1
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Cebolla JJ, Giraldo P, Gómez J, Montoto C, Gervas-Arruga J. Machine Learning-Driven Biomarker Discovery for Skeletal Complications in Type 1 Gaucher Disease Patients. Int J Mol Sci 2024; 25:8586. [PMID: 39201273 PMCID: PMC11354847 DOI: 10.3390/ijms25168586] [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: 07/03/2024] [Revised: 08/01/2024] [Accepted: 08/05/2024] [Indexed: 09/02/2024] Open
Abstract
Type 1 Gaucher disease (GD1) is a rare, autosomal recessive disorder caused by glucocerebrosidase deficiency. Skeletal manifestations represent one of the most debilitating and potentially irreversible complications of GD1. Although imaging studies are the gold standard, early diagnostic/prognostic tools, such as molecular biomarkers, are needed for the rapid management of skeletal complications. This study aimed to identify potential protein biomarkers capable of predicting the early diagnosis of bone skeletal complications in GD1 patients using artificial intelligence. An in silico study was performed using the novel Therapeutic Performance Mapping System methodology to construct mathematical models of GD1-associated complications at the protein level. Pathophysiological characterization was performed before modeling, and a data science strategy was applied to the predicted protein activity for each protein in the models to identify classifiers. Statistical criteria were used to prioritize the most promising candidates, and 18 candidates were identified. Among them, PDGFB, IL1R2, PTH and CCL3 (MIP-1α) were highlighted due to their ease of measurement in blood. This study proposes a validated novel tool to discover new protein biomarkers to support clinician decision-making in an area where medical needs have not yet been met. However, confirming the results using in vitro and/or in vivo studies is necessary.
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Affiliation(s)
| | - Pilar Giraldo
- FEETEG, 50006 Zaragoza, Spain;
- Hospital QuirónSalud Zaragoza, 50012 Zaragoza, Spain
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2
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Giraldo P, Camprodón M, Alcolea PC, Gras-Colomer E, Ibarretxe D, Lakhwani S, Mora E, Calderón MPV, Morales-Conejo M. Identification of patient-reported outcomes measures (PROMs) and patient-reported experiences measures (PREMs) in Gaucher disease in Spain. Med Clin (Barc) 2024:S0025-7753(24)00452-4. [PMID: 39095265 DOI: 10.1016/j.medcli.2024.06.006] [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: 12/23/2023] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) and patient-reported experiences measures (PREMs) are crucial for understanding the impact of GD on quality of life and patient's perceptions on care, but also to guide decision-making processes. Nevertheless, no specific PREMs in GD have been published, neither PROMs for Spanish GD patients have been developed. METHODS Two project coordinators selected key-points to be included in a PROMs/PREMs questionnaire, and the scientific committee and a group of expert patients contributed to the initial draft. Then, 9 meetings with experts were held to discuss controversial points. After, a questionnaire with 103 items regarding symptomatology, aspects of daily life and care experience was developed. Finally, it was conducted a Delphi survey among a multidisciplinary group of experts in GD. RESULTS Consensus was reached on 85 out of the 103 items. Recommendations on PROMs and PREMs regarding symptomatology, aspects of daily life and care experience were obtained. Consensus was reached on the importance of considering fatigue, concentration problems, and communication issues in GD patients using 5-step analog scales. Panelists recommended asking GD patients about the impact on social functioning and work/school performance. Finally, consensus was reached on considering care experiences, such as treatment satisfaction, treatment interruptions or transitions and healthcare professionals involved in patient's management to perceive patient's perceptions. CONCLUSION This expert consensus may help developing GD-specific PROMs/PREMs for improving GD management. Properly developed and validated PROMs/PREMs may help decision-making, establishing patient-tailored therapeutic and follow-up goals.
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Affiliation(s)
- Pilar Giraldo
- Hematology, Hospital Quironsalud, Zaragoza, Spain; Fundación Española para el Estudio y Tratamiento de la Enfermedad de Gaucher (FEETEG), Zaragoza, Spain.
| | - María Camprodón
- Rare and Inherited Metabolic Diseases Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | | | | | - Daiana Ibarretxe
- Unidad de Medicina Vascular y metabolismo, Hospital Universitari Sant Joan de Reus, Universitat Rovira i Virgili, Spain; Institut Investigació Sanitària Pere Virgili (IISPV)-CERCA, Spain; Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - Sunil Lakhwani
- Hematology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Elvira Mora
- Hematology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Purificación Velasco Calderón
- Pharmacist, Spanish Association of Patients and Relatives of Gaucher's Disease (AEEFE, Asociación Española de Enfermos y Familiares de la Enfermedad de Gaucher), Spain
| | - Montserrat Morales-Conejo
- Reference Unit for Inherited Metabolic Disease. Hospital Universitario "12 de Octubre", Madrid, Spain; Spanish Network for Biomedical Research in Rare Diseases (CIBERER), U723, Madrid, Spain
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3
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Bhati AA, Shah SR, Dalal YD, Shah NM, Patel MN. Gaucher's Disease in an Adult Male: A Case Report of a Rare Mutation. Cureus 2024; 16:e58706. [PMID: 38779248 PMCID: PMC11110081 DOI: 10.7759/cureus.58706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/25/2024] Open
Abstract
Gaucher's disease is a rare autosomal recessive inborn error of metabolism. As the presentation of this disease is similar to more common diseases like malaria, portal hypertension, hematological disorders, and kala-azar, this rare disease may not be thought of as a differential diagnosis, and a high index of suspicion is required to avoid diagnostic delay. We report a case of type 1 Gaucher's disease in an adult male born out of a consanguineous marriage. He was from a region where the prevalence of infectious diseases and sickle cell anemia is high. He presented with abdominal distension, hepatosplenomegaly, and pancytopenia. Bone marrow biopsy showed the presence of Gaucher cells. Glucocerebrosidase levels showed decreased enzyme activity. The genetic study revealed a very rare mutation that has not been reported in the 1000 Genomes database till now. Retrospectively, the most important clue was his birth out of a consanguineous marriage of his parents.
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Affiliation(s)
- Adityasinh A Bhati
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Smit R Shah
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | | | - Nehal M Shah
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Monila N Patel
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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4
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Revel-Vilk S, Shalev V, Gill A, Paltiel O, Manor O, Tenenbaum A, Azani L, Chodick G. Assessing the diagnostic utility of the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system using real-world data. Orphanet J Rare Dis 2024; 19:71. [PMID: 38365689 PMCID: PMC10873939 DOI: 10.1186/s13023-024-03042-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: 07/28/2023] [Accepted: 01/19/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Gaucher disease (GD) is a rare autosomal recessive condition associated with clinical features such as splenomegaly, hepatomegaly, anemia, thrombocytopenia, and bone abnormalities. Three clinical forms of GD have been defined based on the absence (type 1, GD1) or presence (types 2 and 3) of neurological signs. Early diagnosis can reduce the likelihood of severe, often irreversible complications. The aim of this study was to validate the ability of factors from the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system to discriminate between patients with GD1 and controls using real-world data from electronic patient medical records from Maccabi Healthcare Services, Israel's second-largest state-mandated healthcare provider. METHODS We applied the GED-C scoring system to 265 confirmed cases of GD and 3445 non-GD controls matched for year of birth, sex, and socioeconomic status identified from 1998 to 2022. The analyses were based on two databases: (1) all available data and (2) all data except free-text notes. Features from the GED-C scoring system applicable to GD1 were extracted for each individual. Patients and controls were compared for the proportion of the specific features and overall GED-C scores. Decision tree and random forest models were trained to identify the main features distinguishing GD from non-GD controls. RESULTS The GED-C scoring distinguished individuals with GD from controls using both databases. Decision tree models for the databases showed good accuracy (0.96 [95% CI 0.95-0.97] for Database 1; 0.95 [95% CI 0.94-0.96] for Database 2), high specificity (0.99 [95% CI 0.99-1]) for Database 1; 1.0 [95% CI 0.99-1] for Database 2), but relatively low sensitivity (0.53 [95% CI 0.46-0.59] for Database 1; 0.32 [95% CI 0.25-0.38]) for Database 2). The clinical features of splenomegaly, thrombocytopenia (< 50 × 109/L), and hyperferritinemia (300-1000 ng/mL) were found to be the three most accurate classifiers of GD in both databases. CONCLUSION In this analysis of real-world patient data, certain individual features of the GED-C score discriminate more successfully between patients with GD and controls than the overall score. An enhanced diagnostic model may lead to earlier, reliable diagnoses of Gaucher disease, aiming to minimize the severe complications associated with this disease.
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Affiliation(s)
- Shoshana Revel-Vilk
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University, Jerusalem, Israel.
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel.
| | - Varda Shalev
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aidan Gill
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Ora Paltiel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
- Department of Hematology , Hadassah Medical Organization, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | | | - Liat Azani
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- MaccabiTech, Maccabi Healthcare Services, Tel Aviv, Israel
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5
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Moutapam-Ngamby-Adriaansen Y, Maillot F, Labarthe F, Lioger B. Blood cytopenias as manifestations of inherited metabolic diseases: a narrative review. Orphanet J Rare Dis 2024; 19:65. [PMID: 38355710 PMCID: PMC10865644 DOI: 10.1186/s13023-024-03074-4] [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: 11/03/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
Inherited Metabolic Diseases (IMD) encompass a diverse group of rare genetic conditions that, despite their individual rarity, collectively affect a substantial proportion, estimated at as much as 1 in 784 live births. Among their wide-ranging clinical manifestations, cytopenia stands out as a prominent feature. Consequently, IMD should be considered a potential diagnosis when evaluating patients presenting with cytopenia. However, it is essential to note that the existing scientific literature pertaining to the link between IMD and cytopenia is limited, primarily comprising case reports and case series. This paucity of data may contribute to the inadequate recognition of the association between IMD and cytopenia, potentially leading to underdiagnosis. In this review, we synthesize our findings from a literature analysis along with our clinical expertise to offer a comprehensive insight into the clinical presentation of IMD cases associated with cytopenia. Furthermore, we introduce a structured diagnostic approach underpinned by decision-making algorithms, with the aim of enhancing the early identification and management of IMD-related cytopenia.
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Affiliation(s)
- Yannick Moutapam-Ngamby-Adriaansen
- Service de Médecine Interne, CHRU de Tours, Tours Cedex 1, France.
- Service de Médecine Interne Et Polyvalente, 2, Centre Hospitalier de Blois, Mail Pierre Charlot, 41000, Blois, France.
| | - François Maillot
- Service de Médecine Interne, CHRU de Tours, Tours Cedex 1, France
- Reference Center for Inborn Errors of Metabolism ToTeM, CHRU de Tours, Hôpital Clocheville, 49 Bd Béranger, 37000, Tours, France
- INSERM U1253, iBrain, Université François Rabelais de Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- INSERM U1069, Nutrition, Croissance et Cancer, Faculté de Médecine, Université François Rabelais de Tours, 10 Boulevard Tonnellé, 37000, Tours, France
| | - François Labarthe
- Reference Center for Inborn Errors of Metabolism ToTeM, CHRU de Tours, Hôpital Clocheville, 49 Bd Béranger, 37000, Tours, France
- INSERM U1069, Nutrition, Croissance et Cancer, Faculté de Médecine, Université François Rabelais de Tours, 10 Boulevard Tonnellé, 37000, Tours, France
- Service de Pédiatrie, CHRU de Tours, Tours Cedex 1, France
| | - Bertrand Lioger
- Service de Médecine Interne Et Polyvalente, 2, Centre Hospitalier de Blois, Mail Pierre Charlot, 41000, Blois, France
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Giuffrida G, Markovic U, Condorelli A, Duminuco A, Calafiore V, Conticello C, Romano A, Grasso S, Riccobene C, Ragusa MTV, Esposito B, Nicolosi D, Calagna M, Nardo A, Consoli U, Uccello G, Di Giacomo V, Neri S, Cingari MR, Rodà F, Innao V, Fiumara A, Duro G, Zizzo C, Di Raimondo F. Gaucher disease prevalence in 600 patients affected by monoclonal gammopathy of undetermined significance. Eur J Haematol 2023; 111:922-929. [PMID: 37747757 DOI: 10.1111/ejh.14105] [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: 06/19/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Gaucher disease (GD) is a rare autosomal recessive inherited disorder caused by the lysosomal enzyme acid β-glucosidase deficiency. Many patients experience a critical delay in the diagnosis of up to 8-10 years due to its rarity and variability in signs and symptoms, with the consultation of several specialists. PATIENTS AND METHODS This prospective observational study analyzed the prevalence of GD in 600 patients with monoclonal gammopathy of uncertain significance (MGUS) from January 2018 until February 2022. RESULTS The mean age of participants was 66 years, with a mean monoclonal component of 0.58 g/dL. In 433 MGUS patients with available data, anemia (hemoglobin level < 10 g/dL) was present in 31 patients (7%), and thrombocytopenia (platelet count <100.000/mm3 ) in 24 (5.5%). Of 600 MGUS patients tested for acid β-glucosidase enzyme activity, 7 patients (1.2%) had activity below 2.5 nmol/h/mL. In comparison, GBA gene analysis was executed in 110 patients. It revealed 4 patients (0.7%) affected by GD (3 patients with compound heterozygous mutation and 1 with homozygous mutation), with a prevalence of 1 every 150 MGUS patients. Furthermore, 12 out of the remaining 106 evaluated patients (11%) were carriers of a single heterozygous mutation while having regular enzyme activity. CONCLUSIONS The clinical heterogeneity of GD and frequent lack of awareness among physicians often lead to diagnostic delays and severe clinical manifestations. The role of MGUS in the presence of at least one clinical sign, such as low platelet count, organomegaly, bone pain, or bleeding tendency, could aid in initiating GD screening with DBS, thus reducing the period between symptom onset and the diagnosis of this rare disease.
