Gene therapy and its role in the medical field have evolved drastically in recent decades. Studies aim to define DNA-based medicine as well as encourage innovation and the further development of novel approaches. Gene therapy has been established as an alternative approach to treat a variety of diseases. Its range of mechanistic applicability is wide; gene therapy has the capacity to address the symptoms of disease, the body’s ability to fight disease, and in some cases has the ability to cure disease, making it a more attractive intervention than some traditional approaches to treatment (i.e., medicine and surgery). Such versatility also suggests gene therapy has the potential to address a greater number of indications than conventional treatments. Many DNA-based therapies have shown promise in clinical trials, and several have been approved for use in humans. Whereas current treatment regimens for chronic disease often require frequent dosing, DNA-based therapies can produce robust and durable expression of therapeutic genes with fewer treatments. This benefit encourages the application of DNA-based gene therapy to manage chronic diseases, an area where improving efficiency of current treatments is urgent. Here, we provide an overview of two DNA-based gene therapies as well as their delivery methods: adeno associated virus (AAV)-based gene therapy and plasmid DNA (pDNA)-based gene therapy. We will focus on how these therapies have already been utilized to improve treatment of chronic disease, as well as how current literature supports the expansion of these therapies to treat additional chronic indications in the future.

Electroporation (EP) stands out as a promising non-viral plasmid delivery strategy, although achieving optimal transfection efficiency in vivo remains a challenge. A noteworthy advancement in the field of in vivo EP is the application of hyaluronidase, an enzyme with the capacity to degrade hyaluronic acid in the extracellular matrix, which thereby enhances DNA transfer efficiency by 2- to 3-fold. This paper focuses on elucidating the mechanism of hyaluronidase’s impact on transfection efficiency. We demonstrate that hyaluronidase promotes a more uniform distribution of plasmid DNA (pDNA) within skeletal muscle. Additionally, our study investigates the effect of the timing of hyaluronidase pretreatment on EP efficiency by including time intervals of 0, 5, and 30 min between hyaluronidase treatment and the application of pulses. Serum levels of the pDNA-encoded transgene reveal a minimal influence of the hyaluronidase pretreatment time on the final serum protein levels following delivery in both mice and rabbit models. Leveraging bioimpedance measurements, we capture morphological changes in muscle induced by hyaluronidase treatment, which result in a varied pDNA distribution. Subsequently, these findings are employed to optimize EP electrical parameters following hyaluronidase treatment in animal models. This paper offers novel insights into the potential of hyaluronidase in enhancing the effectiveness of in vivo EP, as well as guides optimized electroporation strategies following hyaluronidase use.

Incretin receptor agonists (IRAs) have recently come to prominence as powerful weight and glucose control drugs and are approved for the treatment of type 2 diabetes (T2D) and obesity. Semaglutide and tirzepatide, currently the most widely prescribed within this class, are both potent molecules but have a short half-life, requiring weekly dosing. This requirement can negatively affect quality of life and the adherence to therapy, as well as create a significant financial burden for patients who may have a life-long need for treatment. The MYO Technology platform was developed to overcome these barriers. It consists of therapeutic-encoding plasmid DNA, and a proprietary medical device for intramuscular injection and in vivo electroporation of muscle cells. This leads to the uptake of injected DNA, expression of the therapeutic, and its secretion into peripheral circulation. Here, we demonstrate that MYO Technology-delivered IRAs are efficacious in promoting long-lasting weight and glucose control in mouse models of diet-induced obesity. Moreover, engineering the IRAs to facilitate blood-brain barrier penetration further enhances treatment efficacy, with benefits persisting beyond 1 year following a single administration. Together, these findings highlight MYO Technology’s potential to transform standard of care by enabling long-lasting therapeutic effects with minimal dosing.

Therapeutic proteins have seen a substantial increase in clinical development and use across many disease areas. Despite their broad applicability, significant drawbacks limit access to many of these drugs, including: i) high manufacturing costs; ii) administration via time-consuming infusions; iii) frequent dosing, sometimes even daily; and iv) requirements for low temperature storage. MYO Technology was developed to overcome these barriers. The MYO Technology platform consists of therapeutic-encoding plasmid DNA (pDNA), and a proprietary medical device for intramuscular injection and delivery of electrical pulses. These pulses enable the in vivo electroporation of muscle cells and uptake of injected pDNA, leading to the production, secretion, and delivery of the therapeutic protein into peripheral circulation. MYO Technology offers several advantages over standard delivery of therapeutic proteins; pDNA manufacturing is a simpler and less specialized process compared to protein manufacturing, and pDNA is very stable and lacks most cold chain requirements. Furthermore, administration using MYO Technology takes only a few minutes, and the serum level of a therapeutic protein can potentially be maintained for many months without the need for redosing. Incretin receptor agonists (IRAs) are a class of therapeutic proteins that have recently come to prominence as powerful weight and glucose control drugs, and are used for the treatment of type 2 diabetes (T2D) and obesity. Semaglutide and tirzepatide, currently the most widely used within this class, are both potent molecules, but have a short half-life, requiring weekly administration by subcutaneous injections. Moreover, since their clinical benefits rapidly disappear upon treatment cessation, T2D and obese patients may have a life-long dependency on IRAs, and the requirement for weekly injections can negatively affect the quality of life and the adherence to therapy, as well as create a significant financial burden. Therefore, increasing the interval between injections has become one of the major goals in the field. Here, we present our preclinical studies on the delivery of IRAs with MYO Technology. Animal proof-of-concept studies demonstrate that MYO Technology-delivered IRAs are functional, and efficacious in promoting long-lasting weight and glucose control in mouse models of diet-induced obesity. Moreover, engineering the IRAs to facilitate blood–brain barrier penetration further enhances treatment efficacy, with benefits persisting beyond one year following a single administration. Together, these findings highlight MYO Technology’s potential to transform care for patients with T2D and obesity by enabling long-lasting therapeutic effects with minimal dosing, ultimately improving quality of life and treatment adherence.