Intravenous arylsulfatase A in metachromatic leukodystrophy: a phase 1/2 study

Christine Dali, Samuel Groeschel, Mihai Moldovan, Mohamed H. Farah, Ingeborg Kraegeloh-Mann, Margaret Wasilewski, Jing Li, Norman Barton, Christian Krarup*

*Corresponding author for this work

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Abstract

Objective: Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal storage disease caused by deficient activity of arylsulfatase A (ASA), resulting in severe motor and cognitive dysfunction. This phase 1/2 study evaluated the safety and efficacy of intravenous (IV) recombinant human ASA (rhASA; HGT-1111, previously known as Metazym) in children with MLD.Methods: Thirteen children with MLD (symptom onset <4 years of age) were enrolled in an open-label, nonrandomized, dose-escalation trial and received IV rhASA at 50, 100, or 200 U/kg body weight every 14 (+/- 4) days for 52 weeks (NCT00418561; NCT00633139). Eleven children continued to receive rhASA at 100 or 200 U/kg during a 24-month extension period (NCT00681811). Outcome measures included safety observations, changes in motor and cognitive function, and changes in nerve conduction and morphometry. ResultsThere were no serious adverse events considered related to IV rhASA. Motor function and developmental testing scores declined during the study in all dose groups; no significant differences were observed between groups. Nerve conduction studies and morphometric analysis indicated that peripheral nerve pathology did not worsen during the study in any dose group. InterpretationIV rhASA was generally well tolerated. There was no evidence of efficacy in preventing motor and cognitive deterioration, suggesting that IV rhASA may not cross the blood-brain barrier in therapeutic quantities. The relative stability of peripheral nerve function during the study indicates that rhASA may be beneficial if delivered to the appropriate target site and supports the development of rhASA for intrathecal administration in MLD.

Original languageEnglish
JournalAnnals of Clinical and Translational Neurology
Volume8
Issue number1
Pages (from-to)66-80
Number of pages15
ISSN2328-9503
DOIs
Publication statusPublished - 2021

Keywords

  • GROSS MOTOR FUNCTION
  • ENZYME REPLACEMENT THERAPY
  • BLOOD-BRAIN-BARRIER
  • CEREBROSPINAL-FLUID
  • MOUSE MODEL
  • CELL TRANSPLANTATION
  • N-ACETYLASPARTATE
  • LEVELS CORRELATE
  • SYSTEM
  • SULFATIDE

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