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Purine and pyrimidine nucleotides are essential for a vast number of biological processes such as RNA and DNA synthesis and as a component of high-energy nucleotides, e.g., ATP. Polygenic and monogenic diseases are associated with altered purine and pyrimidine metabolism; thus, the genes associated with gout have only minor effects on serum urate levels and the combination of such genetic factors as well as environmental factors cause the disease. Recent genome-wide association studies have identified such genes many of which code for transporters in renal tubules and related proteins. Monogenic diseases include enzyme abnormalities in the purine and pyrimidine pathways. Although most of the abnormalities were found by the candidate gene approach, Miller syndrome was found to be caused by the mutations in dihydroorotate dehydrogenase gene (DHODH) by whole exome sequencing. To date, more than 30 defects associated with purine and pyrimidine metabolism have been described. Inherited disorders of purine and pyrimidine metabolism have a wide variety of clinical presentations including anemia, immunodeficiency, renal stones, convulsions, mental retardation, autism, growth retardation, and serious adverse reactions to medication. For immunodeficiency caused by adenosine deaminase deficiency, enzyme replacement therapy and somatic gene therapy targeted at hematopoietic stem cells have been successful.

Niemann-Pick disease type B is a hereditary rare condition caused by deficiency of the acid sphingomyelinase (ASM) that is needed for lysosomal hydrolysis of sphingomyelin to ceramide and phosphocholine. This deficiency leads to a massive accumulation of sphingomyelin in cells throughout the body, predominantly in the liver, spleen and lungs. Currently, there is no effective treatment available. Olipudase alfa (recombinant human acid sphingomyelinase; rhASM) is an investigational drug that has shown promising results. However, dose-dependent toxicity was observed in mice upon the intravenous administration of rhASM, potentially due to the systemic release of ceramide upon the extracellular degradation of sphingomyelin by rhASM. Using a nanocarrier to deliver the rhASM to cells could improve the therapeutic window by shielding the rhASM to prevent the off-target degradation of sphingomyelin. For this aim, we recombinantly expressed hASM in human cells and loaded it into different liposomal formulations at a drug-to-lipid ratio of 4% (w/w). Among four formulations, the liposomal rhASM formulation with the composition DPPC:DOPS:BMP:CHOL:DiD (59:20:10:10:1 mol%) was selected because of its superiority concerning the encapsulation efficiency of rhASM (21%) and cellular uptake by fibroblasts and macrophages. The selected liposomal rhASM formulation significantly reduced the accumulated lyso-sphingomyelin in NPD-B fibroblasts by 71%, part of this effect was stimulated by the used lipids, compared to 55% when using the free rhASM enzyme. More importantly, the undesired extracellular degradation of sphingomyelin was reduced when using the selected liposomal rhASM by 61% relative to the free rhASM. The presented in vitro data indicate that the liposomal rhASM is effective and may provide a safer intervention than free rhASM.