1. Introduction
Arginase 1 (ARG1) deficiency (ARG1-D) is a rare autosomal recessive genetic disorder that occurs in approximately 2.8 cases per million births with the population prevalence at approximately 1.4 cases per million people worldwide [
1,
2]. ARG1-D is one of the diseases among the urea cycle disorders (UCDs) and is caused by the mutations or deletions of the ARG1 gene located on chromosome 6 (6q23), which leads to a lack of ARG1 protein expression in the patients [
3]. ARG1 is the last enzyme in the urea cycle to catalyze the conversion of arginine into ornithine and urea [
3]. The urea cycle mainly takes place in the hepatocytes in the liver and is the major pathway to detoxify ammonia in mammals [
3]. Patients with ARG1-D usually display symptoms in their late infancy to pre-school age [
4]. With the disease progression, patients would show spasticity mainly in their lower limbs, intellectual disability, motor deficits, seizures, developmental delays/growth deficiency, and other neurological symptoms, which impact the quality of life of the patients and their parents/caregivers [
1,
3,
5]. The standard therapeutic interventions mainly focus on controlling the plasma arginine through dietary protein restrictions, supplementing arginine-free essential amino acids, and the administration of nitrogen scavengers to control the plasma ammonia level [
1,
3,
5,
6]. Over the past two decades, different approaches for ARG1-D-specific therapies have been evaluated, such as recombinant human ARG1 protein [
7], adeno-associated virus (AAV)-based therapies [
8,
9,
10,
11], and lipid-nanoparticle-based mRNA therapy [
12]. Despite the promising data in the preclinical stage, none of these strategies have produced a valuable therapy but the pegylated human ARG1, which was recently approved in the European Union and United Kingdom (
https://www.ema.europa.eu/ Accessed on 2 January 2025). Although the pegylated human ARG1 treatment resulted in improved plasma arginine levels in the preclinical studies [
7] and clinical trials [
13,
14], this approach showed no improvement of lifespans in ARG1-D mouse models [
7], presumably due to the lack of liver-specific delivery.
For the past decade, extracellular vesicles (EVs) have drawn significant attention for their potential applications in both diagnostics and therapeutics [
15,
16]. EVs are nano-sized vesicles naturally secreted by almost all cell types [
17,
18], ~50–150 nm in size, formed from the inward budding of the endosome membranes, functioning as a “messenger” between cells, and involved in different physiological and pathological conditions [
19]. EVs showed low immunogenicity with good biocompatibility and a good safety profile, which are the key features for ideal nanomedicine [
15,
19,
20,
21,
22]. Numerous studies have demonstrated the capability of loading different therapeutic cargos, including protein, small RNA, and small molecules, and many of them are being evaluated in the early to late stages of clinical trials [
19,
20,
22,
23]. However, so far, there is no approved EV-based therapy according to the US Food and Drug Administration.
The goal of the present study is to develop an enzyme replacement therapy for ARG1-D using our StealthXTM exosome-based platform. We successfully engineered 293F cells to express a functional ARG1 enzyme onto the EVs (STX-Arg1) membrane, which resulted in ARG1 delivery to the cells while retaining its enzymatic activity. Our data suggested that the ARG1 EVs were safe and capable of increasing ARG1 activity in the liver and decreasing the levels of circulating arginine at the same time in a wild-type mouse model with a nanogram dosage. Furthermore, the treatment of neonatal Arg1 deficiency in a mouse model with STX-Arg1 EVs resulted in an increased lifespan because of the active delivery of ARG1 into the liver and reduced circulating arginine. The results presented here demonstrate the efficacy and safety of our STX-Arg1 EVs and show tremendous potential as enzyme replacement therapy for the treatment of ARG1-D.
