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Cavaloiu B, Simina IE, Vilciu C, Trăilă IA, Puiu M. Nusinersen Improves Motor Function in Type 2 and 3 Spinal Muscular Atrophy Patients across Time. Biomedicines 2024; 12:1782. [PMID: 39200246 PMCID: PMC11351209 DOI: 10.3390/biomedicines12081782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
Spinal muscular atrophy (SMA) is a genetic disorder primarily caused by mutations in the SMN1 gene, leading to motor neuron degeneration and muscle atrophy, affecting multiple organ systems. Nusinersen treatment targets gene expression and is expected to enhance the motor function of voluntary muscles in the limbs and trunk. Motor skills can be assessed through specific scales like the Revised Upper Limb Module Scale (RULM) and Hammersmith Functional Motor Scale Expanded (HFMSE). This study aims to evaluate the influence of nusinersen on the motor skills of patients with SMA Type 2 and 3 using real-world data collected over 54 months. A prospective longitudinal study was conducted on 37 SMA patients treated with nusinersen, analyzing data with R statistical software. The outcomes revealed significant improvements in motor functions, particularly in SMA Type 3 patients with higher RULM and HFSME scores. Additionally, GEE analysis identified time, type, age, and exon deletions as essential predictors of motor score improvements. The extended observation period is both a major strength and a limitation of this research, as the dropout rates could present challenges in interpretation. Variability in responses, influenced by genetic background, SMA type, and onset age, highlights the need for personalized treatment approaches.
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Affiliation(s)
- Bogdana Cavaloiu
- Faculty of Medicine, Department of Microscopic Morphology, Genetics Discipline, Center of Genomic Medicine, ‘Victor Babes’ University of Medicine and Pharmacy Timisoara, 2 E. Murgu, Sq., 300041 Timisoara, Romania;
- Department of Radiology, ‘Victor Gomoiu’ Children’s Clinical Hospital, 21 Basarabia Blvd., 022102 Bucharest, Romania
| | - Iulia-Elena Simina
- Department of Genetics, Center of Genomic Medicine, ‘Victor Babeş’ University of Medicine and Pharmacy of Timișoara, 300041 Timisoara, Romania;
| | - Crisanda Vilciu
- Department of Neurology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Neurology Clinic, ‘Fundeni’ Clinical Institute, 022328 Bucharest, Romania
| | - Iuliana-Anamaria Trăilă
- Department of Pathology, ‘Pius Brinzeu’ Emergency County Clinical Hospital, 300723 Timisoara, Romania;
| | - Maria Puiu
- Department of Genetics, Center of Genomic Medicine, ‘Victor Babeş’ University of Medicine and Pharmacy of Timișoara, 300041 Timisoara, Romania;
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Couce ML, Bóveda MD, Castiñeiras DE, Vázquez-Mosquera ME, Barbosa-Gouveia S, De Castro MJ, Iglesias-Rodríguez AJ, Colón C, Cocho JA, Sánchez P. A newborn Screening Programme for Inborn errors of metabolism in Galicia: 22 years of evaluation and follow-up. Orphanet J Rare Dis 2024; 19:202. [PMID: 38760795 PMCID: PMC11102203 DOI: 10.1186/s13023-024-03204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/05/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND There is a notable lack of harmonisation in newborn screening (NBS) programmes worldwide. The Galician programme for early detection of inborn errors of metabolism (IEM) was one of the first NBS programmes in Europe to incorporate mass spectrometry (July 2000). This programme currently screens for 26 IEMs in dried blood and urine samples collected 24-72 h after birth. RESULTS In its 22-year history, this programme has analysed samples from 440,723 neonates and identified 326 cases of IEM with a prevalence of 1:1351. The most prevalent IEMs were hyperphenylalaninaemia (n = 118), followed by medium chain acyl-CoA dehydrogenase deficiency (MCADD, n = 26), galactosaemia (n = 20), and cystinurias (n = 43). Sixty-one false positives and 18 conditions related to maternal pathologies were detected. Urine samples have been identified as a useful secondary sample to reduce the rate of false positives and identify new defects. There were 5 false negatives. The overall positive value was 84.23%. The fatality rate over a median of 12.1 years of follow-up was 2.76%. The intelligence quotient of patients was normal in 95.7% of cases, and school performance was largely optimal, with pedagogic special needs assistance required in < 10% of cases. Clinical onset of disease preceded diagnosis in 4% of cases. The age at which first NBS report is performed was reduced by 4 days since 2021. CONCLUSIONS This study highlights the benefits of collecting urine samples, reduce NBS reporting time and expanding the number of IEMs included in NBS programmes.
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Affiliation(s)
- María L Couce
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain.
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain.
| | - María-Dolores Bóveda
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - Daisy E Castiñeiras
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - María-Eugenia Vázquez-Mosquera
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - Sofía Barbosa-Gouveia
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - María-José De Castro
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - Agustin J Iglesias-Rodríguez
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - Cristóbal Colón
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - José A Cocho
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
| | - Paula Sánchez
- Diagnosis and Treatment of Congenital Metabolic Diseases, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela University, CIBERER, RICORS, MetabERN, A Coruña, Spain
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Dabaj I, Ducatez F, Marret S, Bekri S, Tebani A. Neuromuscular disorders in the omics era. Clin Chim Acta 2024; 553:117691. [PMID: 38081447 DOI: 10.1016/j.cca.2023.117691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023]
Abstract
Neuromuscular disorders encompass a spectrum of conditions characterized by primary lesions within the peripheral nervous system, which include the anterior horn cell, peripheral nerve, neuromuscular junction, and muscle. In pediatrics, most of these disorders are linked to genetic causes. Despite the considerable progress, the diagnosis of these disorders remains a challenging due to wide clinical presentation, disease heterogeneity and rarity. It is noteworthy that certain neuromuscular disorders, once deemed untreatable, can now be effectively managed through novel therapies. Biomarkers emerge as indispensable tools, serving as objective measures that not only refine diagnostic accuracy but also provide guidance for therapeutic decision-making and the ongoing monitoring of long-term outcomes. Herein a comprehensive review of biomarkers in neuromuscular disorders is provided. We highlight the role of omics-based technologies that further characterize neuromuscular pathophysiology as well as identify potential therapeutic targets to guide treatment strategies.
