Noninvasive Focal Gene Delivery of Functional Neural Actuators to the Primate Spinal Cord using Focused Ultrasound

Pathologies of the spinal cord -- from degenerative diseases to chronic pain -- represent a substantial global health burden. Although surgical and pharmacological treatments for spinal cord pathologies have advanced considerably, therapies capable of addressing the cellular mechanisms underlying these conditions remain limited. Viral gene therapies present a compelling alternative, allowing for delivery of therapeutic genes that directly target the pathological processes in specific cell-types. Effective viral delivery to the spinal cord, however, remains constrained by a fundamental tradeoff between procedural invasiveness and spatial precision. As such, there remains a need for clinically tractable methods -- that are both noninvasive and focal -- to deliver gene therapeutics across the restrictive vascular boundaries of the blood-spinal cord barrier (BSCB). Here, we demonstrate noninvasive, focal disruption of the BSCB and delivery of systemically administered chemogenetic gene payloads to the cervical and thoracic spinal cord in marmoset nonhuman primates (Callithrix jacchus) using focused ultrasound (FUS). Through systematic testing of ultrasonic pressures and central frequencies, we establish a FUS parameter set optimized for robust, spatially constrained molecular delivery across the marmoset BSCB. Using these optimized parameters, we show that FUS BSCB disruption permitted focal penetrance of systemically administered viral vectors for transduction of both fluorescent transgenes and excitatory chemogenetics within targeted spinal segments. Positron emission tomography (PET) imaging following chemogenetic actuation revealed significantly increased metabolic demand within the targeted region of the spinal cord, demonstrating in vivo evidence of functional transgene expression. Behavioral and histopathological assessments demonstrated preserved neurological function and tissue integrity, supporting the safety of FUS BSCB disruption and viral delivery in nonhuman primates. To facilitate broad application of this platform for noninvasive delivery of receptor-based gene therapeutics in marmosets, we generated an ultra-high-resolution (74 m) multimodal MRI/CT spinal cord template for precise targeting and anatomical localization. We also provide open-access engineering drawings and CAD files for our M-FRAME system (Marmoset Fixation and Reorientation Apparatus for Multimodal Experiments), enabling precise and repeatable spinal targeting without surgical fixation. Together, these results establish FUS-mediated BSCB disruption as a safe and effective approach for noninvasive, focal gene delivery to the primate spinal cord.