The National Institute of Neurological Disorders and Stroke (NINDS), the Office of Rare Diseases (ORD), and the National Institute of Diabetes and Digestive and Kidney Diseases at NIH along with the National MPS Society co-sponsored this workshop. This scientific workshop was organized by Mark Haskins, V.M.D., Ph.D. (University of Pennsylvania); Sissi Langford (National MPS Society); Catherine McKeon, Ph.D. (National Institute of Diabetes and Digestive and Kidney Diseases); Mark Sands, Ph.D. (Washington University School of Medicine); and Danilo A. Tagle, Ph.D. (National Institute of Neurological Disorders and Stroke)
The goals of the workshop include:
There was considerable progress reported at this workshop on both the clinical and basic research areas in the mucopolysaccharidoses (see agenda). The Panel Discussions also identified areas of research that are required for efficient translation of new therapies and approaches into the clinic.
Progress in basic and translational research:
A) Enzyme Replacement:
William Sly presented preliminary data showing that completely de-glycoslyated -glucuronidase had a dramatically increased
half-life in serum and virtually eliminated lysosomal storage in the CNS of adult MPS VII mice. This surprising finding has
obvious and important implications for the treatment of the CNS disease associated with MPS disorders.
Elizabeth Neufeld presented the principles behind the development of aptamer-based modifications of recombinant α-L-iduronidase for treatment of the CNS disease associated with MPS I. Preliminary data generated in an in vitro blood brain barrier model shows that this approach may be able to deliver enzyme across the blood-brain barrier (BBB).
Patricia Dickson showed promising data using intrathecal delivery of α-L-iduronidase in the canine model of MPS I. The levels of glycosaminoglycans in the brain were normalized and the enzyme persisted for 4-7 days.
B) Small Molecule Therapy:
Thomas Seyfried showed that treatment with NB-DGJ, which interferes with the synthesis of gangliosides, decreased the levels
of gangliosides in the mouse models of GM1 gangliosidosis and Sandhoff disease. In addition, he showed that caloric restriction
decreased inflammation, improved rotarod performance, and increased the life span of these mice, however, there was no reduction
in gangliosides. Experiments are ongoing to determine the efficacy of combining substrate reduction and dietary restriction.
Steven Walkley showed that substrate reduction and by-product replacement therapies were partially effective in Niemann-Pick type C disease. He also showed that combining the two approaches was more effective than either therapy alone.
Frances Platt studied the effects of small molecule substrate reduction therapy combined with bone marrow transplantation, neuronal stem cells, or non-steroidal anti-inflammatory drugs. Each therapeutic approach synergized with substrate reduction therapy to varying degrees.
David Bedwell developed a murine model that contained an authentic human non-sense mutation leading to MPS I. Using this model he was able to test a safer (less toxic) analog of gentamycin for stop codon read-through. This safer drug was able to restore approximately 3% of the enzyme activity in vitro and reduced urinary glycoaminoglycans (GAGs) in vivo.
C) Stem Cells
Kyuson Yun showed that fetal liver cells cultured with Noggin resulted in a 5- fold increase in the generation of neuronal
stem cells. Small numbers of these cells were seen in the brain following intracranial injection of transduced cells. Data
was also presented describing an easily accessible source (nasal epithelium) of autologous neuronal stem cells that express
the correct neuronal markers in vitro.
Raquel Walton presented in vitro data suggesting that there is a block in the maturation of neuronal stem cells derived from several different areas of the MPS VII dog brain. When transplanted into the brains of MPS VII dogs, only GUSB-positive astrocytes were observed and no GUSB-positive neurons were detected.
Nobuko Uchida presented pre-clinical data showing that human neuronal stem cells distributed widely throughout the neuraxis and reduced the clinical signs associated with the Shiverer mouse. The cells also distributed similarly throughout the brains in the mouse model of Infantile Batten Disease.
D) Gene Therapy:
Miguel Sena-Esteves showed that direct intracranial injection of either AAV1 or AAV8 reduced ganglioside and cholesterol accumulation
in the brains of GM1 gangliosidosis mice. Retrograde transport of -galactosidase was observed with both vectors, and enzyme
activity was observed as distant as the retina and spinal cord following AAV8 injection.
Gordon Watson showed that intrathecal injection of an AAV vector resulted in persistent expression and widespread reduction of lysosomal storage throughout the CNS in both the MPS VII and MPS I mouse models.