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Affiliation(s)
- Ivana Dabaj
- Normandie Univ, UNIROUEN, INSERM U1245, Nord/Est/Ile de France Neuromuscular Reference Center CHU Rouen, Department of Neonatalogy, Pediatric Intensive Care, and Neuropediatrics, F-76000 Rouen, France.
| | - Franklin Ducatez
- Normandie Univ, UNIROUEN, INSERM U1245, Nord/Est/Ile de France Neuromuscular Reference Center CHU Rouen, Department of Neonatalogy, Pediatric Intensive Care, and Neuropediatrics, F-76000 Rouen, France
| | - Stéphane Marret
- Normandie Univ, UNIROUEN, INSERM U1245, Nord/Est/Ile de France Neuromuscular Reference Center CHU Rouen, Department of Neonatalogy, Pediatric Intensive Care, and Neuropediatrics, F-76000 Rouen, France
| | - Soumeya Bekri
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, F-76000 Rouen, France
| | - Abdellah Tebani
- Normandie Univ, UNIROUEN, INSERM U1245, CHU Rouen, Department of Metabolic Biochemistry, F-76000 Rouen, France
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Kubar A, Temel SG, Beken S, Onder G, Hatirnaz O, Korkmaz A, Alanay Y, Ozbek U, Sag SO, Ergoren MC, Kubar E, Sonmezalp CZ, Doğan O. A new line method; A direct test in spinal muscular atrophy screening for DBS. Mol Genet Genomic Med 2023; 11:e2270. [PMID: 37614112 PMCID: PMC10724511 DOI: 10.1002/mgg3.2270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Nucleic acid-based assays provide an opportunity to screen for genetically encoded diseases like spinal muscular atrophy (SMA), before the onset of symptoms. Nowadays, such assays could be easily utilized as high-throughputs in SMA to detect a homozygous deletion of exon 7 of the survival motor neuron 1 gene (SMN1) that is responsible for >95% of SMA patients. METHODS We developed a new line method (NLM) as a direct real time PCR test procedure without nucleic acid extraction in dried blood spots (DBS) to screen for homozygous deletion of exon 7 of the SMN1 gene. Performance of this setup was evaluated on 580 DBS newborn samples and air dried 50 DBS from whole blood including 20 samples for homozygous deletion of the SMN1 gene detected earlier with MLPA. RESULTS We found all 580 newborn DBS samples as wild type. DBS prepared from 50 whole blood samples also including 20 affected people were correctly identified as homozygous deletions and 30 wild types of exon 7 of SMN1 as before with MLPA. When the MLPA method was taken as the gold standard, the sensitivity and specificity of the NLM test were found 100% for the detection of SMN1 exon 7 homozygous deletion. CONCLUSION In the NLM, the total test duration has been reduced to less than 75 min without requiring any extra process such as DNA extraction step and sample plate preparation after the punching step. Thereby, newborn SMA screening with the NLM has gained an environmentally friendly feature with not requiring additional tedious steps.
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Affiliation(s)
| | - Sehime Gülsüm Temel
- Department of Medical Genetics, Faculty of MedicineBursa Uludag UniversityBursaTurkey
- Department of Translational Medicine, Institute of Health SciencesBursa Uludag UniversityBursaTurkey
| | - Serdar Beken
- Department of Pediatrics, School of MedicineAcibadem Mehmet Ali Aydınlar UniversityIstanbulTurkey
| | - Gizem Onder
- Department of Biochemistry and Molecular Biology, Institute of of Health SciencesAcibadem Mehmet Ali Aydınlar UniversityIstanbulTurkey
| | - Ozden Hatirnaz
- Department of Basic Sciences, Medical Biology, School of MedicineAcibadem Mehmet Ali Aydınlar UniversityIstanbulTurkey
| | - Ayse Korkmaz
- Department of Pediatrics, School of MedicineAcibadem Mehmet Ali Aydınlar UniversityIstanbulTurkey
| | - Yasemin Alanay
- Department of Pediatrics, School of MedicineAcibadem Mehmet Ali Aydınlar UniversityIstanbulTurkey
| | - Ugur Ozbek
- Department of Medical Sciences, Medical Genetics, School of MedicineAcibadem Mehmet Ali Aydınlar UniversityIstanbulTurkey
| | - Sebnem Ozemri Sag
- Department of Medical Genetics, Faculty of MedicineBursa Uludag UniversityBursaTurkey
| | | | - Elif Kubar
- Ege University Faculty of MedicineDepartment of Medical GeneticsIzmirTurkey
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Qu B, Cao J, Qian C, Wu J, Lin J, Wang L, Ou-Yang L, Chen Y, Yan L, Hong Q, Zheng G, Qu X. Current development and prospects of deep learning in spine image analysis: a literature review. Quant Imaging Med Surg 2022; 12:3454-3479. [PMID: 35655825 PMCID: PMC9131328 DOI: 10.21037/qims-21-939] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/04/2022] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND OBJECTIVE As the spine is pivotal in the support and protection of human bodies, much attention is given to the understanding of spinal diseases. Quick, accurate, and automatic analysis of a spine image greatly enhances the efficiency with which spine conditions can be diagnosed. Deep learning (DL) is a representative artificial intelligence technology that has made encouraging progress in the last 6 years. However, it is still difficult for clinicians and technicians to fully understand this rapidly evolving field due to the diversity of applications, network structures, and evaluation criteria. This study aimed to provide clinicians and technicians with a comprehensive understanding of the development and prospects of DL spine image analysis by reviewing published literature. METHODS A systematic literature search was conducted in the PubMed and Web of Science databases using the keywords "deep learning" and "spine". Date ranges used to conduct the search were from 1 January, 2015 to 20 March, 2021. A total of 79 English articles were reviewed. KEY CONTENT AND FINDINGS The DL technology has been applied extensively to the segmentation, detection, diagnosis, and quantitative evaluation of spine images. It uses static or dynamic image information, as well as local or non-local information. The high accuracy of analysis is comparable to that achieved manually by doctors. However, further exploration is needed in terms of data sharing, functional information, and network interpretability. CONCLUSIONS The DL technique is a powerful method for spine image analysis. We believe that, with the joint efforts of researchers and clinicians, intelligent, interpretable, and reliable DL spine analysis methods will be widely applied in clinical practice in the future.
