{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:51:04Z","timestamp":1787010664262,"version":"build-2736575974"},"posted":{"date-parts":[[2024,11,11]]},"group-title":"Bioengineering","reference-count":84,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T00:00:00Z","timestamp":1731283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2024,11,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>\n                  Genetic vascular disorders are prevalent diseases that have diverse etiologies and few treatment options. Pathogenic missense mutations in the alpha actin isotype 2 gene (\n                  <jats:italic>ACTA2<\/jats:italic>\n                  ) primarily affect smooth muscle cell (SMC) function and cause multisystemic smooth muscle dysfunction syndrome (MSMDS), a genetic vasculopathy that is associated with stroke, aortic dissection, and death in childhood. Here, we explored genome editing to correct the most common MSMDS-causative mutation\n                  <jats:italic>ACTA2<\/jats:italic>\n                  R179H. In a first-in-kind approach, we performed mutation-specific protein engineering to develop a bespoke CRISPR-Cas9 enzyme with enhanced on-target activity against the R179H sequence. To directly correct the R179H mutation, we screened dozens of configurations of base editors (comprised of Cas9 enzymes, deaminases, and gRNAs) to develop a highly precise corrective A-to-G edit with minimal deleterious bystander editing that is otherwise prevalent when using wild-type SpCas9 base editors. We then created a murine model of MSMDS that exhibits phenotypes consistent with human patients, including vasculopathy and premature death, to explore the\n                  <jats:italic>in vivo<\/jats:italic>\n                  therapeutic potential of this base editing strategy. Delivery of the customized base editor via an engineered SMC-tropic adeno-associated virus (AAV-PR) vector substantially prolonged survival and rescued systemic phenotypes across the lifespan of MSMDS mice, including in the vasculature, aorta, and brain. Together, our optimization of a customized base editor highlights how bespoke CRISPR-Cas enzymes can enhance on-target correction while minimizing bystander edits, culminating in a precise editing approach that may enable a long-lasting treatment for patients with MSMDS.\n                <\/jats:p>","DOI":"10.1101\/2024.11.11.621817","type":"posted-content","created":{"date-parts":[[2024,11,11]],"date-time":"2024-11-11T22:15:15Z","timestamp":1731363315000},"source":"Crossref","is-referenced-by-count":2,"title":["<i>In vivo<\/i>\n                  Treatment of a Severe Vascular Disease via a Bespoke CRISPR-Cas9 Base Editor"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2646-9689","authenticated-orcid":false,"given":"Christiano R. 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