In this protocol, we detail all the steps necessary to achieve in vivo cardiac gene editing in postnatal mice using rAAVrh.74-mediated delivery of SaCas9 and two gRNAs. As previously noted, this approach can be used to restore dystrophin expression in dystrophic mice as described in our work27, but it could also enable rapid reverse genetics studies of cardiac-related genes in mice without the lengthy process of the traditional knockout approach to generate and breed knockout mouse models.
In order to achieve high gene editing efficiency in the target tissue, there are several critical steps to keep in mind: 1) the efficacy of the SaCas9/gRNA to induce the deletion of targeted genomic DNA needs to be validated using appropriate cell lines; 2) it is very crucial to select a proper AAV serotype that can mediate a high level of gene transduction into the target tissue and 3) determine the optimal delivery route of AAV vectors for gene transfer to the desired tissue.
In the current protocol, the designed SaCas9/gRNAs were packaged into AAVrh.74 rather than previously reported AAV8 and AAV9 to edit Dmd gene12,28. AAVrh.74 exhibits about 93% homology to AAV829 and has been shown to be non-pathogenic and effective in transducing skeletal muscle following isolated limb delivery29,30,31. In this protocol, we use retro-orbital and intraperitoneal injection of rh.74 into neonatal mice for cardiac gene transfer. We found that the neonate administration of rAAVrh.74 is highly efficient for the restoration of dystrophin expression in about 30-40% of cardiomyocytes in the mice receiving a high dosage of rAAVrh.74 (1 x 1012 vg). Interestingly, we found that the skeletal muscle dystrophin expression was not effectively rescued. This is likely due to the low skeletal muscle tropism of rh.74 serotype when administered via intravenous or intraperitoneal injection, although previous studies showed that isolated limb delivery of rAAVrh.74 can effectively transduce mouse and monkey skeletal muscle29,30,31. Also, when the rAAVrh.74 was administered into adult mice, we observed very low efficiency in restoring dystrophin expression. It would be interesting to determine the minimum dosage which is required to achieve the highest dystrophin rescue. Furthermore, other serotypes and delivery methods can be tested and compared for achieving optimal cardiac gene editing.
Successful deletion of a large genomic DNA piece requires simultaneous delivery of two gRNAs. We found it is not necessary to make two separate rAAV preparations for delivering two gRNAs. In this protocol, we simply mixed the two gRNA plasmids in an equal amount during transfection for rAAV production, and this combined production of rAAV was found to be effective in delivering both gRNAs. This combined approach is, therefore, cost- and labor-saving and recommended when simultaneous delivery of two gRNAs are required.
In many cases, it may be necessary to analyze the gene editing efficiency by genetic approaches when a good antibody is not available for the target gene product. However, it is technically challenging to accurately quantify the gene editing efficacy with two gRNAs targeting the same locus since the gene editing products would include target sequence deletion, target sequence inversion, and small indels at only one target site. Instead, it is more meaningful and feasible to quantify the efficiency of the desired targeted sequence deletion as in our case where the reduction of the transcripts containing exons 21-23 can be quantified by real-time RT-PCR.
In this protocol, we also describe the use of T7E1 assay and computational prediction to analyze the potential off-target activity. For the assay to work well, it is necessary to use a high-fidelity DNA polymerase. Also, it is always a good idea to prepare for a negative control experiment (e.g. control DNA products amplified from the cells/tissues without gene editing, and treated the same way as the test samples) and a positive control experiment (e.g. a known sample with well-characterized gene editing). However, it is of note that the detection limit of the T7E1 assay is about 5%32, and thus it may not be detectable by the T7E1 assay if the off-target activity is below 5%. GUIDE-seq33 can be used to unbiasedly analyze the off-target activity of the SaCas9/gRNA-mediated gene editing. The identified off-target sites from T7E1 assay, computational prediction and/or GUIDE-seq approaches can further be quantified for indel frequencies following in vivo gene editing by high-throughput sequencing.
Taken together, we have provided an optimized cardiac gene editing approach using rAAVrh.74. This established protocol can be further tested for therapeutic applications and reverse genetic studies.