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Dimension Therapeutics to Develop Gene Therapy Treatments for Patients with Glycogen Storage Disease Type Ia (GSDIa)

NEWS RELEASE

Dimension Therapeutics to Develop Gene Therapy Treatments for Patients with Ornithine Transcarbamylase (OTC) Deficiency and Glycogen Storage Disease Type Ia (GSDIa)

Severe Forms of These Diseases Have Devastating Consequences for Patients and Families, with Few or No Effective Treatment Options

CAMBRIDGE, MASS., April 23, 2015 – Dimension Therapeutics, Inc. (“Dimension” or the “Company”), a rare disease company advancing novel, liver-directed treatments for diverse genetic disorders, today announced that the company is advancing programs to treat two rare diseases with often devastating outcomes for patients and their families – Ornithine Transcarbamylase (OTC) deficiency and Glycogen Storage Disease Type Ia (GSDIa). Both diseases, due to genetically inherited inborn errors of metabolism, usually present in the neonatal period or infancy, and can have grave effects on patients of all ages. For severe forms, there are few or no effective treatment options other than liver transplantation, leaving patients with significant unmet needs. Dimension is developing novel gene therapy approaches to replace the missing or faulty gene, correcting the underlying defect to restore metabolic function.

“In an important step for both patients and for Dimension, we are launching our first two liver-associated, metabolic disease programs to address rare disorders with the greatest needs and fewest treatment options, other than liver transplant. Transplants are often associated with significant risks both during the procedure and over the long term,” said Dimension’s CEO Annalisa Jenkins, MBBS, MRCP. “Our mission – working in collaboration with patient advocacy communities and with the world’s leading clinical investigators and advisors – is to rapidly and responsibly develop new therapies that can offer hope and better health to those patients in the greatest need.”

Dimension looks forward to continuing the work previously championed by advocacy organizations, including The Children’s Fund for GSD Research, which has funded much of the existing preclinical work in GSDIa. Eric Crombez, MD, Dimension’s Chief Medical Officer, commented, “Dimension is developing and strengthening partnerships with the patient communities, families, and physicians focused on improving the lives of patients affected by OTC deficiency and GSDIa. We will ensure that patient organizations, as key partners, will play an active role in developing these clinical programs.” The company anticipates commencing clinical trials in both patient populations in 2016.

Mark L. Batshaw, MD, Principal Investigator of the Urea Cycle Disorders Consortium (UCDC) and Physician-in-Chief of Children’s National Health System, stated, “In order to solve the most pressing issues in pediatric medicine, we encourage diverse constituencies to come together in a true spirit of collaboration. This approach has been critical to the success of programs at the UCDC, and we believe it will be paramount in addressing the needs of patients and families affected by OTC deficiency.”

David A. Weinstein, MD, MMSc, Director, Glycogen Storage Disease Program at the University of Florida, noted, “Our research program, the largest of its kind pursuing treatments for GSDIa, has dedicated substantial resources to enabling gene therapy, which we ultimately believe will be the most promising approach to long-term care of

patients with GSDIa. New therapies are critically needed, and I look forward to Dimension’s progress in advancing its gene therapy program into the clinic.”

Dimension’s Adeno-Associated Virus (AAV) Vector Platform

Dimension is advancing therapies based on a next-generation AAV platform that has demonstrated early validation and compelling preclinical in vivo proof of concept across multiple disease states in leading academic research centers. Dimension’s current efforts focus on AAV8 and AAVrh10, two forms of AAV vectors that selectively target liver cells and have been optimized to deliver missing intact genes in diseases associated with the

liver. Initial indications of positive net benefit of this approach in patients living with hemophilia B, plus demonstration of robust gene expression in multiple preclinical in vivo models and commercially viable novel CMC approaches, provide a strong foundation for Dimension’s proprietary programs.

Background on OTC Deficiency and GSDIa

OTC deficiency, the most common urea cycle disorder, is caused by a genetic defect in a liver enzyme responsible for detoxification of ammonia. Individuals with OTC deficiency can build-up excessive levels of ammonia in their blood, potentially resulting in neurological deficits and other toxicities. Neonatal onset disease in males is severe and can be fatal at an early age. The greatest percentage of patients experience late-onset disease, representing a clinical spectrum of disease severity. It is estimated that more than 10,000 patients are affected by OTC deficiency worldwide. Currently, the only curative approach is liver transplantation.

