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Zhao Y, Yu X, Li D, He J, Li Y, Zhang B, Zhang N, Wang Q, Yan C. Intracranial vasculopathy: an important organ damage in young adult patients with late-onset Pompe disease. Orphanet J Rare Dis 2024; 19:267. [PMID: 39010129 PMCID: PMC11250947 DOI: 10.1186/s13023-024-03282-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 07/03/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Late-onset Pompe disease (LOPD) is mainly characterized by progressive limb-girdle muscle weakness and respiratory impairment, whereas stroke and cerebrovascular abnormalities have been insufficiently studied in LOPD. This study aimed to evaluate the frequency and pattern of intracranial artery and brain parenchyma abnormalities in LOPD patients. RESULTS Neuroimaging data from 30 Chinese adult LOPD patients were collected from our center. Seven patients (7/30) had acute cerebral infarction or hemorrhage. Brain magnetic resonance angiography (MRA) or computed tomography angiography (CTA) revealed artery abnormalities in 23 patients (23/30). Dilative arteriopathy was found in 19 patients (19/30), with vertebrobasilar dolichoectasia found in 17 patients and dilatation of the anterior circulation arteries found in 8 patients. The maximum diameter of the basilar artery was correlated with disease duration (p < 0.05). In addition, aneurysms (7/30) and fenestrations (3/30) were discovered. There were 14 patients with arterial stenosis (14/30), and both anterior and posterior circulation involvement occurred in 9 patients (9/14). Stenosis and dilative arteriopathy simultaneously occurred in 10 patients (10/30). White matter hyperintensities were present in 13 patients (13/28). Microbleeds, predominantly located in the cerebellum and brainstem, were detected in 7 patients (7/22) via susceptibility-weighted imaging. CONCLUSIONS Intracranial vasculopathy involving both large arteries and small vessels is an important organ damage in LOPD patients. LOPD should be considered a key differential diagnosis in young adults with cryptogenic stroke, and a series of imaging evaluations of the brain and intracranial blood vessels is recommended as a routine workup in adult LOPD patients.
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Affiliation(s)
- Yuying Zhao
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Xiaolin Yu
- Department of Geriatric Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Duoling Li
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Jingzhen He
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yuzhi Li
- Department of Neurology, Jining NO.1 People's Hospital, Jining, 272002, China
| | - Bin Zhang
- Department of Neurology, Liaocheng People's Hospital, Liaocheng, 252000, China
| | - Na Zhang
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qian Wang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
| | - Chuanzhu Yan
- Research Institute of Neuromuscular and Neurodegenerative Diseases and Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- Mitochondrial Medicine Laboratory, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, China.
- Brain Science Research Institute, Shandong University, Jinan, 250012, China.
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2
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Enokizono M, Kurokawa R, Yagishita A, Nakata Y, Koyasu S, Nihira H, Kuwashima S, Aida N, Kono T, Mori H. Clinical and neuroimaging review of monogenic cerebral small vessel disease from the prenatal to adolescent developmental stage. Jpn J Radiol 2024; 42:109-125. [PMID: 37847489 PMCID: PMC10810974 DOI: 10.1007/s11604-023-01493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
Cerebral small vessel disease (cSVD) refers to a group of pathological processes with various etiologies affecting the small vessels of the brain. Most cases are sporadic, with age-related and hypertension-related sSVD and cerebral amyloid angiopathy being the most prevalent forms. Monogenic cSVD accounts for up to 5% of causes of stroke. Several causative genes have been identified. Sporadic cSVD has been widely studied whereas monogenic cSVD is still poorly characterized and understood. The majority of cases of both the sporadic and monogenic types, including cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), typically have their onset in adulthood. Types of cSVD with infantile and childhood onset are rare, and their diagnosis is often challenging. The present review discusses the clinical and neuroimaging findings of monogenic cSVD from the prenatal to adolescent period of development. Early diagnosis is crucial to enabling timely interventions and family counseling.
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Affiliation(s)
- Mikako Enokizono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akira Yagishita
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Yasuhiro Nakata
- Department of Neuroradiology, Tokyo Metropolitan Neurological Hospital, Fuchu, Tokyo, Japan
| | - Sho Koyasu
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Hiroshi Nihira
- Department of Pediatrics, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Shigeko Kuwashima
- Department of Radiology, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Noriko Aida
- Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Kanagawa, Japan
| | - Tatsuo Kono
- Department of Radiology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Harushi Mori
- Department of Radiology, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Labella B, Cotti Piccinelli S, Risi B, Caria F, Damioli S, Bertella E, Poli L, Padovani A, Filosto M. A Comprehensive Update on Late-Onset Pompe Disease. Biomolecules 2023; 13:1279. [PMID: 37759679 PMCID: PMC10526932 DOI: 10.3390/biom13091279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Pompe disease (PD) is an autosomal recessive disorder caused by mutations in the GAA gene that lead to a deficiency in the acid alpha-glucosidase enzyme. Two clinical presentations are usually considered, named infantile-onset Pompe disease (IOPD) and late-onset Pompe disease (LOPD), which differ in age of onset, organ involvement, and severity of disease. Assessment of acid alpha-glucosidase activity on a dried blood spot is the first-line screening test, which needs to be confirmed by genetic analysis in case of suspected deficiency. LOPD is a multi-system disease, thus requiring a multidisciplinary approach for efficacious management. Enzyme replacement therapy (ERT), which was introduced over 15 years ago, changes the natural progression of the disease. However, it has limitations, including a reduction in efficacy over time and heterogeneous therapeutic responses among patients. Novel therapeutic approaches, such as gene therapy, are currently under study. We provide a comprehensive review of diagnostic advances in LOPD and a critical discussion about the advantages and limitations of current and future treatments.
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Affiliation(s)
- Beatrice Labella
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (B.L.); (S.C.P.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (B.L.); (S.C.P.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Brescia, Italy; (B.R.); (F.C.); (S.D.); (E.B.)
| | - Barbara Risi
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Brescia, Italy; (B.R.); (F.C.); (S.D.); (E.B.)
| | - Filomena Caria
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Brescia, Italy; (B.R.); (F.C.); (S.D.); (E.B.)
| | - Simona Damioli
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Brescia, Italy; (B.R.); (F.C.); (S.D.); (E.B.)
| | - Enrica Bertella
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Brescia, Italy; (B.R.); (F.C.); (S.D.); (E.B.)
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (B.L.); (S.C.P.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (B.L.); (S.C.P.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, 25064 Brescia, Italy; (B.R.); (F.C.); (S.D.); (E.B.)
