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Muenzer J, Ho C, Lau H, Dant M, Fuller M, Boulos N, Dickson P, Ellinwood NM, Jones SA, Zanelli E, O'Neill C. Community consensus for Heparan sulfate as a biomarker to support accelerated approval in Neuronopathic Mucopolysaccharidoses. Mol Genet Metab 2024; 142:108535. [PMID: 39018614 DOI: 10.1016/j.ymgme.2024.108535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024]
Abstract
Mucopolysaccharidoses (MPS) disorders are a group of ultra-rare, inherited, lysosomal storage diseases caused by enzyme deficiencies that result in accumulation of glycosaminoglycans (GAGs) in cells throughout the body including the brain, typically leading to early death. Current treatments do not address the progressive cognitive impairment observed in patients with neuronopathic MPS disease. The rarity and clinical heterogeneity of these disorders as well as pre-existing brain disease in clinically diagnosed patients make the development of new therapeutics utilizing a traditional regulatory framework extremely challenging. Children with neuronopathic MPS disorders will likely sustain irreversible brain damage if randomized to a placebo or standard-of-care treatment arm that does not address brain disease. The United States Food and Drug Administration (FDA) recognized these challenges, and, in 2020, issued final guidance for industry on slowly progressive, low-prevalence, rare diseases with substrate deposition that result from single enzyme defects, outlining a path for generating evidence of effectiveness to support accelerated approval based on reduction of substrate accumulation [1]. Neuronopathic MPS disorders, which are characterized by the accumulation of the GAG heparan sulfate (HS) in the brain, fit the intended disease characteristics for which this guidance was written, but to date, this guidance has not yet been applied to any therapeutic candidate for MPS. In February 2024, the Reagan-Udall Foundation for the FDA convened a public workshop for representatives from the FDA, patient advocacy groups, clinical and basic science research, and industry to explore a case study of using cerebrospinal fluid (CSF) HS as a relevant biomarker to support accelerated approval of new therapeutics for neuronopathic MPS disorders. This review provides a summary of the MPS presentations at the workshop and perspective on the path forward for neuronopathic MPS disorders.
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Affiliation(s)
- Joseph Muenzer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Carole Ho
- Denali Therapeutics, 161 Oyster Point Boulevard, South San Francisco, CA 94080, USA.
| | - Heather Lau
- Ultragenyx Pharmaceutical, Inc., 60 Leveroni Court, Novato, CA 94949. USA.
| | - Mark Dant
- The Ryan Foundation, Inc., 5309 McPherson Blvd. 105 #284, Fort Worth, Texas 76123, USA
| | - Maria Fuller
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital and Adelaide Medical School and School of Biological Sciences, University of Adelaide, Adelaide, 5005, SA, Australia.
| | | | - Patricia Dickson
- Washington University School of Medicine, 4444 Forest Park, Suite 5400, St. Louis, MO 63108, USA.
| | | | - Simon A Jones
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Eric Zanelli
- Allievex Corp., PO Box 1056, Marblehead, MA 01945, USA.
| | - Cara O'Neill
- Cure Sanfilippo Foundation, PO Box 6901, Columbia, SC 29260, USA.
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Ferrer-Mallol E, Matthews C, Aziza R, Mendoza A, Sahota N, Komarzynski S, Lakshminarayana R, Davies EH. Video-based assessments of activities of daily living: generating real-world evidence in pediatric rare diseases. Expert Rev Pharmacoecon Outcomes Res 2024; 24:713-721. [PMID: 38789406 DOI: 10.1080/14737167.2024.2360201] [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: 02/11/2024] [Accepted: 05/22/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION Preserving function and independence to perform activities of daily living (ADL) is critical for patients and carers to manage the burden of care and improve quality of life. In children living with rare diseases, video recording ADLs offer the opportunity to collect the patients' experience in a real-life setting and accurately reflect treatment effectiveness on outcomes that matter to patients and families. AREAS COVERED We reviewed the measurement of ADL in pediatric rare diseases and the use of video to develop at-home electronic clinical outcome assessments (eCOA) by leveraging smartphone apps and artificial intelligence-based analysis. We broadly searched PubMed using Boolean combinations of the following MeSH terms 'Rare Diseases,' 'Quality of Life,' 'Activities of Daily Living,' 'Child,' 'Video Recording,' 'Outcome Assessment, Healthcare,' 'Intellectual disability,' and 'Genetic Diseases, Inborn.' Non-controlled vocabulary was used to include human pose estimation in movement analysis. EXPERT OPINION Broad uptake of video eCOA in drug development is linked to the generation of technical and clinical validation evidence to confidently assess a patient's functional abilities. Software platforms handling video data must align with quality regulations to ensure data integrity, security, and privacy. Regulatory flexibility and optimized validation processes should facilitate video eCOA to support benefit/risk drug assessment.