3. Discussion
Currently, the treatment for ARG1-D mainly relies on the restriction of dietary intake of protein, arginine-free essential amino acid supplements, and nitrogen-scavenging drugs, such as glycerol phenylbutyrate or sodium phenylbutyrate, as needed. Although numerous strategies, including AAV-based gene therapy [
8,
9,
10,
11], lipid nanoparticle-based mRNA therapy [
12], recombinant ARG1 protein [
7], hepatocyte transplantation [
25], and stem cell-based therapy [
25,
26,
27], have been evaluated for the treatment for ARG1-D for the past two decades, minimal progress was made in clinical practice. Some approaches were shown to have limited efficacy [
7], and the rest were hindered by various challenges, including pre-existing immune responses against gene therapy vectors and immune-mediated toxicities after the administration of AAV vectors [
28,
29], genotoxicity of AAV-based therapies [
30,
31], the inability of intracellular delivery of hepatocytes [
7], and the safety and adverse effects of synthetic lipid nanocarriers in pediatric cohorts [
32]. Thus far, only one disease-specific drug, a cobalt-substituted pegylated recombinant human ARG1 targeting hyperargininemia, was approved until recently in the EU and UK (
https://www.ema.europa.eu/, accessed 2 January 2025). It is worth noting that while hyperammonemia is typically not present, the ARG1-D diagnosis is increasingly made by expanded newborn screening. Therapeutic drugs that can directly improve the deficit of the ARG1 protein in ARG1-D remain direly needed.
In this study, we developed an EV-based enzyme replacement therapy that successfully prolonged the lifespan of a lethal neonatal Arg1−/− mouse model. By generating EVs carrying the enzymatic active ARG1 protein on the EV surface or inside of the EV lumen, we showed that the capability in catabolizing arginine by EVs carrying a nanogram of ARG1 were similar to the microgram level of free rHuArg1. We further demonstrated intracellular delivery of the functional ARG1 protein by EVs in vitro, but not the recombinant protein alone. In vivo studies demonstrated that STX-Arg1-in EVs were not toxic. Most importantly, the lifespan of the neonatal Arg1−/− mouse model was extended by the treatment of STX-Arg1-in EV due to the successful delivery of the ARG1 enzyme to the liver, retaining its enzymatic activities and reducing the arginine level in circulation.
EVs were chosen as the vehicles for the cargo delivery of the engineered human ARG1 protein. EVs are cell-derived lipid nanoparticles that serve as a messenger for communication between cells. Due to the nature of the EVs, these cell-derived nanovesicles are considered to be safe, have low immunogenicity, and high biocompatibility [
16,
21]. Decades-long application of blood transfusion, which contains high concentrations of EVs, further strengthening the safety of this approach. In our previous studies using StealthX
TM EV platform, we demonstrated a high safety profile of the STX EVs [
33,
34]. This was further supported by the current study: no adverse effects, toxicity, or pathological histopathological changes were found in the wild-type mice receiving STX-Arg1-in EVs (
Figure 5). The high safety profile allowed us to administrate multiple doses for therapeutic purposes.
The goal of the present study was to develop a novel enzyme replacement therapy for ARG1-D using EV-based approaches to reduce the amount of protein needed for therapeutic efficacy and improve delivery to the liver for the treatment of ARG1-D. As anticipated, the localization of the ARG1 protein on EV membrane affected its functionality. Using our StealthX
TM EV-engineering platform, the ARG1 protein was loaded to the EVs through an EV-specific anchor (STX-Arg1-out and STX-Arg1-in) or an anchor-free (Arg1-free) system (
Figure 1A). In alignment with previous data, the EV-specific anchor provided a more efficient loading of the ARG1 protein to the EVs, with STX-Arg1-out and STX-Arg1-in EVs showing higher arginase activities compared to the STX-Arg1-free EVs (
Figure 1D). To gain a better insight into the potential efficacy, in vitro delivery of the ARG1 protein by ARG1 EVs was studied. Our data showed that nanogram-levels of the ARG1 protein delivered by STX-Arg1-out and STX-Arg1-in EVs had comparable enzyme activities in catalyzing arginine to the microgram level of rHuArg1 (
Figure 2A and
Figure 3A). As the urea cycle takes place in the hepatocytes in the liver and catabolizes the toxic ammonia into urea [
2], the expression of functional ARG1 in the hepatocytes has been suggested to be important to resolve hyperammonemia and prolong the survival of the Arg1 knockout mouse models [
7,
8,
9]. Our data showed that STX-Arg1-in EVs, which have the engineered ARG1 protein encapsulated inside of the EVs, could deliver ARG1 into the cells and retain its function, which was not achievable by either STX-Arg1-out EVs (
Figure 2B), or rHuArg1 (
Figure 3B). This difference in activity between the two constructs (STX-Arg1-in and STX-Arg1-out) might be due to the localization of the Arg1 protein in respect to the CD9+linker: the linker might be affecting its enzymatic activity. Moreover, it could also be possible that the localization of the enzyme in the extra vesicle space exhausted its enzymatic activity faster, but could still be useful for the clearance of the circulating arginine.
