Patent Publication Number: US-2021189424-A1

Title: Recombinant aav vectors and methods of using the same

Description:
This application claims priority to U.S. Application No. 62/683,501 filed Jun. 11, 2018, which is incorporated herein by reference in its entirety. 
    
    
     The present disclosure relates to recombinant adeno-associated virus (AAV) vectors expressing the human ND4 gene, methods of preparing recombinant AAV vectors expressing the human ND4 gene, and uses thereof. Recombinant AAV vectors as disclosed herein are useful in treating Leber Hereditary Optic Neuroretinopathy (LHON), including ND4-related LHON. 
     BACKGROUND OF THE DISCLOSURE 
     Leber Hereditary Optic Neuroretinopathy (LHON), also known as “Leber Hereditary Optic Neuropathy,” or “Leber Hereditary Optic Atrophy,” is an optic nerve dysfunction that manifests as bilateral, acute or subacute loss of central vision due to degeneration of retinal ganglion cells. LHON is linked to point mutations in the mitochondrial DNA (mtDNA), which is inherited maternally (Orssaud, C., Orphanet Encyclopedia, http://www.orpha.net/data/patho/GB/uk-LHON.pdf, 2003). The most common mtDNA point mutations that are associated with LHON are G3460A/ND1, G11778A/ND4 and T14484C/ND6. These mutations are linked with defects of subunits of the complex I (NADH-dehydrogenase-ubiquinone reductase) in mitochondria. 
     The G11778A mitochondrial DNA point mutation in the NADH dehydrogenase 4 gene (ND4 gene) leads to the production of a misfolded protein that alters mitochondrial complex I activity and reduces oxidative phosphorylation (Baracca, et al.,  Arch. Neurol.,  62, pp. 730-736 (2005)). This results in a reduced production of ATP and an increased generation of reactive oxygen species, and leads to the death of retinal ganglion cells (RGCs) (Perier et al.,  Proc Natl Acad Sci USA,  102, pp. 19126-19131 (2005); Qi et al.,  Arch. Ophthalmol.,  125, pp. 268-272 (2007)). The G11778A mitochondrial DNA point mutation is manifested by a severe visual impairment. 
     LHON lends itself to gene therapies, including the use of viral vectors, e.g., recombinant adeno-associated viral vectors (AAV), such as serotype 2 (recombinant AAV2 vectors). In some instances, the use of recombinant AAV vectors permits the transfer of recombinant DNA into retinal ganglion cells of the fovea and perifovea in humans. The transfer of cDNA coding for mitochondrial ND4 provides an ND4 protein that localizes to complex I of the mitochondria. 
     In some instances, while not wishing to be bound by theory, recombinant AAV2 vectors expressing the ND4 gene can exert biological activity by virtue of their ability, e.g., to (1) reach the nucleus of a target cell through internalization into the cytoplasm (via endocytosis) and nuclear import via binding of the AAV2 particle with nucleolin (nuclear shuttle protein), (2) form intranuclear episomes transcribing ND4 mRNA coding a functional NADH dehydrogenase 4 protein, and (3) target ND4 mRNA toward mitochondria by virtue of a mitochondrial targeting sequence (MTS) to allow ND4 protein expression into mitochondria (U.S. Pat. No. 9,017,999). 
     SUMMARY OF THE DISCLOSURE 
     In some aspects, the present disclosure relates to the following embodiments:
         1. A recombinant AAV2 vector comprising:
           a 3′UTR Cox/0 sequence comprising SEQ ID No: 1,   a nucleic acid sequence encoding an NADH dehydrogenase 4 (ND4) polypeptide comprising SEQ ID No: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID No: 11.   
           2. A recombinant AAV2 vector comprising:
           a 3′UTR Cox/0 sequence comprising SEQ ID No: 1,   a nucleic acid sequence encoding an NADH dehydrogenase 4 (ND4) polypeptide comprising SEQ ID No: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID No: 12.   
           3. A recombinant AAV2 vector comprising:
           a 3′UTR Cox/0 sequence comprising SEQ ID No: 14,   a nucleic acid sequence encoding an NADH dehydrogenase 4 (ND4) polypeptide comprising SEQ ID No: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID No: 11.   
           4. A recombinant AAV2 vector comprising:
           a 3′UTR Cox/0 sequence comprising SEQ ID No: 14,   a nucleic acid sequence encoding an NADH dehydrogenase 4 (ND4) polypeptide comprising SEQ ID No: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID No: 12.   
           5. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence comprising SEQ ID No: 1,   a sequence encoding ND4 comprising SEQ ID No: 2, and   an MTS Cox10 sequence comprising SEQ ID No: 3.   
           6. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence consisting of SEQ ID No: 1,   a sequence encoding ND4 consisting of SEQ ID No: 2, and   an MTS Cox10 sequence consisting of SEQ ID No: 3.   
           7. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence comprising SEQ ID No: 1,   a sequence encoding ND4 comprising SEQ ID No: 17, and   an MTS Cox10 sequence comprising SEQ ID No: 3.   
           8. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence consisting of SEQ ID No: 1,   a sequence encoding ND4 consisting of SEQ ID No: 17, and   an MTS Cox10 sequence consisting of SEQ ID No: 3.   
           9. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence comprising SEQ ID No: 14,   a sequence encoding ND4 comprising SEQ ID No: 15, and   an MTS Cox10 sequence comprising SEQ ID No: 16.   
           10. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence consisting of SEQ ID No: 14,   a sequence encoding ND4 consisting of SEQ ID No: 15, and   an MTS Cox10 sequence consisting of SEQ ID No: 16.   
           11. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence comprising SEQ ID No: 14,   a sequence encoding ND4 comprising SEQ ID No: 18, and   an MTS Cox10 sequence comprising SEQ ID No: 16.   
           12. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence consisting of SEQ ID No: 14,   a sequence encoding ND4 consisting of SEQ ID No: 18, and   an MTS Cox10 sequence consisting of SEQ ID No: 16.   
           13. The recombinant AAV2 vector of any one of embodiments 1-2 or 5-8, further comprising:
           an HBB2 intron sequence comprising SEQ ID No: 4,   a CMV promoter sequence comprising SEQ ID No: 5,   a first ITR sequence comprising SEQ ID No: 6, and   a second ITR sequence comprising SEQ ID No: 7.   
           14. The recombinant AAV2 vector of any one of embodiments 1-2 or 5-8, further comprising:
           an HBB2 intron sequence consisting of SEQ ID No: 4,   a CMV promoter sequence consisting of SEQ ID No: 5,   a first ITR sequence consisting of SEQ ID No: 6, and   a second ITR sequence consisting of SEQ ID No: 7.   
           15. The recombinant AAV2 vector of any one of embodiments 3-4 or 9-12, further comprising:
           an HBB2 intron sequence comprising SEQ ID No: 24,   a CMV promoter sequence comprising SEQ ID No: 25,   a first ITR sequence comprising SEQ ID No: 26, and   a second ITR sequence comprising SEQ ID No: 27.   
           16. The recombinant AAV2 vector of any one of embodiments 3-4 or 9-12, further comprising:
           an HBB2 intron sequence consisting of SEQ ID No: 24,   a CMV promoter sequence consisting of SEQ ID No: 25,   a first ITR sequence consisting of SEQ ID No: 26, and   a second ITR sequence consisting of SEQ ID No: 27.   
           17. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence comprising SEQ ID No: 1,   a sequence encoding ND4 comprising SEQ ID No: 17, and   an MTS Cox10 sequence comprising SEQ ID No: 3,   an HBB2 intron sequence consisting of SEQ ID No: 4,   a CMV promoter sequence consisting of SEQ ID No: 5,   a first ITR sequence consisting of SEQ ID No: 6, and   a second ITR sequence consisting of SEQ ID No: 7.   
           18. A recombinant AAV2 vector comprising:
           a 3′UTR Cox10 sequence comprising SEQ ID No: 14,   a sequence encoding ND4 comprising SEQ ID No: 18, and   an MTS Cox10 sequence comprising SEQ ID No: 16,   an HBB2 intron sequence consisting of SEQ ID No: 24,   a CMV promoter sequence consisting of SEQ ID No: 25,   a first ITR sequence consisting of SEQ ID No: 26, and   a second ITR sequence consisting of SEQ ID No: 27.   
           19. A method of treating Leber Hereditary Optic Neuroretinopathy in a patient in need thereof, comprising administering to the patient an effective amount of the recombinant AAV2 vector according to any one of embodiments 1-18.   20. A method of treating Leber Hereditary Optic Neuroretinopathy in a patient in need thereof, comprising administering to the patient an effective amount of the recombinant vector according to any one of embodiments 1-18, wherein the patient has experienced a disease duration of less than nine months.   21. A method of treating Leber Hereditary Optic Neuroretinopathy in a patient in need thereof, comprising administering to the patient an effective amount of the recombinant AAV2 vector according to any one of claims  1 - 18 , wherein the patient has experienced a disease duration of six to nine months.   22. A method of treating Leber Hereditary Optic Neuroretinopathy in a patient in need thereof, comprising administering to the patient an effective amount of the recombinant AAV2 vector according to any one of embodiments 1-18, wherein the patient has a baseline visual acuity of &lt;about 1.6 LogMAR.   23. A method of treating Leber Hereditary Optic Neuroretinopathy in a patient in need thereof, comprising administering to the patient an effective amount of the recombinant AAV2 vector according to any one of embodiments 1-18, wherein the patient has experienced a disease duration of less than nine months and the patient has a baseline visual acuity of &lt;about 1.6 LogMAR.   24. A method of treating Leber Hereditary Optic Neuroretinopathy in a patient in need thereof, comprising administering to the patient an effective amount of the recombinant AAV2 vector according to any one of embodiments 1-18, wherein the patient has experienced a disease duration of six to nine months and the patient has a baseline visual acuity of &lt;about 1.6 LogMAR.   25. The method according to any one of embodiments 19-24, wherein the Leber Hereditary Optic Neuroretinopathy is ND4-related Leber Hereditary Optic Neuroretinopathy.   26. The method according to any one of embodiments 19-25, wherein the recombinant AAV2 vector is administered intravitreally.   27. The method according to any one of claims  19 - 26 , wherein the recombinant AAV2 vector is administered intravitreally in an amount of about 10 9  to 10 11  viral genomes per eye.   28. The method according to any one of embodiments 19-27, wherein the recombinant AAV2 vector is administered intravitreally in an amount of about 10 10  to 10 11  viral genomes per eye.   29. The method according to any one of embodiments 19-28, wherein the recombinant AAV2 vector is administered intravitreally in an amount of about 5.0×10 10  to 1.0×10 11  viral genomes per eye.   30. The method according to any one of embodiments 19-29, wherein the recombinant AAV2 vector is administered intravitreally in an amount of about 9.0×10 10  viral genomes per eye.   31. A pAAV-ND4 transfer plasmid comprising:
           a 3′UTR Cox/0 sequence comprising SEQ ID NO: 1,   a coding sequence ND4 comprising SEQ ID NO: 2,   an MTS Cox/0 sequence comprising SEQ ID NO: 3,   an HBB2 intron sequence comprising SEQ ID NO: 4,   a CMV promoter sequence comprising SEQ ID NO: 5,   an ITR sequence comprising SEQ ID NO: 6, and   an ITR sequence comprising SEQ ID NO: 7.   
           32. A pAAV-ND4 transfer plasmid comprising:
           a 3′UTR Cox/0 sequence comprising SEQ ID NO: 1,   a coding sequence ND4 comprising SEQ ID NO: 17,   an MTS Cox/0 sequence comprising SEQ ID NO: 3,   an HBB2 intron sequence comprising SEQ ID NO: 4,   a CMV promoter sequence comprising SEQ ID NO: 5,   an ITR sequence comprising SEQ ID NO: 6, and   an ITR sequence comprising SEQ ID NO: 7.   
           33. The pAAV-ND4 transfer plasmid of embodiment 31 or 32, further comprising:
           an f1 origin of replication sequence comprising SEQ ID NO: 8,   a Kanamycin resistance gene sequence comprising SEQ ID NO: 9,   a ColE1 origin of replication sequence comprising SEQ ID NO: 10.   
           34. A pAAV-ND4 transfer plasmid comprising:
           a 3′UTR Cox/0 sequence consisting of SEQ ID NO: 1,   a coding sequence ND4 consisting of SEQ ID NO: 2,   an MTS Cox/0 sequence consisting of SEQ ID NO: 3,   an HBB2 intron sequence consisting of SEQ ID NO: 4,   a CMV promoter sequence consisting of SEQ ID NO: 5,   an ITR sequence consisting of SEQ ID NO: 6, and   an ITR sequence consisting of SEQ ID NO: 7.   
           35. A pAAV-ND4 transfer plasmid comprising:
           a 3′UTR Cox/0 sequence consisting of SEQ ID NO: 1,   a coding sequence ND4 consisting of SEQ ID NO: 17,   an MTS Cox/0 sequence consisting of SEQ ID NO: 3,   an HBB2 intron sequence consisting of SEQ ID NO: 4,   a CMV promoter sequence consisting of SEQ ID NO: 5,   an ITR sequence consisting of SEQ ID NO: 6, and   an ITR sequence consisting of SEQ ID NO: 7.   
           36. The pAAV-ND4 transfer plasmid of embodiment 34 or 35, further comprising:
           an f1 origin of replication sequence consisting of SEQ ID NO: 8,   a Kanamycin resistance gene sequence consisting of SEQ ID NO: 9, and   a ColE1 origin of replication sequence consisting of SEQ ID NO: 10.   
           37. A pAAV-ND4 transfer plasmid comprising SEQ ID NO: 22.   38. A pAAV-ND4 transfer plasmid comprising SEQ ID NO: 23.   39. A method of preparing the recombinant AAV2 vector according to any one of embodiments 1-18, comprising tri-transfecting in a packaging cell line:
           (i) a pAAV-ND4 transfer plasmid according to any one of embodiments 31-38;   (ii) a rep/cap plasmid, and   (iii) an adenovirus helper plasmid.   
           40. The method according to embodiment 39, wherein the packaging cell line comprises the human embryonic kidney 293 (HEK 293) cell line.   41. The method according to embodiment 38 or 40, wherein the rep/cap plasmid is pRep2Cap2 plasmid.   42. The method according to any one of embodiments 38-41, wherein the adenovirus helper plasmid is pXX6 plasmid.       

    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several non-limiting embodiments of the present disclosure and together with the description, serve to explain the principles of the disclosure. 
         FIG. 1  depicts an embodiment of a recombinant AAV2 vector of the disclosure comprising inverted terminal repeats (ITRs), a cytomegalovirus immediate early promoter (CMV) in an intron-containing expression cassette (beta globin intron, HBB2), an MTS Cox/0 sequence, a coding sequence ND4, and a 3′UTR Cox/0 sequence. 
         FIG. 2  depicts the structure of an embodiment of a pAAV-ND4 plasmid of the disclosure. 
         FIG. 3  depicts an embodiment of a pRep2Cap2 plasmid of the disclosure. 
         FIG. 4  depicts an embodiment of an adenovirus helper pXX6 plasmid of the disclosure. 
         FIG. 5  depicts an example of a Pelli-Robson chart. 
         FIG. 6  depicts sustained bilateral improvement in BCVA with treatment. 
         FIG. 7  depicts the evolution in contrast sensitivity during the course of study. 
     
    
    
     DETAILED DESCRIPTION OF THE DISCLOSURE 
     Disclosed herein in some embodiments are recombinant vectors expressing a gene encoding the human NADH dehydrogenase type 4 (ND4) protein ND4 (SEQ ID NO: 13). Also disclosed herein are methods of treating LHON by administration of recombinant AAV2 vectors expressing the human ND4 protein. 
     The term “a,” “an,” or “the” refers to one or to more than one of the grammatical object of the article. The term may mean “one,” “one or more,” “at least one,” or “one or more than one.” By way of example, “an element” means one element or more than one element. The term “or” means “and/or” unless otherwise stated. The term “including” or “containing” is not limiting. 
     The term “codon” is meant to refer to a sequence of three nucleotides, e.g., deoxyribonucleotides or ribonucleotides, which together form a unit of a genetic code that encodes an amino acid. The term “genetic code” is meant to refer to the full set of relationships between codons and amino acids used by living cells. The genetic code is highly similar among all organisms, and a person of ordinary skill in the art would understand that the terms “universal genetic code” or “standard genetic code” is meant to refer to the most common genetic code, used by most organisms including humans. In some embodiments, the universal genetic code is the genetic code used in eukaryotic cells. In some embodiments, the universal genetic code is the genetic code for nuclear genes. The term “mitochondria genetic code” is meant to refer to the code used in mitochondria, that sets out the codes for mitochondria nucleic acids and proteins. In some embodiments, the mitochondria genetic code is the vertebrate mitochondria code. In some embodiments, the mitochondria genetic code is the human mitochondria code. Codon usage in the mitochondria vs. the universal genetic code is described in Lewin, Genes V, Oxford University Press; New York 1994, the content of which is incorporated by reference. 
     The human NADH dehydrogenase type 4 (ND4) protein is a subunit of NADH dehydrogenase (ubiquinone), which is targeted to the mitochondrial inner membrane, and is the largest of the five complexes of the electron transport chain. The ND4 gene, also known as mitochondrially encoded NADH dehydrogenase 4 (MT-ND4), is located in the human mitochondria DNA. Exemplary nucleic acid sequences encoding the ND4 protein include but are not limited to NCBI NC_012920.1. In some embodiments, the nucleic acid sequence encoding an ND4 polypeptide may be a mitochondrial nucleic acid, or a nuclear nucleic acid encoding for the human ND4 polypeptide. In some embodiments, the nucleic acid sequence encoding an ND4 polypeptide may be any nucleic acid sequence encoding a human ND4 polypeptide. In some embodiments, the nucleic acid sequence encoding a human ND4 protein comprises SEQ ID NO: 2, 15, 17 or 18. Exemplary amino acid sequences for the human ND4 polypeptide include but are not limited to Genbank ACF70814.1. In some embodiments, the amino acid sequence of the human ND4 polypeptide comprises SEQ ID NO: 13. 
     
       
         
           
               
             
               
                 TABLE 1 
               
               
                   
               
               
                 Sequences of various embodiments of the disclosure 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                 SEQ ID NO: 2 
                 ND4 
                 1374 
                 ATGAGAAACCAGTGATAATGTCTGGGTTCAGGGACAGCAGCA 
               
               
                   
                 (3′ to 5′) 
                 nt 
                 GGATGGGAGACAGATGCATAAACATCAGGGTGTTCTCTCTGGT 
               
               
                   
                   
                   
                 GAATGAGGGCTTCATGTTATTAATGTGGTGAGTCAGTGAGCCC 
               
               
                   
                   
                   
                 CACTGGGTAGTGGTAAACATGTACAGGCTGTAGAGGGCTGTG 
               
               
                   
                   
                   
                 ACCAGCATGTTCAGTCCTGTCAGGAGCAGGGTGATGTTGCTC 
               
               
                   
                   
                   
                 CAGGAGAATGTTGTCACCAGCACTGACAGCTCTCCCAGCAGG 
               
               
                   
                   
                   
                 TTAATTGTAGGGGGCAGAGCCAGGTTGGCCAGACTAGCCAGG 
               
               
                   
                   
                   
                 AGCCACCAGAAAGCCATCAGTGGGAGCAGGGTCTGGAGCCCC 
               
               
                   
                   
                   
                 TGACTCAGGATCATAATTCTTGAGTGAGTTCTTTCATAGTTGCT 
               
               
                   
                   
                   
                 ATTTGCCAGGCAGAACAGGAGGCTGCTGGTCAGCCCATGAGC 
               
               
                   
                   
                   
                 AATCATGAGGATCACTGCCCCAGTAAAGGACCAGGGTGTCTG 
               
               
                   
                   
                   
                 AATCAGAATGGCAGTCACCACCAGTGCCATGTGGCTGATGGA 
               
               
                   
                   
                   
                 GCTGTAAGCAATCAGGCTCTTGAGGTCAGTCTGCCTGAGACA 
               
               
                   
                   
                   
                 GATGGAGCTGGTCATGATCATACCCCAGAGGCTCAGAACCAG 
               
               
                   
                   
                   
                 GAAAGGGTAAGCCATGTGCTTTGTCAGAGGGTTCAGGATCAG 
               
               
                   
                   
                   
                 GGTGAGCCTCATCATACCATAACCACCCAGCTTCAGGAGGACA 
               
               
                   
                   
                   
                 GCAGCCAGGACCATGGAGCCAGCTATTGGAGCTTCCACATGA 
               
               
                   
                   
                   
                 GCCTTGGGGAGCCAGAGGTGCAGGCCATAGAGGGGCATCTTC 
               
               
                   
                   
                   
                 ACCATAAAGGCCATTGTATAAGCCAGCCACATCAGGTTGTTTG 
               
               
                   
                   
                   
                 CCCAGGAGTTACTCAGCTCCTGGGCAGTCAGAGTCAGCAGGA 
               
               
                   
                   
                   
                 GGATGTTCAGGCTACCCAGTGTGTTGTGGGTATAGATCAGTGC 
               
               
                   
                   
                   
                 AATCAGCAGGGGCAGTGAGCCCACCAGTGTATAAAAGAGAAA 
               
               
                   
                   
                   
                 GTAGGTGCCTGCATTCAGCCTCTCAGGCTGATTTCCCCACCTA 
               
               
                   
                   
                   
                 GTGATGATGGCCAGGGTTGGGATGAGAGTGGTCTCAAAGAAG 
               
               
                   
                   
                   
                 ATATAGAACATGATCAGCTCAGTGGCTGTGAAGGTCATAATCA 
               
               
                   
                   
                   
                 GGCTGATTTGCAGGCTAATGAGCATGGACAGGTACAGCTTTTT 
               
               
                   
                   
                   
