Construction of minicircle DNA vectors capable of correcting familial hypercholesterolemia phenotype in a LDLR-deficient mouse model.

Familial hypercholesterolemia (FH) caused by defect in low-density lipoprotein receptor (LDLR) is a life-threatening disease with poor response to conventional treatments. Earlier gene therapy studies have generated promising results, but further development is hampered because the cells harboring the viral vectors were eliminated by host immune system soon after delivery, whereas the nonviral vectors were too bulky to be delivered to target cells. To overcome these problems, we constructed multiple minicircle (MC) DNA vectors to express the therapeutic LDLR. MC is an optimized nonviral vector that is capable of expressing high level of transgene product persistently. We found that among the seven MCs tested, the best is MC5 with multiple advanced features. First, the LDLr gene was placed under the control of sterol regulatory element (SRE) using LDLr gene promoter or apoprotein E (ApoE) promoter, allowing the transcription of the LDLr gene to be regulated by serum low-density lipoprotein (LDL) cholesterol as its functional gene counterpart. Second, a hepatic control region (HCR) was placed upstream of the promoter that serves as a controller to ensure liver-specific expression. Third, the modified Kozak sequence was placed in front of the LDLr gene start codon to enhance its translation efficiency. MC5 was 5.23 kb in size, and was capable of tight physiological control in intracellular LDL cholesterol level even when challenged with high dose of sterols in vitro. Importantly, it was able to correct the phenotype of LDLR-deficient mice C57BL/6 LDLR(-/-) for more than 105 days without detectable toxicity. Therefore, this MC has the clinical application potential for treating FH.