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Affiliation(s)
- Biao Qu
- Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China
| | - Jianpeng Cao
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Chen Qian
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jinyu Wu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jianzhong Lin
- Department of Radiology, Zhongshan Hospital of Xiamen University, Xiamen, China
| | - Liansheng Wang
- Department of Computer Science, School of Informatics, Xiamen University, Xiamen, China
| | - Lin Ou-Yang
- Department of Medical Imaging of Southeast Hospital, Medical College of Xiamen University, Zhangzhou, China
| | - Yongfa Chen
- Department of Pediatric Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Liyue Yan
- Department of Information & Computational Mathematics, Xiamen University, Xiamen, China
| | - Qing Hong
- Biomedical Intelligent Cloud R&D Center, China Mobile Group, Xiamen, China
| | - Gaofeng Zheng
- Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China
| | - Xiaobo Qu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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Sutherland CS, Hudson P, Mitchell S, Paracha N. Systematic Literature Review to Identify Utility Values in Patients with Spinal Muscular Atrophy (SMA) and Their Caregivers. PHARMACOECONOMICS 2022; 40:39-67. [PMID: 34907515 PMCID: PMC8994729 DOI: 10.1007/s40273-021-01115-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that has a substantial impact on health-related quality of life for patients with SMA and their caregivers. Utility values ('utilities') are used in health economic analyses to incorporate individual or societal perspectives regarding the desirability of health outcomes such as a certain health state or change in health states over time. OBJECTIVES The primary objective of this systematic literature review (SLR) was to identify published utilities associated with patients with SMA and their caregivers and to determine the extent to which Health Technology Assessment (HTA) requirements of methods used to generate utilities are met. A secondary objective was to broaden the scope to identify utilities associated with other (non-SMA) neuromuscular disorders. METHODS A comprehensive search to capture published utilities associated with patients with SMA and their caregivers was performed in 2019 and updated in 2021 using several electronic databases in addition to supplementary sources. As we anticipated that few published utilities associated with SMA would be identified, the search also captured utilities for other (non-SMA) neuromuscular disorders that may serve as useful surrogate values for studies of SMA and other rare diseases. Electronic searches were performed in Embase, MEDLINE, Evidence-Based Medicine Reviews, and EconLit via the Ovid platform and were supplemented by searches of the grey literature (reference lists, conference proceedings, global HTA body websites, and other relevant sources). Study eligibility criteria were based on the population, interventions, comparators, and outcomes (PICO) framework. The quality of the full-text publications was assessed using a checklist based on UK National Institute for Health and Care Excellence technical support documents. RESULTS In total, 14 publications that reported SMA-related patient or caregiver utilities or disutilities met the eligibility criteria to be included in the SLR; the included studies demonstrate the substantial health-related quality-of-life burden of SMA on both patients with SMA and their caregivers. A variety of preference-based measures were used to derive utilities for patients with SMA and their caregivers. Different methods for collecting utility data included patient and proxy assessment of health states using questionnaires, vignette methodologies, structured forms of expert elicitation, and mapped data from results of clinical trials. A range of utilities was reported from both patient- and proxy-reported data, which reflects the degree of disability associated with early- and later-onset SMA. Methods for deriving utilities were assessed with respect to three reference cases from HTA bodies in the UK, the USA, and Canada. None of the 14 publications met the requirements of all three HTA bodies because of differing tariff requirements between countries; one study met the requirements of HTA bodies in Canada and the UK. Also, six studies did not report the method of valuation, which precluded analysis with respect to the HTA reference cases. CONCLUSIONS This SLR provides a comprehensive repository of the currently available utilities relevant to patients with SMA and their caregivers. This SLR provides recommendations for establishing consensus on the approach to generating utility values for the SMA patient population and their caregivers for health economic decisions.
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Affiliation(s)
- C Simone Sutherland
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124 Building 001/OG13, CH 4070, Basel, Switzerland.
| | | | | | - Noman Paracha
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124 Building 001/OG13, CH 4070, Basel, Switzerland
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Paracha N, Hudson P, Mitchell S, Sutherland CS. Systematic Literature Review to Assess Economic Evaluations in Spinal Muscular Atrophy (SMA). PHARMACOECONOMICS 2022; 40:69-89. [PMID: 34658008 PMCID: PMC8994739 DOI: 10.1007/s40273-021-01095-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a rare, progressive neuromuscular disease that affects individuals with a broad age range. SMA is typically characterised by symmetrical muscle weakness but is also associated with cardiac defects, life-limiting impairments in respiratory function and bulbar function defects that affect swallowing and speech. Despite the advent of three innovative disease-modifying therapies (DMTs) for SMA, the cost of DMTs in addition to the costs of standard of care can be a barrier to treatment access for patients. Health Technology Assessment (HTA) decision makers evaluate the cost effectiveness of a new treatment before making a reimbursement decision. OBJECTIVE The primary objective was to conduct a systematic literature review (SLR) to identify the modelling approaches used in economic evaluations that assess current approved treatments in SMA, with a secondary objective to widen the scope and identify economic evaluations assessing other (non-SMA) neuromuscular disorders. METHODS An SLR was performed to identify available economic evaluations associated with any type of SMA (Type 1, 2, 3 and/or 4). Economic evaluations associated with other (non-SMA) neuromuscular disorders were identified but not further analysed. Electronic searches were conducted in Embase, MEDLINE, Evidence-Based Medicine Reviews and EconLit via the Ovid platform in August 2019, and were supplemented by searches of the grey literature (reference lists, conference proceedings, global HTA body websites and other relevant sources). Eligibility criteria were based on the population, interventions, comparators and outcomes (PICO) framework. Quality assessment of full publications was conducted with reference to a published checklist. RESULTS Nine publications covering eight unique studies met all eligibility criteria for inclusion in the SLR, including four conference abstracts, two peer-reviewed original research articles and three HTA submissions (conducted in Canada, the US and the UK). Evaluations considered patients with early infantile-onset (most likely to develop Type 1 or Type 2 SMA), later-onset SMA and both infantile- and later-onset SMA. Data for the identified economic models were collected from literature reviews and relatively short-term clinical trials. Several intent-to-treat clinical trial populations were used in the studies, which resulted in variation in cycle length and different outcome measures to determine clinical efficacy. The results of the quality assessment on the five full-text, peer-reviewed publications found that they generally provided clear descriptions of objectives, modelling methods and results. However, key decisions, such as choice of economic evaluation, model type and choice of variables for sensitivity analysis, were often not adequately justified. CONCLUSIONS This SLR highlights the need for economic evaluations in SMA to better align in modelling approaches with respect to (i) consistency in model structure and use of motor function milestones as health states; (ii) consensus on measuring quality of life to estimate utilities; (iii) consistency in data collection by registries; and (iv) consensus on SMA-type classification and endpoints that determine intervention efficacy. Future economic evaluations should also incorporate the review group critiques of previous HTA submissions relating to data inputs and approaches to modelling and should include patient data reflective of the SMA population being modelled. Economic evaluations would also be improved with inclusion of long-term efficacy and safety data from clinical trials and valid patient and caregiver utility data.
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Ziegler A. [Precision medicine in pediatric neurology exemplified by the new treatment forms]. DER NERVENARZT 2022; 93:122-134. [PMID: 35037966 PMCID: PMC8825642 DOI: 10.1007/s00115-021-01251-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In recent years the possibilities for molecular diagnostics and treatment of rare childhood diseases have greatly improved. The first gene-modifying drugs have now been approved, leading to a new era of precision treatment in pediatric neurology. OBJECTIVE This article describes the dynamic developments of precision medicine in pediatric neurology in the areas of prevention, diagnostics and targeted treatment. DISCUSSION The paradigm shift as a result of precision medicine is based on a treatment approach focused more strongly on the individual and the corresponding unique characteristics. Modern methods of genetic and molecular diagnostics are used to accurately describe and characterize affected children, complemented by a precise description of the clinical phenotype. Nevertheless, the success of the best individual treatment strategy derived from this information is often dependent on the time of diagnosis. Therefore, methods for disease prevention, particularly newborn screening programs, become increasingly more important to achieve the best possible success of novel therapies even before the onset of disease symptoms. In addition to a precise stratification of therapies, special attention should be paid in the future to the consideration of the individual perspective of patients and parents/guardians. Furthermore, a normative framework for a quality-ensured application of gene-modifying therapies in the German healthcare system must be created.
