Abstract

COPPER HISTIDINATE (ZYCUBO): A CLINICAL REVIEW OF THE FIRST FDA-APPROVED THERAPY FOR MENKES DISEASE

Sandip Paul*, Mohan Kumar L.

ABSTRACT

Menkes Disease (MD) is a lethal X-linked recessive disorder of copper metabolism caused by pathogenic variants in the ATP7A gene. Historically, management has been restricted to palliative care or unstable, non-standardized compounded copper formulations that often failed to prevent neurodegeneration. This review analyses the clinical profile and pharmacological mechanism of Zycubo (copper histidinate), which received FDA approval on January 13, 2026, as the first disease-modifying therapy for MD. Zycubo functions via a "Trojan horse" mechanism, utilizing the LAT1 (SLC7A5) transporter to bypass defective intestinal absorption and cross the blood-brain barrier independently of the failed ATP7A protein. Pivotal clinical trials demonstrate that infants initiated on treatment within the 28-day "Golden Window" achieve a median survival of 177.1 months, compared to 17.6 months in historical controls, representing a 78% reduction in mortality risk. This review discusses the critical role of clinical pharmacists in managing the precise reconstitution of the lyophilized product, ensuring adherence to strict dosing protocols, and monitoring for iatrogenic copper toxicity. The approval of Zycubo marks a paradigm shift in MD management, necessitating widespread newborn screening to realize its life-saving potential.

Keywords: ATP7A; Copper Histidinate; Menkes Disease; Zycubo.