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4
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Hensel O, Burow P, Kraya T, Stoevesandt D, Naegel S. Vertebrobasilar artery elongation in migraine-a retrospective cross-sectional study. Acta Neurol Belg 2023; 123:441-450. [PMID: 35906498 PMCID: PMC10133057 DOI: 10.1007/s13760-022-02039-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous but inconclusive findings have sparked an ongoing debate about whether the arteries of migraine patients undergo vascular alterations. The outlet angle of the superior cerebellar artery (SUCA) and the lateral displacement of basilar arteries are good surrogate parameters for determining elongation of the vertebrobasilar arteries. METHODS We retrospectively determined the SUCA outlet angle and the lateral displacement of the basilar artery in 63 patients with migraine (30.6 ± 8.9 years, 84% women, 16% chronic migraine, 60% migraine with aura) and compared these with 126 age- and sex-matched control subjects. RESULTS In patients with migraine, the SUCA outlet angle was lower (159 ± 26° vs. 169 ± 29°, p = 0.020) and the lateral displacement of the basilar artery was greater (3.7 ± 2.7 mm vs. 2.8 ± 2.4 mm, p = 0.020) than in the control subjects. Age, gender, migraine characteristics and presence of any cardiovascular risk factors did not affect the SUCA outlet angle or lateral displacement of the basilar artery. CONCLUSION Migraine patients exhibited a lower SUCA outlet angle and greater lateral displacement of the basilar arteries. Both may be attributable to the elongation of the vertebrobasilar arteries, which is an indication of arterial wall pathology in migraine.
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Affiliation(s)
- Ole Hensel
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany.
| | - Philipp Burow
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Torsten Kraya
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
- Department of Neurology, St. Georg Hospital Leipzig, Leipzig, Germany
| | - Dietrich Stoevesandt
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
| | - Steffen Naegel
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, University Hospital Halle, Halle (Saale), Germany
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5
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Stevens D, Milani-Nejad S, Mozaffar T. Pompe Disease: a Clinical, Diagnostic, and Therapeutic Overview. Curr Treat Options Neurol 2022; 24:573-588. [PMID: 36969713 PMCID: PMC10035871 DOI: 10.1007/s11940-022-00736-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
This review summarizes the clinical presentation and provides an update on the current strategies for diagnosis of Pompe disease. We will review the available treatment options. We examine newly approved treatments as well as upcoming therapies in this condition. We also provide commentary on the unmet needs in clinical management and research for this disease.
Recent Findings
In March 2015, Pompe disease was added to the Recommended Uniform Screening Panel (RUSP) and since then a number of states have added Pompe disease to their slate of diseases for their Newborn Screening (NBS) program. Data emerging from these programs is revising our knowledge of incidence of Pompe disease. In 2021, two randomized controlled trials involving new forms of enzyme replacement therapy (ERT) were completed and one new product is already FDA-approved and on the market, whereas the other product will come up for FDA review in the fall. Neither of the new ERT were shown to be superior to the standard of care product, alglucosidase. The long-term effectiveness of these newer forms of ERT is unclear. Newer versions of the ERT are in development in addition to multiple different strategies of gene therapy to deliver GAA, the gene responsible for producing acid alpha-glucosidase, the defective protein in Pompe Disease. Glycogen substrate reduction is also in development in Pompe disease and other glycogen storage disorders.
Summary
There are significant unmet needs as it relates to clinical care and therapeutics in Pompe disease as well as in research. The currently available treatments lose effectiveness over the long run and do not have penetration into neuronal tissues and inconsistent penetration in certain muscles. More definitive gene therapy and enzyme replacement strategies are currently in development and testing.
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Affiliation(s)
- David Stevens
- Departments of Neurology, 200 S. Manchester Avenue, Ste. 206, Orange, CA 92868, USA
| | - Shadi Milani-Nejad
- Departments of Neurology, 200 S. Manchester Avenue, Ste. 206, Orange, CA 92868, USA
| | - Tahseen Mozaffar
- Departments of Neurology, 200 S. Manchester Avenue, Ste. 206, Orange, CA 92868, USA
- Pathology & Laboratory Medicine, School of Medicine, University of California, Irvine, USA
- The Institute for Immunology, School of Medicine, University of California, Irvine, USA
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6
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Al Shehri A, Al-Asmi A, Al Salti AM, Almadani A, Hassan A, Bamaga AK, Cupler EJ, Al-Hashel J, Alabdali MM, Alanazy MH, Noori S. A Multidisciplinary Perspective Addressing the Diagnostic Challenges of Late-Onset Pompe Disease in the Arabian Peninsula Region Developed From an Expert Group Meeting. J Neuromuscul Dis 2022; 9:661-673. [PMID: 35754286 PMCID: PMC9535603 DOI: 10.3233/jnd-220819] [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: 11/15/2022]
Abstract
Pompe disease is a rare, metabolic, autosomal recessive disorder. Early diagnosis is critical for progressive Pompe disease as delays can significantly alter the clinical course of the disease. Diagnostic modalities, including dried blood spot testing and genetic testing, are available and are effective for diagnosing patients with late-onset Pompe disease (LOPD). However, clinicians face numerous clinical challenges related to the diagnosis of the disease. Two expert group committee meetings, involving 11 experts from the United Arab Emirates, Kuwait, the Kingdom of Saudi Arabia, and Oman, were convened in October 2019 and November 2020 respectively to develop a uniform diagnostic algorithm for the diagnosis of pediatric and adult LOPD in the Arabian Peninsula region. During the first meeting, the specialty-specific clinical presentation of LOPD was defined. During the second meeting, a diagnostic algorithm was developed after a thorough validation of clinical presentation or symptoms, which was performed with the aid of existing literature and expert judgement. A consensus was reached on the diagnostic algorithm for field specialists, such as neurologists, rheumatologists, general practitioners/internal medicine specialists, orthopedic specialists, and pulmonologists. This specialty-specific diagnostic referral algorithm for pediatric and adult LOPD will guide clinicians in the differential diagnosis of LOPD.
