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Gardin A, Castelle M, Pichard S, Cano A, Chabrol B, Piarroux J, Roubertie A, Nadjar Y, Guemann AS, Tardieu M, Lacombe D, Robert MP, Caillaud C, Froissart R, Leboeuf V, Barbier V, Bouchereau J, Schiff M, Fauroux B, Thierry B, Luscan R, James S, de Saint-Denis T, Pannier S, Gitiaux C, Vergnaud E, Boddaert N, Lascourreges C, Lemoine M, Bonnet D, Blanche S, Dalle JH, Neven B, de Lonlay P, Brassier A. Long term follow-up after haematopoietic stem cell transplantation for mucopolysaccharidosis type I-H: a retrospective study of 51 patients. Bone Marrow Transplant 2023; 58:295-302. [PMID: 36494569 PMCID: PMC10005963 DOI: 10.1038/s41409-022-01886-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
Mucopolysaccharidosis type I-H (MPS I-H) is a rare lysosomal storage disorder caused by α-L-Iduronidase deficiency. Early haematopoietic stem cell transplantation (HSCT) is the sole available therapeutic option to preserve neurocognitive functions. We report long-term follow-up (median 9 years, interquartile range 8-16.5) for 51 MPS I-H patients who underwent HSCT between 1986 and 2018 in France. 4 patients died from complications of HSCT and one from disease progression. Complete chimerism and normal α-L-Iduronidase activity were obtained in 84% and 71% of patients respectively. No difference of outcomes was observed between bone marrow and cord blood stem cell sources. All patients acquired independent walking and 91% and 78% acquired intelligible language or reading and writing. Intelligence Quotient evaluation (n = 23) showed that 69% had IQ ≥ 70 at last follow-up. 58% of patients had normal or remedial schooling and 62% of the 13 adults had good socio-professional insertion. Skeletal dysplasia as well as vision and hearing impairments progressed despite HSCT, with significant disability. These results provide a long-term assessment of HSCT efficacy in MPS I-H and could be useful in the evaluation of novel promising treatments such as gene therapy.
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Affiliation(s)
- Antoine Gardin
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Martin Castelle
- Paediatric Hematology Immunology Rheumatology Unit, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Samia Pichard
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Aline Cano
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Timone Enfants, Marseille, France
| | - Brigitte Chabrol
- Department of Neuropediatrics and Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Timone Enfants, Marseille, France
| | - Julie Piarroux
- Department of Neuropediatrics, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Agathe Roubertie
- Department of Neuropediatrics, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
- INM, Univ Montpellier, INSERM U1298, Montpellier, France
| | - Yann Nadjar
- Neuro-Metabolism Unit, Reference Center for Lysosomal Diseases, Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - Anne-Sophie Guemann
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Jeanne de Flandre, Lille, France
| | - Marine Tardieu
- Department of Pediatrics, Center for Inborn Errors of Metabolism ToTeM, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Didier Lacombe
- Department of Medical Genetics, CHU Bordeaux, Université de Bordeaux, INSERM U1211, Bordeaux, France
| | - Matthieu P Robert
- Department of Ophthalmology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France; Borelli Centre, UMR 9010 CNRS - SSA - ENS Paris Saclay - Paris Cité University, Paris, France
| | - Catherine Caillaud
- Biochemistry, Metabolomics, and Proteomics Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Roseline Froissart
- Biochemical and Molecular Biology Department, Lyon University Hospital, Bron, France
| | - Virginie Leboeuf
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Valérie Barbier
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Juliette Bouchereau
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Manuel Schiff
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, EA 7330 VIFASOM, Paris, France
| | - Briac Thierry
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Romain Luscan
- Department of Pediatric Otolaryngology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Syril James
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Timothée de Saint-Denis
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Stéphanie Pannier
- Paediatric Orthopaedic Service, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Cyril Gitiaux
- Department of Paediatric Neurophysiology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Estelle Vergnaud
- Department of Anesthesia, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163 and U1299, F-75015, Paris, France
| | - Claire Lascourreges
- Department of Pain and Palliative Care Unit, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Michel Lemoine
- Department of Physical Medicine and Rehabilitation, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Damien Bonnet
- Department of Congenital and Pediatric Cardiology, M3C-Necker, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Stéphane Blanche
- Paediatric Hematology Immunology Rheumatology Unit, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Jean-Hugues Dalle
- Hematology and Immunology Department, Hôpital Robert Debré, GHU AP-HP Nord Université Paris-Cité, Paris, France
| | - Bénédicte Neven
- Paediatric Hematology Immunology Rheumatology Unit, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
- Institut Imagine, Paris, France
| | - Pascale de Lonlay
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France
| | - Anaïs Brassier
- Department of Pediatric Metabolism, Reference Center of Inherited Metabolic Disorders, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Cité, Paris, France.
