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Yee KS, Alexanderian D, Merberg D, Natarajan M, Wang S, Wu Y, Whiteman DAH. Cognitive and adaptive behaviors associated with disease severity and genotype in patients with mucopolysaccharidosis II. Mol Genet Metab 2023; 140:107652. [PMID: 37506513 DOI: 10.1016/j.ymgme.2023.107652] [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: 04/21/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Mucopolysaccharidosis II (MPS II) is a rare, X-linked lysosomal storage disease caused by pathogenic variants of the iduronate-2-sulfatase gene (IDS) and is characterized by a highly variable disease spectrum. MPS II severity is difficult to predict based on IDS variants alone; while some genotypes are associated with specific phenotypes, the disease course of most genotypes remains unknown. This study aims to refine the genotype-phenotype categorization by combining information from the scientific literature with data from two clinical studies in MPS II. METHODS Genotype, cognitive, and behavioral data from 88 patients in two clinical studies (NCT01822184, NCT02055118) in MPS II were analyzed post hoc in combination with published information on IDS variants from the biomedical literature through a semi-automated multi-stage review process. The Differential Ability Scales, second edition (DAS-II) and the Vineland Adaptive Behavior Scales™, second edition (VABS-II) were used to measure cognitive function and adaptive behavior. RESULTS The most common category of IDS variant was missense (47/88, 53.4% of total variants). The mean (standard deviation [SD]) baseline DAS-II General Conceptual Ability (GCA) and VABS-II Adaptive Behavior Composite (ABC) scores were 74.0 (16.4) and 82.6 (14.7), respectively. All identified IDS complete deletions/large rearrangements (n = 7) and large deletions (n = 1) were associated with a published 'severe' or 'predicted severe' progressive neuronopathic phenotype, characterized by central nervous system involvement. In categories comprising more than one participant, mean baseline DAS-II GCA scores (SD) were lowest among individuals with complete deletions/large rearrangements 64.0 (9.1, n = 4) and highest among those with splice site variants 83.8 (14.2, n = 4). Mean baseline VABS-II ABC scores (SD) were lowest among patients with unclassifiable variants 79.3 (4.9, n = 3) and highest among those with a splice site variant 87.2 (16.1, n = 5), in variant categories with more than one participant. CONCLUSIONS Most patients in the studies had an MPS II phenotype categorized as 'severe' or 'predicted severe' according to classifications, as reported in the literature. Patients with IDS complete deletion/large rearrangement variants had lower mean DAS-II GCA scores than those with other variants, as well as low VABS-II ABC, confirming an association with the early progressive 'severe' (neuronopathic) disease. These data provide a starting point to improve the classification of MPS II phenotypes and the characterization of the genotype-phenotype relationship.
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Affiliation(s)
- Karen S Yee
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | - David Merberg
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | - Scarlett Wang
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Yuna Wu
- Takeda Development Center Americas, Inc., Lexington, MA, USA
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Ream MA, Lam WKK, Grosse SD, Ojodu J, Jones E, Prosser LA, Rosé AM, Comeau AM, Tanksley S, Powell CM, Kemper AR. Evidence and recommendation for mucopolysaccharidosis type II newborn screening in the United States. Genet Med 2023; 25:100330. [PMID: 36445366 PMCID: PMC9905270 DOI: 10.1016/j.gim.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
Mucopolysaccharidosis type II (MPS II), also known as Hunter syndrome, is an X-linked condition caused by pathogenic variants in the iduronate-2-sulfatase gene. The resulting reduced activity of the enzyme iduronate-2-sulfatase leads to accumulation of glycosaminoglycans that can progressively affect multiple organ systems and impair neurologic development. In 2006, the US Food and Drug Administration approved idursulfase for intravenous enzyme replacement therapy for MPS II. After the data suggesting that early treatment is beneficial became available, 2 states, Illinois and Missouri, implemented MPS II newborn screening. Following a recommendation of the Advisory Committee on Heritable Disorders in Newborns and Children in February 2022, in August 2022, the US Secretary of Health and Human Services added MPS II to the Recommended Uniform Screening Panel, a list of conditions recommended for newborn screening. MPS II was added to the Recommended Uniform Screening Panel after a systematic evidence review reported the accuracy of screening, the benefit of presymptomatic treatment compared with usual case detection, and the feasibility of implementing MPS II newborn screening. This manuscript summarizes the findings of the evidence review that informed the Advisory Committee's decision.
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Affiliation(s)
- Margie A Ream
- Division of Child Neurology, Nationwide Children's Hospital, Columbus, OH.
| | - Wendy K K Lam
- Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jelili Ojodu
- Association of Public Health Laboratories, Silver Spring, MD
| | - Elizabeth Jones
- Association of Public Health Laboratories, Silver Spring, MD
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Angela M Rosé
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Anne Marie Comeau
- New England Newborn Screening Program, Department of Pediatrics, UMass Chan School of Medicine, Worcester, MA
| | - Susan Tanksley
- Laboratory Services Section, Texas Department of State Health Services, Austin, TX
| | - Cynthia M Powell
- Division of Genetics and Metabolism, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alex R Kemper
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
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3
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Millington DS, Ficicioglu C. Addition of MPS-II to the Recommended Uniform Screening Panel in the United States. Int J Neonatal Screen 2022; 8:ijns8040055. [PMID: 36278625 PMCID: PMC9624303 DOI: 10.3390/ijns8040055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
It has recently been announced that the Secretary of the U.S. Department of Health and Human Services has approved the recommendation by the Advisory Committee on Heritable Disorders in Newborns and Children (ACHDNC) to add mucopolysaccharidosis type II (MPS-II, Hunter Syndrome) to the recommended uniform screening panel (RUSP) in the United States [...].
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Affiliation(s)
- David S. Millington
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC 27709, USA
- Correspondence:
| | - Can Ficicioglu
- Section of Biochemical Genetics, Division of Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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4
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Muenzer J, Burton BK, Harmatz P, Gutiérrez-Solana LG, Ruiz-Garcia M, Jones SA, Guffon N, Inbar-Feigenberg M, Bratkovic D, Hale M, Wu Y, Yee KS, Whiteman DAH, Alexanderian D. Intrathecal idursulfase-IT in patients with neuronopathic mucopolysaccharidosis II: Results from a phase 2/3 randomized study. Mol Genet Metab 2022; 137:127-139. [PMID: 36027721 PMCID: PMC10826424 DOI: 10.1016/j.ymgme.2022.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
Two-thirds of patients with mucopolysaccharidosis II (MPS II; Hunter syndrome) have cognitive impairment. This phase 2/3, randomized, controlled, open-label, multicenter study (NCT02055118) investigated the effects of intrathecally administered idursulfase-IT on cognitive function in patients with MPS II. Children older than 3 years with MPS II and mild-to-moderate cognitive impairment (assessed by Differential Ability Scales-II [DAS-II], General Conceptual Ability [GCA] score) who had tolerated intravenous idursulfase for at least 4 months were randomly assigned (2:1) to monthly idursulfase-IT 10 mg (n = 34) via an intrathecal drug delivery device (IDDD; or by lumbar puncture) or no idursulfase-IT treatment (n = 15) for 52 weeks. All patients continued to receive weekly intravenous idursulfase 0.5 mg/kg as standard of care. Of 49 randomized patients, 47 completed the study (two patients receiving idursulfase-IT discontinued). The primary endpoint (change from baseline in DAS-II GCA score at week 52 in a linear mixed-effects model for repeated measures analysis) was not met: although there was a smaller decrease in DAS-II GCA scores with idursulfase-IT than with no idursulfase-IT at week 52, this was not significant (least-squares mean treatment difference [95% confidence interval], 3.0 [-7.3, 13.3]; p = 0.5669). Changes from baseline in Vineland Adaptive Behavioral Scales-II Adaptive Behavior Composite scores at week 52 (key secondary endpoint) were similar in the idursulfase-IT (n = 31) and no idursulfase-IT (n = 14) groups. There were trends towards a potential positive effect of idursulfase-IT across DAS-II composite, cluster, and subtest scores, notably in patients younger than 6 years at baseline. In a post hoc analysis, there was a significant (p = 0.0174), clinically meaningful difference in change from baseline in DAS-II GCA scores at week 52 with idursulfase-IT (n = 13) versus no idursulfase-IT (n = 6) among those younger than 6 years with missense iduronate-2-sulfatase gene variants. Overall, idursulfase-IT reduced cerebrospinal glycosaminoglycan levels from baseline by 72.0% at week 52. Idursulfase-IT was generally well tolerated. These data suggest potential benefits of idursulfase-IT in the treatment of cognitive impairment in some patients with neuronopathic MPS II. After many years of extensive review and regulatory discussions, the data were found to be insufficient to meet the evidentiary standard to support regulatory filings.
