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  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/196—Carboxylic acids, e.g. valproic acid having an amino group the amino group being directly attached to a ring, e.g. anthranilic acid, mefenamic acid, diclofenac, chlorambucil
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  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
  • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
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  • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
  • A61K31/436—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system containing a six-membered ring having oxygen as a ring hetero atom, e.g. rapamycin
• • A—HUMAN NECESSITIES
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  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
  • A61K31/444—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring heteroatom, e.g. amrinone
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  • A61K38/43—Enzymes; Proenzymes; Derivatives thereof
  • A61K38/44—Oxidoreductases (1)
  • A61K38/443—Oxidoreductases (1) acting on CH-OH groups as donors, e.g. glucose oxidase, lactate dehydrogenase (1.1)
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
  • A61K48/0008—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the 'non-active' part of the composition delivered, e.g. wherein such 'non-active' part is not delivered simultaneously with the 'active' part of the composition
  • A61K48/0025—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the 'non-active' part of the composition delivered, e.g. wherein such 'non-active' part is not delivered simultaneously with the 'active' part of the composition wherein the non-active part clearly interacts with the delivered nucleic acid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K48/00—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy
  • A61K48/005—Medicinal preparations containing genetic material which is inserted into cells of the living body to treat genetic diseases; Gene therapy characterised by an aspect of the 'active' part of the composition delivered, i.e. the nucleic acid delivered
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/08—Antiepileptics; Anticonvulsants
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  • C12N9/00—Enzymes; Proenzymes; Compositions thereof; Processes for preparing, activating, inhibiting, separating or purifying enzymes
  • C12N9/0004—Oxidoreductases (1.)
  • C12N9/0008—Oxidoreductases (1.) acting on the aldehyde or oxo group of donors (1.2)
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  • C12Y102/00—Oxidoreductases acting on the aldehyde or oxo group of donors (1.2)
  • C12Y102/01—Oxidoreductases acting on the aldehyde or oxo group of donors (1.2) with NAD+ or NADP+ as acceptor (1.2.1)
  • C12Y102/01024—Succinate-semialdehyde dehydrogenase (NAD+) (1.2.1.24)
• • A—HUMAN NECESSITIES
  • A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
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  • A01K2217/00—Genetically modified animals
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  • A01K2217/075—Animals genetically altered by homologous recombination inducing loss of function, i.e. knock out
• • A—HUMAN NECESSITIES
  • A01—AGRICULTURE; FORESTRY; ANIMAL HUSBANDRY; HUNTING; TRAPPING; FISHING
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  • C12N2740/00—Reverse transcribing RNA viruses
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  • C12N2740/10011—Retroviridae
  • C12N2740/16011—Human Immunodeficiency Virus, HIV
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  • C12N2740/16043—Use of virus, viral particle or viral elements as a vector viral genome or elements thereof as genetic vector

Definitions

• the subject matter disclosed herein is generally directed to compositions and methods for treating neurological disorders.
• therapeutics that rescue this model from premature lethality include GABAB and GHB receptor antagonists, the non-physiological amino acid taurine, the antiepileptic agent vigabatrin, the ketogenic diet, and rapalog agents such as Torin 2, the latter an mTOR inhibitor.
• SGS742, a GABABR antagonist is the subject of an ongoing clinical trial (www.clinicaltrials.gov; NCT02019667).
• GABA the major central inhibitory neurotransmitter
• GABA gamma- hydroxybutyric acid
• composition for treating succinic semialdehyde dehydrogenase deficiency comprising a gene encoding a functional succinic semialdehyde dehydrogenase (SSADH) enzyme operably linked to a targeting vector.
• SSADH succinic semialdehyde dehydrogenase
• the gene may be ALDH5A1.
• the targeting vector is a viral vector.
• Suitable viral vectors include, but are not necessarily limited to, retroviral vectors, adenoviral vectors, or adeno- associated viral vectors.
• the retroviral vector is a lentiviral vector.
• the targeting vector targets the liver.
• the functional SSADH enzyme lowers the levels of circulating gamma-hydroxybutyric acid (GHB) and g-aminobutyric acid (GABA).
• the composition does not cross the blood brain barrier.
• the invention provides a method of treating SSADHD in a subject in need thereof, comprising administering a therapeutically effective amount of any of the compositions described herein.
• the therapeutically effective amount may comprise a range of 1-10,000 pg functional SSADH enzyme per kg of body weight per day.
• the composition is administered once per week, bi-weekly, or once a month.
• the composition is administered intravenously.
• the invention provides a method of treating SSADHD in a subject in need thereof, comprising administering to the subject therapeutically effective amounts of: a composition comprising a gene encoding a functional SSADH enzyme operably linked to a targeting vector; one or more mTOR inhibitors; a GABA-T inhibitor; or a combination thereof.
• Suitable mTOR inhibitors may include, but are not necessarily limited to, rapamycin, sirolimus, temsirolimus, everolimus, and ridaforolimus, Torin 1, and Torin 2.
• the mTOR inhibitor is rapamycin.
• the GABA- T inhibitor is vigabatrin.
• combination therapies comprising administering therapeutically effective amounts of: Torin 2, Vigabatrin, and a composition comprising a gene encoding a functional SSADH enzyme operably linked to a targeting vector.
• the therapeutically effective amount of Torin 2 and/or Vigabatrin comprises 1-25 pg per kg of body weight per day. In some embodiments, the Torin 2 and/or Vigabatrin are administered two or three times a day.
• the subject may have increased levels of circulating metabolites.
• circulating metabolites may include, but are not necessarily limited to, GHB, GABA, or both.
• the invention provides a method of treating SSADHD in a subject in need thereof, comprising administering a therapeutically effective amount of an NKCC1 inhibitor to the subject.
• NKCC1 inhibitors may include, but are not necessarily limited to, bumetanide, allopregnanolone, pregnanolone, progesterone, gaboxadol, etifoxine, XBD- 173, FG-7142, gabazine, isoniazid, encenicline, and AVL-3288.
• the NKCC1 inhibitor is bumetanide.
• FIG. 1 - A schematic illustrating GABA metabolism and intracellular interactions.
• the site of the defect in patients with SSADHD is indicated by "X”.
• GABA GABA, g- aminobutyric acid
• GABAAR ionotropic GABAA receptors
• GABABR metabotropic GABAB receptors.
• GABA-T GABA-transaminase
• SSA succinic semialdehyde
• AKR7a2 aldo-keto reductase 7a2
• GHB g-hydroxybutyric acid
• cAMP cyclic AMP
• NKCC1 sodium potassium chloride cotransporter 1
• KCC2 neuronal potassium chloride cotransporter 2.
• NKCC1 and KCC2 control transmembrane chloride gradient and determine GABAA receptor directional transmembrane chloride flux.
• NKCC1/KCC2 the expression ratio of NKCC1 and KCC2 is elevated (Vogel et al. Pediatr Neurol 66:44-52. el.
• NKCC1 inhibitors like bumetanide lower intracellular chloride concentration.
• bumetanide may thus restore GABA inhibitory neurotransmission activity and efficiently suppress seizures.
• increased GABA activates the mTOR pathway with secondarily increased mitochondria number, oxidative stress, autophagy and mitophagy.
• mTOR inhibitors such as torin 1 and torin 2 improve GABA-induced, mTOR-pathway mediated intracellular defects and significantly prolong the lifespan of aldh5al -deficient mice.
• FIG. 2 - A graph illustrating the cortical gene expression profile of solute carriers (Slc) in aldh5al-/- mice following NCS-382 administration (7 days, q.i.d., 300 mg/kg). Relative levels are displayed, normalized to control aldh5al-/- mice receiving vehicle.