                 CCTTGACAGAGGCTCTGAGCTGAGGTGCCTCTGACTGGCCAT 
               
               
                   
                   
                   
                 GATAGTCAGAGGCAGCAGCCATGTGGTCAGCATGAGCAGGGG 
               
               
                   
                   
                   
                 GGTTGTCAGGGGATCAGAGGAAAAGGTAGGGGAGCATGAAAA 
               
               
                   
                   
                   
                 GAGGTTATTATTAATCTGGTTGAAAAACAGCAGTGGGATGATG 
               
               
                   
                   
                   
                 CTGATAATCAGGCTGTGGGTTGTGGTGTTAATCCAAATCATGT 
               
               
                   
                   
                   
                 GCTTTTTGCTCAGCCATGTGAGAGGCAGCAGCATGATGGTTG 
               
               
                   
                   
                   
                 GCACAATCAGCTTCAGCA 
               
               
                   
               
               
                 SEQ ID NO: 17 
                 ND4 
                 1380 
                 TCAGGATGAGAAACCAGTGATAATGTCTGGGTTCAGGGACAG 
               
               
                   
                 (3′ to 5′) 
                 nt 
                 CAGCAGGATGGGAGACAGATGCATAAACATCAGGGTGTTCTCT 
               
               
                   
                   
                   
                 CTGGTGAATGAGGGCTTCATGTTATTAATGTGGTGAGTCAGTG 
               
               
                   
                   
                   
                 AGCCCCACTGGGTAGTGGTAAACATGTACAGGCTGTAGAGGG 
               
               
                   
                   
                   
                 CTGTGACCAGCATGTTCAGTCCTGTCAGGAGCAGGGTGATGTT 
               
               
                   
                   
                   
                 GCTCCAGGAGAATGTTGTCACCAGCACTGACAGCTCTCCCAG 
               
               
                   
                   
                   
                 CAGGTTAATTGTAGGGGGCAGAGCCAGGTTGGCCAGACTAGC 
               
               
                   
                   
                   
                 CAGGAGCCACCAGAAAGCCATCAGTGGGAGCAGGGTCTGGA 
               
               
                   
                   
                   
                 GCCCCTGACTCAGGATCATAATTCTTGAGTGAGTTCTTTCATAG 
               
               
                   
                   
                   
                 TTGCTATTTGCCAGGCAGAACAGGAGGCTGCTGGTCAGCCCA 
               
               
                   
                   
                   
                 TGAGCAATCATGAGGATCACTGCCCCAGTAAAGGACCAGGGT 
               
               
                   
                   
                   
                 GTCTGAATCAGAATGGCAGTCACCACCAGTGCCATGTGGCTG 
               
               
                   
                   
                   
                 ATGGAGCTGTAAGCAATCAGGCTCTTGAGGTCAGTCTGCCTGA 
               
               
                   
                   
                   
                 GACAGATGGAGCTGGTCATGATCATACCCCAGAGGCTCAGAA 
               
               
                   
                   
                   
                 CCAGGAAAGGGTAAGCCATGTGCTTTGTCAGAGGGTTCAGGA 
               
               
                   
                   
                   
                 TCAGGGTGAGCCTCATCATACCATAACCACCCAGCTTCAGGAG 
               
               
                   
                   
                   
                 GACAGCAGCCAGGACCATGGAGCCAGCTATTGGAGCTTCCAC 
               
               
                   
                   
                   
                 ATGAGCCTTGGGGAGCCAGAGGTGCAGGCCATAGAGGGGCA 
               
               
                   
                   
                   
                 TCTTCACCATAAAGGCCATTGTATAAGCCAGCCACATCAGGTT 
               
               
                   
                   
                   
                 GTTTGCCCAGGAGTTACTCAGCTCCTGGGCAGTCAGAGTCAG 
               
               
                   
                   
                   
                 CAGGAGGATGTTCAGGCTACCCAGTGTGTTGTGGGTATAGATC 
               
               
                   
                   
                   
                 AGTGCAATCAGCAGGGGCAGTGAGCCCACCAGTGTATAAAAG 
               
               
                   
                   
                   
                 AGAAAGTAGGTGCCTGCATTCAGCCTCTCAGGCTGATTTCCCC 
               
               
                   
                   
                   
                 ACCTAGTGATGATGGCCAGGGTTGGGATGAGAGTGGTCTCAA 
               
               
                   
                   
                   
                 AGAAGATATAGAACATGATCAGCTCAGTGGCTGTGAAGGTCAT 
               
               
                   
                   
                   
                 AATCAGGCTGATTTGCAGGCTAATGAGCATGGACAGGTACAGC 
               
               
                   
                   
                   
                 TTTTTCCTTGACAGAGGCTCTGAGCTGAGGTGCCTCTGACTGG 
               
               
                   
                   
                   
                 CCATGATAGTCAGAGGCAGCAGCCATGTGGTCAGCATGAGCA 
               
               
                   
                   
                   
                 GGGGGGTTGTCAGGGGATCAGAGGAAAAGGTAGGGGAGCAT 
               
               
                   
                   
                   
                 GAAAAGAGGTTATTATTAATCTGGTTGAAAAACAGCAGTGGGA 
               
               
                   
                   
                   
                 TGATGCTGATAATCAGGCTGTGGGTTGTGGTGTTAATCCAAAT 
               
               
                   
                   
                   
                 CATGTGCTTTTTGCTCAGCCATGTGAGAGGCAGCAGCATGATG 
               
               
                   
                   
                   
                 GTTGGCACAATCAGCTTCAGCAT 
               
               
                   
               
               
                 SEQ ID NO: 15 
                 ND4 
                 1374 
                 TGCTGAAGCTGATTGTGCCAACCATCATGCTGCTGCCTCTCAC 
               
               
                   
                 (5′ to 3′) 
                 nt 
                 ATGGCTGAGCAAAAAGCACATGATTTGGATTAACACCACAACC 
               
               
                   
                   
                   
                 CACAGCCTGATTATCAGCATCATCCCACTGCTGTTTTTCAACCA 
               
               
                   
                   
                   
                 GATTAATAATAACCTCTTTTCATGCTCCCCTACCTTTTCCTCTG 
               
               
                   
                   
                   
                 ATCCCCTGACAACCCCCCTGCTCATGCTGACCACATGGCTGCT 
               
               
                   
                   
                   
                 GCCTCTGACTATCATGGCCAGTCAGAGGCACCTCAGCTCAGA 
               
               
                   
                   
                   
                 GCCTCTGTCAAGGAAAAAGCTGTACCTGTCCATGCTCATTAGC 
               
               
                   
                   
                   
                 CTGCAAATCAGCCTGATTATGACCTTCACAGCCACTGAGCTGA 
               
               
                   
                   
                   
                 TCATGTTCTATATCTTCTTTGAGACCACTCTCATCCCAACCCTG 
               
               
                   
                   
                   
                 GCCATCATCACTAGGTGGGGAAATCAGCCTGAGAGGCTGAAT 
               
               
                   
                   
                   
                 GCAGGCACCTACTTTCTCTTTTATACACTGGTGGGCTCACTGC 
               
               
                   
                   
                   
                 CCCTGCTGATTGCACTGATCTATACCCACAACACACTGGGTAG 
               
               
                   
                   
                   
                 CCTGAACATCCTCCTGCTGACTCTGACTGCCCAGGAGCTGAGT 
               
               
                   
                   
                   
                 AACTCCTGGGCAAACAACCTGATGTGGCTGGCTTATACAATGG 
               
               
                   
                   
                   
                 CCTTTATGGTGAAGATGCCCCTCTATGGCCTGCACCTCTGGCT 
               
               
                   
                   
                   
                 CCCCAAGGCTCATGTGGAAGCTCCAATAGCTGGCTCCATGGT 
               
               
                   
                   
                   
                 CCTGGCTGCTGTCCTCCTGAAGCTGGGTGGTTATGGTATGATG 
               
               
                   
                   
                   
                 AGGCTCACCCTGATCCTGAACCCTCTGACAAAGCACATGGCTT 
               
               
                   
                   
                   
                 ACCCTTTCCTGGTTCTGAGCCTCTGGGGTATGATCATGACCAG 
               
               
                   
                   
                   
                 CTCCATCTGTCTCAGGCAGACTGACCTCAAGAGCCTGATTGCT 
               
               
                   
                   
                   
                 TACAGCTCCATCAGCCACATGGCACTGGTGGTGACTGCCATTC 
               
               
                   
                   
                   
                 TGATTCAGACACCCTGGTCCTTTACTGGGGCAGTGATCCTCAT 
               
               
                   
                   
                   
                 GATTGCTCATGGGCTGACCAGCAGCCTCCTGTTCTGCCTGGC 
               
               
                   
                   
                   
                 AAATAGCAACTATGAAAGAACTCACTCAAGAATTATGATCCTGA 
               
               
                   
                   
                   
                 GTCAGGGGCTCCAGACCCTGCTCCCACTGATGGCTTTCTGGT 
               
               
                   
                   
                   
                 GGCTCCTGGCTAGTCTGGCCAACCTGGCTCTGCCCCCTACAA 
               
               
                   
                   
                   
                 TTAACCTGCTGGGAGAGCTGTCAGTGCTGGTGACAACATTCTC 
               
               
                   
                   
                   
                 CTGGAGCAACATCACCCTGCTCCTGACAGGACTGAACATGCT 
               
               
                   
                   
                   
                 GGTCACAGCCCTCTACAGCCTGTACATGTTTACCACTACCCAG 
               
               
                   
                   
                   
                 TGGGGCTCACTGACTCACCACATTAATAACATGAAGCCCTCAT 
               
               
                   
                   
                   
                 TCACCAGAGAGAACACCCTGATGTTTATGCATCTGTCTCCCAT 
               
               
                   
                   
                   
                 CCTGCTGCTGTCCCTGAACCCAGACATTATCACTGGTTTCTCA 
               
               
                   
                   
                   
                 T 
               
               
                   
               
               
                 SEQ ID NO: 18 
                 ND4 
                 1380 
                 ATGCTGAAGCTGATTGTGCCAACCATCATGCTGCTGCCTCTCA 
               
               
                   
                 (5′ to 3′) 
                 nt 
                 CATGGCTGAGCAAAAAGCACATGATTTGGATTAACACCACAAC 
               
               
                   
                   
                   
                 CCACAGCCTGATTATCAGCATCATCCCACTGCTGTTTTTCAACC 
               
               
                   
                   
                   
                 AGATTAATAATAACCTCTTTTCATGCTCCCCTACCTTTTCCTCT 
               
               
                   
                   
                   
                 GATCCCCTGACAACCCCCCTGCTCATGCTGACCACATGGCTG 
               
               
                   
                   
                   
                 CTGCCTCTGACTATCATGGCCAGTCAGAGGCACCTCAGCTCA 
               
               
                   
                   
                   
                 GAGCCTCTGTCAAGGAAAAAGCTGTACCTGTCCATGCTCATTA 
               
               
                   
                   
                   
                 GCCTGCAAATCAGCCTGATTATGACCTTCACAGCCACTGAGCT 
               
               
                   
                   
                   
                 GATCATGTTCTATATCTTCTTTGAGACCACTCTCATCCCAACCC 
               
               
                   
                   
                   
                 TGGCCATCATCACTAGGTGGGGAAATCAGCCTGAGAGGCTGA 
               
               
                   
                   
                   
                 ATGCAGGCACCTACTTTCTCTTTTATACACTGGTGGGCTCACT 
               
               
                   
                   
                   
                 GCCCCTGCTGATTGCACTGATCTATACCCACAACACACTGGGT 
               
               
                   
                   
                   
                 AGCCTGAACATCCTCCTGCTGACTCTGACTGCCCAGGAGCTG 
               
               
                   
                   
                   
                 AGTAACTCCTGGGCAAACAACCTGATGTGGCTGGCTTATACAA 
               
               
                   
                   
                   
                 TGGCCTTTATGGTGAAGATGCCCCTCTATGGCCTGCACCTCTG 
               
               
                   
                   
                   
                 GCTCCCCAAGGCTCATGTGGAAGCTCCAATAGCTGGCTCCAT 
               
               
                   
                   
                   
                 GGTCCTGGCTGCTGTCCTCCTGAAGCTGGGTGGTTATGGTAT 
               
               
                   
                   
                   
                 GATGAGGCTCACCCTGATCCTGAACCCTCTGACAAAGCACATG 
               
               
                   
                   
                   
                 GCTTACCCTTTCCTGGTTCTGAGCCTCTGGGGTATGATCATGA 
               
               
                   
                   
                   
                 CCAGCTCCATCTGTCTCAGGCAGACTGACCTCAAGAGCCTGAT 
               
               
                   
                   
                   
                 TGCTTACAGCTCCATCAGCCACATGGCACTGGTGGTGACTGC 
               
               
                   
                   
                   
                 CATTCTGATTCAGACACCCTGGTCCTTTACTGGGGCAGTGATC 
               
               
                   
                   
                   
                 CTCATGATTGCTCATGGGCTGACCAGCAGCCTCCTGTTCTGCC 
               
               
                   
                   
                   
                 TGGCAAATAGCAACTATGAAAGAACTCACTCAAGAATTATGATC 
               
               
                   
                   
                   
                 CTGAGTCAGGGGCTCCAGACCCTGCTCCCACTGATGGCTTTC 
               
               
                   
                   
                   
                 TGGTGGCTCCTGGCTAGTCTGGCCAACCTGGCTCTGCCCCCT 
               
               
                   
                   
                   
                 ACAATTAACCTGCTGGGAGAGCTGTCAGTGCTGGTGACAACAT 
               
               
                   
                   
                   
                 TCTCCTGGAGCAACATCACCCTGCTCCTGACAGGACTGAACAT 
               
               
                   
                   
                   
                 GCTGGTCACAGCCCTCTACAGCCTGTACATGTTTACCACTACC 
               
               
                   
                   
                   
                 CAGTGGGGCTCACTGACTCACCACATTAATAACATGAAGCCCT 
               
               
                   
                   
                   
                 CATTCACCAGAGAGAACACCCTGATGTTTATGCATCTGTCTCC 
               
               
                   
                   
                   
                 CATCCTGCTGCTGTCCCTGAACCCAGACATTATCACTGGTTTC 
               
               
                   
                   
                   
                 TCATCCTGA 
               
               
                   
               
               
                 SEQ ID NO: 13 
                 ND4 
                 459 
                 MLKLIVPTIMLLPLTWLSKKHMIWINTTTHSLIISIIPLLFFNQINNNLF 
               
               
                   
                   
                 AA 
                 SCSPTFSSDPLTTPLLMLTTWLLPLTIMASQRHLSSEPLSRKKLYL 
               
               
                   
                   
                   
                 SMLISLQISLIMTFTATELIMFYIFFETTLIPTLAIITRWGNQPERLNA 
               
               
                   
                   
                   
                 GTYFLFYTLVGSLPLLIALIYTHNTLGSLNILLLTLTAQELSNSWANN 
               
               
                   
                   
                   
                 LMWLAYTMAFMVKMPLYGLHLWLPKAHVEAPIAGSMVLAAVLLKL 
               
               
                   
                   
                   
                 GGYGMMRLTLILNPLTKHMAYPFLVLSLWGMIMTSSICLRQTDLK 
               
               
                   
                   
                   
                 SLIAYSSISHMALVVTAILIQTPWSFTGAVILMIAHGLTSSLLFCLAN 
               
               
                   
                   
                   
                 SNYERTHSRIMILSQGLQTLLPLMAFWWLLASLANLALPPTINLLG 
               
               
                   
                   
                   
                 ELSVLVTTFSWSNITLLLTGLNMLVTALYSLYMFTTTQWGSLTHHI 
               
               
                   
                   
                   
                 NNMKPSFTRENTLMFMHLSPILLLSLNPDIITGFSS 
               
               
                   
               
            
           
         
       
     
     Without being bound by theory, mitochondrial genes may use a mitochondrial genetic code which is different from the universal genetic code used by nuclear genes. When a mitochondrial gene is inserted in a recombinant vector to be expressed in the nucleus, the mitochondrial nucleic acid sequence may be recoded in accordance with the universal genetic code, in order to be correctly expressed and/or translated outside the mitochondria. In some embodiments, a mitochondria-encoded gene may be recoded to form a nuclear-encoded version of the same gene. In some embodiments, the nuclear-encoded version is produced by codon substitution of the mitochondrial nucleic acid. In some embodiments, the nuclear-encoded version is produced by codon substitution to replace the codons of the mitochondrial genetic code with codons of the universal genetic code. Codon usage in the mitochondria vs. the universal genetic code is described in Lewin, Genes V, Oxford University Press; New York 1994, the content of which is incorporated by reference. Exemplary codon substitutions include but are not limited to UGA to UGG, AGA to UAA, UAG or UGA, AGG to UAA, UAG or UGA, AUA to AUG, CUG or GUG, AUU to AUG, CUG or GUG. In some embodiments, the nucleic acid encoding a human ND4 polypeptide is the sequence of a naturally occurring mitochondrial nucleic acid, recoded in accordance with the universal genetic code. 
     Due to the degeneracy of the genetic code, most amino acids can be encoded by multiple synonymous codons (Grantham et al., Nucleic Acids Res., 8(1):r49-r62 (1980). Without being bound by theory, synonymous codons naturally occur with different frequencies in different organisms. The choice of codons may affect protein expression, structure, and function. When expressing a recombinant protein, one may select specific codons to optimize for expression in a chosen host system, thus recoding by taking into account the preferred codon usage. In some embodiments, recoding is done taking into account the preferred usage codon of mammalian cells. In some embodiments, recoding is done taking into account the preferred codon usage in humans. 
     In some embodiments, the nucleic acid sequence encoding a human ND4 protein, recoded in accordance with the universal genetic code, and taking into account the human preferred usage codon comprises the nucleic acid sequence SEQ ID NO: 2 (3′ to 5′ sequence) or its reverse complement SEQ ID NO: 15 (5′ to 3′ sequence). 
     In some embodiments, the nucleic acid sequence encoding human ND4 protein, recoded in accordance with the universal genetic code, and taking into account the human preferred usage codon comprises the nucleic acid sequence SEQ ID NO: 17 (3′ to 5′ sequence) or its reverse complement SEQ ID NO: 18 (5′ to 3′ sequence). 
     The term “vector” refers to any genetic element, such as a plasmid, phage, transposon, cosmid, chromosome, virus, virion, etc., which is capable of replication when associated with the proper control elements and which can transfer gene sequences between cells. Thus, the term includes cloning and expression vehicles, as well as viral vectors. In some embodiments, the vector is a DNA vector. In some embodiments, the vector is a circular vector. In some embodiments, the vector is a plasmid. In some embodiments, the vector is double-stranded. In some embodiments, the vector is single-stranded. 
     In some embodiment, the recombinant vector disclosed herein is a recombinant viral vector. In some embodiments, the viral vector is an adeno-associated viral (AAV) vector, chimeric AAV vector, adenoviral vector, retroviral vector, lentiviral vector, DNA viral vector, herpes simplex viral vector, baculoviral vector, or any mutant or derivative thereof. In some embodiments, the recombinant viral vector is a recombinant adeno-associated virus (AAV) vector. In some embodiments, by an “AAV vector” is meant a vector derived from an adeno-associated virus serotype, including without limitation, AAV-1, AAV-2, AAV-3, AAV-4, AAV-5, AAV-6, AAV-7, AAV-8 and AAV-9. AAV vectors can have one or more of the AAV wild-type genes deleted in whole or part, e.g., the rep and/or cap genes, while retaining functional flanking inverted terminal repeat (ITR) sequences. Functional ITR sequences are necessary for the rescue, replication and packaging of the AAV virion. Thus, an AAV vector is defined herein to include at least those sequences that in cis provide for replication and packaging (e.g., functional ITRs) of the virus. The ITRs need not be the wild-type nucleotide sequences, and may be altered, e.g., by the insertion, deletion or substitution of nucleotides, so long as the sequences provide for functional rescue, replication and packaging. An “AAV vector” may also refer to the protein shell or capsid, which provides an efficient vehicle for delivery of vector nucleic acid to the nucleus of target cells. In some embodiments, the recombinant viral vector is a recombinant AAV2 vector. In some embodiments, a recombinant vector of the disclosure is a recombinant AAV vector, of serotype 2 (rAAV2/2). 
     In some embodiments, a recombinant AAV vector disclosed herein comprises a nucleic acid sequence encoding the ND4 protein, and operatively linked gene regulatory control sequences, including but not limited to promoters, enhancers, termination signals. Without being bound by theory, a cytomegalovirus (CMV) immediate early promoter may provide high and sustained expression levels of an operatively linked nucleic acid sequence in a cell. In some embodiments, the recombinant AAV vector of the disclosure comprises a cytomegalovirus (CMV) immediate early promoter. Without being bound by theory, intronic sequences incorporated into recombinant nucleic acid sequences or transgenes may stabilize mRNA levels and increase expression of an operatively linked nucleic acid sequence. In some embodiments, the recombinant AAV2 vector of the disclosure comprises a beta-globin (HBB2) derived intronic sequence. 
     In some embodiments, a recombinant AAV2 vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the human NADH dehydrogenase 4 (ND4) under the control of the cytomegalovirus immediate early promoter (CMV) in an intron-containing expression cassette (beta globin intron, HBB2), further comprising viral inverted terminal repeats (ITRs) from AAV2/2 ( FIG. 1 ). In some embodiments, a CMV promoter comprises SEQ ID NO: 5 or SEQ ID NO: 25. In some embodiments, a HBB2 intron comprises SEQ ID NO: 4 or SEQ ID NO: 24. In some embodiments, an ITR sequence comprises SEQ ID NO: 6, 7, 26 or 27. 
     
