Journal of Inherited Metabolic Disease

, Volume 37, Issue 2, pp 309–317 | Cite as

Enzyme replacement therapy on hypophosphatasia mouse model

  • Hirotaka Oikawa
  • Shunji Tomatsu
  • Bisong Haupt
  • Adriana M. Montaño
  • Tsutomu Shimada
  • William S. Sly
Original Article


Hypophosphatasia (HPP) is an inborn error of metabolism caused by deficiency of the tissue-nonspecific alkaline phosphatase (TNSALP), resulting in a defect of bone mineralization. Natural substrates for this ectoenzyme accumulate extracellulary including inorganic pyrophosphate (PPi), an inhibitor of mineralization, and pyridoxal 5-phosphate (PLP), a co-factor form of vitamin B6. Enzyme replacement therapy (ERT) for HPP by functional TNSALP is one of the therapeutic options. The C-terminal-anchorless human recombinant TNSALP derived from Chinese hamster ovary cell lines was purified. TNSALP-null mice (Akp2 -/- ), an infantile model of HPP, were treated from birth using TNSALP and vitamin B6 diet. Long-term efficacy studies of ERT consisted of every 3 days subcutaneous or intravenous injections till 28 days old (dose 20 U/g) and subsequently every 3 days intravenous injections for 6 months (dose 10 U/g). We assessed therapeutic effect by growth and survival rates, fertility, skeletal manifestations, and radiographic and pathological finding. Treated Akp2 -/- mice grew normally till 4 weeks and appeared well with a minimum skeletal abnormality as well as absence of epilepsy, compared with untreated mice which died by 3 weeks old. The prognosis of TNSALP-treated Akp2 -/- mice was improved substantially: 1) prolonged life span over 6 months, 2) improvement of the growth, and 3) normal fertility. After 6 months of treatment, we found moderate hypomineralization with abnormal proliferative chondrocytes in growth plate and articular cartilage. In conclusion, ERT with human native TNSALP improves substantial clinical manifestations in Akp2 -/- mice, suggesting that ERT with anchorless TNSALP is also a potential therapy for HPP.


Bone Mineral Density Enzyme Replacement Therapy Fabry Disease Homozygous Mouse Hypophosphatasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



alkaline phosphatase


areas under the curve


bone mineral density


total clearance


peak concentration


a deca-aspartate sequence


enzyme replacement therapy


hematoxylin and eosin






lysosomal storage disorders




mean residence time


pyridoxal 5-phosphate


p-nitrophenyl phosphate


inorganic pyrophosphate




apparent elimination half-life


toluidine blue


concentration peak time


tissue-nonspecific alkaline phosphatase


steady-state distribution volume



This work was supported by grants from the Austrian MPS Society, and International Morquio Organization (Carol Ann Foundation). S.T. is supported by National Institutes of Health grant 8P20 GM103464-08. The content of the article has not been influenced by the sponsors.

Dr. Tomatsu, a principal investigator, was the former employee of Saint Louis University, while the experiments of the project were conducted and completed.

Conflict of interest



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Copyright information

© SSIEM and Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Hirotaka Oikawa
    • 1
  • Shunji Tomatsu
    • 2
  • Bisong Haupt
    • 3
  • Adriana M. Montaño
    • 4
  • Tsutomu Shimada
    • 2
  • William S. Sly
    • 5
  1. 1.Growth, Development and Metabolism ProgramSingapore Institute for Clinical SciencesSingaporeSingapore
  2. 2.Department of Biomedical ResearchNemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  3. 3.Department of Pathology and Genomic MedicineThe Methodist HospitalHoustonUSA
  4. 4.Department of PediatricsSaint Louis UniversitySt. LouisUSA
  5. 5.Department of Molecular BiologySaint Louis UniversitySt. LouisUSA

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