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Affiliation(s)
- Joseph Muenzer
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Barbara K Burton
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | | | - Simon A Jones
- St Mary's Hospital, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Nathalie Guffon
- Reference Center for Inherited Metabolic Diseases, Hospices Civils de Lyon, Lyon, France
| | - Michal Inbar-Feigenberg
- University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada
| | - Drago Bratkovic
- Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Michael Hale
- Takeda Development Center Americas, Inc., Cambridge, MA, USA; Hale Scientific Statistics, LLC, Beaverton, OR, USA
| | - Yuna Wu
- Takeda Development Center Americas, Inc., Lexington, MA, USA
| | - Karen S Yee
- Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | | | - David Alexanderian
- Takeda Development Center Americas, Inc., Lexington, MA, USA; Affinia Therapeutics, Inc., Waltham, MA, USA
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Lau HA, Viskochil D, Tanpaiboon P, Lopez AGM, Martins E, Taylor J, Malkus B, Zhang L, Jurecka A, Marsden D. Long-term efficacy and safety of vestronidase alfa enzyme replacement therapy in pediatric subjects < 5 years with mucopolysaccharidosis VII. Mol Genet Metab 2022; 136:28-37. [PMID: 35331634 DOI: 10.1016/j.ymgme.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/20/2022]
Abstract
Mucopolysaccharidosis (MPS) VII is an ultra-rare, autosomal-recessive, metabolic disease caused by a deficiency of β-glucuronidase, a lysosomal enzyme that hydrolyzes glycosaminoglycans (GAGs), including dermatan sulfate (DS), chondroitin sulfate, and heparan sulfate (HS). β-glucuronidase deficiency leads to progressive accumulation of undegraded GAGs in lysosomes of affected tissues, which may cause hydrops fetalis, short stature, hepatosplenomegaly, and cognitive impairment. An open-label, multicenter, phase II study was conducted in 8 pediatric subjects <5 years of age with MPS VII. Subjects received the recombinant human β-glucuronidase vestronidase alfa 4 mg/kg by intravenous infusion every other week for 48 weeks (treatment period). Those who completed the 48-week treatment were offered to continue treatment with vestronidase alfa 4 mg/kg for up to 240 weeks or until withdrawal of consent, discontinuation, or study termination (continuation period). The level of GAG excreted in urine (uGAG) above normal has been shown to correlate with disease severity and clinical outcomes in MPS diseases. Therefore, the primary efficacy endpoint of this study was to determine the mean percentage change in uGAG DS excretion from baseline to week 48. Statistically significant reductions in uGAG DS from baseline were observed at each visit (p < 0.0001), with a least square mean (standard error) percentage change of -60% (6.6) at week 4 (first post-baseline assessment) and -61% (6.41) at week 48 (final assessment during treatment period). Secondary efficacy endpoints included change from baseline to week 48 in growth and hepatosplenomegaly. Positive trends were observed toward increased standing height Z-score (mean [standard deviation] at baseline, -2.630 [1.17], n = 8; at week 48, -2.045 [0.27], n = 7) and growth velocity (mean [SD] Z-score at baseline, -2.59 [1.49], n = 4; at week 48, -0.39 [2.10], n = 4; p = 0.27). Hepatomegaly was resolved in 3 of 3 subjects assessed by ultrasound and in 5 of 6 subjects assessed by physical examination; splenomegaly was resolved in 1 of 3 subjects assessed by ultrasound and in 2 of 2 subjects assessed by physical examination. There were no new safety signals identified during this study. Mild-to-moderate infusion-associated reactions occurred in 4 (50%) subjects. In conclusion, long-term vestronidase alfa treatment demonstrated a rapid and sustained reduction in uGAGs, maintained growth, and improved hepatosplenomegaly in pediatric subjects with MPS VII <5 years of age. Trial registration: NCT02418455.
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Affiliation(s)
- Heather A Lau
- NYU Grossman School of Medicine, Department of Neurology, New York, NY, USA.
| | - David Viskochil
- University of Utah, Department of Pediatrics, Salt Lake City, UT, USA.
| | - Pranoot Tanpaiboon
- Rare Disease Institute, Children's National Health System, Washington, DC, USA.
| | | | - Esmeralda Martins
- Centro Hospitalar Universitário do Porto, Hospital de Santo António, Porto, Portugal.
| | - Julie Taylor
- Ultragenyx Pharmaceutical Inc., Novato, CA, USA.
| | - Betsy Malkus
- Ultragenyx Pharmaceutical Inc., Novato, CA, USA.
| | - Lin Zhang
- Ultragenyx Pharmaceutical Inc., Novato, CA, USA.
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Muenzer J, Botha J, Harmatz P, Giugliani R, Kampmann C, Burton BK. Evaluation of the long-term treatment effects of intravenous idursulfase in patients with mucopolysaccharidosis II (MPS II) using statistical modeling: data from the Hunter Outcome Survey (HOS). Orphanet J Rare Dis 2021; 16:456. [PMID: 34717704 PMCID: PMC8557006 DOI: 10.1186/s13023-021-02052-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mucopolysaccharidosis II (MPS II; Hunter syndrome) is a rare, life-limiting lysosomal storage disease caused by deficient iduronate-2-sulfatase activity. Enzyme replacement therapy (ERT) with intravenous (IV) idursulfase can stabilize or improve many somatic manifestations, but there remains a need for further analysis of long-term treatment outcomes. Using data from patients with MPS II enrolled in the Hunter Outcome Survey (HOS), mixed modeling was performed to evaluate and predict the effects of IV idursulfase treatment on selected clinical parameters for up to 8 years following treatment start. The modeling population comprised male patients followed prospectively in HOS who had received IV idursulfase for at least 5 years and who had data available for two or more time points (at least one post-ERT). Age at ERT start and time since ERT start were included as covariates. RESULTS In total, 481 patients were eligible for inclusion in at least one model. At 8 years post-ERT start, improvement from baseline was predicted for each age group (< 18 months, 18 months to < 5 years and ≥ 5 years at treatment start) in the following parameters: mean urinary glycosaminoglycan levels (percentage changes of > -75% in each group), mean left ventricular mass index (decreases of ~ 1 g/m2) and mean palpable liver size (decreases of > 2 cm). Improvements in mean 6-min walk test distance (increase of > 50 m) and stabilization in percent predicted forced vital capacity and forced expiratory volume in 1 s (decreases of ~ 4 and ~ 9 percentage points, respectively) at 8 years post-ERT start were predicted for patients aged ≥ 5 years at ERT start (these assessments are unsuitable for patients aged < 5 years). Predicted changes over time were similar across the three age groups; however, overall outcomes were most favorable in children aged < 18 months at ERT start. CONCLUSIONS These findings suggest that the previously reported positive effects of IV idursulfase on the somatic manifestations of MPS II are predicted to be maintained for at least 8 years following ERT initiation and highlight the value of statistical modeling to predict long-term treatment outcomes in patients with rare diseases.
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Affiliation(s)
- Joseph Muenzer
- University of North Carolina at Chapel Hill, 101 Manning Drive CB# 7487, Medical School Wing E Room 117, Chapel Hill, NC 27599-7487 USA
| | - Jaco Botha
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Paul Harmatz
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA USA
| | - Roberto Giugliani
- Department of Genetics, UFRGS, Medical Genetics Service, HCPA, and INAGEMP, Porto Alegre, Brazil
| | | | - Barbara K. Burton
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
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A molecular genetics view on Mucopolysaccharidosis Type II. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2021; 788:108392. [PMID: 34893157 DOI: 10.1016/j.mrrev.2021.108392] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/03/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Abstract
Mucopolysaccharidosis Type II (MPS II) is an X-linked recessive genetic disorder that primarily affects male patients. With an incidence of 1 in 100,000 male live births, the disease is one of the orphan diseases. MPS II symptoms are caused by mutations in the lysosomal iduronate-2-sulfatase (IDS) gene. The mutations cause a loss of enzymatic performance and result in the accumulation of glycosaminoglycans (GAGs), heparan sulfate and dermatan sulfate, which are no longer degradable. This inadvertent accumulation causes damage in multiple organs and leads either to a severe neurological course or to an attenuated course of the disease, although the exact relationship between mutation, extent of GAG accumulation and disease progression is not yet fully understood. This review is intended to present current diagnostic procedures and therapeutic interventions. In times when the genetic profile of patients plays an increasingly important role in the assessment of therapeutic success and future drug design, we chose to further elucidate the impact of genetic diversity within the IDS gene on disease phenotype and potential implications in current diagnosis, prognosis and therapy. We report recent advances in the structural biological elucidation of I2S enzyme that that promises to improve our future understanding of the molecular damage of the hundreds of IDS gene variants and will aid damage prediction of novel mutations in the future.
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Therapy-type related long-term outcomes in mucopolysaccaridosis type II (Hunter syndrome) - Case series. Mol Genet Metab Rep 2021; 28:100779. [PMID: 34258227 PMCID: PMC8251508 DOI: 10.1016/j.ymgmr.2021.100779] [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: 04/26/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022] Open
Abstract
Mucopolysaccharidosis type II (MPS II, Hunter syndrome) is a rare, X-linked recessive multisystem lysosomal storage disease due to iduronate-2-sulfatase enzyme deficiency. We presented three unrelated Slovenian patients with the severe form of MPS II that received three different management approaches: natural course of the disease without received specific treatment, enzyme replacement therapy (ERT), and hematopoietic stem cell transplantation (HSCT). The decision on the management depended on disease severity, degree of cognitive impairment, and parent's informed decision. The current benefits of MPS II treatments are limited. The lifelong costly intravenous ERT brings significant benefits but the patients with severe phenotypes and neurological involvement progress to cognitive decline and disability regardless of ERT, as demonstrated in published reviews and our case series. The patient after HSCT was the only one of the three cases reported to show a slowly progressing cognitive development. The type of information from the case series is insufficient for generalized conclusions, but with advanced myeloablative conditioning, HSCT may be a preferred treatment option in early diagnosed MPS II patients with the severe form of the disease and low disease burden at the time of presentation.