• FIGs. 3A and 3B Enzyme replacement therapy (ERT) in experimental SSADHD.
• FIG. 3A Aldh5al-/- mouse survival-rate to day of life (DOL 30) as a function of enzyme replacement intervention.
• Purified human ALDH5A1 was administered daily (1 mg/kg/day), beginning at DOL 10, via i.p. injection.
• FIG. 3B The expression of GABA-related genes following ERT in aldh5al-/- mice (fold change relative to aldh5al+/+ mice; sagittal slices of 21 day old mice).
• Asterisked values represent directional correction of expression as a function of ERT.
• FIGs. 4A and 4B Metabolic measures in animals treated with ERT.
• the treatment scheme is described in the legend to Fig. 3.
• FIG. 4B GABA in sera. Data depicted as mean ⁇ SD. Statistical analyses employed one-way ANOVA with post-hoc analysis (t test).
• FIGs. 5A-5C Intracellular chloride homeostasis, GABAergic neurotransmission and bumetanide in SSADHD (for abbreviations, see Fig. 1).
• FIG. 5A Schematic diagram of membrane ion transport and mechanism of action of bumetanide.
• FIG. 5C Time to sedation following acute dosing of 100 mg/kg bumetanide.
• Aldh5al-/- mice (mutant; MT) were significantly more resistant to the sedative effects of bumetanide as compared to aldh5al+/+ (wild-type; WT) mice, the latter showing almost instantaneous immobilization.
• WT wild-type mice
• n number of animals studied
• DOL day of life
• sec seconds
• min minutes.
• FIG. 6 Simplified schematic diagram of the roles of AMPK and mTORCl in the regulation of autophagy.
• AMPK adenosine monophosphate-activated protein kinase
• mTOR mechanistic target of rapamycin
• Prkagl and Prkag2 protein kinase cAMP-activated g subunits 1 and 2 represent components of the active AMPK trimeric structure.
• RagB and D ras-related GTP -binding proteins B and D
• Tscl/2 (tuberous sclerosis proteins 1 and 2) are negative regulators of mTORCl .
• FIG. 7 Representative el ectrocorti cographic recordings of seizure types in an aldh5al-/- mouse. These data are representative of traces employed to generate the data of Table 2.
• a“biological sample” may contain whole cells and/or live cells and/or cell debris.
• the biological sample may contain (or be derived from) a“bodily fluid”.
• the present invention encompasses embodiments wherein the bodily fluid is selected from amniotic fluid, aqueous humour, vitreous humour, bile, blood serum, breast milk, cerebrospinal fluid, cerumen (earwax), chyle, chyme, endolymph, perilymph, exudates, feces, female ejaculate, gastric acid, gastric juice, lymph, mucus (including nasal drainage and phlegm), pericardial fluid, peritoneal fluid, pleural fluid, pus, rheum, saliva, sebum (skin oil), semen, sputum, synovial fluid, sweat, tears, urine, vaginal secretion, vomit and mixtures of one or more thereof.
• Biological samples include cell cultures, bodily fluids,
• the terms“subject,”“individual,” and“patient” are used interchangeably herein to refer to a vertebrate, preferably a mammal, more preferably a human. Mammals include, but are not limited to, murines, simians, humans, farm animals, sport animals, and pets. Tissues, cells and their progeny of a biological entity obtained in vivo or cultured in vitro are also encompassed.
• the invention comprises one or more compositions for treating SSADHD.
• SSADHD may manifest through higher than normal levels circulating levels of metabolites.
• metabolites include, but are not necessarily limited to gamma-hydroxybutyric acid (GHB) and g-aminobutyric acid (GABA).
• to“treat” means to cure, ameliorate, stabilize, prevent, or reduce the severity of at least one symptom or a disease, pathological condition, or disorder.
• This term includes active treatment, that is, treatment directed specifically toward the improvement of a disease, pathological condition, or disorder, and also includes causal treatment, that is, treatment directed toward removal of the cause of the associated disease, pathological condition, or disorder.
• this term includes palliative treatment, that is, treatment designed for the relief of symptoms rather than the curing of the disease, pathological condition, or disorder; preventative treatment, that is, treatment directed to minimizing or partially or completely inhibiting the development of the associated disease, pathological condition, or disorder; and supportive treatment, that is, treatment employed to supplement another specific therapy directed toward the improvement of the associated disease, pathological condition, or disorder.
• palliative treatment that is, treatment designed for the relief of symptoms rather than the curing of the disease, pathological condition, or disorder
• preventative treatment that is, treatment directed to minimizing or partially or completely inhibiting the development of the associated disease, pathological condition, or disorder
• supportive treatment that is, treatment employed to supplement another specific therapy directed toward the improvement of the associated disease, pathological condition, or disorder.
• treatment while intended to cure, ameliorate, stabilize, or prevent a disease, pathological condition, or disorder, need not actually result in the cure, amelioration, stabilization or prevention.
• the effects of treatment can be measured or assessed as described herein and as known in the art
• the term“in need of treatment” as used herein refers to a judgment made by a caregiver (e.g. physician, nurse, nurse practitioner, or individual in the case of humans; veterinarian in the case of animals, including non-human animals) that a subject requires or will benefit from treatment. This judgment is made based on a variety of factors that are in the realm of a caregiver’s experience, but that include the knowledge that the subject is ill, or will be ill, as the result of a condition that is treatable by the compositions and therapeutic agents described herein.
• a caregiver e.g. physician, nurse, nurse practitioner, or individual in the case of humans; veterinarian in the case of animals, including non-human animals
• the term“functional” or“functional SSADH enzyme” refers to an enzyme that functions normally, as opposed to an enzyme that originates from a gene with a mutation that renders the enzyme non-existent, deficient, defective or non-functional.
• a functional SSADH enzyme would be a fully operational enzyme, such as an enzyme found in a healthy individual harboring the wild type gene that codes for SSADH.
• Succinic semialdehyde dehydrogenase is an enzyme in the GABA degradation pathway that converts succinic semialdehyde into succinate, an essential component of the Krebs cycle.
• succinic semialdehyde SSA
• succinic semialdehyde SSA
• GHB gamma-hydroxybutyric dehydrogenase
• a“vector” is a tool that allows or facilitates the transfer of an entity from one environment to another. It is a replicon, such as a plasmid, phage, or cosmid, into which another DNA segment may be inserted so as to bring about the replication of the inserted segment. Generally, a vector is capable of replication when associated with the proper control elements.
• the term“vector” refers to a nucleic acid molecule capable of transporting another nucleic acid to which it has been linked.
• Vectors include, but are not limited to, nucleic acid molecules that are single-stranded, double-stranded, or partially double-stranded; nucleic acid molecules that comprise one or more free ends, no free ends (e.g. circular); nucleic acid molecules that comprise DNA, RNA, or both; and other varieties of polynucleotides known in the art.
• a“plasmid” refers to a circular double stranded DNA loop into which additional DNA segments can be inserted, such as by standard molecular cloning techniques.
• viral vector wherein virally-derived DNA or RNA sequences are present in the vector for packaging into a virus (e.g.
• Viral vectors also include polynucleotides carried by a virus for transfection into a host cell.
• Certain vectors are capable of autonomous replication in a host cell into which they are introduced (e.g. bacterial vectors having a bacterial origin of replication and episomal mammalian vectors).
• Other vectors e.g., non-episomal mammalian vectors are integrated into the genome of a host cell upon introduction into the host cell, and thereby are replicated along with the host genome.
• vectors are capable of directing the expression of genes to which they are operatively-linked. Such vectors are referred to herein as“expression vectors.”