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Affiliation(s)
- Andreas Ziegler
- Zentrum für Kinder- und Jugendmedizin, Sektion für Neuropädiatrie und Stoffwechselmedizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland.
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Florian IA, Lupan I, Sur L, Samasca G, Timiș TL. To be, or not to be… Guillain-Barré Syndrome. Autoimmun Rev 2021; 20:102983. [PMID: 34718164 DOI: 10.1016/j.autrev.2021.102983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023]
Abstract
Guillain-Barré Syndrome (GBS) is currently the most frequent cause of acute flaccid paralysis on a global scale, being an autoimmune disorder wherein demyelination of the peripheral nerves occurs. Its main clinical features are a symmetrical ascending muscle weakness with reduced osteotendinous reflexes and variable sensory involvement. GBS most commonly occurs after an infection, especially viral (including COVID-19), but may also transpire after immunization with certain vaccines or in the development of specific malignancies. Immunoglobulins, plasmapheresis, and glucocorticoids represent the principal treatment modalities, however patients with severe disease progression may require supportive therapy in an intensive care unit. Due to its symptomology, which overlaps with numerous neurological and infectious illnesses, the diagnosis of GBS may often be misattributed to pathologies that are essentially different from this syndrome. Moreover, many of these require specific treatment methods distinct to those recommended for GBS, in lack of which the prognosis of the patient is drastically affected. Such diseases include exposure to toxins either environmental or foodborne, central nervous system infections, metabolic or serum ion alterations, demyelinating pathologies, or even conditions amenable to neurosurgical intervention. This extensive narrative review aims to systematically and comprehensively tackle the most notable and challenging differential diagnoses of GBS, emphasizing on the clinical discrepancies between the diseases, the appropriate paraclinical investigations, and suitable management indications.
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Affiliation(s)
- Ioan Alexandru Florian
- Department of Neurology, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania, Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Iulia Lupan
- Department of Molecular Biology, Babes Bolyai University, Cluj-Napoca, Romania.
| | - Lucia Sur
- Department of Pediatrics I, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Teodora Larisa Timiș
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Saffari A, Cannet C, Blaschek A, Hahn A, Hoffmann GF, Johannsen J, Kirsten R, Kockaya M, Kölker S, Müller-Felber W, Roos A, Schäfer H, Schara U, Spraul M, Trefz FK, Vill K, Wick W, Weiler M, Okun JG, Ziegler A. 1H-NMR-based metabolic profiling identifies non-invasive diagnostic and predictive urinary fingerprints in 5q spinal muscular atrophy. Orphanet J Rare Dis 2021; 16:441. [PMID: 34670613 PMCID: PMC8527822 DOI: 10.1186/s13023-021-02075-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background 5q spinal muscular atrophy (SMA) is a disabling and life-limiting neuromuscular disease. In recent years, novel therapies have shown to improve clinical outcomes. Yet, the absence of reliable biomarkers renders clinical assessment and prognosis of possibly already affected newborns with a positive newborn screening result for SMA imprecise and difficult. Therapeutic decisions and stratification of individualized therapies remain challenging, especially in symptomatic children. The aim of this proof-of-concept and feasibility study was to explore the value of 1H-nuclear magnetic resonance (NMR)-based metabolic profiling in identifying non-invasive diagnostic and prognostic urinary fingerprints in children and adolescents with SMA. Results Urine samples were collected from 29 treatment-naïve SMA patients (5 pre-symptomatic, 9 SMA 1, 8 SMA 2, 7 SMA 3), 18 patients with Duchenne muscular dystrophy (DMD) and 444 healthy controls. Using machine-learning algorithms, we propose a set of prediction models built on urinary fingerprints that showed potential diagnostic value in discriminating SMA patients from controls and DMD, as well as predictive properties in separating between SMA types, allowing predictions about phenotypic severity. Interestingly, preliminary results of the prediction models suggest additional value in determining biochemical onset of disease in pre-symptomatic infants with SMA identified by genetic newborn screening and furthermore as potential therapeutic monitoring tool. Conclusions This study provides preliminary evidence for the use of 1H-NMR-based urinary metabolic profiling as diagnostic and prognostic biomarker in spinal muscular atrophy. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02075-x.
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Affiliation(s)
- Afshin Saffari
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | | | - Astrid Blaschek
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, LMU Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Andreas Hahn
- Department of Child Neurology, University Hospital Gießen, Gießen, Germany
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Jessika Johannsen
- Department of Pediatrics, Neuropediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Romy Kirsten
- NCT Liquidbank, National Center for Tumor Diseases, Heidelberg, Germany
| | | | - Stefan Kölker
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Wolfgang Müller-Felber
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, LMU Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Andreas Roos
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Centre for Neuromuscular Disorders in Children, Children's University Clinic Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Ulrike Schara
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, Centre for Neuromuscular Disorders in Children, Children's University Clinic Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Friedrich K Trefz
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Katharina Vill
- Division of Pediatric Neurology and Developmental Medicine and LMU Center for Children With Medical Complexity, LMU Hospital, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen G Okun
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Andreas Ziegler
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
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11
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Galanopoulou AS, Löscher W, Lubbers L, O’Brien TJ, Staley K, Vezzani A, D’Ambrosio R, White HS, Sontheimer H, Wolf JA, Twyman R, Whittemore V, Wilcox KS, Klein B. Antiepileptogenesis and disease modification: Progress, challenges, and the path forward-Report of the Preclinical Working Group of the 2018 NINDS-sponsored antiepileptogenesis and disease modification workshop. Epilepsia Open 2021; 6:276-296. [PMID: 34033232 PMCID: PMC8166793 DOI: 10.1002/epi4.12490] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
Epilepsy is one of the most common chronic brain diseases and is often associated with cognitive, behavioral, or other medical conditions. The need for therapies that would prevent, ameliorate, or cure epilepsy and the attendant comorbidities is a priority for both epilepsy research and public health. In 2018, the National Institute of Neurological Disease and Stroke (NINDS) convened a workshop titled "Accelerating the Development of Therapies for Antiepileptogenesis and Disease Modification" that brought together preclinical and clinical investigators and industry and regulatory bodies' representatives to discuss and propose a roadmap to accelerate the development of antiepileptogenic (AEG) and disease-modifying (DM) new therapies. This report provides a summary of the discussions and proposals of the Preclinical Science working group. Highlights of the progress of collaborative preclinical research projects on AEG/DM of ongoing research initiatives aiming to improve infrastructure and translation to clinical trials are presented. Opportunities and challenges of preclinical epilepsy research, vis-à-vis clinical research, were extensively discussed, as they pertain to modeling of specific epilepsy types across etiologies and ages, the utilization of preclinical models in AG/DM studies, and the strategies and study designs, as well as on matters pertaining to transparency, data sharing, and reporting research findings. A set of suggestions on research initiatives, infrastructure, workshops, advocacy, and opportunities for expanding the borders of epilepsy research were discussed and proposed as useful initiatives that could help create a roadmap to accelerate and optimize preclinical translational AEG/DM epilepsy research.