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Shapiro EG, Eisengart JB. The natural history of neurocognition in MPS disorders: A review. Mol Genet Metab 2021; 133:8-34. [PMID: 33741271 DOI: 10.1016/j.ymgme.2021.03.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023]
Abstract
MPS disorders are associated with a wide spectrum of neurocognitive effects, from mild problems with attention and executive functions to progressive and degenerative neuronopathic disease. Studies of the natural history of neurocognition are necessary to determine the profile of abnormality and the rates of change, which are crucial to select endpoints for clinical trials of brain treatments and to make clinical recommendations for interventions to improve patients' quality of life. The goal of this paper is to review neurocognitive natural history studies to determine the current state of knowledge and assist in directing future research in all MPS disorders. There are seven different types of MPS diseases, each resulting from a specific enzyme deficiency and each having a separate natural history. MPS IX, will not be discussed as there are only 4 cases reported in the literature without cognitive abnormality. For MPS IH, hematopoietic cell transplant (HCT) is standard of care and many studies have documented the relationship between age at treatment and neurocognitive outcome, and to a lesser extent, neurocognitive status at baseline. However, the mortality and morbidity associated with the transplant process and residual long-term problems after transplant, have led to renewed efforts to find better treatments. Rather than natural history, new trials will likely need to use the developmental trajectories of the patients with HCT as a comparators. The literature has extensive data regarding developmental trajectories post-HCT. For attenuated MPS I, significant neurocognitive deficits have been documented, but more longitudinal data are needed in order to support a treatment directed at their attention and executive function abnormalities. The neuronopathic form of MPS II has been a challenge due to the variability of the trajectory of the disease with differences in timing of slowing of development and decline. Finding predictors of the course of the disease has only been partially successful, using mutation type and family history. Because of lack of systematic data and clinical trials that precede a thorough understanding of the disease, there is need for a major effort to gather natural history data on the entire spectrum of MPS II. Even in the attenuated disease, attention and executive function abnormalities need documentation. Lengthy detailed longitudinal studies are needed to encompass the wide variability in MPS II. In MPS IIIA, the existence of three good natural history studies allowed a quasi-meta-analysis. In patients with a rapid form of the disease, neurocognitive development slowed up until 42 to 47 months, halted up to about 54 months, then declined rapidly thereafter, with a leveling off at an extremely low age equivalent score below 22 months starting at about chronological age of 6. Those with slower or attenuated forms have been more variable and difficult to characterize. Because of the plethora of studies in IIIA, it has been recommended that data be combined from natural history studies to minimize the burden on parents and patients. Sufficient data exists to understand the natural history of cognition in MPS IIIA. MPS IIIB is quite similar to IIIA, but more attenuated patients in that phenotype have been reported. MPS IIIC and D, because they are so rare, have little documentation of natural history despite the prospects of treatments. MPS IV and VI are the least well documented of the MPS disorders with respect to their neurocognitive natural history. Because, like attenuated MPS I and II, they do not show progression of neurocognitive abnormality and most patients function in the range of normality, their behavioral, attentional, and executive function abnormalities have been ignored to the detriment of their quality of life. A peripheral treatment for MPS VII, extremely rare even among MPS types, has recently been approved with a post-approval monitoring system to provide neurocognitive natural history data in the future. More natural history studies in the MPS forms with milder cognitive deficits (MPS I, II, IV, and VI) are recommended with the goal of improving these patients' quality of life with and without new brain treatments, beyond the benefits of available peripheral enzyme replacement therapy. Recommendations are offered at-a-glance with respect to what areas most urgently need attention to clarify neurocognitive function in all MPS types.
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Affiliation(s)
- Elsa G Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Shapiro Neuropsychology Consulting LLC, Portland, OR, USA.
| | - Julie B Eisengart
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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May L, Towne MC, Haynes G, Dalton E, LaDuca H, Masciale E, Stephens KJ, Hogan M, Shapiro-Barr M, Sheedy R, Smith E. Backpack health reduces data-sharing barriers between the medical community and individuals with rare diseases. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 187:7-13. [PMID: 33277802 DOI: 10.1002/ajmg.c.31868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 11/06/2022]
Abstract
Technology has changed the way we approach medical care: health data is constantly being generated, medical discoveries are progressing more rapidly, and individuals are more connected across the world than ever before. Backpack Health is a global personal health record platform that harnesses the power of technology to connect users to their primary health data sources, the medical community, and researchers. By syncing with existing patient portals, health data can be stored on the Backpack Health platform and easily accessed and controlled by users in one connected interface. Individuals manage and collate their current and past conditions, genetic test results, symptoms, medications, procedures, labs, and other health data. Users are empowered to disseminate their information to clinicians, researchers, foundations, and pharmaceutical and biotechnology companies they connect with through the Backpack Health application. Here, we describe how two rare disease advocacy groups, The Marfan Foundation and Project Alive, utilize Backpack Health to connect with their target populations. Through secure transfer of pseudonymized data, groups can query their members to improve understanding of clinical features and to facilitate meaningful research. Responses to the groups' surveys show strong member engagement with high completion rates and increases in new Backpack Health users when surveys are deployed. Data from these surveys have been published and used to better inform clinical outcomes for treatment trials. By connecting users directly to the foundations, clinicians, researchers, and industry partners working on their condition, Backpack Health is instrumental in fast-tracking medical discoveries and treatment for rare diseases.
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Affiliation(s)
- Lauren May
- Backpack Health, Boston, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | - Erin Smith
- Backpack Health, Boston, Massachusetts, USA
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Sampayo-Cordero M, Miguel-Huguet B, Malfettone A, Pérez-García JM, Llombart-Cussac A, Cortés J, Pardo A, Pérez-López J. The Value of Case Reports in Systematic Reviews from Rare Diseases. The Example of Enzyme Replacement Therapy (ERT) in Patients with Mucopolysaccharidosis Type II (MPS-II). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6590. [PMID: 32927819 PMCID: PMC7558586 DOI: 10.3390/ijerph17186590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Case reports are usually excluded from systematic reviews. Patients with rare diseases are more dependent on novel individualized strategies than patients with common diseases. We reviewed and summarized the novelties reported by case reports in mucopolysaccharidosis type II (MPS-II) patients treated with enzyme replacement therapy (ERT). METHODS We selected the case reports included in a previous meta-analysis of patients with MPS-II treated with ERT. Later clinical studies evaluating the same topic of those case reports were reported. Our primary aim was to summarize novelties reported in previous case reports. Secondary objectives analyzed the number of novelties evaluated in subsequent clinical studies and the time elapsed between the publication of the case report to the publication of the clinical study. RESULTS We identified 11 innovative proposals in case reports that had not been previously considered in clinical studies. Only two (18.2%) were analyzed in subsequent nonrandomized cohort studies. The other nine novelties (81.8%) were analyzed in later case reports (five) or were not included in ulterior studies (four) after more than five years from their first publication. CONCLUSIONS Case reports should be included in systematic reviews of rare disease to obtain a comprehensive summary of the state of research and offer valuable information for healthcare practitioners.
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Affiliation(s)
- Miguel Sampayo-Cordero
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
| | - Bernat Miguel-Huguet
- Department of Surgery, Hospital de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Andrea Malfettone
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
| | - José Manuel Pérez-García
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
- Institute of Breast Cancer, Quiron Group, 08023 Barcelona, Spain
| | - Antonio Llombart-Cussac
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
- Hospital Arnau de Vilanova, Universidad Católica de Valencia “San Vicente Mártir”, 46015 Valencia, Spain
| | - Javier Cortés
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
- Institute of Breast Cancer, Quiron Group, 08023 Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Almudena Pardo
- Albiotech Consultores y Redacción Científica S.L., 28035 Madrid, Spain;
| | - Jordi Pérez-López
- Department of Internal Medicine, Hospital Vall d’Hebron, 08035 Barcelona, Spain;
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12
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Burton BK, Hickey R, Hitchins L. Newborn Screening for Mucopolysaccharidosis Type II in Illinois: An Update. Int J Neonatal Screen 2020; 6:73. [PMID: 33117908 PMCID: PMC7569764 DOI: 10.3390/ijns6030073] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022] Open
Abstract
Mucopolysaccharidosis type II (MPS II, Hunter syndrome) is a rare, progressive multisystemic lysosomal storage disorder with significant morbidity and premature mortality. Infants with MPS II develop signs and symptoms of the disorder in the early years of life, yet diagnostic delays are very common. Enzyme replacement therapy is an effective treatment option. It has been shown to prolong survival and improve or stabilize many somatic manifestations of the disorder. Our initial experience with newborn screening in 162,000 infants was previously reported. Here, we update that experience with the findings in 339,269 infants. Measurement of iduronate-2-sulfatase (I2S) activity was performed on dried blood spot samples submitted for other newborn screening disorders. A positive screen was defined as I2S activity less than or equal to 10% of the daily median. In this series, 28 infants had a positive screening test result, and four other infants had a borderline result. Three positive diagnoses of MPS II were established, and 25 were diagnosed as having I2S pseudodeficiency. The natural history and the clinical features of MPS II make it an ideal target for newborn screening. Newborn screening was effective in identifying affected infants in our population with an acceptable rate of false positive results.
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Affiliation(s)
- Barbara K Burton
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; (R.H.); (L.H.)
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Rachel Hickey
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; (R.H.); (L.H.)
| | - Lauren Hitchins
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA; (R.H.); (L.H.)
