AAV-Delivered Anti-PC-OxPL Antibody Fragments: A NovelTherapeutic Approach to Target ALS

Amyotrophic lateral sclerosis (ALS) is characterized by the progressive loss of motor neurons and premature death. The limited understanding of the mechanisms underlying selective motor neuron death has significantly hindered the development of disease-modifying treatments. Ferroptosis, a form of cell death dependent on iron accumulation, has been implicated in the selective degeneration of motor neurons in ALS. Oxidized phosphatidylcholines (PC-OxPL) have been identified as key effectors in the pathophysiological processes associated with this pathway. Preclinical observations revealed a distinct PC-OxPL profile in the cerebrospinal fluid (CSF) of sporadic ALS (sALS) patients and identified apolipoprotein E (APOE) particles as the primary carriers of PC-OxPL in the CSF. Furthermore, in ALS brain and spinal cord tissue sections, PC-OxPL was found to be predominantly associated with motor neurons. Exposure of iPSC-derived motor neurons to PC-OxPL led to transcriptomic changes in genes known to be linked to ALS, as well as the induction of significant TDP-43 pathology and motor neuron death. To counter this, we developed a single-chain antibody fragment (scFv) encoded by an AAV-delivered DNA construct that specifically targets PC-OxPL neoepitopes (PC-OxPL-VecTab(R)). PC-OxPL-VecTab(R) effectively neutralized PC-OxPL-induced neurotoxicity and TDP-43 aggregation in motor neurons, while preventing motor neuron death and deficits in a sALS CSF mouse model. When administered intrathecally to minipigs, PC-OxPL-VecTab(R) was distributed to both upper and lower motor neurons and expressed at levels predicted to be therapeutically effective. Our work identifies PC- OxPL as a critical pathological factor and a key inducer of TDP-43 pathology in ALS, providing the foundation for a novel therapeutic intervention modality for patients with sALS. Furthermore, it offers the exciting potential to be expanded to diseases characterized by PC-OxPL neurotoxicity.