GSDIa, the most common glycogen storage disease, has significant unmet needs. Patients have a defective gene for the enzyme glucose-6-phosphatase, resulting in the inability to regulate blood sugar (glucose). If chronically untreated, patients develop severe lactic acidosis, progress to renal failure, and die in infancy or childhood. There are no approved pharmacological therapies, and no ongoing clinical development beyond dietary approaches. An estimated 6,000 or more patients are affected by GSDIa worldwide.

About Dimension Therapeutics

Dimension Therapeutics, Inc., is a rare disease company focused on developing novel treatments for devastating disorders associated with the liver and based on an industry-leading, extensively validated adeno-associated virus (AAV) platform. The company is advancing multiple programs toward clinical development, including: programs addressing unmet needs for patients suffering from OTC deficiency and GSDIa; a collaboration with Bayer HealthCare in hemophilia A, and a wholly owned program in hemophilia B, which is expected to enter clinical testing in the second half of 2015. Dimension has preferred access to multiple best-in-class AAV vectors from REGENXBIO, which founded Dimension with Fidelity Biosciences in October 2013. The Dimension team and senior advisors include biotech industry veterans and renowned thought leaders in gene therapy and rare diseases. For more information, please visit www.dimensiontx.com.

Dylan Siegel, left, has raised more than half a million dollars to help Jonah Pournazarian, right, his friend who suffers from a rare liver disease. (Credit: ABC News)

Boy Author Raises $750k For Sick Friend

by Sydney Lupkin (@slupkin)

Every morning at 3 a.m. Lora Pournazarian is awake to feed her 8-year-old son Jonah a mixture of corn starch and water through a tube in his stomach.

If she doesn’t, Jonah could die because he has a rare form of glycogen storage disease, a hereditary disorder that means his liver can store sugar but can’t release it, causing him to have dangerously low blood sugar levels that can result in seizures or even death.

“That’s huge anxiety every night,” his mother Lora Pournazarian told ABC News. “We go to sleep going, ‘We hope we don’t miss an alarm clock because he could die.’“

But Jonah’s parents aren’t the only ones looking out for him. His best friend from preschool, Dylan Siegel has his back, too.

Dr. David Weinstein, who studies and treats patients with glycogen storage disease at the University of Florida, was almost out of funding when he heard that Dylan wanted to help raise money to find a cure for the disease. Dylan was only 6 years old at the time, so Weinstein mostly just thought he was cute.

But Dylan had other plans. He wrote a book called “Chocolate Bar,” and explained to his parents “chocolate bar” means “awesome” to him. “Disneyland is so chocolate bar,” the book starts out. The last page says, “I like to help my friends. That is the biggest chocolate bar.”

Dylan’s project raised more than $750,000 in a little more than a year by selling the books for $20 each in all 50 states and 42 countries. Every cent goes to Weinstein’s lab.

“Boy, have I been shocked,” Weinstein told ABC News in September, when the book had crossed the $400,000 mark. “He’s raised more money for this disease than all the medical foundations and all the grants combined. Ever.”

When this story aired on ABC World News Wednesday night, “Chocolate Bar” had raised more than $500,000. Fewer than 24 hours later, it had raised an additional $250,000.

When asked where the two boys will be in 10 or 15 years, Dylan said, “High school, and probably his disease would be cured ’cause it’s not going to take like 15 years to be cured.”

That would be so chocolate bar.

Charlotte Jordan, 6, (left) with her sister Alexis Jordan, 10.

Gift of Hope

by Melanie Stawicki Azam

Florida Physician

For Lindsay Jordan, it was a mixed blessing when her daughter Charlotte was diagnosed with glycogen storage disease type 1a.

On one hand, the California mother finally knew why her 3-year-old little girl had been struggling to thrive since birth. At the same time, she faced the sobering reality that Charlotte had a rare genetic disease that could be fatal if not properly treated.

“It was a surreal experience, but I knew she’d been sick,” Jordan said.

