1
|
Koeberl DD, Koch RL, Lim JA, Brooks ED, Arnson BD, Sun B, Kishnani PS. Gene therapy for glycogen storage diseases. J Inherit Metab Dis 2024; 47:93-118. [PMID: 37421310 PMCID: PMC10874648 DOI: 10.1002/jimd.12654] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/24/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023]
Abstract
Glycogen storage disorders (GSDs) are inherited disorders of metabolism resulting from the deficiency of individual enzymes involved in the synthesis, transport, and degradation of glycogen. This literature review summarizes the development of gene therapy for the GSDs. The abnormal accumulation of glycogen and deficiency of glucose production in GSDs lead to unique symptoms based upon the enzyme step and tissues involved, such as liver and kidney involvement associated with severe hypoglycemia during fasting and the risk of long-term complications including hepatic adenoma/carcinoma and end stage kidney disease in GSD Ia from glucose-6-phosphatase deficiency, and cardiac/skeletal/smooth muscle involvement associated with myopathy +/- cardiomyopathy and the risk for cardiorespiratory failure in Pompe disease. These symptoms are present to a variable degree in animal models for the GSDs, which have been utilized to evaluate new therapies including gene therapy and genome editing. Gene therapy for Pompe disease and GSD Ia has progressed to Phase I and Phase III clinical trials, respectively, and are evaluating the safety and bioactivity of adeno-associated virus vectors. Clinical research to understand the natural history and progression of the GSDs provides invaluable outcome measures that serve as endpoints to evaluate benefits in clinical trials. While promising, gene therapy and genome editing face challenges with regard to clinical implementation, including immune responses and toxicities that have been revealed during clinical trials of gene therapy that are underway. Gene therapy for the glycogen storage diseases is under development, addressing an unmet need for specific, stable therapy for these conditions.
Collapse
Affiliation(s)
- Dwight D. Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, United States
| | - Rebecca L. Koch
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Jeong-A Lim
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Elizabeth D. Brooks
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Benjamin D. Arnson
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, United States
| | - Baodong Sun
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Priya S. Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, United States
| |
Collapse
|
2
|
Li J, Shi X, Wang B, Hsi DH, Zhu X, Ta S, Wang J, Lei C, Hu R, Huang J, Zhao X, Liu L. Pompe disease in China: clinical and molecular characteristics. Front Cardiovasc Med 2023; 10:1261172. [PMID: 38162137 PMCID: PMC10755933 DOI: 10.3389/fcvm.2023.1261172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Background Pompe disease (PD) is a rare, progressive, and autosomal recessive lysosomal storage disorder caused by mutations in the acid α-glucosidase gene. The clinical course and molecular mechanism of this disease in China have not been well defined. Methods In this single-center cohort study, we investigated a total of 15 Chinese patients with Pompe disease to better understand the clinical manifestations, echocardiographic imaging and genetic characteristics in this population. Results The median age of 15 patients at symptom onset was 5.07 months (1-24 months). The median age at diagnosis was 19.53 months (range: 3 to 109 months, n = 15). Average diagnostic delay was 13.46 months. None of the patients had received enzyme replacement therapy (ERT). Fifteen patients died at a median age of 24.80 months due to cardiorespiratory failure (range 3-120 months). Myasthenia symptoms and severe hypertrophic cardiomyopathy were universally present (15/15 = 100%). Global longitudinal strain (GLS) by echocardiography was significantly lower in these patients. After adjusting for gender, body surface area (BSA), left ventricular ejection fraction (LVEF), E/e'ratio, maximum left ventricular wall thickness (MLVWT), left ventricular posterior wall (LVPW), left ventricular outflow tract (LVOT)gradient, GLS was independently correlated with survival time (hazard ratio (HR) = 0.702, 95% confidence Interval (CI): 0.532-0.925, P = 0.012). In our cohort, we identified 4 novel GAA mutation: c.2102T > C (p.L701P), c.2006C > T (p.P669l), c.766T > A (p.Y256N), c.2405G > T (p.G802V). 12 patients were compound heterozygotes, and 4 homozygotes. Conclusions Our study provides a comprehensive examination of PD clinical course and mutations of the GAA gene for patients in China. We showed clinical utility of echocardiography in quantifying heart involvement in patients with suspected PD. GLS can provide prognostic information for mortality prediction. We reported four novel mutations in the GAA gene for the first time. Our findings may improve early recognition of PD characteristics in Chinese patients.
Collapse
Affiliation(s)
- Jing Li
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Xiaohe Shi
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Bo Wang
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - David H. Hsi
- Heart & Vascular Institute, Stamford Hospital, CT and Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Xiaoli Zhu
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Shengjun Ta
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Jing Wang
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Changhui Lei
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Rui Hu
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Junzhe Huang
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Xueli Zhao
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| |
Collapse
|
3
|
El Haddad L, Khan M, Soufny R, Mummy D, Driehuys B, Mansour W, Kishnani PS, ElMallah MK. Monitoring and Management of Respiratory Function in Pompe Disease: Current Perspectives. Ther Clin Risk Manag 2023; 19:713-729. [PMID: 37680303 PMCID: PMC10480292 DOI: 10.2147/tcrm.s362871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
Pompe disease (PD) is a neuromuscular disorder caused by a deficiency of acid alpha-glucosidase (GAA) - a lysosomal enzyme responsible for hydrolyzing glycogen. GAA deficiency leads to accumulation of glycogen in lysosomes, causing cellular disruption. The severity of PD is directly related to the extent of GAA deficiency - if no or minimal GAA is produced, symptoms are severe and manifest in infancy, known as infantile onset PD (IOPD). If left untreated, infants with IOPD experience muscle hypotonia and cardio-respiratory failure leading to significant morbidity and mortality in the first year of life. In contrast, late-onset PD (LOPD) patients have more GAA activity and present later in life, but also have significant respiratory function decline. Despite FDA-approved enzyme replacement therapy, respiratory insufficiency remains a major cause of morbidity and mortality, emphasizing the importance of early detection and management of respiratory complications. These complications include impaired cough and airway clearance, respiratory muscle weakness, sleep-related breathing issues, and pulmonary infections. This review aims to provide an overview of the respiratory pathology, monitoring, and management of PD patients. In addition, we discuss the impact of novel approaches and therapies on respiratory function in PD.
Collapse
Affiliation(s)
- Léa El Haddad
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Mainur Khan
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Rania Soufny
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - David Mummy
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Wissam Mansour
- Division of Pulmonary and Sleep Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Mai K ElMallah
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
4
|
Smith EC, Hopkins S, Case LE, Xu M, Walters C, Dearmey S, Han SO, Spears TG, Chichester JA, Bossen EH, Hornik CP, Cohen JL, Bali D, Kishnani PS, Koeberl DD. Phase I study of liver depot gene therapy in late-onset Pompe disease. Mol Ther 2023; 31:1994-2004. [PMID: 36805083 PMCID: PMC10362382 DOI: 10.1016/j.ymthe.2023.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/03/2023] [Accepted: 02/16/2023] [Indexed: 02/21/2023] Open
Abstract
Gene therapy with an adeno-associated virus serotype 8 (AAV8) vector (AAV8-LSPhGAA) could eliminate the need for enzyme replacement therapy (ERT) by creating a liver depot for acid α-glucosidase (GAA) production. We report initial safety and bioactivity of the first dose (1.6 × 1012 vector genomes/kg) cohort (n = 3) in a 52-week open-label, single-dose, dose-escalation study (NCT03533673) in patients with late-onset Pompe disease (LOPD). Subjects discontinued biweekly ERT after week 26 based on the detection of elevated serum GAA activity and the absence of clinically significant declines per protocol. Prednisone (60 mg/day) was administered as immunoprophylaxis through week 4, followed by an 11-week taper. All subjects demonstrated sustained serum GAA activities from 101% to 235% of baseline trough activity 2 weeks following the preceding ERT dose. There were no treatment-related serious adverse events. No subject had anti-capsid T cell responses that decreased transgene expression. Muscle biopsy at week 24 revealed unchanged muscle glycogen content in two of three subjects. At week 52, muscle GAA activity for the cohort was significantly increased (p < 0.05). Overall, these initial data support the safety and bioactivity of AAV8-LSPhGAA, the safety of withdrawing ERT, successful immunoprophylaxis, and justify continued clinical development of AAV8-LSPhGAA therapy in Pompe disease.
Collapse
Affiliation(s)
- Edward C Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Sam Hopkins
- Asklepios Biopharmaceutical, Inc. (Askbio), Durham, NC, USA
| | - Laura E Case
- Department of Orthopedics, Duke University School of Medicine, Durham, NC, USA
| | - Ming Xu
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Crista Walters
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Stephanie Dearmey
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Sang-Oh Han
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Tracy G Spears
- Clinical Trials Statistics, Duke Clinical Research Institute, Durham, NC, USA
| | - Jessica A Chichester
- Immunology Core, Gene Therapy Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward H Bossen
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Jennifer L Cohen
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Deeksha Bali
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Priya S Kishnani
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Dwight D Koeberl
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
| |
Collapse
|
5
|
Alfonsi E, Todisco M, Fresia M, Tassorelli C, Cosentino G. Electrokinesiographic Study of Oropharyngeal Swallowing in Neurogenic Dysphagia. Dysphagia 2023; 38:543-557. [PMID: 34313849 DOI: 10.1007/s00455-021-10336-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/23/2021] [Indexed: 01/04/2023]
Abstract
Electrokinesiographic study of swallowing (EKSS) can be useful for the assessment of patients with suspected or overt neurogenic dysphagia. EKSS consists of multichannel recording of the electromyographic (EMG) activity of the suprahyoid/submental muscle complex (SHEMG), the EMG activity of the cricopharyngeal muscle (CPEMG), and the laryngopharyngeal mechanogram (LPM). The LPM is an expression of the mechanical changes that the laryngopharyngeal structures undergo during the pharyngeal phase of swallowing. This method allows detailed evaluation of the magnitude, duration and temporal relations of the different events that characterize oropharyngeal swallowing, and thus in-depth exploration both of physiological deglutition mechanisms and of pathophysiological features of swallowing in neurogenic dysphagia. Furthermore, EKSS can guide dysphagia treatment strategies, allowing identification of optimal solutions for single patients. For instance, CPEMG recording can identify incomplete or absent relaxation of the upper esophageal sphincter during the pharyngeal phase of swallowing, thus suggesting a therapeutic approach based on botulinum toxin injection into the cricopharyngeal muscle. More recently, the 'shape' of SHEMG and the reproducibility of both SHEMG and LPM over repeated swallowing acts have been implemented as novel electrokinesiographic parameters. These measures could be valuable for straightforward non-invasive investigation of dysphagia severity and response to dysphagia treatment in clinical practice.
