Structural characterization of antibody-responses following Zolgensma treatment for AAV capsid engineering to expand patient cohorts

Mario Mietzsch (), Jane Hsi, Austin R. Nelson, Neeta Khandekar, Ann-Maree Huang, Nicholas JC Smith, Jon Zachary, Lindsay Potts, Michelle A. Farrar, Paul Chipman, Mohammad Ghanem, Ian E. Alexander, Grant J. Logan, Juha T. Huiskonen and Robert McKenna ()
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Mario Mietzsch: University of Florida
Jane Hsi: University of Florida
Austin R. Nelson: University of Florida
Neeta Khandekar: The University of Sydney and Sydney Children’s Hospitals Network
Ann-Maree Huang: The University of Sydney and Sydney Children’s Hospitals Network
Nicholas JC Smith: Women’s and Children’s Hospital
Jon Zachary: University of Florida
Lindsay Potts: University of Florida
Michelle A. Farrar: UNSW Medicine
Paul Chipman: University of Florida
Mohammad Ghanem: University of Helsinki
Ian E. Alexander: The University of Sydney and Sydney Children’s Hospitals Network
Grant J. Logan: The University of Sydney and Sydney Children’s Hospitals Network
Juha T. Huiskonen: University of Helsinki
Robert McKenna: University of Florida

Nature Communications, 2025, vol. 16, issue 1, 1-15

Abstract: Abstract Monoclonal antibodies are useful tools to dissect the neutralizing antibody response against the adeno-associated virus (AAV) capsids that are used as gene therapy delivery vectors. The presence of pre-existing neutralizing antibodies in large portions of the human population poses a significant challenge for AAV-mediated gene therapy, primarily targeting the capsid leading to vector inactivation and loss of treatment efficacy. This study structurally characterizes the interactions of 21 human-derived neutralizing antibodies from three patients treated with the AAV9 vector, Zolgensma®, utilizing high-resolution cryo-electron microscopy. The antibodies bound to the 2-fold depression or the 3-fold protrusions do not conform to the icosahedral symmetry of the capsid, thus requiring localized reconstructions. These complex structures provide unprecedented details of the mAbs binding interfaces, with many antibodies inducing structural perturbations of the capsid upon binding. Key surface capsid amino acid residues were identified facilitating the design of capsid variants with antibody escape phenotypes. These AAV9 capsid variants have the potential to expand the patient cohort to include those that were previously excluded due to their pre-existing neutralizing antibodies against the wtAAV9 capsid, and the possibly of further treatment to those requiring redosing.

Date: 2025
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DOI: 10.1038/s41467-025-59088-4

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