The enrichment of STX-Arg1-in EVs in the liver (
Figure 4,
Figure 5 and
Figure S4) further emphasized the potential of our strategies for the treatment of ARG1-D. The lethal phenotype of the animal models for ARG1-D (Arg1
−/− mouse) makes the development of therapeutics challenging. Unlike human ARG1-D, where the disease rarely leads to death caused by the symptoms due to the lack of ARG1 activity directly, both neonatal/congenital and inducible/conditional Arg1-knockout mouse models were lethal [
7,
27], with a lifespan of 14 days from birth or after induction. The main cause of death of the Arg1-knockout mouse models was considered to be hyperammonemia [
7,
27], which was less frequent in human ARG1-D [
3]. In our study, the therapeutic efficacy of the STX-Arg1-in EVs was evaluated on a neonatal Arg1
−/− mouse model, B6.129-Arg1tm1Rki/J (The Jackson Laboratory, Strain # 007741). STX-Arg1-in rapidly delivered ARG1 to the liver, which resulted in a rapid decrease in the circulating plasma arginine. Fast clearance was observed, with a decline 6 h after injection (
Figure 6). More importantly, our data showed that the i.p. administration of STX-ARG1-in EVs (at a dose of 0.03 mg/kg of ARG1Arg1) weekly or every 48 h was sufficient to extend the lifespan of the Arg1
−/− mice by 45% over day 14, and 25% over day 18 (
Figure 5). This result was not achieved by cobalt-substituted pegylated recombinant human ARG1 [
7]; the authors suggested that the lack of improvement in survival and the control of hyperammonemia may be caused by the inability of the pegylated recombinant human ARG1 entering the liver, although the treatment was demonstrated to be efficient in controlling arginine concentrations in the circulation. The capability of STX-Arg1-in EVs in controlling blood arginine levels in conjunction with extended lifespan of the Arg1
−/− mice strengthens the potential of this strategy as a disease-specific approach in treating ARG1-D.
We are aware of the limitations of the present study. While an improvement in the lifespan was observed after STX-Arg1-in treatment, no long-term survival was achieved. A longer lifespan was achieved by AAV- and LNP-mRNA-based therapies, confirming the need for intracellular delivery of the ARG1 and the constant supply of the enzyme. Further studies with increased amounts of ARG1, new formulations, or engineering strategies to increase the ARG1 half-life are needed to improve the beneficial effects of STX-Arg1-in EV therapy. Additionally, a combination of STX-Arg1-in and STX-Arg1-out could be formulated as a cocktail therapy to combine the potent STX-Arg1-out activity for controlling peripheral arginine levels with the intracellular delivery capability of STX-Arg1-in. Both EV types were biologically active, with no toxic effects, despite the limited data available.
Lastly, the manufacturing of EV-based therapeutics must be considered. Many approaches have been proposed for EV manufacturing [
35]: at Capricor, a scalable process has been developed, using tangential filtration and size exclusion chromatography. This approach has been successfully used for the production of clinical doses for vaccine applications and shows scalable capabilities to support therapeutic applications.
Altogether, our data demonstrated the capability of the STX-Arg1-in EVs generated by our StealthXTM platform in the intracellular delivery of the enzymatic active ARG1 protein, which was further translated to increased arginase activity in the liver, relief of hyperargininemia, and most importantly, an extended survival time of a lethal neonatal Arg1-deficiency mouse model. With the safety of EV-based therapeutics, STX-Arg1-in EVs showed a potential in providing a better therapeutic effect in patients suffering from ARG1-D.