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13
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Bhalla A, Ravi R, Fang M, Arguello A, Davis SS, Chiu CL, Blumenfeld JR, Nguyen HN, Earr TK, Wang J, Astarita G, Zhu Y, Fiore D, Scearce-Levie K, Diaz D, Cahan H, Troyer MD, Harris JM, Escolar ML. Characterization of Fluid Biomarkers Reveals Lysosome Dysfunction and Neurodegeneration in Neuronopathic MPS II Patients. Int J Mol Sci 2020; 21:ijms21155188. [PMID: 32707880 PMCID: PMC7432645 DOI: 10.3390/ijms21155188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
Mucopolysaccharidosis type II is a lysosomal storage disorder caused by a deficiency of iduronate-2-sulfatase (IDS) and characterized by the accumulation of the primary storage substrate, glycosaminoglycans (GAGs). Understanding central nervous system (CNS) pathophysiology in neuronopathic MPS II (nMPS II) has been hindered by the lack of CNS biomarkers. Characterization of fluid biomarkers has been largely focused on evaluating GAGs in cerebrospinal fluid (CSF) and the periphery; however, GAG levels alone do not accurately reflect the broad cellular dysfunction in the brains of MPS II patients. We utilized a preclinical mouse model of MPS II, treated with a brain penetrant form of IDS (ETV:IDS) to establish the relationship between markers of primary storage and downstream pathway biomarkers in the brain and CSF. We extended the characterization of pathway and neurodegeneration biomarkers to nMPS II patient samples. In addition to the accumulation of CSF GAGs, nMPS II patients show elevated levels of lysosomal lipids, neurofilament light chain, and other biomarkers of neuronal damage and degeneration. Furthermore, we find that these biomarkers of downstream pathology are tightly correlated with heparan sulfate. Exploration of the responsiveness of not only CSF GAGs but also pathway and disease-relevant biomarkers during drug development will be crucial for monitoring disease progression, and the development of effective therapies for nMPS II.
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Affiliation(s)
- Akhil Bhalla
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
- Correspondence: (A.B.); (M.L.E.)
| | - Ritesh Ravi
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Meng Fang
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Annie Arguello
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Sonnet S. Davis
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Chi-Lu Chiu
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Jessica R. Blumenfeld
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
- Department of Neuroscience, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Hoang N. Nguyen
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Timothy K. Earr
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Junhua Wang
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Giuseppe Astarita
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Yuda Zhu
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Damian Fiore
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Kimberly Scearce-Levie
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Dolores Diaz
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Heather Cahan
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Matthew D. Troyer
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Jeffrey M. Harris
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Maria L. Escolar
- Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
- Correspondence: (A.B.); (M.L.E.)
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14
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Oguni T, Tomatsu S, Tanaka M, Orii K, Fukao T, Watanabe J, Fukuda S, Notsu Y, Vu DC, Can TBN, Nagai A, Yamaguchi S, Taketani T, Gelb MH, Kobayashi H. Validation of Liquid Chromatography-Tandem Mass Spectrometry-Based 5-Plex Assay for Mucopolysaccharidoses. Int J Mol Sci 2020; 21:E2025. [PMID: 32188102 PMCID: PMC7139616 DOI: 10.3390/ijms21062025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/16/2022] Open
Abstract
Mucopolysaccharidoses (MPSs) are rare lysosomal storage diseases caused by the accumulation of undegraded glycosaminoglycans in cells and tissues. The effectiveness of early intervention for MPS has been reported. Multiple-assay formats using tandem mass spectrometry have been developed. Here, we developed a method for simultaneous preparation and better measurement of the activities of five enzymes involved in MPSs, i.e., MPS I, MPS II, MPS IIIB, MPS IVA, and MPS VI, which were validated using 672 dried blood spot samples obtained from healthy newborns and 23 patients with MPS. The mean values of the enzyme activities and standard deviations in controls were as follows: α-iduronidase (IDUA), 4.19 ± 1.53 µM/h; iduronate-2-sulfatase (I2S), 8.39 ± 2.82 µM/h; N-acetyl-α-glucosaminidase (NAGLU), 1.96 ± 0.57 µM/h; N-acetylgalactosamine-6-sulfatase (GALNS), 0.50 ± 0.20 µM/h; and N-acetylgalactosamine-4-sulfatase (ARSB), 2.64 ± 1.01 µM/h. All patients displayed absent or low enzyme activity. In MPS I, IIIB, and VI, each patient group was clearly separated from controls, whereas there was some overlap between the control and patient groups in MPS II and IVA, suggesting the occurrence of pseudo-deficiencies. Thus, we established a multiplex assay for newborn screening using liquid chromatography tandem mass spectrometry, allowing simultaneous pretreatment and measurement of five enzymes relevant to MPSs.
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Affiliation(s)
- Tsubasa Oguni
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Japan; (T.O.); (Y.N.)
| | - Shunji Tomatsu
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (S.T.); (S.F.); (S.Y.); (T.T.)
- Nemours/Alfred I. DuPont Children’s Hospital, Wilmington, DE 19803, USA
| | - Misa Tanaka
- Shimadzu Corporation, Kyoto 604-8442, Japan; (M.T.); (J.W.)
| | - Kenji Orii
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu 501-1193, Japan; (K.O.); (T.F.)
| | - Toshiyuki Fukao
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu 501-1193, Japan; (K.O.); (T.F.)
| | - Jun Watanabe
- Shimadzu Corporation, Kyoto 604-8442, Japan; (M.T.); (J.W.)
| | - Seiji Fukuda
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (S.T.); (S.F.); (S.Y.); (T.T.)
| | - Yoshitomo Notsu
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Japan; (T.O.); (Y.N.)
| | - Dung Chi Vu
- Department of Medical Genetics and Metabolism; Center for rare disease and Newborn Screening, National Children’s Hospital, Hanoi 18/879, Vietnam; (D.C.V.); (T.B.N.C.)
| | - Thi Bich Ngoc Can
- Department of Medical Genetics and Metabolism; Center for rare disease and Newborn Screening, National Children’s Hospital, Hanoi 18/879, Vietnam; (D.C.V.); (T.B.N.C.)
| | - Atsushi Nagai
- Department of Neurology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan;
| | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (S.T.); (S.F.); (S.Y.); (T.T.)
| | - Takeshi Taketani
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (S.T.); (S.F.); (S.Y.); (T.T.)
| | - Michael H. Gelb
- Departments of Chemistry and Biochemistry, University of Washington, Seattle, WD 98195, USA;
| | - Hironori Kobayashi
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (S.T.); (S.F.); (S.Y.); (T.T.)
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15
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Broomfield A, Davison J, Roberts J, Stewart C, Hensman P, Beesley C, Tylee K, Rust S, Schwahn B, Jameson E, Vijay S, Santra S, Sreekantam S, Ramaswami U, Chakrapani A, Raiman J, Cleary MA, Jones SA. Ten years of enzyme replacement therapy in paediatric onset mucopolysaccharidosis II in England. Mol Genet Metab 2020; 129:98-105. [PMID: 31383595 DOI: 10.1016/j.ymgme.2019.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/26/2019] [Accepted: 07/26/2019] [Indexed: 11/23/2022]
Abstract
The outcome of 110 patients with paediatric onset mucopolysaccharidosis II (MPS II) since the commercial introduction of enzyme replacement therapy (ERT) in England in 2007 is reported. Median length of follow up was 10 years 3 months (range = 1 y 2 m to 18 years 6 month). 78 patients were treated with ERT, 18 had no ERT or disease modifying treatment 7 had haematopoietic stem cell transplant, 4 experimental intrathecal therapy and 3 were lost to follow up. There is clear evidence of improved survival (median age of death of ERT treated (n = 16) = 15.13 years (range = 9.53 to 20.58 y), and untreated (n = 17) = 11.43 y (0.5 to 19.13 y) p = .0005). Early introduction of ERT improved respiratory outcome at 16 years, the median FVC (% predicted) of those in whom ERT initiated <8 years = 69% (range = 34-86%) and 48% (25-108) (p = .045) in those started >8 years. However, ERT appears to have minimal impact on hearing, carpal tunnel syndrome or progression of cardiac valvular disease. Cardiac valvular disease occurred in 18/46 (40%), with progression occurring most frequently in the aortic valve 13/46 (28%). The lack of requirement for neurosurgical intervention in the first 8 years of life suggests that targeted imaging based on clinical symptomology would be safe in this age group after baseline assessments. There is also emerging evidence that the neurological phenotype is more nuanced than the previously recognized dichotomy of severe and attenuated phenotypes in patients presenting in early childhood.