• expression vectors Common expression vectors of utility in recombinant DNA techniques are often in the form of plasmids.
• Recombinant expression vectors can comprise a nucleic acid of the invention in a form suitable for expression of the nucleic acid in a host cell, which means that the recombinant expression vectors include one or more regulatory elements, which may be selected on the basis of the host cells to be used for expression, that is operably linked to the nucleic acid sequence to be expressed.
• the recombinant expression vectors include one or more regulatory elements, which may be selected on the basis of the host cells to be used for expression, that is operably linked to the nucleic acid sequence to be expressed.
• the vector may be a retroviral vector.
• Retroviral vectors may include, but are not necessarily limited to, lentiviral vectors.
• Lentiviruses are complex retroviruses that have the ability to infect and express their genes in both mitotic and post- mitotic cells.
• the most commonly known lentivirus is the human immunodeficiency virus (HIV), which uses the envelope glycoproteins of other viruses to target a broad range of cell types.
• HIV human immunodeficiency virus
• Lentiviruses may be prepared by any method known in the art.
• One exemplary method may include cloning the gene of interest into a plasmid which contains a lentiviral transfer plasmid backbone.
• OptiMEM serum-free
• Cells can be transfected with 10 pg of lentiviral transfer plasmid and the following packaging plasmids: 5 pg of pMD2.G (VSV-g pseudotype), and 7.5ug of psPAX2 (gag/pol/rev/tat). Transfection may be done in 4mL OptiMEM with a cationic lipid delivery agent (50uL Lipofectamine 2000 and lOOul Plus reagent). After 6 hours, the media can be changed to antibiotic-free DMEM with 10% fetal bovine serum. These methods use serum during cell culture, but serum-free methods are preferred.
• Lentivirus may be purified as follows. Viral supernatants can be harvested after 48 hours. Supernatants can first be cleared of debris and filtered through a 0.45um low protein binding (PVDF) filter. They are then spun in an ultracentrifuge for 2 hours at 24,000 rpm. Viral pellets are resuspended in 50ul of DMEM overnight at 4C. They are then aliquotted and immediately frozen at -80°C.
• PVDF 0.45um low protein binding
• minimal non-primate lentiviral vectors based on the equine infectious anemia virus are also contemplated, especially for ocular gene therapy (see, e.g., Balagaan, J Gene Med 2006; 8: 275 - 285).
• RetinoStat® an equine infectious anemia virus-based lentiviral gene therapy vector that expresses angiostatic proteins endostatin and angiostatin that is delivered via a subretinal injection for the treatment of the web form of age-related macular degeneration is also contemplated (see, e.g., Binley et al., HUMAN GENE THERAPY 23 :980-991 (September 2012)) and this vector may be modified as needed to be suitable for the present invention.
• self-inactivating lentiviral vectors with an siRNA targeting a common exon shared by HIV tat/rev, a nucleolar-localizing TAR decoy, and an anti-CCR5- specific hammerhead ribozyme may be used/and or adapted to the system of the present invention.
• a minimum of 2.5 x 106 CD34+ cells per kilogram patient weight may be collected and prestimulated for 16 to 20 hours in X- VIVO 15 medium (Lonza) containing 2 pmol/L-glutamine, stem cell factor (100 ng/ml), Flt-3 ligand (Flt-3L) (100 ng/ml), and thrombopoietin (10 ng/ml) (CellGenix) at a density of 2 x 106 cells/ml.
• Prestimulated cells may be transduced with lentiviral at a multiplicity of infection of 5 for 16 to 24 hours in 75-cm2 tissue culture flasks coated with fibronectin (25 mg/cm2) (RetroNectin,Takara Bio Inc.).
• Lentiviral vectors have been disclosed as in the treatment for Parkinson’s Disease, see, e.g., US Patent Publication No. 20120295960 and US Patent Nos. 7303910 and 7351585. Lentiviral vectors have also been disclosed for the treatment of ocular diseases, see e.g., US Patent Publication Nos. 20060281180, 20090007284, US20110117189; US20090017543; US20070054961, US20100317109. Lentiviral vectors have also been disclosed for delivery to the brain, see, e.g., US Patent Publication Nos. US20110293571; US20110293571, US20040013648, US20070025970, US20090111106 and US Patent No. US7259015.
• the targeting vector is a viral vector, such as including, but not necessarily limited to, a retroviral vector, adenoviral vector, or adeno-associated viral vector.
• the retroviral vector is a lentiviral vector.
• the route of administration, formulation and dose can be as in US Patent No. 8,454,972 and as in clinical trials involving adeno-associated viral vector.
• the route of administration, formulation and dose can be as in US Patent No. 8,404,658 and as in clinical trials involving adenovirus.
• the route of administration, formulation and dose can be as in US Patent No 5,846,946 and as in clinical studies involving plasmids. Doses may be based on or extrapolated to an average 70 kg individual (e.g. a male adult human), and can be adjusted for patients, subjects, mammals of different weight and species.
• Frequency of administration is within the ambit of the medical or veterinary practitioner (e.g., physician, veterinarian), depending on usual factors including the age, sex, general health, other conditions of the patient or subject and the particular condition or symptoms being addressed.
• the viral vectors can be injected into the tissue of interest.
• Cell-type specific expression can be driven by a cell-type specific promoter.
• liver-specific expression might use the Albumin promoter and neuron- specific expression (e.g. for targeting CNS disorders) might use the Synapsin I promoter.
• AAV In terms of in vivo delivery, AAV is advantageous over other viral vectors for a couple of reasons. It has low toxicity (this may be due to the purification method not requiring ultra centrifugation of cell particles that can activate the immune response) and it has a low probability of causing insertional mutagenesis because it doesn’t integrate into the host genome.
• the AAV can be AAV1, AAV2, AAV5 or any combination thereof.
• AAV8 is useful for delivery to the liver.
• a composition comprising a delivery particle formulation may be used.
• the delivery particle comprises a lipid-based particle, optionally a lipid nanoparticle, or cationic lipid and optionally biodegradable polymer.
• the cationic lipid comprises l,2-dioleoyl-3-trimethylammonium- propane (DOTAP).
• the hydrophilic polymer comprises ethylene glycol or polyethylene glycol.
• the delivery particle further comprises a lipoprotein, preferably cholesterol.
• the delivery particles are less than 500 nm in diameter, optionally less than 250 nm in diameter, optionally less than 100 nm in diameter, optionally about 35 nm to about 60 nm in diameter.
• a particle is defined as a small object that behaves as a whole unit with respect to its transport and properties. Particles are further classified according to diameter. Coarse particles cover a range between 2,500 and 10,000 nanometers. Fine particles are sized between 100 and 2,500 nanometers. Ultrafme particles, or nanoparticles, are generally between 1 and 100 nanometers in size. The basis of the lOO-nm limit is the fact that novel properties that differentiate particles from the bulk material typically develop at a critical length scale of under 100 nm.
• a particle delivery system/formulation is defined as any biological delivery system/formulation which includes a particle in accordance with the present invention.
• a particle in accordance with the present invention is any entity having a greatest dimension (e.g. diameter) of less than 100 microns (pm).
• inventive particles have a greatest dimension of less than 10 m m.
• inventive particles have a greatest dimension of less than 2000 nanometers (nm).
• inventive particles have a greatest dimension of less than 1000 nanometers (nm).
• inventive particles have a greatest dimension of less than 900 nm, 800 nm, 700 nm, 600 nm, 500 nm, 400 nm, 300 nm, 200 nm, or 100 nm.
• inventive particles have a greatest dimension (e.g., diameter) of 500 nm or less.