4. Materials and Methods
4.1. Cell Lines
Human embryonic kidney 293 T cells (293T) were purchased from ATCC (Manassas, VA, USA; CRL-3216) and were cultured using Dulbecco’s Modified Eagle Medium (DMEM), high glucose, Glutamax™ containing 10% fetal bovine serum at 37 °C with 5% CO2. FreeStyleTM 293F cells (Gibco, Grand Island, NY, USA) were purchased from ThermoFisher Scientific. 293F cells were served as a parental cell line to generate stable cell lines expressing the human ARG1 protein. Parental 293F cells and the engineered 293F cells were cultured in a Multitron incubator (Infors HT, Annapolis Junction, MD, USA) at 37 °C, under an 80% humidified atmosphere with 8% CO2 on an orbital shaker platform rotating at 110 rpm.
4.2. Lentiviral Vectors
Lentiviral vectors for the expression of human ARG1 (NCBI Reference Sequence: NM_001244438.2) were designed and codon-optimized for the synthesis from Genscript (Piscataway, NJ, USA) together with the two lentiviral packaging plasmids, pMD2.G and psPAX2. Three different designs were utilized: (1) the overexpression of ARG1 (Arg1-free), (2) the extracellular display of ARG1 (Arg1-out) by linking ARG1 with CD9 with a synthetic transmembrane linker at the N-terminal of the ARG1 sequence, and (3) the intracellular packaging of ARG1 (Arg1-in) by linking ARG1 to the C-terminal of the CD9. Production of lentiviral particles for transduction of the cells was performed as previously [
33,
34]. Briefly, lentiviral particles carrying the gene of interest were generated by transfecting 293T cells with pMD2.G (Genescript), psPAX2 (Genescript) and ARG1 expressing vectors (Genscript) at a ratio of 5:5:1 using Lipofectamine 3000 according to the manufacture’s instruction. Lentiviral particles were collected 48 h after transfection and used for the transduction of 293F cells.
4.3. ARG1 EV Production
Suspension Arg1-free, Arg1-out, and Arg1-in cells were cultured in FreeStyle 293 Expression media (Chemical defined, EVs and serum free, ThermoFisher Scientific, Waltham, MA, USA) in a Multitron incubator (Infors HT) at 37 °C under an 80% humidified atmosphere supplied with 8% CO
2 on an orbital shaker platform. Cell suspension was collected 72 h after seeding, and the cells and cell debris were removed by centrifugation, while microvesicles and other extracellular vesicles larger than ~220 nm were removed by vacuum filtration. Clarified supernatants were processed as previously described [
33,
34]. Briefly, the supernatant was subjected to concentrating tangential flow filtration (TFF) on an AKTA Flux s instrument (Cytiva, Marlborough, MA, USA) and then subjected to chromatography on an AKTA Avant 25 (Cytiva).
4.4. Nanoparticle Tracking Analysis
Size distribution and concentration of purified EVs were determined using ZetaView Nanoparticle Tracking Analysis (Particle Metrix, Mebane, NC, USA) according to manufacturer instructions. EV samples were diluted in 0.1 µm-filtered 1X PBS (Gibco) to fall within the instrument’s optimal operating range to allow the optimal characterization of the EVs. For reproducibility, the following conditions were applied: 1. Number of positions: 11; 2. Resolution: high, 60 frames; 3. sensitivity: 84–87; 4. Shutter: 100; 5. Frame rate: 30 fps; 6. Minimum brightness: 20; 7. Max area: 1000; 8. Min area: 10; 9. Trace length: 15; 10. Laser: 488; 11. Temperature: room temperature; 12. Replicates: three (3) replicates per sample.
4.5. Flow Cytometry
ARG1 protein expressions on the cells were detected by standard flow cytometry techniques. The ARG1 protein positioned outside of the cells and EVs (Arg1-out) can be detected by surface staining, while intra-cellular/intra-vesicle ARG1 (Arg1-in) requires membrane permeabilization to allow for its staining/detection. Briefly, for the detection of extracellular ARG1 and CD9, 300,000 cells/well were plated in a 96-well U bottom plate for staining. Cells were incubated at 4 °C for 20 min with 100 µL eBioscience
TM Flow Cytometry Staining Buffer (ThermoFisher Scientific) containing anti-human ARG1 antibodies (Biolegend, San Diego, CA, USA, clone 14D2C43, PE) protected from light. For intracellular ARG1 (STX-Arg-in) staining, cells were permeabilized and fixed for 20 min at 4 °C using BD CytoFix/CytoPerm buffer (BD Bioscience, San Diego, CA, USA), followed by incubation at 4 °C for 20 min with 100 µL BD Perm/Wash Buffer (BD bioscience) containing anti-human ARG1 antibodies (Biolegend, clone 14D2C43, PE) protected from light. After staining, cells were washed and re-suspended in 200 µL eBioscience
TM Flow Cytometry Staining Buffer (ThermoFisher Scientific) for sample acquisition using CytoFlex S flow cytometer (Beckman Coulter, Brea, CA, USA) and the data was analyzed using FlowJo V10 (Becton, Dickinson and Company, Franklin Lakes, NJ, USA). The gating strategy is available in
Supplementary Figure S6.