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Affiliation(s)
- Ali Al Shehri
- Neuromuscular Integrated Practice Unit, Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Al-Asmi
- Neurology Unit, Medicine Department, College of Medicine and Health Sciences andSultan Qabos University Hospital, Sultan Qaboos University, Muscat, Oman
| | | | | | - Ali Hassan
- Head of Neurology Department, Tawam Hospital, AlAin, Abu Dhabi, UAE
| | - Ahmed K Bamaga
- Neurology Division, Pediatric Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Pediatric Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Edward J Cupler
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Jasem Al-Hashel
- Head of Department Neurology, Ebn Sina Neurosurgery Center, Al Jahra, Kuwait
| | - Majed M Alabdali
- Department of Neurology, College of Medicine, Imam Abdulrahman bin Faisal University
| | - Mohammed H Alanazy
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Suzan Noori
- Head of Department Neurology, University Hospital of Sharjah (UHS), Milahah, UAE
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7
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van den Dorpel JJA, van der Vlugt WMC, Dremmen MHG, Muetzel R, van den Berg E, Hest R, de Kriek J, Brusse E, van Doorn PA, van der Ploeg AT, van den Hout JMP, van der Beek NAME. Is the brain involved in patients with late-onset Pompe disease? J Inherit Metab Dis 2022; 45:493-501. [PMID: 34927739 PMCID: PMC9306606 DOI: 10.1002/jimd.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/25/2021] [Accepted: 12/14/2021] [Indexed: 11/15/2022]
Abstract
Our objective was to investigate brain structure, cerebral vasculature, and cognitive function in a cohort of patients with late-onset Pompe disease, with particular reference to the differences from those with the classic infantile phenotype, where extensive white-matter abnormalities (WMA) and impaired cognition on long-term enzyme treatment are reported in a subset of patients. Brain imaging (T1, T2, T2 fluid-attenuated inversion recovery, susceptibility-weighted images, and magnetic resonance angiography-time of flight) was combined with extensive cognitive testing of general intelligence (Wechsler IQ Test, Montreal Cognitive Assessment [MoCA]) and specific neuropsychological domains (verbal fluency, cognitive flexibility, attention, memory, and visuospatial abilities). We included 19 patients with late-onset Pompe disease (age range 11-56 years). Two patients showed mild punctate WMA within normal range for age, with a Fazekas score (FS) of 1 to 2. Magnetic resonance angiography revealed a slight vertebrobasilar dolichoectasia in two patients yet did not show any aneurysms or vascular dissections. Most patients had age-adjusted scores within the normal range for the Wechsler index scores (verbal comprehension, perceptual reasoning, working memory, and processing speed) and combined total intelligence (IQ) score (median 101, interquartile range 91-111; one patient had a below-average score for total IQ) as well as for the specific domains verbal fluency, attention, and memory. A subset of patients performed suboptimally on the Rey Complex Figure Test (9/14 patients) or cube-copying/clock-drawing test of the MoCA (8/10 patients). We therefore concluded that our study showed no brain abnormalities, other than minor microvascular lesions considered within normal range for age, nor general cognitive impairment in late-onset Pompe patients. These findings are in sharp contrast with the widespread WMA and cognitive problems found in some classic infantile patients.
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Affiliation(s)
- Jan J. A. van den Dorpel
- Department of PediatricsErasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic DiseasesRotterdamThe Netherlands
| | | | - Marjolein H. G. Dremmen
- Department of RadiologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Ryan Muetzel
- Department of Child and Adolescent Psychiatry/PsychologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Esther van den Berg
- Department of NeurologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Roos Hest
- Department of NeurologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Joni de Kriek
- Department of NeurologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Esther Brusse
- Department of NeurologyErasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic DiseasesRotterdamThe Netherlands
| | - Pieter A. van Doorn
- Department of NeurologyErasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic DiseasesRotterdamThe Netherlands
| | - Ans T. van der Ploeg
- Department of PediatricsErasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic DiseasesRotterdamThe Netherlands
| | - Johanna M. P. van den Hout
- Department of PediatricsErasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic DiseasesRotterdamThe Netherlands
| | - Nadine A. M. E. van der Beek
- Department of NeurologyErasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic DiseasesRotterdamThe Netherlands
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8
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Korlimarla A, Lim JA, McIntosh P, Zimmerman K, Sun BD, Kishnani PS. New Insights into Gastrointestinal Involvement in Late-Onset Pompe Disease: Lessons Learned from Bench and Bedside. J Clin Med 2021; 10:jcm10153395. [PMID: 34362174 PMCID: PMC8347662 DOI: 10.3390/jcm10153395] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There are new emerging phenotypes in Pompe disease, and studies on smooth muscle pathology are limited. Gastrointestinal (GI) manifestations are poorly understood and underreported in Pompe disease. METHODS To understand the extent and the effects of enzyme replacement therapy (ERT; alglucosidase alfa) in Pompe disease, we studied the histopathology (entire GI tract) in Pompe mice (GAAKO 6neo/6neo). To determine the disease burden in patients with late-onset Pompe disease (LOPD), we used Patient-Reported Outcomes Measurements Information System (PROMIS)-GI symptom scales and a GI-focused medical history. RESULTS Pompe mice showed early, extensive, and progressive glycogen accumulation throughout the GI tract. Long-term ERT (6 months) was more effective to clear the glycogen accumulation than short-term ERT (5 weeks). GI manifestations were highly prevalent and severe, presented early in life, and were not fully amenable to ERT in patients with LOPD (n = 58; age range: 18-79 years, median age: 51.55 years; 35 females; 53 on ERT). CONCLUSION GI manifestations cause a significant disease burden on adults with LOPD, and should be evaluated during routine clinical visits, using quantitative tools (PROMIS-GI measures). The study also highlights the need for next generation therapies for Pompe disease that target the smooth muscles.
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Affiliation(s)
- Aditi Korlimarla
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA; (J.-A.L.); (B.D.S.)
- Correspondence: (A.K.); (P.S.K.)
| | - Jeong-A Lim
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA; (J.-A.L.); (B.D.S.)
| | - Paul McIntosh
- Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA;
| | | | - Baodong D. Sun
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA; (J.-A.L.); (B.D.S.)
| | - Priya S. Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA; (J.-A.L.); (B.D.S.)
- Correspondence: (A.K.); (P.S.K.)
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9
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Del Brutto VJ, Gutierrez J, Goryawala MZ, Sacco RL, Rundek T, Romano JG. Prevalence and Clinical Correlates of Intracranial Dolichoectasia in Individuals With Ischemic Stroke. Stroke 2021; 52:2311-2318. [PMID: 33980042 DOI: 10.1161/strokeaha.120.032225] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Victor J Del Brutto
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Jose Gutierrez
- Department of Neurology, Mailman School of Public Health, Columbia University (J.G.)
| | - Mohammed Z Goryawala
- Departments of Radiology (M.Z.G.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Tatjana Rundek
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
| | - Jose G Romano
- Departments of Neurology (V.J.D.B., R.L.S., T.R., J.G.R.), University of Miami Miller School of Medicine, FL
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10
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van Kooten HA, Roelen CHA, Brusse E, van der Beek NAME, Michels M, van der Ploeg AT, Wagenmakers MAEM, van Doorn PA. Cardiovascular disease in non-classic Pompe disease: A systematic review. Neuromuscul Disord 2021; 31:79-90. [PMID: 33386209 DOI: 10.1016/j.nmd.2020.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 01/14/2023]
Abstract
Pompe disease is a rare inherited metabolic and neuromuscular disorder, presenting as a spectrum, with the classic infantile form on one end and the more slowly progressive non-classic form on the other end. While being a hallmark in classic infantile Pompe disease, cardiac involvement in non-classic Pompe disease seems rare. Vascular abnormalities, such as aneurysms and arterial dolichoectasia, likely caused by glycogen accumulation in arterial walls, have been reported in non-classic Pompe patients. With this first systematic review on cardiovascular disease in non-classic Pompe disease, we aim to gain insight in the prevalence and etiology of cardiovascular disease in these patients. Forty-eight studies (eight case-control studies, 15 cohort studies and 25 case reports/series) were included. Fourteen studies reported cardiac findings, 25 studies described vascular findings, and nine studies reported both cardiac and vascular findings. Severe cardiac involvement in non-classic Pompe disease patients has rarely been reported, particularly in adult-onset patients carrying the common IVS1 mutation. There are indications that intracranial dolichoectasia and aneurysms are more prevalent in non-classic Pompe patients compared to the general population. To further investigate the prevalence of cardiovascular disease in non-classic Pompe patients, larger case-control studies that also study established cardiovascular risk factors should be conducted.
