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      Viral vector‐based gene therapies in the clinic

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          Abstract

          Gene therapies are currently one of the most investigated therapeutic modalities in both the preclinical and clinical settings and have shown promise in treating a diverse spectrum of diseases. Gene therapies aim at introducing a gene material in target cells and represent a promising approach to cure diseases that were thought to be incurable by conventional modalities. In many cases, a gene therapy requires a vector to deliver gene therapeutics into target cells; viral vectors are among the most widely studied vectors owing to their distinguished advantages such as outstanding transduction efficiency. With decades of development, viral vector‐based gene therapies have achieved promising clinical outcomes with many products approved for treating a range of diseases including cancer, infectious diseases and monogenic diseases. In addition, a number of active clinical trials are underway to further expand their therapeutic potential. In this review, we highlight the diversity of viral vectors, review approved products, and discuss the current clinical landscape of in vivo viral vector‐based gene therapies. We have reviewed 13 approved products and their clinical applications. We have also analyzed more than 200 active trials based on various viral vectors and discussed their respective therapeutic applications. Moreover, we provide a critical analysis of the major translational challenges for in vivo viral vector‐based gene therapies and discuss possible strategies to address the same.

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          Most cited references108

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          Safety and Efficacy of Single-Dose Ad26.COV2.S Vaccine against Covid-19

          Background The Ad26.COV2.S vaccine is a recombinant, replication-incompetent human adenovirus type 26 vector encoding full-length severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein in a prefusion-stabilized conformation. Methods In an international, randomized, double-blind, placebo-controlled, phase 3 trial, we randomly assigned adult participants in a 1:1 ratio to receive a single dose of Ad26.COV2.S (5×10 10 viral particles) or placebo. The primary end points were vaccine efficacy against moderate to severe–critical coronavirus disease 2019 (Covid-19) with an onset at least 14 days and at least 28 days after administration among participants in the per-protocol population who had tested negative for SARS-CoV-2. Safety was also assessed. Results The per-protocol population included 19,630 SARS-CoV-2–negative participants who received Ad26.COV2.S and 19,691 who received placebo. Ad26.COV2.S protected against moderate to severe–critical Covid-19 with onset at least 14 days after administration (116 cases in the vaccine group vs. 348 in the placebo group; efficacy, 66.9%; adjusted 95% confidence interval [CI], 59.0 to 73.4) and at least 28 days after administration (66 vs. 193 cases; efficacy, 66.1%; adjusted 95% CI, 55.0 to 74.8). Vaccine efficacy was higher against severe–critical Covid-19 (76.7% [adjusted 95% CI, 54.6 to 89.1] for onset at ≥14 days and 85.4% [adjusted 95% CI, 54.2 to 96.9] for onset at ≥28 days). Despite 86 of 91 cases (94.5%) in South Africa with sequenced virus having the 20H/501Y.V2 variant, vaccine efficacy was 52.0% and 64.0% against moderate to severe–critical Covid-19 with onset at least 14 days and at least 28 days after administration, respectively, and efficacy against severe–critical Covid-19 was 73.1% and 81.7%, respectively. Reactogenicity was higher with Ad26.COV2.S than with placebo but was generally mild to moderate and transient. The incidence of serious adverse events was balanced between the two groups. Three deaths occurred in the vaccine group (none were Covid-19–related), and 16 in the placebo group (5 were Covid-19–related). Conclusions A single dose of Ad26.COV2.S protected against symptomatic Covid-19 and asymptomatic SARS-CoV-2 infection and was effective against severe–critical disease, including hospitalization and death. Safety appeared to be similar to that in other phase 3 trials of Covid-19 vaccines. (Funded by Janssen Research and Development and others; ENSEMBLE ClinicalTrials.gov number, NCT04505722 .)
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            Adeno-associated virus vector as a platform for gene therapy delivery

            Adeno-associated virus (AAV) vectors are the leading platform for gene delivery for the treatment of a variety of human diseases. Recent advances in developing clinically desirable AAV capsids, optimizing genome designs and harnessing revolutionary biotechnologies have contributed substantially to the growth of the gene therapy field. Preclinical and clinical successes in AAV-mediated gene replacement, gene silencing and gene editing have helped AAV gain popularity as the ideal therapeutic vector, with two AAV-based therapeutics gaining regulatory approval in Europe or the United States. Continued study of AAV biology and increased understanding of the associated therapeutic challenges and limitations will build the foundation for future clinical success.
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              Engineering adeno-associated virus vectors for gene therapy

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                Author and article information

                Contributors
                zhaozm@uic.edu
                aanselmo@email.unc.edu
                mitragotri@seas.harvard.edu
                Journal
                Bioeng Transl Med
                Bioeng Transl Med
                10.1002/(ISSN)2380-6761
                BTM2
                Bioengineering & Translational Medicine
                John Wiley & Sons, Inc. (Hoboken, USA )
                2380-6761
                20 October 2021
                January 2022
                : 7
                : 1 ( doiID: 10.1002/btm2.v7.1 )
                : e10258
                Affiliations
                [ 1 ] Department of Pharmaceutical Sciences, College of Pharmacy University of Illinois at Chicago Chicago Illinois USA
                [ 2 ] Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
                [ 3 ] John A. Paulson School of Engineering and Applied Sciences Harvard University Cambridge Massachusetts USA
                [ 4 ] Wyss Institute for Biologically Inspired Engineering Harvard University Boston Massachusetts USA
                Author notes
                [*] [* ] Correspondence

                Zongmin Zhao, Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL 60612, USA.

                Email: zhaozm@ 123456uic.edu

                Aaron C. Anselmo, Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.

                Email: aanselmo@ 123456email.unc.edu

                Samir Mitragotri, John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA.

                Email: mitragotri@ 123456seas.harvard.edu

                Author information
                https://orcid.org/0000-0003-3290-7857
                https://orcid.org/0000-0002-2459-8305
                Article
                BTM210258
                10.1002/btm2.10258
                8780015
                35079633
                dac6dc61-8eaa-4373-acd7-d05e3c7bab23
                © 2021 The Authors. Bioengineering & Translational Medicine published by Wiley Periodicals LLC on behalf of American Institute of Chemical Engineers.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 August 2021
                : 16 June 2021
                : 11 August 2021
                Page count
                Figures: 5, Tables: 5, Pages: 20, Words: 13470
                Funding
                Funded by: School of Engineering & Applied Sciences, Harvard University
                Funded by: Wyss Institute , doi 10.13039/100016528;
                Categories
                Review
                Reviews
                Custom metadata
                2.0
                January 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.0 mode:remove_FC converted:21.01.2022

                adeno‐associated virus,adenovirus,clinical translation,clinical trials,gene,gene therapy,gene transfer,herpes simplex virus,viral vector

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