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96 reviewsAdeno-associated virus (AAV)-based gene therapies, exemplified by the approved therapy for spinal muscular atrophy,have the potential to deliver disease-course-altering treatments for central nervous system (CNS) indications. However,several clinical trials have reported severe adverse events, including patient deaths following high-dose systemic administration for muscle-directed gene transfer, highlighting the need to explore approaches utilizing lower doses whentargeting the CNS. Animal models of disease provide insight into the response to new AAV therapies. However,translation from small to larger animals and eventually to humans is hampered by anatomical and biological differencesacross the species and their impact on AAV delivery. We performed a literature review of preclinical studies of AAVgene therapy biodistribution following cerebrospinal fluid (CSF) delivery (intracerebroventricular, intra-cisterna magna,and intrathecal lumbar). The reviewed literature varies greatly in the reported biodistribution of AAV following administration into the CSF. Differences between studies, including animal model, vector serotype used, method used toassess biodistribution, and route of administration, among other variables, contribute to differing outcomes and difficulties in translating these preclinical results. For example, only half of the published AAV-based gene therapy studiesreport vector copy number, the most direct readout following administration of a vector; none of these studies reporteddetails such as the empty:full capsid ratio and quality of encapsidated genome. Analysis of the last decade’s literaturefocusing on AAV-based gene therapies targeting the CNS underscores limitations of the body of knowledge and room forcontinued research. In particular, there is a need to understand the biodistribution achieved by different CSF-directedroutes of administration and determining if specific cell types/structures
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