Collapse
Affiliation(s)
- Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Massimiliano Todisco
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mauro Fresia
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giuseppe Cosentino
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
6
|
Kinton S, Dufault MR, Zhang M, George K. Transcriptomic characterization of clinical skeletal muscle biopsy from late-onset Pompe patients. Mol Genet Metab 2023; 138:107526. [PMID: 36774918 DOI: 10.1016/j.ymgme.2023.107526] [Citation(s) in RCA: 2] [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: 09/22/2022] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
Pompe disease is a rare lysosomal storage disorder arising from recessive mutations in the acid α-glucosidase gene and resulting in the accumulation of glycogen, particularly in the cardiac and skeletal muscle. The current standard of care is administration of enzyme replacement therapy in the form of alglucosidase alfa or the recently approved avalglucosidase alfa. In order to better understand the underlying cellular processes that are disrupted in Pompe disease, we conducted gene expression analysis on skeletal muscle biopsies obtained from late-onset Pompe disease patients (LOPD) prior to treatment and following six months of enzyme replacement with avalglucosidase alfa. The LOPD patients had a distinct transcriptomic signature as compared to control patient samples, largely characterized by perturbations in pathways involved in lysosomal function and energy metabolism. Although patients were highly heterogeneous, they collectively exhibited a strong trend towards attenuation of the dysregulated genes following just six months of treatment. Notably, the enzyme replacement therapy had a strong stabilizing effect on gene expression, with minimal worsening in genes that were initially dysregulated. Many of the cellular process that were altered in LOPD patients were also affected in the more clinically severe infantile-onset (IOPD) patients. Additionally, both LOPD and IOPD patients demonstrated enrichment across several inflammatory pathways, despite a lack of overt immune cell infiltration. This study provides further insight into Pompe disease biology and demonstrates the positive effects of avalglucosidase alfa treatment.
Collapse
Affiliation(s)
- Sofia Kinton
- Rare and Neurologic Disease Research, Sanofi, 350 Water Street, Cambridge, MA, United States of America.
| | - Michael R Dufault
- Precision Medicine & Computational Biology, Sanofi, 350 Water Street, Cambridge, MA, United States of America
| | - Mindy Zhang
- Precision Medicine & Computational Biology, Sanofi, 350 Water Street, Cambridge, MA, United States of America
| | - Kelly George
- Rare and Neurologic Disease Research, Sanofi, 350 Water Street, Cambridge, MA, United States of America
| |
Collapse
|
7
|
Singer ML, Rana S, Benevides ES, Barral BE, Byrne BJ, Fuller DD. Chemogenetic activation of hypoglossal motoneurons in a mouse model of Pompe disease. J Neurophysiol 2022; 128:1133-1142. [PMID: 35976060 PMCID: PMC9621710 DOI: 10.1152/jn.00026.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
Pompe disease is a lysosomal storage disease resulting from absence or deficiency of acid α-glucosidase (GAA). Tongue-related disorders including dysarthria, dysphagia, and obstructive sleep apnea are common in Pompe disease. Our purpose was to determine if designer receptors exclusively activated by designer drugs (DREADDs) could be used to stimulate tongue motor output in a mouse model of Pompe disease. An adeno-associated virus serotype 9 (AAV9) encoding an excitatory DREADD (AAV9-hSyn-hM3D(Gq)-mCherry, 2.44 × 1010 vg) was administered to the posterior tongue of 5-7-wk-old Gaa null (Gaa-/-) mice. Lingual EMG responses to intraperitoneal injection of saline or a DREADD ligand (JHU37160-dihydrochloride, J60) were assessed 12 wk later during spontaneous breathing. Saline injection produced no consistent changes in lingual EMG. Following the DREADD ligand, there were statistically significant (P < 0.05) increases in both tonic and phasic inspiratory EMG activity recorded from the posterior tongue. Brainstem histology confirmed mCherry expression in hypoglossal (XII) motoneurons in all mice, thus verifying retrograde movement of the AAV9 vector. Morphologically, Gaa-/- XII motoneurons showed histological characteristics that are typical of Pompe disease, including an enlarged soma and vacuolization. We conclude that lingual delivery of AAV9 can be used to drive functional expression of DREADD in XII motoneurons in a mouse model of Pompe disease.NEW & NOTEWORTHY In a mouse model of Pompe disease, lingual injection of adeno-associated virus (AAV) serotype 9 encoding DREADD was histologically verified to produce transgene expression in hypoglossal motoneurons. Subsequent intraperitoneal delivery of a DREADD ligand stimulated tonic and phase tongue motor output.In a mouse model of Pompe disease, lingual injection of adeno-associated virus (AAV) serotype 9 encoding DREADD was histologically verified to produce transgene expression in hypoglossal motoneurons. Subsequent intravenous delivery of a DREADD ligand stimulated tonic and phase tongue motor output.
Collapse
Affiliation(s)
- Michele L Singer
- Rehabilitation Science PhD Program, University of Florida, Gainesville, Florida
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Sabhya Rana
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Ethan S Benevides
- Rehabilitation Science PhD Program, University of Florida, Gainesville, Florida
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Brian E Barral
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
| | - Barry J Byrne
- Department of Pediatrics, University of Florida, Gainesville, Florida
- Powell Gene Therapy Center, University of Florida, Gainesville, Florida
| | - David D Fuller
- Rehabilitation Science PhD Program, University of Florida, Gainesville, Florida
- Department of Physical Therapy, University of Florida, Gainesville, Florida
- Breathing Research and Therapeutics Center, University of Florida, Gainesville, Florida
- McKnight Brain Institute, University of Florida, Gainesville, Florida
| |
Collapse
|
8
|
Lotta S, Lisa B. Congenital or Early Developing Neuromuscular Diseases Affecting Feeding, Swallowing and Speech – A Review of the Literature from January 1998 to August 2021. J Neuromuscul Dis 2022; 9:581-596. [PMID: 35848032 PMCID: PMC9535595 DOI: 10.3233/jnd-210772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. Objective: The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control. Methods: A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords “feeding”, “dysphagia”, “swallowing”, “dysarthria”, “speech”, “drooling” and “sialorrhea” were used in combination with “paediatric neuromuscular disease” or specific diagnoses. Results: Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases. Conclusions: Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
Collapse
Affiliation(s)
- Sjögreen Lotta
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| | - Bengtsson Lisa
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| |
Collapse
|
9
|
Han SO, Gheorghiu D, Chang A, Mapatano SH, Li S, Brooks E, Koeberl D. Efficacious Androgen Hormone Administration in Combination with Adeno-Associated Virus Vector-Mediated Gene Therapy in Female Mice with Pompe Disease. Hum Gene Ther 2022; 33:479-491. [PMID: 35081735 PMCID: PMC9142766 DOI: 10.1089/hum.2021.218] [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: 08/30/2021] [Accepted: 01/24/2022] [Indexed: 11/12/2022] Open
Abstract
Pompe disease is an autosomal recessive lysosomal storage disorder caused by deficiency of acid α-glucosidase (GAA), resulting in skeletal muscle weakness and cardiomyopathy that progresses despite currently available therapy in some patients. The development of gene therapy with adeno-associated virus (AAV) vectors revealed a sex-dependent decrease in efficacy in female mice with Pompe disease. This study evaluated the effect of testosterone on gene therapy with an AAV2/8 vector containing a liver-specific promoter to drive expression of GAA (AAV2/8-LSPhGAA) in female GAA-knockout (KO) mice that were implanted with pellets containing testosterone propionate before vector administration. Six weeks after treatment, neuromuscular function and muscle strength were improved as demonstrated by increased Rotarod and wirehang latency for female mice treated with testosterone and vector, in comparison with vector alone. Biochemical correction improved after the addition of testosterone as demonstrated by increased GAA activity and decreased glycogen content in the skeletal muscles of female mice treated with testosterone and vector, in comparison with vector alone. An alternative androgen, oxandrolone, was evaluated similarly to reveal increased GAA in the diaphragm and extensor digitorum longus of female GAA-KO mice after oxandrolone administration; however, glycogen content was unchanged by oxandrolone treatment. The efficacy of androgen hormone treatment in females correlated with increased mannose-6-phosphate receptor in skeletal muscle. These data confirmed the benefits of brief treatment with an androgen hormone in mice with Pompe disease during gene therapy.
Collapse
Affiliation(s)
- Sang-oh Han
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Dorothy Gheorghiu
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alex Chang
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sweet Hope Mapatano
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Songtao Li
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth Brooks
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Laboratory Animal Resources, Duke University, Durham, North Carolina, USA
| | - Dwight Koeberl
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Molecular Genetics and Microbiology, Duke University, Durham, North Carolina, USA
| |
Collapse
|
10
|
Wang TH, Soong WJ, Niu DM, Chu YL, Chen LZ, Huang LY, Yang CF. Airway abnormalities and pulmonary complications in long-term treated late-onset Pompe disease: Diagnostic and interventional by flexible bronchoscopy. Pediatr Pulmonol 2022; 57:185-192. [PMID: 34647686 DOI: 10.1002/ppul.25725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/27/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022]
Abstract
This study evaluates the whole airway abnormalities of long-term treated late-onset Pompe disease (LOPD) patients, with interventions using the flexible bronchoscope (FB). As a retrospective study, we follow up with our five LOPD patients treated with Myozyme from 2012 to 2021 regularly, but with a focus on the whole airway abnormalities of these patients visualized through FB. The long-term clinical outcomes and relevant airway symptoms were assessed. Pulmonary function test and polysomnography were performed to evaluate the degree of respiratory compromise. All patients in the study had varying degrees of airway collapsibility, pulmonary complications, sleep apnea syndrome, and facial anomalies. Pulmonary function could preserve after Myozyme treatment, but potential deterioration thereafter. This is the first study that focuses on airway abnormalities and pulmonary complications in long-term treated LOPD patients using FB. Despite years of Myozyme treatment, we still observed airway abnormalities in these patients. In our series, the pulmonary complications seem more obvious than those observed in patients with infantile-onset Pompe disease, which might be related to the late diagnosis and treatment. We might recommend that FB could provide dynamic evaluation and interventions of airway abnormalities simultaneously. Early diagnosis of respiratory dysfunction is a critical prognostic factor of the long-term outcome of treated LOPD patients.
Collapse
Affiliation(s)
- Ting-Hao Wang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Jue Soong
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Pediatric Pulmonology, China Medical University Children's Hospital, China Medical University, Taichung, Taiwan.,Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Li-Zhen Chen
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yi Huang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei City Hospital-Heping Fuyou Branch, Taipei, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
11
|
Assessment of Dysphonia in Children with Pompe Disease Using Auditory-Perceptual and Acoustic/Physiologic Methods. J Clin Med 2021; 10:jcm10163617. [PMID: 34441913 PMCID: PMC8396833 DOI: 10.3390/jcm10163617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022] Open
Abstract
Bulbar and respiratory weakness occur commonly in children with Pompe disease and frequently lead to dysarthria. However, changes in vocal quality associated with this motor speech disorder are poorly described. The goal of this study was to characterize the vocal function of children with Pompe disease using auditory-perceptual and physiologic/acoustic methods. High-quality voice recordings were collected from 21 children with Pompe disease. The Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale was used to assess voice quality and ratings were compared to physiologic/acoustic measurements collected during sustained phonation tasks, reading of a standard passage, and repetition of a short phrase at maximal volume. Based on ratings of grade, dysphonia was present in 90% of participants and was most commonly rated as mild or moderate in severity. Duration of sustained phonation tasks was reduced and shimmer was increased in comparison to published reference values for children without dysphonia. Specific measures of loudness were found to have statistically significant relationships with perceptual ratings of grade, breathiness, asthenia, and strain. Our data suggest that dysphonia is common in children with Pompe disease and primarily reflects impairments in respiratory and laryngeal function; however, the primary cause of dysphonia remains unclear. Future studies should seek to quantify the relative contribution of deficits in individual speech subsystems on voice quality and motor speech performance more broadly.