4.6. Simple Western Jess Automated Protein Analysis
Detections of ARG1 protein in cells and EVs were carried out using the Protein Simple’s Jess capillary protein detection system. Cell and EV samples were lysed in RIPA buffer (ThermoFisher Scientific) supplemented with protease/phosphatase inhibitor (ThermoFisher Scientific), quantified using the BCA assay (ThermoFisher Scientific) and run for detection. To detect the engineered ARG1 protein, the separation module 12–230 kDa was used following manufacturer protocol. Briefly, 1 µg of sample and protein standard were run in each capillary, probed with primary antibodies followed by secondary antibodies provided in Jess kits (HRP/IR). Primary antibodies used are as following: rabbit anti-human ARG1 (ThermoFisher Scientific, clone 24H4L3, 1:100 dilution), mouse anti-human actin (Novus Biologicals, Centennial, CO, USA, clone AC-15, 1:20 dilution), rabbit anti-human CD9 (Cell Signaling, clone D9O1A, 1:100 dilution), rabbit anti-human calnexin (Novus Biologicals, 1:100 dilution), mouse anti-human CD81 (Novus Biologicals, 1:10 dilution), rabbit anti-HSP60 (R&D system, Minneapolis, MN, USA, 1:100 dilution), rabbit anti-human GM130 (R&D system, 1:10 dilution).
4.7. Quantification of Recombinant ARG1 Protein by ELISA
Human ARG1 protein carried on the ARG1 EVs was quantified by an enzyme-linked immunosorbent assay (ELISA) using precoated ELISA plates (Invitrogen, Carlsbad, CA, USA) following the manufacturer’s instructions. Briefly, EV samples were lysed with RIPA buffer (ThermoFisher Scientific) supplemented with protease/phosphatase inhibitor (ThermoFisher Scientific) at 1:1 ratio for 30 min on ice. A total of 1 × 1011/mL or 1 × 1010/mL of lysed EVs were plated to antigen-coated wells together with a biotinylated detecting antibody and incubated at room temperature for 2 h on an orbital shaker (200 rpm). After the incubation, the lysates were removed and the wells were washed four times with 1X Wash Buffer, and the Streptavidin-HRP was added into the wells and incubated for 1 h on an orbital shaker (200 rpm). Wells were washed four times after the incubation and TMP substrate was added into the wells to allow the color to develop. The reactions were then stopped with Stop Solution once the color was developed and absorbances at 450 nm and 620 nm were recorded using a BioTeck Gen5 plate reader (Agilent, Santa Clara, CA, USA). The concentrations of ARG1 carried on ARG1 EVs were calculated based on the standard curve.
4.8. Arginase Activities of ARG1 EVs
Arginase activities of the ARG1 EVs were quantified using a colorimetric arginase assay kit (BioAssay System, Hayward, CA, USA). EV samples were lysed with lysis buffer containing 0.4% Triton X-100 (Millipore Sigma Aldrich, Burlington, MA, USA) supplemented with protease/phosphatase inhibitor (ThermoFisher Scientific) for 30 min on ice, and 1 × 1011/mL, 1 × 1010/mL, and 1 × 109/mL of ARG1 EVs were tested following the manufacturer’s instructions. Briefly, arginine substrate containing Mn were incubated with the samples for 2 h at 37 °C and the amount of urea produced by the enzymatic activities of arginase were detected using Urea Reagent by incubating for 1 h at room temperature. After incubation, optical density at 430 nm of the samples were measured using a BioTeck Gen5 plate reader (Agilent) and the arginase activities in the samples were calculated based on the urea standard.