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Polgreen LE, Chen AH, Pak Y, Luzzi A, Morales Garval A, Acevedo J, Bitan G, Iacovino M, O'Neill C, Eisengart JB. Anakinra in Sanfilippo syndrome: a phase 1/2 trial. Nat Med 2024:10.1038/s41591-024-03079-3. [PMID: 38907160 DOI: 10.1038/s41591-024-03079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/19/2024] [Indexed: 06/23/2024]
Abstract
Sanfilippo syndrome is a fatal childhood neurodegenerative disorder involving neuroinflammation among multiple pathologies. We hypothesized that anakinra, a recombinant interleukin-1 receptor antagonist, could improve neurobehavioral and functional symptoms owing to its capacity to treat neuroinflammation. This phase 1/2 trial aimed to test the safety, tolerability and effects of anakinra on neurobehavioral, functional and quality-of-life outcomes in patients and their caregivers. The primary outcome was the percent of participants requiring a dose increase at week 8 or week 16. Secondary efficacy outcomes included a multi-domain responder index (MDRI). Twenty-three participants (6-26 years of age) were enrolled. Twenty continued treatment to week 8, and 15 (75%) required an increased dose at week 8 or week 16. There was an improvement in at least one domain in the MDRI in 18 of 21 (86%) at week 8 and in 15 of 16 (94%) at week 36. Seven participants withdrew (intolerability of daily injections and lost to follow-up) before week 36. Adverse events occurred in 22 of 23 (96%) participants, most commonly mild injection site reactions. No serious adverse events were related to anakinra. In conclusion, anakinra was safe and associated with improved neurobehavioral and functional outcomes, supporting continued investigation of anakinra in Sanfilippo syndrome and other mucopolysaccharidoses. ClinicalTrials.gov identifier: NCT04018755 .
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Affiliation(s)
- Lynda E Polgreen
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA.
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Agnes H Chen
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Youngju Pak
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anna Luzzi
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Adolfo Morales Garval
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jonathan Acevedo
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Gal Bitan
- Department of Neurology, David Geffen School of Medicine, Brain Research Institute and Molecular Biology Institute University of California, Los Angeles, Los Angeles, CA, USA
| | - Michelina Iacovino
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Julie B Eisengart
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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Arpaci T. Experiences of Parents of Children with Mucopolysaccharidosis in Türkiye: A Qualitative Study. J Pediatr Nurs 2024; 76:e60-e68. [PMID: 38278748 DOI: 10.1016/j.pedn.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE Mucopolysaccharidosis increases morbidity and mortality by causing physical and mental limitations in children. Parents experience various difficulties, mostly due to delayed diagnosis and difficult treatment processes. This study aims to examine the experiences of parents regarding their child's illness process. DESIGN AND METHODS In this qualitative study, semi-structured in-depth interviews were conducted with parents (n = 10) who had a child who had suffered from MPS for at least six months. Interviews were conducted and recorded after the parents were contacted through the MPS-LH association and informed consent was obtained. The conducting and reporting of the research were carried out according to the "Consolidated criteria for reporting qualitative research (COREQ)" checklist. RESULTS The mean age of the parents was 41.3 ± 7.83. The diagnosis for most of the children was MPS type 4 A (n = 4) and the mean age of the children was 11.3 ± 6.0. Three main themes were identified: 1) psychosocial effects; 2) difficulties and needs; and 3) coping resources. CONCLUSIONS It was determined that the parents were affected socially and emotionally due to the child's diagnosis and the subsequent process. IMPLICATIONS TO PRACTICE It will be possible to provide the necessary support to parents with comprehensive nursing care that is planned according to the differing needs of children with MPS.
