Enzyme Replacement Therapy for Mucopolysaccharidosis IIID using Recombinant Human α- N-Acetylglucosamine-6-Sulfatase in Neonatal Mice

Mol Pharm. 2021 Jan 4;18(1):214-227. doi: 10.1021/acs.molpharmaceut.0c00831. Epub 2020 Dec 15.


There is currently no cure or effective treatment available for mucopolysaccharidosis type IIID (MPS IIID, Sanfilippo syndrome type D), a lysosomal storage disorder (LSD) caused by the deficiency of α-N-acetylglucosamine-6-sulfatase (GNS). The clinical symptoms of MPS IIID, like other subtypes of Sanfilippo syndrome, are largely localized to the central nervous system (CNS), and any treatments aiming to ameliorate or reverse the catastrophic and fatal neurologic decline caused by this disease need to be delivered across the blood-brain barrier. Here, we report a proof-of-concept enzyme replacement therapy (ERT) for MPS IIID using recombinant human α-N-acetylglucosamine-6-sulfatase (rhGNS) via intracerebroventricular (ICV) delivery in a neonatal MPS IIID mouse model. We overexpressed and purified rhGNS from CHO cells with a specific activity of 3.9 × 104 units/mg protein and a maximal enzymatic activity at lysosomal pH (pH 5.6), which was stable for over one month at 4 °C in artificial cerebrospinal fluid (CSF). We demonstrated that rhGNS was taken up by MPS IIID patient fibroblasts via the mannose 6-phosphate (M6P) receptor and reduced intracellular glycosaminoglycans to normal levels. The delivery of 5 μg of rhGNS into the lateral cerebral ventricle of neonatal MPS IIID mice resulted in normalization of the enzymatic activity in brain tissues; rhGNS was found to be enriched in lysosomes in MPS IIID-treated mice relative to the control. Furthermore, a single dose of rhGNS was able to reduce the accumulated heparan sulfate and β-hexosaminidase. Our results demonstrate that rhGNS delivered into CSF is a potential therapeutic option for MPS IIID that is worthy of further development.

Keywords: CHO cells; DHFR; GNS; MPS IIID; enzyme replacement therapy; recombinant protein production.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Animals, Newborn
  • Brain / drug effects
  • Brain / metabolism
  • CHO Cells
  • Cricetulus
  • Disease Models, Animal
  • Enzyme Replacement Therapy / methods
  • Glycosaminoglycans / metabolism
  • Heparitin Sulfate / metabolism
  • Humans
  • Liver / drug effects
  • Liver / metabolism
  • Lysosomal Storage Diseases / drug therapy
  • Lysosomal Storage Diseases / metabolism
  • Lysosomes / drug effects
  • Lysosomes / metabolism
  • Mice
  • Mucopolysaccharidosis III / drug therapy*
  • Mucopolysaccharidosis III / metabolism
  • Neurons / drug effects
  • Neurons / metabolism
  • Receptor, IGF Type 2 / metabolism
  • Recombinant Proteins / pharmacology*
  • Sulfatases / pharmacology*


  • Glycosaminoglycans
  • Receptor, IGF Type 2
  • Recombinant Proteins
  • Heparitin Sulfate
  • Sulfatases
  • N-acetylglucosamine-6-sulfatase