Gene therapy for hereditary hearing loss: lessons from a mouse model

Hearing impairment is the most common sensory deficit worldwide, affecting at least one child in every one thousand born. Gene therapy targeting the inner ear offers promise for treatment of genetic forms of hearing loss. Many genetic forms of deafness are congenital and gene therapies in these cases would require treatment prior to inner ear maturation. Included in this category is the dominant-negative R75W mutation in GJB2 which encodes connexin 26, a gap junction protein expressed in the supporting cells of the organ of Corti. RNA interference (RNAi)-based therapeutics offer promise for treating dominant-negative diseases. Our goal has been the in vivo application of RNAi-therapy to the GJB2-R75W transgenic mouse, a model of severe-to-profound dominant-negative hearing loss. Here we describe our efforts to identify a therapeutic, a suitable delivery route, and an optimal delivery vector. We have designed and optimized siRNA to achieve robust silencing of the mutant transgene in vitro and have prepared artificial miRNA constructs for in vivo application. We have determined to use the embryonic otocyst microinjection technique as the route for therapeutic delivery and have successfully utilized this technique to study the tropism and safety of several viral vector (adeno-associated virus 2/1, early- and late-generation adenoviruses, and bovine adeno-associated virus). For the first time we have characterized viral tropism for cochlear supporting cells following in utero delivery to their progenitor cells in the developing cochlea and identified bovine adeno-associated virus as a safe vector for gene delivery to the supporting cells of the cochlea. We have also described two previously unreported phenotypes in the GJB2-R75W transgenic mouse model: skin disease and cataracts. Both can be caused by dominant connexin mutations in humans. Our work shows that although gene therapy is not simple, powerful tools are in place for treating dominant forms of hereditary hearing loss.