       
         
           
               
             
               
                 TABLE 2 
               
               
                   
               
               
                 Sequences of various embodiments of the disclosure 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                 SEQ ID NO: 1 
                 3′UTR 
                 595 
                 aacatgtggaatccccagtcccagtgcacagcagccgggtcctagctattggtattgt 
               
               
                   
                 Cox10 
                 nt 
                 tagaaggactatggttgagaatgtgtggggtggggaaaaccaaaaatgcaggccctgg 
               
               
                   
                 (3′ to 
                   
                 ctcagtcaccaggaagggggtgctccgaggcctttgagggacctgagctcacagaact 
               
               
                   
                 5′) 
                   
                 acagacagcagatcatgaggctcacactttctggccaccaagtgccactctgctgggc 
               
               
                   
                   
                   
                 atgtggagtgtgcgtgtggtgtggtggtaaggatggaaccaaaagaggaagctgtgta 
               
               
                   
                   
                   
                 tgtgtacccccatgtgaggaggaagaaacagaatagagggtggggttggaggagagat 
               
               
                   
                   
                   
                 gtataaagaccctcaaagggaaaaataattccttttttgtattcactgactgagctga 
               
               
                   
                   
                   
                 tgcatttcttatttggggagcattttgggtaatatttaaaaaaaaaaaaaactgtcaa 
               
               
                   
                   
                   
                 gtgatcactgggcaccgaattcgtttataatcttgttctaaacccagcaatttctctt 
               
               
                   
                   
                   
                 cttgtgttccagaattaccacaacatgctcgcctggcagcggagggaaaggggcggtg 
               
               
                   
                   
                   
                 ggcgtcccagtgctc 
               
               
                   
               
               
                 SEQ ID NO: 14 
                 3′UTR 
                 595 
                 gagcactgggacgcccaccgcccctttccctccgctgccaggcgagcatgttgtggta 
               
               
                   
                 Cox10 
                 nt 
                 attctggaacacaagaagagaaattgctgggtttagaacaagattataaacgaattcg 
               
               
                   
                 (5′ to 
                   
                 gtgcccagtgatcacttgacagttttttttttttttaaatattacccaaaatgctccc 
               
               
                   
                 3′) 
                   
                 caaataagaaatgcatcagctcagtcagtgaatacaaaaaaggaattatttttccctt 
               
               
                   
                   
                   
                 tgagggtctttatacatctctcctccaaccccaccctctattctgtttcttcctcctc 
               
               
                   
                   
                   
                 acatgggggtacacatacacagcttcctcttttggttccatccttaccaccacaccac 
               
               
                   
                   
                   
                 acgcacactccacatgcccagcagagtggcacttggtggccagaaagtgtgagcctca 
               
               
                   
                   
                   
                 tgatctgctgtctgtagttctgtgagctcaggtccctcaaaggcctcggagcaccccc 
               
               
                   
                   
                   
                 ttcctggtgactgagccagggcctgcatttttggttttccccaccccacacattctca 
               
               
                   
                   
                   
                 accatagtccttctaacaataccaatagctaggacccggctgctgtgcactgggactg 
               
               
                   
                   
                   
                 gggattccacatgtt 
               
               
                   
               
               
                 SEQ ID NO: 3 
                 MTS 
                 84 nt 
                 agtcctcctttccaggtaccacacactcccccccacacagccagtcaggagcctggat 
               
               
                   
                 Cox10 
                   
                 gacagtgtatgggggctggcagccat 
               
               
                   
                 (3′ to 
                   
                   
               
               
                   
                 5′) 
                   
                   
               
               
                   
               
               
                 SEQ ID NO: 16 
                 MTS 
                 84 nt 
                 atggctgccagcccccatacactgtcatccaggctcctgactggctgtgtggggggga 
               
               
                   
                 Cox10 
                   
                 gtgtgtggtacctggaaaggaggact 
               
               
                   
                 (5′ to 
                   
                   
               
               
                   
                 3′) 
                   
                   
               
               
                   
               
               
                 SEQ ID NO: 4 
                 HBB2 
                 398 
                 aattctttgccaaagtgatgggccagcacacagaccagcacgttgcccaggagctgtg 
               
               
                   
                 intron 
                 nt 
                 ggaggaagataagaggtatgaacatgattagcaaaagggcctagcttggactcagaat 
               
               
                   
                 (3′ to 
                   
                 aatccagccttatcccaaccataaaataaaagcagaatggtagctggattgtagctgc 
               
               
                   
                 5′) 
                   
                 tattagcaatatgaaacctcttacatcagttacaatttatatgcagaaatatttatat 
               
               
                   
                   
                   
                 gcagaaatattgctattgccttaacccagaaattatcactgttattctttagaatggt 
               
               
                   
                   
                   
                 gcaaagaggcatgatacattgtatcattattgccctgaaagaaagagattagggaaag 
               
               
                   
                   
                   
                 tattagaaataagataaacaaaaaagtatattaaaagaagaaagcatttt 
               
               
                   
               
               
                 SEQ ID NO: 24 
                 HBB2 
                 398 
                 aaaatgctttcttcttttaatatacttttttgtttatcttatttctaatactttccct 
               
               
                   
                 intron 
                 nt 
                 aatctctttctttcagggcaataatgatacaatgtatcatgcctctttgcaccattct 
               
               
                   
                 (5′ to 
                   
                 aaagaataacagtgataatttctgggttaaggcaatagcaatatttctgcatataaat 
               
               
                   
                 3′) 
                   
                 atttctgcatataaattgtaactgatgtaagaggtttcatattgctaatagcagctac 
               
               
                   
                   
                   
                 aatccagctaccattctgcttttattttatggttgggataaggctggattattctgag 
               
               
                   
                   
                   
                 tccaagctaggcccttttgctaatcatgttcatacctcttatcttcctcccacagctc 
               
               
                   
                   
                   
                 ctgggcaacgtgctggtctgtgtgctggcccatcactttggcaaagaatt 
               
               
                   
               
               
                 SEQ ID NO: 5 
                 CMV 
                 654 
                 ggaggctggatcggtcccggtgtcttctatggaggtcaaaacagcgtggatggcgtct 
               
               
                   
                 promoter 
                 nt 
                 ccaggcgatctgacggttcactaaacgagctctgcttatatagacctcccaccgtaca 
               
               
                   
                 (3′ 
                   
                 cgcctaccgcccatttgcgtcaatggggcggagttgttacgacattttggaaagtccc 
               
               
                   
                 to 5′) 
                   
                 gttgattttggtgccaaaacaaactcccattgacgtcaatggggtggagacttggaaa 
               
               
                   
                   
                   
                 tccccgtgagtcaaaccgctatccacgcccattgatgtactgccaaaaccgcatcacc 
               
               
                   
                   
                   
                 atggtaatagcgatgactaatacgtagatgtactgccaagtaggaaagtcccataagg 
               
               
                   
                   
                   
                 tcatgtactgggcataatgccaggcgggccatttaccgtcattgacgtcaataggggg 
               
               
                   
                   
                   
                 cgtacttggcatatgatacacttgatgtactgccaagtgggcagtttaccgtaaatac 
               
               
                   
                   
                   
                 tccacccattgacgtcaatggaaagtccctattggcgttactatgggaacatacgtca 
               
               
                   
                   
                   
                 ttattgacgtcaatgggcgggggtcgttgggcggtcagccaggcgggccatttaccgt 
               
               
                   
                   
                   
                 aagttatgtaacgcggaactccatatatgggctatgaactaatgaccccgtaattgat 
               
               
                   
                   
                   
                 tactattaataactag 
               
               
                   
               
               
                 SEQ ID NO: 25 
                 CMV 
                 654 
                 ctagttattaatagtaatcaattacggggtcattagttcatagcccatatatggagtt 
               
               
                   
                 promoter 
                 nt 
                 ccgcgttacataacttacggtaaatggcccgcctggctgaccgcccaacgacccccgc 
               
               
                   
                 (5′ 
                   
                 ccattgacgtcaataatgacgtatgttcccatagtaacgccaatagggactttccatt 
               
               
                   
                 to 3′) 
                   
                 gacgtcaatgggtggagtatttacggtaaactgcccacttggcagtacatcaagtgta 
               
               
                   
                   
                   
                 tcatatgccaagtacgccccctattgacgtcaatgacggtaaatggcccgcctggcat 
               
               
                   
                   
                   
                 tatgcccagtacatgaccttatgggactttcctacttggcagtacatctacgtattag 
               
               
                   
                   
                   
                 tcatcgctattaccatggtgatgcggttttggcagtacatcaatgggcgtggatagcg 
               
               
                   
                   
                   
                 gtttgactcacggggatttccaagtctccaccccattgacgtcaatgggagtttgttt 
               
               
                   
                   
                   
                 tggcaccaaaatcaacgggactttccaaaatgtcgtaacaactccgccccattgacgc 
               
               
                   
                   
                   
                 aaatgggcggtaggcgtgtacggtgggaggtctatataagcagagctcgtttagtgaa 
               
               
                   
                   
                   
                 ccgtcagatcgcctggagacgccatccacgctgttttgacctccatagaagacaccgg 
               
               
                   
                   
                   
                 gaccgatccagcctcc 
               
               
                   
               
               
                 SEQ ID NO: 6 
                 ITR (3′ 
                 128 
                 aggaacccctagtgatggagttggccactccctctctgcgcgctcgctcgctcactga 
               
               
                   
                 to 5′) 
                 nt 
                 ggccgggcgaccaaaggtcgcccgacgcccgggctttgcccgggcggcctcagtgagc 
               
               
                   
                   
                   
                 gagcgagcgcgc 
               
               
                   
               
               
                 SEQ ID NO: 26 
                 ITR (5′ 
                 128 
                 gcgcgctcgctcgctcactgaggccgcccgggcaaagcccgggcgtcgggcgaccttt 
               
               
                   
                 to 3′) 
                 nt 
                 ggtcgcccggcctcagtgagcgagcgagcgcgcagagagggagtggccaactccatca 
               
               
                   
                   
                   
                 ctaggggttcct 
               
               
                   
               
               
                 SEQ ID NO: 7 
                 ITR (3′ 
                 130 
                 ctgcgcgctcgctcgctcactgaggccgcccgggcaaagcccgggcgtcgggcgacct 
               
               
                   
                 to 5′) 
                 nt 
                 ttggtcgcccggcctcagtgagcgagcgagcgcgcagagagggagtggccaactccat 
               
               
                   
                   
                   
                 cactaggggttcct 
               
               
                   
               
               
                 SEQ ID NO: 27 
                 ITR (5′ 
                 130 
                 aggaacccctagtgatggagttggccactccctctctgcgcgctcgctcgctcactga 
               
               
                   
                 to 3′) 
                 nt 
                 ggccgggcgaccaaaggtcgcccgacgcccgggctttgcccgggcggcctcagtgagc 
               
               
                   
                   
                   
                 gagcgagcgcgcag 
               
               
                   
               
            
           
         
       
     
     In some embodiments, the recombinant AAV2 vector of the disclosure comprises a coding sequence of human ND4 that is codon-optimized for improved expression in human cells. 
     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence comprising SEQ ID NO: 1;   (ii) a coding sequence ND4 comprising SEQ ID NO: 2; and   (iii) an MTS Cox/0 sequence comprising SEQ ID NO: 3.       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence consisting of SEQ ID NO: 1;   (ii) a coding sequence ND4 consisting of SEQ ID NO: 2; and   (iii) an MTS Cox/0 sequence consisting of SEQ ID NO: 3.       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence comprising SEQ ID NO: 1;   (ii) a coding sequence ND4 comprising SEQ ID NO: 17; and   (iii) an MTS Cox/0 sequence comprising SEQ ID NO: 3.       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence consisting of SEQ ID NO: 1;   (ii) a coding sequence ND4 consisting of SEQ ID NO: 17; and   (iii) an MTS Cox/0 sequence consisting of SEQ ID NO: 3.       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14;   (ii) a coding sequence ND4 comprising SEQ ID NO: 15; and   (iii) an MTS Cox/0 sequence comprising SEQ ID NO: 16       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence consisting of SEQ ID NO: 14;   (ii) a coding sequence ND4 consisting of SEQ ID NO: 15; and   (iii) an MTS Cox/0 sequence consisting of SEQ ID NO: 16.       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14;   (ii) a coding sequence ND4 comprising SEQ ID NO: 18; and   (iii) an MTS Cox/0 sequence comprising SEQ ID NO: 16.       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence consisting of SEQ ID NO: 14;   (ii) a coding sequence ND4 consisting of SEQ ID NO: 18; and   (iii) an MTS Cox/0 sequence consisting of SEQ ID NO: 16.       

     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence of:       

     
       
         
           
               
            
               
                 (SEQ ID NO: 1) 
               
               
                 aacatgtggaatccccagtcccagtgcacagcagccgggtcctagctatt 
               
               
                   
               
               
                 ggtattgttagaaggactatggttgagaatgtgtggggtggggaaaacca 
               
               
                   
               
               
                 aaaatgcaggccctggctcagtcaccaggaagggggtgctccgaggcctt 
               
               
                   
               
               
                 tgagggacctgagctcacagaactacagacagcagatcatgaggctcaca 
               
               
                   
               
               
                 ctttctggccaccaagtgccactctgctgggcatgtggagtgtgcgtgtg 
               
               
                   
               
               
                 gtgtggtggtaaggatggaaccaaaagaggaagctgtgtatgtgtacccc 
               
               
                   
               
               
                 catgtgaggaggaagaaacagaatagagggtggggttggaggagagatgt 
               
               
                   
               
               
                 ataaagaccctcaaagggaaaaataattccttttttgtattcactgactg 
               
               
                   
               
               
                 agctgatgcatttcttatttggggagcattttgggtaatatttaaaaaaa 
               
               
                   
               
               
                 aaaaaaactgtcaagtgatcactgggcaccgaattcgtttataatcttgt 
               
               
                   
               
               
                 tctaaacccagcaatttctcttcttgtgttccagaattaccacaacatgc 
               
               
                   
               
               
                 tcgcctggcagcggagggaaaggggcggtgggcgtcccagtgctc 
               
            
           
         
       
         
         
           
             (ii) a coding sequence ND4 of: 
           
         
       
    
     
       
         
           
               
            
               
                 (SEQ ID NO: 2) 
               
               
                 atgagaaaccagtgataatgtctgggttcagggacagcagcaggatggga 
               
               
                   
               
               
                 gacagatgcataaacatcagggtgttctctctggtgaatgagggcttcat 
               
               
                   
               
               
                 gttattaatgtggtgagtcagtgagccccactgggtagtggtaaacatgt 
               
               
                   
               
               
                 acaggctgtagagggctgtgaccagcatgttcagtcctgtcaggagcagg 
               
               
                   
               
               
                 gtgatgttgctccaggagaatgttgtcaccagcactgacagctctcccag 
               
               
                   
               
               
                 caggttaattgtagggggcagagccaggttggccagactagccaggagcc 
               
               
                   
               
               
                 accagaaagccatcagtgggagcagggtctggagcccctgactcaggatc 
               
               
                   
               
               
                 ataattcttgagtgagttctttcatagttgctatttgccaggcagaacag 
               
               
                   
               
               
                 gaggctgctggtcagcccatgagcaatcatgaggatcactgccccagtaa 
               
               
                   
               
               
                 aggaccagggtgtctgaatcagaatggcagtcaccaccagtgccatgtgg 
               
               
                   
               
               
                 ctgatggagctgtaagcaatcaggctcttgaggtcagtctgcctgagaca 
               
               
                   
               
               
                 gatggagctggtcatgatcataccccagaggctcagaaccaggaaagggt 
               
               
                   
               
               
                 aagccatgtgctttgtcagagggttcaggatcagggtgagcctcatcata 
               
               
                   
               
               
                 ccataaccacccagcttcaggaggacagcagccaggaccatggagccagc 
               
               
                   
               
               
                 tattggagcttccacatgagccttggggagccagaggtgcaggccataga 
               
               
                   
               
               
                 ggggcatcttcaccataaaggccattgtataagccagccacatcaggttg 
               
               
                   
               
               
                 tttgcccaggagttactcagctcctgggcagtcagagtcagcaggaggat 
               
               
                   
               
               
                 gttcaggctacccagtgtgttgtgggtatagatcagtgcaatcagcaggg 
               
               
                   
               
               
                 gcagtgagcccaccagtgtataaaagagaaagtaggtgcctgcattcagc 
               
               
                   
               
               
                 ctctcaggctgatttccccacctagtgatgatggccagggttgggatgag 
               
               
                   
               
               
                 agtggtctcaaagaagatatagaacatgatcagctcagtggctgtgaagg 
               
               
                   
               
               
                 tcataatcaggctgatttgcaggctaatgagcatggacaggtacagcttt 
               
               
                   
               
               
                 ttccttgacagaggctctgagctgaggtgcctctgactggccatgatagt 
               
               
                   
               
               
                 cagaggcagcagccatgtggtcagcatgagcaggggggttgtcaggggat 
               
               
                   
               
               
                 cagaggaaaaggtaggggagcatgaaaagaggttattattaatctggttg 
               
               
                   
               
               
                 aaaaacagcagtgggatgatgctgataatcaggctgtgggttgtggtgtt 
               
               
                   
               
               
                 aatccaaatcatgtgctttttgctcagccatgtgagaggcagcagcatga 
               
               
                   
               
               
                 tggttggcacaatcagcttcagca 
               
            
           
         
       
         
         
           
             (iii) an MTS Cox/0 sequence of: 
           
         
       
    
     
       
         
           
               
            
               
                 (SEQ ID NO: 3) 
               
               
                 agtcctcctttccaggtaccacacactcccccccacacagccagtcagga 
               
               
                   
               
               
                 gcctggatgacagtgtatgggggctggcagccat 
               
            
           
         
       
         
         
           
             (iv) an HBB2 intron sequence of: 
           
         
       
    
     
       
         
           
               
            
               
                 (SEQ ID NO: 4) 
               
               
                 aattctttgccaaagtgatgggccagcacacagaccagcacgttgcccag 
               
               
                   
               
               
                 gagctgtgggaggaagataagaggtatgaacatgattagcaaaagggcct 
               
               
                   
               
               
                 agcttggactcagaataatccagccttatcccaaccataaaataaaagca 
               
               
                   
               
               
                 gaatggtagctggattgtagctgctattagcaatatgaaacctcttacat 
               
               
                   
               
               
                 cagttacaatttatatgcagaaatatttatatgcagaaatattgctattg 
               
               
                   
               
               
                 ccttaacccagaaattatcactgttattctttagaatggtgcaaagaggc 
               
               
                   
               
               
                 atgatacattgtatcattattgccctgaaagaaagagattagggaaagta 
               
               
                   
               
               
                 ttagaaataagataaacaaaaaagtatattaaaagaagaaagcatttt 
               
            
           
         
       
         
         
           
             (v) a CMV promoter sequence of: 
           
         
       
    
     
       
         
           
               
            
               
                 (SEQ ID NO: 5) 
               
               
                 ggaggctggatcggtcccggtgtcttctatggaggtcaaaacagcgtgga 
               
               
                   
               
               
                 tggcgtctccaggcgatctgacggttcactaaacgagctctgcttatata 
               
               
                   
               
               
                 gacctcccaccgtacacgcctaccgcccatttgcgtcaatggggcggagt 
               
               
                   
               
               
                 tgttacgacattttggaaagtcccgttgattttggtgccaaaacaaactc 
               
               
                   
               
               
                 ccattgacgtcaatggggtggagacttggaaatccccgtgagtcaaaccg 
               
               
                   
               
               
                 ctatccacgcccattgatgtactgccaaaaccgcatcaccatggtaatag 
               
               
                   
               
               
                 cgatgactaatacgtagatgtactgccaagtaggaaagtcccataaggtc 
               
               
                   
               
               
                 atgtactgggcataatgccaggcgggccatttaccgtcattgacgtcaat 
               
               
                   
               
               
                 agggggcgtacttggcatatgatacacttgatgtactgccaagtgggcag 
               
               
                   
               
               
                 tttaccgtaaatactccacccattgacgtcaatggaaagtccctattggc 
               
               
                   
               
               
                 gttactatgggaacatacgtcattattgacgtcaatgggcgggggtcgtt 
               
               
                   
               
               
                 gggcggtcagccaggcgggccatttaccgtaagttatgtaacgcggaact 
               
               
                   
               
               
                 ccatatatgggctatgaactaatgaccccgtaattgattactattaataa 
               
               
                   
               
               
                 ctag 
               
            
           
         
       
         
         
           
             (vi) an ITR sequence of: 
           
         
       
    
                    (SEQ ID NO: 6)       aggaacccctagtgatggagttggccactccctctctgcgcgctcgctcg               ctcactgaggccgggcgaccaaaggtcgcccgacgcccgggctttgcccg               ggcggcctcagtgagcgagcgagcgcgc,            
and
         (vii) an ITR sequence of:       

     
       
         
           
               
            
               
                 (SEQ ID NO: 7) 
               
               
                 ctgcgcgctcgctcgctcactgaggccgcccgggcaaagcccgggcgtcg 
               
               
                   
               
               
                 ggcgacctttggtcgcccggcctcagtgagcgagcgagcgcgcagagagg 
               
               
                   
               
               
                 gagtggccaactccatcactaggggttcct. 
               
            
           
         
       
     
     In some embodiments, a recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence comprising SEQ ID NO: 1,   (ii) a coding sequence ND4 comprising SEQ ID NO: 17,   (iii) an MTS Cox/0 sequence comprising SEQ ID NO: 3,   (iv) an HBB2 intron sequence comprising SEQ ID NO: 4,   (v) a CMV promoter sequence comprising SEQ ID NO: 5,   (vi) an ITR sequence comprising SEQ ID NO: 6, and   (vii) an ITR sequence comprising SEQ ID NO: 7.       

