The Business Brew

Current Events - uniQure and the FDA

Mar 6, 2026
Professor Sarah Tabrizi, neurologist and Huntington's researcher, and Dr. Victor Sung, clinician-researcher on AMT-130, discuss AMT-130 gene therapy delivery and trial design. They debate use of EnrollHD as a propensity-matched external control, surgical and imaging details, ethical issues around long blinding, FDA skepticism, and regulatory pathways.
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INSIGHT

AMT-130 Delivery Mechanism And Trial Ethics

  • AMT-130 is a one-time AAV5 viral-vector gene therapy delivered via six burr holes targeting caudate and putamen to reduce huntingtin production.
  • Victor Sung emphasizes the procedure is invasive (14–18 hour surgeries) and the RNA transcript persists without DNA integration, creating long-term effect and ethical trial challenges.
INSIGHT

Trial Design Split Between US And Europe

  • Unicure ran low- and high-dose cohorts with a partial-burr-hole placebo in the US but Europe rejected a placebo arm, so European sites ran open-label.
  • The US placebo subjects were offered treatment after 12 months and four accepted, limiting long-term internal controls.
INSIGHT

EnrollHD As The External Comparator

  • EnrollHD is a large longitudinal external registry (~33,000 participants) used to create propensity-score matched external controls for AMT-130.
  • EnrollHD lacks MRI imaging but provides motor, cognitive, and functional data useful for matched comparisons.
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