4.9. In Vitro Delivery of ARG1 Protein by ARG1 EVs
To evaluate the capability and efficacy of EVs carrying ARG1 in delivering ARG1 protein into the cells, HepG2 cells were treated with either ARG1 EVs or recombinant human ARG1 (rHuArg1) (ACROBiosystems, Newark, DE, USA) for 6, 24, and 48 h, and the urea concentration in the culture supernatant and arginase activities in the cell lysate were measured. 1 × 105 cells were seeded in 12 wells plate 1 day prior to the experiment to allow the cells to attach. To test the in vitro delivery of ARG1 by EVs, Arg1-out or Arg1-in EVs were diluted in 1X PBS to desired concentration ranging between 1 × 1012 and 1 × 1011/mL. For the rHuArg1, the protein was reconstituted in distilled water at 0.5 mg/mL and stored at −80 °C before the experiment without repeated free/thaw cycle. Similar to ARG1 EVs, rHuArg1 was further diluted to 1.25–0.0087 µg/mL using 1X PBS. Cells were washed once with EMEM/10% FBS followed by the treatment of EVs or rHuArg1. Cells treated with 1X PBS served as the negative control. To ensure the culture condition of the cells, the volume of EVs, recombinant protein, and PBS were 10% of the culture media. For each time point, the culture supernatant was collected and centrifuged at 1000× g at 4 °C to remove the debris before testing the urea concentration using a Urea Assay Kit (BioAssay System) by following the manufacturer’s protocols. Cells were kept on ice and washed once with cold 1X PBS followed by lysing with the lysis buffer containing 0.4% Triton X-100 (Millipore Sigma Aldrich) supplemented with protease/phosphatase inhibitor (ThermoFisher Scientific) for 30 min on ice. After incubation, cell lysates were centrifuged at 14,000× g at 4 °C and the supernatants were tested for their arginase activities by arginase activity assay (BioAssay System) by following the manufacturer’s instructions.
4.10. Exosome Labeling
EVs were labeled with IVISense 750 MAL Fluorescent Self-Quenching Dye (Revvity Health Sciences, Waktham, MA, USA). Briefly, 1 mL of 1 × 1012 particle/mL was incubated with 20 µg dye and incubated at 37 °C for 4 h. Free, unbound dye was removed using the Zeba Spin Desalting Columns (Thermofisher Scientific) according to the manufacturer’s instructions.
4.11. Animal Study—Biodistribution in Wild-Type Mice
Studies were conducted according to the guidelines of the Institutional Animal Care and Use Committee (IACUC protocol EB17-004-091, approved 08SEP2023). Mice were fed ad libitum and sterile water; housed in groups of five at 22 °C/30% humidity and light cycles of 0600–1800 h with standard nesting material; and allowed free movement. To examine the tissue distribution of ARG1 EVs, age-matched BALB/c mice (female, 8–10 wk old) received intraperitoneal injections (100 µL) of either (1) PBS, (2) 293F or (3) STX-Arg1-in EVs. A total of 1 × 1011 particles/100 µL were injected and blood and tissues (salivary glands, brain, lungs, heart, diaphragm, liver, spleen, kidney, lower limbs) were collected at 1 h, 24 h and 1 wk after injection. Full body and tissue imaging was acquired on the IVIS imager (PerkinElmer, Waltham, MA, USA). Additionally, blood clearance and liver accumulation were evaluated at shorter timepoints (5, 15, 30, 60 min after injection).