Collapse
|
12
|
Kooi-van Es M, Erasmus CE, de Swart BJM, Voet NBM, van der Wees PJ, de Groot IJM, van den Engel-Hoek L. Dysphagia and Dysarthria in Children with Neuromuscular Diseases, a Prevalence Study. J Neuromuscul Dis 2021; 7:287-295. [PMID: 32176651 PMCID: PMC7369072 DOI: 10.3233/jnd-190436] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Dysphagia and dysarthria are frequently described in pediatric neuromuscular diseases (pNMD). The consequences can be substantial: failure to thrive, malnutrition, aspiration pneumonia, or communication problems. Early detection and identification of risk factors and etiology support preventing complications and morbidity, including impact on quality of life. Information about the prevalence of dysphagia and dysarthria in pNMD is scarce. OBJECTIVE To describe the pooled prevalence of dysphagia and dysarthria in pNMD in the Netherlands. In addition, we describe the prevalence of dysphagia and dysarthria each, and the prevalence of chewing (oral) and swallowing problems per diagnostic group, based on their anatomic origin. METHODS Data were collected from 295 children (mean age 11;0 years, range 2;6-18;0) with pNMD in 12 hospitals and rehabilitation centers in the Netherlands. A speech language therapist established whether dysphagia and dysarthria were present or not. RESULTS In almost all the 14 diagnostic groups of pNMD, dysphagia and dysarthria were present. Pooled overall prevalence of dysphagia and dysarthria was 47.2% and 31.5%, respectively. Of 114 children with dysphagia, 90.0% had chewing problems, 43.0% showed swallowing problems and 33.3% showed both chewing and swallowing problems. CONCLUSIONS The overall pooled prevalence of dysphagia and dysarthria was high in the population of pNMD. It can be argued that periodic monitoring of dysphagia and dysarthria and early referral to a speech language therapist should be a necessity from the start of the diagnosis in the whole pNMD population.
Collapse
Affiliation(s)
- Mieke Kooi-van Es
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Radboud University Medical Centre, Department of Pediatric Neurology - Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Bert J M de Swart
- Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Nicoline B M Voet
- Rehabilitation Centre Klimmendaal, Arnhem, The Netherlands.,Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Philip J van der Wees
- Radboud University Medical Center, Department of Rehabilitation and IQ Healthcare, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Radboud University Medical Center, Department of Rehabilitation, Nijmegen, The Netherlands
| | | | | |
Collapse
|
13
|
McCall AL, Dhindsa JS, Bailey AM, Pucci LA, Strickland LM, ElMallah MK. Glycogen accumulation in smooth muscle of a Pompe disease mouse model. J Smooth Muscle Res 2021; 57:8-18. [PMID: 33883348 PMCID: PMC8053439 DOI: 10.1540/jsmr.57.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pompe disease is a lysosomal storage disease caused by mutations within the
GAA gene, which encodes acid α-glucosidase (GAA)—an enzyme necessary
for lysosomal glycogen degradation. A lack of GAA results in an accumulation of glycogen
in cardiac and skeletal muscle, as well as in motor neurons. The only FDA approved
treatment for Pompe disease—an enzyme replacement therapy (ERT)—increases survival of
patients, but has unmasked previously unrecognized clinical manifestations of Pompe
disease. These clinical signs and symptoms include tracheo-bronchomalacia, vascular
aneurysms, and gastro-intestinal discomfort. Together, these previously unrecognized
pathologies indicate that GAA-deficiency impacts smooth muscle in addition to skeletal and
cardiac muscle. Thus, we sought to characterize smooth muscle pathology in the airway,
vascular, gastrointestinal, and genitourinary in the Gaa−/−
mouse model. Increased levels of glycogen were present in smooth muscle cells of the
aorta, trachea, esophagus, stomach, and bladder of Gaa−/−
mice, compared to wild type mice. In addition, there was an increased
abundance of both lysosome membrane protein (LAMP1) and autophagosome membrane protein
(LC3) indicating vacuolar accumulation in several tissues. Taken together, we show that
GAA deficiency results in subsequent pathology in smooth muscle cells, which may lead to
life-threatening complications if not properly treated.
Collapse
Affiliation(s)
- Angela L McCall
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Justin S Dhindsa
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Aidan M Bailey
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Logan A Pucci
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Laura M Strickland
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Duke University, Durham, NC 27710, USA
| | - Mai K ElMallah
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Duke University, Durham, NC 27710, USA
| |
Collapse
|
14
|
Salabarria SM, Nair J, Clement N, Smith BK, Raben N, Fuller DD, Byrne BJ, Corti M. Advancements in AAV-mediated Gene Therapy for Pompe Disease. J Neuromuscul Dis 2020; 7:15-31. [PMID: 31796685 PMCID: PMC7029369 DOI: 10.3233/jnd-190426] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pompe disease (glycogen storage disease type II) is caused by mutations in acid α-glucosidase (GAA) resulting in lysosomal pathology and impairment of the muscular and cardio-pulmonary systems. Enzyme replacement therapy (ERT), the only approved therapy for Pompe disease, improves muscle function by reducing glycogen accumulation but this approach entails several limitations including a short drug half-life and an antibody response that results in reduced efficacy. To address these limitations, new treatments such as gene therapy are under development to increase the intrinsic ability of the affected cells to produce GAA. Key components to gene therapy strategies include the choice of vector, promoter, and the route of administration. The efficacy of gene therapy depends on the ability of the vector to drive gene expression in the target tissue and also on the recipient's immune tolerance to the transgene protein. In this review, we discuss the preclinical and clinical studies that are paving the way for the development of a gene therapy strategy for patients with early and late onset Pompe disease as well as some of the challenges for advancing gene therapy.
Collapse
Affiliation(s)
- S M Salabarria
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - J Nair
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - N Clement
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - B K Smith
- Department of Physical Therapy and Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - N Raben
- Laboratory of Protein Trafficking and Organelle Biology, Cell and Developmental Biology Center, National Heart, Lung and Blood Institute, NIH, Bethesda, Maryland, USA
| | - D D Fuller
- Department of Physical Therapy and Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - B J Byrne
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| | - M Corti
- Department of Pediatrics and Powell Gene Therapy Center, University of Florida, Gainesville, Floria, USA
| |
Collapse
|
15
|
Korlimarla A, Spiridigliozzi GA, Crisp K, Herbert M, Chen S, Malinzak M, Stefanescu M, Austin SL, Cope H, Zimmerman K, Jones H, Provenzale JM, Kishnani PS. Novel approaches to quantify CNS involvement in children with Pompe disease. Neurology 2020; 95:e718-e732. [PMID: 32518148 PMCID: PMC7455359 DOI: 10.1212/wnl.0000000000009979] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/26/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the extent of CNS involvement in children with Pompe disease using brain MRI and developmental assessments. METHODS The study included 14 children (ages 6-18 years) with infantile Pompe disease (IPD) (n = 12) or late-onset Pompe disease (LOPD) (n = 2) receiving enzyme replacement therapy. White matter (WM) hyperintense foci seen in the brain MRIs were systematically quantified using the Fazekas scale (FS) grading system with a novel approach: the individual FS scores from 10 anatomical areas were summed to yield a total FS score (range absent [0] to severe [30]) for each child. The FS scores were compared to developmental assessments of cognition and language obtained during the same time period. RESULTS Mild to severe WM hyperintense foci were seen in 10/12 children with IPD (median age 10.6 years) with total FS scores ranging from 2 to 23. Periventricular, subcortical, and deep WM were involved. WM hyperintense foci were seen throughout the path of the corticospinal tracts in the brain in children with IPD. Two children with IPD had no WM hyperintense foci. Children with IPD had relative weaknesses in processing speed, fluid reasoning, visual perception, and receptive vocabulary. The 2 children with LOPD had no WM hyperintense foci, and high scores on most developmental assessments. CONCLUSION This study systematically characterized WM hyperintense foci in children with IPD, which could serve as a benchmark for longitudinal follow-up of WM abnormalities in patients with Pompe disease and other known neurodegenerative disorders or leukodystrophies in children.
Collapse
Affiliation(s)
- Aditi Korlimarla
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Gail A Spiridigliozzi
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Kelly Crisp
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Mrudu Herbert
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Steven Chen
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Michael Malinzak
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Mihaela Stefanescu
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Stephanie L Austin
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Heidi Cope
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Kanecia Zimmerman
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Harrison Jones
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - James M Provenzale
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC
| | - Priya S Kishnani
- From the Division of Medical Genetics, Department of Pediatrics (A.K., M.S., S.L.A., H.C., P.S.K.), Department of Psychiatry and Behavioral Sciences (G.A.S.), Department of Surgery (K.C., H.J.), and Department of Neuroradiology (S.C., M.M., J.M.P.), Duke University Medical Center, Durham, NC; Department of Pediatric Neurology (M.H.), University of Kentucky Medical Center, Lexington; and Duke Clinical Research Institute (K.Z.), Durham, NC.
| |
Collapse
|
16
|
Huang HP, Chiang W, Stone L, Kang CK, Chuang CY, Kuo HC. Using human Pompe disease-induced pluripotent stem cell-derived neural cells to identify compounds with therapeutic potential. Hum Mol Genet 2020; 28:3880-3894. [PMID: 31518394 DOI: 10.1093/hmg/ddz218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/26/2019] [Accepted: 09/02/2019] [Indexed: 12/28/2022] Open
Abstract
Pompe disease (OMIM # 232300) is a glycogen storage disease caused by autosomal recessive mutations of the gene encoding alpha-1,4-glucosidase (GAA; EC 3.2.1.20). Despite the relatively effective employment of enzyme replacement therapy, some critical medical issues still exist in patients with this disease, including the persistence of abnormalities in the central nervous system (CNS), probably because of the inability of the recombinant GAA to pass through the blood-brain barrier. To address this issue, identification of more therapeutic agents that target the CNS of patients with Pompe disease may be required. In this study, we derived neuronal cells from Pompe disease-induced pluripotent stem cells (Pom-iPSCs) and proved that they are able to recapitulate the hallmark cellular and biochemical phenotypes of Pompe disease. Using the Pom-iPSC-derived neurons as an in vitro drug-testing model, we then identified three compounds, ebselen, wortmannin and PX-866, with therapeutic potential to alleviate Pompe disease-associated pathological phenotypes in the neurons derived from Pom-iPSCs. We confirmed that all three compounds were able to enhance the GAA activity in the Pom-iPSC-derived neurons. Moreover, they were able to enhance the GAA activity in several important internal organs of GAA-deficient mice when co-injected with recombinant human GAA, and we found that intraperitoneal injection of ebselen was able to promote the GAA activity of the GAA-heterozygous mouse brain. Our results prove the usefulness of Pom-iPSC-derived neuronal populations for identifying new compounds with therapeutic potential.