• inventive particles have a greatest dimension (e.g., diameter) of 250 nm or less.
• inventive particles have a greatest dimension (e.g., diameter) of 200 nm or less.
• inventive particles have a greatest dimension (e.g., diameter) of 150 nm or less.
• inventive particles have a greatest dimension (e.g., diameter) of 100 nm or less. Smaller particles, e.g., having a greatest dimension of 50 nm or less are used in some embodiments of the invention. In some embodiments, inventive particles have a greatest dimension ranging between 25 nm and 200 nm.
• nanoparticle refers to any particle having a diameter of less than 1000 nm.
• nanoparticles of the invention have a greatest dimension (e.g., diameter) of 500 nm or less.
• nanoparticles of the invention have a greatest dimension ranging between 25 nm and 200 nm.
• nanoparticles of the invention have a greatest dimension of 100 nm or less.
• nanoparticles of the invention have a greatest dimension ranging between 35 nm and 60 nm. It will be appreciated that reference made herein to particles or nanoparticles can be interchangeable, where appropriate.
• Nanoparticles encompassed in the present invention may be provided in different forms, e.g., as solid nanoparticles (e.g., metal such as silver, gold, iron, titanium), non-metal, lipid-based solids, polymers), suspensions of nanoparticles, or combinations thereof.
• Metal, dielectric, and semiconductor nanoparticles may be prepared, as well as hybrid structures (e.g., core-shell nanoparticles).
• Nanoparticles made of semiconducting material may also be labeled quantum dots if they are small enough (typically sub 10 nm) that quantization of electronic energy levels occurs. Such nanoscale particles are used in biomedical applications as drug carriers or imaging agents and may be adapted for similar purposes in the present invention.
• Nanoparticles with one half hydrophilic and the other half hydrophobic are termed Janus particles and are particularly effective for stabilizing emulsions. They can self- assemble at water/oil interfaces and act as solid surfactants.
• Particle characterization is done using a variety of different techniques. Common techniques are electron microscopy (TEM, SEM), atomic force microscopy (AFM), dynamic light scattering (DLS), X-ray photoelectron spectroscopy (XPS), powder X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF), ultraviolet-visible spectroscopy, dual polarization interferometry and nuclear magnetic resonance (NMR).
• TEM electron microscopy
• AFM atomic force microscopy
• DLS dynamic light scattering
• XPS X-ray photoelectron spectroscopy
• XRD powder X-ray diffraction
• FTIR Fourier transform infrared spectroscopy
• MALDI-TOF matrix-assisted laser desorption/ionization time-of-flight mass spectrometry
• Characterization may be made as to native particles (i.e., preloading) or after loading of the cargo (herein cargo refers to e.g., a gene encoding a functional SSADH enzyme, a drug, or any combination thereof, and may include additional carriers and/or excipients) to provide particles of an optimal size for delivery for any in vitro, ex vivo and/or in vivo application of the present invention.
• particle dimension (e.g., diameter) characterization is based on measurements using dynamic laser scattering (DLS).
• DLS dynamic laser scattering
• Particles delivery systems within the scope of the present invention may be provided in any form, including but not limited to solid, semi-solid, emulsion, or colloidal particles.
• any of the delivery systems described herein including but not limited to, e.g., lipid-based systems, liposomes, micelles, microvesicles, exosomes, or gene gun may be provided as particle delivery systems within the scope of the present invention.
• lipid nanoparticles are contemplated.
• An antitransthyretin small interfering RNA has been encapsulated in lipid nanoparticles and delivered to humans (see, e.g., Coelho et al., N Engl J Med 2013;369:819-29), and such a system may be adapted and applied to the system of the present invention.
• Doses of about 0.01 to about 1 mg per kg of body weight administered intravenously are contemplated.
• Medications to reduce the risk of infusion-related reactions are contemplated, such as dexamethasone, acetampinophen, diphenhydramine or cetirizine, and ranitidine are contemplated.
• Multiple doses of about 0.3 mg per kilogram every 4 weeks for five doses are also contemplated.
• Zhu et al. (US20140348900) provides for a process for preparing liposomes, lipid discs, and other lipid nanoparticles using a multi-port manifold, wherein the lipid solution stream, containing an organic solvent, is mixed with two or more streams of aqueous solution (e.g., buffer).
• aqueous solution e.g., buffer
• at least some of the streams of the lipid and aqueous solutions are not directly opposite of each other.
• the process does not require dilution of the organic solvent as an additional step.
• one of the solutions may also contain an active pharmaceutical ingredient (API).
• API active pharmaceutical ingredient
• This invention provides a robust process of liposome manufacturing with different lipid formulations and different payloads. Particle size, morphology, and the manufacturing scale can be controlled by altering the port size and number of the manifold ports, and by selecting the flow rate or flow velocity of the lipid and aqueous solutions.
• US Patent No. 8,709,843 incorporated herein by reference, provides a drug delivery system for targeted delivery of therapeutic agent-containing particles to tissues, cells, and intracellular compartments.
• the invention provides targeted particles comprising polymer conjugated to a surfactant, hydrophilic polymer or lipid.
• the lipid or lipid-like compounds described above include the compounds themselves, as well as their salts and solvates, if applicable.
• a salt for example, can be formed between an anion and a positively charged group (e.g., amino) on a lipid-like compound.
• Suitable anions include chloride, bromide, iodide, sulfate, nitrate, phosphate, citrate, methanesulfonate, trifluoroacetate, acetate, malate, tosylate, tartrate, fumurate, glutamate, glucuronate, lactate, glutarate, and maleate.
• a salt can also be formed between a cation and a negatively charged group (e.g., carboxylate) on a lipid-like compound.
• Suitable cations include sodium ion, potassium ion, magnesium ion, calcium ion, and an ammonium cation such as tetramethylammonium ion.
• the lipid-like compounds also include those salts containing quaternary nitrogen atoms.
• a solvate refers to a complex formed between a lipid- like compound and a pharmaceutically acceptable solvent. Examples of pharmaceutically acceptable solvents include water, ethanol, isopropanol, ethyl acetate, acetic acid, and ethanolamine.
• Liposomes are spherical vesicle structures composed of a uni- or multilamellar lipid bilayer surrounding internal aqueous compartments and a relatively impermeable outer lipophilic phospholipid bilayer. Liposomes have gained considerable attention as drug delivery carriers because they are biocompatible, nontoxic, can deliver both hydrophilic and lipophilic drug molecules, protect their cargo from degradation by plasma enzymes, and transport their load across biological membranes and the blood brain barrier (BBB) (see, e.g., Spuch and Navarro, Journal of Drug Delivery, vol. 2011, Article ID 469679, 12 pages, 2011. doi: 10.1155/2011/469679 for review).
• BBB blood brain barrier
• Liposomes can be made from several different types of lipids; however, phospholipids are most commonly used to generate liposomes as drug carriers. Although liposome formation is spontaneous when a lipid film is mixed with an aqueous solution, it can also be expedited by applying force in the form of shaking by using a homogenizer, sonicator, or an extrusion apparatus (see, e.g., Spuch and Navarro, Journal of Drug Delivery, vol. 2011, Article ID 469679, 12 pages, 2011. doi: 10.1155/2011/469679 for review).
• liposomes may be added to liposomes in order to modify their structure and properties.
• either cholesterol or sphingomyelin may be added to the liposomal mixture in order to help stabilize the liposomal structure and to prevent the leakage of the liposomal inner cargo.