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Jameson E, Jones S, Remmington T. Enzyme replacement therapy with laronidase (Aldurazyme ®) for treating mucopolysaccharidosis type I. Cochrane Database Syst Rev 2019; 6:CD009354. [PMID: 31211405 PMCID: PMC6581069 DOI: 10.1002/14651858.cd009354.pub5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Mucopolysaccharidosis type I can be classified as three clinical sub-types; Hurler syndrome, Hurler-Scheie syndrome and Scheie syndrome, with the scale of severity being such that Hurler syndrome is the most severe and Scheie syndrome the least severe. It is a rare, autosomal recessive disorder caused by a deficiency of alpha-L-iduronidase. Deficiency of this enzyme results in the accumulation of glycosaminoglycans within the tissues. The clinical manifestations are facial dysmorphism, hepatosplenomegaly, upper airway obstruction, skeletal deformity and cardiomyopathy. If Hurler syndrome is left untreated, death ensues by adolescence. There are more attenuated variants termed Hurler-Scheie or Scheie syndrome, with those affected potentially not presenting until adulthood. Enzyme replacement therapy has been used for a number of years in the treatment of Hurler syndrome, although the current gold standard would be a haemopoietic stem cell transplant in those diagnosed by 2.5 years of age. This is an updated version of the original Cochrane Review published in 2013 and previously updated in 2015. OBJECTIVES To evaluate the effectiveness and safety of treating mucopolysaccharidosis type I with laronidase enzyme replacement therapy as compared to placebo. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Trials Register, MEDLINE via OVID and Embase.Date of most recent search: 30 January 2019. SELECTION CRITERIA Randomised and quasi-randomised controlled studies of laronidase enzyme replacement therapy compared to placebo. DATA COLLECTION AND ANALYSIS Two authors independently screened the identified studies. The authors then appraised and extracted data. The quality of the evidence was assessed using GRADE. MAIN RESULTS One study (45 participants) met the inclusion criteria. This double-blind, placebo-controlled, randomised, multinational study looked at laronidase at a dose of 0.58 mg/kg/week versus placebo in people with mucopolysaccharidosis type I. All primary outcomes listed in this review were studied in this study. The laronidase group achieved statistically significant improvements in per cent predicted forced vital capacity compared to placebo, MD 5.60 (95% confidence intervals 1.24 to 9.96) (low-quality evidence) and in the six-minute-walk test (mean improvement of 38.1 metres in the laronidase group; P = 0.039, when using a prospectively planned analysis of covariance) (low-quality evidence). The levels of urinary glycoaminoglycans were also significantly reduced (low-quality evidence). In addition, there were improvements in hepatomegaly, sleep apnoea and hypopnoea. Laronidase antibodies were detected in nearly all participants in the treatment group with no apparent clinical effect and titres were reducing by the end of the study (very low-quality evidence). Infusion-related adverse reactions occurred in both groups but all were mild and none necessitated medical intervention or infusion cessation (low-quality evidence). As assessed by questionnaires,changes in a 'Disability Index' after treatment were small and did not differ between groups (low-quality evidence). There were no deaths in either group (low-quality evidence). AUTHORS' CONCLUSIONS The current evidence demonstrates that laronidase is effective when compared to placebo in the treatment of mucopolysaccharidosis type I. The included study was comprehensive, with few participants and of low quality. The study included all of the key outcome measures we wished to look at. It demonstrated that laronidase is efficacious in relation to reducing biochemical parameters (reduced urine glycosaminoglycan excretion) and improved functional capacity as assessed by forced vital capacity and the six-minute-walk test. In addition glycosaminoglycan storage was reduced as ascertained by a reduction in liver volume. Laronidase appeared to be safe and, while antibodies were generated, these titres were reducing by the end of the study. More studies are required to determine long-term effectiveness and safety and to assess the impact upon quality of life. Enzyme replacement therapy with laronidase can be used pre- and peri-haemopoietic stem cell transplant, which is now the gold standard treatment in those individuals diagnosed under 2.5 years of age. We do not anticipate any further trials to be undertaken and therefore do not plan to update this review.
