title: Clearance of Hepatic Sphingomyelin by Olipudase Alfa Is Associated With Improvement in Lipid Profiles in Acid Sphingomyelinase Deficiency.
abstract: Acid sphingomyelinase deficiency (ASMD; Niemann-Pick disease type A and B) is a lysosomal storage disorder characterized by abnormal intracellular sphingomyelin (SM) accumulation. Prominent liver involvement results in hepatomegaly, fibrosis/cirrhosis, abnormal liver chemistries, and a proatherogenic lipid profile. Olipudase alfa (recombinant human ASM) is in clinical development as an investigational enzyme replacement therapy for the non-neurological manifestations of ASMD. In a phase 1b study conducted to evaluate the safety and tolerability of within-patient dose escalation with olipudase alfa, measurement of SM levels in liver biopsies was used as a pharmacodynamic biomarker of substrate burden. Five adult patients with non neuronopathic ASMD received escalating doses of olipudase alfa every 2 weeks for 26 weeks. Liver biopsies obtained at baseline and 26 weeks after treatment were evaluated for SM storage by histomorphometric analysis, biochemistry, and electron microscopy. Biopsies were also assessed for inflammation and fibrosis, and for the association of SM levels with liver volume, liver function tests, and lipid profiles. At baseline, SM storage present in Kupffer cells and hepatocytes ranged from 9.8% to 53.8% of the microscopic field. After 26 weeks of treatment, statistically significant reductions in SM (P<0.0001) measured by morphometry were seen in 4 patients with evaluable liver biopsies. The 26-week biopsy of the fifth patient was insufficient for morphometric quantitation. Posttreatment SM levels ranged from 1.2% to 9.5% of the microscopic field, corresponding to an 84% to 92% relative reduction from baseline. Improvements in liver volume, liver function tests, and lipid profiles were also observed. This study illustrates the utility of SM assessment by liver biopsy as a pharmacodynamic biomarker of disease burden in these patients.
authors.affiliation: Departments of *Pathology †Clinical Development, Sanofi Genzyme, Cambridge ¶Division of Genetics, Children's Hospital Boston #Department of Pediatrics, Harvard Medical School, Boston, MA ‡Division of Pediatric Genetic Medicine, The Children's Hospital at Montefiore, Bronx ∥Division of Liver Diseases, Mount Sinai School of Medicine, NY, NY §Manchester Centre for Genomic Medicine, St Mary's Hospital, CMFT, University of Manchester, Manchester, UK.
authors.forename: Beth L
authors.initials: BL
authors.lastname: Thurberg
authors.forename: Melissa P
authors.initials: MP
authors.lastname: Wasserstein
authors.forename: Simon A
authors.initials: SA
authors.lastname: Jones
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Schiano
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Cox
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Puga
mesh_terms: D000328:Adult; D000368:Aged; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007150:Immunohistochemistry; D008099:Liver / Q000187:drug effects / Q000378:metabolism* / Q000473:pathology; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D052536:Niemann-Pick Disease, Type A / Q000188:drug therapy*; D052537:Niemann-Pick Disease, Type B / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013108:Sphingomyelin Phosphodiesterase / Q000627:therapeutic use*; D013109:Sphingomyelins / Q000378:metabolism*
chemical_list: D011994:Recombinant Proteins; D013109:Sphingomyelins; D013108:Sphingomyelin Phosphodiesterase; C000608782:olipudase alfa