• liposomes are prepared from hydrogenated egg phosphatidylcholine or egg phosphatidylcholine, cholesterol, and dicetyl phosphate, and their mean vesicle sizes were adjusted to about 50 and 100 nm. (see, e.g., Spuch and Navarro, Journal of Drug Delivery, vol. 2011, Article ID 469679, 12 pages, 2011. doi: 10.1155/2011/469679 for review).
• a liposome formulation may be mainly comprised of natural phospholipids and lipids such as l,2-distearoryl-sn-glycero-3 -phosphatidyl choline (DSPC), sphingomyelin, egg phosphatidylcholines and monosialoganglioside. Since this formulation is made up of phospholipids only, liposomal formulations have encountered many challenges, one of the ones being the instability in plasma. Several attempts to overcome these challenges have been made, specifically in the manipulation of the lipid membrane. One of these attempts focused on the manipulation of cholesterol.
• DSPC l,2-distearoryl-sn-glycero-3 -phosphatidyl choline
• sphingomyelin sphingomyelin
• egg phosphatidylcholines monosialoganglioside.
• Specific targeting vectors can be developed that target antigens on specific cells. Upon local or systemic introduction, these vectors can circulate and home to specific cells. Targeting of specific cells and tissues would greatly enhance the safety of gene therapeutic applications. Inappropriate expression due to inadvertent infection of irrelevant cells or tissues is one cause for concern in gene therapy applications. Accordingly, targeting to specific cells would lessen the possibility of adverse side effects.
• such target cells may include, but are not necessarily limited to, liver cells, lymph, blood, plasma, cerebrospinal fluid, pancreas, nephron, glial cells, astroglia, oligodendrocytes, neurons, astrocytes, hepatocytes, white blood cells, monocytes, leukocytes, spleen, platelets, gonads, ovaries, eye, retinal pigment epithelia, amacrine cells, bipolar cells, vitreous humor, aqueous humor, retina, lens.
• the target cells are liver cells.
• “operably linked” is intended to mean that the nucleotide sequence or gene of interest is linked or complexed to the regulatory element(s) or to the targeting vector in a manner that allows for expression of the nucleotide sequence or gene (e.g., in an in vitro transcription/translation system or in a host cell when the vector is introduced into the host cell).
• the invention comprises a composition for treating SSADHD comprising a gene encoding a functional SSADH enzyme operably linked to a targeting vector.
• the gene may be ALDH5A1.
• the ALDH5A1 gene belongs to the aldehyde dehydrogenase family of proteins.
• the gene encodes a mitochondrial NAD + -dependent succinic semialdehyde dehydrogenase (SSADH).
• SSADH mitochondrial NAD + -dependent succinic semialdehyde dehydrogenase
• SSADH mitochondrial NAD + -dependent succinic semialdehyde dehydrogenase
• SSADH mitochondrial NAD + -dependent succinic semialdehyde dehydrogenase
• ALDH5A1 may be produced in bacterial cell lines, as described in the examples. In some embodiments, ALDH5A1 may be produced in a number of bacterial and mammalian cells, including, but not necessarily limited to, HEK, yeast, and CHO cells.
• a functional SSADH enzyme may lead to lower levels of circulating metabolites.
• circulation metabolites may include, but are not necessarily limited to, GHB and GABA.
• a functional SSADH enzyme lowers the levels of circulating GHB and GABA.
• the composition does not cross the blood brain barrier.
• the blood brain barrier is a highly selective semipermeable border that separates the circulating blood from the brain and extracellular fluid in the central nervous system.
• the blood brain barrier is formed by endothelial cells of the capillary wall, astrocyte end-feet ensheathing the capillary, and pericytes embedded in the capillary basement membrane. This allows the passage of water, some gases, and lipid-soluble molecules by passive diffusion, as well as the selective transport of molecules such as glucose and amino acids that are crucial to neuron function.
• the blood brain barrier restricts the diffusion of solutes in the blood (e.g.
• to“treat” means to cure, ameliorate, stabilize, prevent, or reduce the severity of at least one symptom or a disease, pathological condition, or disorder.
• the subject has SSADHD.
• the subject has increased circulating levels of metabolites.
• the terms “high,” “higher,” “increased,”“elevated,” or“elevation” refer to increases above basal levels, e.g., as compared to a control.
• the terms“low,”“lower,”“reduced,” or“reduction refer to decreases below basal levels, e.g., as compared to a control.
• control refers to any reference standard suitable to provide a comparison to the expression products in the test sample.
• the control comprises obtaining a“control sample” from which expression product levels are detected and compared to the expression product levels from the test sample.
• a control sample may comprise any suitable sample, including but not limited to a sample from a control patient (can be stored sample or previous sample measurement) with a known outcome; normal tissue, fluid, or cells isolated from a subject, such as a normal patient or the patient having a condition of interest.
• the term“altered amount” or“altered level” refers to increased or decreased copy number (e.g., germline and/or somatic) of a metabolite or biomarker nucleic acid, as compared to the expression level or copy number of the metabolite or biomarker nucleic acid in a control sample.
• the term“altered amount” of a biomarker also includes an increased or decreased protein level of a biomarker protein in a sample, as compared to the corresponding protein level in a normal, control sample.
• an altered amount of a biomarker protein may be determined by detecting posttranslational modification such as methylation status of the marker, which may affect the expression or activity of the biomarker protein.
• the amount of a metabolite or biomarker in a subject is“significantly” higher or lower than the normal amount of the metabolite or biomarker, if the amount of the biomarker is greater or less, respectively, than the normal or control level by an amount greater than the standard error of the assay employed to assess amount, and preferably at least 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, 150%, 200%, 300%, 350%, 400%, 500%, 600%, 700%, 800%, 900%, 1000% or than that amount.
• the amount of the biomarker in the subject can be considered“significantly” higher or lower than the normal and/or control amount if the amount is at least about two, and preferably at least about 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 95%, 100%, 105%, 110%, 115%, 120%, 125%, 130%, 135%, 140%, 145%, 150%, 155%, 160%, 165%, 170%, 175%, 180%, 185%, 190%, 195%, two times, three times, four times, five times, or more, or any range in between, such as 5%-l00%, higher or lower, respectively, than the normal and/or control amount of the biomarker.
• Such significant modulation values can be applied to any metric described herein, such as altered level of expression, altered activity, changes in cancer cell hyperproliferative growth, changes in cancer cell death, changes in biomarker inhibition, changes in
• the term“altered level of expression” of a marker refers to an expression level or copy number of a marker in a test sample e.g., a sample derived from a subject suffering from cancer, that is greater or less than the standard error of the assay employed to assess expression or copy number, and is preferably at least twice, and more preferably three, four, five or ten or more times the expression level or copy number of the marker or chromosomal region in a control sample (e.g., sample from a healthy subject not having the associated disease) and preferably, the average expression level or copy number of the marker or chromosomal region in several control samples.
• a test sample e.g., a sample derived from a subject suffering from cancer
• a control sample e.g., sample from a healthy subject not having the associated disease
• the altered level of expression is greater or less than the standard error of the assay employed to assess expression or copy number, and is preferably at least twice, and more preferably three, four, five or ten or more times the expression level or copy number of the marker in a control sample (e.g., sample from a healthy subject not having the associated disease) and preferably, the average expression level or copy number of the marker in several control samples.
• a control sample e.g., sample from a healthy subject not having the associated disease
• altered activity of a marker refers to an activity of a marker which is increased or decreased in a disease state, e.g., in a cancer sample, as compared to the activity of the marker in a normal, control sample.
• Altered activity of a marker may be the result of, for example, altered expression of the marker, altered protein level of the marker, altered structure of the marker, or, e.g., an altered interaction with other proteins involved in the same or different pathway as the marker, or altered interaction with transcriptional activators or inhibitors.