4.12. Animal Study—Toxicity in Wild-Type Mice
Studies were conducted according to the guideline of the Institutional Animal Care and Use Committee (IACUC protocol EB17-004-091, approved 08SEP2023). Mice were fed ad libitum and sterile water; housed in groups of five at 22 °C/30% humidity and light cycles of 0600–1800 h with standard nesting material; and allowed free movement. To address activity and evaluate toxicity of STX-Arg1 EVs repeated injections, age-matched BALB/c mice (female, 8–10 wk old) received intraperitoneal injections (100 µL) of either (1) PBS, or (2) STX-Arg1-in EVs, at the highest dose allowed by our manufacturing scale (0.012 mg/kg). Mice were divided into two dose groups: (1) Dose 1 received one i.p. injection per week, and (2) Dose 2 received two i.p. injections per week. Weight was monitored weekly. At the end of the fourth week, mice were anesthetized using isoflurane, blood collected from the submandibular vein (in EDTA coated tubes), and peripheral tissues (salivary glands, brain, lungs, heart, diaphragm, liver, spleen, kidney, lower limbs) processed for histological analysis. Blood was further processed for plasma isolation after centrifugation at 4000 rpm for 5 min at 4 °C. Plasma was analyzed for arginine levels (LSBio, Seattle, WA, USA, see below), as indirect measurements of STX-Arg1-in activity. Liver toxicity was additionally assessed by the quantification of aspartate aminotransferase (AST) (Abcam) levels in blood.
4.13. Animal Study—Efficacy in Arg1 Knock-Out Mice
Studies were conducted according to the guideline of the Institutional Animal Care and Use Committee (IACUC protocol EB17-004-091, approved 08SEP2023). Mice were fed ad libitum and sterile water; housed in groups of five at 22 °C/30% humidity and light cycles of 0600–1800 h with standard nesting material; and allowed free movement. To evaluate the therapeutic potential of STX-Arg1 EVs, Arg1 knock-out mice (B6.129-Arg1tm1Rki/J, Strain #:007741; RRID: IMSR_JAX:007741) were acquired from Jackson Laboratory. Colony was expanded from cryo-embryos to obtain heterozygous mice for subsequent breeding. Heterozygote mice are viable and fertile, while homozygous Arg1 mutant completely lack hepatic ARG1 activity, exhibit hyperargininemia, severe symptoms of hyperammonemia (including decerebrate posture, lethargy, and high-frequency tremor of the extremities, particularly the tail) and die between 10 and 14 days after birth [
36,
37]. Mice received either an i.p. injection of 10 µL/g every 2 or 4 days for a final dose of 30 µg/kg ARG1 as delivered by STX-Arg1-in EVs. Weight gain and growth was monitored across the study and lifespan recorded. Additionally, a time course study was performed to evaluate the distribution of STX-Arg1-in EVs in the liver of knock-out mice and its activity. After injection, the blood and the liver were collected at 2, 6 and 24 h after injection. The liver was lysed in RIPA buffer (ThermoFisher Scientific) with 1X Protease inhibitors (ThermoFisher Scientific). ARG1 levels were quantified by human ARG1 ELISA (Invitrogen). Blood was centrifuged at 4500×
g for 10 min and plasma collected for arginine levels quantification by ELISA (LSBio, see below).
4.14. Arginine ELISA
Arginine levels in the blood were quantified by competitive ELISA (LSBio, Seattle, WA, USA) as per the manufacturer’s instructions. ELISA was used as an indirect measure of the STX-Arg1-in EVs in vivo. Briefly, 50 μL of either standards or samples are added to the wells together to a fixed quantity of biotin-conjugated target antigen. The antigens in the standards or samples compete with the biotin-conjugated antigen to bind to the captured antibody. Unbound antigen is washed away. An Avidin-Horseradish Peroxidase (HRP) conjugate is then added, which binds to the biotin. After the removal of unbound HRP-conjugate, a TMB substrate is then added, which reacts with the HRP enzyme resulting in color development. The reaction is topped with a sulfuric acid stop solution and the optical density (OD) of the well is measured at a wavelength of 450 nm: the greater the amount of antigen in the sample, the lower the color development and optical density reading.
4.15. Statistics
For in vitro studies of the delivery of ARG1 by EVs, the differences between ARG1 EVs and the rHuArg1 were tested using ordinary one-way analysis of variance (ANOVA) with Tukey’s multiple comparison test with a pooled variance to compare the urea concentration in the culture supernatants and the increase in arginase activities in the cell lysate between the HepG2 cells treated with different EVs or rHuArg1 at the same time points. A p value < 0.05 was considered statistically significant. For in vivo studies, a 2-tailed t-test or one-way ANOVA controlled for multiple comparisons were used. Details are to be found in figure legends. All the statistical analyses were performed using GraphPad Prism Version 10 (San Diego, CA, USA).