Methods and compositions for CNS delivery of heparan N-sulfatase
The present invention provides, among other things, compositions and methods for CNS delivery of lysosomal enzymes for effective treatment of lysosomal storage diseases. In some embodiments, the present invention includes a stable formulation for direct CNS intrathecal administration comprising a heparan N-sulfatase (HNS) protein, salt, and a polysorbate surfactant for the treatment of Sanfilippo Syndrome Type A.
1. A method of treating Sanfilippo A Syndrome comprising a step of administering intrathecally to a human subject in need of treatment a formulation comprising a heparan N-sulfatase (HNS) protein at a concentration at or greater than 5 mg/ml at a dose of at least 10 mg, wherein the formulation comprises 5 mM to 50 mM of phosphate.
2. The method of claim 1 , wherein the step of administering intrathecally results in no substantial adverse effects in the subject.
3. The method of claim 2 , wherein the step of administering intrathecally results in no substantial adaptive T cell-mediated immune response in the subject.
4. The method of claim 1 , wherein the step of administering intrathecally results in delivery of the FINS protein to one or more target brain tissues.
5. The method of claim 4 , wherein the one or more target brain tissues are selected from the group consisting of tissues from gray matter, white matter, periventricular areas, pia-arachnoid, meninges, neocortex, cerebellum, deep tissues in cerebral cortex, molecular layer, caudate/putamen region, midbrain, deep regions of the pons or medulla, and combinations thereof.
6. The method of claim 1 , wherein the step of administering intrathecally results in delivery of the FINS protein to neurons, glial cells, perivascular cells and/or meningeal cells.
7. The method of claim 1 , wherein the step of administering intrathecally results in delivery of the FINS protein to the neurons in the spinal cord.
8. The method of claim 1 , wherein the step of administering intrathecally results in systemic delivery of the FINS protein in peripheral target tissues.
9. The method of claim 8 , wherein the peripheral target tissues are selected from liver, kidney, and/or heart.
10. The method of claim 1 , wherein the step of administering intrathecally results in lysosomal localization in brain target tissues, spinal cord neurons and/or peripheral target tissues.
11. The method of claim 1 , wherein the step of administering intrathecally results in reduction of GAG storage in brain target tissues, spinal cord neurons and/or peripheral target tissues.
12. The method of claim 1 , wherein the step of administering intrathecally results in reduced vacuolization in neurons.
13. The method of claim 1 , wherein the step of administering intrathecally results in increased FINS enzymatic activity in brain target tissues, spinal cord neurons and/or peripheral target tissues.
14. The method of claim 1 , wherein the step of administering intrathecally results in reduced intensity, severity, or frequency, or delayed onset of at least one symptom or feature of the Sanfilippo A Syndrome.
15. The method of claim 14 , wherein the at least one symptom or feature of the San A disease is hearing loss, delayed speech development, deficits in motor skills, hyperactivity, mental retardation, aggressiveness and/or sleep disturbances.
16. The method of claim 1 , wherein the step of administering intrathecally takes place at an interval selected from once every two weeks, once every month, once every two months.
17. The method of claim 1 , wherein the step of administering intrathecally is used in conjunction with intravenous administration.
18. The method of claim 1 , wherein the step of administering intrathecally is used in absence of intravenous administration.
19. The method of claim 1 , wherein the step of administering intrathecally is used in absence of concurrent immunosuppressive therapy.
20. The method of claim 1 , wherein the formulation comprises NaCl at a concentration of approximately 145 mM, polysorbate 20 at a concentration of approximately 0.02%, and a pH of approximately 7.
21. The method of claim 1 , wherein the HNS protein is a synthetic, recombinant, gene-activated or natural enzyme.
22. The method of claim 1 , wherein the HNS protein is present at a concentration of at least about 10 mg/ml.
23. The method of claim 1 , wherein the HNS protein is present at a concentration of at least 30 mg/ml.
24. The method of claim 1 , wherein the formulation contains a phosphate concentration no greater than 25 mM.
25. The method of claim 11 , wherein the GAG storage is reduced by at least 20% as compared to an untreated control.
26. The method of claim 13 , wherein the HNS enzymatic activity is increased by at least 1-fold as compared to an untreated control.
27. The method of claim 13 , wherein the increased HNS enzymatic activity is at least 10 nmol/hr/mg.
28. The method of claim 13 , wherein the HNS enzymatic activity is increased in the lumbar region.
29. The method of claim 5 , wherein the target brain tissues comprise white matter and/or gray matter.
30. The method of claim 5 , wherein the target brain tissue is a deep brain tissue at least 4 mm below the surface of the cerebrum.
31. The method of claim 6 , wherein the neurons comprise Purkinje cells.
32. The method of claim 1 , wherein the formulation is administered in a volume of less than 3 ml.
33. The method of claim 1 , wherein the dose is of at least 15 mg.
34. A method of treating Sanfilippo A Syndrome, comprising a step of administering intrathecally to a subject in need of treatment a formulation comprising heparan N-sulfatase (HNS) protein at a concentration at or greater than 5 mg/ml at a dose of at least 10 mg, salt at a concentration of approximately 0-300 mM, a polysorbate surfactant at a concentration of approximately 0-0.02%, phosphate at a concentration of approximately 5-50 mM, and a pH of approximately 6.0-7.0.
35. The method of claim 1 , wherein
the step of administering intrathecally results in delivery of the replacement enzyme to one or more tissues of brain or spinal cord at least 4 mm below the external surface.
36. The method of claim 35 , wherein the one or more tissues of brain or spinal cord is at least 10 mm below the external surface.
37. The method of claim 35 , wherein the one or more tissues of brain comprise a tissue of cerebrum.
38. The method of claim 35 , wherein the one or more tissues of the brain comprise a tissue of cerebellum.
39. The method of claim 38 , wherein the tissue of cerebellum is selected from the group consisting of tissues of the molecular layer, tissues of the Purkinje cell layer, tissues of the Granular cell layer, cerebellar peduncles, and combination thereof.
40. The method of claim 35 , wherein the one or more tissues of brain comprise a tissue of the brainstem.
41. The method of claim 1 , wherein the step of administering intrathecally is carried out at a regular administration interval.
42. The method of claim 41 , wherein the regular administration interval is selected form the group consisting of annually, monthly, bi-weekly, weekly and daily.
43. The method of claim 42 , wherein the regular administration interval is once a month.