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Atidarsagene autotemcel for metachromatic leukodystrophy

Messina, M; Gissen, P; (2023) Atidarsagene autotemcel for metachromatic leukodystrophy. Drugs of Today , 59 (2) pp. 63-70. 10.1358/dot.2023.59.2.3461911. Green open access

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Abstract

Metachromatic leukodystrophy (MLD) is a rare autosomal recessive disorder of sphingolipid metabolism, due to a deficiency of the enzyme arylsulfatase A (ARSA). The main clinical signs of the disease are secondary to central and peripheral nervous system demyelination. MLD is subdivided into early and lateonset subtypes based upon the onset of neurological disease. The earlyonset subtype is associated with a more rapid progression of the disease that leads to death within the first decade of life. Until recently, no effective treatment was available for MLD. The blood–brain barrier (BBB) prevents systemically administered enzyme replacement therapy from reaching target cells in MLD. The evidence for the efficacy of hematopoietic stem cell transplantation is limited to the lateonset MLD subtype. Here, we review the preclinical and clinical studies that facilitated the approval of the ex vivo gene therapy atidarsagene autotemcel for earlyonset MLD by the European Medicines Agency (EMA) in December 2020. This approach was studied in an animal model first and then in a clinical trial, eventually proving its efficacy in preventing disease manifestations in presymptomatic patients and stabilizing its progression in paucisymptomatic subjects. This new therapeutic consists of patients’ CD34+ hematopoietic stem/progenitor cells (HSPCs) transduced with a lentiviral vector encoding functional ARSA cDNA. The genecorrected cells get reinfused into the patients after a cycle of chemotherapy conditioning.

Type: Article
Title: Atidarsagene autotemcel for metachromatic leukodystrophy
Location: Spain
Open access status: An open access version is available from UCL Discovery
DOI: 10.1358/dot.2023.59.2.3461911
Publisher version: http://dx.doi.org/10.1358/dot.2023.59.2.3461911
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Pharmacology & Pharmacy, Atidarsagene autotemcel, Metachromatic leukodystrophy, - Arylsulfatase A (ARSA) mimetics, Lysosomal storage diseases, Gene therapy, LYSOSOMAL STORAGE DISORDERS, CELL GENE-THERAPY, OPEN-LABEL
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Genetics and Genomic Medicine Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10168772
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