Collapse
Affiliation(s)
- Hsiang-Po Huang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, 10051, Taiwan
| | - Wei Chiang
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei 11529, Taiwan
| | - Lee Stone
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei 11529, Taiwan
| | - Chun-Kai Kang
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, 10051, Taiwan
| | - Ching-Yu Chuang
- Genomics Research Center, Academia Sinica, Taipei 11529, Taiwan
| | - Hung-Chih Kuo
- Graduate Institute of Medical Genomics and Proteomics, National Taiwan University College of Medicine, Taipei, 10051, Taiwan.,Institute of Cellular and Organismic Biology, Academia Sinica, Taipei 11529, Taiwan
| |
Collapse
|
17
|
Su HT, Wang LM, Yang CF, Lee LH, Brajot FX. Language, speech, and oromotor function in children with Pompe disease. Neuromuscul Disord 2020; 30:400-412. [PMID: 32387282 DOI: 10.1016/j.nmd.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/03/2020] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
Abstract
Advances in the treatment of Pompe disease have improved life expectancy and quality of life, but speech and oromotor function remain significantly affected. The purpose of this study was to expand on existing data and present new findings of speech acoustic and physiologic outcomes in Pompe disease. A retrospective analysis was carried out on results of speech, language and oromotor tests carried out in 14 children diagnosed with Pompe disease. The assessment battery included standardized tests of language, picture naming, maximum performance tests, and oromotor resistance tasks. Speech production was scored with respect to intelligibility, hypernasality, and articulatory accuracy. Language delays ranged from mild to severe in 1/3 of the children. Reduced speech intelligibility, disordered articulation, and hypernasality were present in at least 2/3 of the children. Maximum performance tests all fell at least 1 SD below normative means. Significant correlations were identified between maximum phonation time and articulation and between the S/Z ratio and intelligibility. Positive correlations were also found between tongue strength and articulation. Results confirm previous reports of speech and language function in Pompe disease. Clinical acoustic measures provide important insights into the speech deficits in this group of children and suggest possible treatment strategies.
Collapse
Affiliation(s)
- Hsiao-Ting Su
- Communication Sciences and Disorders, Ohio University, Grover Center W218, Athens, OH 45701, United States.
| | - Li-Mei Wang
- Speech-Language Pathology Division of the Otolaryngology Department, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Hong Lee
- Research and Treatment Center of Rare Disease, Taipei Veterans General Hospital, Taipei, Taiwan
| | - François-Xavier Brajot
- Communication Sciences and Disorders, Ohio University, Grover Center W218, Athens, OH 45701, United States
| |
Collapse
|
18
|
Jones HN, Fernandes S, Hannah WB, Kansagra S, Raynor EM, Kishnani PS. Adenotonsillectomy should be avoided whenever possible in infantile-onset Pompe disease. Mol Genet Metab Rep 2020; 23:100574. [PMID: 32090020 PMCID: PMC7026278 DOI: 10.1016/j.ymgmr.2020.100574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Harrison N. Jones
- Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA
- Department of Speech Pathology & Audiology, Duke University, Durham, NC, USA
| | - Samuela Fernandes
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
| | - William B. Hannah
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
| | - Sujay Kansagra
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Eileen M. Raynor
- Department of Surgery, Division of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC, USA
| | - Priya S. Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University, Durham, NC, USA
- Corresponding author.
| |
Collapse
|
19
|
Yang CF, Niu DM, Tai SK, Wang TH, Su HT, Huang LY, Soong WJ. Airway abnormalities in very early treated infantile-onset Pompe disease: A large-scale survey by flexible bronchoscopy. Am J Med Genet A 2020; 182:721-729. [PMID: 31953985 DOI: 10.1002/ajmg.a.61481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/08/2019] [Accepted: 12/16/2019] [Indexed: 11/08/2022]
Abstract
Early enzyme replacement therapy (ERT) improve long-term outcomes in patients with infantile-onset Pompe disease (IOPD). Our cohort of patients with IOPD at Taipei Veterans General Hospital (TVGH) joined Taiwan Pompe newborn screening program from 2008, testing more than one million newborns until 2018. By 2010, we had established rapid diagnostic strategies. Now, the average age of ERT initiation starts at an average age of <10 days-old, the earliest group in the world. However, they still presented some airway problems. We present a retrospective study focused on airway abnormalities in these patients along 8 years of observation. Fifteen patients with IOPD, who received very early treatment at a mean age of 8.94 ± 3.75 days, underwent flexible bronchoscopy (FB) for dynamic assessment of the whole airway. Long-term clinical outcomes and relevant symptoms of the upper airway were assessed. All patients in the study had varying degrees of severity of upper airway abnormalities and speech disorders. The three oldest children (Age 94, 93, and 88 months, respectively) had poor movement of the vocal cords with reduced abduction and adduction and had silent aspiration of saliva through the glottis during respiration. This is the largest cohort study presented to date about airway abnormalities in very early treated patients with IOPD patients by FB. Despite very early treatment, we observed upper airway abnormalities in these IOPD patients. In IOPD, upper airway abnormalities seem inevitable over time. We suggest early and continuous monitoring for all IOPD patients, even with early and regular treatment.
Collapse
Affiliation(s)
- Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shyh-Kuan Tai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ting-Hao Wang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiao-Ting Su
- Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
| | - Ling-Yi Huang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Children's Hospital, China Medical University, Taichung, Taiwan
| |
Collapse
|
20
|
Doyle BM, Turner SM, Sunshine MD, Doerfler PA, Poirier AE, Vaught LA, Jorgensen ML, Falk DJ, Byrne BJ, Fuller DD. AAV Gene Therapy Utilizing Glycosylation-Independent Lysosomal Targeting Tagged GAA in the Hypoglossal Motor System of Pompe Mice. Mol Ther Methods Clin Dev 2019; 15:194-203. [PMID: 31660421 PMCID: PMC6807287 DOI: 10.1016/j.omtm.2019.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/23/2019] [Indexed: 12/17/2022]
Abstract
Pompe disease is caused by mutations in the gene encoding the lysosomal glycogen-metabolizing enzyme, acid-alpha glucosidase (GAA). Tongue myofibers and hypoglossal motoneurons appear to be particularly susceptible in Pompe disease. Here we used intramuscular delivery of adeno-associated virus serotype 9 (AAV9) for targeted delivery of an enhanced form of GAA to tongue myofibers and motoneurons in 6-month-old Pompe (Gaa -/- ) mice. We hypothesized that addition of a glycosylation-independent lysosomal targeting tag to the protein would result in enhanced expression in tongue (hypoglossal) motoneurons when compared to the untagged GAA. Mice received an injection into the base of the tongue with AAV9 encoding either the tagged or untagged enzyme; tissues were harvested 4 months later. Both AAV9 constructs effectively drove GAA expression in lingual myofibers and hypoglossal motoneurons. However, mice treated with the AAV9 construct encoding the modified GAA enzyme had a >200% increase in the number of GAA-positive motoneurons as compared to the untagged GAA (p < 0.008). Our results confirm that tongue delivery of AAV9-encoding GAA can effectively target tongue myofibers and associated motoneurons in Pompe mice and indicate that the effectiveness of this approach can be improved by addition of the glycosylation-independent lysosomal targeting tag.
Collapse
Affiliation(s)
- Brendan M. Doyle
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| | - Sara M.F. Turner
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| | - Michael D. Sunshine
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| | - Phillip A. Doerfler
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
- Powell Gene Therapy Center, University of Florida, Gainesville, FL 32610, USA
| | - Amy E. Poirier
- Department of Neuroscience, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| | - Lauren A. Vaught
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
- Powell Gene Therapy Center, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| | - Marda L. Jorgensen
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
| | - Darin J. Falk
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
- Powell Gene Therapy Center, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| | - Barry J. Byrne
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA
- Powell Gene Therapy Center, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| | - David D. Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA
- Mcknight Brain Institute, University of Florida, Gainesville, FL 32610, USA
- Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, FL 32610, USA
| |
Collapse
|
21
|
Benz K, Hahn P, Hanisch M, Lücke K, Lücke T, Jackowski J. Systematic review of oral and craniofacial findings in patients with Fabry disease or Pompe disease. Br J Oral Maxillofac Surg 2019; 57:831-838. [PMID: 31405600 DOI: 10.1016/j.bjoms.2019.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 07/20/2019] [Indexed: 12/21/2022]
Abstract
Fabry disease and Pompe disease are rare lysosomal storage disorders that belong to a heterogeneous group of more than 200 distinct inborn metabolic diseases. Mutations followed by loss of function of enzymes or transporters that are localised in the acidic environment of the lysosome may result in degradation of many substrates, such as glycosaminoglycans, glycosphingolipids, glycogen, cholesterol, oligosaccharides, glycoproteins, and peptides, or the excretion of the products degraded by the lysosome. Our aim was to identify the oral signs and symptoms of Fabry disease and Pompe disease from a systematic review made using MEDLINE/PubMed, and a hand search for relevant articles, following the PRISMA guidelines. Both diseases show various craniofacial and oral changes, including supernumerary teeth, dental agenesis, angiokeratoma, and telangiectases in Fabry disease; and macroglossia, teeth fusion, and taurodontism in Pompe disease. Common clinical signs of Fabry disease include hyposalivation, hypohidrosis, and xerophthalmia, and a generally reduced physical resilience was apparent in patients with Pompe disease. Oral and craniofacial changes in patients with both diseases extend over their entire lifetime and can be detected even in an infant. Lysosomal storage diseases should be taken into consideration in the differential diagnosis of relevant diverse symptoms, because treatment, when available, is most effective when started early. The main therapeutic concepts are enzymatic replacement for Pompe disease, whereas patients with Fabry disease require additional oral chaperone treatment or enzyme replacement.
Collapse
Affiliation(s)
- Korbinian Benz
- Department of Oral Surgery and Dental Emergency Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany.
| | - Philipp Hahn
- Clinic for Child and Adolescent Medicine, Faculty of Medicine, Ruhr-University Bochum, Alexandrinenstr. 5, 44791 Bochum, Germany
| | - Marcel Hanisch
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Straße 33, 48149 Münster, Germany
| | - Katrin Lücke
- Private Practice, Breddestr. 20, 58452 Witten, Germany
| | - Thomas Lücke
- Clinic for Child and Adolescent Medicine, Faculty of Medicine, Ruhr-University Bochum, Alexandrinenstr. 5, 44791 Bochum, Germany
| | - Jochen Jackowski
- Department of Oral Surgery and Dental Emergency Care, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
| |
Collapse
|
22
|
Korlimarla A, Lim JA, Kishnani PS, Sun B. An emerging phenotype of central nervous system involvement in Pompe disease: from bench to bedside and beyond. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:289. [PMID: 31392201 DOI: 10.21037/atm.2019.04.49] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pompe disease (PD) is a lysosomal storage disorder caused by deficiency of the lysosomal enzyme acid-alpha glucosidase (GAA). Pathogenic variants in the GAA gene lead to excessive accumulation of lysosomal glycogen primarily in the cardiac, skeletal, and smooth muscles. There is growing evidence of central nervous system (CNS) involvement in PD. Current research is focused on determining the true extent of CNS involvement, its effects on behavior and cognition, and effective therapies that would correct the disease in both muscle and the CNS. This review article summarizes the CNS findings in patients, highlights the importance of research on animal models, explores the probable success of gene therapy in reversing CNS pathologies as reported by some breakthrough preclinical studies, and emphasizes the need to follow patients and monitor for CNS involvement over time. Lessons learned from animal models (bench) and from the literature available to date on patients will guide future clinical trials in patients (bedside) with PD. Our preliminary studies in infantile PD show that some patients are susceptible to early and extensive CNS pathologies, as assessed by neuroimaging and developmental assessments. This article highlights the importance of neuroimaging which could serve as useful tools to diagnose and monitor certain CNS pathologies such as white matter hyperintense foci (WMF) in the brain. Longitudinal studies with large sample sizes are warranted at this time to better understand the emergence, progression and consequences of CNS involvement in patients with PD.