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Affiliation(s)
- H A van Kooten
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - C H A Roelen
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - E Brusse
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - N A M E van der Beek
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - M Michels
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - A T van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - M A E M Wagenmakers
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - P A van Doorn
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
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11
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Mormina E, Musumeci O, Tessitore A, Ciranni A, Tavilla G, Pitrone A, Vinci SL, Caragliano AA, Longo M, Granata F, Toscano A. Intracranial aneurysm management in patients with late-onset Pompe disease (LOPD). Neurol Sci 2020; 42:2411-2419. [PMID: 33067680 DOI: 10.1007/s10072-020-04819-2] [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: 05/30/2020] [Accepted: 10/09/2020] [Indexed: 11/25/2022]
Abstract
Pompe disease is a rare hereditary metabolic disorder caused by α-glucosidase (GAA) deficiency. The late-onset form of the disease (LOPD) is considered a multisystemic disorder which could involve vascular system with cerebrovascular abnormalities such as intracranial aneurysms or dolichoectasia. Intracranial aneurysm rupture may represent a life-threatening emergency. A possible treatment of unruptured intracranial aneurysms (UIAs) should consider both aneurysm-related (aneurysmal size, shape, localization, numbers and hemodynamic factors) and patient-related risk factors (patient's age and sex, hypertension, smoke exposure). Moreover, UIAs management of LOPD patients needs also to take into account the altered blood vessels integrity and elasticity, whose consistency is likely weakened by the deficient GAA activity as a further potential risk factor. We herein present our approach for of UIAs management in three patients with LOPD. Among them, only one patient with a left saccular UIA of the anterior communicating artery, after careful consideration of risk factors, underwent the endovascular treatment. The other two patients were scheduled for a 1-year follow-up, according to radiological, clinical, and risk evaluation features. Finally, we would like to suggest some general recommendations for UIAs management. In particular, if no risk factors are identified, a cautious yearly follow-up is suggested; otherwise, if risk factors are present, endovascular treatment should be considered.
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Affiliation(s)
- Enricomaria Mormina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy. .,Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Agostino Tessitore
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Anna Ciranni
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Graziana Tavilla
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Pitrone
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Armando Caragliano
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Marcello Longo
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98100, Messina, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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12
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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.
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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
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13
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Viamonte M, Tuna I, Rees J. Dilated Cerebral Arteriopathy in Classical Pompe Disease: A Novel Finding. Pediatr Neurol 2020; 108:117-120. [PMID: 32248988 DOI: 10.1016/j.pediatrneurol.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND In Pompe disease, glycogen deposition results in an augmentation of blood flow and abnormal remodeling, with resultant weakening of the arterial walls, which may result in pathologic dilatation of the cerebral arteries. This complication is rare in patients with late-onset Pompe disease, but it has not been well-described in infantile-onset Pompe disease. The effect of enzyme replacement therapy on this process is not known. METHODS We examined clinical and imaging data on two patients who exhibit cerebrovascular arteriopathy: a 14-year-old boy with infantile-onset Pompe disease on enzyme replacement therapy and a 23-year-old woman with late-onset Pompe disease who was also receiving enzyme replacement therapy. RESULTS Our 14-year-old patient exhibits cerebrovascular arteriopathy, primarily proximal and vertebrobasilar, while the 23-year-old patient has a more diffuse pattern. The 14-year-old patient is unique because cerebral dolichoectasias have not been described in infantile-onset Pompe disease. The 23-year-old patient is notable given the age and history of enzyme replacement therapy since age 15 years. CONCLUSIONS Dilative cerebral arteriopathy in infantile-onset Pompe disease is novel and similarly atypical is the diffuse vascular dilation seen in our young patient with late-onset Pompe disease, both receiving enzyme replacement therapy. We should be cognizant of the risk of cerebrovascular disease in Pompe disease regardless of the disease variant and enzyme replacement therapy status.
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Affiliation(s)
- Manuel Viamonte
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.
| | - Ibrahim Tuna
- Division of Neuroradiology, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida
| | - John Rees
- Division of Neuroradiology, Department of Radiology, University of Florida College of Medicine, Gainesville, Florida
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14
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Zhang DP, Yin S, Zhang HL, Li D, Song B, Liang JX. Association between Intracranial Arterial Dolichoectasia and Cerebral Small Vessel Disease and Its Underlying Mechanisms. J Stroke 2020; 22:173-184. [PMID: 32635683 PMCID: PMC7341005 DOI: 10.5853/jos.2019.02985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/06/2020] [Indexed: 12/29/2022] Open
Abstract
Intracranial arterial dolichoectasia (IADE), also known as dilatative arteriopathy of the brain vessels, refers to an increase in the length and diameter of at least one intracranial artery, and accounts for approximately 12% of all patients with stroke. However, the association of IADE with stroke is usually unclear. Cerebral small vessel disease (CSVD) is characterized by pathological changes in the small vessels. Clinically, patients with CSVD can be asymptomatic or present with stroke or cognitive decline. In the past 20 years, a series of studies have strongly promoted an understanding of the association between IADE and CSVD from clinical and pathological perspectives. It has been proposed that IADE and CSVD may be attributed to abnormal vascular remodeling driven by an abnormal matrix metalloproteinase/tissue inhibitor of metalloproteinase pathway. Also, IAD-Erelated hemodynamic changes may result in initiation or progression of CSVD. Additionally, genetic factors are implicated in the pathogenesis of IADE and CSVD. Patients with Fabry’s disease and late-onset Pompe’s disease are prone to developing concomitant IADE and CSVD, and patients with collagen IV alpha 1 or 2 gene (COL4A1/COL4A2) and forkhead box C1 (FOXC1) variants present with IADE and CSVD. Race, strain, familial status, and vascular risk factors may be involved in the pathogenesis of IADE and CSVD. As well, experiments in mice have pointed to genetic strain as a predisposing factor for IADE and CSVD. However, there have been few direct genetic studies aimed towards determining the association between IADE and CSVD. In the future, more clinical and basic research studies are needed to elucidate the causal relationship between IADE and CSVD and the related molecular and genetic mechanisms.