     In some embodiments, the recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14,   (ii) a coding sequence ND4 comprising SEQ ID NO: 15,   (iii) an MTS Cox/0 sequence comprising SEQ ID NO: 16,   (iv) an HBB2 intron sequence comprising SEQ ID NO: 24,   (v) a CMV promoter sequence comprising SEQ ID NO: 25,   (vi) an ITR sequence comprising SEQ ID NO: 26, and   (vii) an ITR sequence comprising SEQ ID NO: 27.       

     In some embodiments, the recombinant AAV vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding the gene of the human NADH dehydrogenase 4 (ND4), and comprises:
         (i) a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14,   (ii) a coding sequence ND4 comprising SEQ ID NO: 18,   (iii) an MTS Cox/0 sequence comprising SEQ ID NO: 16,   (iv) an HBB2 intron sequence comprising SEQ ID NO: 24,   (v) a CMV promoter sequence comprising SEQ ID NO: 25,   (vi) an ITR sequence comprising SEQ ID NO: 26, and   (vii) an ITR sequence comprising SEQ ID NO: 27.       

     In some embodiment, the recombinant vector of the disclosure further comprises:
         (i) an HBB2 intron sequence comprising SEQ ID NO: 4,   (ii) a CMV promoter sequence comprising SEQ ID NO: 5,   (iii) an ITR sequence comprising SEQ ID NO: 6, and   (iv) an ITR sequence comprising SEQ ID No: 7.       

     In some embodiment, the recombinant vector of the disclosure further comprises:
         (i) an HBB2 intron sequence consisting of SEQ ID NO: 4,   (ii) a CMV promoter sequence consisting of SEQ ID NO: 5,   (iii) an ITR sequence consisting of SEQ ID NO: 6, and   (iv) an ITR sequence consisting of SEQ ID No: 7.       

     In some embodiment, the recombinant vector of the disclosure further comprises:
         (i) an HBB2 intron sequence comprising SEQ ID NO: 24,   (ii) a CMV promoter sequence comprising SEQ ID NO: 25,   (iii) an ITR sequence comprising SEQ ID NO: 26, and   (iv) an ITR sequence comprising SEQ ID No: 27.       

     In some embodiment, the recombinant vector of the disclosure further comprises:
         (i) an HBB2 intron sequence consisting of SEQ ID NO: 24,   (ii) a CMV promoter sequence consisting of SEQ ID NO: 25,   (iii) an ITR sequence consisting of SEQ ID NO: 26, and   (iv) an ITR sequence consisting of SEQ ID No: 27.       

     In some embodiments, a recombinant vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding a ND4 protein, and comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14,   a nucleic acid sequence encoding an ND4 polypeptide comprising SEQ ID NO: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide sequence comprising SEQ ID NO: 11.       

     In some embodiments, a recombinant vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding a ND4 protein, and comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14,   a nucleic acid sequence encoding an ND4 polypeptide SEQ ID NO: 13, and   a nucleic acid sequence encoding MTS Cox/0 polypeptide sequence comprising SEQ ID NO: 12.       

     In some embodiments, a recombinant vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding a ND4 protein, and comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO: 1,   a nucleic acid sequence encoding an ND4 polypeptide comprising SEQ ID NO: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide sequence comprising SEQ ID NO: 11.       

     In some embodiments, a recombinant vector of the disclosure is a recombinant adeno-associated virus (AAV), serotype 2, (rAAV2/2) encoding a ND4 protein, and comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO: 1,   a nucleic acid sequence encoding an ND4 polypeptide SEQ ID NO: 13, and   a nucleic acid sequence encoding MTS Cox/0 polypeptide sequence comprising SEQ ID NO: 12.       

     
       
         
           
               
             
               
                 TABLE 3 
               
               
                   
               
               
                 Sequences of various embodiments of the disclosure 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                 SEQ ID 
                 Cox10 MTS 
                 20 
                 MAASPHTLSSRLLTGCVGGS 
               
               
                 NO: 11 
                 (cleaved) 
                 AA 
                   
               
               
                   
               
               
                 SEQ ID 
                 Cox10 MTS 
                 28 
                 MAASPHTLSSRLLTGCVGGSVWYLERRT 
               
               
                 NO: 12 
                 (uncleaved) 
                 AA 
               
               
                   
               
            
           
         
       
     
     Sequences such as promoters, introns or ITR are well known to person of ordinary skill in the art who can easily interchange each of them with other elements known in the art. 
     Recombinant vectors of the disclosure are useful in treating Leber Hereditary Optic Neuroretinopathy (LHON), including ND4-related LHON. 
     In some embodiments, a recombinant vector of the disclosure is administered to a patient in need thereof via intravitreal injection. 
     In some embodiments, a recombinant vector of the disclosure is administered to a patient in need thereof via a single intravitreal injection. 
     In some embodiments, a recombinant viral vector of the disclosure is administered to patients in need thereof in one or more doses of about 10 9  to 10 11  vg (viral genomes) per eye. In some embodiments, a recombinant AAV2 vector of the disclosure is administered to patients in need thereof in one or more doses of about 10 10  vg per eye, for example 9×10 10  vg per eye. 
     One aspect of the disclosure pertains to a pAAV-ND4 transfer plasmid that, in some embodiments, may be used in the preparation of a recombinant AAV2 vector of the disclosure. 
     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises the following functional elements and sequences: 
     3′UTR Cox10: nt 11-605=595 bp 
     Coding sequence ND4: nt 618-1997=1380 bp 
     MTS Cox10: nt 1998-2081=84 bp 
     HBB2 intron: nt 2124-2616=493 bp
 
CMV promoter: nt 2624-3283=660 bp
 
     ITR: nt 3327-3454=128 bp 
     F1 origin: nt 3872-4327=456 bp
 
Kana R gene: nt 4482-5273=792 bp
 
COLE1 origin: nt 5488-6102=615 bp
 
     ITR: nt 6324-6453=130 bp. 
       
     
       
         
           
               
             
               
                 TABLE 4 
               
             
            
               
                   
               
               
                 Annotated regions within one embodiment of the pAAV-ND4 plasmid 
               
            
           
           
               
               
               
               
            
               
                 Name 
                 Start 
                 Stop 
                 Sequence 
               
               
                   
               
            
           
           
               
               
               
               
            
               
                 3′UTR 
                 11 
                 605 
                 aacatgtggaatccccagtcccagtgcacagcagccgggtcctagctattggtattgttagaa 
               
               
                 COX10 
                   
                   
                 ggactatggttgagaatgtgtggggtggggaaaaccaaaaatgcaggccctggctcagtca 
               
               
                 (polyA 
                   
                   
                 ccaggaagggggtgctccgaggcctttgagggacctgagctcacagaactacagacagca 
               
               
                 sequence 
                   
                   
                 gatcatgaggctcacactttctggccaccaagtgccactctgctgggcatgtggagtgtgcgtg 
               
               
                 underlined) 
                   
                   
                 tggtgtggtggtaaggatggaaccaaaagaggaagctgtgtatgtgtacccccatgtgagga 
               
               
                   
                   
                   
                 ggaagaaacagaatagagggtggggttggaggagagatgtataaagaccctcaaaggga 
               
               
                   
                   
                   
                 aaaataattccttttttgtattcactgactgagctgatgcatttc ttattt ggggagcattttgggtaat 
               
               
                   
                   
                   
                 atttaaaaaaaaaaaaaactgtcaagtgatcactgggcaccgaattcgtttataatcttgttcta 
               
               
                   
                   
                   
                 aacccagcaatttctcttcttgtgttccagaattaccacaacatgctcgcctggcagcggaggg 
               
               
                   
                   
                   
                 aaaggggcggtgggcgtcccagtgctc 
               
               
                   
               
               
                 ND4 
                 618 
                 1997 
                 tcaggatgagaaaccagtgataatgtctgggttcagggacagcagcaggatgggagacag 
               
               
                   
                   
                   
                 atgcataaacatcagggtgttctctctggtgaatgagggcttcatgttattaatgtggtgagtcagt 
               
               
                   
                   
                   
                 gagccccactgggtagtggtaaacatgtacaggctgtagagggctgtgaccagcatgttcag 
               
               
                   
                   
                   
                 tcctgtcaggagcagggtgatgttgctccaggagaatgttgtcaccagcactgacagctctcc 
               
               
                   
                   
                   
                 cagcaggttaattgtagggggcagagccaggttggccagactagccaggagccaccagaa 
               
               
                   
                   
                   
                 agccatcagtgggagcagggtctggagcccctgactcaggatcataattcttgagtgagttcttt 
               
               
                   
                   
                   
                 catagttgctatttgccaggcagaacaggaggctgctggtcagcccatgagcaatcatgagg 
               
               
                   
                   
                   
                 atcactgccccagtaaaggaccagggtgtctgaatcagaatggcagtcaccaccagtgcca 
               
               
                   
                   
                   
                 tgtggctgatggagctgtaagcaatcaggctcttgaggtcagtctgcctgagacagatggagc 
               
               
                   
                   
                   
                 tggtcatgatcataccccagaggctcagaaccaggaaagggtaagccatgtgctttgtcaga 
               
               
                   
                   
                   
                 gggttcaggatcagggtgagcctcatcataccataaccacccagcttcaggaggacagcag 
               
               
                   
                   
                   
                 ccaggaccatggagccagctattggagcttccacatgagccttggggagccagaggtgcag 
               
               
                   
                   
                   
                 gccatagaggggcatcttcaccataaaggccattgtataagccagccacatcaggttgtttgc 
               
               
                   
                   
                   
                 ccaggagttactcagctcctgggcagtcagagtcagcaggaggatgttcaggctacccagtg 
               
               
                   
                   
                   
                 tgttgtgggtatagatcagtgcaatcagcaggggcagtgagcccaccagtgtataaaagaga 
               
               
                   
                   
                   
                 aagtaggtgcctgcattcagcctctcaggctgatttccccacctagtgatgatggccagggttg 
               
               
                   
                   
                   
                 ggatgagagtggtctcaaagaagatatagaacatgatcagctcagtggctgtgaaggtcata 
               
               
                   
                   
                   
                 atcaggctgatttgcaggctaatgagcatggacaggtacagctttttccttgacagaggctctg 
               
               
                   
                   
                   
                 agctgaggtgcctctgactggccatgatagtcagaggcagcagccatgtggtcagcatgagc 
               
               
                   
                   
                   
                 aggggggttgtcaggggatcagaggaaaaggtaggggagcatgaaaagaggttattatta 
               
               
                   
                   
                   
                 atctggttgaaaaacagcagtgggatgatgctgataatcaggctgtgggttgtggtgttaatcc 
               
               
                   
                   
                   
                 aaatcatgtgctttttgctcagccatgtgagaggcagcagcatgatggttggcacaatcagcttc 
               
               
                   
                   
                   
                 agcat 
               
               
                   
               
               
                 MTS Cox10 
                 1998 
                 2081 
                 agtcctcctttccaggtaccacacactcccccccacacagccagtcaggagcctggatgaca 
               
               
                   
                   
                   
                 gtgtatgggggctggcagccat 
               
               
                   
               
               
                 betaglobin 
                 2124 
                 2616 
                 atcccaattctttgccaaagtgatgggccagcacacagaccagcacgttgcccaggagctgt 
               
               
                 intron 
                   
                   
                 gggaggaagataagaggtatgaacatgattagcaaaagggcctagcttggactcagaata 
               
               
                   
                   
                   
                 atccagccttatcccaaccataaaataaaagcagaatggtagctggattgtagctgctattagc 
               
               
                   
                   
                   
                 aatatgaaacctcttacatcagttacaatttatatgcagaaatatttatatgcagaaatattgctatt 
               
               
                   
                   
                   
                 gccttaacccagaaattatcactgttattctttagaatggtgcaaagaggcatgatacattgtatc 
               
               
                   
                   
                   
                 attattgccctgaaagaaagagattagggaaagtattagaaataagataaacaaaaaagtat 
               
               
                   
                   
                   
                 attaaaagaagaaagcattttttgtgggcctatagactctataggcggtacttacgtcactcttgg 
               
               
                   
                   
                   
                 cacggggaatccgcgttccaatgcaccgttcccggccgggattcg 
               
               
                   
               
               
                 CMV 
                 2624 
                 3283 
                 ggaggctggatcggtcccggtgtcttctatggaggtcaaaacagcgtggatggcgtctccagg 
               
               
                 promoter 
                   
                   
                 cgatctgacggttcactaaacgagctctgcttatatagacctcccaccgtacacgcctaccgcc 
               
               
                   
                   
                   
                 catttgcgtcaatggggcggagttgttacgacattttggaaagtcccgttgattttggtgccaaaa 
               
               
                   
                   
                   
                 caaactcccattgacgtcaatggggtggagacttggaaatccccgtgagtcaaaccgctatc 
               
               
                   
                   
                   
                 cacgcccattgatgtactgccaaaaccgcatcaccatggtaatagcgatgactaatacgtag 
               
               
                   
                   
                   
                 atgtactgccaagtaggaaagtcccataaggtcatgtactgggcataatgccaggcgggcca 
               
               
                   
                   
                   
                 tttaccgtcattgacgtcaatagggggcgtacttggcatatgatacacttgatgtactgccaagt 
               
               
                   
                   
                   
                 gggcagtttaccgtaaatactccacccattgacgtcaatggaaagtccctattggcgttactatg 
               
               
                   
                   
                   
                 ggaacatacgtcattattgacgtcaatgggcgggggtcgttgggcggtcagccaggcgggcc 
               
               
                   
                   
                   
                 atttaccgtaagttatgtaacgcggaactccatatatgggctatgaactaatgaccccgtaattg 
               
               
                   
                   
                   
                 attactattaataactagacgcgt 
               
               
                   
               
               
                 5′ ITR 
                 3327 
                 3454 
                 aggaacccctagtgatggagttggccactccctctctgcgcgctcgctcgctcactgaggccg 
               
               
                   
                   
                   
                 ggcgaccaaaggtcgcccgacgcccgggctttgcccgggcggcctcagtgagcgagcga 
               
               
                   
                   
                   
                 gcgcgc 
               
               
                   
               
               
                 F1 origin 
                 3872 
                 4327 
                 acgcgccctgtagcggcgcattaagcgcggcgggtgtggtggttacgcgcagcgtgaccgc 
               
               
                   
                   
                   
                 tacacttgccagcgccctagcgcccgctcctttcgctttcttcccttcctttctcgccacgttcgccg 
               
               
                   
                   
                   
                 gctttccccgtcaagctctaaatcgggggctccctttagggttccgatttagtgctttacggcacct 
               
               
                   
                   
                   
                 cgaccccaaaaaacttgattagggtgatggttcacgtagtgggccatcgccctgatagacggt 
               
               
                   
                   
                   
                 ttttcgccctttgacgttggagtccacgttctttaatagtggactcttgttccaaactggaacaaca 
               
               
                   
                   
                   
                 ctcaaccctatctcggtctattcttttgatttataagggattttgccgatttcggcctattggttaaaaa 
               
               
                   
                   
                   
                 atgagctgatttaacaaaaatttaacgcgaattttaacaaaatattaacgcttacaattt 
               
               
                   
               
               
                 Kana R gene 
                 4482 
                 5273 
                 attgaacaagatggattgcacgcaggttctccggccgcttgggtggagaggctattcggctat 
               
               
                   
                   
                   
                 gactgggcacaacagacaatcggctgctctgatgccgccgtgttccggctgtcagcgcaggg 
               
               
                   
                   
                   
                 gcgcccggttctttttgtcaagaccgacctgtccggtgccctgaatgaactgcaagacgaggc 
               
               
                   
                   
                   
                 agcgcggctatcgtggctggccacgacgggcgttccttgcgcagctgtgctcgacgttgtcact 
               
               
                   
                   
                   
                 gaagcgggaagggactggctgctattgggcgaagtgccggggcaggatctcctgtcatctca 
               
               
                   
                   
                   
                 ccttgctcctgccgagaaagtatccatcatggctgatgcaatgcggcggctgcatacgcttgat 
               
               
                   
                   
                   
                 ccggctacctgcccattcgaccaccaagcgaaacatcgcatcgagcgagcacgtactcgg 
               
               
                   
                   
                   
                 atggaagccggtcttgtcgatcaggatgatctggacgaagagcatcaggggctcgcgccag 
               
               
                   
                   
                   
                 ccgaactgttcgccaggctcaaggcgagcatgcccgacggcgaggatctcgtcgtgaccca 
               
               
                   
                   
                   
                 tggcgatgcctgcttgccgaatatcatggtggaaaatggccgcttttctggattcatcgactgtgg 
               
               
                   
                   
                   
                 ccggctgggtgtggcggaccgctatcaggacatagcgttggctacccgtgatattgctgaaga 
               
               
                   
                   
                   
                 gcttggcggcgaatgggctgaccgcttcctcgtgctttacggtatcgccgctcccgattcgcag 
               
               
                   
                   
                   
                 cgcatcgccttctatcgccttcttgacgagttcttctga 
               
               
                   
               
               
                 ColE1 origin 
                 5488 
                 6102 
                 aaaggatcttcttgagatcctttttttctgcgcgtaatctgctgcttgcaaacaaaaaaaccaccg 
               
               
                   
                   
                   
                 ctaccagcggtggtttgtttgccggatcaagagctaccaactctttttccgaaggtaactggcttc 
               
               
                   
                   
                   
                 agcagagcgcagataccaaatactgtccttctagtgtagccgtagttaggccaccacttcaag 
               
               
                   
                   
                   
                 aactctgtagcaccgcctacatacctcgctctgctaatcctgttaccagtggctgctgccagtgg 
               
               
                   
                   
                   
                 cgataagtcgtgtcttaccgggttggactcaagacgatagttaccggataaggcgcagcggtc 
               
               
                   
                   
                   
                 gggctgaacggggggttcgtgcacacagcccagcttggagcgaacgacctacaccgaact 
               
               
                   
                   
                   
                 gagatacctacagcgtgagctatgagaaagcgccacgcttcccgaagggagaaaggcgg 
               
               
                   
                   
                   
                 acaggtatccggtaagcggcagggtcggaacaggagagcgcacgagggagcttccagg 
               
               
                   
                   
                   
                 gggaaacgcctggtatctttatagtcctgtcgggtttcgccacctctgacttgagcgtcgatttttgt 
               
               
                   
                   
                   
                 gatgctcgtcaggggggcggagcctatggaaaaacgccagcaacgcg 
               
               
                   
               
               
                 3′ ITR 
                 6324 
                 6453 
                 ctgcgcgctcgctcgctcactgaggccgcccgggcaaagcccgggcgtcgggcgacctttg 
               
               
                   
                   
                   
                 gtcgcccggcctcagtgagcgagcgagcgcgcagagagggagtggccaactccatcacta 
               
               
                   
                   
                   
                 ggggttcct 
               
               
                   
               
            
           
         
       
     
     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises:
         (i) a 3′UTR Cox/0 sequence of SEQ ID NO: 1,   (ii) a coding sequence ND4 of SEQ ID NO: 2,   (iii) an MTS Cox/0 sequence of SEQ ID NO: 3,   (iv) an HBB2 intron sequence of SEQ ID NO: 4,   (v) a CMV promoter sequence of SEQ ID NO: 5,   (vi) an ITR sequence of SEQ ID NO: 6, and   (vii) an ITR sequence of SEQ ID NO: 7.       

     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises:
         (i) a 3′UTR Cox/0 sequence of SEQ ID NO: 1,   (ii) a coding sequence ND4 of SEQ ID NO: 17,   (iii) an MTS Cox/0 sequence of SEQ ID NO: 3,   (iv) an HBB2 intron sequence of SEQ ID NO: 4,   (v) a CMV promoter sequence of SEQ ID NO: 5,   (vi) an ITR sequence of SEQ ID NO: 6, and   (vii) an ITR sequence of SEQ ID NO: 7.       

     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises:
         (i) a 3′UTR Cox/0 sequence of SEQ ID NO: 14,   (ii) a coding sequence ND4 of SEQ ID NO: 15,   (iii) an MTS Cox/0 sequence of SEQ ID NO: 16,   (iv) an HBB2 intron sequence of SEQ ID NO: 24,   (v) a CMV promoter sequence of SEQ ID NO: 25,   (vi) an ITR sequence of SEQ ID NO: 26, and   (vii) an ITR sequence of SEQ ID NO: 27.       

     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises:
         (i) a 3′UTR Cox/0 sequence of SEQ ID NO: 14,   (ii) a coding sequence ND4 of SEQ ID NO: 18,   (iii) an MTS Cox/0 sequence of SEQ ID NO: 16,   (iv) an HBB2 intron sequence of SEQ ID NO: 24,   (v) a CMV promoter sequence of SEQ ID NO: 25,   (vi) an ITR sequence of SEQ ID NO: 26, and   (vii) an ITR sequence of SEQ ID NO: 27.       