Collapse
Affiliation(s)
- Aditi Korlimarla
- Department of Pediatrics, Division of Medical Genetics, Duke University School of Medicine, Durham, NC, USA
| | - Jeong-A Lim
- Department of Pediatrics, Division of Medical Genetics, Duke University School of Medicine, Durham, NC, USA
| | - Priya S Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University School of Medicine, Durham, NC, USA
| | - Baodong Sun
- Department of Pediatrics, Division of Medical Genetics, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
23
|
Hahn A, Schänzer A. Long-term outcome and unmet needs in infantile-onset Pompe disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:283. [PMID: 31392195 DOI: 10.21037/atm.2019.04.70] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infantile-onset Pompe disease (IOPD) is characterized by virtually complete absence of acid alpha-glucosidase (GAA)-activity, resulting in rapidly progressive hypertrophic cardiomyopathy (HCM), profound skeletal muscle weakness, and death usually within the first 12 months of life. Enzyme replacement therapy (ERT) with recombinant GAA in humans started in 1999, and pivotal studies demonstrated that the treatment ameliorated HCM, improved motor function in some patients, and prolonged overall and ventilator-free survival. These outcomes led to the approval of ERT in 2006. Implementation of ERT has uncovered multisystemic character of IOPD, not known in the pre-ERT era. Although ERT has substantially improved the prognosis of IOPD, mortality is still considerable, and decline of motor function with time is frequent in long-term survivors. This review details the new complex IOPD phenotype, outlines problems related to ERT, and highlights unmet needs.
Collapse
Affiliation(s)
- Andreas Hahn
- Department of Child Neurology, Justus-Liebig-University, Giessen, Germany
| | - Anne Schänzer
- Institute of Neuropathology, Justus-Liebig-University, Giessen, Germany
| |
Collapse
|
24
|
Tarnopolsky MA, Nilsson MI. Nutrition and exercise in Pompe disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:282. [PMID: 31392194 DOI: 10.21037/atm.2019.05.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The current standard of care for Pompe disease (PD) is the administration of enzyme replacement therapy (ERT). Exercise and nutrition are often considered as complementary strategies rather than "treatments" per se. Nutritional assessment is important in patients with locomotor disability because the relative hypodynamia limits energy expenditure and thus the total amount of energy must be reduced to avoid obesity. A lower total energy intake often leads to lower protein and micronutrient intake. Consequently, ensuring that Pompe patients are tested for and replaced for deficiencies (protein, vitamin D, vitamin B12, etc.) is an important aspect of care. Furthermore, given the role of autophagy in the pathophysiology of PD and the fact that fasting induces autophagy, it is important that strategies such as nutritional timing and amino acid intake (L-arginine, L-leucine) be evaluated as therapies. Exercise interventions have been shown to improve six-minute walk testing distance by more than what was seen in the seminal ERT study in late-onset PD. Exercise therapy can also activate autophagy, and this is likely another component of its efficacy. The current review will evaluate the theoretical and practical aspects of nutrition and exercise as therapies for patients with PD.
Collapse
Affiliation(s)
- Mark A Tarnopolsky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mats I Nilsson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
25
|
Morales-Estrella JL, Aboussouan LS. Sleep Disturbances in Patients with Disorders of the Nerve and Muscle Diseases. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
26
|
Han SO, Li S, Everitt JI, Koeberl DD. Salmeterol with Liver Depot Gene Therapy Enhances the Skeletal Muscle Response in Murine Pompe Disease. Hum Gene Ther 2019; 30:855-864. [PMID: 30803275 DOI: 10.1089/hum.2018.197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Gene therapy for Pompe disease with adeno-associated virus (AAV) vectors has advanced into early phase clinical trials; however, the paucity of cation-independent mannose-6-phosphate receptor (CI-MPR) in skeletal muscle, where it is needed to take up acid α-glucosidase (GAA), has impeded the efficacy of Pompe disease gene therapy. Long-acting selective β2 receptor agonists previously enhanced the CI-MPR expression in muscle. In this study we have evaluated the selective β2 agonist salmeterol in GAA knockout mice in combination with an AAV vector expressing human GAA specifically in the liver. Quadriceps glycogen content was significantly decreased by administration of the AAV vector with salmeterol, in comparison with the AAV vector alone (p < 0.01). Importantly, glycogen content of the quadriceps was reduced to its lowest level by the combination of AAV vector and salmeterol administration. Rotarod testing revealed significant improvement following treatment, in comparison with untreated mice, and salmeterol improved wirehang performance. Salmeterol treatment decreased abnormalities of autophagy in the quadriceps, as shown be lower LC3 and p62. Vector administration reduced the abnormal vacuolization and accumulation of nuclei in skeletal muscle. Thus, salmeterol could be further developed as adjunctive therapy to improve the efficacy of liver depot gene therapy for Pompe disease.
Collapse
Affiliation(s)
- Sang-Oh Han
- 1Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, North Carolina
| | - Songtao Li
- 1Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, North Carolina
| | - Jeffrey I Everitt
- 2Department of Pathology, Duke University Medical School, Durham, North Carolina
| | - Dwight D Koeberl
- 1Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, North Carolina.,3Department of Molecular Genetics and Metabolism, Duke University Medical School, Durham, North Carolina
| |
Collapse
|
27
|
Macroglossia, Motor Neuron Pathology, and Airway Malacia Contribute to Respiratory Insufficiency in Pompe Disease: A Commentary on Molecular Pathways and Respiratory Involvement in Lysosomal Storage Diseases. Int J Mol Sci 2019; 20:ijms20030751. [PMID: 30754627 PMCID: PMC6387234 DOI: 10.3390/ijms20030751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022] Open
Abstract
The authors of the recently published, "Molecular Pathways and Respiratory Involvement in Lysosomal Storage Diseases", provide an important review of the various mechanisms of lysosomal storage diseases (LSD) and how they culminate in similar clinical pathologies [...].
Collapse
|
28
|
Herbert M, Case LE, Rairikar M, Cope H, Bailey L, Austin SL, Kishnani PS. Early-onset of symptoms and clinical course of Pompe disease associated with the c.-32-13 T > G variant. Mol Genet Metab 2019; 126:106-116. [PMID: 30655185 PMCID: PMC9310053 DOI: 10.1016/j.ymgme.2018.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/27/2018] [Accepted: 08/17/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Individuals with late-onset Pompe disease (LOPD) and the common c.-32-13 T > G variant are widely thought to have milder, adult-onset disease. This belief, and the consequent low suspicion of clinical involvement in children, has led to delays in diagnosis and treatment initiation in patients with early onset of symptoms. Previous reports of LOPD in children do not include description of the early-onset phenotype. This description of signs and symptoms, some of which are subtle and less known, is important to facilitate prompt identification and appropriate treatment in symptomatic children. METHODS Retrospective chart review of a cohort of 84 LOPD patients with the c.-32-13 T > G variant was conducted to identify patients diagnosed clinically (as opposed to through newborn screening) who had clinically documented symptom-onset within the first two years of life. RESULTS Four patients had early onset of symptoms, with age at onset ranging from 10 days to 20 months. Initial symptoms included delay in achievement of gross motor milestones, signs of proximal muscle weakness, swallow and feeding difficulties, and sleep apnea. Early and characteristic alterations in posture and movement were identified in all patients. Age at diagnosis ranged from 10 months to 26 months. Median age at enzyme replacement therapy (ERT) initiation was 23.5 months. Despite ERT, progression of musculoskeletal involvement and residual muscle weakness was evident in all patients, as evidenced by ptosis, myopathic facies, scoliosis, lumbar lordosis, scapular winging, and trunk and lower extremity weakness. Standardized functional assessments showed gross motor function below age level as measured by the Alberta Infant Motor Scales, the Peabody Developmental Motor Scales-2, the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, and the six-minute walk test. CONCLUSIONS Onset of symptoms including delay in achievement of gross motor milestones, signs of proximal muscle weakness, swallow and feeding difficulties, and sleep apnea in the first two years of life is not uncommon in individuals with LOPD and the c.-32-13 T > G variant. Patients with early-onset disease appear to have a more, rapid and severe progression of disease with persistent residual muscle deficits which partially improve with higher doses of ERT. Careful evaluation for specific and characteristic patterns of posture and movement in patients with this variant is necessary to identify those who have early onset of disease. Increased awareness of the early-onset signs and symptoms may also enable early identification of disease onset in children who are diagnosed through newborn screening.
Collapse
Affiliation(s)
- Mrudu Herbert
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, 905 S. LaSalle street, GSRB1, Durham, NC, USA.
| | - Laura E Case
- Doctor of Physical Therapy Division, Department of Orthopedics, Duke University School of Medicine, Durham, NC, USA.
| | - Mugdha Rairikar
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, 905 S. LaSalle street, GSRB1, Durham, NC, USA
| | - Heidi Cope
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, 905 S. LaSalle street, GSRB1, Durham, NC, USA.
| | - Lauren Bailey
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, 905 S. LaSalle street, GSRB1, Durham, NC, USA.
| | - Stephanie L Austin
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, 905 S. LaSalle street, GSRB1, Durham, NC, USA.
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, 905 S. LaSalle street, GSRB1, Durham, NC, USA.
| |
Collapse
|
29
|
Bir olgu nedeniyle: infantil Pompe hastalığı ve komplikasyonlar. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.450859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
30
|
Szklanny K, Tylki-Szymańska A. Follow-up analysis of voice quality in patients with late-onset Pompe disease. Orphanet J Rare Dis 2018; 13:189. [PMID: 30367637 PMCID: PMC6204008 DOI: 10.1186/s13023-018-0932-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late-onset Pompe disease (LOPD) is a metabolic myopathy disorder characterized by progressive muscle damage and among others dysfunction of the voice apparatus, which affects speech and - above all - voice quality. Symptoms include dysphonia, instability, glottic insufficiency, and tense voice. The aim of this study was to evaluate and compare voice quality disorder in a group of 15 LOPD patients who were first examined in 2014 and then re-examined in 2017. METHODS In both 2014 and 2017, the same 15 LOPD patients, ranging in age from 15 to 57, from 10 different families, underwent the following examinations: perceptual assessment of voice quality on the RBH scale, electroglottographic recordings, and acoustic recordings. All the patients were on enzyme replacement therapy (ERT). RESULTS Three years after the 2014 study, the LOPD patients demonstrated a deterioration in voice quality. A statistically significant increase in glottic insufficiency (p = 0.0399) and a shift towards tense voice (p = 0.0417) were observed. Two patients - out of three who had received presymptomatic treatment - demonstrated stable voice quality compared with 2014. CONCLUSIONS The results suggest increased muscle weakness and progression of LOPD. The parameters Closed Quotient (calculated on the basis of an electroglottographic signal) and Peak Slope (calculated on the basis of an acoustic signal) proved to be the most sensitive.
