iPSC-derived hepatocytes accurately recapitulate population diversity in alpha-1-antitrypsin deficiency and offer a novel in vitro model for large-scale drug efficacy screening studies.

BackgroundAlpha-1 antitrypsin deficiency (A1ATD) is a hereditary recessive disorder caused by mutations in the SERPINA1 gene. It is a clinically under-recognised disease characterised by low circulating A1AT levels and intracellular accumulation of misfolded A1AT in hepatocytes. Deposition of excessive abnormal A1AT in the liver leads to liver failure, yet no specific treatments are available due to the lack of physiologically relevant disease modelling platforms. MethodsWe have hypothesised that human induced pluripotent stem cell (iPSC)-derived hepatocytes can provide an efficient platform to study A1ATD. Using CRISPR/Cas9, we have generated wild-type and A1ATD iPSC-derived hepatocytes (Opti-HEP) from healthy and A1ATD donors and developed a bioassay that mimics the accumulation of misfolded A1AT in the liver. Responses to the reference drug carbamazepine (CBZ), known to reduce intracellular misfolded A1AT levels, and RNA-based therapeutics were subsequently investigated. ResultsAll lines successfully differentiated into hepatocytes as measured by comparable key hepatic and disease markers to those seen in primary human hepatocytes. The diseased lines displayed increased intracellular accumulation of misfolded A1AT compared to isogenic controls. Diseased cell lines showed significant decreases in intracellular accumulation of polymeric A1AT following transfection with RNA-based therapeutics, but a differential response upon treatment with CBZ. ConclusionWe have developed a specific and robust in vitro model of A1ATD that recapitulates disease pathophysiology and responds to small molecule-based treatments and advanced therapeutic strategies. These data demonstrate the suitability of this model for large-scale efficacy screening studies for the treatment of A1ATD and help pave the way towards the development of novel therapies.