     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises: 
     
       
         
           
               
               
            
               
                 (SEQ ID NO: 22) 
                   
               
               
                 gctcggtccgaacatgtggaatccccagtcccagtgcacagcagccgggtcctagctattggtattgttaga 
                   
               
               
                   
               
               
                 aggactatggttgagaatgtgtggggtggggaaaaccaaaaatgcaggccctggctcagtcaccaggaa 
               
               
                   
               
               
                 gggggtgctccgaggcctttgagggacctgagctcacagaactacagacagcagatcatgaggctcaca 
               
               
                   
               
               
                 ctttctggccaccaagtgccactctgctgggcatgtggagtgtgcgtgtggtgtggtggtaaggatggaacca 
               
               
                   
               
               
                 aaagaggaagctgtgtatgtgtacccccatgtgaggaggaagaaacagaatagagggtggggttggag 
               
               
                   
               
               
                 gagagatgtataaagaccctcaaagggaaaaataattccttttttgtattcactgactgagctgatgcatttctt 
               
               
                   
               
               
                 atttggggagcattttgggtaatatttaaaaaaaaaaaaaactgtcaagtgatcactgggcaccgaattcgttt 
               
               
                   
               
               
                 ataatcttgttctaaacccagcaatttctcttcttgtgttccagaattaccacaacatgctcgcctggcagcgga 
               
               
                   
               
               
                 gggaaaggggcggtgggcgtcccagtgctcagatctctcgagtcaggatgagaaaccagtgataatgtct 
               
               
                   
               
               
                 gggttcagggacagcagcaggatgggagacagatgcataaacatcagggtgttctctctggtgaatgagg 
               
               
                   
               
               
                 gcttcatgttattaatgtggtgagtcagtgagccccactgggtagtggtaaacatgtacaggctgtagagggc 
               
               
                   
               
               
                 tgtgaccagcatgttcagtcctgtcaggagcagggtgatgttgctccaggagaatgttgtcaccagcactga 
               
               
                   
               
               
                 cagctctcccagcaggttaattgtagggggcagagccaggttggccagactagccaggagccaccagaa 
               
               
                   
               
               
                 agccatcagtgggagcagggtctggagcccctgactcaggatcataattcttgagtgagttctttcatagttgc 
               
               
                   
               
               
                 tatttgccaggcagaacaggaggctgctggtcagcccatgagcaatcatgaggatcactgccccagtaaa 
               
               
                   
               
               
                 ggaccagggtgtctgaatcagaatggcagtcaccaccagtgccatgtggctgatggagctgtaagcaatc 
               
               
                   
               
               
                 aggctcttgaggtcagtctgcctgagacagatggagctggtcatgatcataccccagaggctcagaaccag 
               
               
                   
               
               
                 gaaagggtaagccatgtgctttgtcagagggttcaggatcagggtgagcctcatcataccataaccaccca 
               
               
                   
               
               
                 gcttcaggaggacagcagccaggaccatggagccagctattggagcttccacatgagccttggggagcc 
               
               
                   
               
               
                 agaggtgcaggccatagaggggcatcttcaccataaaggccattgtataagccagccacatcaggttgttt 
               
               
                   
               
               
                 gcccaggagttactcagctcctgggcagtcagagtcagcaggaggatgttcaggctacccagtgtgttgtg 
               
               
                   
               
               
                 ggtatagatcagtgcaatcagcaggggcagtgagcccaccagtgtataaaagagaaagtaggtgcctgc 
               
               
                   
               
               
                 attcagcctctcaggctgatttccccacctagtgatgatggccagggttgggatgagagtggtctcaaagaa 
               
               
                   
               
               
                 gatatagaacatgatcagctcagtggctgtgaaggtcataatcaggctgatttgcaggctaatgagcatgga 
               
               
                   
               
               
                 caggtacagctttttccttgacagaggctctgagctgaggtgcctctgactggccatgatagtcagaggcagc 
               
               
                   
               
               
                 agccatgtggtcagcatgagcaggggggttgtcaggggatcagaggaaaaggtaggggagcatgaaaa 
               
               
                   
               
               
                 gaggttattattaatctggttgaaaaacagcagtgggatgatgctgataatcaggctgtgggttgtggtgttaat 
               
               
                   
               
               
                 ccaaatcatgtgctttttgctcagccatgtgagaggcagcagcatgatggttggcacaatcagcttcagcata 
               
               
                   
               
               
                 gtcctcctttccaggtaccacacactcccccccacacagccagtcaggagcctggatgacagtgtatgggg 
               
               
                   
               
               
                 gctggcagccatgtcgactctagaggatccccggggaattcaatcgatgttcgaatcccaattctttgccaaa 
               
               
                   
               
               
                 gtgatgggccagcacacagaccagcacgttgcccaggagctgtgggaggaagataagaggtatgaaca 
               
               
                   
               
               
                 tgattagcaaaagggcctagcttggactcagaataatccagccttatcccaaccataaaataaaagcaga 
               
               
                   
               
               
                 atggtagctggattgtagctgctattagcaatatgaaacctcttacatcagttacaatttatatgcagaaatattt 
               
               
                   
               
               
                 atatgcagaaatattgctattgccttaacccagaaattatcactgttattctttagaatggtgcaaagaggcatg 
               
               
                   
               
               
                 atacattgtatcattattgccctgaaagaaagagattagggaaagtattagaaataagataaacaaaaaag 
               
               
                   
               
               
                 tatattaaaagaagaaagcattttttgtgggcctatagactctataggcggtacttacgtcactcttggcacggg 
               
               
                   
               
               
                 gaatccgcgttccaatgcaccgttcccggccgggattcgaatccgcggaggctggatcggtcccggtgtctt 
               
               
                   
               
               
                 ctatggaggtcaaaacagcgtggatggcgtctccaggcgatctgacggttcactaaacgagctctgcttata 
               
               
                   
               
               
                 tagacctcccaccgtacacgcctaccgcccatttgcgtcaatggggcggagttgttacgacattttggaaagt 
               
               
                   
               
               
                 cccgttgattttggtgccaaaacaaactcccattgacgtcaatggggtggagacttggaaatccccgtgagtc 
               
               
                   
               
               
                 aaaccgctatccacgcccattgatgtactgccaaaaccgcatcaccatggtaatagcgatgactaatacgt 
               
               
                   
               
               
                 agatgtactgccaagtaggaaagtcccataaggtcatgtactgggcataatgccaggcgggccatttaccg 
               
               
                   
               
               
                 tcattgacgtcaatagggggcgtacttggcatatgatacacttgatgtactgccaagtgggcagtttaccgtaa 
               
               
                   
               
               
                 atactccacccattgacgtcaatggaaagtccctattggcgttactatgggaacatacgtcattattgacgtca 
               
               
                   
               
               
                 atgggcgggggtcgttgggcggtcagccaggcgggccatttaccgtaagttatgtaacgcggaactccata 
               
               
                   
               
               
                 tatgggctatgaactaatgaccccgtaattgattactattaataactagacgcgtgcggccgtagataagtag 
               
               
                   
               
               
                 catggcgggttaatcattaactacaaggaacccctagtgatggagttggccactccctctctgcgcgctcgct 
               
               
                   
               
               
                 cgctcactgaggccgggcgaccaaaggtcgcccgacgcccgggctttgcccgggcggcctcagtgagc 
               
               
                   
               
               
                 gagcgagcgcgccagctggcgtaatagcgaagaggcccgcaccgatcgcccttcccaacagttgcgca 
               
               
                   
               
               
                 gcctgaatggcgaatggattccagacgattgagcgtcaaaatgtaggtatttccatgagcgtttttccgttgca 
               
               
                   
               
               
                 atggctggcggtaatattgttctggatattaccagcaaggccgatagtttgagttcttctactcaggcaagtgat 
               
               
                   
               
               
                 gttattactaatcaaagaagtattgcgacaacggttaatttgcgtgatggacagactcttttactcggtggcctc 
               
               
                   
               
               
                 actgattataaaaacacttctcaggattctggcgtaccgttcctgtctaaaatccctttaatcggcctcctgtttag 
               
               
                   
               
               
                 ctcccgctctgattctaacgaggaaagcacgttatacgtgctcgtcaaagcaaccatagtacgcgccctgta 
               
               
                   
               
               
                 gcggcgcattaagcgcggcgggtgtggtggttacgcgcagcgtgaccgctacacttgccagcgccctagc 
               
               
                   
               
               
                 gcccgctcctttcgctttcttcccttcctttctcgccacgttcgccggctttccccgtcaagctctaaatcgggggc 
               
               
                   
               
               
                 tccctttagggttccgatttagtgctttacggcacctcgaccccaaaaaacttgattagggtgatggttcacgta 
               
               
                   
               
               
                 gtgggccatcgccctgatagacggtttttcgccctttgacgttggagtccacgttctttaatagtggactcttgttc 
               
               
                   
               
               
                 caaactggaacaacactcaaccctatctcggtctattcttttgatttataagggattttgccgatttcggcctattg 
               
               
                   
               
               
                 gttaaaaaatgagctgatttaacaaaaatttaacgcgaattttaacaaaatattaacgcttacaatttaggtgg 
               
               
                   
               
               
                 cacttttcggggaaatgtgcgcggaacccctatttgtttatttttctaaatacattcaaatatgtatccgctcatga 
               
               
                   
               
               
                 gacaataaccctgataaatgcttcaataatagcacctagatcaagagacaggatgaggatcgtttcgcatg 
               
               
                   
               
               
                 attgaacaagatggattgcacgcaggttctccggccgcttgggtggagaggctattcggctatgactgggca 
               
               
                   
               
               
                 caacagacaatcggctgctctgatgccgccgtgttccggctgtcagcgcaggggcgcccggttctttttgtca 
               
               
                   
               
               
                 agaccgacctgtccggtgccctgaatgaactgcaagacgaggcagcgcggctatcgtggctggccacga 
               
               
                   
               
               
                 cgggcgttccttgcgcagctgtgctcgacgttgtcactgaagcgggaagggactggctgctattgggcgaa 
               
               
                   
               
               
                 gtgccggggcaggatctcctgtcatctcaccttgctcctgccgagaaagtatccatcatggctgatgcaatgc 
               
               
                   
               
               
                 ggcggctgcatacgcttgatccggctacctgcccattcgaccaccaagcgaaacatcgcatcgagcgagc 
               
               
                   
               
               
                 acgtactcggatggaagccggtcttgtcgatcaggatgatctggacgaagagcatcaggggctcgcgcca 
               
               
                   
               
               
                 gccgaactgttcgccaggctcaaggcgagcatgcccgacggcgaggatctcgtcgtgacccatggcgat 
               
               
                   
               
               
                 gcctgcttgccgaatatcatggtggaaaatggccgcttttctggattcatcgactgtggccggctgggtgtggc 
               
               
                   
               
               
                 ggaccgctatcaggacatagcgttggctacccgtgatattgctgaagagcttggcggcgaatgggctgacc 
               
               
                   
               
               
                 gcttcctcgtgctttacggtatcgccgctcccgattcgcagcgcatcgccttctatcgccttcttgacgagttcttct 
               
               
                   
               
               
                 gaattattaacgcttacaatttcctgatgcggtattttctccttacgcatctgtgcggtatttcacaccgcatcaggt 
               
               
                   
               
               
                 ggcacttttcggggaaatgtgcgcggaacccctatttgtttatttttctaaatacattcaaatatgtatccgctcat 
               
               
                   
               
               
                 gaccaaaatcccttaacgtgagttttcgttccactgagcgtcagaccccgtagaaaagatcaaaggatcttct 
               
               
                   
               
               
                 tgagatcctttttttctgcgcgtaatctgctgcttgcaaacaaaaaaaccaccgctaccagcggtggtttgtttgc 
               
               
                   
               
               
                 cggatcaagagctaccaactctttttccgaaggtaactggcttcagcagagcgcagataccaaatactgtcc 
               
               
                   
               
               
                 ttctagtgtagccgtagttaggccaccacttcaagaactctgtagcaccgcctacatacctcgctctgctaatc 
               
               
                   
               
               
                 ctgttaccagtggctgctgccagtggcgataagtcgtgtcttaccgggttggactcaagacgatagttaccgg 
               
               
                   
               
               
                 ataaggcgcagcggtcgggctgaacggggggttcgtgcacacagcccagcttggagcgaacgacctac 
               
               
                   
               
               
                 accgaactgagatacctacagcgtgagctatgagaaagcgccacgcttcccgaagggagaaaggcgg 
               
               
                   
               
               
                 acaggtatccggtaagcggcagggtcggaacaggagagcgcacgagggagcttccagggggaaacg 
               
               
                   
               
               
                 cctggtatctttatagtcctgtcgggtttcgccacctctgacttgagcgtcgatttttgtgatgctcgtcagggggg 
               
               
                   
               
               
                 cggagcctatggaaaaacgccagcaacgcggcctttttacggttcctggccttttgctggccttttgctcacat 
               
               
                   
               
               
                 gttctttcctgcgttatcccctgattctgtggataaccgtattaccgcctttgagtgagctgataccgctcgccgca 
               
               
                   
               
               
                 gccgaacgaccgagcgcagcgagtcagtgagcgaggaagcggaagagcgcccaatacgcaaaccg 
               
               
                   
               
               
                 cctctccccgcgcgttggccgattcattaatgcagctgcgcgctcgctcgctcactgaggccgcccgggcaa 
               
               
                   
               
               
                 agcccgggcgtcgggcgacctttggtcgcccggcctcagtgagcgagcgagcgcgcagagagggagtg 
               
               
                   
               
               
                 gccaactccatcactaggggttccttgtagttaatgattaacccgccatgctacttatcta 
               
            
           
         
       
     
     In some other embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises the following functional elements and sequences: 
     3′UTR Cox10: nt 11-605=595 bp 
     Coding sequence ND4: nt 618-1997=1380 bp 
     MTS Cox10: nt 1998-2081=84 bp 
     HBB2 intron: nt 2124-2616=493 bp
 
CMV promoter: nt 2624-3283=660 bp
 
     ITR: nt 3327-3454=128 bp 
     F1 origin: nt 3827-4282=456 bp
 
Kana R gene: nt 4437-5228=792 bp
 
COLE1 origin: nt 5443-6057=615 bp
 
     ITR: nt 6279-6408=130 bp. 
       
     
       
         
           
               
             
               
                 TABLE 5 
               
             
            
               
                   
               
               
                 Annotated regions within one embodiment of the pAAV-ND4 plasmid 
               
            
           
           
               
               
               
               
            
               
                 Name 
                 Start 
                 Stop 
                 Sequence 
               
               
                   
               
            
           
           
               
               
               
               
            
               
                 3′UTR 
                 11 
                 605 
                 aacatgtggaatccccagtcccagtgcacagcagccgggtcctagctattggtattgttagaa 
               
               
                 COX10 
                   
                   
                 ggactatggttgagaatgtgtggggtggggaaaaccaaaaatgcaggccctggctcagtca 
               
               
                 (polyA 
                   
                   
                 ccaggaagggggtgctccgaggcctttgagggacctgagctcacagaactacagacagca 
               
               
                 sequence 
                   
                   
                 gatcatgaggctcacactttctggccaccaagtgccactctgctgggcatgtggagtgtgcgtg 
               
               
                 underlined) 
                   
                   
                 tggtgtggtggtaaggatggaaccaaaagaggaagctgtgtatgtgtacccccatgtgagga 
               
               
                   
                   
                   
                 ggaagaaacagaatagagggtggggttggaggagagatgtataaagaccctcaaaggga 
               
               
                   
                   
                   
                 aaaataattccttttttgtattcactgactgagctgatgcatttc ttattt ggggagcattttgggtaat 
               
               
                   
                   
                   
                 atttaaaaaaaaaaaaaactgtcaagtgatcactgggcaccgaattcgtttataatcttgttcta 
               
               
                   
                   
                   
                 aacccagcaatttctcttcttgtgttccagaattaccacaacatgctcgcctggcagcggaggg 
               
               
                   
                   
                   
                 aaaggggcggtgggcgtcccagtgctc 
               
               
                   
               
               
                 ND4 
                 618 
                 1997 
                 tcaggatgagaaaccagtgataatgtctgggttcagggacagcagcaggatgggagacag 
               
               
                   
                   
                   
                 atgcataaacatcagggtgttctctctggtgaatgagggcttcatgttattaatgtggtgagtcagt 
               
               
                   
                   
                   
                 gagccccactgggtagtggtaaacatgtacaggctgtagagggctgtgaccagcatgttcag 
               
               
                   
                   
                   
                 tcctgtcaggagcagggtgatgttgctccaggagaatgttgtcaccagcactgacagctctcc 
               
               
                   
                   
                   
                 cagcaggttaattgtagggggcagagccaggttggccagactagccaggagccaccagaa 
               
               
                   
                   
                   
                 agccatcagtgggagcagggtctggagcccctgactcaggatcataattcttgagtgagttcttt 
               
               
                   
                   
                   
                 catagttgctatttgccaggcagaacaggaggctgctggtcagcccatgagcaatcatgagg 
               
               
                   
                   
                   
                 atcactgccccagtaaaggaccagggtgtctgaatcagaatggcagtcaccaccagtgcca 
               
               
                   
                   
                   
                 tgtggctgatggagctgtaagcaatcaggctcttgaggtcagtctgcctgagacagatggagc 
               
               
                   
                   
                   
                 tggtcatgatcataccccagaggctcagaaccaggaaagggtaagccatgtgctttgtcaga 
               
               
                   
                   
                   
                 gggttcaggatcagggtgagcctcatcataccataaccacccagcttcaggaggacagcag 
               
               
                   
                   
                   
                 ccaggaccatggagccagctattggagcttccacatgagccttggggagccagaggtgcag 
               
               
                   
                   
                   
                 gccatagaggggcatcttcaccataaaggccattgtataagccagccacatcaggttgtttgc 
               
               
                   
                   
                   
                 ccaggagttactcagctcctgggcagtcagagtcagcaggaggatgttcaggctacccagtg 
               
               
                   
                   
                   
                 tgttgtgggtatagatcagtgcaatcagcaggggcagtgagcccaccagtgtataaaagaga 
               
               
                   
                   
                   
                 aagtaggtgcctgcattcagcctctcaggctgatttccccacctagtgatgatggccagggttg 
               
               
                   
                   
                   
                 ggatgagagtggtctcaaagaagatatagaacatgatcagctcagtggctgtgaaggtcata 
               
               
                   
                   
                   
                 atcaggctgatttgcaggctaatgagcatggacaggtacagctttttccttgacagaggctctg 
               
               
                   
                   
                   
                 agctgaggtgcctctgactggccatgatagtcagaggcagcagccatgtggtcagcatgagc 
               
               
                   
                   
                   
                 aggggggttgtcaggggatcagaggaaaaggtaggggagcatgaaaagaggttattatta 
               
               
                   
                   
                   
                 atctggttgaaaaacagcagtgggatgatgctgataatcaggctgtgggttgtggtgttaatcc 
               
               
                   
                   
                   
                 aaatcatgtgctttttgctcagccatgtgagaggcagcagcatgatggttggcacaatcagcttc 
               
               
                   
                   
                   
                 agcat 
               
               
                   
               
               
                 MTS Cox10 
                 1998 
                 2081 
                 agtcctcctttccaggtaccacacactcccccccacacagccagtcaggagcctggatgaca 
               
               
                   
                   
                   
                 gtgtatgggggctggcagccat 
               
               
                   
               
               
                 betaglobin 
                 2124 
                 2616 
                 atcccaattctttgccaaagtgatgggccagcacacagaccagcacgttgcccaggagctgt 
               
               
                 intron 
                   
                   
                 gggaggaagataagaggtatgaacatgattagcaaaagggcctagcttggactcagaata 
               
               
                   
                   
                   
                 atccagccttatcccaaccataaaataaaagcagaatggtagctggattgtagctgctattagc 
               
               
                   
                   
                   
                 aatatgaaacctcttacatcagttacaatttatatgcagaaatatttatatgcagaaatattgctatt 
               
               
                   
                   
                   
                 gccttaacccagaaattatcactgttattctttagaatggtgcaaagaggcatgatacattgtatc 
               
               
                   
                   
                   
                 attattgccctgaaagaaagagattagggaaagtattagaaataagataaacaaaaaagtat 
               
               
                   
                   
                   
                 attaaaagaagaaagcattttttgtgggcctatagactctataggcggtacttacgtcactcttgg 
               
               
                   
                   
                   
                 cacggggaatccgcgttccaatgcaccgttcccggccgggattcg 
               
               
                   
               
               
                 CMV 
                 2624 
                 3283 
                 ggaggctggatcggtcccggtgtcttctatggaggtcaaaacagcgtggatggcgtctccagg 
               
               
                 promoter 
                   
                   
                 cgatctgacggttcactaaacgagctctgcttatatagacctcccaccgtacacgcctaccgcc 
               
               
                   
                   
                   
                 catttgcgtcaatggggcggagttgttacgacattttggaaagtcccgttgattttggtgccaaaa 
               
               
                   
                   
                   
                 caaactcccattgacgtcaatggggtggagacttggaaatccccgtgagtcaaaccgctatc 
               
               
                   
                   
                   
                 cacgcccattgatgtactgccaaaaccgcatcaccatggtaatagcgatgactaatacgtag 
               
               
                   
                   
                   
                 atgtactgccaagtaggaaagtcccataaggtcatgtactgggcataatgccaggcgggcca 
               
               
                   
                   
                   
                 tttaccgtcattgacgtcaatagggggcgtacttggcatatgatacacttgatgtactgccaagt 
               
               
                   
                   
                   
                 gggcagtttaccgtaaatactccacccattgacgtcaatggaaagtccctattggcgttactatg 
               
               
                   
                   
                   
                 ggaacatacgtcattattgacgtcaatgggcgggggtcgttgggcggtcagccaggcgggcc 
               
               
                   
                   
                   
                 atttaccgtaagttatgtaacgcggaactccatatatgggctatgaactaatgaccccgtaattg 
               
               
                   
                   
                   
                 attactattaataactagacgcgt 
               
               
                   
               
               
                 5′ ITR 
                 3327 
                 3454 
                 aggaacccctagtgatggagttggccactccctctctgcgcgctcgctcgctcactgaggccg 
               
               
                   
                   
                   
                 ggcgaccaaaggtcgcccgacgcccgggctttgcccgggcggcctcagtgagcgagcga 
               
               
                   
                   
                   
                 gcgcgc 
               
               
                   
               
               
                 F1 origin 
                 3827 
                 4282 
                 acgcgccctgtagcggcgcattaagcgcggcgggtgtggtggttacgcgcagcgtgaccgc 
               
               
                   
                   
                   
                 tacacttgccagcgccctagcgcccgctcctttcgctttcttcccttcctttctcgccacgttcgccg 
               
               
                   
                   
                   
                 gctttccccgtcaagctctaaatcgggggctccctttagggttccgatttagtgctttacggcacct 
               
               
                   
                   
                   
                 cgaccccaaaaaacttgattagggtgatggttcacgtagtgggccatcgccctgatagacggt 
               
               
                   
