Sustainable recovery of MBNL activity in autoregulatory feedback loop in myotonic dystrophy

Muscleblind-like proteins (MBNLs) are RNA-binding proteins essential for the developmental regulation of various processes including alternative splicing. Their activity is misregulated in myotonic dystrophy type 1 (DM1), an incurable genetic, neuromuscular disorder caused by uncontrolled expansion of CTG repeats. Mutant RNAs containing hundreds or thousands of repeats efficiently sequester MBNL proteins. As a consequence, global alternative splicing abnormalities are induced. Importantly, the size of expansion differs significantly not only between patients but also between different parts of the same muscle as a consequence of somatic expansion. One of the potential therapeutic strategies in DM is overexpression of MBNLs. However, gene therapy tools might induce excessive activity of MBNLs, what in turn might change the metabolism of many RNAs. To overcome these limitations, we designed an autoregulated MBNL1 overexpression system. The genetic construct contains an MBNL1-coding sequence separated by the fragment of ATP2A1 pre-mRNA with an MBNL-sensitive alternative exon containing stop codon in the reading frame of MBNL1. Inclusion of this exon leads to the arrangement of an inactive form of the protein, but exclusion gives rise to fully active MBNL1. This approach enables the autoregulation of the amount of overexpressed MBNL1 with high dynamic range which ensures a homogeneous level of this protein in cells treated with the genetic construct. We demonstrated beneficial effects of an autoregulated construct on alternative splicing patterns in DM1 models and cells derived from patients with DM1.