle. In this study we have evaluated the selective β2 agonist salmeterol in GAA knockout mice in combination with an AAV vector expressing human GAA specifically in the liver. Quadriceps glycogen content was significantly decreased by administration of the AAV vector with salmeterol, in comparison with the AAV vector alone (p < 0.01). Importantly, glycogen content of the quadriceps was reduced to its lowest level by the combination of AAV vector and salmeterol administration. Rotarod testing revealed significant improvement following treatment, in comparison with untreated mice, and salmeterol improved wirehang performance. Salmeterol treatment decreased abnormalities of autophagy in the quadriceps, as shown be lower LC3 and p62. Vector administration reduced the abnormal vacuolization and accumulation of nuclei in skeletal muscle. Thus, salmeterol could be further developed as adjunctive therapy to improve the efficacy of liver depot gene therapy for Pompe disease.

Keywords: Pompe disease; adeno-associated virus vector; beta2 agonist; glycogen storage disease; mannose-6-phosphate receptor.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Dependovirus / genetics
  • Disease Models, Animal
  • Enzyme Activation
  • Gene Expression
  • Gene Transfer Techniques
  • Genetic Therapy* / methods
  • Genetic Vectors / genetics
  • Glycogen Storage Disease Type II / genetics*
  • Glycogen Storage Disease Type II / metabolism
  • Glycogen Storage Disease Type II / therapy*
  • Mice
  • Mice, Knockout
  • Muscle, Skeletal / drug effects*
  • Muscle, Skeletal / metabolism*
  • Receptor, IGF Type 2 / genetics
  • Receptor, IGF Type 2 / metabolism
  • Salmeterol Xinafoate / pharmacology*
  • Transduction, Genetic


  • Receptor, IGF Type 2
  • Salmeterol Xinafoate