                   
                   
                 ttttcgccctttgacgttggagtccacgttctttaatagtggactcttgttccaaactggaacaaca 
               
               
                   
                   
                   
                 ctcaaccctatctcggtctattcttttgatttataagggattttgccgatttcggcctattggttaaaaa 
               
               
                   
                   
                   
                 atgagctgatttaacaaaaatttaacgcgaattttaacaaaatattaacgcttacaattt 
               
               
                   
               
               
                 Kana R gene 
                 4437 
                 5228 
                 attgaacaagatggattgcacgcaggttctccggccgcttgggtggagaggctattcggctat 
               
               
                   
                   
                   
                 gactgggcacaacagacaatcggctgctctgatgccgccgtgttccggctgtcagcgcaggg 
               
               
                   
                   
                   
                 gcgcccggttctttttgtcaagaccgacctgtccggtgccctgaatgaactgcaagacgaggc 
               
               
                   
                   
                   
                 agcgcggctatcgtggctggccacgacgggcgttccttgcgcagctgtgctcgacgttgtcact 
               
               
                   
                   
                   
                 gaagcgggaagggactggctgctattgggcgaagtgccggggcaggatctcctgtcatctca 
               
               
                   
                   
                   
                 ccttgctcctgccgagaaagtatccatcatggctgatgcaatgcggcggctgcatacgcttgat 
               
               
                   
                   
                   
                 ccggctacctgcccattcgaccaccaagcgaaacatcgcatcgagcgagcacgtactcgg 
               
               
                   
                   
                   
                 atggaagccggtcttgtcgatcaggatgatctggacgaagagcatcaggggctcgcgccag 
               
               
                   
                   
                   
                 ccgaactgttcgccaggctcaaggcgagcatgcccgacggcgaggatctcgtcgtgaccca 
               
               
                   
                   
                   
                 tggcgatgcctgcttgccgaatatcatggtggaaaatggccgcttttctggattcatcgactgtgg 
               
               
                   
                   
                   
                 ccggctgggtgtggcggaccgctatcaggacatagcgttggctacccgtgatattgctgaaga 
               
               
                   
                   
                   
                 gcttggcggcgaatgggctgaccgcttcctcgtgctttacggtatcgccgctcccgattcgcag 
               
               
                   
                   
                   
                 cgcatcgccttctatcgccttcttgacgagttcttctga 
               
               
                   
               
               
                 ColE1 origin 
                 5443 
                 6057 
                 aaaggatcttcttgagatcctttttttctgcgcgtaatctgctgcttgcaaacaaaaaaaccaccg 
               
               
                   
                   
                   
                 ctaccagcggtggtttgtttgccggatcaagagctaccaactctttttccgaaggtaactggcttc 
               
               
                   
                   
                   
                 agcagagcgcagataccaaatactgtccttctagtgtagccgtagttaggccaccacttcaag 
               
               
                   
                   
                   
                 aactctgtagcaccgcctacatacctcgctctgctaatcctgttaccagtggctgctgccagtgg 
               
               
                   
                   
                   
                 cgataagtcgtgtcttaccgggttggactcaagacgatagttaccggataaggcgcagcggtc 
               
               
                   
                   
                   
                 gggctgaacggggggttcgtgcacacagcccagcttggagcgaacgacctacaccgaact 
               
               
                   
                   
                   
                 gagatacctacagcgtgagctatgagaaagcgccacgcttcccgaagggagaaaggcgg 
               
               
                   
                   
                   
                 acaggtatccggtaagcggcagggtcggaacaggagagcgcacgagggagcttccagg 
               
               
                   
                   
                   
                 gggaaacgcctggtatctttatagtcctgtcgggtttcgccacctctgacttgagcgtcgatttttgt 
               
               
                   
                   
                   
                 gatgctcgtcaggggggcggagcctatggaaaaacgccagcaacgcg 
               
               
                   
               
               
                 3′ ITR 
                 6279 
                 6408 
                 ctgcgcgctcgctcgctcactgaggccgcccgggcaaagcccgggcgtcgggcgacctttg 
               
               
                   
                   
                   
                 gtcgcccggcctcagtgagcgagcgagcgcgcagagagggagtggccaactccatcacta 
               
               
                   
                   
                   
                 ggggttcct 
               
               
                   
               
            
           
         
       
     
     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises: 
     
       
         
           
               
               
            
               
                 (SEQ ID NO: 23) 
                   
               
               
                 gctcggtccgaacatgtggaatccccagtcccagtgcacagcagccgggtcctagctattggtattgttaga 
                   
               
               
                   
               
               
                 aggactatggttgagaatgtgtggggtggggaaaaccaaaaatgcaggccctggctcagtcaccaggaa 
               
               
                   
               
               
                 gggggtgctccgaggcctttgagggacctgagctcacagaactacagacagcagatcatgaggctcaca 
               
               
                   
               
               
                 ctttctggccaccaagtgccactctgctgggcatgtggagtgtgcgtgtggtgtggtggtaaggatggaacca 
               
               
                   
               
               
                 aaagaggaagctgtgtatgtgtacccccatgtgaggaggaagaaacagaatagagggtggggttggag 
               
               
                   
               
               
                 gagagatgtataaagaccctcaaagggaaaaataattccttttttgtattcactgactgagctgatgcatttctt 
               
               
                   
               
               
                 atttggggagcattttgggtaatatttaaaaaaaaaaaaaactgtcaagtgatcactgggcaccgaattcgttt 
               
               
                   
               
               
                 ataatcttgttctaaacccagcaatttctcttcttgtgttccagaattaccacaacatgctcgcctggcagcgga 
               
               
                   
               
               
                 gggaaaggggcggtgggcgtcccagtgctcagatctctcgagtcaggatgagaaaccagtgataatgtct 
               
               
                   
               
               
                 gggttcagggacagcagcaggatgggagacagatgcataaacatcagggtgttctctctggtgaatgagg 
               
               
                   
               
               
                 gcttcatgttattaatgtggtgagtcagtgagccccactgggtagtggtaaacatgtacaggctgtagagggc 
               
               
                   
               
               
                 tgtgaccagcatgttcagtcctgtcaggagcagggtgatgttgctccaggagaatgttgtcaccagcactga 
               
               
                   
               
               
                 cagctctcccagcaggttaattgtagggggcagagccaggttggccagactagccaggagccaccagaa 
               
               
                   
               
               
                 agccatcagtgggagcagggtctggagcccctgactcaggatcataattcttgagtgagttctttcatagttgc 
               
               
                   
               
               
                 tatttgccaggcagaacaggaggctgctggtcagcccatgagcaatcatgaggatcactgccccagtaaa 
               
               
                   
               
               
                 ggaccagggtgtctgaatcagaatggcagtcaccaccagtgccatgtggctgatggagctgtaagcaatc 
               
               
                   
               
               
                 aggctcttgaggtcagtctgcctgagacagatggagctggtcatgatcataccccagaggctcagaaccag 
               
               
                   
               
               
                 gaaagggtaagccatgtgctttgtcagagggttcaggatcagggtgagcctcatcataccataaccaccca 
               
               
                   
               
               
                 gcttcaggaggacagcagccaggaccatggagccagctattggagcttccacatgagccttggggagcc 
               
               
                   
               
               
                 agaggtgcaggccatagaggggcatcttcaccataaaggccattgtataagccagccacatcaggttgttt 
               
               
                   
               
               
                 gcccaggagttactcagctcctgggcagtcagagtcagcaggaggatgttcaggctacccagtgtgttgtg 
               
               
                   
               
               
                 ggtatagatcagtgcaatcagcaggggcagtgagcccaccagtgtataaaagagaaagtaggtgcctgc 
               
               
                   
               
               
                 attcagcctctcaggctgatttccccacctagtgatgatggccagggttgggatgagagtggtctcaaagaa 
               
               
                   
               
               
                 gatatagaacatgatcagctcagtggctgtgaaggtcataatcaggctgatttgcaggctaatgagcatgga 
               
               
                   
               
               
                 caggtacagctttttccttgacagaggctctgagctgaggtgcctctgactggccatgatagtcagaggcagc 
               
               
                   
               
               
                 agccatgtggtcagcatgagcaggggggttgtcaggggatcagaggaaaaggtaggggagcatgaaaa 
               
               
                   
               
               
                 gaggttattattaatctggttgaaaaacagcagtgggatgatgctgataatcaggctgtgggttgtggtgttaat 
               
               
                   
               
               
                 ccaaatcatgtgctttttgctcagccatgtgagaggcagcagcatgatggttggcacaatcagcttcagcata 
               
               
                   
               
               
                 gtcctcctttccaggtaccacacactcccccccacacagccagtcaggagcctggatgacagtgtatgggg 
               
               
                   
               
               
                 gctggcagccatgtcgactctagaggatccccggggaattcaatcgatgttcgaatcccaattctttgccaaa 
               
               
                   
               
               
                 gtgatgggccagcacacagaccagcacgttgcccaggagctgtgggaggaagataagaggtatgaaca 
               
               
                   
               
               
                 tgattagcaaaagggcctagcttggactcagaataatccagccttatcccaaccataaaataaaagcaga 
               
               
                   
               
               
                 atggtagctggattgtagctgctattagcaatatgaaacctcttacatcagttacaatttatatgcagaaatattt 
               
               
                   
               
               
                 atatgcagaaatattgctattgccttaacccagaaattatcactgttattctttagaatggtgcaaagaggcatg 
               
               
                   
               
               
                 atacattgtatcattattgccctgaaagaaagagattagggaaagtattagaaataagataaacaaaaaag 
               
               
                   
               
               
                 tatattaaaagaagaaagcattttttgtgggcctatagactctataggcggtacttacgtcactcttggcacggg 
               
               
                   
               
               
                 gaatccgcgttccaatgcaccgttcccggccgggattcgaatccgcggaggctggatcggtcccggtgtctt 
               
               
                   
               
               
                 ctatggaggtcaaaacagcgtggatggcgtctccaggcgatctgacggttcactaaacgagctctgcttata 
               
               
                   
               
               
                 tagacctcccaccgtacacgcctaccgcccatttgcgtcaatggggcggagttgttacgacattttggaaagt 
               
               
                   
               
               
                 cccgttgattttggtgccaaaacaaactcccattgacgtcaatggggtggagacttggaaatccccgtgagtc 
               
               
                   
               
               
                 aaaccgctatccacgcccattgatgtactgccaaaaccgcatcaccatggtaatagcgatgactaatacgt 
               
               
                   
               
               
                 agatgtactgccaagtaggaaagtcccataaggtcatgtactgggcataatgccaggcgggccatttaccg 
               
               
                   
               
               
                 tcattgacgtcaatagggggcgtacttggcatatgatacacttgatgtactgccaagtgggcagtttaccgtaa 
               
               
                   
               
               
                 atactccacccattgacgtcaatggaaagtccctattggcgttactatgggaacatacgtcattattgacgtca 
               
               
                   
               
               
                 atgggcgggggtcgttgggcggtcagccaggcgggccatttaccgtaagttatgtaacgcggaactccata 
               
               
                   
               
               
                 tatgggctatgaactaatgaccccgtaattgattactattaataactagacgcgtgcggccgtagataagtag 
               
               
                   
               
               
                 catggcgggttaatcattaactacaaggaacccctagtgatggagttggccactccctctctgcgcgctcgct 
               
               
                   
               
               
                 cgctcactgaggccgggcgaccaaaggtcgcccgacgcccgggctttgcccgggcggcctcagtgagc 
               
               
                   
               
               
                 gagcgagcgcgcagctggcgtaatagcgaagaggcccgcaccgatcgcccttcccaacagttgcgcag 
               
               
                   
               
               
                 cctgaatggcgaatggcgattccgttgcaatggctggcggtaatattgttctggatattaccagcaaggccga 
               
               
                   
               
               
                 tagtttgagttcttctactcaggcaagtgatgttattactaatcaaagaagtattgcgacaacggttaatttgcgt 
               
               
                   
               
               
                 gatggacagactcttttactcggtggcctcactgattataaaaacacttctcaggattctggcgtaccgttcctgt 
               
               
                   
               
               
                 ctaaaatccctttaatcggcctcctgtttagctcccgctctgattctaacgaggaaagcacgttatacgtgctcg 
               
               
                   
               
               
                 tcaaagcaaccatagtacgcgccctgtagcggcgcattaagcgcggcgggtgtggtggttacgcgcagcg 
               
               
                   
               
               
                 tgaccgctacacttgccagcgccctagcgcccgctcctttcgctttcttcccttcctttctcgccacgttcgccgg 
               
               
                   
               
               
                 ctttccccgtcaagctctaaatcgggggctccctttagggttccgatttagtgctttacggcacctcgaccccaa 
               
               
                   
               
               
                 aaaacttgattagggtgatggttcacgtagtgggccatcgccctgatagacggtttttcgccctttgacgttgga 
               
               
                   
               
               
                 gtccacgttctttaatagtggactcttgttccaaactggaacaacactcaaccctatctcggtctattcttttgattt 
               
               
                   
               
               
                 ataagggattttgccgatttcggcctattggttaaaaaatgagctgatttaacaaaaatttaacgcgaattttaa 
               
               
                   
               
               
                 caaaatattaacgcttacaatttaggtggcacttttcggggaaatgtgcgcggaacccctatttgtttatttttcta 
               
               
                   
               
               
                 aatacattcaaatatgtatccgctcatgagacaataaccctgataaatgcttcaataatagcacctagatcaa 
               
               
                   
               
               
                 gagacaggatgaggatcgtttcgcatgattgaacaagatggattgcacgcaggttctccggccgcttgggtg 
               
               
                   
               
               
                 gagaggctattcggctatgactgggcacaacagacaatcggctgctctgatgccgccgtgttccggctgtca 
               
               
                   
               
               
                 gcgcaggggcgcccggttctttttgtcaagaccgacctgtccggtgccctgaatgaactgcaagacgaggc 
               
               
                   
               
               
                 agcgcggctatcgtggctggccacgacgggcgttccttgcgcagctgtgctcgacgttgtcactgaagcgg 
               
               
                   
               
               
                 gaagggactggctgctattgggcgaagtgccggggcaggatctcctgtcatctcaccttgctcctgccgaga 
               
               
                   
               
               
                 aagtatccatcatggctgatgcaatgcggcggctgcatacgcttgatccggctacctgcccattcgaccacc 
               
               
                   
               
               
                 aagcgaaacatcgcatcgagcgagcacgtactcggatggaagccggtcttgtcgatcaggatgatctgga 
               
               
                   
               
               
                 cgaagagcatcaggggctcgcgccagccgaactgttcgccaggctcaaggcgagcatgcccgacggcg 
               
               
                   
               
               
                 aggatctcgtcgtgacccatggcgatgcctgcttgccgaatatcatggtggaaaatggccgcttttctggattc 
               
               
                   
               
               
                 atcgactgtggccggctgggtgtggcggaccgctatcaggacatagcgttggctacccgtgatattgctgaa 
               
               
                   
               
               
                 gagcttggcggcgaatgggctgaccgcttcctcgtgctttacggtatcgccgctcccgattcgcagcgcatcg 
               
               
                   
               
               
                 ccttctatcgccttcttgacgagttcttctgaattattaacgcttacaatttcctgatgcggtattttctccttacgcat 
               
               
                   
               
               
                 ctgtgcggtatttcacaccgcatcaggtggcacttttcggggaaatgtgcgcggaacccctatttgtttatttttct 
               
               
                   
               
               
                 aaatacattcaaatatgtatccgctcatgaccaaaatcccttaacgtgagttttcgttccactgagcgtcagac 
               
               
                   
               
               
                 cccgtagaaaagatcaaaggatcttcttgagatcctttttttctgcgcgtaatctgctgcttgcaaacaaaaaa 
               
               
                   
               
               
                 accaccgctaccagcggtggtttgtttgccggatcaagagctaccaactctttttccgaaggtaactggcttca 
               
               
                   
               
               
                 gcagagcgcagataccaaatactgttcttctagtgtagccgtagttaggccaccacttcaagaactctgtagc 
               
               
                   
               
               
                 accgcctacatacctcgctctgctaatcctgttaccagtggctgctgccagtggcgataagtcgtgtcttaccg 
               
               
                   
               
               
                 ggttggactcaagacgatagttaccggataaggcgcagcggtcgggctgaacgggggggtcgtgcacac 
               
               
                   
               
               
                 agcccagcttggagcgaacgacctacaccgaactgagatacctacagcgtgagctatgagaaagcgcc 
               
               
                   
               
               
                 acgcttcccgaagggagaaaggcggacaggtatccggtaagcggcagggtcggaacaggagagcgc 
               
               
                   
               
               
                 acgagggagcttccagggggaaacgcctggtatctttatagtcctgtcgggtttcgccacctctgacttgagc 
               
               
                   
               
               
                 gtcgatttttgtgatgctcgtcaggggggcggagcctatggaaaaacgccagcaacgcggcctttttacggtt 
               
               
                   
               
               
                 cctggccttttgctggccttttgctcacatgttctttcctgcgttatcccctgattctgtggataaccgtattaccgcct 
               
               
                   
               
               
                 ttgagtgagctgataccgctcgccgcagccgaacgaccgagcgcagcgagtcagtgagcgaggaagcg 
               
               
                   
               
               
                 gaagagcgcccaatacgcaaaccgcctctccccgcgcgttggccgattcattaatgcagctgcgcgctcg 
               
               
                   
               
               
                 ctcgctcactgaggccgcccgggcaaagcccgggcgtcgggcgacctttggtcgcccggcctcagtgag 
               
               
                   
               
               
                 cgagcgagcgcgcagagagggagtggccaactccatcactaggggttccttgtagttaatgattaacccgc 
               
               
                   
               
               
                 catgctacttatctac 
               
            
           
         
       
     
     In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises a Kanamycin resistance gene to allow for antibiotic selection. In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises an f1 origin of replication sequence to allow for replication of the plasmid. In some embodiments, a pAAV-ND4 transfer plasmid of the disclosure comprises a ColE1 origin of replication sequence to allow for replication of plasmid. 
     Thus, in some embodiments, a pAAV-ND4 transfer plasmid of the disclosure further comprises:
         (i) an f1 origin of replication sequence comprising:       

     
       
         
           
               
            
               
                 (SEQ ID No: 8) 
               
               
                 acgcgccctgtagcggcgcattaagcgcggcgggtgtggtggttacgcgc 
               
               
                   
               
               
                 agcgtgaccgctacacttgccagcgccctagcgcccgctcctttcgcttt 
               
               
                   
               
               
                 cttcccttcctttctcgccacgttcgccggctttccccgtcaagctctaa 
               
               
                   
               
               
                 atcgggggctccctttagggttccgatttagtgctttacggcacctcgac 
               
               
                   
               
               
                 cccaaaaaacttgattagggtgatggttcacgtagtgggccatcgccctg 
               
               
                   
               
               
                 atagacggtttttcgccctttgacgttggagtccacgttctttaatagtg 
               
               
                   
               
               
                 gactcttgttccaaactggaacaacactcaaccctatctcggtctattct 
               
               
                   
               
               
                 tttgatttataagggattttgccgatttcggcctattggttaaaaaatga 
               
               
                   
               
               
                 gctgatttaacaaaaatttaacgcgaattttaacaaaatattaacgctta 
               
               
                   
               
               
                 caattt, 
               
            
           
         
       
         
         
           
             (ii) a Kanamycin resistance gene sequence comprising: 
           
         
       
    
                    (SEQ ID No: 9)       attgaacaagatggattgcacgcaggttctccggccgcttgggtggagag               gctattcggctatgactgggcacaacagacaatcggctgctctgatgccg               ccgtgttccggctgtcagcgcaggggcgcccggttctttttgtcaagacc               gacctgtccggtgccctgaatgaactgcaagacgaggcagcgcggctatc               gtggctggccacgacgggcgttccttgcgcagctgtgctcgacgttgtca               ctgaagcgggaagggactggctgctattgggcgaagtgccggggcaggat               ctcctgtcatctcaccttgctcctgccgagaaagtatccatcatggctga               tgcaatgcggcggctgcatacgcttgatccggctacctgcccattcgacc               accaagcgaaacatcgcatcgagcgagcacgtactcggatggaagccggt               cttgtcgatcaggatgatctggacgaagagcatcaggggctcgcgccagc               cgaactgttcgccaggctcaaggcgagcatgcccgacggcgaggatctcg               tcgtgacccatggcgatgcctgcttgccgaatatcatggtggaaaatggc               cgcttttctggattcatcgactgtggccggctgggtgtggcggaccgcta               tcaggacatagcgttggctacccgtgatattgctgaagagcttggcggcg               aatgggctgaccgcttcctcgtgctttacggtatcgccgctcccgattcg               cagcgcatcgccttctatcgccttcttgacgagttcttctga,            
and
         (iii) a ColE1 origin of replication sequence comprising:       

     
       
         
           
               
            
               
                 (SEQ ID No: 10) 
               
               
                 aaaggatcttcttgagatcctttttttctgcgcgtaatctgctgcttgca 
               
               
                   
               
               
                 aacaaaaaaaccaccgctaccagcggtggtttgtttgccggatcaagagc 
               
               
                   
               
               
                 taccaactctttttccgaaggtaactggcttcagcagagcgcagatacca 
               
               
                   
               
               
                 aatactgtccttctagtgtagccgtagttaggccaccacttcaagaactc 
               
               
                   
               
               
                 tgtagcaccgcctacatacctcgctctgctaatcctgttaccagtggctg 
               
               
                   
               
               
                 ctgccagtggcgataagtcgtgtcttaccgggttggactcaagacgatag 
               
               
                   
               
               
                 ttaccggataaggcgcagcggtcgggctgaacggggggttcgtgcacaca 
               
               
                   
               
               
                 gcccagcttggagcgaacgacctacaccgaactgagatacctacagcgtg 
               
               
                   
               
               
                 agctatgagaaagcgccacgcttcccgaagggagaaaggcggacaggtat 
               
               
                   
               
               
                 ccggtaagcggcagggtcggaacaggagagcgcacgagggagcttccagg 
               
               
                   
               
               
                 gggaaacgcctggtatctttatagtcctgtcgggtttcgccacctctgac 
               
               
                   
               
               
                 ttgagcgtcgatttttgtgatgctcgtcaggggggcggagcctatggaaa 
               
               
                   
               
               
                 aacgccagcaacgcg. 
               
