Subretinal Gene Therapy for X-Linked Retinoschisis

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Mean BCVA improvement: 10.8 letters (treated) vs 2.4 letters (untreated eyes)

• Primary Outcome: No grade 3+ adverse events or ocular inflammation in 52 weeks

• Nnt Or Sensitivity: 100% anatomical response rate (macular schisis closure in all 12 patients by week 13)

• Confidence Interval: Not reported

Clinical Application

Requires specialised vitreoretinal surgery and gene therapy infrastructure Would require TGA approval for clinical use; potential PBS consideration given orphan disease status; specialist centres in major cities could deliver treatment Paediatric and adolescent patients with genetically confirmed X-linked retinoschisis

Abstract

BACKGROUND: X-linked retinoschisis is a recessive disease characterized by progressive macular degeneration and vision loss due to pathogenic variation in RS1. METHODS: We administered a single subretinal injection of an AAV8 vector containing human RS1 complementary DNA (scAAV8-hRS1) into one eye of patients 5 to 18 years of age who had X-linked retinoschisis. The primary end point was safety during the 52-week period after injection. Secondary end points included the change from baseline to week 52 in the best corrected visual acuity (BCVA), retinal structure (assessed with swept-source optical coherence tomography; SS-OCT), the function of photoreceptor and bipolar cells (assessed with full-field electroretinography), and macular sensitivity to light (assessed with microperimetry). RESULTS: A total of 12 patients were enrolled. The dose-escalation phase included two cohorts of 3 patients each who received scAAV8-hRS1 at a dose of 7.5×1010 or 1×1011 vector genomes. In the dose-expansion phase, 3 additional patients were enrolled in each cohort. Overall, 56 adverse events were reported during the 52 weeks after surgery. No patient was reported to have an adverse event of grade 3 or higher or ocular inflammation. A macular hole in the treated eye was observed at week 1 in 1 patient. The mean increase at week 52 in the BCVA was 10.8 letters among the treated eyes and 2.4 letters among the untreated eyes. SS-OCT imaging showed closure of the macular schisis cavity by week 13 in the treated eye in all 12 patients. The mean change at week 52 in central retinal thickness was -437.7 μm among the treated eyes and -17.2 μm among the untreated eyes; the outer retinal layers in the treated eyes of 9 patients were continuous at week 52. No clinically meaningful changes in the function of photoreceptor and bipolar cells or macular retinal sensitivity were observed in the treated eyes. CONCLUSIONS: In this study of subretinal gene therapy with scAAV8-hRS1 in 12 patients with X-linked retinoschisis, there were no reports of adverse events of grade 3 or higher or ocular inflammation. Further clinical testing of scAAV8-hRS1 is warranted. (Funded by the National Natural Science Foundation of China and others; Chinese Clinical Trial Registry number, ChiCTR2300076682.).

References

1. 1.Liang, L., She, K., Ren, C., Li, R., Liao, M., Tao, Z., Liu, F., Su, J., Hu, M., Yang, Y., Wang, X., Zhang, C. L., Bao, L., Chen, Q., Zhang, K., Wei, Y., Yang, Y., & Lu, F. (2026). Subretinal gene therapy for X-linked retinoschisis. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2515953