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Affiliation(s)
- Gaetano Giuffrida
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Uros Markovic
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Annalisa Condorelli
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Andrea Duminuco
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Valeria Calafiore
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Concetta Conticello
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Alessandra Romano
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Stephanie Grasso
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Carla Riccobene
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Benedetta Esposito
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Daniela Nicolosi
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Marianna Calagna
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Antonella Nardo
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
- Postgraduate School of Hematology, University of Catania, Catania, Italy
| | - Ugo Consoli
- Unità Operativa Complessa (UOC) di Ematologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy
| | - Giuseppina Uccello
- Unità Operativa Complessa (UOC) di Ematologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy
| | | | - Santo Neri
- UOC di Ematologia, Azienda Ospedaliera Papardo, Messina, Italy
| | - Maria Rocca Cingari
- Unità Operativa Semplice Dipartimentale Ematologia, Ospedale San Vincenzo, Taormina, Italy
| | - Filippo Rodà
- Hemato-Oncology and Radiotherapy Department, Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Vanessa Innao
- Unità Operativa Complessa (UOC) di Ematologia, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy
| | - Agata Fiumara
- Regional Referral Centre for Metabolic Diseases, Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Catania, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Giovanni Duro
- Institute for Biomedical Research and Innovation (IRIB-CNR), National Research Council of Italy, Palermo, Italy
| | - Carmela Zizzo
- Institute for Biomedical Research and Innovation (IRIB-CNR), National Research Council of Italy, Palermo, Italy
| | - Francesco Di Raimondo
- Division of Hematology, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
- Postgraduate School of Hematology, University of Catania, Catania, Italy
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7
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Wilson A, Chiorean A, Aguiar M, Sekulic D, Pavlick P, Shah N, Sniderman King L, Génin M, Rollot M, Blanchon M, Gosset S, Montmerle M, Molony C, Dumitriu A. Development of a rare disease algorithm to identify persons at risk of Gaucher disease using electronic health records in the United States. Orphanet J Rare Dis 2023; 18:280. [PMID: 37689674 PMCID: PMC10492341 DOI: 10.1186/s13023-023-02868-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Early diagnosis of Gaucher disease (GD) allows for disease-specific treatment before significant symptoms arise, preventing/delaying onset of complications. Yet, many endure years-long diagnostic odysseys. We report the development of a machine learning algorithm to identify patients with GD from electronic health records. METHODS We utilized Optum's de-identified Integrated Claims-Clinical dataset (2007-2019) for feature engineering and algorithm training/testing, based on clinical characteristics of GD. Two algorithms were selected: one based on age of feature occurrence (age-based), and one based on occurrence of features (prevalence-based). Performance was compared with an adaptation of the available clinical diagnostic algorithm for identifying patients with diagnosed GD. Undiagnosed patients highly-ranked by the algorithms were compared with diagnosed GD patients. RESULTS Splenomegaly was the most important predictor for diagnosed GD with both algorithms, followed by geographical location (northeast USA), thrombocytopenia, osteonecrosis, bone density disorders, and bone pain. Overall, 1204 and 2862 patients, respectively, would need to be assessed with the age- and prevalence-based algorithms, compared with 20,743 with the clinical diagnostic algorithm, to identify 28 patients with diagnosed GD in the integrated dataset. Undiagnosed patients highly-ranked by the algorithms had similar clinical manifestations as diagnosed GD patients. CONCLUSIONS The age-based algorithm identified younger patients, while the prevalence-based identified patients with advanced clinical manifestations. Their combined use better captures GD heterogeneity. The two algorithms were about 10-20-fold more efficient at identifying GD patients than the clinical diagnostic algorithm. Application of these algorithms could shorten diagnostic delay by identifying undiagnosed GD patients.
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Affiliation(s)
- Amanda Wilson
- Health Economics and Value Assessment, Sanofi, Cambridge, MA USA
| | | | - Mario Aguiar
- Global Medical Affairs, RD Hematology, Sanofi, Cambridge, MA USA
| | - Davorka Sekulic
- Global Medical Affairs, RD Hematology, Sanofi, Cambridge, MA USA
| | | | - Neha Shah
- Medical Diagnostics, Sanofi, Cambridge, MA USA
| | | | | | | | | | | | | | | | - Alexandra Dumitriu
- Global Medical Affairs, Medical Evidence Generation, Sanofi, Cambridge, MA USA
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8
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Sudul P, Piatkowska-Jakubas B, Pawlinski L, Galazka K, Sacha T, Kiec-Wilk B. The Complexities of Diagnosis with Co-Existing Gaucher Disease and Hemato-Oncology-A Case Report and Review of the Literature. J Clin Med 2023; 12:5518. [PMID: 37685585 PMCID: PMC10488105 DOI: 10.3390/jcm12175518] [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: 07/07/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
Hematological abnormalities are the most common early symptoms of Gaucher disease (GD), with an increased risk of hematopoietic system malignancies reported in patients with GD. GD may be associated with monoclonal and polyclonal gammopathies; however, the mechanism of association of GD with multiple myeloma (MM) remains uncertain. Enzyme replacement therapy (ERT) has been shown to improve patients' cytopenia and it seems to facilitate anti-myeloma therapy in patients with co-occurring GD and MM. Although it is necessary to demonstrate the deficiency of enzymatic activity, as well as using genetic tests to finally diagnose GD, due to changes in the blood count image, bone marrow biopsy is still a frequent element of the GD diagnosis procedure. The diagnosis of GD is often delayed, mainly due to the heterogeneity of the histopathological picture of bone marrow biopsy or overlapping hematological abnormalities. Unrecognized and untreated GD worsens the response of a patient with an oncological disease to targeted treatment. We present a literature review, inspired by the case of a Caucasian patient initially diagnosed with MM and later confirmed with comorbid GD type 1 (GD1). We would like to point out the problem of underdiagnosis and delay in patients with GD.
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Affiliation(s)
- Paulina Sudul
- University Hospital, 30-688 Krakow, Poland
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Beata Piatkowska-Jakubas
- University Hospital, 30-688 Krakow, Poland
- Department of Hematology, Jagiellonian University Medical College, 30-501 Krakow, Poland
| | - Lukasz Pawlinski
- University Hospital, 30-688 Krakow, Poland
- European Reference Network for Rare Metabolic Disease MetabERN, 30-688 Krakow, Poland
| | - Krystyna Galazka
- Department of Pathomorphology, Jagiellonian University Medical College, 31-531 Krakow, Poland
| | - Tomasz Sacha
- University Hospital, 30-688 Krakow, Poland
- Department of Hematology, Jagiellonian University Medical College, 30-501 Krakow, Poland
| | - Beata Kiec-Wilk
- University Hospital, 30-688 Krakow, Poland
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland
- European Reference Network for Rare Metabolic Disease MetabERN, 30-688 Krakow, Poland
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9
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Arslan N, Coker M, Gokcay GF, Kiykim E, Onenli Mungan HN, Ezgu F. Expert opinion on patient journey, diagnosis and clinical monitoring in acid sphingomyelinase deficiency in Turkey: a pediatric metabolic disease specialist's perspective. Front Pediatr 2023; 11:1113422. [PMID: 37435168 PMCID: PMC10330960 DOI: 10.3389/fped.2023.1113422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
This review by a panel of pediatric metabolic disease specialists aimed to provide a practical and implementable guidance document to assist clinicians in best clinical practice in terms of recognition, diagnosis and management of patients with acid sphingomyelinase deficiency (ASMD). The participating experts consider the clinical suspicion of ASMD by the physician to be of utmost importance in the prevention of diagnostic delay and strongly suggest the use of a diagnostic algorithm including/starting with dried blood spots assay in the timely diagnosis of ASMD in patients presenting with hepatosplenomegaly and a need for increased awareness among physicians in this regard to consider ASMD in the differential diagnosis. In anticipation of the introduction of enzyme replacement therapy, raising awareness of the disease among physicians to prevent diagnostic delay and further investigation addressing natural history of ASMD across the disease spectrum, potential presenting characteristics with a high index of suspicion, as well as biomarkers and genotype-phenotype correlations suggestive of poor prognosis seem important in terms of implementation of best practice patterns.
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Affiliation(s)
- Nur Arslan
- Division of Pediatric Metabolism, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Türkiye
| | - Mahmut Coker
- Division of Pediatric Metabolism, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Gulden Fatma Gokcay
- Division of Pediatric Metabolism, Department of Pediatrics, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Ertugrul Kiykim
- Division of Pediatric Metabolism, Department of Pediatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Türkiye
| | | | - Fatih Ezgu
- Division of Pediatric Metabolism and Pediatric Genetics, Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Türkiye
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10
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Pession A, Di Rocco M, Venturelli F, Tappino B, Morello W, Santoro N, Giordano P, Filippini B, Rinieri S, Russo G, Girardi K, Ruggiero A, Galea E, Antonucci R, Tovaglieri N, Porta F, Tartaglione I, Giona F, Fagioli F, Burlina A. GAU-PED study for early diagnosis of Gaucher disease in children with splenomegaly and cytopenia. Orphanet J Rare Dis 2023; 18:151. [PMID: 37328863 DOI: 10.1186/s13023-023-02760-z] [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: 09/24/2022] [Accepted: 06/04/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Gaucher disease (GD) diagnosis can be delayed due to non-specific symptoms and lack of awareness, leading to unnecessary procedures and irreversible complications. GAU-PED study aims to assess GD prevalence in a high-risk pediatric population and the presence, if any, of novel clinical or biochemical markers associated with GD. MATERIALS AND METHODS DBS samples were collected and tested for β-glucocerebrosidase enzyme activity for 154 patients selected through the algorithm proposed by Di Rocco et al. Patients showing β-glucocerebrosidase activity below normal values were recalled to confirm the enzyme deficiency with the gold standard essay on cellular homogenate. Patients tested positive at the gold standard analysis were evaluated through GBA1 gene sequencing. RESULTS 14 out of 154 patients were diagnosed with GD, with a prevalence of 9.09% (5.06-14.78%, CI 95%). Hepatomegaly, thrombocytopenia, anemia, growth delay/deceleration, elevated serum ferritin, elevated Lyso-Gb1 and chitotriosidase were significantly associated with GD. CONCLUSIONS GD prevalence in a pediatric population at high-risk appeared to be higher compared to high-risk adults. Lyso-Gb1 was associated with GD diagnosis. The algorithm proposed by Di Rocco et al. can potentially improve the diagnostic accuracy of pediatric GD, allowing the prompt start of therapy, aiming to reduce irreversible complications.
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Affiliation(s)
- Andrea Pession
- Pediatric Unit, S. Orsola - Malpighi Clinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy
| | - Francesco Venturelli
- Pediatric Unit, S. Orsola - Malpighi Clinic, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138, Bologna, Italy.
| | - Barbara Tappino
- Unit of Rare Diseases, Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico Di Milano, Milan, Italy
| | - Nicola Santoro
- Paediatric Oncology Department, Bari Policlinico General Hospital, Bari, Italy
| | - Paola Giordano
- Interdisciplinary Department of Medicine, Aldo Moro University, Bari, Italy
| | - Beatrice Filippini
- SSD Oncoematologia Pediatrica U.O. Pediatria, Dipartimento Salute, Donna, Infanzia e Adolescenza Ospedale Infermi Rimini, Rimini, Italy
| | - Simona Rinieri
- Pediatric Onco-Hematology Unit, Azienda Ospedaliero-Universitaria Sant'Anna di Ferrara, Ferrara, Italy
| | - Giovanna Russo
- Department of Clinical and Experimental Medicine, Paediatric Oncohematology Unit, University of Catania Medical School, 95122, Catania, Italy
| | - Katia Girardi
- Department of Pediatric Hematology and Oncology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica Sacro Cuore, 00168, Rome, Italy
| | - Eulalia Galea
- Department of Pediatric Onco-Hematology, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Roberto Antonucci
- Pediatric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | | | - Immacolata Tartaglione
- Pediatric Hematology Unit, Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania, Naples, Italy
| | - Fiorina Giona
- Hematology, Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
| | - Franca Fagioli
- Department of Public Health and Paediatrics, Regina Margherita Children's Hospital, University of Turin, Turin, TO, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Women's and Children's Health, University Hospital, Padua, Italy
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11
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Perez Y, Belmatoug N, Bengherbia M, Yousfi K, Lioger B. [Misdiagnosis of Gaucher disease in real life: Retrospective study of the French Gaucher's disease registry]. Rev Med Interne 2023; 44:55-61. [PMID: 36669934 DOI: 10.1016/j.revmed.2022.11.012] [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: 12/27/2021] [Revised: 11/14/2022] [Accepted: 11/30/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Gaucher disease is an autosomal recessive genetic disorder. It is caused by a deficiency of the lysosomal enzyme, glucocerebrosidase which leads to an accumulation of glucosylceramide in the macrophages. Splenomegaly, hepatomegaly, cytopenias (anemia, thrombocytopenia) and bone disorders are the main symptoms. The diagnosis is often delayed, leading to unnecessary investigations and treatments, and delaying the specific treatment. The primary objective of our study was to establish, in patients who had a diagnostic delay of more than one year, the reported misdiagnoses before the final diagnosis. The secondary objectives were to investigate the risk factors associated with error and delayed diagnosis. METHODS Retrospective study including patients with Gaucher disease from the French Gaucher Disease Registry. Collection of data by a single investigator from a standardized form. RESULTS Among 83 patients with a known diagnostic delay, 13 patients (15 %) had one or two misdiagnoses. These included osteo-articular diagnoses (osteomyelitis, osteoarthritis, arthritis, osteochondritis, rheumatic fever, n=8), haematological diagnoses (gestational thrombocytopenia, immunological thrombocytopenia, n=4), infectious diagnoses (visceral leishmaniasis, mononucleosis, n=2) and hemochromatosis. The osteo-articular and infectious diagnoses concerned the child and the adolescent while the haematological diagnoses and the hemochromatosis concerned the adult. No factors were found associated with misdiagnoses. Patients with a diagnostic delay greater than one year were less likely to have hepatosplenomegaly as the first symptom. CONCLUSION There is a risk of diagnostic error related to phenotypic heterogeneity and lack of specificity of Gaucher disease symptoms. This study helps to better identify the misdiagnoses associated with Gaucher disease.