John Wolfe showed that intracranial injection of an AAV1 vector into the brain of -mannosidosis cats resulted in widespread correction of disease, and dramatic clinical improvement of the animals. He also showed that a 1 l injection of AAV in the ventral tegmental area, which sends projections to many areas of the brain, can deliver enzyme and reduce lysosomal storage throughout the brain in MPS VII mice.
Kathy Ponder extended her studies using retroviral-mediated gene therapy in newborn MPS I dogs and showed that in addition to correction in visceral organs, other tissues that have been refractory to conventional therapies (aorta and brain) also respond to high expression during the newborn period. Alberto Auricchio, using MPS VI rats and cats, showed that AAV1 and AAV8 expressing arylsulfatase B transduced the muscle and liver, respectively. He showed that each target tissue expressed high levels of enzyme but arylsulfatase B was not secreted from muscle. Data describing the clinical response is still pending.
Jay Dritz showed pre-clinical data comparing the levels of expression of GUSB and GUSB-TAT in the hematopoietic compartment following lentiviral mediated gene therapy. High level expression in multiple tissues was observed. Effects on critical tissues such as the brain and kidney are pending. Jean-Michel Heard showed that there was persistent and widespread expression of α-L-iduronidase in the brains of MPS I dogs following 8 separate injections of an AAV5 vector. Lysosomal storage was reduced in targeted areas of the brain. However, immunosuppression (cyclosporine) was required to maintain expression.
Matthew Ellinwood presented similar data in the canine model of MPS IIIB. Three affected but pre-symptomatic dogs were injected intracranially with an AAV5 vector and were maintained on an immunosuppressive regimen. There was widespread enzyme distribution and their neurological exam was normal at sacrifice, however, significant inflammatory lesions were seen in the absence of immunosuppression.
Xiucui Ma presented data showing that long term expression of α-L-iduronidase was possible in dogs with MPS I treated as young adults following transient treatment with anti-CD4 or anti-CD40 ligand combined with CTLA-4. Interestingly, data was also presented that showed improvements in skeletal disease, auditory-evoked brain stem responses, and decreased storage in the brain. Adarsh Reddy showed that bone marrow transplantation or CNS-directed AAV-mediated gene therapy alone in the murine model of globoid-cell leukodystrophy resulted in significant increases in life span to an average of 45 and 55 days of age, respectively. However, when combined the two disparate therapies synergized dramatically and resulted in an average life span of 105 days.
Mark Sands presented follow- up data on the original observation of hepatocellular carcinoma following systemic AAV-mediated gene therapy. They repeated the original observation in a larger cohort of animals and showed that all of the AAV proviral sequences integrated in a region of mouse chromosome 12 that contains a large number of microRNAs. These integration events disrupted the normal expression pattern in that region.
E) Animal Models:
Andrea Ballabio discussed the characterization of the multiple sulfatase deficiency mice. This mouse has a very severe phenotype
which includes systemic inflammation, neurodegeneration, and a defect in autophagy.
Progress in clinical research:
A) Enzyme Replacement:
Three recombinant protein products are currently approved for clinical use for enzyme replacement therapy in MPS I (Aldurazyme),
MPS II (Elaprase) and MPS VI (Naglazyme). In general, the clinical response following intravenous infusion has been positive
with reduced hepatosplenomegaly, increased range of motion, increased stamina, and decreased urinary GAGs. Enzyme replacement
products are in development for MPS IV and MPS VII.
Patricia Dickson discussed the preliminary findings of a human clinical trial to test the safety of intrathecal delivery of α-L-iduronidase. Three patients have been entered into the trial. So far the drug seems to be well tolerated with no severe adverse reactions and two patients have shown some symptomatic improvement.
B) Gene Therapy:
Ron Crystal discussed the preliminary data from an AAV2-mediated CNS-directed gene therapy clinical trial in children with
Late Infantile Neuronal Ceroid Lipofuscinosis. So far, the procedure has been well tolerated and there is preliminary evidence
that the procedure may be providing some efficacy. He also outlined improvements to the current protocol, specifically, the
use of a new AAV serotype (rh from rhesus) that results in higher level expression and distribution in the brain. Jean-Michel
Heard outlined an AAV5-mediated CNS-directed human gene therapy clinical trial for MPS I. This trial is based on the pre-clinical
data generated in the canine model of MPS I.