Little did she know that Charlotte’s condition would take her to the other side of the U.S. for treatment and inspire her family to donate $1 million to UF to help find a cure for glycogen storage disease type 1a, also known as GSD 1a.

The Fry Foundation, which Lindsay Jordan’s parents, Stephen T. and Cynthia Fry, created, donated the money to establish The Charlotte’s Cure for Type 1a GSD fund. The money will support research geared toward finding a cure for the disease.

“Their gift is the biggest in the history of the program,” said David Weinstein, MD, MMSc, a professor of pediatrics and director of the UF Glycogen Storage Disease Program. “It allows me to focus on some of the programs we’re working on, including gene therapy.”

The UF GSD program is the largest of its kind in the world for care and research for the liver forms of GSD, such as type 1a. It follows more than 425 patients from 37 countries and all U.S. states.

GSD type 1, which affects about one in 100,000 children, impacts the body’s ability to correctly store and use sugar between meals.

After Charlotte was diagnosed with GSD 1a at her local hospital in California, she still struggled from complications related to the disease.

Charlotte met with Weinstein in November 2011 and thrived under his care. Now 6 years old, she visits him annually.

“He could have dedicated himself to anything and for him to pick this little–known disease and try to make a difference for these kids is amazing,” Jordan said.

Photo Credit:  Jordan Family Photo

A boy’s serious ailment required only a simple fix once it was diagnosed.

By Sandra G. Boodman

When she heard her younger son’s quavery cry of “M-o-o-o-m-m-m” drifting down the hall in the middle of the night, Jocelyn Mathiasen stiffened, braced for what lay ahead.

Sometimes the little boy would awaken just before dawn shaky and weak, complaining of hunger or thirst; after consuming something he would quickly recover. But on the bad nights Peter Dawson would spend hours lying on the floor of the bathroom clutching his stomach, vomiting intermittently and refusing to drink anything. It took him hours to rebound — and it was never clear what had made him so sick.

Mathiasen did not know what to make of these episodes, which at first were only mild and infrequent, blips in the life of her otherwise healthy child. But when Peter turned 5 in 2006 and the family moved to Easton, Conn., from Seattle, Mathiasen asked her new pediatrician whether the episodes were normal. Leveling a hard look at her, he told her that what she was describing was definitely not normal — and might signify a serious problem, such as juvenile, or Type 1, diabetes. But after tests for diabetes were negative, the search for the underlying cause of Peter’s odd problem floundered.

It would take nearly five years for a specialist eight states away to figure out what was wrong. The solution was a surprisingly cheap and prosaic remedy — but one that recently drew attention in an airport security line.

As an infant, Peter would periodically wake up in the morning in obvious distress, grabbing his bottle and sucking down the contents “in one gulp, like he was desperate,” his mother recalled.

“I didn’t worry too much about it because it didn’t happen often, and after he ate he seemed fine,” Mathiasen said. For some reason the episodes were worse when the family traveled. Mathiasen said she refrained from mentioning them to his doctor, not wanting to seem alarmist. “I was trying to be this relaxed mother,” she said.

After the test for diabetes was negative, the pediatrician referred Peter to a pediatric endocrinologist in New Haven. Once a tumor and several other disorders had been ruled out, the doctor settled on a diagnosis of reactive hypoglycemia: severely low blood sugar that occurs several hours after eating. She predicted that Peter would outgrow the problem when he hit puberty and recommended that he eat yogurt at bedtime: The protein would be slowly digested and would prevent his blood sugar from plummeting.

By 2007 Mathiasen had become increasingly uneasy. Despite the yogurt, Peter kept having episodes. She began keeping lollipops or Skittles in the house: A rapid hit of sugar seemed to help him recover faster.

After four incidents in four weeks, Mathiasen consulted a second pediatric endocrinologist. He admitted the first-grader to a hospital overnight, hoping to catch an episode, which could provide important clues. Peter underwent hourly checks; although his blood sugar dropped, the readings were not alarming.

When he was discharged the following morning, Mathiasen was told to continue the yogurt regimen; by now he was eating two heaping bowls at bedtime.

