AAV-Mediated Dual-Gene Therapy Restores Metabolic Function in Mice with Propionic Acidemi

Xu, H.; Tao, Z.; Zhang, T.; Zhang, X.; Zhou, Y.; Cen, Z.; Liu, J.; Zhang, H.; Maimaitijiang, A.; Chen, D.; Li, D.; Yin, S.; An, L.; Huang, X.; Zhang, Y.

doi:10.64898/2026.03.06.709717

bioRxiv · 10.64898/2026.03.06.709717

AAV-Mediated Dual-Gene Therapy Restores Metabolic Function in Mice with Propionic Acidemi

Xu, H.·Tao, Z.·Zhang, T.·Zhang, X.·Zhou, Y.·Cen, Z.·Liu, J.·Zhang, H.·Maimaitijiang, A.·Chen, D.·Li, D.·Yin, S.·An, L.·Huang, X.·Zhang, Y.

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Abstract

Background and AimsPropionic acidemia (PA) is a rare autosomal recessive disorder caused by mutations in PCCA or PCCB, which encode the two subunits of propionyl-CoA carboxylase (PCC). PCC deficiency causes toxic metabolite accumulation and multi-organ damage. Current management, including dietary restriction, pharmacological support, and liver transplantation, does not restore enzymatic activity. We developed a dual-gene adeno-associated virus (AAV) therapy that delivers both PCC subunits to treat both PA subtypes. MethodsWe generated a clinically relevant PCCA-R73W knock-in mouse model and administered AAV8 vectors encoding native human PCCA and PCCB under the control of a liver-specific thyroxine-binding globulin promoter (AAV8-TBG-hPCCA-P2A-hPCCB). Metabolite levels and organ safety were longitudinally assessed. ResultsDual-gene therapy produced dose-dependent reductions in plasma C3/C2 ratio, 3-hydroxypropionic acid, 2-methylcitric acid, and propionylglycine, and significantly outperformed single-gene (PCCA-only) therapy. Neonatal facial-vein injection achieved metabolic correction comparable to or better than adult treatment. The longitudinal follow-up revealed sustained efficacy over a 16-week period, with no signs of hepatotoxicity or adverse effects. ConclusionsSingle-dose, dual-gene AAV therapy achieves sustained metabolic correction and demonstrates long-term safety in a clinically relevant PA model, supporting its translational potential for both type I and type II propionic acidemia.

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Xu, H., Tao, Z., Zhang, T., Zhang, X., Zhou, Y., Cen, Z., Liu, J., Zhang, H., Maimaitijiang, A., Chen, D., Li, D., Yin, S., An, L., Huang, X., Zhang, Y.. 2026-03-07. AAV-Mediated Dual-Gene Therapy Restores Metabolic Function in Mice with Propionic Acidemi. https://doi.org/10.64898/2026.03.06.709717

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