Neutralizing antibodies against adeno-associated virus examined prospectively in pediatric patients with hemophilia

C. Li, N. Narkbunnam, R. J. Samulski, A. Asokan, G. Hu, L. J. Jacobson, M. J. Manco-Johnson, P. E. Monahan*, Brenda Riske, Ray Kilcoyne, Sharon Funk, Linda Jacobson, J. David Ingram, Thomas C. Abshire, Amy D. Shapiro, Michele R. Hacker, Leonard A. Valentino, W. Keith Hoots, Deborah Brown, George R. BuchananDonna DiMichele, Michael Recht, Cindy Leissinger, Shirley Bleak, Alan Cohen, Prasad Mathew, Alison Matsunaga, Desiree Medeiros, Diane Nugent, Gregory A. Thomas, Alexis A. Thompson, Kevin McRedmond, J. Michael Soucie, Harlan Austin, Bruce L. Evatt

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

172 Scopus citations


Recombinant adeno-associated virus (rAAV) is a promising gene delivery vector and has recently been used in patients with hemophilia. One limitation of AAV application is that most humans have experienced wild-type AAV serotype 2 exposure, which frequently generates neutralizing antibodies (NAbs) that may inhibit rAAV2 vector transduction. Employing alternative serotypes of rAAV vectors may circumvent this problem. We investigated the development of NAbs in early childhood by examining sera gathered prospectively from 62 children with hemophilia A, participating in a multi-institutional hemophilia clinical trial (the Joint Outcome Study). Clinical applications in hemophilia therapy have been suggested for serotypes AAV2, AAV5 and AAV8, therefore NAbs against these serotypes were serially assayed over a median follow-up of 4 years. NAbs prevalence increased during early childhood for all serotypes. NAbs against AAV2 (43.5%) were observed more frequently and at higher titers compared with both AAV5 (25.8%) and AAV8 (22.6%). NAbs against AAV5 or AAV8 were rarely observed in the absence of co-prevalent and higher titer AAV2 NAbs, suggesting that NAbs to AAV5 and AAV8 were detected following AAV2 exposure due to partial cross-reactivity of AAV2-directed NAbs. The results may guide rational design of clinical trials using alternative AAV serotypes and suggest that younger patients who are given AAV gene therapy will benefit from the lower prevalence of NAbs.

Original languageEnglish (US)
Pages (from-to)288-294
Number of pages7
JournalGene therapy
Issue number3
StatePublished - Mar 1 2012


  • AAV
  • children
  • hemophilia
  • neutralizing antibody
  • prevalence
  • serotype

ASJC Scopus subject areas

  • Genetics
  • Molecular Medicine
  • Molecular Biology


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