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Iduronate-2-Sulfatase Fused To A Fc Polypeptide That Binds To The Human Transferrin Receptor

This article discusses clinical trials investigating the use of Iduronate-2-Sulfatase fused to a Fc polypeptide that binds to the human transferrin receptor (DNL310) for treating Hunter syndrome, also known as Mucopolysaccharidosis Type II (MPS II). These trials aim to evaluate the safety, efficacy, and long-term effects of DNL310 in pediatric and young adult patients with both neuronopathic and non-neuronopathic forms of MPS II. The studies focus on assessing the drug’s impact on central nervous system function, adaptive behavior, and physical endurance, among other outcomes.

Table of Contents

What is DNL310?

DNL310 is an experimental medication being developed to treat Hunter syndrome, also known as Mucopolysaccharidosis Type II (MPS II). It is a new type of enzyme replacement therapy that has been designed to cross the blood-brain barrier, potentially addressing both the body-wide and brain-related symptoms of the disease.[1]

The full name of the active substance in DNL310 is iduronate-2-sulfatase fused to a Fc polypeptide that binds to the human transferrin receptor. This long name describes how the medication is structured to perform its function.[2]

How DNL310 Works

DNL310 works by replacing the enzyme that is missing or defective in people with Hunter syndrome. This enzyme, called iduronate-2-sulfatase, is responsible for breaking down certain complex sugars in the body. When it’s missing, these sugars build up and cause damage to various organs and tissues.[1]

What makes DNL310 unique is its ability to cross the blood-brain barrier. This is a protective barrier that prevents many substances, including traditional enzyme replacement therapies, from entering the brain. By crossing this barrier, DNL310 has the potential to address the brain-related symptoms of Hunter syndrome, which current treatments cannot do effectively.[2]

Target Condition: Hunter Syndrome (MPS II)

Hunter syndrome, or MPS II, is a rare genetic disorder that primarily affects boys. It is caused by a deficiency of the enzyme iduronate-2-sulfatase, which leads to the buildup of complex sugars called glycosaminoglycans (GAGs) in various organs and tissues.[1]

There are two main types of Hunter syndrome:

  • Neuronopathic MPS II (nMPS II): This is the more severe form, affecting both the body and the brain. It can lead to developmental delays, cognitive decline, and behavioral problems.
  • Non-neuronopathic MPS II (nnMPS II): This form primarily affects the body but not the brain.

Symptoms of Hunter syndrome can include coarse facial features, enlarged liver and spleen, joint stiffness, hearing loss, heart problems, and in the case of nMPS II, cognitive impairment.[3]

Clinical Trials of DNL310

Several clinical trials are currently underway to evaluate the safety and effectiveness of DNL310 for treating Hunter syndrome:

  1. Long-term Safety and Efficacy Study: This open-label extension study is investigating the long-term safety, tolerability, and efficacy of DNL310 in patients with MPS II who participated in previous studies.[1]
  2. Pediatric Safety and Efficacy Study: This study is evaluating the safety, how the body processes the drug (pharmacokinetics), and how the drug affects the body (pharmacodynamics) of DNL310 in children with Hunter syndrome.[2]
  3. Comparative Study with Current Treatment: This phase 2/3 study is comparing the efficacy and safety of DNL310 to idursulfase (the current standard treatment) in children and young adults with both neuronopathic and non-neuronopathic MPS II.[3]

Potential Benefits of DNL310

Based on the ongoing clinical trials, DNL310 shows potential for several benefits:

  • Brain-related improvements: By crossing the blood-brain barrier, DNL310 may help reduce the buildup of harmful substances in the brain, potentially improving cognitive function and adaptive behavior in patients with neuronopathic MPS II.[3]
  • Body-wide effects: DNL310 is expected to reduce the levels of glycosaminoglycans (GAGs) throughout the body, which may help improve various symptoms of Hunter syndrome.[1]
  • Improved physical endurance: One of the goals of the clinical trials is to assess whether DNL310 can improve physical endurance, as measured by the Six Minute Walk Test.[1]
  • Reduced organ enlargement: The trials are also evaluating whether DNL310 can reduce liver and spleen enlargement, which are common problems in Hunter syndrome.[1]

Safety and Side Effects

As DNL310 is still in clinical trials, its full safety profile is not yet established. The ongoing studies are closely monitoring for any side effects or adverse reactions. Some potential side effects being watched for include:

  • Infusion-related reactions
  • Changes in laboratory test results
  • Immune system responses to the medication

It’s important to note that all participants in the clinical trials are being closely monitored for any potential side effects or safety concerns.[2]

Future Prospects

If the clinical trials show positive results, DNL310 could potentially become a groundbreaking treatment for Hunter syndrome, especially for patients with the neuronopathic form of the disease. By addressing both the body-wide and brain-related symptoms, it may offer a more comprehensive treatment option than currently available therapies.[3]

However, it’s important to remember that DNL310 is still an experimental treatment. More research is needed to fully understand its effectiveness and safety profile. Patients and families affected by Hunter syndrome should discuss current treatment options and potential clinical trial participation with their healthcare providers.

