I am familiar with bicistronic AAV gene therapy vectors that have two cistrons with an IRES between them. Since this is known to result in less efficient expression of the second gene why not simply create vectors with the structure ITR-promoter-gene1-promoter2-gene2-WPRE-polyA-ITR or ITR-promoter-gene1-promoter2-pA-gene2-WPRE-polyA-ITR if this fits the 4800 KB limit? I can find no published examples of this design being used in primate studies and little in rodent studies. Are there known issues with this approach?

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