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Affiliation(s)
- Aristea S. Galanopoulou
- Saul R. Korey Department of NeurologyDominick P. Purpura Department of NeuroscienceIsabelle Rapin Division of Child NeurologyAlbert Einstein College of MedicineBronxNYUSA
| | - Wolfgang Löscher
- Department of Pharmacology, Toxicology, and PharmacyUniversity of Veterinary Medicine HannoverHannoverGermany
| | | | - Terence J. O’Brien
- Department of NeuroscienceCentral Clinical SchoolAlfred HealthMonash UniversityMelbourneVic.Australia
| | - Kevin Staley
- Department of NeurologyMassachusetts General HospitalBostonMAUSA
| | - Annamaria Vezzani
- Department of NeuroscienceIRCCS‐Mario Negri Institute for Pharmacological ResearchMilanoItaly
| | | | - H. Steve White
- Department of PharmacySchool of PharmacyUniversity of WashingtonSeattleWAUSA
| | | | - John A. Wolf
- Center for Brain Injury and RepairDepartment of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
- Corporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPAUSA
| | | | - Vicky Whittemore
- National Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaMDUSA
| | - Karen S. Wilcox
- Department of Pharmacology & ToxicologyUniversity of UtahSalt Lake CityUTUSA
| | - Brian Klein
- National Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaMDUSA
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12
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Kekou K, Svingou M, Sofocleous C, Mourtzi N, Nitsa E, Konstantinidis G, Youroukos S, Skiadas K, Katsalouli M, Pons R, Papavasiliou A, Kotsalis C, Pavlou E, Evangeliou A, Katsarou E, Voudris K, Dinopoulos A, Vorgia P, Niotakis G, Diamantopoulos N, Nakou I, Koute V, Vartzelis G, Papadimas GK, Papadopoulos C, Tsivgoulis G, Traeger-Synodinos J. Evaluation of Genotypes and Epidemiology of Spinal Muscular Atrophy in Greece: A Nationwide Study Spanning 24 Years. J Neuromuscul Dis 2021; 7:247-256. [PMID: 32417790 PMCID: PMC7836056 DOI: 10.3233/jnd-190466] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Promising genetic treatments targeting the molecular defect of severe early-onset genetic conditions are expected to dramatically improve patients’ quality of life and disease epidemiology. Spinal Muscular Atrophy (SMA), is one of these conditions and approved therapeutic approaches have recently become available to patients. Objective: Analysis of genetic and clinical data from SMA patients referred to the single public-sector provider of genetic services for the disease throughout Greece followed by a retrospective assessment in the context of epidemiology and genotype-phenotype associations. Methods: Molecular genetic analysis and retrospective evaluation of findings for 361 patients tested positive for SMA- and 862 apparently healthy subjects from the general population. Spearman rank test and generalized linear models were applied to evaluate secondary modifying factors with respect to their impact on clinical severity and age of onset. Results: Causative variations- including 5 novel variants- were detected indicating a minimal incidence of about 1/12,000, and a prevalence of at least 1.5/100,000. For prognosis a minimal model pertaining disease onset before 18 months was proposed to include copy numbers of NAIP (OR = 9.9;95% CI, 4.7 to 21) and SMN2 (OR = 6.2;95% CI, 2.5–15.2) genes as well as gender (OR = 2.2;95% CI, 1.04 to 4.6). Conclusions: This long-term survey shares valuable information on the current status and practices for SMA diagnosis on a population basis and provides an important reference point for the future assessment of strategic advances towards disease prevention and health care planning.
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Affiliation(s)
- Kyriaki Kekou
- Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens
| | - Maria Svingou
- Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens
| | - Christalena Sofocleous
- Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens.,Research Institute for the Study of Genetic and Malignant Disorders in Childhood, "Aghia Sophia" Children's Hospital, Athens
| | - Niki Mourtzi
- First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens
| | - Evangelia Nitsa
- Postgraduate Program in Biostatistics School Of Medicine, National and Kapodistrian University of Athens, Athens
| | - George Konstantinidis
- Laboratory of, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens
| | - Sotiris Youroukos
- First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens
| | | | | | - Roser Pons
- First Department of Paediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens
| | | | | | - Evangelos Pavlou
- 2nd Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki
| | - Athanasios Evangeliou
- Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki
| | | | | | - Argirios Dinopoulos
- Third Department of Pediatrics, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens
| | - Pelagia Vorgia
- Pediatric Department, University Hospital of Heraklion, Crete
| | - George Niotakis
- Pediatric Neurology Clinics, Venizeleion General Hospital, Heraklion, Crete
| | | | - Iliada Nakou
- Department of Pediatrics, University of Ioannina, Stavros Niarchos Avenue, Ioannina
| | - Vasiliki Koute
- Pediatric Department, University Hospital of Larissa, University of Thessaly, Larissa
| | - George Vartzelis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, "P. & A. Kyriakou" Children's Hospital, Athens, Greece
| | | | - Constantinos Papadopoulos
- Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Athens
| | - Joanne Traeger-Synodinos
- Laboratory of Medical Genetics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens
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13
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Kariyawasam DS, D'Silva AM, Vetsch J, Wakefield CE, Wiley V, Farrar MA. " We needed this": perspectives of parents and healthcare professionals involved in a pilot newborn screening program for spinal muscular atrophy. EClinicalMedicine 2021; 33:100742. [PMID: 33842861 PMCID: PMC8020144 DOI: 10.1016/j.eclinm.2021.100742] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Newborn screening (NBS) for spinal muscular atrophy (SMA) is a recognised model through which health outcomes can be improved. However, perspectives of parents and healthcare professionals (HCPs) involved in such programs are largely unknown. METHODS A pilot program for SMA ran from August 2018-July 2020. Using a mixed-methods convergent methodology, we used a self-administered questionnaire to understand parents' perceptions and psychological impact of the program from diagnosis to treatment. We thematically analysed successes/challenges encountered by HCPs and recommendations for service improvement from both participant groups. FINDINGS 202,388 infants were screened for SMA and the perceptions of 44 parents and HCPs affected by a positive result in eighteen newborns was ascertained. Parents (n=29, 100%) were satisfied with NBS for SMA. Although screen-positive result was distressing for all parents, quality of life improved over time [CarerQoL-7D baseline median score 4 (SD=1.4) vs six-month median score 8 (SD=1.3), p<0.001)]. Challenges for HCPs included managing the time-critical nature of the pathway whilst remaining cognisant of limitations associated with the predictive screening test. INTERPRETATION Interpretation: NBS for SMA fulfils criteria for population-wide screening. Net benefits are acknowledged by stakeholders to optimise lifelong outcomes. Harms including psychological distress associated with a screen-positive result may be managed by targeted psychosocial support, information provision and a personalised model of care together strengthening healthcare systems. FUNDING The NSW Pilot NBS study was funded by Luminesce Alliance. Dr Kariyawasam received funding from the RTP Scholarship, University of New South Wales and The Freedman Family Foundation Scholarship, Sydney Children's Hospital Foundation.
