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Image-guided, direct convective delivery of glucocerebrosidase for neuronopathic Gaucher disease

From the Surgical Neurology Branch (R.R.L., R.A.R., S.W., D.M.P., E.H.O.), and Developmental and Metabolic Neurology Branch (R.S., G.J.M., R.O.B.), National Institute of Neurological Disorders and Stroke, Section of Neuroradiology (J.A.B.), Diagnostic Radiology Department, and Department of Anesthesiology (Z.Q.), Warren Grant Magnuson Clinical Center, and Division of Bioengineering and Physical Science (P.F.M.), Office of Research Services, NIH, Bethesda, MD, and Division of Pediatric Neurosurgery (M.L.W.), Department of Neurosurgery, Primary Children's Medical Center, University of Utah Health Science Center, Salt Lake City, UT.

Address correspondence and reprint requests to Dr Lonser, Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bldg. 10, Rm. 5D37, Bethesda, MD 20892-1414; e-mail: lonserr{at}ninds.nih.gov

Objective: To determine if convection-enhanced delivery (CED) of glucocerebrosidase could be used to treat targeted sites of disease progression in the brain and brainstem of a patient with neuronopathic Gaucher disease while monitoring enzyme distribution using MRI.

Methods: A CED paradigm in rodents (n = 8) and primates (n = 5) that employs co-infusion of a surrogate MRI tracer (gadolinium diethylenetriamine penta-acetic acid [Gd-DTPA]) with glucocerebrosidase to permit real-time monitoring of distribution was developed. The safety and feasibility of this delivery and monitoring paradigm were evaluated in a patient with type 2 Gaucher disease.

Results: Animal studies revealed that real-time, T1-weighted, MRI of Gd-DTPA accurately tracked enzyme distribution during CED. Targeted perfusion of clinically affected anatomic sites in a patient with neuronopathic Gaucher disease (frontal lobe and brainstem) with glucocerebrosidase was successfully performed. Real-time MRI revealed progressive and complete filling of the targeted region with enzyme and Gd-DTPA infusate. The patient tolerated the infusions without evidence of toxicity.

Conclusions: Convection-enhanced delivery can be used to safely perfuse large regions of the brain and brainstem with therapeutic levels of glucocerebrosidase. Co-infused imaging surrogate tracers can be used to monitor and control the distribution of therapeutic agents in vivo. Patients with neuronopathic Gaucher disease and other intrinsic CNS disorders may benefit from a similar treatment paradigm.

This article was previously published in electronic format as an Expedited E-Pub on October 25, 2006, at www.neurology.org.

Supported by the Intramural Research Program of the National Institute of Neurologic Disorders and Stroke (NIH).

Disclosure: The authors report no conflicts of interest. Roscoe Brady is a consultant for Genzyme Corporation.

Received July 4, 2006. Accepted in final form August 22, 2006.

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