Collapse
Affiliation(s)
- Krzysztof Szklanny
- Multimedia Department, Polish-Japanese Academy of Information Technology, Warsaw, Poland.
| | - Anna Tylki-Szymańska
- Department of Paediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute in Warsaw, Warsaw, Poland
| |
Collapse
|
31
|
Abstract
Lysosomal storage diseases (LSDs) are a group of over 70 diseases that are characterized by lysosomal dysfunction, most of which are inherited as autosomal recessive traits. These disorders are individually rare but collectively affect 1 in 5,000 live births. LSDs typically present in infancy and childhood, although adult-onset forms also occur. Most LSDs have a progressive neurodegenerative clinical course, although symptoms in other organ systems are frequent. LSD-associated genes encode different lysosomal proteins, including lysosomal enzymes and lysosomal membrane proteins. The lysosome is the key cellular hub for macromolecule catabolism, recycling and signalling, and defects that impair any of these functions cause the accumulation of undigested or partially digested macromolecules in lysosomes (that is, 'storage') or impair the transport of molecules, which can result in cellular damage. Consequently, the cellular pathogenesis of these diseases is complex and is currently incompletely understood. Several LSDs can be treated with approved, disease-specific therapies that are mostly based on enzyme replacement. However, small-molecule therapies, including substrate reduction and chaperone therapies, have also been developed and are approved for some LSDs, whereas gene therapy and genome editing are at advanced preclinical stages and, for a few disorders, have already progressed to the clinic.
Collapse
|
32
|
Keeler AM, Zieger M, Todeasa SH, McCall AL, Gifford JC, Birsak S, Choudhury SR, Byrne BJ, Sena-Esteves M, ElMallah MK. Systemic Delivery of AAVB1-GAA Clears Glycogen and Prolongs Survival in a Mouse Model of Pompe Disease. Hum Gene Ther 2018; 30:57-68. [PMID: 29901418 DOI: 10.1089/hum.2018.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pompe disease is an autosomal recessive glycogen storage disorder caused by deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA). GAA deficiency results in systemic lysosomal glycogen accumulation and cellular disruption in muscle and the central nervous system (CNS). Adeno-associated virus (AAV) gene therapy is ideal for Pompe disease, since a single systemic injection may correct both muscle and CNS pathologies. Using the Pompe mouse (B6;129-GaaTm1Rabn/J), this study sought to explore if AAVB1, a newly engineered vector with a high affinity for muscle and CNS, reduces systemic weakness and improves survival in adult mice. Three-month-old Gaa-/- animals were injected with either AAVB1 or AAV9 vectors expressing GAA and tissues were harvested 6 months later. Both AAV vectors prolonged survival. AAVB1-treated animals had a robust weight gain compared to the AAV9-treated group. Vector genome levels, GAA enzyme activity, and histological analysis indicated that both vectors transduced the heart efficiently, leading to glycogen clearance, and transduced the diaphragm and CNS at comparable levels. AAVB1-treated mice had higher GAA activity and greater glycogen clearance in the tongue. Finally, AAVB1-treated animals showed improved respiratory function comparable to wild-type animals. In conclusion, AAVB1-GAA offers a promising therapeutic option for the treatment of muscle and CNS in Pompe disease.
Collapse
Affiliation(s)
- Allison M Keeler
- 1 Division of Pulmonary Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester Massachusetts.,2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts
| | - Marina Zieger
- 1 Division of Pulmonary Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester Massachusetts.,2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts
| | - Sophia H Todeasa
- 2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts.,3 Department of Neurology, University of Massachusetts Medical School, Worcester Massachusetts
| | - Angela L McCall
- 4 Department of Pediatrics, Duke University, Durham, North Carolina
| | - Jennifer C Gifford
- 2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts.,3 Department of Neurology, University of Massachusetts Medical School, Worcester Massachusetts
| | - Samantha Birsak
- 1 Division of Pulmonary Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester Massachusetts.,2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts
| | - Sourav R Choudhury
- 2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts.,3 Department of Neurology, University of Massachusetts Medical School, Worcester Massachusetts
| | - Barry J Byrne
- 5 Department of Pediatrics, University of Florida, Gainesville, Florida.,6 Powell Gene Therapy Center, University of Florida, Gainesville, Florida
| | - Miguel Sena-Esteves
- 2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts.,3 Department of Neurology, University of Massachusetts Medical School, Worcester Massachusetts
| | - Mai K ElMallah
- 1 Division of Pulmonary Medicine, Department of Pediatrics, University of Massachusetts Medical School, Worcester Massachusetts.,2 Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester Massachusetts.,4 Department of Pediatrics, Duke University, Durham, North Carolina
| |
Collapse
|
33
|
McCall AL, Salemi J, Bhanap P, Strickland LM, Elmallah MK. The impact of Pompe disease on smooth muscle: a review. J Smooth Muscle Res 2018; 54:100-118. [PMID: 30787211 PMCID: PMC6380904 DOI: 10.1540/jsmr.54.100] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/26/2018] [Indexed: 12/24/2022] Open
Abstract
Pompe disease (OMIM 232300) is an autosomal recessive disorder caused by mutations in the gene encoding acid α-glucosidase (GAA) (EC 3.2.1.20), the enzyme responsible for hydrolyzing lysosomal glycogen. The primary cellular pathology is lysosomal glycogen accumulation in cardiac muscle, skeletal muscle, and motor neurons, which ultimately results in cardiorespiratory failure. However, the severity of pathology and its impact on clinical outcomes are poorly described in smooth muscle. The advent of enzyme replacement therapy (ERT) in 2006 has improved clinical outcomes in infantile-onset Pompe disease patients. Although ERT increases patient life expectancy and ventilator free survival, it is not entirely curative. Persistent motor neuron pathology and weakness of respiratory muscles, including airway smooth muscles, contribute to the need for mechanical ventilation by some patients on ERT. Some patients on ERT continue to experience life-threatening pathology to vascular smooth muscle, such as aneurysms or dissections within the aorta and cerebral arteries. Better characterization of the disease impact on smooth muscle will inform treatment development and help anticipate later complications. This review summarizes the published knowledge of smooth muscle pathology associated with Pompe disease in animal models and in patients.
Collapse
Affiliation(s)
- Angela L McCall
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Jeffrey Salemi
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Preeti Bhanap
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Laura M Strickland
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Mai K Elmallah
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| |
Collapse
|
34
|
Kronn DF, Day-Salvatore D, Hwu WL, Jones SA, Nakamura K, Okuyama T, Swoboda KJ, Kishnani PS. Management of Confirmed Newborn-Screened Patients With Pompe Disease Across the Disease Spectrum. Pediatrics 2017; 140:S24-S45. [PMID: 29162675 DOI: 10.1542/peds.2016-0280e] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/24/2022] Open
Abstract
After a Pompe disease diagnosis is confirmed in infants identified through newborn screening (NBS), when and if to start treatment with enzyme replacement therapy (ERT) with alglucosidase alfa must be determined. In classic infantile-onset Pompe disease, ERT should start as soon as possible. Once started, regular, routine follow-up is necessary to monitor for treatment effects, disease progression, and adverse effects. Decision-making for when or if to start ERT in late-onset Pompe disease (LOPD) is more challenging because patients typically have no measurable signs or symptoms or predictable time of symptom onset at NBS. With LOPD, adequate, ongoing follow-up and assessments for onset or progression of signs and symptoms are important to track disease state and monitor and adjust care before and after treatment is started. Because numerous tests are used to monitor patients at variable frequencies, a standardized approach across centers is lacking. Significant variability in patient assessments may result in missed opportunities for early intervention. Management of Pompe disease requires a comprehensive, multidisciplinary approach with timely disease-specific interventions that target the underlying disease process and symptom-specific manifestations. Regardless of how identified, all patients who have signs or symptoms of the disease require coordinated medical care and follow-up tailored to individual needs throughout their lives. The Pompe Disease Newborn Screening Working Group identifies key considerations before starting and during ERT; summarizes what comprises an indication to start ERT; and provides guidance on how to determine appropriate patient management and monitoring and guide the frequency and type of follow-up assessments for all patients identified through NBS.
Collapse
Affiliation(s)
- David F Kronn
- Department of Pathology and Pediatrics, New York Medical College, Valhalla, New York
| | | | - Wuh-Liang Hwu
- Department of Pediatrics and Medical Genetics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, Saint Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | | | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kathryn J Swoboda
- Center for Human Genetics Research, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | | |
Collapse
|
35
|
Guimarães MJ, Winck JC, Conde B, Mineiro A, Raposo M, Moita J, Marinho A, Silva JM, Pires N, André S, Loureiro C. Prevalence of late-onset pompe disease in Portuguese patients with diaphragmatic paralysis - DIPPER study. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:208-215. [PMID: 28499810 DOI: 10.1016/j.rppnen.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/24/2017] [Accepted: 02/15/2017] [Indexed: 11/28/2022] Open
Abstract
Pompe disease is a rare autosomal recessive neuromuscular disorder caused by acid α-glucosidase enzyme (GAA) deficiency and divided into two distinct variants, infantile- and late-onset. The late-onset variant is characterized by a spectrum of phenotypic variation that may range from asymptomatic, to reduced muscle strength and/or diaphragmatic paralysis. Since muscle strength loss is characteristic of several different conditions, which may also cause diaphragmatic paralysis, a protocol was created to search for the diagnosis of Pompe disease and exclude other possible causes. METHODS We collected a sample size of 18 patients (10 females, 8 males) with a median age of 60 years and diagnosis of diaphragmatic paralysis of unknown etiology, followed in the Pulmonology outpatient consultation of 9 centers in Portugal, over a 24-month study period. We evaluated data from patient's clinical and demographic characteristics as well as complementary diagnostic tests including blood tests, imaging, neurophysiologic and respiratory function evaluation. All patients were evaluated for GAA activity with DBS (dried blood test) or serum quantification and positive results confirmed by serum quantification and sequencing. RESULTS Three patients were diagnosed with Pompe's disease and recommended for enzyme replacement therapy. The prevalence of Pompe, a rare disease, in our diaphragmatic paralysis patient sample was 16.8%. CONCLUSION We conclude that DBS test for GAA activity should be recommended for all patients with diaphragmatic paralysis which, despite looking at all the most common causes, remains of unknown etiology; this would improve both the timing and accuracy of diagnosis for Pompe disease in this patient population. Accurate diagnosis will lead to improved care for this rare, progressively debilitating but treatable neuromuscular disease.