“It was a very, very disconcerting experience,” recalled Mathiasen, who had become increasingly convinced that waiting for the problem to disappear was not a solution. In the spring of 2008, Peter had a scary episode on a trip. The family had forgotten his bedtime yogurt, and he awoke shaky and incoherent. His parents gave him a lollipop and bundled him into the car; at the airport he vomited several times, reluctantly ate a cookie and then fell into a deep sleep on the plane. After he woke up he drank six glasses of milk, then seemed fine.

“At that point, I said we really need to figure out what’s going on here,” Mathiasen recalled.

In December 2008, Peter underwent a complete workup with the second endocrinologist, which provided no answers. Mathiasen had been monitoring Peter’s blood sugar when he woke; she found that readings on some days were very high, not low. Because nothing else seemed to fit, the endocrinologist suggested that Peter might have a rare condition: glycogen storage disease (GSD).

The inherited metabolic problem is a constellation of 14 disorders, ranging from mild to life-threatening, that result from the impaired regulation of glycogen, the stored form of glucose, which the body uses for fuel. DNA testing for the disease, which afffects about one in 20,000 people, according to Cincinnati Children’s Hospital, had recently become available. The doctor suggested that Peter undergo a test for a mild form of GSD that seemed to fit his symptoms. After several months, the family’s insurance company agreed to pay for it.

Months went by — genetic tests often take a long time — and Mathiasen, who had heard nothing, began calling the doctor. In October 2009, he sent her an apologetic e-mail: The lab had lost the sample before the DNA test could be performed.

“My clinical impression [is] that this glycogen storage disease diagnosis is highly unlikely,” he wrote. He proposed that Peter undergo a procedure to implant a device that continuously monitors glucose levels to see if he might have a rare condition called exercise-
induced hyperinsulinism, or low blood sugar after exercise, because some episodes had occurred after skiing.

Mathiasen, who was then spending hours online researching Peter’s symptoms, assisted by a friend who is an endocrinologist in Baltimore, decided that maybe GSD wasn’t so unlikely. The name of one expert kept popping up: pediatric endocrinologist David A. Weinstein, who heads the Glycogen Storage Disease Program at the University of Florida College of Medicine.

One evening in February 2010, Mathiasen sent Weinstein an e-mail. She described Peter’s case and said she’d hit a brick wall. Did Weinstein have any suggestions?

Soon afterward Weinstein called Mathiasen back. He agreed that Peter might have GSD and recommended the family buy a monitor that could check the level of ketones, potentially dangerous substances that can cause nausea and vomiting and, at sustained high levels, death. Ketones, produced when the body uses fat rather than glucose for energy, would be an important clue to a diagnosis; ketotic hypoglycemia is a symptom of some forms of GSD. Testing over the next few months showed that Peter’s ketone levels were sometimes dangerously elevated; his body was literally starving for energy.

A cheap treatment

Weinstein agreed to accept Peter as a patient and to perform DNA testing. He advised Mathiasen to replace the bedtime yogurt with a drink containing several tablespoons of cornstarch. One of the cheapest ingredients in a supermarket at less than $2 per box, cornstarch provides slow-release glucose. Within weeks, Peter’s episodes largely disappeared.

In June 2011, after the first DNA test proved to be negative, Peter and his mother flew to Florida to see Weinstein, who observed Peter having an episode in the hospital. Peter was then tested for two other generally mild forms. Six months later, just as the family was departing for a holiday trip, Weinstein called with the diagnosis that had taken five years: Peter’s DNA test revealed he had a type of GSD that is caused by a deficiency in the liver enzyme phosphorylase kinase.

GSD has received scant attention and is, in Weinstein’s view, underdiagnosed; in part, this is because there is little incentive to develop sophisticated treatments, since cornstarch has proven effective for certain forms of the disease if detected early enough. “One of the problems we’ve had is that treatments are not fancy — cornstarch is a gravy thickener,” observed Weinstein, who said his program has treated 400 children from 31 countries and nearly every state. “Most people feel that if we’re not treating it with a fancy medication, it’s not a real medical condition,” and in some cases schools don’t take it seriously.

Although Peter’s type of GSD tends to be mild and can be controlled with a combination of careful monitoring, a high-protein diet and cornstarch, Weinstein said he has seen babies who needed liver transplants. “There’s a variability we don’t quite understand” in the severity of the disease.