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Affiliation(s)
- Dao Pei Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Suo Yin
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Huai Liang Zhang
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Dan Li
- Department of Neurology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Bo Song
- Department of Neurology, The First Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jia Xu Liang
- Department of Image, The People's Hospital of Henan University of Chinese Medicine, Zhengzhou, China
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15
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Vanherpe P, Fieuws S, D'Hondt A, Bleyenheuft C, Demaerel P, De Bleecker J, Van den Bergh P, Baets J, Remiche G, Verhoeven K, Delstanche S, Toussaint M, Buyse B, Van Damme P, Depuydt CE, Claeys KG. Late-onset Pompe disease (LOPD) in Belgium: clinical characteristics and outcome measures. Orphanet J Rare Dis 2020; 15:83. [PMID: 32248831 PMCID: PMC7133011 DOI: 10.1186/s13023-020-01353-4] [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] [Received: 01/24/2020] [Accepted: 03/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background Late-onset Pompe disease (LOPD) is a rare, hereditary, progressive disorder that is usually characterized by limb-girdle muscle weakness and/or respiratory insufficiency. LOPD is caused by mutations in the acid alpha-glucosidase (GAA) gene and treated with enzyme replacement therapy (ERT). Methods We studied the clinical, brain imaging, and genetic features of the Belgian cohort of late-onset Pompe disease patients (N = 52), and explored the sensitivity of different outcome measures, during a longitudinal period of 7 years (2010–2017), including the activity limitations ActivLim score, 6 min walking distance (6MWD), 10 m walk test (10MWT), MRC sum score, and forced vital capacity (FVC) sitting/supine. Results In Belgium, we calculated an LOPD prevalence of 3.9 per million. Mean age at onset of 52 LOPD patients was 28.9 years (SD: 15.8 y), ranging from 7 months to 68 years. Seventy-five percent (N = 39) of the patients initially presented with limb-girdle weakness, whereas in 13% (N = 7) respiratory symptoms were the only initial symptom. Non-invasive ventilation (NIV) was started in 37% (N = 19), at a mean age of 49.5 years (SD: 11.9 y), with a mean duration of 15 years (SD: 10.2 y) after symptom onset. Brain imaging revealed abnormalities in 25% (N = 8) of the patients, with the presence of small cerebral aneurysm(s) in two patients and a vertebrobasilar dolichoectasia in another two. Mean diagnostic delay was 12.9 years. All patients were compound heterozygotes with the most prevalent mutation being c.-32-13 T > G in 96%. We identified two novel mutations in GAA: c.1610_1611delA and c.186dup11. For the 6MWD, MRC sum score, FVC sitting and FVC supine, we measured a significant decrease over time (p = 0.0002, p = 0.0001, p = 0.0077, p = 0.0151), which was not revealed with the ActivLim score and 10MWT (p > 0.05). Conclusions Awareness on LOPD should even be further increased because of the long diagnostic delay. The 6MWD, but not the ActivLim score, is a sensitive outcome measure to follow up LOPD patients.
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Affiliation(s)
- P Vanherpe
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - S Fieuws
- KU Leuven - University of Leuven, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | - A D'Hondt
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | | | - P Demaerel
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - J De Bleecker
- Department of Neurology, Neuromuscular Reference Centre, University Hospital Gent, Gent, Belgium
| | - P Van den Bergh
- Department of Neurology, Neuromuscular Reference Centre, University Hospital Saint-Luc, Brussels, Belgium
| | - J Baets
- Department of Neurology, Neuromuscular Reference Centre, University Hospital Antwerpen, Antwerpen, Belgium
| | - G Remiche
- Department of Neurology, Neuromuscular Reference Centre, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - K Verhoeven
- Department of Neurology, AZ Sint-Jan Brugge, Brugge, Belgium
| | - S Delstanche
- Department of Neurology, Neuromuscular Reference Centre of Liège, CHU Liège, Liège, Belgium
| | - M Toussaint
- Department of Rehabilitation, Centre for Home Mechanical Ventilation and Neuromuscular Reference Centre, Rehabilitation Hospital Inkendaal, Brussels, Belgium
| | - B Buyse
- Department of Pulmonology, Leuven University Centre for Sleep and Wake Disorders, University Hospitals Leuven, Leuven, Belgium
| | - P Van Damme
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
| | - C E Depuydt
- Department of Neurosciences - Experimental Neurology, Laboratory for Muscle Diseases and Neuropathies, KU Leuven, Leuven, Belgium
| | - K G Claeys
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Neurosciences - Experimental Neurology, Laboratory for Muscle Diseases and Neuropathies, KU Leuven, Leuven, Belgium.
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16
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Response: Late-onset Pompe disease manifests in the brain. Mol Genet Metab Rep 2019; 21:100516. [PMID: 31660291 PMCID: PMC6807269 DOI: 10.1016/j.ymgmr.2019.100516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 11/23/2022] Open
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17
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Arbustini E, Di Toro A, Giuliani L, Favalli V, Narula N, Grasso M. Cardiac Phenotypes in Hereditary Muscle Disorders: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 72:2485-2506. [PMID: 30442292 DOI: 10.1016/j.jacc.2018.08.2182] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/20/2018] [Accepted: 08/10/2018] [Indexed: 01/05/2023]
Abstract
Hereditary muscular diseases commonly involve the heart. Cardiac manifestations encompass a spectrum of phenotypes, including both cardiomyopathies and rhythm disorders. Common biomarkers suggesting cardiomuscular diseases include increased circulating creatine kinase and/or lactic acid levels or disease-specific metabolic indicators. Cardiac and extra-cardiac traits, imaging tests, family studies, and genetic testing provide precise diagnoses. Cardiac phenotypes are mainly dilated and hypokinetic in dystrophinopathies, Emery-Dreifuss muscular dystrophies, and limb girdle muscular dystrophies; hypertrophic in Friedreich ataxia, mitochondrial diseases, glycogen storage diseases, and fatty acid oxidation disorders; and restrictive in myofibrillar myopathies. Left ventricular noncompaction is variably associated with the different myopathies. Conduction defects and arrhythmias constitute a major phenotype in myotonic dystrophies and skeletal muscle channelopathies. Although the actual cardiac management is rarely based on the cause, the cardiac phenotypes need precise characterization because they are often the only or the predominant manifestations and the prognostic determinants of many hereditary muscle disorders.
