Enzyme replacement therapy, a state-of-the-art treatment for many lysosomal storage disorders, relies on
carbohydrate-mediated binding of recombinant
enzymes to receptors that mediate lysosomal delivery via
clathrin-dependent endocytosis. Suboptimal glycosylation of recombinant
enzymes and deficiency of
clathrin-mediated endocytosis in some lysosomal
enzyme-deficient cells limit delivery and efficacy of
enzyme replacement therapy for lysosomal disorders. We explored a novel delivery strategy utilizing nanocarriers targeted to a glycosylation- and
clathrin-independent receptor,
intercellular adhesion molecule (ICAM)-1, a
glycoprotein expressed on diverse cell types, up-regulated and functionally involved in
inflammation, a hallmark of many lysosomal disorders. We targeted recombinant human
acid sphingomyelinase (ASM), deficient in types A and B
Niemann-Pick disease, to
ICAM-1 by loading this
enzyme to nanocarriers coated with anti-ICAM. Anti-ICAM/ASM nanocarriers, but not control ASM or ASM nanocarriers, bound to ICAM-1-positive cells (activated endothelial cells and
Niemann-Pick disease patient fibroblasts) via
ICAM-1, in a glycosylation-independent manner. Anti-ICAM/ASM nanocarriers entered cells via CAM-mediated endocytosis, bypassing the
clathrin-dependent pathway, and trafficked to lysosomes, where delivered ASM displayed stable activity and alleviated lysosomal
lipid accumulation. Therefore, lysosomal
enzyme targeting using nanocarriers targeted to
ICAM-1 bypasses defunct pathways and may improve the efficacy of
enzyme replacement therapy for lysosomal disorders, such as
Niemann-Pick disease.