• The“amount” of a metabolite or marker e.g., expression or copy number of a metabolite or marker, or protein level of a marker, in a subject is“significantly” higher or lower than the normal amount of a marker, if the amount of the marker is greater or less, respectively, than the normal level by an amount greater than the standard error of the assay employed to assess amount, and preferably at least twice, and more preferably three, four, five, ten or more times that amount.
• the amount of the marker in the subject can be considered “significantly” higher or lower than the normal amount if the amount is at least about two, and preferably at least about three, four, or five times, higher or lower, respectively, than the normal amount of the marker.
• the subject has increased levels of circulating metabolites.
• metabolites may include alcohols, amino acids, nucleotides, antioxidants, organic acids, polyols, and vitamins.
• the metabolites described herein include, but are not necessarily limited to, GHB, GABA, or both.
• subjects with a SSADHD condition exhibit increased, or higher than normal circulating levels of GHB, GABA, or both.
• the vector e.g., plasmid or viral vector is delivered to the tissue of interest by, for example intravenous, intradermal, transdermal, subcutaneous, intramuscular, intraperitoneal, intrarectal, intraarterial, intralymphatic, intrathecal, intratracheal, intranasal, oral, mucosal, or other delivery methods.
• the method of delivery may depend on whether local or systemic treatment is desired, and on the area to be treated.
• Parenteral administration, if used, is generally characterized by injection.
• Injectables can be prepared in conventional forms, either as liquid solutions or suspensions, solid forms suitable for solution or suspension in liquid prior to injection, or as emulsions.
• Such delivery may be either via a single dose, or multiple doses.
• the actual dosage to be delivered herein may vary greatly depending upon a variety of factors, such as the vector choice, the target cell, organism, or tissue, the general condition of the subject to be treated, the degree of transformation/modification sought, the administration route, the administration mode, the type of transformation/modification sought, etc.
• Such a dosage may further contain, for example, a carrier (water, saline, ethanol, glycerol, lactose, sucrose, calcium phosphate, gelatin, dextran, agar, pectin, peanut oil, sesame oil, etc.), a diluent, a pharmaceutically-acceptable carrier (e.g., phosphate-buffered saline), a pharmaceutically-acceptable excipient, and/or other compounds known in the art.
• a carrier water, saline, ethanol, glycerol, lactose, sucrose, calcium phosphate, gelatin, dextran, agar, pectin, peanut oil, sesame oil, etc.
• a pharmaceutically-acceptable carrier e.g., phosphate-buffered saline
• a pharmaceutically-acceptable excipient e.g., phosphate-buffered saline
• the dosage may further contain one or more pharmaceutically acceptable salts such as, for example, a mineral acid salt such as a hydrochloride, a hydrobromide, a phosphate, a sulfate, etc.; and the salts of organic acids such as acetates, propionates, malonates, benzoates, etc.
• auxiliary substances such as wetting or emulsifying agents, pH buffering substances, gels or gelling materials, flavorings, colorants, microspheres, polymers, suspension agents, etc. may also be present herein.
• Suitable exemplary ingredients include microcrystalline cellulose, carboxymethylcellulose sodium, polysorbate 80, phenylethyl alcohol, chlorobutanol, potassium sorbate, sorbic acid, sulfur dioxide, propyl gallate, the parabens, ethyl vanillin, glycerin, phenol, parachlorophenol, gelatin, albumin and a combination thereof.
• the delivery is via an adenovirus, which may be at a single booster dose containing at least 1 x 105 particles (also referred to as particle units, pu) of adenoviral vector.
• the dose preferably is at least about 1 x 106 particles (for example, about 1 x 106-1 x 1012 particles), more preferably at least about 1 x
• 107 particles more preferably at least about 1 x 108 particles (e.g., about 1 x 108-1 x 1011 particles or about 1 x 108-1 x 1012 particles), and most preferably at least about 1 x 100 particles (e.g., about 1 x 109-1 x 1010 particles or about 1 x 109-1 x 1012 particles), or even at least about 1 x 1010 particles (e.g., about 1 x 1010-1 x 1012 particles) of the adenoviral vector.
• 1 x 108 particles e.g., about 1 x 108-1 x 1011 particles or about 1 x 108-1 x 1012 particles
• 1 x 100 particles e.g., about 1 x 109-1 x 1010 particles or about 1 x 109-1 x 1012 particles
• 1 x 1010 particles e.g., about 1 x 1010-1 x 1012 particles
• the dose comprises no more than about 1 x 1014 particles, preferably no more than about 1 x 1013 particles, even more preferably no more than about 1 x 1012 particles, even more preferably no more than about 1 x 1011 particles, and most preferably no more than about 1 x 1010 particles (e.g., no more than about 1 x 109 articles).
• the dose may contain a single dose of adenoviral vector with, for example, about 1 x 106 particle units (pu), about 2 x 106 pu, about 4 x 106 pu, about 1 x 107 pu, about 2 x 107 pu, about 4 x 107 pu, about 1 x
• the adenovirus is delivered via multiple doses.
• the delivery is via an AAV.
• a therapeutically effective dosage for in vivo delivery of the AAV to a human is believed to be in the range of from about 20 to about 50 ml of saline solution containing from about 1 x 1010 to about 1 x 1010 functional AAV/ml solution. The dosage may be adjusted to balance the therapeutic benefit against any side effects.
• the AAV dose is generally in the range of concentrations of from about 1 x 105 to 1 x 1050 genomes AAV, from about 1 x 108 to 1 x 1020 genomes AAV, from about 1 x 1010 to about 1 x 1016 genomes, or about 1 x 1011 to about 1 x 1016 genomes AAV.
• a human dosage may be about 1 x 1013 genomes AAV. Such concentrations may be delivered in from about 0.001 ml to about 100 ml, about 0.05 to about 50 ml, or about 10 to about 25 ml of a carrier solution. Other effective dosages can be readily established by one of ordinary skill in the art through routine trials establishing dose response curves. See, for example, U.S. Patent No. 8,404,658 B2 to Hajjar, et al., granted on March 26, 2013, at col. 27, lines 45-60.
• the delivery is via a plasmid.
• the dosage should be a sufficient amount of plasmid to elicit a response.
• suitable quantities of plasmid DNA in plasmid compositions can be from about 0.1 to about 2 mg, or from about 1 pg to about 10 pg per 70 kg individual.
• mice used in experiments are typically about 20 g and from mice experiments one can scale up to a 70 kg individual.
• the dosage used for the compositions provided herein include dosages for repeated administration or repeat dosing.
• the administration is repeated within a period of several weeks, months, or years. Suitable assays can be performed to obtain an optimal dosage regime. Repeated administration can allow the use of lower dosage, which can positively affect off-target modifications.
• the term “effective amount” or “therapeutically effective amount” of a compound, composition, or drug as provided herein is meant a nontoxic but sufficient amount of the composition to provide the desired result.
• the exact amount required will vary from subject to subject, depending on the species, age, and general condition of the subject, the severity of the disease that is being treated, the particular composition used, its mode of administration, and the like. Thus, it is not possible to specify and exact“effective amount.” However, an appropriate effective amount can be determined by one of ordinary skill in the art using only routine experimentation.
• the therapeutically effective amount comprises a range of 1- 10,000 pg functional SSADH enzyme per kg of body weight per day.
• the composition may be administered once per week, bi-weekly, or once a month.
• the invention comprises a method of treating SSADHD in a subject in need thereof, comprising administering to the subject therapeutically effective amounts of a composition comprising a gene encoding a functional SSADH enzyme operably linked to a targeting vector as described herein, and one or more mTOR inhibitors, a GABA- T inhibitor, or a combination thereof.