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Affiliation(s)
- A Broomfield
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK.
| | - J Davison
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J Roberts
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - C Stewart
- Department of Inherited Metabolic Disorders, Birmingham Women's and Children's Hospital Foundation Trust, Steelhouse Lane, Birmingham, UK
| | - P Hensman
- Department of Physiotherapy, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - C Beesley
- Regional Genetics Laboratories, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Tylee
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - S Rust
- Department of Psychology, Royal Manchester Children's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - B Schwahn
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - E Jameson
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
| | - S Vijay
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - S Santra
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - S Sreekantam
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - U Ramaswami
- Lysosomal Disorders Unit, Institute of Immunity and Transplantation, Royal Free London NHS Foundation Trust, Pond Street, London NW32QG, UK
| | - A Chakrapani
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J Raiman
- Department of Inherited Metabolic Disorders, Birmingham Women's and Children's Hospital Foundation Trust, Steelhouse Lane, Birmingham, UK
| | - M A Cleary
- Metabolic Medicine Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - S A Jones
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Foundation Trust, Manchester M13 9WL, UK
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16
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Eisengart JB, King KE, Shapiro EG, Whitley CB, Muenzer J. The nature and impact of neurobehavioral symptoms in neuronopathic Hunter syndrome. Mol Genet Metab Rep 2019; 22:100549. [PMID: 31890590 PMCID: PMC6931227 DOI: 10.1016/j.ymgmr.2019.100549] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
In neuronopathic Hunter syndrome, neurobehavioral symptoms are known to be serious but have been incompletely described. While families face significant stress stemming from this complex and far-reaching array of symptoms, neither caregiver burden nor the neurobehavioral symptoms have been measured comprehensively. We delineated these neurobehavioral characteristics and their impact on the caregiver using multiple approaches. Methods: As part of the initial phase of developing a Hunter-specific behavioral assessment tool, we used multiple methods to obtain data on patient behaviors and caregiver burden, with the intention of drafting item sets for the tool. We utilized 1) caregiver descriptions from focus groups and individual interviews, 2) observations from video-recorded play of affected children, 3) descriptions from historic chart review, 4) consultation with patient advocacy groups and international experts, 5) reports from a caregiver advisory board, and 6) literature review. Results: Neurobehavioral symptoms were diverse and categorized as focus/attention, impulsivity/heightened activity, sensation seeking, emotional/behavioral function, social interaction, and sleep. A significant reported challenge was susceptibility to misinterpretation of some behaviors as defiant or aggressive, particularly if physical. Caregiver burden involved social isolation, exhaustion, stress, and financial and vocational strain. These new descriptions will aid in developing quantitative measures of change in neurobehavioral symptoms and family burden. These descriptions will be the foundation of a neurobehavioral rating scale, which is very much needed to aid in patient management and assess interventions for individuals with neuronopathic Hunter syndrome.
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Affiliation(s)
- J B Eisengart
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - K E King
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - E G Shapiro
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.,Shapiro Neuropsychology Consulting, LLC, Portland, OR, USA
| | - C B Whitley
- Department of Experimental and Clinical Pharmacology and Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - J Muenzer
- Division of Genetics and Metabolism, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Burton BK, Hoganson GE, Fleischer J, Grange DK, Braddock SR, Hickey R, Hitchins L, Groepper D, Christensen KM, Kirby A, Moody C, Shryock H, Ashbaugh L, Shao R, Basheeruddin K. Population-Based Newborn Screening for Mucopolysaccharidosis Type II in Illinois: The First Year Experience. J Pediatr 2019; 214:165-167.e1. [PMID: 31477379 DOI: 10.1016/j.jpeds.2019.07.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/28/2019] [Accepted: 07/23/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To assess the outcome of population-based newborn screening for mucopolysaccharidosis type II (MPS II) during the first year of screening in Illinois. STUDY DESIGN Tandem mass spectrometry was used to measure iduronate-2-sulfatase (I2S) activity in dried blood spot specimens obtained from 162 000 infant samples sent to the Newborn Screening Laboratory of the Illinois Department of Public Health in Chicago. RESULTS One case of MPS II and 14 infants with pseudodeficiency for I2S were identified. CONCLUSIONS Newborn screening for MPS II by measurement of I2S enzyme activity was successfully integrated into the statewide newborn screening program in Illinois.
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Affiliation(s)
- Barbara K Burton
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL.
| | | | | | | | - Stephen R Braddock
- Saint Louis University, St. Louis, MO; SSM Health Cardinal Glennon Children's Medical Center, St. Louis, MO
| | - Rachel Hickey
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Lauren Hitchins
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Katherine M Christensen
- Saint Louis University, St. Louis, MO; SSM Health Cardinal Glennon Children's Medical Center, St. Louis, MO
| | - Amelia Kirby
- Saint Louis University, St. Louis, MO; SSM Health Cardinal Glennon Children's Medical Center, St. Louis, MO
| | - Conny Moody
- Office of Health Promotion, Illinois Department of Public Health, Springfield, IL
| | - Heather Shryock
- Office of Health Promotion, Illinois Department of Public Health, Springfield, IL
| | - Laura Ashbaugh
- Office of Health Promotion, Illinois Department of Public Health, Springfield, IL
| | - Rong Shao
- Newborn Screening Laboratory, Illinois Department of Public Health, Chicago, IL
| | - Khaja Basheeruddin
- Newborn Screening Laboratory, Illinois Department of Public Health, Chicago, IL
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18
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González-Gutiérrez-Solana L, Guillén-Navarro E, del Toro M, Dalmau J, González-Meneses A, Couce ML. Diagnosis and follow-up of patients with Hunter syndrome in Spain: A Delphi consensus. Medicine (Baltimore) 2018; 97:e11246. [PMID: 30024503 PMCID: PMC6086518 DOI: 10.1097/md.0000000000011246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hunter syndrome or mucopolysaccharidosis type II (MPSII) is a progressive multisystem X-linked lysosomal storage disease caused by mutations in the IDS gene that shows a wide spectrum of clinical symptoms and severity. Idursulfase, a specific enzyme replacement therapy (ERT) for MPSII, has been available since 2007. ERT, along with symptomatic management of patients, is fundamental for improving patient prognosis and quality of life. The aims of this study were to investigate whether Spanish pediatricians who are experts in managing the disease agreed with current international guidelines regarding MPSII patient diagnosis and follow-up; and to reach a consensus regarding which items are essential for the diagnosis, follow-up, and treatment of these patients in Spain.An advisory panel of 5 experts from the Hunter Spanish Working Group reviewed key studies, developed a questionnaire based on a modified Delphi method, sent the questionnaire to selected experts, and reviewed the responses. The final questionnaire had 83 items in the following categories: diagnosis, ERT considerations after diagnosis, Periodic assessments, and ERT considerations during follow-up. A total of 85 experts were invited to participate; 28 (35%) responded and showed a strong consensus for most items. The advisory panel decided not to perform a second Delphi round. There was strong agreement (>3.1 median value; range, 1 to 4) for 43/56 items in Diagnosis, for 4/6 items in "ERT considerations after diagnosis," for 6/16 items in "Periodic assessments," and for 3/5 items in "ERT considerations during follow-up." Most responses were in agreement with international guidelines, and controversial items were discussed by the advisory panel. Based on the results, on the key studies, and on clinical experience and opinions, the panel developed and scheduled recommendations for the diagnosis and follow-up of patients with MPSII.An expert 5-person panel oversaw a Delphi survey of 28 pediatricians and reached a consensus on recommendations for the diagnosis and follow-up of MPSII patients. This document will help guide clinicians involved in the diagnosis, management, and treatment of MPSII.
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Affiliation(s)
| | - Encarnación Guillén-Navarro
- Sección de Genética Médica, Servicio de Pediatría, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia; Grupo Clínico vinculado al Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid
| | - Mireia del Toro
- Servicio de Neurología Pediátrica, Hospital Universitario Vall d’Hebrón, Vall d’Hebrón, Universitat Autònoma de Barcelona, Barcelona
| | - Jaime Dalmau
- Unidad de Nutrición y Metabolopatías. Hospital Infantil La Fe. Valencia
| | | | - María L. Couce
- Metabolic Unit, Service of Neonatology. Department of Pediatrics. Hospital Clínico Universitario de Santiago, IDIS, CIBERER, ISCIII, Santiago de Compostela, Spain
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19
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Whiteman DA, Kimura A. Development of idursulfase therapy for mucopolysaccharidosis type II (Hunter syndrome): the past, the present and the future. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2467-2480. [PMID: 28860717 PMCID: PMC5574592 DOI: 10.2147/dddt.s139601] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Mucopolysaccharidosis type II (MPS II; Hunter syndrome; OMIM 309900) is a rare, multisystemic, progressive lysosomal storage disease caused by deficient activity of the iduronate-2-sulfatase (I2S) enzyme. Accumulation of the glycosaminoglycans dermatan sulfate and heparan sulfate results in a broad range of disease manifestations that are highly variable in presentation and severity; notably, approximately two-thirds of individuals are affected by progressive central nervous system involvement. Historically, management of this disease was palliative; however, during the 1990s, I2S was purified to homogeneity for the first time, leading to cloning of the corresponding gene and offering a means of addressing the underlying cause of MPS II using enzyme replacement therapy (ERT). Recombinant I2S (idursulfase) was produced for ERT using a human cell line and was shown to be indistinguishable from endogenous I2S. Preclinical studies utilizing the intravenous route of administration provided valuable insights that informed the design of the subsequent clinical studies. The pivotal Phase II/III clinical trial of intravenous idursulfase (Elaprase®; Shire, Lexington, MA, USA) demonstrated improvements in a range of clinical parameters; based on these findings, intravenous idursulfase was approved for use in patients with MPS II in the USA in 2006 and in Europe and Japan in 2007. Evidence gained from post-approval programs has helped to improve our knowledge and understanding of management of patients with the disease; as a result, idursulfase is now available to young pediatric patients, and in some countries patients have the option to receive their infusions at home. Although ERT with idursulfase has been shown to improve somatic signs and symptoms of MPS II, the drug does not cross the blood–brain barrier and so treatment of neurological aspects of the disease remains challenging. A number of novel approaches are being investigated, and these may help to improve the care of patients with MPS II in the future.