Collapse
Affiliation(s)
- M J Guimarães
- Hospital Guimarães, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
| | - J C Winck
- Universidade do Porto, Porto, Portugal
| | - B Conde
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - A Mineiro
- Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - M Raposo
- Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - J Moita
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Marinho
- Centro Hospitalar de São João, Porto, Portugal
| | - J M Silva
- Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - N Pires
- Hospital de Santa Maria Maior, Barcelos, Portugal
| | - S André
- Centro Hospitalar do Porto, Porto, Portugal
| | - C Loureiro
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
36
|
Longitudinal follow-up to evaluate speech disorders in early-treated patients with infantile-onset Pompe disease. Eur J Paediatr Neurol 2017; 21:485-493. [PMID: 28039015 DOI: 10.1016/j.ejpn.2016.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 11/14/2016] [Accepted: 12/06/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with infantile-onset Pompe disease (IOPD) can be treated by recombinant human acid alpha glucosidase (rhGAA) replacement beginning at birth with excellent survival rates, but they still commonly present with speech disorders. This study investigated the progress of speech disorders in these early-treated patients and ascertained the relationship with treatments. METHODS Speech disorders, including hypernasal resonance, articulation disorders, and speech intelligibility, were scored by speech-language pathologists using auditory perception in seven early-treated patients over a period of 6 years. Statistical analysis of the first and last evaluations of the patients was performed with the Wilcoxon signed-rank test. RESULTS A total of 29 speech samples were analyzed. All the patients suffered from hypernasality, articulation disorder, and impairment in speech intelligibility at the age of 3 years. The conditions were stable, and 2 patients developed normal or near normal speech during follow-up. Speech therapy and a high dose of rhGAA appeared to improve articulation in 6 of the 7 patients (86%, p = 0.028) by decreasing the omission of consonants, which consequently increased speech intelligibility (p = 0.041). Severity of hypernasality greatly reduced only in 2 patients (29%, p = 0.131). CONCLUSION Speech disorders were common even in early and successfully treated patients with IOPD; however, aggressive speech therapy and high-dose rhGAA could improve their speech disorders.
Collapse
|
37
|
Swift G, Cleary M, Grunewald S, Lozano S, Ryan M, Davison J. Swallow Prognosis and Follow-Up Protocol in Infantile Onset Pompe Disease. JIMD Rep 2016; 33:11-17. [PMID: 27344650 DOI: 10.1007/8904_2016_576] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/21/2016] [Accepted: 05/20/2016] [Indexed: 12/15/2022] Open
Abstract
Oro-pharyngeal dysphagia commonly occurs in patients with infantile onset Pompe disease (IOPD), which is a rare recessive neuromuscular disorder caused by deficiency of the lysosomal enzyme acid alpha-glucosidase. Without treatment, death occurs by 1 year of age from cardiorespiratory failure. Enzyme replacement therapy (ERT) has been used to increase life expectancy, however emerging developmental and medical morbidities have become apparent. A case file review of the feeding outcomes of 12 patients with IOPD, managed at a single tertiary centre, was undertaken. Two types of assessment had been completed: clinical feeding assessment (CFA) and instrumental videofluoroscopy swallow study (VFSS). A rating of functional oral intake at every Speech and Language Therapy feeding assessment from initial diagnosis to the most recent assessment was applied using the functional oral intake scale (FOIS).Results indicate, initial diagnosis VFSS predicts long-term feeding outcomes. Even if a patient had an improvement in oral feeding after diagnosis, over a period of time their oral intake returned to the initial diagnosis VFSS level or below. All patients (8/8) who required non-oral feeding support under 6 months of age went on to require non-oral feeding support, even if they had periods of full oral feeding. CRIM negative status predicted significant oral feeding difficulties. An evidence-based follow-up protocol was developed. The information is used at diagnosis to counsel families regarding feeding prognosis and consideration of early gastrostomy when cardiac status allows safe anaesthesia. The results reinforce that feeding changes over time and patients require on-going dysphagia monitoring.
Collapse
Affiliation(s)
- Gyani Swift
- Department of Speech and Language Therapy, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Maureen Cleary
- Department of Metabolic Medicine, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Stephanie Grunewald
- Department of Metabolic Medicine, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Sonia Lozano
- Department of Speech and Language Therapy, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - Martina Ryan
- Department of Speech and Language Therapy, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - James Davison
- Department of Metabolic Medicine, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| |
Collapse
|
38
|
Han SO, Li S, Koeberl DD. Salmeterol enhances the cardiac response to gene therapy in Pompe disease. Mol Genet Metab 2016; 118:35-40. [PMID: 27017193 PMCID: PMC4833676 DOI: 10.1016/j.ymgme.2016.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/16/2016] [Accepted: 03/16/2016] [Indexed: 12/21/2022]
Abstract
Enzyme replacement therapy (ERT) with recombinant human (rh) acid α-glucosidase (GAA) has prolonged the survival of patients. However, the paucity of cation-independent mannose-6-phosphate receptor (CI-MPR) in skeletal muscle, where it is needed to take up rhGAA, correlated with a poor response to ERT by muscle in Pompe disease. Clenbuterol, a selective β2 receptor agonist, enhanced the CI-MPR expression in striated muscle through Igf-1 mediated muscle hypertrophy, which correlated with increased CI-MPR (also the Igf-2 receptor) expression. In this study we have evaluated 4 new drugs in GAA knockout (KO) mice in combination with an adeno-associated virus (AAV) vector encoding human GAA, 3 alternative β2 agonists and dehydroepiandrosterone (DHEA). Mice were injected with AAV2/9-CBhGAA (1E+11 vector particles) at a dose that was not effective at clearing glycogen storage from the heart. Heart GAA activity was significantly increased by either salmeterol (p<0.01) or DHEA (p<0.05), in comparison with untreated mice. Furthermore, glycogen content was reduced in the heart by treatment with DHEA (p<0.001), salmeterol (p<0.05), formoterol (p<0.01), or clenbuterol (p<0.01) in combination with the AAV vector, in comparison with untreated GAA-KO mice. Wirehang testing revealed that salmeterol and the AAV vector significantly increased performance, in comparison with the AAV vector alone (p<0.001). Similarly, salmeterol with the vector increased performance significantly more than any of the other drugs. The most effective individual drugs had no significant effect in absence of vector, in comparison with untreated mice. Thus, salmeterol should be further developed as adjunctive therapy in combination with either ERT or gene therapy for Pompe disease.
Collapse
Affiliation(s)
- Sang-Oh Han
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Songtao Li
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Dwight D Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| |
Collapse
|
39
|
Pompe Disease: Diagnosis and Management. Evidence-Based Guidelines from a Canadian Expert Panel. Can J Neurol Sci 2016; 43:472-85. [DOI: 10.1017/cjn.2016.37] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPompe disease is a lysosomal storage disorder caused by a deficiency of the enzyme acid alpha-glucosidase. Patients have skeletal muscle and respiratory weakness with or without cardiomyopathy. The objective of our review was to systematically evaluate the quality of evidence from the literature to formulate evidence-based guidelines for the diagnosis and management of patients with Pompe disease. The literature review was conducted using published literature, clinical trials, cohort studies and systematic reviews. Cardinal treatment decisions produced seven management guidelines and were assigned a GRADE classification based on the quality of evidence in the published literature. In addition, six recommendations were made based on best clinical practices but with insufficient data to form a guideline. Studying outcomes in rare diseases is challenging due to the small number of patients, but this is in particular the reason why we believe that informed treatment decisions need to consider the quality of the evidence.
Collapse
|
40
|
van den Engel-Hoek L, de Groot IJM, de Swart BJM, Erasmus CE. Feeding and Swallowing Disorders in Pediatric Neuromuscular Diseases: An Overview. J Neuromuscul Dis 2015; 2:357-369. [PMID: 27858755 PMCID: PMC5240596 DOI: 10.3233/jnd-150122] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Feeding and swallowing problems in infants and children have a great impact on health and wellbeing. The aim of this study was to provide an overview of recognized feeding and swallowing problems in different groups of children with neuromuscular diseases, based on relevant literature and expert opinion, and to propose recommendations for the assessment and treatment of these problems. Almost all pediatric neuromuscular diseases are accompanied by feeding and swallowing problems during the different phases of deglutition, problems that give rise to a wide variety of signs and symptoms, which emphasizes the importance of a comprehensive feeding and swallowing assessment by a speech and language therapist.
Collapse
Affiliation(s)
- Lenie van den Engel-Hoek
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Imelda J M de Groot
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bert J M de Swart
- Donders Centre for Neuroscience, Department of Rehabilitation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Donders Centre for Neuroscience, Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
41
|
LaMantia AS, Moody SA, Maynard TM, Karpinski BA, Zohn IE, Mendelowitz D, Lee NH, Popratiloff A. Hard to swallow: Developmental biological insights into pediatric dysphagia. Dev Biol 2015; 409:329-42. [PMID: 26554723 DOI: 10.1016/j.ydbio.2015.09.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 12/16/2022]
Abstract
Pediatric dysphagia-feeding and swallowing difficulties that begin at birth, last throughout childhood, and continue into maturity--is one of the most common, least understood complications in children with developmental disorders. We argue that a major cause of pediatric dysphagia is altered hindbrain patterning during pre-natal development. Such changes can compromise craniofacial structures including oropharyngeal muscles and skeletal elements as well as motor and sensory circuits necessary for normal feeding and swallowing. Animal models of developmental disorders that include pediatric dysphagia in their phenotypic spectrum can provide mechanistic insight into pathogenesis of feeding and swallowing difficulties. A fairly common human genetic developmental disorder, DiGeorge/22q11.2 Deletion Syndrome (22q11DS) includes a substantial incidence of pediatric dysphagia in its phenotypic spectrum. Infant mice carrying a parallel deletion to 22q11DS patients have feeding and swallowing difficulties that approximate those seen in pediatric dysphagia. Altered hindbrain patterning, craniofacial malformations, and changes in cranial nerve growth prefigure these difficulties. Thus, in addition to craniofacial and pharyngeal anomalies that arise independently of altered neural development, pediatric dysphagia may result from disrupted hindbrain patterning and its impact on peripheral and central neural circuit development critical for feeding and swallowing. The mechanisms that disrupt hindbrain patterning and circuitry may provide a foundation to develop novel therapeutic approaches for improved clinical management of pediatric dysphagia.
Collapse
Affiliation(s)
- Anthony-Samuel LaMantia
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Sally A Moody
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Thomas M Maynard
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Beverly A Karpinski
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Irene E Zohn
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Center for Neuroscience Research, Children's National Health System, Washington D.C., USA
| | - David Mendelowitz
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Norman H Lee
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Pharmacology and Physiology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| | - Anastas Popratiloff
- Institute for Neuroscience, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA; Department of Anatomy and Regenerative Biology, George Washington University, School of Medicine and Health Sciences, Washington D.C., USA
| |
Collapse
|
42
|
Chien YH, Hwu WL, Lee NC. Advances in newborn screening for Pompe disease and resulting clinical outcomes. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2016.1107472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
43
|
Han SO, Li S, Bird A, Koeberl D. Synergistic Efficacy from Gene Therapy with Coreceptor Blockade and a β2-Agonist in Murine Pompe Disease. Hum Gene Ther 2015; 26:743-50. [PMID: 26417913 DOI: 10.1089/hum.2015.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pompe disease (glycogen storage disease type II; acid maltase deficiency) is a devastating myopathy resulting from acid α-glucosidase (GAA) deficiency in striated and smooth muscle. Despite the availability of enzyme replacement therapy (ERT) with recombinant human GAA (rhGAA), the limitations of ERT have prompted the preclinical development of gene therapy. Gene therapy has the advantage of continuously producing GAA, in contrast to ERT, which requires frequent injections of rhGAA. An adeno-associated viral (AAV) vector containing a muscle-specific promoter, AAV-MHCK7hGAApA, achieved high GAA expression in heart and skeletal muscle in mice with Pompe disease. However, elevated GAA activity was not sufficient to completely clear accumulated glycogen in skeletal muscle. The process of glycogen clearance from lysosomes might require improved trafficking of GAA to the lysosomes in skeletal muscle, previously achieved with the β(2)-agonist clenbuterol that enhanced glycogen clearance in skeletal muscle without increasing GAA activity. Glycogen clearance was clearly enhanced by treatment with a nondepleting anti-CD4 monoclonal antibody (anti-CD4 mAb) along with muscle-specific GAA expression in cardiac muscle, but that treatment was not effective in skeletal muscle. Furthermore, anti-CD4 mAb treatment along with clenbuterol achieved synergistic therapeutic efficacy in both cardiac and skeletal muscle. This triple therapy increased both muscle strength and weight gain. Overall, triple therapy to enhance GAA trafficking and to suppress immune responses significantly improved the efficacy of muscle-targeted gene therapy in murine Pompe disease.