C) Stem Cell-Mediated Therapy:
Nobuko Uchida presented preliminary data regarding a human clinical trial for Infantile Neuronal Ceroid Lipofuscinosis using
neuronal stem cells. Several children have been injected and there have been no severe adverse reactions as of yet. Clinical
evaluation is pending.
Joanne Kurtzberg discussed the use of umbilical cord blood for the treatment of lysosomal disorders. They have clear evidence that early treatment (as early as several weeks or months of age) is critical for effective therapy. They have also initiated a trial where they have added accessory cells that enhance early engraftment (data are pending).
D) Newborn Screening and developing Outcome Measures
Ronald Scott and John Hopwood gave updates on the progress with comprehensive newborn screening for lysosomal storage diseases.
John Hopwood discussed his plans for screening 100,000 newborns in Australia with his mass spectrometry approach.
Joe Muenzer, Chet Whitley and Maria Escolar discussed the importance of meaningful clinical outcomes and natural history collection for the evaluation of various clinical trials.
Research Directions and Anticipated Needs:
The most important issues that the workshop participants expressed consist of 1) the need for natural history studies, 2) newborn screening programs, and 3) meaningful clinical outcome measures.
It is becoming clear that initiating therapy as early as possible is critical for the effective treatment of these diseases. This highlights the need for newborn screening and the collection of natural history data to move the novel therapies to the clinic.
There is growing evidence that combining various therapeutic modalities (small molecule, enzyme replacement, bone marrow transplantation, and gene therapy) can be synergistic and dramatically increase efficacy.
Over the last 5-10 years, the discussions have shifted from "how to treat these diseases" to "how do we get the therapies into the clinic". This is a very encouraging sign!
Workshop Objectives: To identify and address impediments to effective therapies, and to develop a strategy to determine the minimum standard protocol for clinical application of effective therapies for MPS and other LSDs
Organizers: Mark Haskins, V.M.D., Ph.D. (University of Pennsylvania); Sissi Langford (National MPS Society); Catherine McKeon, Ph.D. (National Institute of Diabetes and Digestive and Kidney Diseases); Mark S. Sands, Ph.D. (Washington University in St. Louis); and Danilo Tagle, Ph.D. (National Institute of Neurological Disorders and Stroke)
Tuesday, March 6, 2007
Wednesday, March 7, 2007
Thursday, March 8, 2007
Mark Haskins, V.M.D., Ph.D.
Professor of Pathology and Medical Genetics
University of Pennsylvania
Sissi Langford
Chair, Committee on Federal Legislation
National MPS Society
Catherine McKeon, Ph.D.
Senior Advisor for Genetic Research
National Institute of Diabetes and Digestive and Kidney Diseases
National Institutes of Health
Mark S. Sands, Ph.D.
Associate Professor
Departments of Internal Medicine
Washington University in St. Louis
School of Medicine
Danilo Tagle, Ph.D.
Program Director
Neurogenetics
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Alberto Auricchio, M.D.
Associate Professor of Medical Genetics,
Department of Pediatrics
University Federico II of Naples
Principal Investigator, Telethon Institute of Genetics and Medicine (TIGEM)
David M. Bedwell, Ph.D.
Professor
University of Alabama at Birmingham
Department of Microbiology
Ronald G. Crystal, M.D.
Professor and Chair
Department of Genetic Medicine
Weill Medical College of Cornell University
Patricia Dickson, M.D.
Assistant Professor
Harbor-University of California, Los Angeles
Jay H. Dritz, M.D.
Newborn Medicine Fellow
Washington University in St. Louis
School of Medicine
Christopher Eckman, Ph.D.
Associate Professor
Mayo Clinic
N. Matthew Ellinwood, D.V.M, Ph.D.
Assistant Professor
Companion Animal Genomics
Department of Animal Science
Iowa State University
Maria Luisa Escolar, M.D., M.S.
Director
Program for Neurodevelopmental Function in Rare Disorders
Center for Development and Learning
University of North Carolina at Chapel Hill
Paul M. Fernhoff, M.D.
Associate Professor
Human Genetics and Pediatrics
Medical Director
Emory Genetics and Emory Lysosomal Disease
Department of Human Genetics
Division of Medical Genetics
Emory University School of Medicine
Stephen C. Groft, Pharm.D.