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Affiliation(s)
- Didu S.T. Kariyawasam
- Department of Neurology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
| | - Arlene M. D'Silva
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
| | - Janine Vetsch
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Claire E. Wakefield
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
- Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Veronica Wiley
- NSW Newborn Screening Program, Children's Hospital Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michelle A. Farrar
- Department of Neurology, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia
- School of Women's and Children's Health, University of New South Wales Medicine, UNSW Sydney, New South Wales, Australia
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14
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Chen TH. Circulating microRNAs as potential biomarkers and therapeutic targets in spinal muscular atrophy. Ther Adv Neurol Disord 2020; 13:1756286420979954. [PMID: 33488772 PMCID: PMC7768327 DOI: 10.1177/1756286420979954] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022] Open
Abstract
Spinal muscular atrophy (SMA), a leading genetic cause of infant death, is a neurodegenerative disease characterized by the selective loss of particular groups of motor neurons (MNs) in the anterior horn of the spinal cord with progressive muscle wasting. SMA is caused by a deficiency of the survival motor neuron (SMN) protein due to a homozygous deletion or mutation of the SMN1 gene. However, the molecular mechanisms whereby the SMN complex regulates MN functions are not fully elucidated. Emerging studies on SMA pathogenesis have turned the attention of researchers to RNA metabolism, given that increasingly identified SMN-associated modifiers are involved in both coding and non-coding RNA (ncRNA) processing. Among various ncRNAs, microRNAs (miRNAs) are the most studied in terms of regulation of posttranscriptional gene expression. Recently, the discovery that miRNAs are critical to MN function and survival led to the study of dysregulated miRNAs in SMA pathogenesis. Circulating miRNAs have drawn attention as a readily available biomarker due to their property of being clinically detectable in numerous human biofluids through non-invasive approaches. As there are recent promising findings from novel miRNA-based medicines, this article presents an extensive review of the most up-to-date studies connecting specific miRNAs to SMA pathogenesis and the potential applications of miRNAs as biomarkers and therapeutic targets for SMA.
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Affiliation(s)
- Tai-Heng Chen
- Department of Pediatrics, Division of Pediatric Emergency, Kaohsiung Medical University Hospital, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 80708, Taiwan
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15
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Kollmer J, Kessler T, Sam G, Hayes JM, Lentz SI, Heiland S, Bendszus M, Wick W, Weiler M. Magnetization transfer ratio: a quantitative imaging biomarker for 5q spinal muscular atrophy. Eur J Neurol 2020; 28:331-340. [PMID: 32918834 DOI: 10.1111/ene.14528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE We quantified peripheral nerve lesions in adults with 5q-linked spinal muscular atrophy (SMA) type 3 by analysing the magnetization transfer ratio (MTR) of the sciatic nerve, and tested its potential as a novel biomarker for macromolecular changes. METHODS Eighteen adults with SMA 3 (50% SMA 3a, 50% SMA 3b) and 18 age-/sex-matched healthy controls prospectively underwent magnetization transfer contrast imaging in a 3-Tesla magnetic resonance scanner. Two axial three-dimensional gradient echo sequences, with and without an off-resonance saturation rapid frequency pulse, were performed at the right distal thigh. Sciatic nerve regions of interest were manually traced on 10 consecutive axial slices in the images generated without off-resonance saturation, and then transferred to corresponding slices generated by the sequence with the off-resonance saturation pulse. Subsequently, MTR and cross-sectional areas (CSAs) of the sciatic nerve were analysed. In addition, detailed neurologic, physiotherapeutic and electrophysiologic examinations were conducted in all patients. RESULTS Sciatic nerve MTR and CSA reliably differentiated between healthy controls and SMA 3, 3a or 3b. MTR was lower in the SMA 3 (P < 0.0001), SMA 3a (P < 0.0001) and SMA 3b groups (P = 0.0020) than in respective controls. In patients with SMA 3, MTR correlated with all clinical scores, and arm nerve compound motor action potentials (CMAPs). CSA was lower in the SMA 3 (P < 0.0001), SMA 3a (P < 0.0001) and SMA 3b groups (P = 0.0006) than in controls, but did not correlate with clinical scores or electrophysiologic results. CONCLUSIONS Magnetization transfer ratio is a novel imaging marker that quantifies macromolecular nerve changes in SMA 3, and positively correlates with clinical scores and CMAPs.
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Affiliation(s)
- J Kollmer
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Kessler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - G Sam
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - J M Hayes
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - S I Lentz
- Department of Internal Medicine, Division of Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - S Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.,Division of Experimental Radiology, Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - W Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Weiler
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
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16
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Kirschner J, Butoianu N, Goemans N, Haberlova J, Kostera-Pruszczyk A, Mercuri E, van der Pol WL, Quijano-Roy S, Sejersen T, Tizzano EF, Ziegler A, Servais L, Muntoni F. European ad-hoc consensus statement on gene replacement therapy for spinal muscular atrophy. Eur J Paediatr Neurol 2020; 28:38-43. [PMID: 32763124 PMCID: PMC7347351 DOI: 10.1016/j.ejpn.2020.07.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022]
Abstract
Spinal muscular atrophy (SMA) used to be one of the most common genetic causes of infant mortality. New disease modifying treatments have changed the disease trajectories and most impressive results are seen if treatment is initiated in the presymptomatic phase of the disease. Very recently, the European Medicine Agency approved Onasemnogene abeparvovec (Zolgensma®) for the treatment of patients with SMA with up to three copies of the SMN2 gene or the clinical presentation of SMA type 1. While this broad indication provides new opportunities, it also triggers discussions on the appropriate selection of patients in the context of limited available evidence. To aid the rational use of Onasemnogene abeparvovec for the treatment of SMA, a group of European neuromuscular experts presents in this paper eleven consensus statements covering qualification, patient selection, safety considerations and long-term monitoring.
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Affiliation(s)
| | - Nina Butoianu
- Pediatric Neurology Clinic, "Prof. Dr. Al. Obregia" Hospital, Bucharest, Faculty of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.
| | - Nathalie Goemans
- Dept of Pediatric Neurology, University Hospitals Leuven, Belgium.
| | - Jana Haberlova
- Dept of Pediatric Neurology, Motol University Hospital, Prague, Czech Republic.
| | | | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy; Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - W Ludo van der Pol
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Susana Quijano-Roy
- Neuromuscular Unit, Child Neurology and ICU Department, Raymond Poincaré University Hospital (UVSQ), APHP Paris Saclay, Garches, France.
| | - Thomas Sejersen
- Department of Womeńs and Childreńs Health, Karolinska Institutet, Stockholm, Sweden.
| | - Eduardo F Tizzano
- Department of Clinical and Molecular Genetics, Medicine Genetics Group, University Hospital Vall d'Hebron, Barcelona, Spain.
| | - Andreas Ziegler
- Department of Neuropediatrics and Metabolic Medicine, Centre for Childhood and Adolescent Medicine, University Hospital Heidelberg, Germany.
| | - Laurent Servais
- University of Liège, Neuromuscular Reference Center Disease, Department of Pediatrics, Liege, Belgium; MDUK Neuromuscular Center, Department of Pediatrics, University of Oxford, UK.