Peter, who will soon turn 11, has been told that when he is older he must completely abstain from alcohol, because it could damage his liver. He takes cornstarch dissolved in a drink at bedtime every night and also during the day if he is especially active. And he always travels with several boxes of the cheap white powder and a scale to measure it. For children who travel by air, the cornstarch regimen can raise questions. Recently, Mathiasen said, her family was stopped at a New York airport, where airline security guards tested Peter’s cornstarch. (Weinstein said he offers patients a letter explaining the therapy.)

The strange, shaky episodes are a thing of the past, and Peter is living a normal life. “Now I know what’s wrong, how to treat it, what’s going to happen next and I have a doctor to call,” Mathiasen said. “It’s such a relief.”

Photo Credit:  Family Photo

At 9 months old, Avery Robinson got a diagnosis that just three decades ago would have been a death sentence.

Avery has glycogen storage disease, a disease so rare that only one other child in the state of Mississippi is thought to have it, according to Avery’s doctors and parents.

The rare genetic disorder is marked by her body’s inability to produce an enzyme that allows her to maintain blood sugar levels. As a result, Avery has to eat or be fed every two waking hours or every four hours when asleep. She risks dangerous build-ups of lactate, uric acid and triglycerides leading to impaired breathing, seizures and coma if her strict regimen is disturbed in any way.

She has never eaten fruit, simple sugars or dairy. And at age 4, Avery, who lives in Hernando, knows more about GSD than even some of the local medical community.

“I have to wait now because in a minute I have to have my cornstarch,” she said before heading off to gymnastics.

Cornstarch, which is slowly digested, is a major staple in Avery’s life. She eats it to maintain her blood sugar between her carefully planned meals. When she is going to be active, she eats a little more than usual.

Just looking at her, it’s hard to tell she is sick. Credit for that goes to her parents, Adam and Nikki Robinson, and Dr. David Weinstein at the University of Florida, the leading authority on the disease.

With about 400 patients, Weinstein said he treats about 90 percent of the cases diagnosed in the U.S. as well as treating patients from 28 other countries.

“Prior to 1971, it was fatal and even as late as 10 years ago, many children weren’t surviving. That’s why I have made this my life’s work,” he said.

Weinstein has run the GSD research program at the University of Florida for the past seven years. His research has been focused on finding a treatment that minimizes the disease in his patients’ lives. He has already accomplished this in the lab.

“There is a breed of dog in which this condition is naturally occurring, and we have successfully treated them and they are now living very normal lives,” he said.

Weinstein said he hopes to apply for FDA permission to begin his gene therapy treatment in humans in the next one to two years. He believes that the gene therapy treatment will make the disease a very minor part of the children’s lives.

“Avery is thriving because of Dr. Weinstein’s work on GSD,” Adam said. “And the thing is, he is close to a treatment.”

The rarity of the disease is what led the Robinsons to start Avery’s Hope Fund. It’s designed to raise public awareness so they will help fund Weinstein’s research.

“Because GSD is so rare, it gets no federal funding and unlike autism, cancer or diabetes, no one has heard of it. How do you raise funds for something no one has heard of? We had never heard of it before Avery was diagnosed with it,” Adam said.

Now, there is not an aspect of the disease the Robinsons are not familiar with, out of necessity. Any sign of something like a stomach flu in Avery’s case is life-threatening. If she vomits, her parents have less than two hours to hook up a pump directly to a port in her stomach to maintain her blood sugar. If they are unable to for any reason, the next step is hospitalization.

“We have had to call paramedics and they always first think to give Avery glucagon like they would low blood sugar in a diabetic, but Avery’s body can’t take that. In fact, it could raise her lactate levels so high it could kill her,” Nikki said.

But the Robinsons are quick to point out that none of the money donated to Avery’s Fund is for Avery’s care; they have that well in hand. The fund’s goal is to make Weinstein’s research and the gene therapy treatment a reality for everyone with GSD.

Since the Robinsons began the fund last summer, they have raised $15,000. Adam estimates it will cost about $3 million raised by funds like Avery’s before the human trials can begin.

For more information on GSD or donate to Avery’s Hope Fund, visit averyshope.org.

Photo Credit: Stan Carroll