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2015 ; 21
(1
): 389-99
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gab.com Text
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English Wikipedia
Efficacy of Enzyme and Substrate Reduction Therapy with a Novel Antagonist of
Glucosylceramide Synthase for Fabry Disease
#MMPMID25938659
Ashe KM
; Budman E
; Bangari DS
; Siegel CS
; Nietupski JB
; Wang B
; Desnick RJ
; Scheule RK
; Leonard JP
; Cheng SH
; Marshall J
Mol Med
2015[Apr]; 21
(1
): 389-99
PMID25938659
show ga
Fabry disease, an X-linked glycosphingolipid storage disorder, is caused by the
deficient activity of ?-galactosidase A (?-Gal A). This results in the lysosomal
accumulation in various cell types of its glycolipid substrates, including
globotriaosylceramide (GL-3) and lysoglobotriaosylceramide (globotriaosyl
lysosphingolipid, lyso-GL-3), leading to kidney, heart, and cerebrovascular
disease. To complement and potentially augment the current standard of care,
biweekly infusions of recombinant ?-Gal A, the merits of substrate reduction
therapy (SRT) by selectively inhibiting glucosylceramide synthase (GCS) were
examined. Here, we report the development of a novel, orally available GCS
inhibitor (Genz-682452) with pharmacological and safety profiles that have
potential for treating Fabry disease. Treating Fabry mice with Genz-682452
resulted in reduced tissue levels of GL-3 and lyso-GL-3 and a delayed loss of the
thermal nociceptive response. Greatest improvements were realized when the
therapeutic intervention was administered to younger mice before they developed
overt pathology. Importantly, as the pharmacologic profiles of ?-Gal A and
Genz-682452 are different, treating animals with both drugs conferred the
greatest efficacy. For example, because Genz-682452, but not ?-Gal A, can
traverse the blood-brain barrier, levels of accumulated glycosphingolipids were
reduced in the brain of Genz-682452-treated but not ?-Gal A-treated mice. These
results suggest that combining substrate reduction and enzyme replacement may
confer both complementary and additive therapeutic benefits in Fabry disease.