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Affiliation(s)
- Elisabeth Jameson
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Oxford Road, Manchester, UK, M13 9WL
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Han SO, Ronzitti G, Arnson B, Leborgne C, Li S, Mingozzi F, Koeberl D. Low-Dose Liver-Targeted Gene Therapy for Pompe Disease Enhances Therapeutic Efficacy of ERT via Immune Tolerance Induction. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2017; 4:126-136. [PMID: 28344998 PMCID: PMC5363303 DOI: 10.1016/j.omtm.2016.12.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 12/30/2016] [Indexed: 11/18/2022]
Abstract
Pompe disease results from acid α-glucosidase (GAA) deficiency, and enzyme replacement therapy (ERT) with recombinant human (rh) GAA has clinical benefits, although its limitations include the short half-life of GAA and the formation of antibody responses. The present study compared the efficacy of ERT against gene transfer with an adeno-associated viral (AAV) vector containing a liver-specific promoter. GAA knockout (KO) mice were administered either a weekly injection of rhGAA (20 mg/kg) or a single injection of AAV2/8-LSPhGAA (8 × 1011 vector genomes [vg]/kg). Both treatments significantly reduced glycogen content of the heart and diaphragm. Although ERT triggered anti-GAA antibody formation, there was no detectable antibody response following AAV vector administration. The efficacy of three lower dosages of AAV2/8-LSPhGAA was evaluated in GAA-KO mice, either alone or in combination with ERT. The minimum effective dose (MED) identified was 8 × 1010 vg/kg to reduce glycogen content in the heart and diaphragm of GAA-KO mice. A 3-fold higher dose was required to suppress antibody responses to ERT. Efficacy from liver gene therapy was slightly greater in male mice than in female mice. Vector dose correlated inversely with anti-GAA antibody formation, whereas higher vector doses suppressed previously formed anti-GAA antibodies as late as 25 weeks after the start of ERT and achieved biochemical correction of glycogen accumulation. In conclusion, we identified the MED for effective AAV2/8-LSPhGAA-mediated tolerogenic gene therapy in Pompe disease mice.
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Affiliation(s)
- Sang-oh Han
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Benjamin Arnson
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | | | - Songtao Li
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
| | - Federico Mingozzi
- Genethon and INSERM U951, 91002 Evry, France
- University Pierre and Marie Curie – Paris 6, 75005 Paris, France
| | - Dwight Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC 27710, USA
- Corresponding author: Dwight Koeberl, Duke University Medical Center, Box 103856, Durham, NC 27710, USA.
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Peck SH, Casal ML, Malhotra NR, Ficicioglu C, Smith LJ. Pathogenesis and treatment of spine disease in the mucopolysaccharidoses. Mol Genet Metab 2016; 118:232-43. [PMID: 27296532 PMCID: PMC4970936 DOI: 10.1016/j.ymgme.2016.06.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/21/2022]
Abstract
The mucopolysaccharidoses (MPS) are a family of lysosomal storage disorders characterized by deficient activity of enzymes that degrade glycosaminoglycans (GAGs). Skeletal disease is common in MPS patients, with the severity varying both within and between subtypes. Within the spectrum of skeletal disease, spinal manifestations are particularly prevalent. Developmental and degenerative abnormalities affecting the substructures of the spine can result in compression of the spinal cord and associated neural elements. Resulting neurological complications, including pain and paralysis, significantly reduce patient quality of life and life expectancy. Systemic therapies for MPS, such as hematopoietic stem cell transplantation and enzyme replacement therapy, have shown limited efficacy for improving spinal manifestations in patients and animal models. Therefore, there is a pressing need for new therapeutic approaches that specifically target this debilitating aspect of the disease. In this review, we examine how pathological abnormalities affecting the key substructures of the spine - the discs, vertebrae, odontoid process and dura - contribute to the progression of spinal deformity and symptomatic compression of neural elements. Specifically, we review current understanding of the underlying pathophysiology of spine disease in MPS, how the tissues of the spine respond to current clinical and experimental treatments, and discuss future strategies for improving the efficacy of these treatments.
