Methods to treat mucopolysaccharide type I or deficiency in alpha-L-iduronidase using a recombinant adeno-associated virus encoding alpha-L-iduronidase

1. A method to inhibit or treat one or more symptoms of mucopolysaccharide type I (MPSI) in a mammal in need thereof, comprising:

administering to a cisterna magna of the mammal in need thereof a composition comprising an amount of a recombinant adeno-associated virus (rAAV) 9 or rAAVrh10vector comprising an open reading frame encoding alpha-L-iduronidase effective to inhibit or treat the one or more symptoms of MPSI.

2. The method of claim 1 wherein the mammal is an immunocompetent adult.

3. The method of claim 1 wherein the mammal is a human.

4. The method of claim 1 wherein neurodegeneration is inhibited or treated by the administration.

5. The method of claim 1 wherein prior to administration of the composition the mammal is immunotolerized to alpha-L-iduronidase.

6. The method of claim 1 wherein the amount administered reduces glycosaminoglycans (GAG).

7. The method of claim 1 wherein rAAV9 vector is administered.

8. The method of claim 1 wherein rAAVrh10 vector is administered.

9. A method to inhibit or treat one or more symptoms of mucopolysaccharidosis type I (MPSI) in a mammal in need thereof, comprising:

administering to the mammal in need thereof an immune suppressant, and to a cisterna magna of the mammal a composition comprising an amount of a rAAV9 or rAAVrh10 vector comprising an open reading frame encoding alpha-L-iduronidase effective to inhibit or treat the one or more symptoms of MPSI.

10. The method of claim 9 wherein the immune suppressant comprises cyclophosphamide.

11. The method of claim 9 wherein the immune suppressant comprises a glucocorticoid, cytostatic agents including an alkylating agent, an anti-metabolite, a cytotoxic antibiotic, an antibody, or an agent active on immunophilin.

12. The method of claim 9 wherein the immune suppressant comprises a nitrogen mustard, nitrosourea, platinum compound, methotrexate, azathioprine, mercaptopurine, fluorouracil, dactinomycin, an anthracyclin e, mitomycin C, bleomycin, mithramycin, IL-2 receptor-(CD25-) or CD3-directed antibodies, anti-IL-2 antibodies, ciclosporin, tacrolimus, sirolimus, IFN-β, IFN-γ, an opioid, or TNF-α (tumor necrosis factor-alpha) binding agent.

13. The method of claim 9 wherein the rAAV vector and the immune suppressant are co-administered or the immune suppressant is administered after the rAAV vector.

14. The method of claim 9 wherein the rAAV vector is a rAAV-9 vector.

15. The method of claim 9 wherein multiple doses of the composition comprising the rAAV9 or rAAVrh10 vector are administered.

16. The method of claim 9 wherein the rAAV vector is rAAVrh10 vector.

17. The method of claim 9 wherein the immune suppressant is administered before the rAAV9 or rAAVrh10 vector.

18. The method of claim 9 wherein the immune suppressant is systemically administered.

19. The method of claim 9 wherein the mammal is a human.

20. The method of claim 9 wherein the amount administered reduces glycosaminoglycans (GAG).

21. A method to inhibit or treat one or more symptoms associated with a deficiency in alpha-L-iduronidase (IDUA) in a mammal, comprising:

providing a mammal with a deficiency in alpha-L-iduronidase that is immunotolerized to alpha-L-iduronidase ; and

administering to a cisterna magna of the mammal a composition comprising an amount of a rAAV9 or rAAVrh10 vector comprising an open reading frame encoding alpha-L-iduronidase effective to inhibit or treat the one or more symptoms associated with the deficiency in alpha-L-iduronidase.

22. The method of claim 21 wherein multiple doses of the composition comprising the rAAV9 or rAAVrh10 vector are administered.

23. The method of claim 21 wherein rAAV9 vector is administered.

24. The method of claim 21 wherein rAAVrh10 vector is administered.

25. The method of claim 21 wherein the mammal is a human.

26. The method of claim 21 wherein the amount administered reduces glycosaminoglycans (GAG).