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Affiliation(s)
- Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy.
| | - Alessandro Di Toro
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Giuliani
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
| | | | - Nupoor Narula
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy; Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Maurizia Grasso
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
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18
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Schneider I, Hensel O, Zierz S. White matter lesions in treated late onset Pompe disease are not different to matched controls. Mol Genet Metab 2019; 127:128-131. [PMID: 31153821 DOI: 10.1016/j.ymgme.2019.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Genetic deficiency of α-1,4-glucosidase leads to multi-systemic glycogen storage and causes muscular disorder known as classic infantile Pompe disease (CIOPD) and late onset Pompe disease (LOPD). Treatment with recombinant human alglucosidase alfa is available as enzyme replacement therapy (ERT). Recently progressive white matter lesions (WML) have been observed as a new phenotype in CIOPD patients on treatment with ERT. OBJECTIVE To investigate the impact of disease and ERT for the development of WML in LOPD. METHODS WML were analysed in 19 treated LOPD patients and compared with findings of 38 matched controls. RESULTS Patients median age was 54.4 years (range 19 to 82 years) with median disease duration of 7 years (range 2 to 40 years). Median ERT duration was 63 months (range 9 to 135 months). Grading of WML by Fazekas Score was not different in LOPD patients and controls: Mean of total Fazekas score in LOPD was 2.42 ± 2.40 and in controls 1.60 ± 2.64; p = 0.68. Also volume of WML was similar in patients and controls (mean 5.27 ml ± 5.88 and 7.89 ml ± 11.40 respectively, p = 0.35). Total Fazekas grade correlated directly with the age in LOPD patients (r = 0.60; p = 0.007) and in controls (r = 0.32; p = 0.04). There was a negative correlation of ERT duration and total Fazekas grade (r = -0.41; p = 0.04). CONCLUSION The study suggests that WML in LOPD mainly result from concomitant cerebrovascular risk factors rather than from the Pompe disease itself.
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Affiliation(s)
- Ilka Schneider
- Department of Neurology, University hospital, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
| | - Ole Hensel
- Department of Neurology, University hospital, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
| | - Stephan Zierz
- Department of Neurology, University hospital, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany.
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Assessing the Role of Anti rh-GAA in Modulating Response to ERT in a Late-Onset Pompe Disease Cohort from the Italian GSDII Study Group. Adv Ther 2019; 36:1177-1189. [PMID: 30879255 DOI: 10.1007/s12325-019-00926-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Patients with late-onset Pompe disease (LOPD) receiving enzyme replacement therapy (ERT) may develop IgG antibodies against alglucosidase alpha (anti-rhGAA) in the first 3 months of treatment. The exact role of these antibodies in modulating efficacy of ERT in this group of patients is still not fully understood. To assess whether anti rh-GAA antibodies interfere with ERT efficacy, we studied a large Italian cohort of LOPD patients. METHODS We analyzed clinical findings and performed serial measurements of IgG anti rh-GAA antibody titers from 64 LOPD patients treated with ERT. The first examination (T0) was completed on average at 17.56 months after starting ERT, while the follow-up (T1) was collected on average at 38.5 months. Differences in T0-T1 delta of the six-minute walking test (6MWT), MRC sum score (MRC), gait, stairs and chair performance (GSGC) and forced vital capacity (FVC) were considered and then related to the antibody titers. RESULTS Almost 22% of the patients never developed antibodies against GAA, while 78.1% had a positive titer (31.2% patients developed a low titer, 43.8% a medium titer and 3.1% a high titer). No statistical significance was found in relating the T0-T1 delta differences and antibody titers, except for MRC sum score values in a subgroup of patients treated < 36 months, in which those with a null antibody titer showed a greater clinical improvement than patients with a positive titer. CONCLUSION Our results confirm that in a large cohort of LOPD patients, anti rh-GAA antibody generation did not significantly affect either clinical outcome or ERT efficacy. However, in the first 36 months of treatment, a possible interference of low-medium antibody titers with the clinical status could be present. Therefore, a careful and regular evaluation of antibody titers, especially in cases with evidence of clinical decline despite ERT, should be performed.
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Musumeci O, Marino S, Granata F, Morabito R, Bonanno L, Brizzi T, Lo Buono V, Corallo F, Longo M, Toscano A. Central nervous system involvement in late‐onset Pompe disease: clues from neuroimaging and neuropsychological analysis. Eur J Neurol 2018; 26:442-e35. [DOI: 10.1111/ene.13835] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022]
Affiliation(s)
- O. Musumeci
- Department of Clinical and Experimental MedicineUniversity of MessinaMessina
| | - S. Marino
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging University of MessinaMessina
- IRCCS Centro Neurolesi ‘Bonino‐Pulejo’ Messina
| | - F. Granata
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging University of MessinaMessina
| | - R. Morabito
- IRCCS Centro Neurolesi ‘Bonino‐Pulejo’ Messina
| | - L. Bonanno
- IRCCS Centro Neurolesi ‘Bonino‐Pulejo’ Messina
| | - T. Brizzi
- Department of Clinical and Experimental MedicineUniversity of MessinaMessina
- DIBIMIS University of Palermo Palermo Italy
| | - V. Lo Buono
- IRCCS Centro Neurolesi ‘Bonino‐Pulejo’ Messina
| | - F. Corallo
- IRCCS Centro Neurolesi ‘Bonino‐Pulejo’ Messina
| | - M. Longo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging University of MessinaMessina
| | - A. Toscano
- Department of Clinical and Experimental MedicineUniversity of MessinaMessina
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Pappa E, Papadopoulos C, Grimbert P, Laforêt P, Bassez G. Renal artery fibromuscular dysplasia in Pompe disease: A case report. Mol Genet Metab Rep 2018; 16:64-65. [PMID: 30090700 PMCID: PMC6078050 DOI: 10.1016/j.ymgmr.2018.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 12/03/2022] Open
Abstract
Vascular involvement in Late Onset Pompe Disease, glycogen storage disease type II characterized by limb-girdle muscle and diaphragmatic weakness, is well documented. Abnormalities of posterior cerebral circulation have mostly been reported, whereas there are also cases of associated extracerebral arteriopathy. We report the case of a 42-year-old man diagnosed with LOPD a year after renal infarct due to renal artery fibromuscular dysplasia. We propose that the association of LOPD and arteriopathy should always be considered in clinical practice.
