uniQure is developing a gene therapy for Huntington’s disease (HD), a rare, fatal, neurodegenerative genetic disorder that affects motor function and leads to behavioral symptoms and cognitive decline in young adults, resulting in total physical and mental deterioration. HD is caused by the expansion of CAG trinucleotide in exon 1 of a multifunctional gene coding for protein called huntingtin.
According to the EMA, Huntington’s disease affects approximately 70,000 people in the U.S. and Europe, making this one of the largest clinical unmet needs in the rare disease field. Despite the clear etiology of the disease, there are no therapies available to treat the disease, delay its onset, or slow the progression of a patient's decline.
Our gene therapy product candidate AMT-130 consists of an AAV5 vector carrying an artificial micro-RNA specifically tailored to silence the huntingtin gene, leveraging our proprietary miQURE™ silencing technology. The therapeutic goal is to inhibit the production of the mutant protein (mHTT). Using AAV vectors to deliver micro-RNAs directly to the brain for non-selective knockdown of the huntingtin gene represents a highly innovative and promising approach to treating Huntington’s disease.
Animated illustration of how AMT-130 is administered into the caudate and striatum regions of the brain via a micro-catheter
In February 2019, uniQure presented 12-month follow-up data in a Huntington’s disease minipig model, the largest available animal model for the disease. (view presentation). The data demonstrate that a single administration of AMT-130 resulted in a dose-dependent and sustained reduction of mutant huntingtin protein (mHTT) in the deep structures of the brain – including the striatum and the putamen, where Huntington’s disease is known to manifest, and the cortex. Once administered, AMT-130 was observed to spread to the cerebral cortex and lowered mHTT in the frontal areas of the brain that show neuropathological changes later in the course of the disease, providing evidence that AMT-130 spread from the injection sites to the cerebral cortex.
Preclinical studies using a non-invasive technique, Magnetic Resonance Spectroscopy (MRS), demonstrate that next to significant knock-down of mHTT, a single administration of AMT-130 also leads to an improvement in brain cell function, a reversal in HD neuropathology, and a partial reversal of volume loss in a key brain area involved in memory, called the hippocampus (view presentation).
uniQure’s gene therapy candidate for Huntington’s disease is differentiated in that:
AMT-130 targets the deep brain structures known for the disease pathology onset.
AMT-130 silences mutant huntingtin protein at levels not demonstrated in other studies.
AMT-130 targets the accumulation of the exon 1 HTT fragment, the most toxic source of abnormal protein aggregation in Huntington’s disease.
We are very encouraged by the significant reductions in mutant huntingtin protein, and believe that knock-down of this magnitude has the potential to significantly alter the course of the disease.
The U.S. Food and Drug Administration has granted orphan drug designation for AMT-130 in Huntington’s disease and AMT-130 has received an Orphan Medicinal Product Designation (OMPD) from the European Medicines Agency for the same indication, making it the first investigational AAV-gene therapy in Huntington's disease to receive such designation. In April 2019, we announced that the U.S. Food and Drug Administration (FDA) has granted Fast Track designation for AMT-130.
Our U.S. Phase I/II clinical trial of AMT-130 is exploring the safety, tolerability, and efficacy of AMT-130 for the treatment of Huntington’s disease. It’s a double blinded, placebo-controlled trial that will enroll a total 26 patients, split into a 10-patient, low-dose cohort of 6e12vg, followed by a 16-patient, higher-dose cohort of 6e13vg.
The patients are Stage 1 and early Stage 2 of the disease - the earliest symptomatic stages of Huntington’s disease. The multi-center trial consists of a blinded 12-month core study period followed by unblinded long-term follow-up for five years.
Because this is a first-in-human experience with AMT-130, our data safety monitoring board has been following the trial closely. We have had five DSMB meetings over the course of the study and after each meeting, the committee has given us permission to continue dosing.
AMT-130 has been well tolerated to date, and we are very pleased with the progress we’re making.
In December 2021, we announced that we have enrolled a total of nineteen patients, ten in the low dose and nine in the high dose cohort. We are encouraged with this progress and on track to finish enrollment in the study in the first half of next year. A total of four patients, two dosed with the low dose of AMT-130 and two control patients who had imitation surgery have reached the end of the first year of monitoring. (View press release.)
We also have added a third cohort to the ongoing U.S. study that will explore the use of alternative stereotactic navigation systems to simplify placement of catheters for infusions of AMT-130. This will help us simplify and shorten the surgical procedure.
We have also initiated patient screening in an open-label study in the EU. This Phase Ib/II study of AMT-130 will enroll 15 patients with early manifest Huntington’s disease across the same two doses being explored in the U.S. trial. The first procedures in the low-dose cohort are expected to be completed in early 2022, and we expect patient enrollment in the EU study to be complete in early 2023.