An Open-label, Phase 1/2 Trial of Gene Therapy 4D-310 in Adults With Fabry Disease

Open to people ages 18 years and up

1. Male or female ≥ 18 years of age
2. Pathogenic GLA mutation consistent with Fabry Disease
3. Confirmed diagnosis of classic or late-onset Fabry disease
4. Individuals on ERT must be on a stable dose for at least 6 months (and a minimum of 12 months total exposure) prior to study enrollment
5. Agree to use highly effective contraception

1. Presence of high titer neutralizing antibody to 4D-310 capsid, or presence of high antibody titer to AGA
2. eGFR <45 mL/min/1.73 m2
3. Undergone kidney transplantation or currently on hemodialysis or peritoneal dialysis
4. HIV, active or chronic hepatitis B or C,
5. Evidence of liver disease, severe pulmonary disease or diabetes with poor glycemic control
6. History of stroke or transient ischemic attack within the last 12 months, or other significant thromboembolic disease history (e.g. pulmonary embolism)
7. Contraindication to systemic corticosteroid therapy or immunosuppressive therapy
8. Chronic steroid use, defined as ≥ 3 months of oral corticosteroid use within the last 12 months.

9. Moderately severe to severe cardiovascular disease or uncontrolled hypertension

   10. Left ventricular ejection fraction of <45% on echocardiogram (ECHO) 11. Currently receiving investigational drug, device or therapy or having ever received

   gene therapy

   12. History of infusion related response to ERT or any adverse reaction leading to ERT

   discontinuation

   13. History of cancer within 2 years (exceptions include non-melanoma skin cancer,

   localized prostate cancer treated with curative intent)

   14. Pregnant or breast-feeding