Aspect Details
Drug Name DNL310 (Iduronate-2-Sulfatase fused to Fc polypeptide)
Target Condition Mucopolysaccharidosis Type II (MPS II, Hunter syndrome)
Trial Phases Phase 1/2, Phase 2/3
Age Groups Pediatric to young adult (varies by trial, range from <4 years to <26 years)
Administration Intravenous infusion, typically 15 mg/kg weekly
Primary Outcomes Safety, tolerability, CSF heparan sulfate levels, adaptive behavior
Secondary Outcomes Neurocognitive development, physical endurance, organ volumes, urine GAG levels
Study Durations 24 weeks to 5 years, depending on the trial
Comparator Idursulfase (standard enzyme replacement therapy) in some trials
Special Features Designed to cross blood-brain barrier, addressing both CNS and peripheral symptoms

FAQ

  • What is DNL310 and how does it work? DNL310 is a fusion protein consisting of iduronate-2-sulfatase and a Fc polypeptide that binds to the human transferrin receptor. It is designed to cross the blood-brain barrier and treat both central nervous system and peripheral symptoms of Hunter syndrome (MPS II).
  • What are the main objectives of the clinical trials for DNL310? The main objectives include assessing the safety and tolerability of DNL310, evaluating its effects on central nervous system function through cerebrospinal fluid biomarkers, measuring improvements in adaptive behavior and neurocognitive development, and determining its impact on physical endurance and organ volumes.
  • Who is eligible to participate in these clinical trials? Eligibility varies by trial, but generally includes pediatric and young adult patients (up to 26 years old) with confirmed diagnoses of MPS II, including both neuronopathic and non-neuronopathic forms. Some trials require prior enzyme replacement therapy, while others include treatment-naïve patients.
  • How is DNL310 administered in these trials? DNL310 is administered as an intravenous infusion, typically at a dose of 15 mg/kg weekly. The duration of treatment varies by trial, ranging from 24 weeks to 5 years.
  • What are some of the key outcomes being measured in these trials? Key outcomes include changes in cerebrospinal fluid heparan sulfate levels, improvements in adaptive behavior and cognitive function, changes in liver and spleen volumes, physical endurance measured by the 6-minute walk test, and safety assessments including adverse events and immunogenicity.

Ongoing Clinical Trials on Iduronate-2-Sulfatase Fused To A Fc Polypeptide That Binds To The Human Transferrin Receptor

  • Study on the Effectiveness and Safety of DNL310 vs Idursulfase for Children and Young Adults with Mucopolysaccharidosis Type II

    Recruiting

    4 1 1 1
    Investigated drugs:
    Belgium Czechia France Germany Italy The Netherlands +2

  • Study on Long-Term Safety and Effects of DNL310 for Patients with Mucopolysaccharidosis Type II (MPS II)

    Recruiting

    3 1 1
    Investigated drugs:
    Belgium Czechia France Germany Italy The Netherlands +2

  • Study on the Safety of DNL310 for Children with Hunter Syndrome

    Not recruiting

    2 1 1
    Investigated drugs:
    The Netherlands

Glossary

  • Hunter syndrome (MPS II): A rare genetic disorder caused by a deficiency of the enzyme iduronate-2-sulfatase, leading to the accumulation of glycosaminoglycans in various tissues and organs, resulting in progressive damage.
  • Iduronate-2-sulfatase: An enzyme that breaks down specific types of complex sugars in the body. Its deficiency causes Hunter syndrome.
  • Neuronopathic MPS II (nMPS II): A severe form of Hunter syndrome that affects the central nervous system, leading to cognitive decline and developmental issues.
  • Non-neuronopathic MPS II (nnMPS II): A milder form of Hunter syndrome that does not significantly affect the central nervous system but still impacts other organs and tissues.
  • Cerebrospinal fluid (CSF): A clear, colorless fluid that surrounds the brain and spinal cord, protecting them and providing nutrients.
  • Heparan sulfate (HS): A type of glycosaminoglycan that accumulates in Hunter syndrome and is used as a biomarker to assess disease progression and treatment efficacy.
  • Vineland Adaptive Behavior Scales (Vineland-3): A standardized assessment tool used to measure adaptive behavior and track developmental progress in individuals with various disabilities.
  • Six Minute Walk Test (6MWT): A clinical test that measures the distance an individual can walk on a flat surface in six minutes, used to assess physical endurance and functional capacity.
  • Enzyme Replacement Therapy (ERT): A treatment approach for certain genetic disorders where the missing or deficient enzyme is replaced with a manufactured version.
  • Blood-brain barrier: A protective boundary between the brain's blood vessels and the cells and other components that make up brain tissue, which regulates the passage of substances between the bloodstream and the central nervous system.

References

  1. http://clinicaltrials.eu/trial/study-on-long-term-safety-and-effects-of-dnl310-for-patients-with-mucopolysaccharidosis-type-ii-mps-ii/
  2. http://clinicaltrials.eu/trial/study-on-the-safety-of-dnl310-for-children-with-hunter-syndrome/
  3. http://clinicaltrials.eu/trial/study-on-the-effectiveness-and-safety-of-dnl310-vs-idursulfase-for-children-and-young-adults-with-mucopolysaccharidosis-type-ii/