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Affiliation(s)
- Y Perez
- Service de médecine interne, CHRU de Tours, 2 boulevard Tonnelé, 37044 Tours cedex, France.
| | - N Belmatoug
- Centre de référence des maladies lysosomales, hôpitaux universitaires Paris Nord-Val-de-Seine, CHU Paris Nord-Val de Seine, hôpital Beaujon, Assistance publique-Hôpitaux de Paris (AP-HP), 100, boulevard du Général-Leclerc, 92110 Clichy, France; Service de médecine interne, hôpital Beaujon, Paris, France
| | - M Bengherbia
- Centre de référence des maladies lysosomales, hôpitaux universitaires Paris Nord-Val-de-Seine, CHU Paris Nord-Val de Seine, hôpital Beaujon, Assistance publique-Hôpitaux de Paris (AP-HP), 100, boulevard du Général-Leclerc, 92110 Clichy, France; Service de médecine interne, hôpital Beaujon, Paris, France
| | - K Yousfi
- Centre de référence des maladies lysosomales, hôpitaux universitaires Paris Nord-Val-de-Seine, CHU Paris Nord-Val de Seine, hôpital Beaujon, Assistance publique-Hôpitaux de Paris (AP-HP), 100, boulevard du Général-Leclerc, 92110 Clichy, France; Service de médecine interne, hôpital Beaujon, Paris, France
| | - B Lioger
- Service de médecine interne et polyvalente, centre hospitalier Simone Veil, 1 mail Pierre-Charlot, Blois, France
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Cappellini MD, Motta I, Barbato A, Giuffrida G, Manna R, Carubbi F, Giona F. Similarities and differences between Gaucher disease and acid sphingomyelinase deficiency: An algorithm to support the diagnosis. Eur J Intern Med 2023; 108:81-84. [PMID: 36443133 DOI: 10.1016/j.ejim.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Lysosomal storage disorders are a group of inborn errors of metabolism due to defects in proteins crucial for lysosomal function. Gaucher disease is the most common autosomal recessive lysosomal storage disorder due to mutations in the GBA1 gene, resulting in the lysosomal deficiency of glucocerebrosidase activity. Gaucher disease is characterized by the toxic accumulation of glucosylceramide in the reticuloendothelial system. Acid sphingomyelinase deficiency (ASMD), previously known as Niemann Pick A/B disease, is also an autosomal recessive lysosomal storage disorder due to mutations in the SMPD1 gene, which result in acid sphingomyelinase deficiency and the accumulation of sphingomyelin in mononuclear phagocytic system and hepatocytes. The phenotypic expression of Gaucher disease type 1 (GD1), the most common type, and chronic visceral ASMD may overlap for several signs or symptoms. Splenomegaly is detectable in approximately 90% of the patients in both conditions; however, since GD1 is more frequent than ASMD, clinicians are more prone to suspect it, often neglecting the diagnosis of ASMD. Based on previous experience, a group of experts in the clinical and laboratory diagnosis, management, and treatment of lysosomal storage disorders developed an algorithm for both GD1 and ASMD to support physicians, including primary care providers, internists, and specialists (e.g., hepatologists, hematologists, and pulmonologists) to suspect and differentiate GD1 and ASMD and to provide the appropriate referral.
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Affiliation(s)
- Maria Domenica Cappellini
- Unit of Medicine and Metabolic Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Irene Motta
- Unit of Medicine and Metabolic Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Antonio Barbato
- Department of Clinical Medicine and Surgery, Federico II University of Naples Medical School, Naples, Italy
| | - Gaetano Giuffrida
- Centro di riferimento regionale per la prevenzione, diagnosi e cura delle malattie rare, Division of Haematology, A.O.U Policlinico-S. Marco, Università degli studi di Catania, Catania, Italy
| | - Raffaele Manna
- Department of Internal Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesca Carubbi
- Metabolic Medicine Unit, Azienda Ospedaliero Universitaria Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Fiorina Giona
- Department of Translational and Precision Medicine, Sapienza University of Rome, AOU Policlinico Umberto I, Rome, Italy
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13
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Giraldo P, Andrade‐Campos M, Morales M. Recommendations on the follow-up of patients with Gaucher disease in Spain: Results from a Delphi survey. JIMD Rep 2023; 64:90-103. [PMID: 36636594 PMCID: PMC9830018 DOI: 10.1002/jmd2.12342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 11/11/2022] Open
Abstract
Management of Gaucher disease (GD) is challenging due to its wide genotypic and phenotypic variability and changing clinical manifestations due to effective treatment. Sixteen face-to-face meetings with experts were held in order to discuss daily clinical practice and identify controversies regarding the management of GD. With this information, a questionnaire with 93 recommendations for different clinical scenarios was designed, and a Delphi survey among 86 physicians with experience in GD was conducted. Consensus was reached on 73 out of the 93 items. Recommendations on follow-up of adult and pediatric patients were in line with current guidelines, and underscored the importance of a patient-tailored approach. For the follow-up of stable patients receiving long-term treatment, consensus was reached on the importance of multidisciplinary care that involves pediatricians, internal medicine, and primary care, specialized radiologists, orthopedic surgeons, and hematologists when required. Degree of pain, use of painkillers and antidepressants, and quality of life should be evaluated at every follow-up visit or at least once per year. In general, a closer follow-up was recommended for untreated patients or patients who underwent a treatment change (every 3 months during the first year) and during pregnancy. For pregnant patients, hemostasis and risk of hemorrhage should be assessed, but no consensus was reached for initiation of treatment in asymptomatic pregnant patients. Lastly, recommendations on how to adapt GD management during a COVID-19 pandemic were collected. This expert consensus may help decision-making during the management of GD in specific clinical scenarios.
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Affiliation(s)
- Pilar Giraldo
- HematologyHospital QuironsaludZaragozaSpain
- Fundación Española para el Estudio y Tratamiento de la Enfermedad de Gaucher (FEETEG)ZaragozaSpain
| | - Marcio Andrade‐Campos
- Fundación Española para el Estudio y Tratamiento de la Enfermedad de Gaucher (FEETEG)ZaragozaSpain
- HematologyInstitut Hospital del Mar d'Investigacions Mèdiques, IMIM‐Parc de Salut MarBarcelonaSpain
| | - Montserrat Morales
- Reference Unit for Inherited Metabolic Disease, Hospital Universitario “12 de Octubre”MadridSpain
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Castillon G, Chang SC, Moride Y. Global Incidence and Prevalence of Gaucher Disease: A Targeted Literature Review. J Clin Med 2022; 12:jcm12010085. [PMID: 36614898 PMCID: PMC9821068 DOI: 10.3390/jcm12010085] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Incidence and prevalence estimates for Gaucher disease (GD) are scarce for this rare disease and can be variable within the same region. This review provides a qualitative synthesis of global GD incidence and prevalence estimates, GD1-3 type-specific and overall, published in the last 10 years. A targeted literature search was conducted across multiple databases from January 2011 to September 2020, including web-based sources and congress proceedings to May 2021. Searches yielded 490 publications, with 31 analyzed: 20 cohort studies (15 prospective, 5 retrospective), 6 cross-sectional studies, 5 online reports (most from Europe (n = 11) or North America (n = 11); one multiregional). Across all GD types, incidence estimates ranged 0.45-25.0/100,000 live births (16 studies), lowest for Asia-Pacific. Incidence of GD1: 0.45-22.9/100,000 live births (Europe and North America) and GD3: 1.36/100,000 live births (Asia-Pacific only). GD type-specific prevalence estimates per 100,000 population were GD1: 0.26-0.63; GD2 and GD3: 0.02-0.08 (Europe only); estimates for GD type unspecified or overall ranged 0.11-139.0/100,000 inhabitants (17 studies), highest for North America. Generalizability was assessed as "adequate"or "intermediate" for all regions with data. GD incidence and prevalence estimates for the last 10 years varied considerably between regions and were poorly documented outside Europe and North America. Data for GD2 and GD3 were limited.
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Affiliation(s)
| | - Shun-Chiao Chang
- Takeda Development Center Americas, Inc., Cambridge, MA 02142, USA
- Correspondence:
| | - Yola Moride
- YolaRX Consultants Inc., Montreal, QC H3H 1V4, Canada
- Center for Pharmacoepidemiology and Treatment Science, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA
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15
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Pehrsson M, Heikkinen H, Wartiovaara-Kautto U, Mäntylahti S, Bäckström P, Lassenius MI, Uusi-Rauva K, Carpén O, Elomaa K. Screening for potential undiagnosed Gaucher disease patients: Utilisation of the Gaucher earlier diagnosis consensus point-scoring system (GED-C PSS) in conjunction with electronic health record data, tissue specimens, and small nucleotide polymorphism (SNP) genotype data available in Finnish biobanks. Mol Genet Metab Rep 2022; 33:100911. [PMID: 36092251 PMCID: PMC9449642 DOI: 10.1016/j.ymgmr.2022.100911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/15/2022] Open
Abstract
Background Autosomal recessive Gaucher disease (GD) is likely underdiagnosed in many countries. Because the number of diagnosed GD patients in Finland is relatively low, and the true prevalence is currently not known, it was hypothesized that undiagnosed GD patients may exist in Finland. Our previous study demonstrated the applicability of Gaucher Earlier Diagnosis Consensus point-scoring system (GED-C PSS; Mehta et al., 2019) and Finnish biobank data and specimens in the automated point scoring of large populations. An indicative point-score range for Finnish GD patients was determined, but undiagnosed patients were not identified partly due to high number of high-score subjects in combination with a lack of suitable samples for diagnostics in the assessed biobank population. The current study extended the screening to another biobank and evaluated the feasibility of utilising the automated GED-C PSS in conjunction with small nucleotide polymorphism (SNP) chip genotype data from the FinnGen study of biobank sample donors in the identification of undiagnosed GD patients in Finland. Furthermore, the applicability of FFPE tissues and DNA restoration in the next-generation sequencing (NGS) of the GBA gene were tested. Methods Previously diagnosed Finnish GD patients eligible to the study, and up to 45,100 sample donors in Helsinki Biobank (HBB) were point scored. The GED-C point scoring, adjusted to local data, was automated, but also partly manually verified for GD patients. The SNP chip genotype data for rare GBA variants was visually assessed. FFPE tissues of GD patients were obtained from HBB and Biobank Borealis of Northern Finland (BB). Results Three previously diagnosed GD patients and one patient previously treated for GD-related features were included. A genetic diagnosis was confirmed for the patient treated for GD-related features. The GED-C point score of the GD patients was 12.5–22.5 in the current study. The score in eight Finnish GD patients of the previous and the current study is thus 6–22.5 points per patient. In the automated point scoring of the HBB subpopulation (N ≈ 45,100), the overall scores ranged from 0 to 17.5, with 0.77% (346/45,100) of the subjects having ≥10 points. The analysis of SNP chip genotype data was able to identify the diagnosed GD patients, but potential undiagnosed patients with the GED-C score and/or the GBA genotype indicative of GD were not discovered. Restoration of the FFPE tissue DNA improved the quality of the GBA NGS, and pathogenic GBA variants were confirmed in five out of six unrestored and in all four restored FFPE DNA samples. Discussion These findings imply that the prevalence of diagnosed patients (~1:325,000) may indeed correspond the true prevalence of GD in Finland. The SNP chip genotype data is a valuable tool that complements the screening with the GED-C PSS, especially if the genotyping pipeline is tuned for rare variants. These proof-of-concept biobank tools can be adapted to other rare genetic diseases.
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Do YR, Choi Y, Heo MH, Kim JS, Yoon JH, Lee JH, Park JS, Sohn SK, Kim SH, Lim S, Chung JS, Jo DY, Eom HS, Kim H, Jeon SY, Won JH, Lee HJ, Shin JW, Jang JH, Yoon SS. Early diagnosis of Gaucher disease in Korean patients with unexplained splenomegaly: a multicenter observational study. Blood Res 2022; 57:207-215. [PMID: 35880496 PMCID: PMC9492528 DOI: 10.5045/br.2022.2022089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Gaucher disease (GD) is an autosomal recessive disorder characterized by excessive accumulation of glucosylceramide in multiple organs. This study was performed to determine the detection rate of GD in a selected patient population with unexplained splenomegaly in Korea. Methods This was a multicenter, observational study conducted at 18 sites in Korea between December 2016 and February 2020. Adult patients with unexplained splenomegaly were enrolled and tested for β-glucosidase enzyme activity on dried blood spots (DBS) and in peripheral blood leukocytes. Mutation analysis was performed if the test was positive or indeterminate for the enzyme assay. The primary endpoint was the percentage of patients with GD in patients with unexplained splenomegaly. Results A total of 352 patients were enrolled in this study (male patients, 199; mean age, 48.42 yr). Amongst them, 14.77% of patients had concomitant hepatomegaly. The most common sign related to GD was splenomegaly (100%), followed by thrombocytopenia (44.32%) and, anemia (40.91%). The β-glucosidase activity assay on DBS and peripheral leukocytes showed abnormal results in sixteen and six patients, respectively. Eight patients were tested for the mutation, seven of whom were negative and one patient showed a positive mutation analysis result. One female patient who presented with splenomegaly and thrombocytopenia was diagnosed with type 1 GD. The detection rate of GD was 0.2841% (exact 95% CI, 0.0072‒1.5726). Conclusion The detection rate of GD in probable high-risk patients in Korea was lower than expected. However, the role of hemato-oncologists is still important in the diagnosis of GD.