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Affiliation(s)
- Evangelia Pappa
- Centre de Référence Neuromusculaire Nord/Est/Ile de France, AP-HP, Institut de Myologie, GH Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Constantinos Papadopoulos
- Centre de Référence Neuromusculaire Nord/Est/Ile de France, AP-HP, Institut de Myologie, GH Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Philippe Grimbert
- Service de Néphrologie et Transplantation, Hôpital Henri-Mondor, AP-HP, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - Pascal Laforêt
- Centre de Référence Neuromusculaire Nord/Est/Ile de France, Service de Neurologie, Hôpital Raymond-Poincaré, AP-HP, 104 Boulevard Raymond Poincaré, 92380 Garches, France
| | - Guillaume Bassez
- Centre de Référence Neuromusculaire Nord/Est/Ile de France, AP-HP, Institut de Myologie, GH Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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Pawlowska E, Szczepanska J, Wisniewski K, Tokarz P, Jaskólski DJ, Blasiak J. NF-κB-Mediated Inflammation in the Pathogenesis of Intracranial Aneurysm and Subarachnoid Hemorrhage. Does Autophagy Play a Role? Int J Mol Sci 2018; 19:E1245. [PMID: 29671828 PMCID: PMC5979412 DOI: 10.3390/ijms19041245] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/13/2018] [Accepted: 04/17/2018] [Indexed: 12/12/2022] Open
Abstract
The rupture of saccular intracranial aneurysms (IA) is the commonest cause of non-traumatic subarachnoid hemorrhage (SAH)—the most serious form of stroke with a high mortality rate. Aneurysm walls are usually characterized by an active inflammatory response, and NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) has been identified as the main transcription factor regulating the induction of inflammation-related genes in IA lesions. This transcription factor has also been related to IA rupture and resulting SAH. We and others have shown that autophagy interacts with inflammation in many diseases, but there is no information of such interplay in IA. Moreover, NF-κB, which is a pivotal factor controlling inflammation, is regulated by autophagy-related proteins, and autophagy is regulated by NF-κB signaling. It was also shown that autophagy mediates the normal functioning of vessels, so its disturbance can be associated with vessel-related disorders. Early brain injury, delayed brain injury, and associated cerebral vasospasm are among the most serious consequences of IA rupture and are associated with impaired function of the autophagy⁻lysosomal system. Further studies on the role of the interplay between autophagy and NF-κB-mediated inflammation in IA can help to better understand IA pathogenesis and to identify IA patients with an increased SAH risk.
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Affiliation(s)
- Elzbieta Pawlowska
- Department of Orthodontics, Medical University of Lodz, 92-216 Lodz, Poland.
| | - Joanna Szczepanska
- Department of Pediatric Dentistry, Medical University of Lodz, 92-216 Lodz, Poland.
| | - Karol Wisniewski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego 22, 90-153 Lodz, Poland.
| | - Paulina Tokarz
- Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland.
| | - Dariusz J Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego 22, 90-153 Lodz, Poland.
| | - Janusz Blasiak
- Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland.
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Abstract
PURPOSE OF REVIEW This review aims to highlight the most relevant clinical and laboratory findings, regarding acute and progressive metabolic myopathies, and to develop an algorithm addressing clinicians to clinical practice. RECENT FINDINGS Although diagnosis of metabolic myopathies remains still challenging, the recent identification of new disorders has increased the number of patients requiring specific investigations. Nowadays, a more detailed characterization of the clinical spectrum of metabolic myopathies improved awareness as well as a deeper knowledge on their natural history or multisystem involvement. Diagnostic procedures, as first-line screening tests are necessary for an earlier and more accurate diagnostic work up, not only in infantile cases, but also in adults with suspected metabolic myopathies. New generation diagnostic techniques such as NGS (Next Generation Sequencing) and whole exome/genome sequencing have emerged as innovative tools to extensively evaluate either known genes variants or new candidate genes as possible causes of metabolic myopathies. SUMMARY Diagnosis of metabolic myopathies is still challenging for clinicians because of rarity and clinical heterogeneity which is often overlapping with other neuromuscular disorders. Detailed algorithms supported by advanced laboratory investigations may be helpful to timely reach a diagnosis, so allowing an earlier therapeutic decision.
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24
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Decreased outlet angle of the superior cerebellar artery as indicator for dolichoectasia in late onset Pompe disease. Orphanet J Rare Dis 2018; 13:57. [PMID: 29653542 PMCID: PMC5899367 DOI: 10.1186/s13023-018-0794-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 03/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lysosomal α-glucosidase deficiency (Pompe disease) not only leads to glycogen accumulation in skeletal muscle, but also in the cerebral arteries. Dolichoectasia of the basilar artery (BA) has been frequently reported. Therefore progression of BA dolichoectasia in late onset Pompe patients (LOPD) was studied. METHODS BA length, diameter and volume, and cerebral lesions were analysed by MRI/TOF-MR angiography or CT/CT angiography in 20 LOPD patients and 40 controls matching in age, sex- and cardiovascular risk factors. The height of BA bifurcation was assessed semi-quantitatively using the Smoker's criteria and quantitatively by measuring the outlet angle of the superior cerebellar artery (SUCA). Nine patients were followed over 5 years. RESULTS The height of the BA bifurcation was abnormal in 12/20 (60%) LOPD patients and in 12/40 (30%) matched controls. The SUCA outlet angle was reduced in LOPD patients compared to controls (127 ± 33° vs. 156 ± 32°, p = 0.0024). The diameter, length and volume of the BA were significantly increased in LOPD patients compared to controls. 12/20 (60%) LOPD patients and 27/40 (68%) controls presented white matter lesions. During 5 years 2/9 LOPD patients developed an abnormal height of BA bifurcation according to the Smoker's criteria and in all patients the SUCA outlet angle decreased (138 ± 34° vs. 128 ± 32°, p = 0.019). One patient with prominent basilar dolichoectasia experienced a thalamic hemorrhage. CONCLUSION Pompe disease is associated with BA dilation, elongation and elevated bifurcation height of the BA which might result in cerebrovascular complications. The SUCA outlet angle seems to be useful for monitoring the progression of BA dolichoectasia.
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25
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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.
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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
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26
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Pichiecchio A, Sacco S, De Filippi P, Caverzasi E, Ravaglia S, Bastianello S, Danesino C. Late-onset Pompe disease: a genetic-radiological correlation on cerebral vascular anomalies. J Neurol 2017; 264:2110-2118. [PMID: 28856460 DOI: 10.1007/s00415-017-8601-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
Pompe disease is an autosomal recessive disorder in which deficiency of the lysosomal enzyme acid alpha-glucosidase results in the accumulation of glycogen mostly in muscle tissues. Several reports suggest a higher incidence of intracranial vascular abnormalities (IVAs) in this condition, as well as brain microbleeds and cerebral vasculopathy. The aim of our study was to evaluate through neuroimaging studies the incidence of these anomalies in our cohort of late-onset Pompe disease (LOPD) patients asymptomatic for cerebrovascular disease, looking for correlations with clinical and genetic data. We studied 18 LOPD patients with brain magnetic resonance angiography (MRA), or contrast-enhanced computed tomography (CECT). Diameters of individual arteries were measured and compared with average values as proposed in the literature. We found IVAs in 13 of the 18 patients, mostly dilatative arteriopathy affecting the vertebrobasilar system. The anterior circle was involved in seven of the 18 patients. The diameter of the basilar artery at 1 cm was found to correlate both with age (spearman rho, p = 0.037) and disease duration (p = 0.004), but no other statistically significant correlation was documented. The incidence of intracranial dilatative arteriopathy in LOPD was higher than in the general population, confirming the literature data. However, we did not find intracranial aneurysms microbleeds or significant cerebrovascular disease. Abnormalities in the anterior and the posterior circle of Willis correlated with age and disease duration, but not with the severity of muscle/respiratory involvement or with genetic data. Further studies in larger cohorts of patients are needed to confirm these findings.