• mTOR (mammalian target of rapamycin) is a kinase that is a member of the phosphatidylinositol 3 -kinase-related kinase family of protein kinases. mTOR links with other proteins and serves as a core component of two distinct protein complexes, mTOR complex 1 and mTOR complex 2, which regulate different cellular processes. In particular, as a core component of both complexes, mTOR functions as a serine/threonine protein kinase that regulates cell growth, cell proliferation, cell motility, cell survival, protein synthesis, autophagy, and transcription. mTOR inhibitors are a class of drugs that inhibit the mTOR kinase.
• the term“inhibit” or“downregulate” includes the decrease, limitation, or blockage, of, for example a particular action, function, or interaction.
• a biological function such as the function of a protein, is inhibited if it is decreased as compared to a reference state, such as a control like a wild-type state.
• Such inhibition or deficiency can be induced, such as by application of agent at a particular time and/or place, or can be constitutive, such as by a heritable mutation.
• Such inhibition or deficiency can also be partial or complete ( e.g ., essentially no measurable activity in comparison to a reference state, such as a control like a wild-type state). Essentially complete inhibition or deficiency is referred to as blocked.
• the term“promote” or“upregulate” has the opposite meaning.
• Exemplary mTOR inhibitors include, but are not necessarily limited to a class of drugs known as rapalogs.
• Rapalogs include, but are not necessarily limited to rapamycin and its analogs, such as sirolimus, temsirolimus, everolimus, and ridaforolimus.
• the preferred rapalog is rapamycin.
• mTOR inhibitors may comprise Torin 1 and Torin 2.
• GABA-T GABA transaminase
• a GABA-T inhibitor is an enzyme inhibitor that acts upon GABA-T, inhibiting its function.
• GABA-T inhibitors include, but are not necessarily limited to, valproic acid, vigabatrin, phenylethylidenehydrazine, ethanolamine-O-sulfate (EOS), and L- cycloserine.
• the preferred GABA-T inhibitor is vigabatrin.
• combination therapies may comprise the administration of therapeutically effective amounts of a composition comprising a gene encoding a functional SSADH enzyme operably linked to a targeting vector, Torin 2, and Vigabatrin.
• mTOR inhibitor and/or GABA-T inhibitor may be administered in doses ranging from 1-25 pg per kg of body weight per day. In some embodiments, the mTOR inhibitor and/or GABA-T inhibitor may be administered two times a day. In some embodiments, the mTOR inhibitor and/or GABA-T inhibitor may be administered three times a day.
• the invention comprises methods of treating SSADHD in a subject in need thereof, comprising administering a therapeutically effective amount of Na-K-Cl cotransporter 1 (NKCC1) inhibitor to the subject.
• NKCC1 Na-K-Cl cotransporter 1
• NKCC proteins are membrane transport proteins that transport sodium, potassium, and chloride ions across the cell membrane. Because they move each solute in the same direction, NKCC proteins are considered symporters. They maintain electroneutrality by moving two positively charged solutes (sodium and potassium) alongside two parts of a negatively charged solute (chloride). NKCC1 is widely distributed throughout the human body, especially in organs that secrete fluids, called exocrine glands.
• NKCC1 is also expressed in many regions of the brain during early development, but not in adulthood. This change in NKCC1 presence seems to be responsible for altering responses to the neurotransmitters GABA and glycine from excitatory to inhibitory, which was suggested to be important for early neuronal development. As long as NKCC1 transporters are predominantly active, internal chloride concentrations in neurons is raised in comparison with mature chloride concentrations, which is important for GABA and glycine responses, as respective ligand-gated anion channels are permeable to chloride. With higher internal chloride concentrations, outward driving force for this ions increases, and thus channel opening leads to chloride leaving the cell, thereby depolarizing it.
• NKCC1 NKCC1
• KCC2 K-Cl cotransporter a KCC2 K-Cl cotransporter
• SSADHD may be treated by administering a therapeutically effective amount of an NKCC1 inhibitor to a subject in need thereof.
• Suitable NKCC1 inhibitors include, but are not necessarily limited to, bumetanide, allopregnanolone, pregnanolone, progesterone, gaboxadol, etifoxine, XBD-173, FG-7142, gabazine, isoniazid, encenicline, and AVL-3288.
• the NKCC1 inhibitor is bumetanide.
• NCS-382 is a putative GHB receptor (GHBR) antagonist with a Ki 14 times lower than that of GHB (Fig. 1) (Maitre Prog Neurobiol 51 :337-361 (1997); Vogensen et al. J Med Chem 56:8201-8205 (2013)), and may be the only known antagonist of GHBRs (Bay et al. Biochem Pharmacol 87:220-228 (2014)), whose molecular structure(s) remain undefined. NCS-382 was effective in rescuing aldh5al -/- mice from premature lethality and in blocking the motor deficits induced by the GHB prodrug, gamma-butyrolactone (GBL) (Ainslie et al.
• GHB gamma-butyrolactone
• NCS-382 exists as a racemic mixture (hydroxyl-carbon; Fig. 1). The R-isomer is twice as potent as the racemic mixture, and 13 -fold more potent than the S-enantiomer (Castelli et al. CNS Drug Rev 10:243-260 (2004)).
• NCS-382 Limited earlier studies on the pharmacodynamic characteristics of NCS-382 were performed in baboon and pigeon, and were designed to exploit antagonist specificity for the GHBR in order to interrogate the central effects of GHB (Quang et al. Life Sci 71 :771-778 (2002); Castelli et al. J Neurochem 87:722-732 (2003); Castelli et al. CNS Drug Rev 10:243- 260 (2004)). Applicants obtained detailed pharmacokinetic measures following i.p. administration of NCS-382 (100 to 500 mg/kg) in C57/B6 mice (Ainslie et al. Pharmacol Res Perspect 4:e00265 (2016)).
• the plasma elimination tl/2 for NCS-382 ranged from 0.25-0.68 h in a dose-dependent fashion. Brain residence for NCS-382 was longer, with tl/2 ranging from 0.76-0.97 h, and decreasing with increasing dose. The brain-to-plasma ratio based on area under the concentration-time curves (AUCs) ranged from 0.72-1.8. The trend for decreased brain tl/2 with increasing dose may reflect saturation of central GHB binding sites, leaving more unbound NCS-382 for return to the systemic circulation.
• NCS-382 The fraction of total NCS-382 dose recovered in the urine was low ( ⁇ 4%), and undetectable in the feces ( ⁇ 150 ng/mg feces), suggesting metabolism as the primary route of elimination featuring glucuronidation (major product) and dehydrogenation (minor product) at the hydroxyl-moiety (Fig. 1).
• the intrinsic clearance of NCS-382 (Clint) in the presence of NADPH and assessed by monitoring parent disappearance was 0.587 and 0.513 mL/min/mg protein in mouse and human liver microsomes (MLMs, HLMs), respectively. Calculated murine and human hepatic clearances were 5.2 and 1.2 L/h/kg body weight, respectively.
• the Michaelis constant (Km) for dehydrogenation was 29.5 ⁇ 10 and 12.7 ⁇ 4.9 mM in mouse and human, respectively.
• Glucuronide formation was linear in both species up to 100 mM.
• UGT2B7 uridine 5'-diphosphoglucuronosyltransferase; UDP-glucuronosyltransferase 2B7 was suspected as the primary isoform of glucuronidating enzymes responsible for NCS-382 metabolism, based upon competition studies with the UGT2B7 inhibitor, diclofenac (Ainslie et al. Pharmacol Res Perspect 4:e00265 (2016)).