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Affiliation(s)
- Young Rok Do
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Yunsuk Choi
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Mi Hwa Heo
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jin Seok Kim
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Ho Yoon
- Division of Hematology, Department of Internal Medicine, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Je-Hwan Lee
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Seong Park
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Sang Kyun Sohn
- Departments of Oncology/Hematology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sung Hyun Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sungnam Lim
- Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Joo Seop Chung
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Deog-Yeon Jo
- Division of Hematology/Oncology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyeon Seok Eom
- Department of Hematology-Oncology, Center for Hematologic Malignancy, National Cancer Center, Goyang, Korea
| | - Hawk Kim
- Division of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - So Yeon Jeon
- Division of Hematology/Oncology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jong-Ho Won
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Korea
| | - Hee Jeong Lee
- Department of Internal Medicine, Hemato-Oncology, Chosun University Hospital, Gwangju, Korea
| | - Jung Won Shin
- Sanofi, Division of Hematology/Oncology, Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Ho Jang
- Samsung Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Soo Yoon
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Yoshimitsu M, Ono M, Inoue Y, Sagara R, Baba T, Fernandez J. A cross-sectional web-based survey among haematologists and gastroenterologists in Japan to identify the key factors for early diagnosis of Gaucher Disease. Intern Med J 2022. [PMID: 35499124 DOI: 10.1111/imj.15790] [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: 03/15/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Gaucher Disease (GD) is a rare, inherited metabolic disorder resulting from glucocerebrosidase deficiency. Patients benefit from early treatment as complications can arise from delayed diagnosis. AIMS To measure GD awareness among Japanese haematologists and gastroenterologists, who are the specialists most likely to encounter patients with symptoms recognised in the Gaucher Earlier Diagnosis Consensus (GED-C), such as hepatosplenomegaly and thrombocytopenia. Additionally, we aimed to determine key signs from the GED-C associated with early diagnosis. METHODS A quantitative web survey assessed Japanese haematologists and gastroenterologists for their i) basic awareness of GD, ii) explicit awareness of GD signs, iii) explicit awareness of GD treatments, and iv) accuracy in suspecting GD in model patients. RESULTS Survey results from 160 haematologists and 166 gastroenterologists indicated that more than 50% of haematologists were aware of GD symptoms, diagnostic criteria and/or treatments, and 38% of them had experienced or suspected GD. The majority of gastroenterologists were unaware of GD or knew the disease only by name, with 20% experiencing or suspecting GD in practice. Almost 70% of haematologists knew of enzyme replacement therapy (ERT), while 47% of gastroenterologists were not aware of any treatments for GD. Of the GED-C items, an awareness of bone-associated signs was correlated with accurate GD diagnosis in model patients and this awareness was greater among haematologists than gastroenterologists. CONCLUSIONS Our study showed that haematologists had greater awareness of GD than gastroenterologists, and that bone pain may be a key sign of GD to enhance early diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Makoto Yoshimitsu
- Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima, Japan
| | - Midori Ono
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Yoichi Inoue
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Rieko Sagara
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Terumi Baba
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Jovelle Fernandez
- Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
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Kishnani PS, Al-Hertani W, Balwani M, Göker-Alpan Ö, Lau HA, Wasserstein M, Weinreb NJ, Grabowski G. Screening, patient identification, evaluation, and treatment in patients with Gaucher disease: Results from a Delphi consensus. Mol Genet Metab 2022; 135:154-162. [PMID: 34972655 DOI: 10.1016/j.ymgme.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Several guidelines are available for identification and management of patients with Gaucher disease, but the most recent guideline was published in 2013. Since then, there have been significant advances in newborn screening, phenotypic characterization, identification of biomarkers and their integration into clinical practice, and the development and approval of new treatment options. Accordingly, the goal of this Delphi consensus exercise was to extend prior initiatives of this type by addressing issues related to newborn screening, diagnostic evaluations, and treatment (both disease directed and adjunctive). The iterative Delphi process involved creation of an initial slate of statements, review by a steering committee, and three rounds of consensus development by an independent panel. A preliminary set of statements was developed by the supporting agency based on literature searches covering the period from 1965 to 2020. The Delphi process reduced an initial set of 185 statements to 65 for which there was unanimous support from the panel. The statements supported may ultimately provide a framework for more detailed treatment guidelines. In addition, the statements for which unanimous support could not be achieved help to identify evidence gaps that are targets for future research.
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Affiliation(s)
- Priya S Kishnani
- Duke University Medical Center, Department of Molecular Genetics and Microbiology, 905 Lasalle Street, GSRB1, 4th Floor, Durham, NC 27710, USA.
| | - Walla Al-Hertani
- Harvard Medical School, Boston Children's Hospital, Department of Pediatrics, Division of Genetics and Genomics, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Manisha Balwani
- Icahn School of Medicine at Mount Sinai, Division of Medical Genetics and Genomics, Department of Genetics and Genomic Sciences, 1428 Madison Avenue, 1st Floor, New York, NY 10029, USA
| | - Özlem Göker-Alpan
- Lysosomal & Rare Disorders Research & Treatment Center, 3702 Pender Drive, Suite 170, Fairfax, VA 22030, USA
| | - Heather A Lau
- Ultragenyx Pharmaceutical Inc., Global Clinical Development, 840 Memorial Drive, Cambridge, MA 02139, USA
| | - Melissa Wasserstein
- The Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Division of Pediatric Genetic Medicine, Departments of Pediatrics and Genetics, 3411 Wayne Ave, 9th Floor, Bronx, NY 10467, USA
| | - Neal J Weinreb
- University of Miami Miller School of Medicine, Departments of Human Genetics and Medicine, Hematology Division, 7367 Wexford Terrace, Boca Raton, FL 33433, USA
| | - Gregory Grabowski
- University of Cincinnati College of Medicine, Department of Pediatrics, and Department of Molecular Genetics, Biochemistry and Microbiology, Division of Human Genetics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH, USA
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19
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de Dios García-Díaz J, López-Rodríguez M, Morales-Conejo M, Riera-Mestre A. Understanding the ecosystem of patients with lysosomal storage diseases in Spain: a qualitative research with patients and health care professionals. Orphanet J Rare Dis 2022; 17:17. [PMID: 35031060 PMCID: PMC8760689 DOI: 10.1186/s13023-021-02168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Lysosomal Storage Diseases (LSDs) are a group of Rare Diseases (RDs) caused by lysosomal enzyme deficiencies. Patients with LSDs suffer from a wide range of symptoms with a strong impact in their daily routines. In this study we aimed to explore the impact of the disease on the lives of patients with four LSDs, as well as how they experience Patient Journey from diagnosis to follow up. Unmet Needs (UNs) perceived by patients and clinicians were assessed to have a better understanding of which initiatives could improve LSDs management and especially those that could result in an improvement of patients’ quality of life. Methods Qualitative research was the research methodology selected for the study. It provides plentiful and holistic insights into people’s views and actions. The study was conducted through in-depth face-to-face semi-structured interviews. Results In total, 20 patients and 25 Health Care Professionals (HCPs) from different Spanish regions were interviewed. Patients perceived that the highest impact of the LSDs was on their daily routines, specifically on their emotional side, their work/school environment, their family and their social life. Regarding the Patient Journey experience, the worst perceived stage was the pre-diagnosis, where patients only reported negative perceptions, being the delay in diagnosis and misdiagnosis the most commented issues. On the contrary, the follow-up stage was the one with less negative perceptions. Overall, patients and HCPs agreed on the priority UNs, such as accelerating diagnosis, reducing bureaucracy for the treatment access and a more coordinated attention for the patients, not only among different physicians but also with other professionals such as genetic counselors or social workers. Conclusions Our data shows that there are still UNs to be addressed from the perspective of patients and HCPs. The main UN is accelerating diagnosis, which could be achieved by medical awareness and education, according to clinicians. A more comprehensive disease management was another main point to be worked on to improve LSD-patient experience and quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02168-7.
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Affiliation(s)
- Juan de Dios García-Díaz
- Clinical Genetics Unit, Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
| | | | - Montserrat Morales-Conejo
- Department of Internal Medicine, Hospital Universitario, 12 de Octubre, Madrid, Spain.,CSUR de Errores Congénitos del Metabolismo y miembro adscrito colaborador grupo de Enfermedades Mitocondriales Y Neuromusculares, Madrid, Spain.,Instituto de Investigación Hospital 12 de Octubre. Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Unidad 723, Madrid, Spain
| | - Antoni Riera-Mestre
- Department of Internal Medicine, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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20
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Elstein D, Belmatoug N, Deegan P, Göker-Alpan Ö, Hughes DA, Schwartz IVD, Weinreb N, Bonner N, Panter C, Fountain D, Lenny A, Longworth L, Miller R, Shah K, Schenk J, Sen R, Zimran A. Development and validation of Gaucher disease type 1 (GD1)-specific patient-reported outcome measures (PROMs) for clinical monitoring and for clinical trials. Orphanet J Rare Dis 2022; 17:9. [PMID: 34991656 PMCID: PMC8734239 DOI: 10.1186/s13023-021-02163-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/19/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Disease-specific patient-reported outcome measures (PROMs) are fundamental to understanding the impact on, and expectations of, patients with genetic disorders, and can facilitate constructive and educated conversations about treatments and outcomes. However, generic PROMs may fail to capture disease-specific concerns. Here we report the development and validation of a Gaucher disease (GD)-specific PROM for patients with type 1 Gaucher disease (GD1) a lysosomal storage disorder characterized by hepatosplenomegaly, thrombocytopenia, anemia, bruising, bone disease, and fatigue. RESULTS AND DISCUSSION The questionnaire was initially developed with input from 85 patients or parents of patients with GD1 or GD3 in Israel. Owing to few participating patients with GD3, content validity was assessed for patients with GD1 only. Content validity of the revised questionnaire was assessed in 33 patients in the US, France, and Israel according to US Food and Drug Administration standards, with input from a panel of six GD experts and one patient advocate representative. Concept elicitation interviews explored patient experience of symptoms and treatments, and a cognitive debriefing exercise explored patients' understanding and relevance of instructions, items, response scales, and recall period. Two versions of the questionnaire were subsequently developed: a 24-item version for routine monitoring in clinical practice (rmGD1-PROM), and a 17-item version for use in clinical trials (ctGD1-PROM). Psychometric validation of the ctGD1-PROM was assessed in 46 adult patients with GD1 and re-administered two weeks later to examine test-retest reliability. Findings from the psychometric validation study revealed excellent internal consistency and strong evidence of convergent validity of the ctGD1-PROM based on correlations with the 36-item Short Form Health Survey. Most items were found to show moderate, good, or excellent test-retest reliability. CONCLUSIONS Development of the ctGD1-PROM represents an important step forward for researchers measuring the impact of GD and its respective treatment.
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Affiliation(s)
- Deborah Elstein
- Takeda Pharmaceuticals International AG, Zurich, Switzerland.
| | - Nadia Belmatoug
- Assistance-Publique Hôpitaux de Paris Nord, Université de Paris, Paris, France
| | - Patrick Deegan
- Lysosomal Disorders Unit, Cambridge University Hospitals, Cambridge, UK
| | - Özlem Göker-Alpan
- Lysosomal Disorders Unit and Center for Clinical Trials, O&O Alpan LLC, Fairfax, VA, USA
| | | | | | - Neal Weinreb
- University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | | | | | | | | | - Jörn Schenk
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Rohini Sen
- Takeda Pharmaceuticals Company Ltd, Cambridge, MA, USA
| | - Ari Zimran
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
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21
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Tankeu AT, Tran C. [Chronic Fatigue: When to Suspect an Inherited Metabolic Disease?]. PRAXIS 2022; 110:38-43. [PMID: 34983209 DOI: 10.1024/1661-8157/a003772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Chronic Fatigue: When to Suspect an Inherited Metabolic Disease? Abstract. Chronic fatigue is a non-specific symptom, frequent in outpatient adults' consultations. Persistent physical fatigue of unknown etiology should prompt the search for rare diseases including inherited metabolic disorder (IMD) after elimination of common causes. The main characteristic of chronic fatigue in IMD is its dynamic nature, worsened by circumstances leading to an increased metabolism such as physical exertion, cold, fasting or infection. IMD leading to chronic fatigue are metabolic myopathies, in particular glycogen storage disease affecting muscle, fatty acid oxidation disorders and mitochondrial diseases. The diagnosis is confirmed by specific biochemical and/or molecular analyzes with multidisciplinary management.
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Affiliation(s)
- Aurel T Tankeu
- Centre des maladies moléculaires (CMM), Service de Médecine Génétique, Centre Hospitalier et Universitaire Vaudois (CHUV), Lausanne
| | - Christel Tran
- Centre des maladies moléculaires (CMM), Service de Médecine Génétique, Centre Hospitalier et Universitaire Vaudois (CHUV), Lausanne
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22
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Tankeu AT, Tran C. [Chronic Fatigue: When to Suspect an Inherited Metabolic Disease?]. PRAXIS 2022; 110:1-6. [PMID: 34983208 DOI: 10.1024/1661-8157/a003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Chronic Fatigue: When to Suspect an Inherited Metabolic Disease? Abstract. Chronic fatigue is a non-specific symptom, frequent in outpatient adults' consultations. Persistent physical fatigue of unknown etiology should prompt the search for rare diseases including inherited metabolic disorder (IMD) after elimination of common causes. The main characteristic of chronic fatigue in IMD is its dynamic nature, worsened by circumstances leading to an increased metabolism such as physical exertion, cold, fasting or infection. IMD leading to chronic fatigue are metabolic myopathies, in particular glycogen storage disease affecting muscle, fatty acid oxidation disorders and mitochondrial diseases. The diagnosis is confirmed by specific biochemical and/or molecular analyzes with multidisciplinary management.
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Affiliation(s)
- Aurel T Tankeu
- Zentrum für Molekularkrankheiten (CMM), Abteilung für genetische Medizin, Centre Hospitalier et Universitaire Vaudois (CHUV), Lausanne
| | - Christel Tran
- Zentrum für Molekularkrankheiten (CMM), Abteilung für genetische Medizin, Centre Hospitalier et Universitaire Vaudois (CHUV), Lausanne
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23
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Giraldo P, Andrade-Campos M. Novel Management and Screening Approaches for Haematological Complications of Gaucher's Disease. J Blood Med 2021; 12:1045-1056. [PMID: 34908889 PMCID: PMC8665828 DOI: 10.2147/jbm.s279756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose Gaucher disease (GD) is the most common lysosomal storage disorder. The principal manifestations for its diagnosis and further monitoring include haematological manifestations such as anaemia, thrombocytopaenia, spleen enlargement, and bleeding disorders, among others. This review aims to summarise and update the role of haematological complications in GD diagnosis and follow-up, describe their management strategies, and to use these indicators as part of the diagnostic approach. Materials and Methods A systematic review following the recommendations of PRISMA-P 2020 was carried out. Publications indexed in the databases PubMed, Embase, Science Open, Mendeley, and Web of Science were electronically searched by three independent reviewers, and publications up to June 2021 were accessed. A total of 246 publications were initially listed, of which 129 were included for further review and analysis. Case reports were considered if they were representative of a relevant hematologic complication. Results From the first review dated in 1974 to the latest publication in 2021, including different populations confirmed that the haematological manifestations such as thrombocytopaenia and splenomegaly at diagnosis of GD type 1 are the most frequent features of the disease. The incorporation of haematological parameters to diagnosis strategies increases their cost-effectiveness. Hematologic parameters are part of the scoring system for disease assessment and the evaluation of therapeutic outcomes, providing reliable and accessible data to improve the management of GD. However, cytopaenia, underlying coagulation disorders, and platelet dysfunction need to be addressed, especially during pregnancy or surgery. Long-term haematological complications include the risk of neoplasia and immune impairment, an area of unmet need that is currently under research. Conclusion Haematological features are key for GD suspicion, diagnosis, and management. Normalization of hematological parameters is achieved with the treatment; however, there are unmet needs such as the underlying inflammatory status and the long-term risk of hematologic neoplasia.