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Affiliation(s)
- Sun H Peck
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, United States; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, United States
| | - Margret L Casal
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, United States
| | - Neil R Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, United States; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, United States
| | - Can Ficicioglu
- Division of Human Genetics and Metabolism, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, United States
| | - Lachlan J Smith
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, United States; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, United States.
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Jameson E, Jones S, Remmington T. Enzyme replacement therapy with laronidase (Aldurazyme(®)) for treating mucopolysaccharidosis type I. Cochrane Database Syst Rev 2016; 4:CD009354. [PMID: 27033167 DOI: 10.1002/14651858.cd009354.pub4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Mucopolysaccharidosis type I can be classified as three clinical sub-types; Hurler syndrome, Hurler-Scheie syndrome and Scheie syndrome, with the scale of severity being such that Hurler syndrome is the most severe and Scheie syndrome the least severe. It is a rare, autosomal recessive disorder caused by a deficiency of alpha-L-iduronidase. Deficiency of this enzyme results in the accumulation of glycosaminoglycans within the tissues. The clinical manifestations are facial dysmorphism, hepatosplenomegaly, upper airway obstruction, skeletal deformity and cardiomyopathy. If Hurler syndrome is left untreated, death ensues by adolescence. There are more attenuated variants termed Hurler-Scheie or Scheie syndrome, with those affected potentially not presenting until adulthood. Enzyme replacement therapy has been used for a number of years in the treatment of Hurler syndrome, although the current gold standard would be a haemopoietic stem cell transplant in those diagnosed by 2.5 years of age. This is an updated version of the original Cochrane review published in 2013. OBJECTIVES To evaluate the effectiveness and safety of treating mucopolysaccharidosis type I with laronidase enzyme replacement therapy as compared to placebo. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Trials Register, MEDLINE via OVID and Embase.Date of most recent search: 05 October 2015. SELECTION CRITERIA Randomised and quasi-randomised controlled studies of laronidase enzyme replacement therapy compared to placebo. DATA COLLECTION AND ANALYSIS Two authors independently screened the identified studies. The authors then appraised and extracted data. MAIN RESULTS One study of 45 patients met the inclusion criteria. This double-blind, placebo-controlled, randomised, multinational study looked at laronidase at a dose of 0.58 mg/kg/week versus placebo in patients with mucopolysaccharidosis type I. All primary outcomes listed in this review were studied in this study. The laronidase group achieved statistically significant improvements in per cent predicted forced vital capacity compared to placebo, MD 5.60 (95% confidence intervals 1.24 to 9.96) and in the six-minute-walk test (mean improvement of 38.1 metres in the laronidase group; P = 0.039, when using a prospectively planned analysis of covariance). The levels of urinary glycoaminoglycans were also significantly reduced. In addition, there were improvements in hepatomegaly, sleep apnoea and hypopnoea. Laronidase antibodies were detected in nearly all patients in the treatment group with no apparent clinical effect and titres were reducing by the end of the study. Infusion-related adverse reactions occurred in both groups but all were mild and none necessitated medical intervention or infusion cessation. AUTHORS' CONCLUSIONS The current evidence demonstrates that laronidase is effective when compared to placebo in the treatment of mucopolysaccharidosis type I. The included study was comprehensive and of good quality, although there were few participants. The study included all of the key outcome measures we wished to look at. It demonstrated that laronidase is efficacious in relation to reducing biochemical parameters (reduced urine glycosaminoglycan excretion) and improved functional capacity as assessed by forced vital capacity and the six-minute-walk test. In addition glycosaminoglycan storage was reduced as ascertained by a reduction in liver volume. Laronidase appeared to be safe and, while antibodies were generated, these titres were reducing by the end of the study. More studies are required to determine long-term effectiveness and safety and to assess the impact upon quality of life. Enzyme replacement therapy with laronidase can be used pre- and peri-haemopoietic stem cell transplant, which is now the gold standard treatment in those patients diagnosed under 2.5 years of age.
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Affiliation(s)
- Elisabeth Jameson
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Oxford Road, Manchester, UK, M13 9WL
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