Novel treatment for PXE: Recombinant ENPP1 enzyme therapy

Mol Ther. 2024 Nov 6;32(11):3815-3820. doi: 10.1016/j.ymthe.2024.09.028. Epub 2024 Sep 27.

Abstract

Pseudoxanthoma elasticum (PXE) is a genetic multisystem ectopic calcification disorder caused by inactivating mutations in the ABCC6 gene encoding ABCC6, a hepatic efflux transporter. ABCC6-mediated ATP secretion by the liver is the main source of a potent endogenous calcification inhibitor, plasma inorganic pyrophosphate (PPi); the deficiency of plasma PPi underpins PXE. Recent studies demonstrated that INZ-701, a recombinant human ENPP1 that generates PPi and is now in clinical trials, restored plasma PPi levels and prevented ectopic calcification in the muzzle skin of Abcc6-/-mice. This study examined the pharmacokinetics, pharmacodynamics, and potency of a new ENPP1-Fc isoform, BL-1118, in Abcc6-/- mice. When Abcc6-/- mice received a single subcutaneous injection of BL-1118 at 0.25, 0.5, or 1 mg/kg, they had dose-dependent elevations in plasma ENPP1 enzyme activity and PPi levels, with an enzyme half-life of approximately 100 h. When Abcc6-/- mice were injected weekly from 5 to 15 weeks of age, BL-1118 dose-dependently increased steady-state plasma ENPP1 activity and PPi levels and significantly reduced ectopic calcification in the muzzle skin and kidneys. These results suggest that BL-1118 is a promising second generation enzyme therapy for PXE, the first generation of which is currently in clinical testing.

Keywords: ABCC6; ENPP1; ectopic calcification; enzyme therapy; pseudoxanthoma elasticum; pyrophosphate.

MeSH terms

  • Animals
  • Diphosphates / metabolism
  • Disease Models, Animal
  • Humans
  • Mice
  • Mice, Knockout
  • Multidrug Resistance-Associated Proteins* / genetics
  • Multidrug Resistance-Associated Proteins* / metabolism
  • Phosphoric Diester Hydrolases* / genetics
  • Phosphoric Diester Hydrolases* / metabolism
  • Pseudoxanthoma Elasticum* / drug therapy
  • Pseudoxanthoma Elasticum* / genetics
  • Pyrophosphatases* / genetics
  • Pyrophosphatases* / metabolism
  • Recombinant Proteins / genetics

Substances

  • Pyrophosphatases
  • Phosphoric Diester Hydrolases
  • ectonucleotide pyrophosphatase phosphodiesterase 1
  • Multidrug Resistance-Associated Proteins
  • Diphosphates
  • Recombinant Proteins
  • diphosphoric acid
  • Abcc6 protein, mouse