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Affiliation(s)
- Pilar Giraldo
- Haematology, Hospital Quironsalud, Zaragoza, Spain.,Foundation FEETEG, Zaragoza, Spain
| | - Marcio Andrade-Campos
- Foundation FEETEG, Zaragoza, Spain.,Haematology Department, Hospital del Mar, Barcelona, Spain
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24
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Zhang P, Zheng MF, Cui SY, Zhang W, Gao RP. Ambroxol chaperone therapy for Gaucher disease type I-associated liver cirrhosis and portal hypertension: a case report. Endocr Metab Immune Disord Drug Targets 2021; 22:658-662. [PMID: 34802413 DOI: 10.2174/1871530321666211119145230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Gaucher disease (GD) is a rare autosomal recessive inherited disease caused by the deficiency of glucocerebrosidase and characterized by a broad spectrum of clinical manifestations, including hepatosplenomegaly, bone infiltration, and cytopenia. Moreover, it is even involved in the central nervous system. GD is classified into three phenotypes on the ground of neurologic involvement: type 1 (GD1), the commonly adult-onset, non-neuropathic variant; type 2 (GD2), the acute neuropathic form; and type 3 (GD3), the severe chronic neuro-visceral form. Recently, several studies have shown a promising outcome of ambroxol chaperone therapy for the treatment of GD, but its therapeutic role in GD1-associated liver cirrhosis and portal hypertension was not verified. CASE PRESENTATION A 36-year-old male patient was admitted for esophageal varices lasting for one year with a 34-year history of liver and spleen enlargement. The patient was diagnosed with GD1 with cirrhosis and portal hypertension based on the identification of Gaucher cells and advanced fibrosis in the liver biopsy tissue and two known pathogenic mutations on the glucocerebrosidase (GBA) gene. The patient received 660 mg/d of ambroxol for up to two years. At his six-month follow-up, the patient exhibited a remarkable increase in GBA activity (+35.5%) and decrease in liver stiffness (-19.5%) and portal vein diameter (-41.2%) as examined by ultrasound elastography and computer tomography, respectively. At two-year follow-up, the liver stiffness was further reduced (-55.5%) in comparison with untreated patients. CONCLUSION This case report suggests that long-term treatment with high dose ambroxol may play a role in the reduction of hepatic fibrosis in GD1.
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Affiliation(s)
- Peng Zhang
- Department of Infectious Diseases, the First Hospital of Jilin University, Changchun 130021. China
| | - Mei-Fang Zheng
- Department of Hepatic Biliary Pancreatic Medicine, First Hospital of Jilin University, Changchun 130021. China
| | - Shi-Yuan Cui
- Department of Hepatic Biliary Pancreatic Medicine, First Hospital of Jilin University, Changchun 130021. China
| | - Wei Zhang
- Department of Hepatic Biliary Pancreatic Medicine, First Hospital of Jilin University, Changchun 130021. China
| | - Run-Ping Gao
- Department of Hepatic Biliary Pancreatic Medicine, First Hospital of Jilin University, Changchun 130021. China
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25
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Komada N, Fujiwara T, Yoshizumi H, Ida H, Shimoda K. A Japanese Patient with Gaucher Disease Treated with the Oral Drug Eliglustat as Substrate Reducing Therapy. Case Rep Gastroenterol 2021; 15:838-845. [PMID: 34720832 PMCID: PMC8543309 DOI: 10.1159/000519005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022] Open
Abstract
Gaucher disease is a rare genetic disorder caused by the deficiency of acid β-glucosidase to effectively catalyze the degradation of glucosylceramide to glucose and ceramide. We report here the case of a 31-year-old male Japanese patient with Gaucher disease who switched from enzyme replacement therapy (ERT) to substrate reducing therapy (SRT). Liver dysfunction was identified at a routine medical checkup, and the patient was referred to our hospital with “idiopathic liver disease.” Clinical laboratory tests indicated thrombocytopenia and splenomegaly, which are characteristic symptoms of Gaucher disease. To definitively diagnose Gaucher disease, a bone marrow biopsy and acid β-glucosidase activity measurement were conducted; the results supported a diagnosis of Gaucher disease. This case emphasizes that it is possible for periodic medical checkups in adults to lead to the diagnosis of rare genetic disorders. The patient underwent ERT treatment with imiglucerase for 5 years; the platelet count rapidly increased and the spleen size rapidly decreased, indicating a good response to the drug. However, the patient increasingly felt the burden of visiting the hospital for 2 h of infusion ERT every 2 weeks. Consequently, it was jointly decided that he should switch from ERT to SRT with an oral drug. This switch was successful with no deterioration of laboratory data. This case report is the first to describe a Japanese Gaucher disease patient treated with eliglustat for >2 years. We showed that SRT is a well-tolerated and effective option for the treatment of Gaucher disease.
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Affiliation(s)
- Naoto Komada
- National Hospital Organization Miyakonojou Medical Center, Miyazaki, Japan
| | - Toshinari Fujiwara
- National Hospital Organization Miyakonojou Medical Center, Miyazaki, Japan
| | - Hideyuki Yoshizumi
- National Hospital Organization Miyakonojou Medical Center, Miyazaki, Japan
| | - Hiroyuki Ida
- Department of Pediatrics, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuya Shimoda
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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26
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Messelodi D, Bertuccio SN, Indio V, Strocchi S, Taddia A, Serravalle S, Bandini J, Astolfi A, Pession A. iPSC-Derived Gaucher Macrophages Display Growth Impairment and Activation of Inflammation-Related Cell Death. Cells 2021; 10:cells10112822. [PMID: 34831047 PMCID: PMC8616237 DOI: 10.3390/cells10112822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/20/2022] Open
Abstract
Gaucher disease is a lysosomal storage disorder characterized by β-glucosidase enzyme deficiency and substrate accumulation, especially in cells of the reticuloendothelial system. Typical features of the disease are the unrestrained activation of inflammatory mechanisms, whose molecular pathways are still unclear. To investigate biological mechanisms underlying the macrophage activation in GD, we derived iPSCs from a healthy donor and a GD patient line and differentiated them into hematopoietic progenitors. While GD iPSCs are able to efficiently give rise to CD33+/CD45+ myeloid progenitors, the maturation towards the CD14+/CD163+ monocyte/macrophages fate resulted enhanced in the GD lines, that in addition displayed a decreased growth potential compared to control cells either in semisolid or in liquid culture. The GD lines growth impairment was associated with a significant upregulation of RIPK3 and MLKL, two key effectors of necroptosis, the inflammation related cell death pathway. The activation of necroptosis, which has already been linked to neuronopathic GD, may play a role in the disease proinflammatory condition and in the identified cell growth defects. Understanding the GD macrophage role in the alteration of mechanisms linked to cellular metabolism imbalance, cell death and inflammation are crucial in identifying new ways to approach the disease.
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Affiliation(s)
- Daria Messelodi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (D.M.); (S.N.B.); (A.T.)
| | - Salvatore Nicola Bertuccio
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (D.M.); (S.N.B.); (A.T.)
| | - Valentina Indio
- Alma Mater Institute on Healthy Planet, University of Bologna, 40138 Bologna, Italy;
| | - Silvia Strocchi
- Laboratory of Translational Research, Ospedale Santa Maria Nuova–IRCCS, 42123 Reggio Emilia, Italy;
| | - Alberto Taddia
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (D.M.); (S.N.B.); (A.T.)
| | - Salvatore Serravalle
- Division of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.S.); (J.B.); (A.P.)
| | - Jessica Bandini
- Division of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.S.); (J.B.); (A.P.)
| | - Annalisa Astolfi
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Correspondence:
| | - Andrea Pession
- Division of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (S.S.); (J.B.); (A.P.)
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27
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Qi X, Xu J, Shan L, Li Y, Cui Y, Liu H, Wang K, Gao L, Kang Z, Wu Q. Economic burden and health related quality of life of ultra-rare Gaucher disease in China. Orphanet J Rare Dis 2021; 16:358. [PMID: 34380529 PMCID: PMC8356434 DOI: 10.1186/s13023-021-01963-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background The diagnosis and health care of patients with rare diseases present a tremendous challenge worldwide. This study described the health care service utilization through participants’ perspective and estimated the cost of illness (COI), and patients with Gaucher disease (GD)’s/caregivers’ health-related quality of life in China. Method An online retrospective survey of patients with GD and their caregivers was conducted during May–June 2018. Socio-demographic, health service utilization, disease-related expenses, social support, sleep quality (Pittsburgh Sleep Quality Index [PSQI]), and the Short Form Health Survey (SF-36) were investigated. Using self-reported information, we estimated the annual COI, including direct healthcare, direct non-healthcare, and indirect costs. Results Forty patients and their 49 caregivers were surveyed. The patients’ onset age of GD was 9.3 ± 10.9; their disease course was 3.5 ± 3.1 years. 21 (42.9%) patients had ≥ 2 caregivers, but 35 (71.4%) caregivers reported have no experience as a caregiver. 79.6% caregivers have stopped working, and 87.8% changed weekly working schedule. Before final diagnosis, patients visited 3.9 ± 3.1 (max = 20) hospitals and took 1.2 ± 1.7 (max = 6.6) years for confirmed diagnosis. On average, 5.0 ± 9.6 misdiagnoses occurred, and the per-patient diagnoses cost was USD ($) 7576. After GD confirmation, 8 (16.3%) patients received no treatment, 40 (81.6%) received pharmacotherapy, 10 (20.4%) received surgery, 38 (77.6%) received outpatient service (8.8 ± 9.1 times/annually), and 37 (77.5%) received inpatient service (4.0 ± 3.5 times/annually). Annual per-patient COI was USD ($) 49,925 (95% confidence interval: 29,178, 70,672). Average direct healthcare cost was $41,816, including pharmaceutical ($29,908), inpatient ($7,451), and outpatient ($1,838). Productivity loss per-caregiver was $1,980, and their Zarit Burden Inventory score was moderate-severe (48.6 ± 19.6). Both patients/caregivers reported lower social support (32.4 ± 7.4, 34.9 ± 7.6), two times higher PSQI (7.9 ± 2.9, 8.7 ± 3.6), and half lower SF-36 (41.3 ± 18.6, 46.5 ± 19.3) than those reported for healthy Chinese individuals. Conclusions The high misdiagnosis rate, together with delayed diagnosis, substantial costs, and deteriorated health-related quality of life of GD patients as well as their heavy care burden, calls for extreme attention from policymakers in China. Further efforts of government and society are urgently demanded, including pharmaceutical reimbursement, screening newborns, developing precise diagnostic tools, and training doctors. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01963-6.
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Affiliation(s)
- Xinye Qi
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiao Xu
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Linghan Shan
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ye Li
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Yu Cui
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Huan Liu
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Kexin Wang
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Lijun Gao
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Zheng Kang
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China.,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China
| | - Qunhong Wu
- Department of Health Policy, Health Management College, Harbin Medical University, No. 157, Baojian 21 Road, Nangang District, Harbin, 150081, Heilongjiang Province, China. .,Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China.
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Hyperferritinemia-A Clinical Overview. J Clin Med 2021; 10:jcm10092008. [PMID: 34067164 PMCID: PMC8125175 DOI: 10.3390/jcm10092008] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Ferritin is one of the most frequently requested laboratory tests in primary and secondary care, and levels often deviate from reference ranges. Serving as an indirect marker for total body iron stores, low ferritin is highly specific for iron deficiency. Hyperferritinemia is, however, a non-specific finding, which is frequently overlooked in general practice. In routine medical practice, only 10% of cases are related to an iron overload, whilst the rest is seen as a result of acute phase reactions and reactive increases in ferritin due to underlying conditions. Differentiation of the presence or absence of an associated iron overload upon hyperferritinemia is essential, although often proves to be complex. In this review, we have performed a review of a selection of the literature based on the authors’ own experiences and assessments in accordance with international recommendations and guidelines. We address the biology, etiology, and epidemiology of hyperferritinemia. Finally, an algorithm for the diagnostic workup and management of hyperferritinemia is proposed, and general principles regarding the treatment of iron overload are discussed.
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Mehta A, Rivero-Arias O, Abdelwahab M, Campbell S, McMillan A, Rolfe MJ, Bright JR, Kuter DJ. Scoring system to facilitate diagnosis of Gaucher disease. Intern Med J 2021; 50:1538-1546. [PMID: 33174353 PMCID: PMC7839708 DOI: 10.1111/imj.14942] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022]
Abstract
Background Gaucher disease (GD) manifests heterogeneously and other conditions are often misdiagnosed in its place, leading to diagnostic delays. The Gaucher Earlier Diagnosis Consensus (GED‐C) initiative proposed a point‐scoring system (PSS) based on the signs and covariables that are most indicative of GD to help clinicians identify which individuals to test for GD. Aims To validate the PSS retrospectively in a test population including patients with GD and other conditions with overlapping manifestations. Methods Four cohorts of adults with GD, liver disease, haematological malignancy or immune thrombocytopenia were identified from hospital records. Clinical data were audited for GED‐C factors identified as potentially indicative of GD and aggregate scores calculated (sum of scores/number of factors) based on published PSS weightings. Threshold discriminatory PSS scores, sensitivity and specificity were determined by receiver‐operating characteristic analysis. Results Among 100 patients (GD, n = 25; non‐GD, n = 75), analyses based on 11 possible factors estimated group mean (standard deviation) PSS scores of: GD (n = 14), 1.08 (0.25); non‐GD (n = 38), 0.58 (0.31). Mean between‐group difference (95% confidence interval) was −0.49 (−0.68, −0.31) and area under the receiver‐operating characteristic analysis curve (95% confidence interval) was 0.88 (0.78, 0.97). A threshold PSS score of 0.82 identified all 14 patients with GD in the analysis set (100% sensitivity) and 27 of 38 patients in the non‐GD group (71% specificity). Patients with liver disease and haematological malignancy were most likely to have manifestations overlapping GD. Conclusions Preliminary validation of the GED‐C PSS discriminated effectively between patients with GD and those with overlapping signs.
