Augmented acid alpha-glucosidase for the treatment of Pompe disease
A method for treating Pompe disease including administration of recombinant human acid α-glucosidase having optimal glycosylation with mannose-6-phosphate residues in combination with an amount of miglustat effective to maximize tissue uptake of recombinant human acid α-glucosidase while minimizing inhibition of the enzymatic activity of the recombinant human acid α-glucosidase is provided.
1. A method of treating Pompe disease in a patient in need thereof, comprising administering miglustat to the patient in combination with a composition comprising recombinant human acid α-glucosidase (rhGAA) molecules,
wherein the composition is administered intravenously at a dose of about 5 mg/kg to about 20 mg/kg and the miglustat is administered orally at a dose of about 260 mg or about 130 mg, and
wherein the rhGAA molecules are produced in Chinese hamster ovary (CHO) cells, the rhGAA molecules comprise first, second, third, fourth, fifth, sixth, and seventh potential N-glycosylation sites at amino acid positions corresponding to N84, N177, N334, N414, N596, N826, and N869 of SEQ ID NO: 5, respectively, 40%-60% of the N-glycans on the rhGAA molecules are complex type N-glycans, and at least 50% of the rhGAA molecules bear a bis-mannose-6-phosphate (bis-M6P) unit at the first potential N-glycosylation site.
2. The method of claim 1 , wherein the rhGAA molecules, after post translational modification, comprise
(i) a sequence at least 95% identical to SEQ ID NO: 4; or
(ii) the sequence of SEQ ID NO: 4, wherein the rhGAA molecules lack the first 56 amino acids.
3. The method of claim 1 , wherein at least 55% of the rhGAA molecules bear a bis-M6P unit at the first potential N-glycosylation site.
4. The method of claim 1 , wherein at least 70% of the rhGAA molecules are phosphorylated at the first potential N-glycosylation site.
5. The method of claim 1 , wherein at least 40% of the rhGAA molecules bear a mono-mannose-6-phosphate (mono-M6P) unit at the second potential N-glycosylation site.
6. The method of claim 1 , wherein at least 40% of the rhGAA molecules bear a bis-M6P unit at the fourth potential N-glycosylation site.
7. The method of claim 1 , wherein at least 25% of the rhGAA molecules bear a mono-M6P unit at the fourth potential N-glycosylation site.
8. The method of claim 1 , wherein the composition is administered at a dose of about 20 mg/kg by intravenous infusion over approximately four hours every 2 weeks, wherein the miglustat is administered one hour prior to the intravenous infusion of the composition, and wherein the patient fasts for at least two hours before and at least two hours after the oral administration of miglustat.
9. The method of claim 1 , wherein the composition is administered intravenously at a dose of about 20 mg/kg and the miglustat is administered orally at a dose of about 260 mg.
10. A kit comprising
a pharmaceutically acceptable dosage form comprising miglustat configured for oral administration at a dose of about 260 mg or about 130 mg,
a pharmaceutically acceptable dosage form comprising recombinant human acid α-glucosidase (rhGAA) molecules configured for intravenous administration at a dose of about 5 mg/kg to about 20 mg/kg, and
instructions for administering the pharmaceutically acceptable dosage form comprising miglustat and the pharmaceutically acceptable dosage form comprising rhGAA molecules to a patient in need thereof,
wherein
the rhGAA molecules are produced in Chinese hamster ovary (CHO) cells,
the rhGAA molecules comprise first, second, third, fourth, fifth, sixth, and seventh potential N-glycosylation sites at amino acid positions corresponding to N84, N177, N334, N414, N596, N826, and N869 of SEQ ID NO: 5, respectively,
40%-60% of the N-glycans on the rhGAA molecules are complex type N-glycans, and
at least 50% of the rhGAA molecules bear a bis-mannose-6-phosphate (bis-M6P) unit at the first potential N-glycosylation site.
11. The kit of claim 10 , wherein the instructions comprise
instructions to administer the pharmaceutically acceptable dosage form comprising rhGAA molecules at a dose of about 20 mg/kg by intravenous infusion over approximately four hours every 2 weeks, and
instructions to administer the pharmaceutically acceptable dosage form comprising rhGAA molecules one hour after the oral administration of the pharmaceutically acceptable dosage form comprising miglustat, and
instructions that the patient fasts for at least two hours before and at least two hours after the oral administration of the pharmaceutically acceptable dosage form comprising miglustat.
12. A kit comprising
a pharmaceutically acceptable dosage form comprising recombinant human acid α-glucosidase (rhGAA) molecules configured for intravenous administration at a dose of about 5 mg/kg to about 20 mg/kg, and
instructions for administering to a patient in need thereof the pharmaceutically acceptable dosage form comprising rhGAA molecules in combination with a pharmaceutically acceptable dosage form comprising miglustat,
wherein
the rhGAA molecules are produced in Chinese hamster ovary (CHO) cells,
the rhGAA molecules comprise first, second, third, fourth, fifth, sixth, and seventh potential N-glycosylation sites at amino acid positions corresponding to N84, N177, N334, N414, N596, N826, and N869 of SEQ ID NO: 5, respectively,
40%-60% of the N-glycans on the rhGAA molecules are complex type N-glycans, and
at least 50% of the rhGAA molecules bear a bis-mannose-6-phosphate (bis-M6P) unit at the first potential N-glycosylation site.
13. The kit of claim 12 , wherein the instructions comprise instructions to
administer the pharmaceutically acceptable dosage form comprising rhGAA molecules at a dose of about 20 mg/kg by intravenous infusion over approximately four hours every 2 weeks,
administer the pharmaceutically acceptable dosage form comprising rhGAA molecules one hour after an oral administration of the pharmaceutically acceptable dosage form comprising miglustat, and
instructions that the patient fasts for at least two hours before and at least two hours after the oral administration of the pharmaceutically acceptable dosage form comprising miglustat.