Clinical report on a boy who developed a brain tumor after AAV gene therapy for treating his mucopolysaccharidosis (MPS). Fortunately, the boy has so far survived and thrived despite the MPS, the cancer, and the surgery to remove the tumor. Molecular analysis of the tumor revealed that it was caused by integration of parts of the AAV’s DNA into the genome, triggering overexpression of an oncogene called PLAG1. This case highlights the clinical importance of rare integration events in AAV gene therapy and reminds us that we must remain vigilant of the risks from these treatments.
Recombinant adeno-associated virus (AAV) vectors are predominantly nonintegrating, but rare genomic integration events have been associated with oncogenesis in neonatal murine models. Here we report a case of a neuroepithelial tumor that developed in a 5-year-old boy with severe mucopolysaccharidosis type I (MPSI, Hurler subtype) 4 years after intracisternal magna administration of AAV serotype 9 gene therapy. The patient underwent successful resection of the primary tumor. Postoperatively, he has continued to have advanced cognitive function for his age, a finding that indicates mitigation of MPSI. Molecular analysis of the tumor showed clonal integration of rearranged AAV vector elements into the gene PLAG1 and expression of a chimeric AAV-PLAG1 transcript.