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Affiliation(s)
- Atul Mehta
- Department of Haematology, University College London, London, UK
| | - Oliver Rivero-Arias
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Magy Abdelwahab
- Department of Paediatric Haematology, Cairo University Paediatric Hospital, Cairo, Egypt
| | - Samantha Campbell
- Department of Hepatology and Gastroenterology, Royal Free Hospital, University College London School of Medicine, London, UK
| | - Annabel McMillan
- Department of Haematology, Royal Free Hospital, University College London School of Medicine, London, UK
| | | | | | - David J Kuter
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Center for Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Deegan P, Khan A, Camelo JS, Batista JL, Weinreb N. The International Collaborative Gaucher Group GRAF (Gaucher Risk Assessment for Fracture) score: a composite risk score for assessing adult fracture risk in imiglucerase-treated Gaucher disease type 1 patients. Orphanet J Rare Dis 2021; 16:92. [PMID: 33602299 PMCID: PMC7893749 DOI: 10.1186/s13023-020-01656-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background Fractures in Gaucher disease type 1 (GD1) patients cause significant morbidity. Fracture risk may be decreased by enzyme replacement therapy (ERT) but not eliminated. When considering initiation of treatment, it is useful to know to what extent fixed patient-specific factors determine risk for future fractures beyond standard risk factors that change with time and treatment, such as decreased bone mineral density. We developed a tool called the GRAF score (Gaucher Risk Assessment for Fracture) that applies 5 widely available characteristics (sex, age at treatment initiation [ATI], time interval between diagnosis and treatment initiation, splenectomy status, history of pre-treatment bone crisis) and provides a practical method to assess future fracture risk when imiglucerase ERT is initiated. Methods Inclusion criteria: GD1 patients in the International Collaborative Gaucher Group Gaucher Registry as of September 2019 initially treated with alglucerase/imiglucerase; known splenectomy status; at least one skeletal assessment on treatment (3216 of 6422 patients). Data were analyzed by ATI group (< 18, ≥ 18 to < 50, or ≥ 50 years of age) using Cox proportional hazards regression with all 5 risk factors included in the multivariable model. A composite risk score was calculated by summing the contribution of each parameter weighted by the strength of its association (regression coefficient) with fracture risk. Results Patients were followed from the date of treatment initiation (or age 18 years for patients if treatment started earlier) to the date of first adult fracture (n = 288 first fracture endpoints), death, or end of follow-up. The GRAF score for each ATI group was associated with a 2.7-fold increased risk of adult fracture for each one-point increase (p < 0.02 for < 18 ATI, p < 0.0001 for ≥ 18 to < 50 ATI and ≥ 50 ATI). Conclusions The GRAF score is a tool to be used with bone density and other modifiable, non-GD-specific risk factors (e.g. smoking, alcohol intake, frailty) to inform physicians and previously untreated GD1 patients about risk for a future fracture after starting imiglucerase regardless of whether there is an eventual switch to an alternative ERT or to substrate reduction therapy. GRAF can also help predict the extent that fracture risk increases if initiation of treatment is further delayed.
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Affiliation(s)
- Patrick Deegan
- Lysosomal Disorders Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Box 135, Cambridge, CB2 0QQ, UK.
| | - Aneal Khan
- Department of Medical Genetics and Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - José Simon Camelo
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Neal Weinreb
- Departments of Human Genetics and Medicine (Hematology), University of Miami Miller School of Medicine, Miami, FL, USA
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31
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Motta I, Consonni D, Stroppiano M, Benedetto C, Cassinerio E, Tappino B, Ranalli P, Borin L, Facchini L, Patriarca A, Barcellini W, Lanza F, Filocamo M, Cappellini MD. Predicting the probability of Gaucher disease in subjects with splenomegaly and thrombocytopenia. Sci Rep 2021; 11:2594. [PMID: 33510429 PMCID: PMC7843616 DOI: 10.1038/s41598-021-82296-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/14/2021] [Indexed: 12/11/2022] Open
Abstract
Hematologists are frequently involved in the diagnostic pathway of Gaucher disease type 1 (GD1) patients since they present several hematological signs. However, GD1 is mainly underdiagnosed because of a lack of awareness. In this multicenter study, we combine the use of a diagnostic algorithm with a simple test (β-glucosidase activity on Dried Blood Spot) in order to facilitate the diagnosis in a population presenting to the hematologist with splenomegaly and/or thrombocytopenia associated with other hematological signs. In this high-risk population, the prevalence of GD1 is 3.3%. We propose an equation that predicts the probability of having GD1 according to three parameters that are routinely evaluated: platelet count, ferritin, and transferrin saturation.
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Affiliation(s)
- Irene Motta
- General Medicine Unit, Rare Diseases Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza, 35, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marina Stroppiano
- Laboratorio Di Genetica Molecolare E Biobanche, Istituto G. Gaslini, Genoa, Italy
| | | | - Elena Cassinerio
- General Medicine Unit, Rare Diseases Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza, 35, 20122, Milan, Italy
| | - Barbara Tappino
- Laboratorio Di Genetica Molecolare E Biobanche, Istituto G. Gaslini, Genoa, Italy
| | - Paola Ranalli
- Hemophilia and Rare Blood Diseases Centre, Oncology and Hematology Department, S. Spirito Hospital, Pescara, Italy
| | - Lorenza Borin
- Hematology Division, San Gerardo Hospital, Monza, Italy
| | - Luca Facchini
- Division of Hematology, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont and Ospedale Maggiore Della Carità, Novara, Italy
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Lanza
- Laboratorio Di Genetica Molecolare E Biobanche, Istituto G. Gaslini, Genoa, Italy
| | - Mirella Filocamo
- Laboratorio Di Genetica Molecolare E Biobanche, Istituto G. Gaslini, Genoa, Italy
| | - Maria Domenica Cappellini
- General Medicine Unit, Rare Diseases Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza, 35, 20122, Milan, Italy. .,Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy.
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Owaidah T, Alabbas F, Alhazmi I, Al Saeed H, Balelah S, ElYamany G, Kashari O, Qari M, Saleh M, Roushdy S, ElBagoury M. Diagnosis and management of hematological manifestations of gaucher disease: Insights from Saudi Arabia. JOURNAL OF APPLIED HEMATOLOGY 2021. [DOI: 10.4103/joah.joah_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Marchi G, Nascimbeni F, Motta I, Busti F, Carubbi F, Cappellini MD, Pietrangelo A, Corradini E, Piperno A, Girelli D. Hyperferritinemia and diagnosis of type 1 Gaucher disease. Am J Hematol 2020; 95:570-576. [PMID: 32031266 DOI: 10.1002/ajh.25752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/28/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Giacomo Marchi
- EuroBloodNet Referral Center for Iron Disorders and Gruppo Interdisciplinare Malattie del Ferro, Internal Medicine Unit, Azienda Ospedaliera Universitaria Integrata Verona Italy
| | - Fabio Nascimbeni
- Regional Referral Center for Lysosomal Storage Diseases, Division of Internal Medicine and MetabolismAzienda Ospedaliero‐Universitaria di Modena ‐ Ospedale Civile, University of Modena and Reggio Emilia Modena Italy
| | - Irene Motta
- Department of Medicine and Medical SpecialitiesFondazione IRCSS Cà Granda Milan Italy
- Department of Clinical Sciences and Community HealthUniversity of Milan Milan Italy
| | - Fabiana Busti
- EuroBloodNet Referral Center for Iron Disorders and Gruppo Interdisciplinare Malattie del Ferro, Internal Medicine Unit, Azienda Ospedaliera Universitaria Integrata Verona Italy
| | - Francesca Carubbi
- Regional Referral Center for Lysosomal Storage Diseases, Division of Internal Medicine and MetabolismAzienda Ospedaliero‐Universitaria di Modena ‐ Ospedale Civile, University of Modena and Reggio Emilia Modena Italy
| | - Maria Domenica Cappellini
- Department of Medicine and Medical SpecialitiesFondazione IRCSS Cà Granda Milan Italy
- Department of Clinical Sciences and Community HealthUniversity of Milan Milan Italy
| | - Antonello Pietrangelo
- Division of Internal Medicine and Center for Hemochromatosis and Heredometabolic Liver Diseases, EuroBloodNet Referral Center for Iron DisordersAzienda Ospedaliero‐Universitaria di Modena ‐ Policlinico Modena Italy
- Department of Medical and Surgical SciencesUniversity of Modena and Reggio Emilia Modena Italy
| | - Elena Corradini
- Division of Internal Medicine and Center for Hemochromatosis and Heredometabolic Liver Diseases, EuroBloodNet Referral Center for Iron DisordersAzienda Ospedaliero‐Universitaria di Modena ‐ Policlinico Modena Italy
- Department of Medical and Surgical SciencesUniversity of Modena and Reggio Emilia Modena Italy
| | - Alberto Piperno
- EuroBloodNet and MetabERN Referral Center, Department of Medicine and SurgeryUniversity of Milano‐Bicocca, Medical Genetics, ASST Monza ‐ S. Gerardo Hospital Monza Italy
| | - Domenico Girelli
- EuroBloodNet Referral Center for Iron Disorders and Gruppo Interdisciplinare Malattie del Ferro, Internal Medicine Unit, Azienda Ospedaliera Universitaria Integrata Verona Italy
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Carubbi F, Cappellini MD, Fargion S, Fracanzani AL, Nascimbeni F. Liver involvement in Gaucher disease: A practical review for the hepatologist and the gastroenterologist. Dig Liver Dis 2020; 52:368-373. [PMID: 32057684 DOI: 10.1016/j.dld.2020.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/02/2020] [Accepted: 01/12/2020] [Indexed: 02/06/2023]
Abstract
Gaucher disease (GD), a rare lysosomal storage disorder caused by deficient glucocerebrosidase activity and consequent accumulation of glycosphingolipids in the mononuclear phagocyte system, may progress to disabling and potentially life-threatening complications when left undiagnosed and untreated. Unfortunately, because of non-specific signs and symptoms and lack of awareness, patients with type 1 GD, the most common non-neuropathic variant, frequently experience diagnostic delays. Since splenomegaly and thrombocytopenia are the dominant clinical features in many GD patients leading to first medical contact, the hepatologist and the gastroenterologist need to be aware of this condition. Liver involvement has been reported in the majority of GD patients, and comprises hepatomegaly, with or without liver enzymes alteration, fibrosis/cirrhosis, portal hypertension, focal liver lesions, and cholelithiasis. Moreover, GD is associated with several biochemical alterations of potential interest for the hepatologist and the gastroenterologist, including hypergammaglobulinemia, hyperferritinemia and metabolic abnormalities, that may lead to misdiagnoses with chronic liver diseases of common etiology, such as primary hemochromatosis, autoimmune liver diseases or nonalcoholic fatty liver disease. This comprehensive review, based on the collaborative experience of physicians managing patients with GD, provides practical information on the clinical, histological and radiological hepatic manifestations of GD aiming at facilitating the diagnosis of GD for the hepatologist and the gastroenterologist.
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Affiliation(s)
- Francesca Carubbi
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Maria Domenica Cappellini
- Rare Diseases Center, Department of Medicine, "Ca' Granda" Foundation IRCCS, Policlinico Hospital, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Silvia Fargion
- "Ca' Granda" Foundation IRCCS, Policlinico Hospital, University of Milan, Milan, Italy
| | - Anna Ludovica Fracanzani
- "Ca' Granda" Foundation IRCCS, Policlinico Hospital, University of Milan, Milan, Italy; Department of Pathophysiology and Transplantation, Unit of Medicine and Metabolic Disorders, Milan, Italy
| | - Fabio Nascimbeni
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism, Civil Hospital, AOU of Modena, University of Modena and Reggio Emilia, Modena, Italy
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35
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Muñoz G, García-Seisdedos D, Ciubotariu C, Piris-Villaespesa M, Gandía M, Martín-Moro F, Gutiérrez-Solana LG, Morado M, López-Jiménez J, Sánchez-Herranz A, Villarrubia J, Del Castillo FJ. Early detection of lysosomal diseases by screening of cases of idiopathic splenomegaly and/or thrombocytopenia with a next-generation sequencing gene panel. JIMD Rep 2019; 51:53-61. [PMID: 32071839 PMCID: PMC7012743 DOI: 10.1002/jmd2.12078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/06/2019] [Accepted: 09/12/2019] [Indexed: 02/02/2023] Open
Abstract
Lysosomal diseases (LD) are a group of about 70 rare hereditary disorders (combined incidence 1:5000) in which diverse lysosomal functions are impaired, impacting multiple organs and systems. The first clinical signs and symptoms are usually unspecific and shared by hundreds of other disorders. Diagnosis of LD traditionally relies on performing specific enzymatic assays, if available, upon clinical suspicion of the disorder. However, the combination of the insidious onset of LD and the lack of awareness on these rare diseases among medical personnel results in undesirable diagnostic delays, with unchecked disease progression, appearance of complications and a worsened prognosis. We tested the usefulness of a next‐generation sequencing‐based gene panel for quick, early detection of LD among cases of idiopathic splenomegaly and/or thrombocytopenia, two of the earliest clinical signs observed in most LD. Our 73‐gene panel interrogated 28 genes for LD, 1 biomarker and 44 genes underlying non‐LD differential diagnoses. Among 38 unrelated patients, we elucidated eight cases (21%), five with LD (GM1 gangliosidosis, Sanfilippo disease A and B, Niemann‐Pick disease B, Gaucher disease) and three with non‐LD conditions. Interestingly, we identified three LD patients harboring pathogenic mutations in two LD genes each, which may result in unusual disease presentations and impact treatment. Turnaround time for panel screening and genetic validation was 1 month. Our results underline the usefulness of resequencing gene panels for quick and cost‐effective screening of LDs and disorders sharing with them early clinical signs.
