First Human Use of High Dose IV Trehalose: Safety, Tolerability and Pharmacokinetic Results from the Oculopharyngeal Muscular Dystrophy (OPMD) Therapy Trial (P7.068)

Objective: To demonstrate the safety and tolerability of repeated high dose IV administration of trehalose (Cabaletta) in OPMD patients, as part of a phase 2 therapy trial. Background: Trehalose is a disaccharide with protein stabilizing and autophagy enhancing properties. It showed efficacy in reducing abnormal protein aggregation in animal models of several human poly A- and poly Q- mediated hereditary neurological disorders (of which OPMD is an example). Design and Methods: Eleven patients with molecularly confirmed OPMD (age: mean 63 years, range 43-78; disease duration: mean 10.6 years, range 1-24) received weekly infusion of 30 gr Cabaletta for 9-16 weeks (at time of abstract submission). Results: No drug-related adverse effects were noted, in particular no cardiovascular changes were observed. A subtle increase (mean= 5 mg[percnt]) in plasma glucose concentrations was observed 1 hour after trehalose administration. No increase in insulin levels was found. Short term glycosuria was recorded, probably due to trehalase activity in the kidney. Levels of plasma trehalose after a single administration in humans reached the expected concentrations determined in the animal studies as necessary for intracellular activity of trehalose (max. levels of 1000-2000 mgr/mL after 1 hour) and were retained up to 5 hours. Conclusions: Based on these preliminary findings, high dose IV trehalose (Cabaletta) is safe in humans. Clinical trials in OPMD and spinocerebellar atrophy type 3 are currently going on. More disorders with similar PolyA/Poly Q genotypic changes may be suitable for such trials. Disclosure: Dr. Argov has received personal compensation for activities with BioBlast Pharma as chief medical officer. Dr. Vornovitsky has nothing to disclose. Dr. Blumen has received personal compensation for activities with Bioblast Pharma as a consultant. Dr. Caraco has received personal compensation for activities with Sanofi, NeuroDerm, and Roche as a consultant.