Enzyme replacement and beyond.
During the last decade, enzyme replacement therapy for lysosomal storage diseases became a reality with the demonstration of its safety and effectiveness in type 1 Gaucher disease. Currently, enzyme replacement and several other potential therapeutic strategies are being developed for selected lysosomal storage diseases, including Fabry disease due to the deficient activity of alpha-galactosidase A (alpha-Gal A). The development and clinical evaluation of these new therapies require a stepwise process, each step being rigorously reviewed and approved by national or international regulatory agencies. For lethal disorders that affect small populations, such as many inherited metabolic diseases, this process can be accelerated by 'orphan drug' and 'fast track' regulations. As an example of the drug development process, the development of recombinant human alpha-Gal A (r-halphaGal A) replacement for Fabry disease is presented, including the preclinical studies in the 'Fabry mouse' model, and the clinical phase 1/2, phase 3, and phase 3 extension studies, which demonstrate the safety and efficacy of this new therapy.
Desnick
R J
RJ
Department of Human Genetics, Mount Sinai School of Medicine of New York University, New York 10029, USA. rjdesnick@mssm.edu
D000818:Animals; D002986:Clinical Trials as Topic; D000795:Fabry Disease / Q000188:drug therapy; D015316:Genetic Therapy; D006801:Humans; D016464:Lysosomal Storage Diseases / Q000188:drug therapy* / Q000235:genetics; D000519:alpha-Galactosidase / Q000009:adverse effects / Q000627:therapeutic use*
D000519:alpha-Galactosidase