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Affiliation(s)
- Gloria Muñoz
- UCA de Genómica Traslacional Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain
| | | | - Crina Ciubotariu
- UCA de Genómica Traslacional Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain
| | | | - Marta Gandía
- UCA de Genómica Traslacional Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain
| | - Fernando Martín-Moro
- Servicio de Hematología Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain
| | - Luis G Gutiérrez-Solana
- Consulta de Neurodegenerativas, Servicio de Neurología Pediátrica Hospital Infantil Universitario Niño Jesús Madrid Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Madrid Spain
| | - Marta Morado
- Servicio de Hematología Hospital Universitario La Paz Madrid Spain
| | - Javier López-Jiménez
- Servicio de Hematología Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain
| | | | - Jesús Villarrubia
- UCA de Genómica Traslacional Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain.,Servicio de Hematología Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain
| | - Francisco J Del Castillo
- UCA de Genómica Traslacional Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER) Madrid Spain.,Servicio de Genética Hospital Universitario Ramón y Cajal, IRYCIS Madrid Spain
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Deriaz S, Serratrice C, Lidove O, Noël E, Masseau A, Lorcerie B, Jaussaud R, Marie I, Lavigne C, Cabane J, Kaminsky P, Chérin P, Maillot F. [Diagnostic journey of type 1 Gaucher Disease patients: A survey including internists and hematologists]. Rev Med Interne 2019; 40:778-784. [PMID: 31500934 DOI: 10.1016/j.revmed.2019.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/22/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Gaucher disease (GD) is a rare genetic lysosomal storage disorder caused by a beta-glucocerebrosidase deficiency and responsible for a lysosomal storage disorder. GD is characterized by haematological, visceral and bone involvements. The aim of this study was to describe the diagnostic journey of type 1 GD patients as well as the role of the internist. METHODS A retrospective multicentric study involving type 1 GD patients has been conducted in 16 centers, between 2009 and 2011. RESULTS Fifty-five type 1 GD patients were included, under the care of an internist or an haematologist. They were originally hospitalized in 8 different specialized units. Diagnosis was established by bone-marrow aspiration in 22 patients (40%), by enzymatic assay of glucocerebrosidase activity in 15 patients (27%), and by bone-marrow biopsy in 9 patients (16%). The use of enzymatic assay became more frequent after 1990. The delay between first hospitalization due to GD symptoms and definitive diagnosis was less than one year for 38 patients. Patients with suspected GD were mainly referred to an internist physician. CONCLUSION GD seems to be better recognized and quickly diagnosed since 1990 in spite of the multiplicity of journeys. The role of the internist seems important.
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Affiliation(s)
- S Deriaz
- CHRU, université de Tours, service de médecine interne, Tours, France
| | - C Serratrice
- Service de médecine interne, hôpital Saint-Joseph, Marseille, France; Département de médecine interne et réhabilitation, hôpital universitaire de Genève, Suisse
| | - O Lidove
- Service de médecine interne, hôpital de la Croix Saint-Simon, Paris, France
| | - E Noël
- Service de médecine interne, CHRU de Strasbourg, Strasbourg, France
| | - A Masseau
- Service de médecine interne, CHRU de Nantes, Nantes, France
| | - B Lorcerie
- Service de médecine interne, CHRU de Dijon, Dijon, France
| | - R Jaussaud
- Service de médecine interne, CHRU de Reims, Reims, France
| | - I Marie
- Service de médecine interne, CHRU de Rouen, Rouen, France
| | - C Lavigne
- Service de médecine interne, CHRU d'Angers, Angers, France
| | - J Cabane
- Service de médecine interne, hôpital Saint-Antoine, Paris, France
| | - P Kaminsky
- Service de médecine interne, CHRU de Nancy, Nancy, France
| | - P Chérin
- Service de médecine interne, hôpital de la Pitié-Salpétrière, Paris, France
| | - F Maillot
- CHRU, université de Tours, service de médecine interne, Tours, France.
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Les erreurs diagnostiques dans le parcours de soins de la Maladie de Gaucher : étude rétrospective du Centre de Référence des Maladies Lysosomales. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hughes D, Mikosch P, Belmatoug N, Carubbi F, Cox T, Goker-Alpan O, Kindmark A, Mistry P, Poll L, Weinreb N, Deegan P. Gaucher Disease in Bone: From Pathophysiology to Practice. J Bone Miner Res 2019; 34:996-1013. [PMID: 31233632 PMCID: PMC6852006 DOI: 10.1002/jbmr.3734] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/28/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
Gaucher disease (GD) is a rare, genetic lysosomal disorder leading to lipid accumulation and dysfunction in multiple organs. Involvement of the skeleton is one of the most prevalent aspects of GD and a major cause of pain, disability, and reduced quality of life. Uniform recommendations for contemporary evaluation and management are needed. To develop practical clinical recommendations, an international group of experienced physicians conducted a comprehensive review of 20 years' of the literature, defining terms according to pathophysiological understanding and pointing out best practice and unmet needs related to the skeletal features of this disorder. Abnormalities of bone modeling, reduced bone density, bone infarction, and plasma cell dyscrasias accompany the displacement of healthy adipocytes in adult marrow. Exposure to excess bioactive glycosphingolipids appears to affect hematopoiesis and the balance of osteoblast and osteoclast numbers and activity. Imbalance between bone formation and breakdown induces disordered trabecular and cortical bone modeling, cortical bone thinning, fragility fractures, and osteolytic lesions. Regular assessment of bone mineral density, marrow infiltration, the axial skeleton and searching for potential malignancy are recommended. MRI is valuable for monitoring skeletal involvement: It provides semiquantitative assessment of marrow infiltration and the degree of bone infarction. When MRI is not available, monitoring of painful acute bone crises and osteonecrosis by plain X-ray has limited value. In adult patients, we recommend DXA of the lumbar spine and left and right hips, with careful protocols designed to exclude focal disease; serial follow-up should be done using the same standardized instrument. Skeletal health may be improved by common measures, including adequate calcium and vitamin D and management of pain and orthopedic complications. Prompt initiation of specific therapy for GD is crucial to optimizing outcomes and preventing irreversible skeletal complications. Investing in safe, clinically useful, and better predictive methods for determining bone integrity and fracture risk remains a need. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Derralynn Hughes
- Royal Free London NHS Foundation Trust and University College London, UK
| | - Peter Mikosch
- Department of Internal Medicine 2, Landesklinikum Mistelbach, Austria, and Medical University Vienna, Externe Lehre, Vienna, Austria
| | - Nadia Belmatoug
- Referral Center for Lysosomal Diseases, Department of Internal Medicine, University Hospital Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Francesca Carubbi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, NOCSAE Hospital, AOU Modena, Italy
| | - TimothyM Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Andreas Kindmark
- Department of Endocrinology and Diabetology, Uppsala University Hospital, Uppsala, Sweden
| | - PramodK Mistry
- Department of Internal Medicine (Digestive Diseases), Yale University School of Medicine, New Haven, CT, USA
| | - Ludger Poll
- Practice of Radiology and Nuclear Medicine Duisburg-Moers, Heinrich-Heine University Düsseldorf, Duisburg, Germany
| | - Neal Weinreb
- Departments of Human Genetics and Medicine (Hematology), Miller School of Medicine, University of Miami, FL, USA
| | - Patrick Deegan
- Lysosomal Disorders Unit, Addenbrooke's Hospital, Cambridge, UK
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Mehta A, Kuter DJ, Salek SS, Belmatoug N, Bembi B, Bright J, vom Dahl S, Deodato F, Di Rocco M, Göker‐Alpan O, Hughes DA, Lukina EA, Machaczka M, Mengel E, Nagral A, Nakamura K, Narita A, Oliveri B, Pastores G, Pérez‐López J, Ramaswami U, Schwartz IV, Szer J, Weinreb NJ, Zimran A. Presenting signs and patient co-variables in Gaucher disease: outcome of the Gaucher Earlier Diagnosis Consensus (GED-C) Delphi initiative. Intern Med J 2019; 49:578-591. [PMID: 30414226 PMCID: PMC6852187 DOI: 10.1111/imj.14156] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/31/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gaucher disease (GD) presents with a range of signs and symptoms. Physicians can fail to recognise the early stages of GD owing to a lack of disease awareness, which can lead to significant diagnostic delays and sometimes irreversible but avoidable morbidities. AIM The Gaucher Earlier Diagnosis Consensus (GED-C) initiative aimed to identify signs and co-variables considered most indicative of early type 1 and type 3 GD, to help non-specialists identify 'at-risk' patients who may benefit from diagnostic testing. METHODS An anonymous, three-round Delphi consensus process was deployed among a global panel of 22 specialists in GD (median experience 17.5 years, collectively managing almost 3000 patients). The rounds entailed data gathering, then importance ranking and establishment of consensus, using 5-point Likert scales and scoring thresholds defined a priori. RESULTS For type 1 disease, seven major signs (splenomegaly, thrombocytopenia, bone-related manifestations, anaemia, hyperferritinaemia, hepatomegaly and gammopathy) and two major co-variables (family history of GD and Ashkenazi-Jewish ancestry) were identified. For type 3 disease, nine major signs (splenomegaly, oculomotor disturbances, thrombocytopenia, epilepsy, anaemia, hepatomegaly, bone pain, motor disturbances and kyphosis) and one major co-variable (family history of GD) were identified. Lack of disease awareness, overlooking mild early signs and failure to consider GD as a diagnostic differential were considered major barriers to early diagnosis. CONCLUSION The signs and co-variables identified in the GED-C initiative as potentially indicative of early GD will help to guide non-specialists and raise their index of suspicion in identifying patients potentially suitable for diagnostic testing for GD.
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Affiliation(s)
- Atul Mehta
- Lysosomal Storage Disorders Unit, Department of HaematologyRoyal Free Hospital, UCL Medical SchoolLondonUK
| | - David J. Kuter
- Center for HematologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Sam S. Salek
- School of Life and Medical Sciences, University of HertfordshireHatfieldUK
| | - Nadia Belmatoug
- Referral Center for Lysosomal Diseases, University Hospital Paris Nord Val de Seine, site Beaujon, ClichyParisFrance
| | - Bruno Bembi
- Centre for Rare DiseasesAcademic Medical Centre Hospital of UdineUdineItaly
| | - Jeremy Bright
- Research Evaluation UnitOxford PharmaGenesis LtdOxfordUK
| | - Stephan vom Dahl
- Department of Gastroenterology, Hepatology and Infectious DiseasesHeinrich‐Heine UniversityDüsseldorfGermany
| | - Federica Deodato
- Division of Metabolism, Department of Pediatric SpecialistBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of PediatricsIRCCS Giannina Gaslini InstituteGenoaItaly
| | - Ozlem Göker‐Alpan
- Lysosomal Disorders Unit and CFCTO and O Alpan LLCFairfaxVirginiaUSA
| | - Derralynn A. Hughes
- Lysosomal Storage Disorders Unit, Department of HaematologyRoyal Free Hospital, UCL Medical SchoolLondonUK
| | - Elena A. Lukina
- Department of Orphan DiseasesNational Research Center for HematologyMoscowRussia
| | - Maciej Machaczka
- Medical FacultyUniversity of RzeszowRzeszowPoland
- Department of Medicine at HuddingeHematology Center Karolinska, Karolinska Institute, Karolinska University Hospital HuddingeStockholmSweden
| | - Eugen Mengel
- Villa MetabolicaCenter of Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Aabha Nagral
- Department of GastroenterologyJaslok Hospital and Research CentreMumbaiIndia
- Department of GastroenterologyApollo HospitalMumbaiIndia
| | - Kimitoshi Nakamura
- Department of PediatricsGraduate School of Medical Sciences, Kumamoto UniversityKumamotoJapan
| | - Aya Narita
- Department of Child NeurologyFaculty of Medicine, Tottori UniversityYon agoJapan
| | - Beatriz Oliveri
- Osteoporosis and Metabolic Bone Diseases Laboratory, Institute of Immunology, Genetics, and Metabolism (INIGEM) CONICET ‐ UBABuenos AiresArgentina
| | - Gregory Pastores
- University College Dublin, The Mater Misericordiae University HospitalDublinIreland
| | | | - Uma Ramaswami
- Lysosomal Storage Disorders Unit, Department of HaematologyRoyal Free Hospital, UCL Medical SchoolLondonUK
| | - Ida V. Schwartz
- Medical Genetics Service – HCPA, Genetics DepartmentUFRGSPorto AlegreBrazil
| | - Jeff Szer
- Department of Clinical Haematology, Bone Marrow Transplant ServiceThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Neal J. Weinreb
- Department of Human Genetics and Medicine (Hematology)University of Miami Miller School of Medicine, UHealth Sylvester Coral SpringsCoral SpringsFloridaUSA
| | - Ari Zimran
- Shaare Zedek Medical Center and Hadassah Medical SchoolJerusalemIsrael
- Hadassah Medical SchoolJerusalemIsrael
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Nguyen Y, Stirnemann J, Belmatoug N. La maladie de Gaucher : quand y penser ? Rev Med Interne 2019; 40:313-322. [DOI: 10.1016/j.revmed.2018.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/12/2018] [Accepted: 11/25/2018] [Indexed: 12/23/2022]
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Jaffe DH, Flaks-Manov N, Benis A, Gabay H, DiBonaventura M, Rosenbaum H, Joseph A, Bachrach A, Leventer-Roberts M. Population-based cohort of 500 patients with Gaucher disease in Israel. BMJ Open 2019; 9:e024251. [PMID: 30670517 PMCID: PMC6347887 DOI: 10.1136/bmjopen-2018-024251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To characterise a population-based cohort of patients with Gaucher disease (GD) in Israel relative to the general population and describe sociodemographic and clinical differences by disease severity (ie, enzyme replacement therapy [ERT] use). DESIGN A cross-sectional study was conducted. SETTING Data from the Clalit Health Services electronic health record (EHR) database were used. PARTICIPANTS The study population included all patients in the Clalit EHR database identified as having GD as of 30 June 2014. RESULTS A total of 500 patients with GD were identified and assessed. The majority were ≥18 years of age (90.6%), female (54.0%), Jewish (93.6%) and 34.8% had high socioeconomic status, compared with 19.0% in the general Clalit population. Over half of patients with GD with available data (51.0%) were overweight/obese and 63.5% had a Charlson Comorbidity Index ≥1, compared with 46.6% and 30.4%, respectively, in the general Clalit population. The majority of patients with GD had a history of anaemia (69.6%) or thrombocytopaenia (62.0%), 40.4% had a history of bone events and 22.2% had a history of cancer. Overall, 41.2% had received ERT. CONCLUSIONS Establishing a population-based cohort of patients with GD is essential to understanding disease progression and management. In this study, we highlight the need for physicians to monitor patients with GD regardless of their ERT status.