            
           
         
       
     
     Generation of a pAAV-ND4 transfer plasmid of the disclosure can be accomplished using a suitable genetic engineering technique known in the art (see, e.g., Green, et al., Molecular Cloning: A Laboratory Manual, 4th edition, Cold Spring Harbor Press, (2012)). 
     In some embodiments, a recombinant AAV vector of the disclosure is produced by tri-transfection in a transitory packaging cell line with (i) a pAAV-ND4 transfer plasmid of the disclosure (e.g., that shown in  FIG. 2 ), (ii) a rep/cap plasmid providing to host cells the genetic material encoding for the synthesis of essential proteins (e.g., as non-limiting examples, enzymes and structural proteins) involved in the production of the AAV2/2 particle, and (iii) an adenovirus helper plasmid providing the helper function to induce the expression of rep/cap gene. 
     In some embodiments, the packaging cell line comprises the human embryonic kidney 293 (HEK 293) cell line. 
     In some embodiments, the rep/cap plasmid is pRep2Cap2 plasmid. In some embodiments, the rep/cap plasmid is pRep2Cap2 plasmid comprising the following elements ( FIG. 3 ):
         i. a rep sequence from AAV2/2 serotype (nt 281-2212, 1932 bp),   ii. a cap sequence from AAV2/2 serotype (nt 2163-4370; 2208 bp),   iii. a Kanamycin resistance gene (nt 5712-6506, complementary; 795 bp), and   iv. a prokaryotic origin of replication (nt 4896-5496; 601 bp) and phage f1 origin of replication (nt 6658-7113; 456 bp).       

     In some embodiments, the adenovirus helper plasmid is pXX6 plasmid. In some embodiments, the adenovirus helper plasmid is pXX6 plasmid comprising the following elements ( FIG. 4 ):
         i. adenoviral ITRs: (nt 1-85 and 18638-18732),   ii. a Kanamycin resistance gene (nt 1402-2196, 795 bp),   iii. a prokaryotic origin of replication (nt 2411-3025; 615 bp) and phage f1 origin of replication (nt 795-1250; 456 bp), and   iv. 13 specific adenoviral sequences (from VA1 RNA sequence to E4orf2 sequence, nt 4259-17916).       

     Patients suffering from LHON and treated with the recombinant vectors disclosed herein may receive therapeutic benefit, e.g., by an improvement in visual acuity. The term “treatment” as used herein, is defined as the application or administration of a therapeutic agent to a subject, who has a disease, a symptom of disease or a predisposition toward a disease, with the purpose to cure, heal, alleviate, relieve, alter, remedy, ameliorate, improve, or affect the disease, one or more symptoms of the disease, or the predisposition toward the disease. As long as the compositions of the disclosure either alone or in combination with another therapeutic agent cure, heal, alleviate, relive, alter, remedy, ameliorate, improve or affect at least one symptom of LHON being treated, as compared to that symptom in the absence of treatment, the result is considered a treatment of the underlying disorder regardless of whether all the symptoms of the disorder are cured, healed, alleviated, relieved, altered, remedied, ameliorated, improved or affected or not. Treatment may be achieved using an “effective amount” of a therapeutic agent, which shall be understood to embrace partial and complete treatment, e.g., partial or complete curing, healing, alleviating, relieving, altering, remedying, ameliorating, improving, or affecting the disease, one or more symptoms of the disease, or the predisposition toward the disease. An “effective amount” of may be determined empirically. Likewise, a “therapeutically effective amount” is a concentration or which is effective for achieving a stated therapeutic effect. 
     In one embodiment, the term “treating” comprises the step of administering an effective dose, or effective multiple doses, of a composition comprising a nucleic acid, a vector, a recombinant virus, or a pharmaceutical composition as disclosed herein, to an animal (including a human being) in need thereof. If the dose is administered prior to development of a disorder/disease, the administration is prophylactic. If the dose is administered after the development of a disorder/disease, the administration is therapeutic. In embodiments, an effective dose is a dose that detectably alleviates (either eliminates or reduces) at least one symptom associated with the disorder/disease state being treated, that slows or prevents progression to a disorder/disease state, that slows or prevents progression of a disorder/disease state, that diminishes the extent of disease, that results in remission (partial or total) of disease, and/or that prolongs survival. The term encompasses but does not require complete treatment (i.e., curing) and/or prevention. 
     In some embodiments, the titer of recombinant vector administered is measured in viral genomes (vg). In some embodiments, the titer of recombinant vector administered is measured by quantitative polymerase chain reaction (qPCR). In some embodiments, the titer of recombinant vector administered is measured by digital droplet PCR (ddPCR). In some embodiments, recombinant AAV vector is administered intravitreally at an amount of about 1.0×10 9  to 1.0×10 12  vg per eye. In some embodiments, recombinant AAV vector is administered intravitreally at an amount of about 5.0×10 9  to 5×10 11  vg per eye. In some embodiments, recombinant AAV vector is administered intravitreally at an amount of about 1.0×10 10  to 1×10 11  vg per eye. In some embodiments, recombinant AAV vector is administered intravitreally at an amount of about 9×10 11  vg per eye. The titer of recombinant vector may be measured by PCR from primers that hybridize within the recombinant vector. Examples of primers include but are not limited to: CTCCATCACTAGGGGTTCCTTG AAV22mers.F (SEQ ID NO: 19) GTAGATAAGTAGCATGGC AAV18mers.R (SEQ ID NO: 20) TAGTTAATGATTAACCC AAV_MGB.P (SEQ ID NO: 21) 
     In some embodiments, the recombinant vector of the disclosure, e.g. an AAV, serotype 2, (rAAV) encoding the gene of the human NADH dehydrogenase 4 (ND4), comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO:1,   a nucleic acid sequence encoding an ND4 polypeptide comprising SEQ ID NO: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID NO: 11,       

     is administered at an effective dose into a patient in need thereof. In some embodiments, the patient suffers from LHON. 
     In some embodiments, the recombinant vector of the disclosure, e.g. an AAV, serotype 2, (rAAV) encoding the gene of the human NADH dehydrogenase 4 (ND4), comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO:1,   a nucleic acid sequence encoding an ND4 polypeptide comprising SEQ ID NO: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID NO: 12,       

     is administered at an effective dose into a patient in need thereof. In some embodiments, the patient suffers from LHON. 
     In some embodiments, the recombinant vector of the disclosure, e.g. an AAV, serotype 2, (rAAV) encoding the gene of the human NADH dehydrogenase 4 (ND4), comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14,   a nucleic acid sequence encoding an ND4 polypeptide comprising SEQ ID NO: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID NO: 11,       

     is administered at an effective dose into a patient in need thereof. In some embodiments, the patient suffers from LHON. 
     In some embodiments, the recombinant vector of the disclosure, e.g. an AAV, serotype 2, (rAAV) encoding the gene of the human NADH dehydrogenase 4 (ND4), comprises:
         a 3′UTR Cox/0 sequence comprising SEQ ID NO: 14,   a nucleic acid sequence encoding an ND4 polypeptide comprising SEQ ID NO: 13, and   a nucleic acid sequence encoding an MTS Cox/0 polypeptide comprising SEQ ID NO: 12,       

     is administered at an effective dose into a patient in need thereof. In some embodiments, the patient suffers from LHON. 
     Onset of LHON may be determined by the presence of symptoms. In some embodiments, the recombinant vectors are administered to patients with disease onset of less than 9 months, e.g., 6 to 9 months, 3 to 6 months, or 1 to 3 months. In some embodiments, the recombinant vectors are administered to patients with disease onset of more than 9 months, e.g., for 12 months, for 2 years, or for 3 years. In some embodiments, the patient shows one or more symptoms of LHON, e.g., loss in visual acuity. 
     A scale to measure visual acuity in a patient may be expressed as the (decadic) logarithm of the minimum angle of resolution (MAR) (Bailey I L, Lovie J E. I, Am. J. Optom. Physiol. Opt., 53 (11): 740-745 (1976)). The LogMAR scale converts the geometric sequence of a traditional chart to a linear scale. It measures visual acuity loss: positive values indicate vision loss, while negative values denote normal or better visual acuity. In some embodiments, visual acuity of a patient suffering from LHON is measured by the LogMar Scale. In some embodiments, visual acuity of a patient suffering from LHON is measured by the Snellen Scale. 
     Another commonly used measure of visual acuity is the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity charts, which is capable of quantifying visual acuity to very low vision levels (Ferris et al., Am. J. Opthalmol., 94:91-96 (1982)). In some embodiments, visual acuity of a patient suffering from LHON is measured by the ETDRS charts. 
     Contrast is determined by the difference in the color and brightness of an object and other objects within the same field of view. Patients suffering from LHON may have reduced sensitivity for contrast. Another scale that measures visual acuity may be the Pelli-Robson contrast sensitivity chart (Pelli et al., Clin. Vision Sci., 2(3):187-199 (1988). In some embodiments, visual acuity of a patient suffering from LHON is measured by a Pelli Robson chart. 
     In some embodiments, treatment is administered in patients with visual acuity at before treatment e.g., at baseline, of &lt;2.0 LogMAR, e.g., &lt;1.8, &lt;1.6, &lt;1.4, &lt;1.2, &lt;1.0, or &lt;0.8 LogMAR. In some embodiments, treatment is administered in patients with visual acuity at before treatment e.g., at baseline, of at least 3 letters, e.g., at least 4, 5, 6, 7, 8, 9, 10, 11, or 12 letters. 
     Efficacy or response to treatment may be measured by reversal or amelioration of disease symptoms. In some embodiments, a baseline visual acuity is measured before administration of treatment. In some embodiments, efficacy or response to treatment is measured by an increase in visual acuity. In some embodiments, efficacy or response to treatment is measured by an increase in visual acuity after treatment compared to the baseline before treatment. In some embodiments, efficacy or response to the treatment is measured by the difference between ETDRS scores before and after treatment. In some embodiments, efficacy or response to the treatment is measured by a difference of at least +5.0 ETDRS score, e.g., at least +6.0, +7.0, +8.0, +9.0, +10.0, +11.0, +12.0, +13.0, +14.0, +15.0, or +16.0 after treatment compared to baseline. In some embodiments, efficacy or response to the treatment is measured by a difference of at least 0.05 LogMAR, e.g., at least 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, or 1.0 after treatment compared to baseline. 
     As disclosed herein, and without being bound by theory, patients who respond to treatment with a recombinant vector of the disclosure (e.g. patients for which an increase in visual acuity was observed) may include those patients with a disease duration (e.g., vision loss) at baseline of less than 9 months, for example, of 6 to 9 months, and/or with visual acuity at baseline of &lt;1.6 LogMAR. In some embodiments, a criterion (e.g., a disease duration as measured by vision loss at baseline of less than 9 months, or of 6 to 9 months, and/or visual acuity at baseline of &lt;1.6 LogMAR) may be used to identify a patient sub-population that is expected to respond better to treatment with recombinant vector of the disclosure (e.g., a patient population for which an increase in visual acuity may be expected). 
     The present disclosure further describes the use of recombinant vector encoding a human NADH dehydrogenase 4 (ND4) polypeptide and comprising (i) a nucleic acid sequence encoding a MTS Cox10 sequence comprising SEQ ID NO: 11, (ii) a nucleic acid sequence encoding a NADH dehydrogenase 4 (ND4) polypeptide comprising SEQ ID No: 13, and (iii) a 3′UTR Cox10 sequence comprising SEQ ID NO: 14 (or its reverse complement SEQ ID NO: 1), in the treatment of Leber Hereditary Optic Neuroretinopathy (LHON) for a group of patients with (i) disease duration at baseline of less than 9 months (e.g. 6 to 9 months) and/or (ii) visual acuity at baseline of less than 1.6 LogMAR. 
     The present disclosure also describes a method of treating patients suffering from LHON, with (i) disease duration at baseline of less than 9 months (e.g. 6 to 9 months) and/or (ii) visual acuity at baseline of less than 1.6 LogMAR, comprising administering an effective amount of a recombinant vector encoding a human NADH dehydrogenase 4 (ND4) polypeptide and comprising (i) a nucleic acid sequence encoding a MTS Cox10 sequence comprising SEQ ID NO: 11, (ii) a nucleic acid sequence encoding NADH dehydrogenase 4 (ND4) polypeptide comprising SEQ ID No: 13, and (iii) a 3′UTR Cox10 sequence comprising SEQ ID NO: 14 (or its reverse complement SEQ ID NO: 1). 
     The present disclosure is further illustrated by the following examples that should not be construed as limiting. The contents of all references, patents, and published patent applications cited throughout this application, as well as the Figures, are incorporated herein by reference in their entirety for all purposes. 
     Example 1 
     The safety and efficacy of a vector, as disclosed herein, comprising a recombinant adeno-associated virus (AAV) vector, serotype 2, containing the human mitochondrial ND4 gene (rAAV2/2-ND4) (“Vector A”) in patients having Leber Hereditary Optic Neuroretinopathy was investigated. 
     Patients participating in the study suffered vision loss for a duration of greater than six months up to one year. Enrolled subjects had a confirmed G11778A mutation in the ND4 gene. Enrolled subjects also had baseline vision greater than or equal to Count Fingers. 
     Each patient had one eye randomly selected to receive a single injection of Vector A, while the other eye received a sham injection. In a first patient group, the right eye (OD) was treated with Vector A, while the left eye (OS) was sham-treated. In a second patient group, the right eye (OD) was sham-treated, while the left eye (OS) was treated with Vector A. 
     Treatment with Vector A was by means of intravitreal injection containing 9×10 10  viral genomes in 90 μL balanced salt solution plus 0.001% Pluronic F68®. Sham-treatment comprised intravitreal injection that was performed by applying pressure to the eye at the location of a typical intravitreal injection procedure, using the blunt end of a syringe without a needle. 
     Comparisons were made between vector A-treated eyes versus sham-treated eyes in changes from baseline (pre-study) point and week 48 of LogMAR acuity derived from the number of letters patients read on the ETDRS chart at week 48 post-treatment. In a separate mode of comparison, the better-seeing eye of each patient was determined at visit 1, prior to randomization, based on vision testing results. Better-seeing eyes that received Vector A were compared to better-seeing eyes that received the sham injection. A similar analysis was performed for the worse-seeing eyes. As would be understood by a person having ordinary skill in the art, ETDRS (Early Treatment Diabetic Retinopathy Study) is a measurement of visual acuity that is capable of quantifying visual acuity to very low vision levels. 
     As would be understood by a person having ordinary skill in the art, MAR refers to minimum angle of resolution (in minutes of arc) of the stroke width of the smallest letter recognized. The logarithm of MAR (LogMAR) and, by way of a non-limiting example, LogMAR charts, are used to determine visual acuity. (Johnston, A.,  Association of Contact Lens Manufacturers Year Book  2011-2016, pp. 38-39 (2016)). 
     Patient demographics at baseline are presented in Table 6. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 6 
               
               
                   
                   
               
               
                   
                 Statistic 
                 Study 
               
               
                   
                   
               
             
            
               
                   
                 N subjects 
                 37 
               
               
                   
                 Demographics 
               
               
                   
                 N males (%) 
                 29 (78.4)  
               
               
                   
                 Mean age - years (SD) 
                 34.2 (15.2)       
               
               
                   
                 Median age - years (range) 
                  30 (15, 67) 
               
               
                   
                 Vision loss duration (VLD) 
               
               
                   
                 Eyes with available data 
                 74 
               
               
                   
                 Mean VLD - days (SD) 
                 270.9 (59.4)     
               
               
                   
                 Median VLD - days (range) 
                     262 (181, 364) 
               
               
                   
                 Simultaneous bilateral onset 
               
               
                   
                 N subjects (%) 
                 7 (19%) 
               
               
                   
                   
               
               
                   
                 SD: standard deviation, 
               
               
                   
                 VLD: vision loss duration 
               
            
           
         
       
     
     Data pertaining to patient visual acuity at baseline are presented in Table 7. 
     
       
         
           
               
               
               
               
             
               
                 TABLE 7 
               
               
                   
               
               
                 Statistic 
                 Study 
                 Treated eyes 
                 Sham eyes 
               
               
                   
               
             
            
               
                 N subjects 
                 37 
                   
                   
               
               
                 N eyes with available data 
                 74 
               
               
                 All eyes 
               
               
                 Mean LogMAR (SD) 
                 1.6 
                 1.66 
                 1.55 
               
               
                   
                 (0.4) 
                 (0.5) 
                 (0.42) 
               
               
                 Median LogMAR (range) 
                 1.6 
                 1.6 
                 1.5 
               
               
                   
                 (0.7, 3.2) 
                 (0.8, 3.17) 
                 (0.7, 2.81) 
               
               
                 Best-seeing eyes 
               
               
                 Mean LogMAR (SD) 
                 1.5 
                 1.44 
                 1.50 
               
               
                   
                 (0.4) 
                 (0.33) 
                 (0.38) 
               
               
                 Median LogMAR (range) 
                 1.5 
                 1.45 
                 1.50 
               
               
                   
                 (0.7, 2.2) 
                 (0.8, 2.09) 
                 (0.7, 2.22) 
               
               
                 Worst-seeing eyes 
               
               
                 Mean LogMAR (SD) 
                 1.7 
                 1.84 
                 1.61 
               
               
                   
                 (0.5) 
                 (0.55) 
                 (0.48) 
               
               
                 Median LogMAR (range) 
                 1.6 
                 1.6 
                 1.55 
               
               
                   
                 (0.8, 3.2) 
                 (0.8, 3.17) 
                 (0.9, 2.81) 
               
               
                   
               
            
           
         
       
     
     At 48 weeks, a favorable safety profile of Vector A was reported. 75% of adverse events (AEs) were ocular. 50% of ocular AEs were related to Vector A, and 48% of ocular AEs were related to the procedure. The most common ocular AEs comprised anterior chamber inflammation (15%), vitritis (9%), punctate keratitis (9%), and IOP elevation (8%). 
     At 48 weeks, tRNFL (temporal retinal nerve fiber layer)/PM (papillomacular) bundle thickness was significantly preserved in treated eyes and decreased in untreated eyes. Data pertaining to the change of RNFL temporal quadrant from baseline to week 48 are provided in Table 8. 
     
       
         
           
               
             
               
                 TABLE 8 
               
             
            
               
                   
               
               
                 Secondary Efficacy Analysis 
               
               
                 Change of RNFL Temporal Quadrant from Baseline to Week 48 
               
            
           
           
               
               
               
               
               
            
               
                 RNFL Quadrant Temporal 
                   
                 LS Mean 
                 95% 
                   
               
               
                 (μm) 
                 n 
                 (SE)  [a]   
                 CI  [a]   
                 p-value 
               
               
                   
               
               
                 Change from Baseline to 
                 37 
                 −0.6 
                 −2.6, 1.4  
                   
               
               
                 Week 48 All-Treated Eyes 
                   
                 (1.0) 
               
               
                 Change from Baseline to 
                 35 
                 −3.4 
                 −5.4, −1.3 
               
               
                 Week 48 All-Sham Eyes 
                   
                 (1.0) 
               
               
                 Difference between All- 
                 35 
                 2.8 
                   
                 0.0359  [a]   
               
               
                 Treated Eyes and All- 
                   
                 (0.2, 
               
               
                 Sham Eyes Treatment 
                   
                 5.4) 
               
               
                 Effect (95% CI) 
               
               
                 Wilcoxon Signed-Rank 
                   
                   
                   
                 0.0416  
               
               
                 Test 
               
               
                   
               
               
                   [a]  A mixed model of analysis of covariance (ANCOVA) was used with change from baseline at week 48 as the response, and subject, eyes of the subject as random factor, treatment and the baseline GCL Thickness/Volume value as covariates in the model. LS mean refers to least-squares mean. 
               
            
           
         
       
     
     At 48 weeks, GCL (Ganglion cell layer) volume was significantly preserved in treated eyes and decreased in untreated eyes. At least these results suggested that the biological targets of Vector A were successfully engaged. Data pertaining to the change of GCL volume and topographical map from baseline to week 48 are presented in Table 9. 
     
       
         
           
               
             
               
                 TABLE 9 
               
             
            
               
                   
               
               
                 Secondary Efficacy Analysis 
               
               
                 Change of GCL Volume and Topographical 
               
               
                 Map from Baseline to Week 48 
               
            
           
           
               
               
               
               
               
            
               
                 GCL Macular Volume 
                   
                 LS Mean 
                 95% 
                   
               
               
                 (mm 3 ) 
                 n 
                 (SE)  [a]   
                 CI  [a]   
                 p-value 
               
               
                   
               
               
                 Change from Baseline to 
                 36 
                 −0.003 
                 −0.028, 0.022  
                   
               
               
                 Week 48 All-Treated Eyes 
                   
                 (0.012) 
               
               
                 Change from Baseline to 
                 36 
                 −0.038 
                 −0.062, −0.013 
               
               
                 Week 48 All-Sham Eyes 
                   
                 (0.012) 
               
               
                 Difference between All- 
                 36 
                 0.035 
                   
                 0.0189 [a] 
               
               
                 Treated Eyes and All- 
                   
                 (0.006, 
               
               
                 Sham Eyes Treatment 
                   
                 0.063) 
               
               
                 Effect (95% CI) 
               
               
                 Wilcoxon Signed-Rank 
                   
                   
                   
                 0.0448      
               
               
                 Test 
               
               
                   
               
               
                   [a]  A mixed model of analysis of covariance (ANCOVA) was used with change from baseline at week 48 as the response, and subject, eyes of the subject as random factor, treatment and the baseline GCL Thickness/Volume value as covariates in the model. 
               