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, and NIHR Biomedical Research Centre, Great Ormond Street Hospital for Children, London, UK.
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17
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Bonanno S, Marcuzzo S, Malacarne C, Giagnorio E, Masson R, Zanin R, Arnoldi MT, Andreetta F, Simoncini O, Venerando A, Gellera C, Pantaleoni C, Mantegazza R, Bernasconi P, Baranello G, Maggi L. Circulating MyomiRs as Potential Biomarkers to Monitor Response to Nusinersen in Pediatric SMA Patients. Biomedicines 2020; 8:biomedicines8020021. [PMID: 31991852 PMCID: PMC7168147 DOI: 10.3390/biomedicines8020021] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/21/2020] [Accepted: 01/23/2020] [Indexed: 12/14/2022] Open
Abstract
Spinal muscular atrophy (SMA) is an autosomal recessive disorder caused by mutations in survival motor neuron (SMN) 1 gene, resulting in a truncated SMN protein responsible for degeneration of brain stem and spinal motor neurons. The paralogous SMN2 gene partially compensates full-length SMN protein production, mitigating the phenotype. Antisense oligonucleotide nusinersen (Spinraza®) enhances SMN2 gene expression. SMN is involved in RNA metabolism and biogenesis of microRNA (miRNA), key gene expression modulators, whose dysregulation contributes to neuromuscular diseases. They are stable in body fluids and may reflect distinct pathophysiological states, thus acting as promising biomarkers. Muscle-specific miRNAs (myomiRs) as biomarkers for clinical use in SMA have not been investigated yet. Here, we analyzed the expression of miR-133a, -133b, -206 and -1, in serum of 21 infantile SMA patients at baseline and after 6 months of nusinersen treatment, and correlated molecular data with response to therapy evaluated by the Hammersmith Functional Motor Scale Expanded (HFMSE). Our results demonstrate that myomiR serological levels decrease over disease course upon nusinersen treatment. Notably, miR-133a reduction predicted patients’ response to therapy. Our findings identify myomiRs as potential biomarkers to monitor disease progression and therapeutic response in SMA patients.
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Affiliation(s)
- Silvia Bonanno
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
- Correspondence: (S.B.); (S.M.); Tel.: +39-02-2394-2284 (S.B.); +39-02-2394-4651 (S.M.); Fax: +39-02-70633874 (S.B. & S.M.)
| | - Stefania Marcuzzo
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
- Correspondence: (S.B.); (S.M.); Tel.: +39-02-2394-2284 (S.B.); +39-02-2394-4651 (S.M.); Fax: +39-02-70633874 (S.B. & S.M.)
| | - Claudia Malacarne
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
- PhD Program in Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Eleonora Giagnorio
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
- PhD Program in Neuroscience, University of Milano-Bicocca, via Cadore 48, 20900 Monza, Italy
| | - Riccardo Masson
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (R.M.); (R.Z.); (M.T.A.); (C.P.); (G.B.)
| | - Riccardo Zanin
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (R.M.); (R.Z.); (M.T.A.); (C.P.); (G.B.)
| | - Maria Teresa Arnoldi
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (R.M.); (R.Z.); (M.T.A.); (C.P.); (G.B.)
| | - Francesca Andreetta
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
| | - Ornella Simoncini
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
| | - Anna Venerando
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.G.); (A.V.)
| | - Cinzia Gellera
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.G.); (A.V.)
| | - Chiara Pantaleoni
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (R.M.); (R.Z.); (M.T.A.); (C.P.); (G.B.)
| | - Renato Mantegazza
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
| | - Pia Bernasconi
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
| | - Giovanni Baranello
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (R.M.); (R.Z.); (M.T.A.); (C.P.); (G.B.)
- The Dubowitz Neuromuscular Centre, UCL NIHR GOSH Biomedical Research Centre, Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Lorenzo Maggi
- Neurology IV–Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; (C.M.); (E.G.); (F.A.); (O.S.); (P.B.); (L.M.)
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18
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Schorling DC, Pechmann A, Kirschner J. Advances in Treatment of Spinal Muscular Atrophy - New Phenotypes, New Challenges, New Implications for Care. J Neuromuscul Dis 2020; 7:1-13. [PMID: 31707373 PMCID: PMC7029319 DOI: 10.3233/jnd-190424] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spinal Muscular Atrophy (SMA) is caused by autosomal recessive mutations in SMN1 and results in the loss of motor neurons and progressive muscle weakness. The spectrum of disease severity ranges from early onset with respiratory failure during the first months of life to a mild, adult-onset type with slow rate of progression. Over the past decade, new treatment options such as splicing modulation of SMN2 and SMN1 gene replacement by gene therapy have been developed. First drugs have been approved for treatment of patients with SMA and if initiated early they can significantly modify the natural course of the disease. As a consequence, newborn screening for SMA is explored and implemented in an increasing number of countries. However, available evidence for these new treatments is often limited to a small spectrum of patients concerning age and disease stage. In this review we provide an overview of available and emerging therapies for spinal muscular atrophy and we discuss new phenotypes and associated challenges in clinical care. Collection of real-world data with standardized outcome measures will be essential to improve both the understanding of treatment effects in patients of all SMA subtypes and the basis for clinical decision-making in SMA.
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Affiliation(s)
- David C. Schorling
- Department of Neuropediatrics and Muscle Disorders, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Neuropediatrics, University Hospital Bonn, Germany
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19
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Lin Y, Lin CH, Yin X, Zhu L, Yang J, Shen Y, Yang C, Chen X, Hu H, Ma Q, Shi X, Shen Y, Hu Z, Huang C, Huang X. Newborn Screening for Spinal Muscular Atrophy in China Using DNA Mass Spectrometry. Front Genet 2019; 10:1255. [PMID: 31921298 PMCID: PMC6928056 DOI: 10.3389/fgene.2019.01255] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Spinal muscular atrophy (SMA) is the most common neurodegenerative disorder and the leading genetic cause of infant mortality. Early detection of SMA through newborn screening (NBS) is essential to selecting pre-symptomatic treatment and ensuring optimal outcome, as well as, prompting the urgent need for effective screening methods. This study aimed to determine the feasibility of applying an Agena iPLEX SMA assay in NBS for SMA in China. Methods: We developed an Agena iPLEX SMA assay based on the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and evaluated the performance of this assay through assessment of 167 previously-genotyped samples. Then we conducted a pilot study to apply this assay for SMA NBS. The SMN1 and SMN2 copy number of screen-positive patients were determined by multiplex ligation-dependent probe amplification analysis. Results: The sensitivity and specificity of the Agena iPLEX SMA assay were both 100%. Three patients with homozygous SMN1 deletion were successfully identified and conformed by multiplex ligation-dependent probe amplification analysis. Two patients had two SMN2 copies, which was correlated with severe SMA type I phenotype; both of them exhibited neurogenic lesion and with decreased muscle power. Another patient with four SMN2 copies, whose genotype correlated with milder SMA type III or IV phenotype, had normal growth and development without clinical symptoms. Conclusions: The Agena iPLEX SMA assay is an effective and reliable approach for population-based SMA NBS. The first large-scale pilot study using this assay in the Mainland of China showed that large-scale implementation of population-based NBS for SMA is feasible.