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Affiliation(s)
- Dena H Jaffe
- Health Outcomes Practice, Kantar Health, Tel Aviv, Israel
| | | | - Arriel Benis
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Hagit Gabay
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | | | - Hanna Rosenbaum
- Department of Oncology, Clalit Medical Center, Nazareth, Israel
| | - Alain Joseph
- Health Economics and Health Outcomes, Shire GmbH Zug, Zug, Switzerland
| | - Asaf Bachrach
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
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Russell SA, Sholzberg M, Mangel J, Keeney M, Hedley B, Bode M, Gob A, Lam S, Phua C, Hsia CC. Gaucher disease screening at a general adult hematology tertiary care centre: A prospective study. Int J Lab Hematol 2018; 41:e66-e69. [DOI: 10.1111/ijlh.12960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Steven A. Russell
- Department of Internal Medicine Western University London Ontario Canada
| | - Michelle Sholzberg
- Department of Medicine and Laboratory Medicine & Pathobiology St. Michael's Hospital, Li Ka Shing Knowledge Institute, University of Toronto London Ontario Canada
| | - Joy Mangel
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Michael Keeney
- MLT London Laboratory Services Group London Ontario Canada
| | - Ben Hedley
- MLT London Laboratory Services Group London Ontario Canada
| | - Margo Bode
- MLT London Laboratory Services Group London Ontario Canada
| | - Alan Gob
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Selay Lam
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Chai Phua
- Division of Hematology, Department of Medicine Western University London Ontario Canada
| | - Cyrus C. Hsia
- Division of Hematology, Department of Medicine Western University London Ontario Canada
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Kim EA, Lim YT, Hah JO, Sohn YB, Kim YK, Choi JH, Kim SY, Jang KM, Ahn J, Lee JM. Neuronopathic Gaucher disease presenting with microcytic hypochromic anemia. Int J Hematol 2018; 109:361-365. [PMID: 30456712 DOI: 10.1007/s12185-018-2559-3] [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: 07/05/2018] [Revised: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
Gaucher disease (GD) is caused by a hereditary deficiency of glucocerebrosidase, resulting in accumulation of glucosylceramide and potentially manifesting as hepatosplenomegaly. We report the case of a 15-month-old boy with chronic neuronopathic GD. The patient had prolonged anemia despite continued iron supplementation for 3 months. White blood count (WBC), hemoglobin (Hb), platelet count, and corrected reticulocyte count were 3,300 /µL, 8.7 g/dL, 90,000 /µL, and 0.55, respectively. The patient had microcytic hypochromic anemia with mildly elevated ferritin. Physical examination revealed hepatosplenomegaly. Bone-marrow aspiration showed sheets of Gaucher cells. Glucocerebrosidase activity in monocytes was significantly lower than normal. Genetic analysis revealed a homozygous L444P mutation of GBA, and he was diagnosed with type 1 GD. Enzyme replacement treatment (ERT) consisting of imiglucerase was initiated and was effective; WBC, Hb, and platelet count gradually normalized and the hepatosplenomegaly improved. However, when the patient entered elementary school, he showed mild impaired cognitive function, and supranuclear gaze palsy occurred the same year. He was ultimately diagnosed with type 3 GD and continued ERT. Pediatric hemato-oncologists should be aware of GD, especially when patients exhibit anemia refractory to iron therapy, radiologic bone deformity, neurologic signs or symptoms, and growth retardation.
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Affiliation(s)
- Eun Ah Kim
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Young Tae Lim
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jeong Ok Hah
- Department of Pediatrics, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Young Bae Sohn
- Department of Medical Genetics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yu Kyung Kim
- Department of Clinical Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Joon Hyuk Choi
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Sae Yoon Kim
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Kyung Mi Jang
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - JiYoung Ahn
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Jae Min Lee
- Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Republic of Korea.
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Weinreb NJ, Mistry PK, Rosenbloom BE, Dhodapkar MV. MGUS, lymphoplasmacytic malignancies, and Gaucher disease: the significance of the clinical association. Blood 2018; 131:2500-2501. [PMID: 29650800 PMCID: PMC5981170 DOI: 10.1182/blood-2018-02-834689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Neal J Weinreb
- Department of Human Genetics and
- Division of Hematology, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Pramod K Mistry
- Section of Digestive Diseases, Department of Medicine, Yale Liver Center, Yale University School of Medicine, New Haven, CT
| | - Barry E Rosenbloom
- Cedars-Sinai/Tower Hematology Oncology, Beverly Hills, CA
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA; and
| | - Madhav V Dhodapkar
- Section of Hematology, Department of Medicine, Yale Cancer Center, Yale University School of Medicine, New Haven, CT
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Revel-Vilk S, Szer J, Mehta A, Zimran A. How we manage Gaucher Disease in the era of choices. Br J Haematol 2018; 182:467-480. [PMID: 29808905 DOI: 10.1111/bjh.15402] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Treatment of Gaucher Disease (GD) is now beset with the abundance of therapeutic options for an individual patient, making the choice of therapy complex for both expert and non-expert clinicians. The pathogenesis of all disease manifestations is a gene mutation-driven deficiency of glucocerebrosidase, but the clinical expression and response of each of the clinical manifestations to different therapies can be difficult to predict. Enzyme replacement therapy has been available since 1991 and is well-established, with known efficacy and minimal toxicity. Of interest, the three available enzymes are distinct molecules and were registered as new products, not biosimilars. Oral substrate reduction therapy has undergone a revitalisation with a newly approved agent in this class for which some efficacy and toxicity questions have been raised. Herein we present our approach to the management of GD in the era of choices, including a new algorithm for how to manage a newly diagnosed patient.
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Affiliation(s)
- Shoshana Revel-Vilk
- Gaucher Clinic, Shaare Zedek Medical Centre, Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Jeff Szer
- Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Atul Mehta
- Department of Haematology, Royal Free Hospital, London, UK
| | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Centre, Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Diagnosis and Management of Gaucher Disease in India – Consensus Guidelines of the Gaucher Disease Task Force of the Society for Indian Academy of Medical Genetics and the Indian Academy of Pediatrics. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1249-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Justification
Gaucher disease (GD) is amongst the most frequently occurring lysosomal storage disorder in all ethnicities. The clinical manifestations and natural history of GD is highly heterogeneous with extreme geographic and ethnic variations. The literature on GD has paucity of information and optimal management guidelines for Indian patients.
Process
Gaucher Disease Task Force was formed under the auspices of the Society for Indian Academy of Medical Genetics. Invited experts from various specialties formulated guidelines for the management of patients with GD. A writing committee was formed and the draft guidelines were circulated by email to all members for comments and inputs. The guidelines were finalized in December 2016 at the annual meeting of the Indian Academy of Medical Genetics.
Objectives
These guidelines are intended to serve as a standard framework for treating physicians and the health care systems for optimal management of Gaucher disease in India and to define unique needs of this patient population.
Recommendations
Manifestations of GD are protean and a high index of suspicion is essential for timely diagnosis. Patients frequently experience diagnostic delays during which severe irreversible complications occur. Leucocyte acid β-glucosidase activity is mandatory for establishing the diagnosis of Gaucher disease; molecular testing can help identify patients at risk of neuronopathic disease. Enzyme replacement therapy for type 1 and type 3 Gaucher disease is the standard of care. Best outcomes are achieved by early initiation of therapy before onset of irreversible complications. However, in setting of progressive neurological symptoms such as seizures and or/neuroregression, ERT is not recommended, as it cannot cross the blood brain barrier. The recommendations herein are for diagnosis, for initiation of therapy, therapeutic goals, monitoring and follow up of patients. We highlight that prevention of recurrence of the disease through genetic counseling and prenatal diagnosis is essential in India, due to uniformly severe phenotypes encountered in our population.
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Lei K, Zhao Y, Sun L, Liang H, Luo R, Sun X, Tao Y, Chen L, Zhang L, Li A, Li F, Ding H. A pilot screening of high-risk Gaucher disease children using dried blood spot methods in Shandong province of China. Orphanet J Rare Dis 2018; 13:48. [PMID: 29625627 PMCID: PMC5889577 DOI: 10.1186/s13023-018-0782-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 03/09/2018] [Indexed: 11/25/2022] Open
Abstract
Background The study aim was to verify the feasibility of a diagnostic algorithm with the evaluation of beta glucocerebrosidase (GBA) activity on dried blood spots (DBS) in screening high-risk Gaucher disease (GD) children in China, and to investigate the GD prevalence in this selected population. Methods Children were recruited from 20 departments of pediatrics or children’s hospitals in Shandong Province, China, due to splenomegaly and/or thrombocytopenia associated with one or more of the following creteria: anemia, history of bone pain, monoclonal gammopathy of unknown significance (MGUS), polyclonal gammopathy and splenectomy. GBA activity on DBS was tested, and patients with DBS GBA activity under 30 nmol/h.ml were recalled to assess enzyme assay with gold standard and molecular GBA gene analysis on leukocytes. Results A total of 73 children (47 boys and 26 girls) were enrolled in this study. GBA activity DBS < 30 nmol/h.ml was found in 18 (23.7%) children among which four (three boys and one girl) were diagnosed as GD with a median age 1.5 years, and the prevalence in this pediatric population was 5.5% (1.5%~ 13.4%). Three new mutations of GBA found in the four GD patients, L264I, A100Cfs*7 and D399E, have not been reported before. Conclusions With evaluation of GBA activity on DBS as a preliminary screening method, the diagnostic algorithm used in this study is appropriate to make early diagnosis for GD patients with mild symptoms or atypical symptoms and avoid diagnosis delay. Trial registration Not applicable.
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Affiliation(s)
- Ke Lei
- Pediatric Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yanxia Zhao
- Pediatric Center, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lirong Sun
- Pediatric Center, Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Hui Liang
- Department of Pediatric Hematology, Qingdao Children's Hospital, Qingdao, China
| | - Ronghua Luo
- Department of Pediatrics, Taian City Central Hospital, Taian, China
| | - Xiaojing Sun
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Yanling Tao
- Department of Pediatrics, Affiliated Hospital of Jining Medical College, Jining, China
| | - Lijun Chen
- Department of Pediatric Endocrinology and Hematology, Shandong Provincial Hospital, Jinan, China
| | - Lingling Zhang
- Department of Pediatrics, Linyi People's Hospital, Linyi, China
| | - Aimin Li
- Department of Pediatrics, Yantai Yuhuangding Hospital, Yantai, China
| | - Fu Li
- Department of Pediatric Hematology, Jinan Children's Hospital, Jinan, China
| | - Hongfang Ding
- Department of Pediatrics, Shengli Oilfield Central Hospital, Dongying, China
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Ferritinemia and serum inflammatory cytokines in Swedish adults with Gaucher disease type 1. Blood Cells Mol Dis 2018; 68:35-42. [DOI: 10.1016/j.bcmd.2016.10.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023]
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Mendelsohn E, Meir A, Abrahamov A, Elstein D, Zimran A, Levy-Khademi F. Growth and final height of children with Gaucher disease: A 15-year follow-up at an Israeli Gaucher center. Blood Cells Mol Dis 2018; 68:97-99. [DOI: 10.1016/j.bcmd.2016.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/29/2022]
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Mehta A, Belmatoug N, Bembi B, Deegan P, Elstein D, Göker-Alpan Ö, Lukina E, Mengel E, Nakamura K, Pastores GM, Pérez-López J, Schwartz I, Serratrice C, Szer J, Zimran A, Di Rocco M, Panahloo Z, Kuter DJ, Hughes D. Exploring the patient journey to diagnosis of Gaucher disease from the perspective of 212 patients with Gaucher disease and 16 Gaucher expert physicians. Mol Genet Metab 2017; 122:122-129. [PMID: 28847676 DOI: 10.1016/j.ymgme.2017.08.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022]
Abstract
Gaucher disease (GD) is a rare hereditary disorder caused by a deficiency of the lysosomal enzyme β-glucocerebrosidase. Diagnosis is challenging owing to a wide variability in clinical manifestations and severity of symptoms. Many patients may experience marked delays in obtaining a definitive diagnosis. The two surveys reported herein aimed to explore the patient journey to diagnosis of GD from the perspectives of Gaucher expert physicians and patients. Findings from the surveys revealed that many patients experienced diagnostic delays and misdiagnoses, with nearly 1 in 6 patients stating that they were not diagnosed with GD for 7years or more after first consulting a doctor. Physicians and patients both reported multiple referrals to different specialties before a diagnosis of GD was obtained, with primary care, haematology/haematology-oncology and paediatrics the main specialties to which patients first presented. Splenomegaly, thrombocytopenia, anaemia and bone pain were reported as the most common medical problems at first presentation in both surveys. These findings support a clear need for straightforward and easy-to-follow guidance designed to assist non-specialists to identify earlier patients who are at risk of GD.
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Affiliation(s)
- Atul Mehta
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, London, UK.
| | - Nadia Belmatoug
- Referral Centre for Lysosomal Diseases, University Hospital Paris Nord Val de Seine, Clichy, France.
| | - Bruno Bembi
- Academic Medical Centre Hospital of Udine, Regional Coordinator Centre for Rare Diseases, Udine, Italy.
| | | | | | - Özlem Göker-Alpan
- Lysosomal Disorders Unit and Center for Clinical Trials, O&O Alpan, LLC, Fairfax, VA, USA.
| | - Elena Lukina
- National Research Center for Hematology, Moscow, Russia.
| | - Eugen Mengel
- Villa Metabolica, Center for Pediatric and Adolescent Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
| | | | - Gregory M Pastores
- University College Dublin, and Mater Misericordiae University Hospital, Dublin, Ireland.
| | | | - Ida Schwartz
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Christine Serratrice
- Foundation Hospital Saint Joseph, Marseille, France and Geneva University Hospital, Thonex, Switzerland.
| | - Jeffrey Szer
- Royal Melbourne Hospital, Parkville, Victoria, Australia.
| | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy.
| | | | - David J Kuter
- Center for Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Derralynn Hughes
- Lysosomal Storage Disorders Unit, Department of Haematology, Royal Free Hospital, UCL Medical School, London, UK.
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