• NCS-382 The identity of drug metabolizing enzymes active in the biotransformation(s) of NCS-382 also has not been reported, nor has the ability of NCS-382 to inhibit the typical enzymes, namely cytochrome P450s (CYP), involved in the metabolism of drugs. Accordingly, Applicants employed HLMs and FDA-recommended probe substrates in reactions catalyzed by seven CYP isoforms (CYP I A2, 2B6, 2C8, 2C9, 2C19, 2D6 and 3A4) (Vogel et al. Toxicol In Vitro 40: 196-202 (2017)). NCS-382 did not inhibit any of the tested enzymes at the highest tested dose (30 pM).
• NCS-382 manifested minimal capacity to induce nuclear receptors involved in drug biotransformation and transport (aryl hydrocarbon, constitutive androstane, and pregnane X receptors) at supraphysiological doses (up to 500 mM).
• NCS-382 demonstrated only minimal pharmacotoxicity in neural stem cells (NSCs, or neuronal progenitor cells) derived from aldh5al-/- mice (e.g., aldh5aJ-/- NSCs) (Vogel et al. Toxicol In Vitro 46:203-212 (2017)). These cells were developed as an in vitro model of SSADHD, showing increased GHB content in culture medium, enhanced biomarkers of oxidative stress and increased mitochondrial number and highlighting the utility of NSCs as a useful preclinical screening tool for evaluating therapeutics for SSADHD (Vogel et al. PLoS One !2(l0):e0l869l9 (2017)). In sum, although a number of additional studies will be needed, pilot pharmacokinetic/safety/toxicological evaluations support the potential for clinical application of NCS-382 in SSADHD.
• NCS-382 Applicants subsequently turned attention to the transport of NCS-382 in vitro.
• the objective here was to investigate the potential ofNCS-382 to block uptake of GHB.
• MDCK Madin-Darby Canine Kidney
• NCS-382 may only be modestly beneficial since brain GHB levels do not appear to be modified with chronic treatment.
• Applicants examined cortical regions from the NCS-treated mice and evaluated the expression of a number of solute carriers involved in neurotransmitter transport. As shown in Fig. 2., Applicants found essentially all of these transporters down-regulated in aldh5al-/- cortex in the absence of treatment.
• NCS-382 normalized the aberrant expression of seven of these carriers, including both glutamate and GABA transporters, had no effect on six and actually induced significant down-regulation of the glutamate-cystine antiporter.
• ERT enzyme replacement therapy
• coli were harvested that had been transfected and grown in standard LB broth supplemented with ampicillin at 37°C overnight, pelleted and lysed with Pefabloc (protease inhibitor; Sigma-Aldrich, St. Louis, MO USA) and lysozyme.
• Pefabloc prote inhibitor; Sigma-Aldrich, St. Louis, MO USA
• GST- hSSADH resident in crude lysates of E. Coli was purified using PierceTM GST spin purification kits, followed by dialysis and subsequent concentration using polyethersulfone (PES) columns. Resultant protein content was quantified using a standard BCA protein assay.
• the GST-tagged enzyme activity was cleaved with thrombin and the activity of ALDH5A1 determined employing spectrofluorometry based on the NAD/NADH couple (Gibson et al. Clin Chim Acta 196:219-221 (1991)).
• Example 3 The Paradox of Seizures in a SSADHD, a HyperGABAergic Disorder
• Chloride directional flux through the GABAA receptor in mammalian brain is regulated by the transmembrane chloride gradient which is itself controlled primarily by two transporters, the sodium -potassium-chloride symporter (NKCC1) and the potassium-chloride cotransporter (KCC2) (Fig. 5A) (Kilb Neuroscientist 18:613-630 (2012)).
• NKCC1 sodium -potassium-chloride symporter
• KCC2 potassium-chloride cotransporter
• Activation of the GABAA receptor when the activity of NKCC1 is increased and intracellular chloride concentrations are elevated results in chloride efflux, plasma membrane depolarization and paradoxical neurotransmission activation.
• NKCC1 was highly overexpressed in aldh5al-/- brain (Fig. 5B).
• the NKCC1 to KCC2 ratio was significantly increased, suggesting that intracellular chloride concentrations might be increased in the aldh5al-/- brain, favoring a depolarizing and excitatory activity as the predominant role for GABAA receptors. This remains to be quantitatively evaluated employing neurophysiological assessments in vitro via patch-clamp methodology, or perhaps in vivo using two-photon measurement with chloride ion probes.
• NKCC1 inhibition in SSADHD was next examined.
• Bumetanide is a known inhibitor of both NKCC1 and 2 originally approved for edema but with demonstrated antiepileptic efficacy in several neurological/epileptic disorders despite poor brain penetration (Levy et al.
• Example 4 - GABA and mTOR Treatment Strategies and Pathophysiological insights in SSADHD
• Torin 2 Automatically detected events were verified by visual inspection (Dhamne et al. Mol Autism 8:26 (2017)). Our prediction was that Torin 2 administration would lead to improvement in both parameters. Applicants found that Torin 2 was ineffective at reducing seizure frequency in aldh5al-/- mice (Table 2), and unexpectedly found that it significantly extended the total ictal time (Table 2). It is of interest that Torin 2 corrected (up- regulated) a number of GABA(A)ergic receptor subunits (Vogel et al. J Inherit Metab Dis 39:877-886 (2016)).
• Vigabatrin (VGB)-treated mice represent a drug-induced form of GABA- transaminase deficiency, since VGB irreversibly inhibits this first enzyme of GABA metabolism (Fig. 1).
• VGB significantly elevated GABA in the CNS can be achieved at relatively low daily doses (-10 mg/kg), or via chronic subcutaneous delivery with calibrated osmotic minipumps (Vogel et al. J Inherit Metab Dis 39:877-886 (2016); Vogel et al. Toxicol In Vitro 40: 196-202 (2017)).
• mTOR coordinates numerous intracellular bioenergetic cues that serve to control growth and catabolism (i.e. translation, autophagy) (Fig. 6).
• Prkagl was down-regulated in brain of both models (Vogel et al. Toxicol In Vitro 40: 196-202 (2017); Vogel et al. Pediatr Neurol 66:44-52. el . (2017)).
• Prkagl is a gamma regulatory subunit of the heterotrimeric AMP- activated protein kinase (AMPK), which also contains an alpha catalytic subunit and a non- catalytic beta subunit (Fig. 6).
• AMPK AMP- activated protein kinase
• AMPK is an important energy-sensing enzyme that monitors cellular energy status. In response to cellular metabolic stresses, AMPK is activated, and thus phosphorylates and inactivates acetyl-CoA carboxylase (ACC) and 3 -hydroxy 3- methylglutaryl-CoA reductase (HMGCR), key enzymes involved in regulating de novo biosynthesis of fatty acid and cholesterol. AMPK acts via direct phosphorylation of metabolic enzymes; and acts longer-term via phosphorylation of transcription regulators. During low energy conditions AMPK is a critical negative effector of mTOR activation.
• ACC acetyl-CoA carboxylase
• HMGCR 3 -hydroxy 3- methylglutaryl-CoA reductase
• Prkag2 was also down-regulated in aldh5al-/- brain (and downregulated in VGB- treated mouse eye). Decreased expression of Prkagl and 2 was normalized by the mTOR inhibitor Torin 1, and correction of AMPK's activator (downregulated in aldh5al-/- mice), Stkl l, was normalized by Torin2. As well, Tscl and 2, signaling systems downstream of AMPK, also exhibited lower expression which was normalized by Torin 1 and Torin 2 in aldh5al-/- mouse brain.

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