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Affiliation(s)
- David Ah Whiteman
- Research & Development, Shire Human Genetic Therapies, Inc., Lexington, MA, USA
| | - Alan Kimura
- Research & Development, Shire Human Genetic Therapies, Inc., Lexington, MA, USA
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20
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Barth AL, de Magalhães TSPC, Reis ABR, de Oliveira ML, Scalco FB, Cavalcanti NC, Silva DSE, Torres DA, Costa AAP, Bonfim C, Giugliani R, Llerena JC, Horovitz DDG. Early hematopoietic stem cell transplantation in a patient with severe mucopolysaccharidosis II: A 7 years follow-up. Mol Genet Metab Rep 2017. [PMID: 28649514 PMCID: PMC5470531 DOI: 10.1016/j.ymgmr.2017.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Mucopolysaccharidosis type II (MPS II - Hunter syndrome) is an X-linked lysosomal storage disorder caused by a deficiency in the enzyme iduronate-2 sulfatase (I2S), leading to the accumulation of the glycosaminoglycans, affecting multiple organs and systems. Enzyme replacement therapy does not cross the blood brain barrier, limiting results in neurological forms of the disease. Another option of treatment for severe MPS, hematopoietic stem cell transplantation (HSCT) has become the treatment of choice for the severe form of MPS type I, since it can preserve neurocognition when performed early in the course of the disease. To date, only few studies have examined the long-term outcomes of HSCT in patients with MPS II. We describe the seven-year follow-up of a prenatally diagnosed MPS II boy with positive family history of severe MPS form, submitted to HSCT with umbilical cord blood cells at 70 days of age. Engraftment after 30 days revealed mixed chimerism with 79% donor cells; after 7 years engraftment remains at 80%. I2S activity 30 days post-transplant was low in plasma and normal in leukocytes and the same pattern is observed to date. At age 7 years growth charts are normal and he is very healthy, although mild signs of dysostosis multiplex are present, as well as hearing loss. The neuropsychological evaluation (Wechsler Intelligence Scale for Children - Fourth Edition - WISC-IV), disclosed an IQ of 47. Despite this low measured IQ, the patient continues to show improvements in cognitive, language and motor skills, being quite functional. We believe that HSCT is a therapeutic option for MPS II patients with the severe phenotype, as it could preserve neurocognition or even halt neurodegeneration, provided strict selection criteria are followed.
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Affiliation(s)
- Anneliese L Barth
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Tatiana S P C de Magalhães
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Ana Beatriz R Reis
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Maria Lucia de Oliveira
- Laboratório de Erros Inatos do Metabolismo, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda B Scalco
- Laboratório de Erros Inatos do Metabolismo, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nicolette C Cavalcanti
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Daniel S E Silva
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Danielle A Torres
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Alessandra A P Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Carmem Bonfim
- Bone Marrow Transplantation Unit, Federal University of Paraná, Curitiba, Brazil
| | - Roberto Giugliani
- Medical Genetics Service, Hospital de Clinicas de Alegre, Porto Alegre, Brazil
| | - Juan C Llerena
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
| | - Dafne D G Horovitz
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira - Fiocruz, Rio de Janeiro, Brazil
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21
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Janzen D, Delaney KA, Shapiro EG. Cognitive and adaptive measurement endpoints for clinical trials in mucopolysaccharidoses types I, II, and III: A review of the literature. Mol Genet Metab 2017; 121:57-69. [PMID: 28506702 DOI: 10.1016/j.ymgme.2017.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 11/15/2022]
Abstract
Sensitive, reliable measurement instruments are critical for the evaluation of disease progression and new treatments that affect the brain in the mucopolysaccharidoses (MPS). MPS I, II, and III have early onset clinical phenotypes that affect the brain during development and result in devastating cognitive decline and ultimately death without treatment. Comparisons of outcomes are hindered by diverse protocols and approaches to assessment including applicability to international trials necessary in rare diseases. We review both cognitive and adaptive measures with the goal of providing evidence to a Delphi panel to come to a consensus about recommendations for clinical trials for various age groups. The results of the consensus panel are reported in an accompanying article. The following data were gathered (from internet resources and from test manuals) for each measure and summarized in the discussion: reliability, validity, date and adequacy of normative data, applicability of the measure's metrics, cross cultural validity including translations and adaptations, feasibility in the MPS population, familiarity to sites, sensitivity to change, and interpretability. If, resulting from this consensus, standard protocols are used for both natural history and treatment studies, patients, their families, and health care providers will benefit from the ability to compare study outcomes.
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Affiliation(s)
- Darren Janzen
- Oregon Health & Science University, Institute on Development & Disability, United States
| | | | - Elsa G Shapiro
- Shapiro & Delaney LLC, United States; University of Minnesota, Department of Pediatrics and Neurology, United States.
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22
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van der Lee JH, Morton J, Adams HR, Clarke L, Ebbink BJ, Escolar ML, Giugliani R, Harmatz P, Hogan M, Jones S, Kearney S, Muenzer J, Rust S, Semrud-Clikeman M, Wijburg FA, Yu ZF, Janzen D, Shapiro E. Cognitive endpoints for therapy development for neuronopathic mucopolysaccharidoses: Results of a consensus procedure. Mol Genet Metab 2017; 121:70-79. [PMID: 28501294 DOI: 10.1016/j.ymgme.2017.05.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 05/05/2017] [Indexed: 12/22/2022]
Abstract
The design and conduct of clinical studies to evaluate the effects of novel therapies on central nervous system manifestations in children with neuronopathic mucopolysaccharidoses is challenging. Owing to the rarity of these disorders, multinational studies are often needed to recruit enough patients to provide meaningful data and statistical power. This can make the consistent collection of reliable data across study sites difficult. To address these challenges, an International MPS Consensus Conference for Cognitive Endpoints was convened to discuss approaches for evaluating cognitive and adaptive function in patients with mucopolysaccharidoses. The goal was to develop a consensus on best practice for the design and conduct of clinical studies investigating novel therapies for these conditions, with particular focus on the most appropriate outcome measures for cognitive function and adaptive behavior. The outcomes from the consensus panel discussion are reported here.
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Affiliation(s)
- Johanna H van der Lee
- Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | | | - Heather R Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lorne Clarke
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Berendine Johanne Ebbink
- Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Maria L Escolar
- Department of Pediatrics, Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Roberto Giugliani
- Department of Genetics/UFRGS, Medical Genetic Service/HCPA, Porto Alegre, Brazil
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Simon Jones
- Willink Biochemical Genetic Unit, Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Manchester, UK
| | - Shauna Kearney
- Clinical Paediatric Psychology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Joseph Muenzer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stewart Rust
- Paediatric Psychosocial Department, Royal Manchester Children's Hospital, Manchester, UK
| | | | - Frits A Wijburg
- Department of Pediatrics, Academic Medical Center, Amsterdam, Netherlands
| | - Zi-Fan Yu
- Statistics Collaborative, Inc., Washington, DC, USA
| | - Darren Janzen
- Institute on Development & Disability, Oregon Health & Science University, Portland, OR, USA
| | - Elsa Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Shapiro Neuropsychology Consulting, LLC, Portland, OR, USA.
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23
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Bradley LA, Haddow HRM, Palomaki GE. Treatment of mucopolysaccharidosis type II (Hunter syndrome): results from a systematic evidence review. Genet Med 2017. [PMID: 28640238 DOI: 10.1038/gim.2017.30] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PurposeA pilot systematic evidence review to establish methodology utility in rare genetic diseases, support clinical recommendations, and identify important knowledge gaps.MethodsBroad-based published/gray-literature searches through December 2015 for studies of males with confirmed mucopolysaccharidosis type II (any age, phenotype, genotype, family history) treated with enzyme replacement therapy or hematopoietic stem cell transplantation. Preset inclusion criteria employed for abstract and full document selection, and standardized methods for data extraction and assessment of quality and strength of evidence.ResultsTwelve outcomes reported included benefits of urinary glycosaminoglycan and liver/spleen volume reductions and harms of immunoglobulin G/neutralizing antibody development (moderate strength of evidence). Less clear were benefits of improved 6-minute walk tests, height, early treatment, and harms of other adverse reactions (low strength of evidence). Benefits and harms of other outcomes were unclear (insufficient strength of evidence). Current benefits and harms of hematopoietic stem cell transplantation are unclear, based on dated, low-quality studies. A critical knowledge gap is long-term outcomes. Consensus on selection of critical outcomes and measures is needed to definitively evaluate treatment safety and effectiveness.ConclusionMinor methodology modifications and a focus on critical evidence can reduce review time and resources. Summarized evidence was sufficient to support guidance development and highlight important knowledge gaps.
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Affiliation(s)
- Linda A Bradley
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Warren Alpert, Medical School at Brown University, Providence, Rhode Island, USA
| | | | - Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital/Warren Alpert, Medical School at Brown University, Providence, Rhode Island, USA
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24
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A case report of a patient with mucopolysaccharidosis type II. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Narayanan DL, Srivastava P, Mandal K, Gambhir PS, Phadke SR. Hunter Syndrome in Northern India: Clinical features and Mutation Spectrum. Indian Pediatr 2017; 53:134-6. [PMID: 26897145 DOI: 10.1007/s13312-016-0807-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study the clinical profile and mutation spectrum of Hunter syndrome. METHODS Evaluation of 18 cases of Hunter syndrome from 17 families was done. Mutation analysis of Iduronate sulfatase (IDS) gene was done in 9 families, and mothers of four affected children with no family history. RESULTS Joint contracture, hepatomegaly and radiological changes were present in all children. 6 (33%) children had normal cognitive function at presentation. Point mutations were identified in all the 9 families for whom mutation analysis was done. Among 4 mothers tested from families without any family history, 2 (50%) were found to be carriers. CONCLUSION Accurate etiological diagnosis by mutation analysis of IDS gene is important in Hunter syndrome.
