Characterization and AAV-mediated CRB gene augmentation in human-derived CRB1^KO and CRB1KOCRB2^+/- retinal organoids

The majority of patients with mutations in CRB1 develop either early-onset retinitis pigmentosa as young children or Leber congenital amaurosis as newborns. The cause for the pheno-typic variability in CRB1-associated retinopathies is unknown, but might be linked to differences in CRB1 and CRB2 protein levels in Muller glial cells and photoreceptor cells. Here, CRB1KO and CRB1KOCRB2+/-differentiation day 210 retinal organoids showed a significant decrease in the number of photoreceptor nuclei in a row and a significant increase in the number of photoreceptor cell nuclei above the outer limiting membrane. This phenotype with outer retinal abnormalities is similar to CRB1 patient-derived retinal organoids and Crb1 or Crb2 mutant mouse retinal disease models. The CRB1KO and CRB1KOCRB2+/-retinal organoids develop an additional inner retinal phenotype due to the complete loss of CRB1 from Muller glial cells, suggesting an essential role for CRB1 in proper local-ization of neuronal cell types. Adeno-associated viral (AAV) transduction was explored at early and late stages of organoid development. Moreover, AAV-mediated gene augmentation therapy with AAV.hCRB2 improved the outer retinal pheno-type in CRB1KO retinal organoids. Altogether, these data pro -vide essential information for future gene therapy approaches for patients with CRB1-associated retinal dystrophies.