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Affiliation(s)
- Yiming Lin
- Department of Genetics and Metabolism, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.,Neonatal Disease Screening Center, Quanzhou Maternity and Children's Hospital, Quanzhou, China
| | - Chien-Hsing Lin
- Department of Research and Development, Feng Chi Biotech Corp, Taipei, Taiwan
| | - Xiaoshan Yin
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburg, Edinburg, United Kingdom
| | - Lin Zhu
- Department of Translational Medicine, Hangzhou Genuine Clinical Laboratory Co. Ltd, Hangzhou, China
| | - Jianbin Yang
- Department of Genetics and Metabolism, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuyan Shen
- Neonatal Disease Screening Center, Huaihua Maternal and Child Health Hospital, Huaihua, China
| | - Chiju Yang
- Neonatal Disease Screening Center, Jining Maternal and Child Health Family Service Center, Jining, China
| | - Xigui Chen
- Neonatal Disease Screening Center, Jining Maternal and Child Health Family Service Center, Jining, China
| | - Haili Hu
- Neonatal Disease Screening Center, Hefei Women and Children's Health Care Hospital, Hefei, China
| | - Qingqing Ma
- Neonatal Disease Screening Center, Hefei Women and Children's Health Care Hospital, Hefei, China
| | - Xueqin Shi
- Department of Pediatrics, Yancheng Maternity and Child Health Care Hospital, Yancheng, China
| | - Yaping Shen
- Department of Genetics and Metabolism, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhenzhen Hu
- Department of Genetics and Metabolism, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chenggang Huang
- Research and Development Center, Zhejiang Biosan Biochemical Technologies Co., Ltd, Hangzhou, China
| | - Xinwen Huang
- Department of Genetics and Metabolism, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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20
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High-throughput genetic newborn screening for spinal muscular atrophy by rapid nucleic acid extraction from dried blood spots and 384-well qPCR. Eur J Hum Genet 2019; 28:23-30. [PMID: 31363188 DOI: 10.1038/s41431-019-0476-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022] Open
Abstract
Establishing nucleic acid-based assays for genetic newborn screening (NBS) provides the possibility to screen for genetically encoded diseases like spinal muscular atrophy (SMA), best before the onset of symptoms. Such assays should be easily scalable to 384-well reactions that make the screening of up to 2000 samples per day possible. We developed a test procedure based on a cleanup protocol for dried blood spots and a quantitative (q)PCR to screen for a homozygous deletion of exon 7 of the survival of motor neuron 1 gene (SMN1) that is responsible for >95% of SMA patients. Performance of this setup is evaluated in detail and tested on routine samples. Our cleanup method for nucleic acids from dried blood spots yields enough DNA for diverse subsequent qPCR applications. To date, we have applied this approach to test 213,279 samples within 18 months. Thirty patients were identified and confirmed, implying an incidence of 1:7109 for the homozygous deletion. Using our cleanup method, a rapid workflow could be established to prepare nucleic acids from dried blood spot cards. Targeting the exon 7 deletion, no invalid, false-positive, or false-negative results were reported to date. This allows timely identification of the disease and grants access to the recently introduced treatment options, in most cases before the onset of symptoms. Carriers are not identified, thus, there are no concerns of whether to report them.
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21
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Kollmer J, Hilgenfeld T, Ziegler A, Saffari A, Sam G, Hayes JM, Pietsch A, Jost M, Heiland S, Bendszus M, Wick W, Weiler M. Quantitative MR neurography biomarkers in 5q-linked spinal muscular atrophy. Neurology 2019; 93:e653-e664. [PMID: 31292223 DOI: 10.1212/wnl.0000000000007945] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/21/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To characterize and quantify peripheral nerve lesions and muscle degeneration in clinically, genetically, and electrophysiologically well-classified, nonpediatric patients with 5q-linked spinal muscular atrophy (SMA) by high-resolution magnetic resonance neurography (MRN). METHODS Thirty-one adult patients with genetically confirmed 5q-linked SMA types II, IIIa, and IIIb and 31 age- and sex-matched healthy volunteers were prospectively investigated. All patients received neurologic, physiotherapeutic, and electrophysiologic assessments. MRN at 3.0T with anatomic coverage from the lumbosacral plexus and proximal thigh down to the tibiotalar joint was performed with dual-echo 2D relaxometry sequences with spectral fat saturation and a 3D T2-weighted inversion recovery sequence. Detailed quantification of nerve injury by morphometric and microstructural MRN markers and qualitative classification of fatty muscle degeneration were conducted. RESULTS Established clinical scores and compound muscle action potentials discriminated well between the 3 SMA types. MRN revealed that peroneal and tibial nerve cross-sectional area (CSA) at the thigh and lower leg level as well as spinal nerve CSA were markedly decreased throughout all 3 groups, indicating severe generalized peripheral nerve atrophy. While peroneal and tibial nerve T2 relaxation time was distinctly increased at all analyzed anatomic regions, the proton spin density was clearly decreased. Marked differences in fatty muscle degeneration were found between the 3 groups and for all analyzed compartments. CONCLUSIONS MRN detects and quantifies peripheral nerve involvement in SMA types II, IIIa, and IIIb with high sensitivity in vivo. Quantitative MRN parameters (T2 relaxation time, proton spin density, CSA) might serve as novel imaging biomarkers in SMA to indicate early microstructural nerve tissue changes in response to treatment.
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Affiliation(s)
- Jennifer Kollmer
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany.
| | - Tim Hilgenfeld
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Andreas Ziegler
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Afshin Saffari
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Georges Sam
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - John M Hayes
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Adriana Pietsch
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Marie Jost
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Sabine Heiland
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Martin Bendszus
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Wolfgang Wick
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany
| | - Markus Weiler
- From the Department of Neuroradiology (J.K., T.H., A.P., M.J., S.H., M.B.), Division of Child Neurology and Metabolic Medicine (A.Z., A.S.), Center for Child and Adolescent Medicine, Department of Neurology (G.S., W.W., M.W.), and Department of Neuroradiology (S.H.), Division of Experimental Radiology, Heidelberg University Hospital, Germany; Department of Neurology (J.M.H.), University of Michigan, Ann Arbor; Medical Faculty (M.J.), University of Tübingen; and German Cancer Consortium (DKTK) within the German Cancer Research Center (DKFZ) (W.W.), Heidelberg, Germany.
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