Collapse
Affiliation(s)
- Sang-oh Han
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Songtao Li
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Andrew Bird
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Dwight Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| |
Collapse
|
44
|
Chien YH, Lee NC, Chen CA, Tsai FJ, Tsai WH, Shieh JY, Huang HJ, Hsu WC, Tsai TH, Hwu WL. Long-term prognosis of patients with infantile-onset Pompe disease diagnosed by newborn screening and treated since birth. J Pediatr 2015; 166:985-91.e1-2. [PMID: 25466677 DOI: 10.1016/j.jpeds.2014.10.068] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/25/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the benefit of newborn screening for the long-term prognosis of patients with classic infantile-onset Pompe disease (IOPD). STUDY DESIGN A cohort of patients with classic IOPD were diagnosed by newborn screening, treated with recombinant human acid α-glucosidase (rhGAA), and followed prospectively. Outcome measurements included survival, left ventricular mass, serum creatinine kinase, motor function, mental development, and systemic manifestations. RESULTS Ten patients who presented with left ventricular hypertrophy at diagnosis received rhGAA infusions starting at a median age of 16 days (6-34 days). All patients were cross-reactive immunologic material-positive. After a median treatment time of 63 months (range 28-90 months), all could walk independently, and none required mechanical ventilation. All patients had motor capability sufficient for participating in daily activities, but muscle weakness over the pelvic girdle appeared gradually after 2 years of age. Ptosis was present in one-half of the patients, and speech disorders were common. Anti-rhGAA antibody titers were low (median maximal titer value 1:1600, range: undetectable ∼ 1:12,800). CONCLUSION By studying patients treated since birth who have no significant anti-rhGAA antibody interference, this prospective study demonstrates that the efficacy of rhGAA therapy is high and consistent for the treatment of classic IOPD. This study also exposes limitations of rhGAA treatment. The etiology of the manifestations in these early-treated patients will require further study.
Collapse
Affiliation(s)
- Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Fuu-Jen Tsai
- Department of Pediatrics and Medical Genetics, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Hui Tsai
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiang-Ju Huang
- Department of Rehabilitation Medicine, Chen-Hsin Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hsun Tsai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
45
|
Postmortem Findings and Clinical Correlates in Individuals with Infantile-Onset Pompe Disease. JIMD Rep 2015; 23:45-54. [PMID: 25763511 DOI: 10.1007/8904_2015_426] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/12/2015] [Accepted: 02/18/2015] [Indexed: 12/12/2022] Open
Abstract
Pompe disease (OMIM 232300), a glycogen storage disorder caused by deficiency in the lysosomal enzyme acid alpha-glucosidase (EC 3.2.1.20), results in weakness and cardiomyopathy in infants affected with the classic form. Although the primary disease manifestations are due to glycogen accumulation in skeletal and cardiac muscle, glycogen also accumulates in a variety of additional tissues. To improve our understanding of disease pathogenesis in long-term survivors, we reviewed postmortem results for three infants with the classic form of Pompe disease. We have observed a number of new complications in long-term survivors of infantile-onset Pompe disease, and we focused this postmortem study on pathological correlates. Findings in survivors include cardiac arrhythmias, which may be related to glycogen accumulation in cardiac conduction tissue; urinary incontinence, likely due to glycogen accumulation in smooth muscle; and refractory errors, possibly related to accumulation in ocular structures. These observations provide potential pathophysiologic correlates for complications in long-term survivors of infantile Pompe disease.
Collapse
|
46
|
Kansagra S, Austin S, DeArmey S, Kazi Z, Kravitz RM, Kishnani PS. Longitudinal polysomnographic findings in infantile Pompe disease. Am J Med Genet A 2015; 167A:858-61. [DOI: 10.1002/ajmg.a.37007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 01/19/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Sujay Kansagra
- Division of Pediatric Neurology; Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Stephanie Austin
- Division of Medical Genetics; Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Stephanie DeArmey
- Division of Medical Genetics; Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Zoheb Kazi
- Division of Medical Genetics; Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Richard M Kravitz
- Division of Pulmonary and Sleep Medicine; Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Priya S Kishnani
- Division of Medical Genetics; Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| |
Collapse
|
47
|
Sustained correction of motoneuron histopathology following intramuscular delivery of AAV in pompe mice. Mol Ther 2013; 22:702-12. [PMID: 24336173 DOI: 10.1038/mt.2013.282] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 12/06/2013] [Indexed: 12/12/2022] Open
Abstract
Pompe disease is an autosomal recessive disorder caused by mutations in the acid-α glucosidase (GAA) gene. Lingual dysfunction is prominent but does not respond to conventional enzyme replacement therapy (ERT). Using Pompe (Gaa(-/-)) mice, we tested the hypothesis that intralingual delivery of viral vectors encoding GAA results in GAA expression and glycogen clearance in both tongue myofibers and hypoglossal (XII) motoneurons. An intralingual injection of an adeno-associated virus (AAV) vector encoding GAA (serotypes 1 or 9; 1 × 10(11) vector genomes, CMV promoter) was performed in 2-month-old Gaa(-/-) mice, and tissues were harvested 4 months later. Both serotypes robustly transduced tongue myofibers with histological confirmation of GAA expression (immunochemistry) and glycogen clearance (Period acid-Schiff stain). Both vectors also led to medullary transgene expression. GAA-positive motoneurons did not show the histopathologic features which are typical in Pompe disease and animal models. Intralingual injection with the AAV9 vector resulted in approximately threefold more GAA-positive XII motoneurons (P < 0.02 versus AAV1); the AAV9 group also gained more body weight over the course of the study (P < 0.05 versus AAV1 and sham). We conclude that intralingual injection of AAV1 or AAV9 drives persistent GAA expression in tongue myofibers and motoneurons, but AAV9 may more effectively target motoneurons.
Collapse
|
48
|
Fuller DD, ElMallah MK, Smith BK, Corti M, Lawson LA, Falk DJ, Byrne BJ. The respiratory neuromuscular system in Pompe disease. Respir Physiol Neurobiol 2013; 189:241-9. [PMID: 23797185 PMCID: PMC4083814 DOI: 10.1016/j.resp.2013.06.007] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 11/17/2022]
Abstract
Pompe disease is due to mutations in the gene encoding the lysosomal enzyme acid α-glucosidase (GAA). Absence of functional GAA typically results in cardiorespiratory failure in the first year; reduced GAA activity is associated with progressive respiratory failure later in life. While skeletal muscle pathology contributes to respiratory insufficiency in Pompe disease, emerging evidence indicates that respiratory neuron dysfunction is also a significant part of dysfunction in motor units. Animal models show profound glycogen accumulation in spinal and medullary respiratory neurons and altered neural activity. Tissues from Pompe patients show central nervous system glycogen accumulation and motoneuron pathology. A neural mechanism raises considerations about the current clinical approach of enzyme replacement since the recombinant protein does not cross the blood-brain-barrier. Indeed, clinical data suggest that enzyme replacement therapy delays symptom progression, but many patients eventually require ventilatory assistance, especially during sleep. We propose that treatments which restore GAA activity to respiratory muscles, neurons and networks will be required to fully correct ventilatory insufficiency in Pompe disease.
Collapse
Affiliation(s)
- David D. Fuller
- Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States
| | - Mai K. ElMallah
- Department of Pediatrics, Division of Pulmonary Medicine, University of Florida, Gainesville, FL 32610, United States
| | - Barbara K. Smith
- Department of Physical Therapy and McKnight Brain Institute, University of Florida, Gainesville, FL 32610, United States
| | - Manuela Corti
- Department of Pediatrics, Child Health Research Institute, University of Florida, Gainesville, FL 32610, United States
| | - Lee Ann Lawson
- Department of Pediatrics, Child Health Research Institute, University of Florida, Gainesville, FL 32610, United States
| | - Darin J. Falk
- Department of Pediatrics, Child Health Research Institute, University of Florida, Gainesville, FL 32610, United States
- Powell Gene Therapy Center, University of Florida, Gainesville, FL 32610, United States
| | - Barry J. Byrne
- Department of Pediatrics, Child Health Research Institute, University of Florida, Gainesville, FL 32610, United States
- Powell Gene Therapy Center, University of Florida, Gainesville, FL 32610, United States
| |
Collapse
|
49
|
Kansagra S, Austin S, DeArmey S, Kishnani PS, Kravitz RM. Polysomnographic findings in infantile Pompe disease. Am J Med Genet A 2013; 161A:3196-200. [DOI: 10.1002/ajmg.a.36227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 08/18/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Sujay Kansagra
- Division of Pediatric Neurology, Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Stephanie Austin
- Division of Medical Genetics, Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Stephanie DeArmey
- Division of Medical Genetics, Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Priya S. Kishnani
- Division of Medical Genetics, Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| | - Richard M. Kravitz
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics; Duke University Medical Center; Durham North Carolina
| |
Collapse
|
50
|
Chien YH, Hwu WL, Lee NC. Pompe disease: early diagnosis and early treatment make a difference. Pediatr Neonatol 2013; 54:219-27. [PMID: 23632029 DOI: 10.1016/j.pedneo.2013.03.009] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 03/22/2013] [Indexed: 11/16/2022] Open
Abstract
Pompe disease (glycogen storage disease type II or acid maltase deficiency) is a lysosomal disorder in which acid α-glucosidase (GAA) deficiencies lead to intralysosomal accumulation of glycogen in all tissues; most notably in skeletal muscles. Both the patient's age at the onset of Pompe disease symptoms and the rate of deterioration caused by the disease can vary considerably. In classical infant-onset Pompe disease (IOPD), symptoms start very early in life, and death occurs soon afterward if the disease remains untreated. In later-onset Pompe disease, symptoms are slower to appear, and patients often progress to wheelchair confinement and eventual respiratory failure. A diagnosis can be made by screening for GAA in dried blood samples, followed either by GAA assessment in lymphocytes or in fibroblasts or by the genetic analysis of mutations. Treatment by enzyme replacement therapy (ERT) with alglucosidase alfa was approved for human use in 2006. In classical IOPD, treatment significantly lengthens survival and improves motor development and cardiac function. The sooner ERT begins, the better are the results. Newborn screening aims to take advantage of different technologies for diagnosing and treating newborns early on and it yields better outcomes. However, newborns diagnosed early and other long-term survivors may encounter fresh problems, making up a new phenotype of IOPD patients. Further modifications of the treatment, such as a decrease in immune responses to ERT, a higher dosage, a better uptake formulation, and gene therapy delivered locally or systemically are being explored.
Collapse
Affiliation(s)
- Yin-Hsiu Chien
- Department of Medical Genetics and Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | | |
Collapse
|