Allele-specific correction of dominant Best vitelliform macular dystrophy in patient-derived retinal pigment epithelium

Autosomal dominant Best vitelliform macular dystrophy (BVMD) caused by variants in the BEST1 gene is characterized by dysfunction of the macular retinal pigment epithelium (RPE) and secondary degeneration of the photoreceptors. There are currently no approved treatments for BVMD, and owing to its dominant nature, there remains uncertainty regarding the utility of traditional gene augmentation. Here we evaluated whether a dominant pathogenic BEST1 allele can be corrected by base editing in differentiated RPE cells. We identified a patient with a likely pathogenic BEST1 c.851A>G (p. Tyr284Cys) variant that was amenable to cytidine base editing. After establishing patient-derived induced pluripotent stem cells (iPSCs), we corrected the pathogenic variant in the iPSCs to obtain corrected iPSCs with the same genetic background. Corrected iPSC-derived RPE exhibited normalized monolayer appearance, improved barrier integrity, reduced cell death, and restored RPE-specific transcriptome. We then used a dual adeno-associated virus (AAV) split-intein system to deliver a CRISPR-associated protein 9 cytidine base editor (SpCas9-CBE) to BEST1 c.851A>G mutant RPE monolayers and achieved editing of the pathogenic allele with a maximum efficiency of 13.42 ± 3.64% (mean ± SD). Together, these results demonstrate progress towards allele-specific base editing in a dominantly inherited retinal disorder.