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Affiliation(s)
- A Pichiecchio
- Neuroradiology Department, C. Mondino National Neurological Institute, Pavia, Italy
| | - S Sacco
- Institute of Radiology, University of Pavia, Pavia, Italy.
| | - P De Filippi
- Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - E Caverzasi
- Neurology, University of California, San Francisco, San Francisco, CA, United States.,Biomedical Sciences PhD, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - S Ravaglia
- Department of Public Health and Neurosciences, University of Pavia, Pavia, Italy
| | - S Bastianello
- Neuroradiology Department, C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - C Danesino
- Department of Molecular Medicine, University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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27
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Ripolone M, Violano R, Ronchi D, Mondello S, Nascimbeni A, Colombo I, Fagiolari G, Bordoni A, Fortunato F, Lucchini V, Saredi S, Filosto M, Musumeci O, Tonin P, Mongini T, Previtali S, Morandi L, Angelini C, Mora M, Sandri M, Sciacco M, Toscano A, Comi GP, Moggio M. Effects of short-to-long term enzyme replacement therapy (ERT) on skeletal muscle tissue in late onset Pompe disease (LOPD). Neuropathol Appl Neurobiol 2017; 44:449-462. [PMID: 28574618 DOI: 10.1111/nan.12414] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/26/2017] [Accepted: 06/02/2017] [Indexed: 12/31/2022]
Abstract
AIMS Pompe disease is an autosomal recessive lysosomal storage disorder resulting from deficiency of acid α-glucosidase (GAA) enzyme. Histopathological hallmarks in skeletal muscle tissue are fibre vacuolization and autophagy. Since 2006, enzyme replacement therapy (ERT) is the only approved treatment with human recombinant GAA alglucosidase alfa. We designed a study to examine ERT-related skeletal muscle changes in 18 modestly to moderately affected late onset Pompe disease (LOPD) patients along with the relationship between morphological/biochemical changes and clinical outcomes. Treatment duration was short-to-long term. METHODS We examined muscle biopsies from 18 LOPD patients at both histopathological and biochemical level. All patients underwent two muscle biopsies, before and after ERT administration respectively. The study is partially retrospective because the first biopsies were taken before the study was designed, whereas the second biopsy was always performed after at least 6 months of ERT administration. RESULTS After ERT, 15 out of 18 patients showed improved 6-min walking test (6MWT; P = 0.0007) and most of them achieved respiratory stabilization. Pretreatment muscle biopsies disclosed marked histopathological variability, ranging from an almost normal pattern to a severe vacuolar myopathy. After treatment, we detected morphological improvement in 15 patients and worsening in three patients. Post-ERT GAA enzymatic activity was mildly increased compared with pretreatment levels in all patients. Protein levels of the mature enzyme increased in 14 of the 18 patients (mean increase = +35%; P < 0.05). Additional studies demonstrated an improved autophagic flux after ERT in some patients. CONCLUSIONS ERT positively modified skeletal muscle pathology as well as motor and respiratory outcomes in the majority of LOPD patients.
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Affiliation(s)
- M Ripolone
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - R Violano
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Ronchi
- Neurology Unit, Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Centre, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - S Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - A Nascimbeni
- Department of Neurosciences, University of Padova, Padova, Italy
| | - I Colombo
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - G Fagiolari
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Bordoni
- Neurology Unit, Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Centre, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - F Fortunato
- Neurology Unit, Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Centre, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - V Lucchini
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - S Saredi
- Neuromuscular Diseases and Neuroimmunology, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - M Filosto
- Unit of Neurology, Center for Neuromuscular Diseases and Neuropathies, University Hospital "Spedali Civili", Brescia, Italy
| | - O Musumeci
- Department of Clinical and Experimental Medicine, Centro di Riferimento Regionale per le Malattie Neuromuscolari rare, University of Messina, Messina, Italy
| | - P Tonin
- Section of Clinical Neurology, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - T Mongini
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - S Previtali
- Division of Neuroscience, Inspe, San Raffaele, Milan, Italy
| | - L Morandi
- Neuromuscular Diseases and Neuroimmunology, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - C Angelini
- Fondazione San Camillo Hospital IRCCS, Venice, Italy
| | - M Mora
- Neuromuscular Diseases and Neuroimmunology, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - M Sandri
- Department of Biomedical Science, University of Padova, Padova, Italy.,Dulbecco Telethon Institute at Venetian Institute of Molecular Medicine, Padova, Italy
| | - M Sciacco
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Toscano
- Department of Clinical and Experimental Medicine, Centro di Riferimento Regionale per le Malattie Neuromuscolari rare, University of Messina, Messina, Italy
| | - G P Comi
- Neurology Unit, Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Centre, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - M Moggio
- Neuromuscular and Rare Diseases Unit, Department of Neuroscience, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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28
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Marino M, Musumeci O, Paleologo G, Cucinotta M, Migliorato A, Rodolico C, Toscano A. Ischemic stroke due to hypoperfusion in a patient with a previously unrecognized Danon disease. Neuromuscul Disord 2016; 26:890-894. [PMID: 27816333 DOI: 10.1016/j.nmd.2016.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/29/2016] [Accepted: 09/30/2016] [Indexed: 12/27/2022]
Abstract
Danon disease, an X-linked multisystemic disorder, is due to deficiency of Lysosome-Associated Membrane Protein 2 (LAMP2). It is usually characterized by hypertrophic cardiomyopathy, mental retardation and skeletal myopathy, sometimes also with atypical features. A 20-year-old man with cognitive impairment was admitted to the Emergency Room because of a sudden chest pain. ECG showed Wolff-Parkinson-White syndrome; echocardiography revealed hypertrophic cardiomyopathy, and, shortly after, he experienced a cardiac arrest followed by an occipital ischemic stroke. On neurological examination, he complained of visual loss, and diffuse muscle wasting and weakness were also unexpectedly noted. Electromyography evidenced a myopathic pattern and a peripheral neuropathy. A muscle biopsy disclosed vacuolar myopathy with glycogen storage; immunohistochemical studies demonstrated a LAMP-2 deficiency. LAMP2 molecular analysis identified a "de novo" mutation (p. Q353X). This patient with a neglected Danon disease, experienced an unusual complication as a stroke due to cerebral hypoperfusion after cardiac arrest caused by WPW syndrome.
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Affiliation(s)
- Marco Marino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Olimpia Musumeci
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Paleologo
- Department of Cardiovascular Diseases, Papardo - Piemonte Hospital, Messina, Italy
| | - Maria Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alba Migliorato
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo Rodolico
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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