On 17 July 2013, orphan designation (EU/3/13/1162) was granted by the European Commission to Promethera Biosciences, Belgium, for heterologous human adult liver-derived progenitor cells for the treatment of citrullinaemia type 1.
- What is citrullinaemia type 1?
Citrullinaemia type 1 is one of the inherited disorders known as ‘urea-cycle disorders’, which cause ammonia to accumulate in the blood. Patients with this disorder lack ‘argininosuccinate synthase’, one of the liver enzymes that are needed to get rid of excess nitrogen. In the absence of this liver enzyme, excess nitrogen accumulates in the body in the form of ammonia, which can be toxic at high levels, especially to the brain. Symptoms of the disease usually appear in the first few days of life and include lethargy (lack of energy), vomiting, loss of appetite, seizures (fits) and coma.
Citrullinaemia type 1 is a long-term debilitating and life-threatening disease that leads to mental retardation and is associated with poor overall survival.
- What is the estimated number of patients affected by the condition?
At the time of designation, citrullinaemia type 1 affected approximately 0.06 in 10,000 people in the European Union (EU). This was equivalent to a total of around 3,000 people*, and is below the ceiling for orphan designation, which is 5 people in 10,000. This is based on the information provided by the sponsor and the knowledge of the Committee for Orphan Medicinal Products (COMP).
*Disclaimer: For the purpose of the designation, the number of patients affected by the condition is estimated and assessed on the basis of data from the European Union (EU 27), Norway, Iceland and Liechtenstein. This represents a population of 509,000,000 (Eurostat 2013).
- What treatments are available?
At the time of designation, sodium phenylbutyrate, sodium phenylacetate and sodium benzoate were authorised in the EU for the treatment of some urea-cycle disorders, including citrullinaemia type 1. In addition, patients were advised to control their dietary intake of proteins, which are rich in nitrogen, to reduce the amount of ammonia formed in the body. The only cure for the disease was liver transplantation.
The sponsor has provided sufficient information to show that heterologous human adult liver-derived progenitor cells might be of significant benefit for patients with citrullinaemia type 1 because early studies in experimental models show that it might lead to healthy liver cells that can produce the argininosuccinate synthase enzyme, thereby improving the treatment of patients with this condition. This assumption will need to be confirmed at the time of marketing authorisation, in order to maintain the orphan status.
- How is this medicine expected to work?
This medicine is an advanced-therapy medicine that belongs to the group called ‘somatic-cell-therapy products’. These are medicines that contain cells or tissues that have been manipulated to change their biological characteristics so that they can be used to cure, diagnose or prevent a disease. The medicine is made up of progenitor (immature) cells derived from the liver of an adult donor (‘heterologous’). When implanted into the liver of a patient, it is believed that these heterologous liver-derived progenitor cells will develop into mature, healthy liver cells that can produce the argininosuccinate synthase enzyme. The new cells are thereby expected to reduce the accumulation of ammonia and to relieve the symptoms of the disease.
- What is the stage of development of this medicine?
The effects of heterologous human adult liver-derived progenitor cells have been evaluated in experimental models.
At the time of submission of the application for orphan designation, clinical trials with the medicine in patients with urea-cycle disorders were ongoing.
At the time of submission, the medicine was not authorised anywhere in the EU for citrullinaemia type 1. Orphan designation of the medicine had been granted in the United States for urea-cycle disorders.
In accordance with Regulation (EC) No 141/2000 of 16 December 1999, the COMP adopted a positive opinion on 13 June 2013 recommending the granting of this designation.
- Opinions on orphan medicinal product designations are based on the following three criteria:
- the seriousness of the condition;
- the existence of alternative methods of diagnosis, prevention or treatment;
- either the rarity of the condition (affecting not more than 5 in 10,000 people in the EU) or insufficient returns on investment.
Designated orphan medicinal products are products that are still under investigation and are considered for orphan designation on the basis of potential activity. An orphan designation is not a marketing authorisation. As a consequence, demonstration of quality, safety and efficacy is necessary before a product can be granted a marketing authorisation.
|Name||Language||First published||Last updated|
|EU/3/13/1162: Public summary of opinion on orphan designation: Heterologous human adult liver-derived progenitor cells for the treatment of citrullinaemia type 1||(English only)||21/08/2013|
|Active substance||Heterologous human adult liver-derived progenitor cells|
|Disease/condition||Treatment of citrullinaemia type 1|
|Date of decision||17/07/2013|
|Orphan decision number||EU/3/13/1162|
Review of designation
The Committee for Orphan Medicinal Products reviews the orphan designation of a product if it is approved for marketing authorisation.
Sponsor’s contact details
Watson & Crick Hill
11 Rue Granbonpré
Tel. +32 103 943 00
Fax +32 394 301
For contact details of patients’ organisations whose activities are targeted at rare diseases, see:
- Orphanet, a database containing information on rare diseases, which includes a directory of patients’ organisations registered in Europe;
- European Organisation for Rare Diseases (EURORDIS), a non-governmental alliance of patient organisations and individuals active in the field of rare diseases.