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Affiliation(s)
- Dhanya Lakshmi Narayanan
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. Correspondence to: Dr Kausik Mandal, Assistant Professor, Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
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26
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Do Cao J, Wiedemann A, Quinaux T, Battaglia-Hsu SF, Mainard L, Froissart R, Bonnemains C, Ragot S, Leheup B, Journeau P, Feillet F. 30 months follow-up of an early enzyme replacement therapy in a severe Morquio A patient: About one case. Mol Genet Metab Rep 2016; 9:42-45. [PMID: 27761411 PMCID: PMC5065040 DOI: 10.1016/j.ymgmr.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/01/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022] Open
Abstract
Patients under 5 years were not evaluated in the phase-3 study for enzyme replacement therapy (ERT) in MPS IV A. Here we describe the evolution of a severe Morquio A pediatric patient who was diagnosed at 19 months old and treated by ERT at 21 months old for the next 30 months. Applying the standard ERT protocol on this very young patient appeared to reduce his urinary excretion of glycosaminoglycans (GAGs); the improvements in both the 6 minute-walk test (6MWT) and the stair climb test, however, were no different than those reported in the nature history study. Additionally, this young patient experienced many ERT-associated side effects, and as a result a specific corticosteroid protocol (1 mg/kg of betamethasone the day before and 1 h before the ERT infusion) was given to avoid adverse events. Under these treatments, the height of this patient increased during the first year of the ERT although no more height gain was observed thereafter for 18 months. However, despite of ERT, his bone deformities (including severe pectus carinatum) actually worsened and his medullar cervical spine compression showed no improvement (thus needed decompression surgery). CONCLUSION early ERT treatment did not improve the bone outcome in this severe MPS IV A patient after the 30 months-long treatment. A longer term follow up is required to further assess the efficacy of ERT on both the motor and the respiratory function of the patient.
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Affiliation(s)
- J Do Cao
- Reference Center for Inborn Errors of Metabolism, University Children's Hospital, 5 rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
| | - A Wiedemann
- Reference Center for Inborn Errors of Metabolism, University Children's Hospital, 5 rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
| | - T Quinaux
- Reference Center for Inborn Errors of Metabolism, University Children's Hospital, 5 rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
| | - S F Battaglia-Hsu
- Reference Center for Inborn Errors of Metabolism, University Children's Hospital, 5 rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
| | - L Mainard
- Radiology Department, University Children's Hospital, Vandoeuvre-les-Nancy, France
| | - R Froissart
- Biochemistry and Molecular Biology, University Hospital, Lyon, France
| | - C Bonnemains
- Reference Center for Inborn Errors of Metabolism, University Children's Hospital, 5 rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
| | - S Ragot
- Rehabilitation center, University Children's Hospital, Vandoeuvre-les-Nancy, France
| | - B Leheup
- Genetic Department, University Children's Hospital, Vandoeuvre-les-Nancy, France
| | - P Journeau
- Pediatric Orthopedic surgery department, University Children's Hospital, Vandoeuvre-les-Nancy, France
| | - F Feillet
- Reference Center for Inborn Errors of Metabolism, University Children's Hospital, 5 rue du Morvan, 54511 Vandoeuvre-les-Nancy, France
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27
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Jacques CED, Donida B, Mescka CP, Rodrigues DGB, Marchetti DP, Bitencourt FH, Burin MG, de Souza CFM, Giugliani R, Vargas CR. Oxidative and nitrative stress and pro-inflammatory cytokines in Mucopolysaccharidosis type II patients: effect of long-term enzyme replacement therapy and relation with glycosaminoglycan accumulation. Biochim Biophys Acta Mol Basis Dis 2016; 1862:1608-16. [PMID: 27251652 DOI: 10.1016/j.bbadis.2016.05.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/05/2016] [Accepted: 05/26/2016] [Indexed: 12/12/2022]
Abstract
Mucopolysaccharidosis type II (MPS II) is a lysosomal storage disease caused by a deficient activity of iduronate-2-sulfatase, leading to abnormal accumulation of glycosaminoglycans (GAG). The main treatment for MPS II is enzyme replacement therapy (ERT). Previous studies described potential benefits of six months of ERT against oxidative stress in patients. Thus, the aim of this study was to investigate oxidative, nitrative and inflammatory biomarkers in MPS II patients submitted to long term ERT. It were analyzed urine and blood samples from patients on ERT (mean time: 5.2years) and healthy controls. Patients presented increased levels of lipid peroxidation, assessed by urinary 15-F2t-isoprostane and plasmatic thiobarbituric acid-reactive substances. Concerning to protein damage, urinary di-tyrosine (di-Tyr) was increased in patients; however, sulfhydryl and carbonyl groups in plasma were not altered. It were also verified increased levels of urinary nitrate+nitrite and plasmatic nitric oxide (NO) in MPS II patients. Pro-inflammatory cytokines IL-1β and TNF-α were increased in treated patients. GAG levels were correlated to di-Tyr and nitrate+nitrite. Furthermore, IL-1β was positively correlated with TNF-α and NO. Contrastingly, we did not observed alterations in erythrocyte superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase activities, in reduced glutathione content and in the plasmatic antioxidant capacity. Although some parameters were still altered in MPS II patients, these results may suggest a protective role of long-term ERT against oxidative stress, especially upon oxidative damage to protein and enzymatic and non-enzymatic defenses. Moreover, the redox imbalance observed in treated patients seems to be GAG- and pro-inflammatory cytokine-related.
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Affiliation(s)
- Carlos Eduardo Diaz Jacques
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, UFRGS, Av. Ipiranga, 2752, CEP 90610-000 Porto Alegre, RS, Brazil; Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Bruna Donida
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, R. Ramiro Barcelos, 2600, CEP 90035-003 Porto Alegre, RS, Brazil; Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Caroline P Mescka
- Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Daiane G B Rodrigues
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, UFRGS, Av. Ipiranga, 2752, CEP 90610-000 Porto Alegre, RS, Brazil; Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Desirèe P Marchetti
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, R. Ramiro Barcelos, 2600, CEP 90035-003 Porto Alegre, RS, Brazil; Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Fernanda H Bitencourt
- Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, UFRGS, Av. Bento Gonçalves, 9500, CEP 90650-001 Porto Alegre, RS, Brazil.
| | - Maira G Burin
- Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Carolina F M de Souza
- Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
| | - Roberto Giugliani
- Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Genética e Biologia Molecular, Instituto de Biociências, UFRGS, Av. Bento Gonçalves, 9500, CEP 90650-001 Porto Alegre, RS, Brazil.
| | - Carmen Regla Vargas
- Programa de Pós-Graduação em Ciências Farmacêuticas, Faculdade de Farmácia, UFRGS, Av. Ipiranga, 2752, CEP 90610-000 Porto Alegre, RS, Brazil; Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, UFRGS, R. Ramiro Barcelos, 2600, CEP 90035-003 Porto Alegre, RS, Brazil; Serviço de Genética Médica, HCPA, R. Ramiro Barcelos, 2350, CEP 90035-003 Porto Alegre, RS, Brazil.
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Dalmau Serra J, Vitoria Miñana I, Calderón Fernández R, Cortell Aznar I. Clinical response to long term enzyme replacement treatment in children, adolescent and adult patients with Hunter syndrome. Med Clin (Barc) 2015; 145:392-8. [DOI: 10.1016/j.medcli.2015.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/08/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
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Horovitz DDG, Acosta AX, de Rosso Giuliani L, Ribeiro EM. Mucopolysaccharidosis type VI on enzyme replacement therapy since infancy: Six years follow-up of four children. Mol Genet Metab Rep 2015. [PMID: 28649537 PMCID: PMC5471404 DOI: 10.1016/j.ymgmr.2015.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Dafne D G Horovitz
- Centro de Genetica Medica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/FIOCRUZ, Rio de Janeiro, RJ, Brazil
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30
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Lacritin and other autophagy associated proteins in ocular surface health. Exp Eye Res 2015; 144:4-13. [PMID: 26318608 DOI: 10.1016/j.exer.2015.08.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/20/2015] [Accepted: 08/18/2015] [Indexed: 12/19/2022]
Abstract
Advantage may be taken of macroautophagy ('autophagy') to promote ocular health. Autophagy continually captures aged or damaged cellular material for lysosomal degradation and recyling. When autophagic flux is chronically elevated, or alternatively deficient, health suffers. Chronic elevation of flux and stress are the consequence of inflammatory cytokines or of dry eye tears but not normal tears invitro. Exogenous tear protein lacritin transiently accelerates flux to restore homeostasis invitro and corneal health invivo, and yet the monomeric active form of lacritin appears to be selectively deficient in dry eye. Tissue transglutaminase-dependent cross-linking of monomer decreases monomer quantity and monomer affinity for coreceptor syndecan-1 thereby abrogating activity. Tissue transglutaminase is elevated in dry eye. Mutation of arylsulfatase A, arylsulfatase B, ceroid-lipofuscinosis neuronal 3, mucolipin, or Niemann-Pick disease type C1 respectively underlie several diseases of apparently insufficient autophagic flux that affect the eye, including: metachromatic leukodystrophy, mucopolysaccharidosis type VI, juvenile-onset Batten disease, mucolipidosis IV, and Niemann-Pick type C associated with myelin sheath destruction of corneal sensory and ciliary nerves and of the optic nerve; corneal clouding, ocular hypertension, glaucoma and optic nerve atrophy; accumulation of 'ceroid-lipofuscin' in surface conjunctival cells, and in ganglion and neuronal cells; decreased visual acuity and retinal dystrophy; and neurodegeneration. For some, enzyme or gene replacement, or substrate reduction, therapy is proving to be successful. Here we discuss examples of restoring ocular surface homeostasis through alteration of autophagy, with particular attention to lacritin.
