Methods of treating tissue calcification

Abstract

The present invention provides a method of treating NPP1 deficiency or NPP1-associated disease such as idiopathic infantile arterial calcification (IIAC), pseudoxanthoma elasticum, vascular calcification in chronic kidney disease (VCCKD), insulin resistance, hypophosphatemic rickets, myocardial ischemia, joint calcification, angioid streaks, and ossification of the posterior longitudinal ligament of the spine. The present invention provides a method for treating tissue calcification by administering soluble NPP1 to produce a transient increase in serum pyrophosphate levels.

What is claimed is: 
     
       1. A method for reducing vascular calcification treating a subject having Pseudoxanthoma elasticum (PXE), comprising administering to a the subject with below normal plasma pyrophosphate (PPi) or above normal serum phosphate (Pi) two or more doses of an effective amount of soluble ectonucleotide pyrophosphatase phosphodiesterase (sNPP1), fragment or fusion protein thereof, wherein each dose contains an amount of sNPP1 that is sufficient to achieve a transient increase in plasma PPi in the subject, the transient increase in plasma PPi characterized by a peak plasma PPi level that is at least about 40% of the normal plasma PPi level and a return to base-line plasma PPi level within about 48 hours after administration of the dose; wherein a) the time period between doses is at least 2 days; b) the normal level of plasma PPi is 2.63±0.47 microMolar; c) the normal level of plasma Pi is 1.5±0.5 milliMolar; and d) wherein sNPP1 has pyrophosphatase activity, phosphodiesterase activity, or pyrophosphatase and phosphodiesterase activity, with the proviso that when the sNPP1 is a fusion protein comprising an NPP1 component and one or more fusion partners, each fusion partner is located C-terminally to the NPP1 component. 
     
     
       2. The method of  claim 1 , wherein the transient increase in plasma PPi is maintained for at least about 4 hours. 
     
     
       3. The method of  claim 1 , wherein the vascular subject has calcification is arterial calcification of soft tissue. 
     
     
       4. The method of  claim 1 , wherein the vascular calcification is intimal calcification subject has calcification of the skin and/or eye(s). 
     
     
       5. The method of  claim 1 , wherein said subject has NPP1 deficiency. 
     
     
       6. The method of  claim 1 , wherein the subject has chronic kidney disease (CKD) or end-stage renal disease (ESRD). 
     
     
       7. The method of  claim 1 , wherein the subject has generalized arterial calcification of infancy (GACI). 
     
     
       8. The method of  claim 1 , wherein the subject has a cardiovascular disorder, diabetes mellitus II, atherosclerosis, or Pseudoxanthoma elasticum (PXE). 
     
     
       9. The method of  claim 1 , wherein the levels of plasma pyrophosphate (PPi) in the subject before treatment is at least about 40% lower than that of the normal plasma PPi levels. 
     
     
       10. The method of  claim 1 , wherein the subject is human. 
     
     
       11. The method of  claim 1 , wherein each dose contains said effective amount comprises about 1.0 0.1 mg/kg to about 10.0 2.0 mg/kg sNPP1. 
     
     
       12. The method of  claim 1 , wherein time period between said sNPP1 doses is at least 3 days. 
     
     
       13. The method of  claim 1 , wherein the administration is intravenous, subcutaneous, or intraperitoneal. 
     
     
       14. The method of  claim 1 , wherein the sNPP1 comprises an isolated recombinant human sNPP1. 
     
     
       15. The method of  claim 1 , wherein the sNPP1 is a fusion protein comprising a) an NPP1 component that lacks the N-terminal cytosolic and transmembrane domains, and b) a fusion partner located C-terminally to the NPP1 component. 
     
     
       16. The method of  claim 15 , wherein the fusion protein further comprises a targeting moiety. 
     
     
       17. The method of  claim 1 , wherein the sNPP1 is SEQ ID NO:3, SEQ ID NO:4, SEQ ID NO:9, SEQ ID NO:10, SEQ ID NO:11 or SEQ ID NO:12. 
     
     
       18. The method of  claim 1 , wherein the subject has elevated inorganic phosphate and a ratio of PPi to Pi that is at least 10% higher or lower than normal. 
     
     
       19. The method of  claim 15 , wherein the fusion partner comprises the Fc region of an immunoglobulin. 
     
     
       20. The method of  claim 15 , wherein the fusion protein further comprises a linker, a peptide that targets the fusion protein to sites of calcification, or a linker and a peptide that targets the fusion protein to sites of calcification. 
     
     
       21. The method of claim 11, where said effective amount comprises 0.5 mg/kg sNPP1.  
     
     
       22. The method of claim 11, wherein said effective amount comprises 1.0 mg/kg sNPP1.  
     
     
       23. The method of claim 11, wherein said effective amount comprises 5.0 mg/kg sNPP1.  
     
     
       24. The method of claim 11, wherein said effective amount comprises 10 mg/kg sNPP1.  
     
     
       25. The method of claim 1, wherein said administration is weekly.  
     
     
       26. The method of claim 1, wherein said administration is bi-weekly.  
     
     
       27. The method of claim 1, wherein said administration is monthly.  
     
     
       28. The method of claim 13, wherein said administration is intravenous.  
     
     
       29. The method of claim 13, wherein said administration is subcutaneous.