Director
Office of Rare Diseases
National Institutes of Health
Mark Haskins, V.M.D., Ph.D.
Professor of Pathology and Medical Genetics
University of Pennsylvania
Jean-Michel Heard, Ph.D.
Head, Retrovirus and Genetic Transfer
Institute Pasteur
Paris, France
John Hopwood, Ph.D.
Professor
Women's and Children's Hospital
South Australia
Joanne Kurtzberg, M.D.
Professor of Pediatrics and Pathology
Director, Pediatric Blood and Marrow Transplant Program
Director, Carolinas Cord Blood Bank at Duke
Duke University Medical Center
Story C. Landis, Ph.D.
Director
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Catherine McKeon, Ph.D.
Senior Advisor for Genetic Research
National Institute of Diabetes and Digestive and Kidney Diseases
National Institutes of Health
Joseph Muenzer, M.D., Ph.D.
Associate Professor
University of North Carolina
Department of Pediatrics
Elizabeth F. Neufeld, Ph.D.
Professor of Biological Chemistry
David Geffen School of Medicine
University of California at Los Angeles
Tan Nguyen, M.D., Ph.D.
Medical Officer
Office of Orphan Products Development
Food and Drug Administration
Fran Platt, Ph.D.
University of Oxford
Department of Pharmacology
Oxford, England
Katherine Ponder, M.D.
Associate Professor
Washington University in St. Louis
School of Medicine
Department of Internal Medicine
St. Louis, MO 63110
Adarsh S. Reddy, Ph.D.
Washington University in St. Louis
Mark S. Sands, Ph.D.
Associate Professor
Departments of Internal Medicine
Washington University in St. Louis
School of Medicine
Miguel Sena-Esteves, Ph.D.
Assistant Professor of Neurology
Massachusetts General Hospital
C. Ronald Scott, M.D.
Professor
University of Washington
Department of Pediatrics, 356320
Thomas N. Seyfried, Ph.D.
Professor
Boston College
Department of Biology
William S. Sly, M.D.
Professor and Chairman
Department of Biochemistry
Saint Louis University School of Medicine
Giovanna Spinella, M.D.
Science and Program Coordinator
Office of Rare Diseases
National Institutes of Health
Danilo Tagle, Ph.D.
Program Director
Neurogenetics
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Nobuko Uchida, Ph.D.
Vice President
Stem Cell Biology
StemCells, Inc.
Charles H. Vite, D.V.M., Ph.D.
Assistant Professor of Neurology
School of Veterinary Medicine
University of Pennsylvania
Steven U. Walkley, D.V.M., Ph.D.
Professor of Neuroscience
Albert Einstein College of Medicine
Raquel M. Walton, V.M.D, Ph.D.
Assistant Professor of Clinical Pathology
Department of Pathobiology
University of Pennsylvania School of Veterinary Medicine
Gordon Watson, Ph.D.
Scientist
Children's Hospital Oakland Research Institute
David A. Wenger, Ph.D.
Professor
Jefferson Medical College
Chester B. Whitley, M.D., Ph.D.
Professor
Department of Pediatrics, and Institute of Human Genetics
University of Minnesota
John H. Wolfe, V.M.D., Ph.D.
Professor of Pathological and Medical Genetics
Children's Hospital of Philadelphia
Kyuson Yun, Ph.D.
Associate Staff Scientist
The Jackson Laboratory
Andrea Ballabio, M.D.
Professor and Director
Telethon Institute of Genetics and Medicine (TIGEM)
Napoli, Italy
Brian Bigger, Ph.D.
Group Leader
MPS Stem Cell Research Laboratory
Giving for Living Research Centre
University of Manchester
Royal Manchester Children's Hospital
Manchester, England
Agnes Chen, M.D.
Pediatric Neurology Fellow
Harbor-University of California, Los Angeles
Medical Center
Department of Neurology
Chi-hong B. Chen, Ph.D.
Research Biochemist
University of California, Los Angeles
Alessandra D'Azzo, Ph.D.
Professor and Member
St. Jude Children's Research Hospital
Karen Kline, D.V.M., M.S.
Associate Professor
Neurology and Neurosurgery
Diplomate ACVIM Neurology
Iowa State University
College of Veterinary Medicine
Emyr Lloyd-Evans, Ph.D.