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Parini R, Rigoldi M, Tedesco L, Boffi L, Brambilla A, Bertoletti S, Boncimino A, Del Longo A, De Lorenzo P, Gaini R, Gallone D, Gasperini S, Giussani C, Grimaldi M, Grioni D, Meregalli P, Messinesi G, Nichelli F, Romagnoli M, Russo P, Sganzerla E, Valsecchi G, Biondi A. Enzymatic replacement therapy for Hunter disease: Up to 9 years experience with 17 patients. Mol Genet Metab Rep 2015; 3:65-74. [PMID: 26937399 PMCID: PMC4750582 DOI: 10.1016/j.ymgmr.2015.03.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hunter disease is an X-linked lysosomal storage disorder characterized by progressive storage of glycosaminoglycans (GAGs) and multi-organ impairment. The central nervous system (CNS) is involved in at least 50% of cases. Since 2006, the enzymatic replacement therapy (ERT) is available but with no effect on the cognitive impairment, as the present formulation does not cross the blood-brain barrier. Here we report the outcome of 17 Hunter patients treated in a single center. Most of them (11) started ERT in 2006, 3 had started it earlier in 2004, enrolled in the phase III trial, and 3 after 2006, as soon as the diagnosis was made. The liver and spleen sizes and urinary GAGs significantly decreased and normalized throughout the treatment. Heart parameters improved, in particular the left ventricular mass index/m(2) decreased significantly. Amelioration of hearing was seen in many patients. Joint range of motion improved in all patients. However, no improvement on respiratory function, eye, skeletal and CNS disease was found. The developmental quotient of patients with a CNS involvement showed a fast decline. These patients were no more testable after 6 years of age and, albeit the benefits drawn from ERT, their quality of life worsened throughout the years. The whole group of patients showed a consistent residual disease burden mainly represented by persistent skeletal disease and frequent need of surgery. This study suggests that early diagnosis and treatment and other different therapies which are able to cross the blood-brain barrier, might in the future improve the MPS II outcome.
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Key Words
- 6MWT, Six minute walking test
- BAER, Brainstem auditory evoked responses
- CNS, Central nervous system
- EF, Ejection fraction
- ENT, Ear nose and throat
- ERT
- ERT, Enzyme replacement therapy
- Enzymatic replacement therapy
- GAGs, Glycosaminoglycans
- HAQ, Health Assessment Questionnaire
- Hunter disease
- Hunter syndrome
- I2S, Iduronate-2-sulfatase
- Idursulfase
- JROM, Joint range of motion
- LVM/LVMI, Left ventricular mass/left-ventricular mass index
- MDCT, Multidetector computed tomography
- MPS II
- MPS II, Mucopolysaccharidosis type II
- MPS, Mucopolysaccharidosis
- MRI, Magnetic resonance imaging
- Mucopolysaccharidosis type II
- QoL, Quality of Life
- UAI, Upper airway infections
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Affiliation(s)
- Rossella Parini
- Dept of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Miriam Rigoldi
- Dept of Internal Medicine, San Gerardo Hospital, Monza, Italy
| | - Lucia Tedesco
- Dept of Rehabilitation Medicine San Gerardo Hospital, Monza, Italy
| | - Lucia Boffi
- Dept of Cardiology, San Gerardo Hospital, Monza, Italy
| | | | - Sara Bertoletti
- Dept of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Agata Boncimino
- Dept of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | | | - Paola De Lorenzo
- Statistical Unit, Department of Preventive Medicine, University Milano Bicocca, Monza, Italy
| | - Renato Gaini
- Dept of Otholaryngology, San Gerardo Hospital, Monza, Italy
| | | | - Serena Gasperini
- Dept of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Carlo Giussani
- Dept of Neurosurgery, San Gerardo Hospital, Monza, Italy
| | | | - Daniele Grioni
- Dept of Pediatric Neurology San Gerardo Hospital, Monza, Italy
| | - Pamela Meregalli
- Dept of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Grazia Messinesi
- Dept of Pneumology, University of Milano—Bicocca, San Gerardo Hospital, Monza, Italy
| | | | | | | | - Erik Sganzerla
- Dept of Neurosurgery, San Gerardo Hospital, Monza, Italy
| | - Grazia Valsecchi
- Statistical Unit, Department of Preventive Medicine, University Milano Bicocca, Monza, Italy
| | - Andrea Biondi
- Dept of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
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Giugliani R, Brusius-Facchin AC, Moura de Souza CF, Civallero G, Burin M, Leistner-Segal S, Baldo G, Vairo F. Diagnosis and therapy options in mucopolysaccharidosis II (Hunter syndrome). Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.999666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Yund B, Rudser K, Ahmed A, Kovac V, Nestrasil I, Raiman J, Mamak E, Harmatz P, Steiner R, Lau H, Vekaria P, Wozniak JR, Lim KO, Delaney K, Whitley C, Shapiro EG. Cognitive, medical, and neuroimaging characteristics of attenuated mucopolysaccharidosis type II. Mol Genet Metab 2015; 114:170-7. [PMID: 25541100 PMCID: PMC4312717 DOI: 10.1016/j.ymgme.2014.12.299] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED The phenotype of attenuated mucopolysaccharidosis type II (MPS II), also called Hunter syndrome, has not been previously studied in systematic manner. In contrast to the "severe" phenotype, the "attenuated" phenotype does not present with behavioral or cognitive impairment; however, the presence of mild behavior and cognitive impairment that might impact long-term functional outcomes is unknown. Previously, significant MRI abnormalities have been found in MPS II. Recent evidence suggests white matter abnormalities in many MPS disorders. METHODS As the initial cross-sectional analysis of a longitudinal study, we studied the association of brain volumes and somatic disease burden with neuropsychological outcomes, including measures of intelligence, memory, and attention in 20 patients with attenuated MPS II with a mean age of 15.8. MRI volumes were compared to 55 normal controls. RESULTS While IQ and memory were average, measures of attention were one standard deviation below the average range. Corpus callosum volumes were significantly different from age-matched controls, differing by 22%. Normal age-related volume increases in white matter were not seen in MPS II patients as they were in controls. Somatic disease burden and white matter and corpus callosum volumes were significantly associated with attention deficits. Neither age at evaluation nor age at starting treatment predicted attention outcomes. CONCLUSIONS Despite average intelligence, attention is compromised in attenuated MPS II. Results confirm an important role of corpus callosum and cortical white matter abnormality in MPS II as well as the somatic disease burden in contributing to attention difficulties. Awareness by the patient and caregivers with appropriate management and symptomatic support will benefit the attenuated MPS II patient.
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Affiliation(s)
- Brianna Yund
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Alia Ahmed
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Victor Kovac
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Igor Nestrasil
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Julian Raiman
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Eva Mamak
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Harmatz
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Robert Steiner
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Heather Lau
- Department of Neurology, New York University, New York, NY, USA
| | - Pooja Vekaria
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | - Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kathleen Delaney
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Chester Whitley
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Elsa G Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
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Tomanin R, Zanetti A, D'Avanzo F, Rampazzo A, Gasparotto N, Parini R, Pascarella A, Concolino D, Procopio E, Fiumara A, Borgo A, Frigo AC, Scarpa M. Clinical efficacy of enzyme replacement therapy in paediatric Hunter patients, an independent study of 3.5 years. Orphanet J Rare Dis 2014; 9:129. [PMID: 25231261 PMCID: PMC4180060 DOI: 10.1186/s13023-014-0129-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hunter Syndrome is an X-linked lysosomal storage disorder due to the deficit of iduronate 2-sulfatase, an enzyme catalysing the degradation of the glycosaminoglycans (GAG) dermatan- and heparan-sulfate. Treatment of the disease is mainly performed by Enzyme Replacement Therapy (ERT) with idursulfase, in use since 2006. Clinical efficacy of ERT has been monitored mainly by the Hunter Outcome Survey (HOS) while very few independent studies have been so far conducted. The present study is a 3.5-years independent follow-up of 27 Hunter patients, starting ERT between 1.6 and 27 years of age, with the primary aim to evaluate efficacy of the therapy started at an early age (<12 years). METHODS In this study, we evaluated: urinary GAG content, hepato/splenomegaly, heart valvulopathies, otorinolaryngological symptoms, joint range of motion, growth, distance covered in the 6-minute walk test, neurological involvement. For data analysis, the 27 patients were divided into three groups according to the age at start of ERT: ≤5 years, >5 and ≤ 12 years and > 12 years. Patients were analysed both as 3 separate groups and also as one group; in addition, the 20 patients who started ERT up to 12 years of age were analysed as one group. Finally, patients presenting a "severe" phenotype were compared with "attenuated" ones. RESULTS Data analysis revealed a statistically significant reduction of the urinary GAG in patients ≤5 years and ≤ 12 years and of the hepatomegaly in the group aged >5 and ≤ 12 years. Although other clinical signs improved in some of the patients monitored, statistical analysis of their variation did not reveal any significant changes following enzyme administration. The evaluation of ERT efficacy in relation to the severity of the disease evidenced slightly higher improvements as for hepatomegaly, splenomegaly, otological disorders and adenotonsillar hypertrophy in severe vs attenuated patients. CONCLUSIONS Although the present protocol of idursulfase administration may result efficacious in delaying the MPS II somatic disease progression at some extent, in this study we observed that several signs and symptoms did not improve during the therapy. Therefore, a strict monitoring of the efficacy obtained in the patients under ERT is becoming mandatory for clinical, ethical and economic reasons.
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