

Drug discovery
22
drugs
With orphan designations
Overview
Ornithine transcarbamylase deficiency (OTCD) is an X-linked urea cycle disorder caused by mutations in the OTC gene, leading to impaired ammonia detoxification. Accumulated ammonia causes neurotoxicity, presenting as lethargy, vomiting, seizures, or coma, with severity ranging from neonatal hyperammonemic crisis to late-onset episodic encephalopathy. Diagnosis involves elevated plasma ammonia, low citrulline, genetic testing, and urine orotic acid analysis [1][6][9]. Management combines protein restriction, nitrogen scavengers (e.g., sodium phenylbutyrate), arginine/citrulline supplementation, and emergent hemodialysis for acute crises [5][10]. Liver transplantation remains the only curative option [3][15].
Population
Prevalence: Estimated 1:14,000–1:77,000 [1][8][9]; neonatal-onset predominantly affects males, while 10–40% of heterozygous females develop symptoms due to skewed X-inactivation [6][16].
Mortality: ~43–50% in untreated neonatal-onset cases [1][16]; 11-year survival rates: 35% for early-onset vs. 87% for late-onset hyperammonemia [4].
Burden
Neurological: Intellectual disability, developmental delays, or metabolic stroke in 20–50% of survivors [1][7][16].
Systemic: Chronic liver dysfunction, coagulopathy, and risk of acute liver failure during decompensation [6][15].
Quality of life: Lifelong dietary/medication adherence, recurrent hospitalizations, and high economic burden [4][14].
Therapies
Acute: Hemodialysis (for氨 >500 µmol/L), IV sodium benzoate/phenylacetate, and arginine [5][10].
Chronic: Protein-restricted diet, oral scavengers (glycerol phenylbutyrate), citrulline/arginine supplementation [5][12].
Curative: Liver transplantation (prevents recurrent crises but requires lifelong immunosuppression) [3][15].
Categories: rare genetic diseases, rare inborn errors of metabolism, rare neurological diseases
Drug Discovery Landscape
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
adeno-associated viral vector serotype LK03 containing the human ornithine transcarbamylase gene | gene therapies | FDA | 2023-08-08 | — | Bloomsbury Genetic Therapies Ltd. |
A replication-deficient adeno-associated virus serotype 9 vector containing the ornithine transcarbamylase gene within the transposon and a lipid nanoparticle containing messenger RNA for the transposase | gene therapies | FDA | 2023-07-24 | — | Poseida Therapeutics, Inc. |
Adeno-associated virus serotype rh79 containing the human OTC gene, adeno-associated virus serotype rh79 encoding a meganuclease for targeted editing of the human PCSK9 gene | gene therapies | EMA | 2022-12-09 | — | Pharma Gateway AB |
non-replicating recombinant adeno-associated virus serotype rh79 (AAVrh.79) vectors: AAVrh79.TBG.M2PCSK9.WPRE.bGH and AAVrh79.hHDR.TBG.hOTCco.bGH | gene therapies | FDA | 2022-09-01 | — | iECURE, Inc. |
mRNA encoding modified human ornithine transcarbamylase | RNAs | EMA | 2022-07-18 | — | Arcturus Therapeutics Europe B.V. |
L-Citrulline | small molecules | FDA | 2020-11-03 | — | Orpha Labs, AG |
Ornithine transcarbamylase messenger RNA | gene therapies | FDA | 2019-06-26 | — | Arcturus Therapeutics, Inc. |
Sodium benzoate, sodium phenylacetate | small molecules | EMA | 2019-04-24 | — | Dipharma B.V. |
Codon-optimised human ornithine transcarbamylase mRNA complexed with lipid-based nanoparticles | RNAs | EMA | 2018-06-27 | — | Transcrip Ireland Limited |
Nanoparticle suspension containing biosynthetic codon-optimized human ornithine transcarbamylase messenger RNA | RNAs | FDA | 2018-03-28 | — | Translate Bio, Inc. |
Modified messenger ribonucleic acid encoding human ornithine transcarbamylase enzyme encapsulated into lipid nanoparticles | RNAs | EMA | 2017-04-20 | — | PhaseRx Ireland, Ltd |
Adeno-associated viral vector serotype LK03 encoding human ornithine transcarbamylase | gene therapies | EMA | 2017-03-20 | — | UCL Research Limited |
mRNA encoding human ornithine transcarbamylase | RNAs | FDA | 2016-11-23 | — | PhaseRx, Inc. |
Sodium benzoate | small molecules | EMA | 2016-07-14 | — | Lucane Pharma SA |
Adeno-associated viral vector serotype 8 encoding human ornithine transcarbamylase | gene therapies | EMA | 2016-03-21 | — | Ultragenyx Germany GmbH |
recombinant adeno-associated virus serotype AAV8 vector encoding human ornithine transcarbamylase | gene therapies | FDA | 2015-12-29 | — | Dimension Therapeutics |
Sodium phenylbutyrate [Pheburane] | small molecules | EMA | 2012-02-09 | — | Lucane Pharma |
Heterologous human adult liver-derived stem cells | cell therapies | EMA | 2011-09-27 | — | Unicyte S.R.L. |
Glyceryl tri-(4-phenylbutyrate) [Ravicti] | small molecules | EMA | 2010-06-10 | 2015-12-01 | Immedica Pharma AB |
Heterologous human adult liver derived stem cells | cell therapies | EMA | 2008-02-04 | — | Cellaion |
Human heterologous liver cells (for infusion) | gene therapies | EMA | 2007-09-14 | — | Promethera Biosciences |
Benzoate and phenylacetate [Ucephan] | small molecules | FDA | 1986-01-21 | 1987-12-23 | ImmunexImmunex |