Department of Pharmacology
University of Oxford
Oxford, England
Xiucui Ma, Ph.D.
Senior Research Technician
Washington University in St. Louis
School of Medicine
Stanley Tamaki, Ph.D.
Director
Antibody and Assay Development
StemCells, Inc.
Alessandra Tessitore, Ph.D.
Postdoctoral Researcher
Telethon Institute of Genetics and Medicine (TIGEM)
Napoli, Italy
Karen Aiach
President
Alliance Sanfilippo
Amy Barkley
MPS II, Mother
Kendra Bjoraker, Ph.D.
Pediatric Neuropsychologist
University of Minnesota
Melissa Boyter
BioMarin
Jessie Brenton
MPS III A, Sister
Mati Buccini
MPS I, Aunt
Ellen Buck-McFadyen
MPS VI, Mother
Lawrence Charnas, M.D., Ph.D.
Associate Professor of Pediatrics
University of Minnesota
Steve Chesser
MPS II, Father
Joan Cohen
MPS II, Mother
Adam Cohen
MPS II
Bill Cummings
Genzyme
Olivier Danos, Ph.D.
Directeur de Recherche CNRS
Inserm U781
Bâtiment Maurice Lamy
Hôpital Necker-Enfants Malades
Paris, France
Mark Dant
The Ryan Foundation for MPS Children
Jeanne Dant
The Ryan Foundation for MPS Children
Cristin Davidson, B.S.
Sidney Weisner Laboratory of Genetic Neurological Disease
Department of Neuroscience
Rose F. Kennedy Center for Research in Mental Retardation and Human Development
Albert Einstein College of Medicine
Brian Delaney
The Ryan Foundation for MPS Children
Maggie Delaney
The Ryan Foundation for MPS Children
Denise Dengel
MPS I
Ernie Dummann
MPS III A, Father
Debbie Dummann
MPS III A, Mother
Tim Edmunds, Ph.D.
Vice President
Therapeutic Protein Research
Genzyme Corporation
Rebecca Farkas, Ph.D.
Science Policy Analyst
Office of Science Policy and Planning
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Ann Hale, Ph.D.
Executive Director
Global Organization for Lysosomal Diseases
England
Sheryl Hall
MPS III A, Mother
Gerald Hall
MPS III A, Father
Kirsten Harkins
Executive Director
The Canadian Society for Mucopolysaccharide and Related Diseases, Inc.
Paul Harmatz, M.D.
Children's Hospital Oakland
Mike Havert, Ph.D
Product Reviewer
Food and Drug Administration (FDA)
Carolyn Hinton
MPS II, Mother
Steve Holland
MPS I, Father
Amy Holland
MPS I, Mother
Jonathan Jacoby
Hide & Seek Foundation for Lysosomal Disease Research
Barbara Keeney
MPS II, Grandmother
Kris Klenke
MPS II, Mother
National MPS Society
Larry Kirch
MPS III A, Father
Karin Ludwig, M.D.
Senior Vice President
Clinical Research
Amicus Therapeutics, Inc.
Alice Martin
Claudina Bonetti Marcus
MPS I, Mother
Paige Migliozzi
MPS I, Mother
Paul J. Orchard, M.D.
Associate Professor
University of Minnesota
Department of Pediatrics
Richard L. O'Sullivan, M.D.
Senior Medical Director
Shire Human Genetic Therapies
George Sarantinos
MPS III B, Father
Athena Sarantinos
MPS III B, Mother
Les Sheaffer
MPS III, Father
Former Board Member
National MPS Society
Teri Sheaffer
MPS III, Mother
National MPS Society
Enrico Maria Surace, D.V.M.
Assistant Investigator.
Telethon Institute of Genetics and Medicine (TIGEM)
Napoli, Italy
Patty Taormino
MPS III A, Mother
Jakub Tolar, M.D., Ph.D.
Assistant Professor
University of Minnesota
Laurie Turner
Program Director
National MPS Society
William Vespe
Family Member
Barbara Wedehase, C.G.C., M.S.W.
Executive Director
National MPS Society
Ellen Welch, Ph.D.
Group Leader
PTC Therapeutic
Klane White
MPS I, Father
Kym Wigglesworth
MPS I, Mother
Last updated March 31, 2011