Three-year-old Gunreet Kaur has become one of the first patients in the UK to receive a groundbreaking gene therapy that delivers treatment directly to the brain, marking a significant milestone for the NHS and offering new hope for children with a rare, life-threatening genetic condition.
Gunreet received Upstaza (eladocagene exuparvovec) in February 2024 at Great Ormond Street Hospital (GOSH), the only facility in the UK offering this treatment. The therapy represents the first NHS England commissioned gene therapy infused directly into the brain, targeting aromatic l-amino acid decarboxylase (AADC) deficiency.
Remarkable Clinical Progress
Since receiving the treatment, Gunreet has demonstrated substantial improvements that her mother, Sandeep Kaur, described as progress she "thought would never be possible." The child now cries less, smiles more, and has developed new motor capabilities including reaching for objects, holding her head up, and rolling from her stomach to her back.
"She can hold her head up and is trying to sit up, she's recently learned how to roll from her stomach to her back which is fantastic to see," Sandeep Kaur explained. "Her general health has improved, she has more co-ordination, she can bring her palms together and is able to move her hand to her mouth."
Professor Manju Kurian, consultant paediatric neurologist at GOSH, emphasized the significance of these developments: "The natural history of the condition is that most patients cannot fully hold their head or make any developmental progress after that milestone. Gunreet's progress over the last year has been really impressive in that context, as well as the virtual disappearance of the eye crises."
Understanding AADC Deficiency
AADC deficiency is caused by mutations in the gene that produces the AADC enzyme, which is essential for producing dopamine, a neurotransmitter crucial for controlling movement. Children with this condition have little or no dopamine in their brains, resulting in severe developmental delays, weak muscle tone, and inability to control limb movement.
The condition affects children's ability to control their head, blood pressure, and heart rate. Patients often experience painful episodes that can last for hours, and the condition is frequently fatal, with many children not reaching adulthood.
Gunreet was diagnosed at nine months old after her mother noticed she wasn't reaching developmental milestones. "She couldn't hold her own head up or reach out for items. She cried a lot and always wanted to be held," Sandeep Kaur recalled.
Precision Gene Delivery Technology
The Upstaza treatment consists of a virus containing a working version of the AADC gene. The therapy is delivered with millimetre precision to exact locations in the patient's brain by a medical team assisted by robotic surgery tools.
Once administered, the virus carries the AADC gene into nerve cells, enabling them to produce the missing enzyme. This process is expected to allow cells to generate the dopamine needed for proper function, thereby improving symptoms of the condition.
Clinical Optimism and Future Prospects
Professor Kurian expressed optimism about the treatment's potential: "We're hopeful that one day she will be able to talk or walk, as seen in some of the young patients treated in the clinical trial."
The neurologist also highlighted the transformative nature of having such advanced therapies available through the NHS: "It's incredible to me that I can now prescribe novel gene therapies just as I would prescribe paracetamol and antibiotics."
NHS Innovation Commitment
Professor James Palmer, NHS medical director for specialised commissioning, emphasized the broader implications of this development: "This is wonderful news for Gunreet and her family, and a powerful example of how these commitments are translating into real improvements in people's lives. By bringing cutting-edge medicines like eladocagene exuparvovec into the health service and setting up our expert clinical teams to successfully deliver them, the NHS is making clear its commitment to improving care through innovation."
The successful implementation of this therapy required collaborative efforts across multiple medical disciplines, including physiotherapists, surgeons, dietitians, and speech therapists, alongside partnerships with pharmaceutical companies supplying these advanced treatments.
