Gene therapy for organic acidemias: Lessons learned from methylmalonic and propionic acidemia

J Inherit Metab Dis. 2024 Jan;47(1):63-79. doi: 10.1002/jimd.12665. Epub 2023 Aug 7.

Abstract

Organic acidemias (OA) are a group of rare autosomal recessive disorders of intermediary metabolism that result in a systemic elevation of organic acid. Despite optimal dietary and cofactor therapy, OA patients still suffer from potentially lethal metabolic instability and experience long-term multisystemic complications. Severely affected patients can benefit from elective liver transplantation, which restores hepatic enzymatic activity, improves metabolic stability, and provides the theoretical basis for the pursuit of gene therapy as a new treatment for patients. Because of the poor outcomes reported in those with OA, especially methylmalonic and propionic acidemia, multiple gene therapy approaches have been explored in relevant animal models. Here, we review the results of gene therapy experiments performed using MMA and PA mouse models to illustrate experimental paradigms that could be applicable for all forms of OA.

Keywords: AAV; CRISPR; MMA; PA; adeno-associated virus; gene therapy; genome editing; homologous recombination; mRNA therapy; methylmalonic acidemia; mouse models; organic acidemia; propionic acidemia.

Publication types

  • Review

MeSH terms

  • Amino Acid Metabolism, Inborn Errors* / complications
  • Amino Acid Metabolism, Inborn Errors* / genetics
  • Amino Acid Metabolism, Inborn Errors* / therapy
  • Animals
  • Disease Models, Animal
  • Genetic Therapy
  • Humans
  • Liver Transplantation* / adverse effects
  • Methylmalonic Acid
  • Mice
  • Propionic Acidemia* / complications
  • Propionic Acidemia* / genetics
  • Propionic Acidemia* / therapy

Substances

  • Methylmalonic Acid