The laboratory is testing three approaches to delivering the TPP1 enzyme to treat CLN2 disease: enzyme replacement therapy via biweekly infusion; direct gene therapy to instruct brain cells to produce the enzyme; and ex vivo gene therapy using stem cells modified to continuously produce the enzyme with a single treatment. For ex vivo gene therapy, bone marrow cells are modified to produce TPP1 and re-injected into the brain or eye. Preliminary clinical trial data shows ex vivo gene therapy improved retinal response to light in a CLN2 patient compared to untreated patients, offering promise for a one-time curative treatment. The laboratory aims to optimize long-term enzyme delivery to delay disease progression in a dog model of CLN2.