            
           
         
       
     
     At 48 weeks, visual acuity improvement was observed in both eyes (−0.21 LogMAR on average). Data pertaining to the change of LogMAR from baseline to week 48 are presented in Table 10. No statistically significant difference between treated and untreated eyes was observed. 
     
       
         
           
               
             
               
                 TABLE 10 
               
             
            
               
                   
               
               
                 Primary Efficacy Analysis 
               
               
                 Change of LogMAR from Baseline to Week 48 
               
            
           
           
               
               
               
               
               
            
               
                   
                   
                 LS Mean 
                 95% 
                   
               
               
                 Visual acuity (LogMAR) 
                 n 
                 (SE)  [a]   
                 CI  [a]   
                 p-value 
               
               
                   
               
               
                 Change from Baseline to 
                 37 
                 −0.218 
                 −0.328, −0.108 
                   
               
               
                 Week 48 All-Treated Eyes 
                   
                 (0.055) 
               
               
                 Change from Baseline to 
                 37 
                 −0.211 
                 −0.320, −0.101 
               
               
                 Week 48 All-Sham Eyes 
                   
                 (0.055) 
               
               
                 Difference between All- 
                 37 
                 −0.007 
                   
                 0.8942  [a]   
               
               
                 Treated Eyes and All- 
                   
                 (−0.118, 
               
               
                 Sham Eyes Treatment 
                   
                 0.103) 
               
               
                 Effect (95% CI) 
               
               
                 Wilcoxon Signed-Rank 
                   
                   
                   
                 0.3875  
               
               
                 Test 
               
               
                   
               
               
                   [a]  A mixed model of analysis of covariance (ANCOVA) was used with change from baseline at week 48 as the response, and subject, eyes of the subject as random factor, treatment and the baseline LogMAR value as covariates in the model. 
               
            
           
         
       
     
     At 48 weeks, visual field testing was performed using Humphrey® Visual Field analysis (mean deviation and foveal threshold). Data pertaining to the visual field testing are presented in Table 11 and Table 12. No difference between treated and untreated eyes was observed. 
     
       
         
           
               
               
             
               
                   
                 TABLE 11 
               
             
            
               
                   
                   
               
               
                   
                 Mean (SD) 
               
            
           
           
               
               
               
               
               
            
               
                 VF Foveal Threshold (dB) 
                 n 
                 Treated eyes 
                 n 
                 Sham eyes 
               
               
                   
               
            
           
           
               
               
               
               
               
            
               
                 Baseline 
                 13 
                 19.6 
                 14 
                 21.9 
               
               
                   
                   
                 (16.9) 
                   
                 (15.0) 
               
               
                 Week 48 
                 25 
                 14.9 
                 25 
                 13.6 
               
               
                   
                   
                 (11.4) 
                   
                 (11.6) 
               
               
                 Change from baseline 
                 9 
                 0.7 
                 11 
                 −0.5 
               
               
                   
                   
                 (8.9) 
                   
                 (11.9) 
               
               
                   
               
            
           
         
       
     
     
       
         
           
               
               
             
               
                   
                 TABLE 12 
               
             
            
               
                   
                   
               
               
                   
                 Mean (SD) 
               
            
           
           
               
               
               
               
               
            
               
                 VF Mean Deviation (dB) 
                 n 
                 Treated eyes 
                 n 
                 Sham eyes 
               
               
                   
               
               
                 Baseline 
                 37 
                 −25.99 
                 37 
                 −24.94 
               
               
                   
                   
                 (8.37) 
                   
                 (9.70) 
               
               
                 Week 48 
                 37 
                 −22.83 
                 37 
                 −22.94 
               
               
                   
                   
                 (9.43) 
                   
                 (9.80) 
               
               
                 Change from baseline 
                 37 
                 3.15 
                 37 
                 2.00 
               
               
                   
                   
                 (6.96) 
                   
                 (5.04) 
               
               
                   
               
            
           
         
       
     
     At 48 weeks, contrast sensitivity was assessed using the Pelli-Robson chart (see also  FIG. 5 ). At baseline, contrast sensitivity was worse in treated eyes (as determined by LogMAR visual acuity). At week 48, the measure of contrast sensitivity in eyes treated with Vector A almost doubled, while the measure of contrast sensitivity in sham-treated eyes remained stable. Data pertaining to contrast sensitivity assessed using the Pelli-Robson chart are provided in Table 13. 
     
       
         
           
               
               
               
             
               
                 TABLE 13 
               
             
            
               
                   
               
               
                 Log of Contrast 
                 Mean (SD) 
                   
               
            
           
           
               
               
               
               
               
            
               
                 Sensitivity (LogCS) 
                 n 
                 Treated eyes 
                 n 
                 Sham eyes 
               
               
                   
               
               
                 Baseline 
                 37 
                 0.25 
                 37 
                 0.35 
               
               
                   
                   
                 (0.40) 
                   
                 (0.46) 
               
               
                 Week 48 
                 37 
                 0.45 
                 37 
                 0.43 
               
               
                   
                   
                 (0.50) 
                   
                 (0.49) 
               
               
                 Change from baseline 
                 37 
                 0.20 
                 37 
                 0.08 
               
               
                   
                   
                 (0.36) 
                   
                 (0.28) 
               
               
                   
               
            
           
         
       
     
     Color vision was tested using the Farnsworth-Munsell 100-hue color test. At baseline, extremely poor scores for color discrimination were observed. At week 48, no difference between treated and untreated eyes was observed. Data pertaining to color vision tested are presented in Table 14. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 14 
               
             
            
               
                   
                   
               
               
                   
                 Mean (SD) 
                   
               
            
           
           
               
               
               
               
               
            
               
                 Total Error Score 
                 n 
                 Treated eyes 
                 n 
                 Sham eyes 
               
               
                   
               
               
                 Baseline 
                 28 
                 649.3 
                 28 
                 661.9 
               
               
                   
                   
                 (420.5) 
                   
                 (433.7) 
               
               
                 Week 48 
                 28 
                 623.6 
                 28 
                 622.3 
               
               
                   
                   
                 (400.4) 
                   
                 (430.3) 
               
               
                 Change from baseline 
                 28 
                 −25.7 
                 28 
                 −39.6 
               
               
                   
                   
                 (235.6) 
                   
                 (172.3) 
               
               
                   
               
            
           
         
       
     
     Quality of life was assessed at week 48 using the Visual Functional Questionnaire-25 (VFQ-25). Data from selected sub-scales are presented in Table 15. Although the difference in scores between scores is small, treatment of the patient&#39;s worse-seeing eye appeared to lead to improved quality of life metrics. Such a trend was observed across all sections of the questionnaire. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 15 
               
             
            
               
                   
                   
               
               
                   
                 Mean scores at Week 48 (SD) 
                   
               
            
           
           
               
               
               
               
               
            
               
                   
                   
                 Best-seeing 
                   
                 Best-seeing 
               
               
                 Selected sub-scales 
                 n 
                 Treated eyes 
                 n 
                 Sham eyes 
               
               
                   
               
               
                 General Vision 
                 16 
                 38.8 
                 21 
                 42.9 
               
               
                   
                   
                 (13.6) 
                   
                 (20.3) 
               
               
                 Near Activities 
                 16 
                 32.3 
                 21 
                 35.3 
               
               
                   
                   
                 (19.7) 
                   
                 (19.7) 
               
               
                 Distant Activities 
                 16 
                 42.4 
                 21 
                 47.0 
               
               
                   
                   
                 (22.3) 
                   
                 (24.8) 
               
               
                   
               
            
           
         
       
     
     Study data were further analyzed to identify patient populations that were especially responsive to treatment with Vector A (e.g., patients for which an increase in visual acuity was observed). 
     Data pertaining to the change in visual acuity from baseline for on-chart best-seeing eyes treated with Vector A and for on-chart best-seeing eyes that were sham-treated are presented in Table 16. “On-chart” refers to subjects who can read at least three letters on an ETDRS chart and/or having visual acuity below 1.6 LogMAR. 
     
       
         
           
               
               
               
               
               
             
               
                 TABLE 16 
               
               
                   
               
               
                 Change from 
                   
                   
                   
                   
               
               
                 baseline in 
                   
                   
                 95% 
                 ETDRS 
               
               
                 visual acuity 
                   
                 LS Mean 
                 Confidence 
                 letters 
               
               
                 (LogMAR) 
                 n 
                 (SE) 
                 Interval 
                 equivalent 
               
               
                   
               
             
            
               
                 Best-seeing 
                 12 
                 −0.236 
                 −0.405, −0.067 
                 +12 
               
               
                 treated eyes 
                   
                 (0.082) 
               
               
                 Best-seeing 
                 17 
                 −0.075 
                 −0.216, 0.067  
                  +4* 
               
               
                 Sham eyes 
                   
                 (0.069) 
               
               
                 p-value  a   
                   
                 0.1466 
               
               
                   
               
               
                   a  Significance of the difference between All-treated and All-Sham with respect to change of LogMAR from baseline. 
               
               
                 *Does not statistically differ from 0. 
               
            
           
         
       
     
     The difference in the change in ETDRS score relative to baseline was measured. As shown in Table 17, this difference was greater for the set of on-chart best-seeing eyes relative to the set of all on-chart eyes (+6.1 versus+4.5). 
     
       
         
           
               
               
               
               
               
             
               
                   
                 TABLE 17 
               
               
                   
                   
               
               
                   
                 Change from 
                   
                   
                 Difference 
               
               
                   
                 baseline in 
                 Treated 
                 Sham 
                 Treated - 
               
               
                   
                 ETDRS score 
                 eyes 
                 eyes 
                 Untreated 
               
               
                   
                   
               
             
            
               
                   
                   
                 (n = 24) 
                 (n = 28) 
                   
               
               
                   
                 All eyes 
                 +8.8 
                 +4.3 
                 +4.5 
               
               
                   
                   
                 (n = 13) 
                 (n = 17) 
               
               
                   
                 Best-seeing eyes 
                 +9.8 
                 +3.7 
                 +6.1 
               
               
                   
                   
               
            
           
         
       
     
     Among the set of on-chart eyes treated with Vector A and for which an increase in visual acuity was measured at week 48, 75% ( 12/16) had a disease duration at baseline of 6 to 9 months, while 25% ( 4/16) had a disease duration at baseline of 9 to 12 months (Cf. Table 18). Among the set of on-chart sham-treated eyes for which an increase in visual acuity was measured at week 48, 50% ( 8/16) had a disease duration at baseline of 6 to 9 months, while 50% ( 8/16) had a disease duration at baseline of 9 to 12 months. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 18 
               
             
            
               
                   
                   
               
               
                   
                 Disease duration at baseline 
                   
               
            
           
           
               
               
               
               
            
               
                   
                 6 to 9 months 
                 9 to 12 months 
                 Total 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
            
               
                   
                 Treated eyes 
                 12 
                 4 
                 16 
               
               
                   
                   
                 (75%) 
                 (25%) 
               
               
                   
                   
                  8 
                 8 
               
               
                   
                 Sham eyes 
                 (50%) 
                 (50%) 
                 16 
               
               
                   
                 Total 
                 20 
                 12  
                 32 
               
               
                   
                   
               
            
           
         
       
     
     In a further analysis, “responder” referred to improvement in visual acuity in on-chart patients of at least 0.25 LogMAR (+12.5 ETDRS equivalent). As shown in Table 19, 24.0% of all on-chart eyes treated with Vector A and 14.3% of all on-chart sham-treated eyes were characterized as “Responder Eyes.” 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 19 
               
               
                   
                   
               
               
                   
                 All On-chart 
                 All On-chart 
               
               
                   
                 Treated eyes 
                 Sham eyes 
               
               
                   
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                   
                 Responder eye 
                 6 
                 4 
               
               
                   
                   
                 (24.0%) 
                 (14.3%) 
               
               
                   
                 Non-Responder eye 
                 19  
                 24  
               
            
           
           
               
               
               
               
            
               
                   
                 McNemar p-value 
                 0.5637 
               
               
                   
                   
               
            
           
         
       
     
     In a further analysis, “responder” referred to improvement in visual acuity in best-seeing eyes of on-chart patients of at least 0.25 LogMAR (+12.5 ETDRS equivalent). As shown in Table 20, 25.0% of on-chart best-seeing eyes treated with Vector A and 5.6% of best-seeing on-chart sham-treated eyes were characterized as “Responder Eyes.” 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 20 
               
             
            
               
                   
                   
               
               
                   
                 On-chart eyes 
                   
               
            
           
           
               
               
               
            
               
                   
                 Best-seeing 
                 Best-seeing 
               
               
                   
                 Treated eyes 
                 Sham eyes 
               
               
                   
                   
               
            
           
           
               
               
               
               
            
               
                   
                 Responder eye 
                 3 
                 1 
               
               
                   
                   
                 (25.0%) 
                 (5.6%) 
               
               
                   
                 Non-Responder eye 
                 9 
                 16  
               
            
           
           
               
               
               
               
            
               
                   
                 McNemar p-value 
                 0.2785 
               
               
                   
                   
               
            
           
         
       
     
     Study data were further analyzed using a generalized estimating equation (GEE) model to assess the effect of treatment with Vector A on achievement of a 20/200 visual acuity endpoint. Results showed that eyes treated with Vector A were significantly more likely to achieve the 20/200 visual acuity endpoint than were sham-treated eyes (p=0.0005). The odds ratio was 18.45 (lower 95% boundary=3.60). 
     Data pertaining to the number of eyes legally blind at baseline and, of those eyes blind at baseline, the number of eyes rescued from legal blindness are presented in Table 21. In this context, a legally-blind eye is defined as having visual acuity worse than 20/200. 
     
       
         
           
               
               
               
             
               
                   
                 TABLE 21 
               
               
                   
                   
               
               
                   
                 Treated eyes 
                 Sham eyes 
               
               
                   
                   
               
             
            
               
                   
               
            
           
           
               
               
               
               
            
               
                   
                 Number of eyes legally blind at 
                 24  
                 25  
               
               
                   
                 baseline 
               
               
                   
                 Of those eyes blind at baseline, 
                 2 
                 1 
               
               
                   
                 number of eyes rescued from legal 
                 (8.3%) 
                 (4.0%) 
               
               
                   
                 blindness 
               
               
                   
                   
               
            
           
         
       
     
     Analysis of the study data indicated that the set of patients who responded better to treatment with Vector A (e.g. patients for which an increase in visual acuity was observed) included those patients having a disease duration (e.g., vision loss) at baseline of less than 9 months, for example, of 6 to 9 months, and/or with visual acuity at baseline of &lt;1.6 LogMAR. Thus, in some embodiments, these criteria (a disease duration (e.g., vision loss) at baseline of less than 9 months, for example, of 6 to 9 months and/or visual acuity at baseline of &lt;1.6 LogMAR) may be used to identify a patient sub-population expected to better respond to treatment with Vector A (e.g., a patient population for which an increase in visual acuity may be expected). 
     Example 2 
     The trial evaluated the safety and efficacy of a single intravitreal injection of Vector A (rAAV2/2-ND4) in 37 subjects whose visual loss due to 11778-ND4 Leber Hereditary Optic Neuropathy (LHON) commenced between 6 and 12 months prior to study treatment. Week 96 is the last of the scheduled readouts for the trial and marks the time when the data are unmasked, providing access to individual patient profiles. 
     At Week 96, Vector A-treated eyes showed a mean improvement of −0.308 LogMAR compared to baseline, equivalent to +15.4 ETDRS letters or 3 lines on the ETDRS vision chart ( FIG. 6 ). This clinically meaningful level of improvement in visual acuity maintains the gain observed at Week 72 (+14.7 ETDRS letters equivalent). As in readouts at Week 48 and Week 72, best-corrected visual acuity (BCVA) in sham-treated eyes evolved on a relatively parallel trajectory, achieving a mean improvement of −0.259 LogMAR over baseline, or a gain of +12.9 ETDRS letters equivalent, at Week 96. Although lower in magnitude, the mean BCVA improvement of sham-treated eyes was not statistically significant from that of Vector A-treated eyes. 
     Consistent with natural history, subjects experienced an initial point of low visual acuity, or nadir. The nadir is defined as the lowest post-treatment BCVA as measured by LogMAR up to the week of measurement. Eyes of trial subjects recovered significantly. By week 96, Vector A-treated eyes had gained+28 more letters relative to their nadir. 
     
       
         
           
               
             
               
                 TABLE 22 
               
             
            
               
                   
               
               
                 Recovery of BCVA from nadir as measured by difference from nadir 
               
               
                 in ETDRS letters equivalent, mean and standard deviation 
               
            
           
           
               
               
               
               
               
            
               
                   
                 n 
                 Week 48 
                 Week 72 
                 Week 96 
               
               
                   
                   
               
            
           
           
               
               
               
               
               
               
            
               
                   
                 Vector A- 
                 37 
                 +24.1 
                 +27.4 
                 +28.1 
               
               
                   
                 treated eyes 
                   
                 (21.1) 
                 (21.8) 
                 (22.0) 
               
               
                   
                 Sham-treated 
                 37 
                 +20.3 
                 +22.6 
                 +23.2 
               
               
                   
                 eyes 
                   
                 (23.4) 
                 (25.5) 
                 (24.5) 
               
               
                   
                   
               
            
           
         
       
     
     At Week 96, low-contrast visual acuity, as measured on the Pelli-Robson chart showed a similar trend of improvement for both Vector A-treated eyes and sham-treated eyes. The trajectories of sham- and Vector A-treated eyes did not track each other as closely as BCVA. Mean contrast sensitivity showed a more robust improvement versus baseline over the course of the trial ( FIG. 7 ). 
     The proportion of Vector A-treated eyes that achieved at least a −0.2 LogMAR or +10 ETDRS letters equivalent improvement versus baseline at Week 96 is statistically significantly higher than the corresponding proportion of sham-treated eyes (65% vs. 46%, p-value=0.0348). Vector A-treated eyes were also significantly more likely than sham-treated eyes to achieve another measure of treatment success improving by at least 15 ETDRS letters at Week 96 from on-chart acuity at baseline, or avoiding the US legal blindness threshold of 20/200 at Week 96 (32% vs. 16%, p=0.0196). 
     Based on a generalized estimating equations (GEE) model, Vector A-treated eyes were 2.8 times more likely to be at or above 20/200 than sham-treated eyes (p=0.0094). When only eyes that were strictly above the threshold were considered, the odds ratio rose to 3.6 (p=0.0032). 
     Additionally, 68% of trial subjects achieved a spontaneous “clinically relevant recovery (CRR)” in at least one eye at Week 96, defined by an improvement of (a) at least 10 ETDRS letters from on-chart visual acuity, or (b) an improvement from off-chart visual acuity to being able to read at least 5 ETDRS letters. Vector A-treated eyes were significantly more likely to achieve this than sham-treated eyes (62% vs. 43%, p=0.0348). In comparison, in a previous natural history study, only 15% of patients with the same 11778A mutation achieved CRR. 
     In terms of quality of life, improvement in visual function were reflected in scores on the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) survey, a validated, vision-specific quality-of-life instrument completed by trial subjects. As shown in Table 23, mean composite score and means of relevant sub-scale scores continued to improve over baseline, particularly for the ability to carry out near and distance activities. The increase over baseline of the mean sub-scale scores exceeded those that have been associated with a 15-letter improvement in BCVA in other ocular diseases. 
     
       
         
           
               
             
               
                 TABLE 23 
               
             
            
               
                   
               
               
                 Meaningful Improvements in Quality of Life Scores Reported by Patients 
               
               
                 (NEI VFQ-25) - Mean change from baseline (absolute score and percentage) 
               
            
           
           
               
               
               
               
               
               
               
               
            
               
                   
                 Composite 
                 Near 
                 Distance 
                   
                 Role 
                 General 
                 Mental 
               
               
                   
                 Score** 
                 Activities 
                 Activities 
                 Dependency 
                 Difficulties 
                 Vision 
                 Health 
               
               
                   
               
            
           
           
               
               
               
               
               
               
               
               
            
               
                 Week 48 
                 +7.2 
                 +10.4  
                 +9.6  
                 +12.4  
                 +14.5  
                 +10.3  
                 +11.2  
               
               
                   
                 +23.2% 
                 +65.1% 
                 +49.8% 
                 +100.6% 
                 + 65.0% 
                 +50.9% 
                 +81.9% 
               
               
                 Week 72 
                 +8.1  
                 +9.5  
                 +8.2  
                 +18.9  
                 +15.2  
                 +11.9  
                 +15.2  
               
               
                   
                 +25.2% 
                 +58.1% 
                 +42.5% 
                 +130.2% 
                 +70.9% 
                 +54.1% 
                 +105.6% 
               
               
                 Week 96 
                 +9.5  
                 +13.3  
                 +10.7  
                 +18.5  
                 +15.9 
                 +6.5  
                 +16.1  
               
               
                   
                 +28.8% 
                 +78.1% 
                 +47.4% 
                 +130.2% 
                 +78.9% 
                 +32.4% 
                 +108.2% 
               
               
                 Clinically 
                 +3.90 to  
                 +4.67 to  
                 +5.15 to 
                 +4.72 to  
                 +3.31 to  
                 +4.38 to 
                 +4.70 to  
               
               
                 Relevant 
                 +4.34 
                 +6.06 
                 +5.38 
                 +4.98 
                 +4.70 
                 +4.82 
                 +4.88 
               
               
                 Difference 
               
               
                   
               
               
                 **The composite score is an average of the vision-targeted sub-scale scores, excluding the general health rating question. 
               
            
           
         
       
     
     Structural metrics indicate that GS010-treated eyes maintained the stability achieved in previous readouts in ganglion cell volume. The differential effect of therapy was, however, more prominent in previous readouts.