Skeletal phenotype amelioration in Mucopolysaccharidosis VI requires intervention at the earliest stages of postnatal development.

Abstract

Mucopolysaccharidosis VI (MPS VI) is a rare lysosomal disease arising from impaired function of the enzyme Arylsulfatase B (ARSB). This causes aberrant accumulation of dermatan sulfate, a glycosaminoglycan (GAG) abundant in cartilage. While clinical severity varies along with age at first symptom manifestation, MPS VI usually presents early and strongly affects the skeleton. Current enzyme replacement therapy (ERT) does not provide effective treatment for the skeletal manifestations of MPS VI. This lack of efficacy may be due to inability of ERT to reach affected cells, or irreversibility of disease. To address the question of reversibility of skeletal phenotypes, we generated a conditional by inversion (COIN) mouse model of MPS VI, ArsbCOIN/COIN, wherein Arsb is initially null and can be restored to wild type using Cre. We restored Arsb at different times during postnatal development, using a tamoxifen-dependent global Cre driver. By restoring Arsb at postnatal days 7, 21, and 56-70 (P7, P21, and P56-P70), we determined that skeletal phenotypes can be fully rescued if Arsb restoration occurs at P7, while only achieving partial rescue at P21, and no significant rescue at P56-70. This work has highlighted the importance of early intervention in MPS VI patients to maximize therapeutic impact.