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Affiliation(s)
- Tuba Arpaci
- Department of Nursing, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Turkey.
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5
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Thomas S, Morrison A, Morton G, Roberts P, Clark V, Imrie J. The burden of disease in metachromatic leukodystrophy: results of a caregiver survey in the UK and Republic of Ireland. Orphanet J Rare Dis 2024; 19:87. [PMID: 38403596 PMCID: PMC10895743 DOI: 10.1186/s13023-023-03001-z] [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: 11/15/2022] [Accepted: 12/19/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Metachromatic Leukodystrophy (MLD) is a rare, autosomal recessive lysosomal storage disease characterised by the progressive loss of motor function and severe decline in cognitive function. Limited information is available on the burden MLD places on patients and their families and the medical and social support these patients need. Three UK-based MLD patient organisations commissioned an online survey, and follow-up semi-structured interviews to describe and quantify these burdens across MLD subtypes, stage of disease (including end of life) and treatment status (untreated, gene therapy or hematopoietic stem cell transplant [HSCT]). RESULTS A total of 24 patients were included in the study: thirteen late infantile (LI), six early juvenile (EJ), two late juvenile (LJ) and three adult onset (AO). Six patients had received gene therapy and one had received an HSCT. MLD patients receiving no disease modifying treatment bore a high symptom burden: 94% were wheelchair dependent, 88% required tube feeding, 88% were incontinent, 82% had lost their speech and all the children were either unable to attend education or needed specialist provision. Patients were reliant on numerous medical interventions and assistive equipment. All early-onset patients (LI and EJ) were wheelchair dependent, and tube fed, with all EJ patients having lost all speech. The caregiving responsibilities of parents impacted their employment, finances, relationships and health. Patients treated with gene therapy or HSCT were more mobile and were able to eat normally and two thirds of the children were able to attend mainstream school. CONCLUSIONS The impact of illness that patients and their caregivers faced was extensive, and the level of care, amount of medication, number of hospital visits and educational support required were substantial. Financial constraints often brought about by inability to work also placed considerable strain on families. The study increases understanding of the burden of MLD on patients and their families, and the level of unmet need in the treatment of the disease.
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Affiliation(s)
| | | | - Georgina Morton
- ArchAngel MLD Trust, 59 Warwick Square, London, SW1V 2AL, UK
| | - Pat Roberts
- ArchAngel MLD Trust, 59 Warwick Square, London, SW1V 2AL, UK
| | - Vivienne Clark
- MLD Support Association UK, Floor 5, Amphenol Business Complex, Thanet Way, Whitstable, CT5 3SB, UK
| | - Jackie Imrie
- MLD Support Association UK, Floor 5, Amphenol Business Complex, Thanet Way, Whitstable, CT5 3SB, UK
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6
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Shapiro EG, Eisengart JB, Whiteman D, Whitley CB. Ability change across multiple domains in mucopolysaccharidosis (Sanfilippo syndrome) type IIIA. Mol Genet Metab 2024; 141:108110. [PMID: 38151384 DOI: 10.1016/j.ymgme.2023.108110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
The objective of this paper is 1) to expand the scope of the domains previously published in a natural history study of Mucopolysaccharidosis IIIA (Sanfilippo syndrome type A) (MPS IIIA) and 2) to present evidence regarding the capacity of a new metric, Growth Scale Values (GSVs), in comparison with traditional metrics, to show changes in skills as assessed by the Bayley Scales of Infant Development -III (BSID-III) and the Vineland Adaptive Behavior Scales, Second Edition (VABS-II). We re-analyzed a cohort of 25 children, 20 with rapid progressing disease and 5 with slow progression, who had been followed over two years using the BSID-III, and the VABS-II. Previously findings were reported using age equivalent scores; now we are also presenting findings with GSVs. For the re-analysis, Language and Motor scores were added to the Cognitive scale on the BSID-III, and Domain- and Subdomain-level scores added to the Total VABS-II score (i.e., ABC Composite). We evaluated raw scores, age equivalent scores, and GSVs (and standard scores for the VABS-II only). Individual patient data can be found in the appendices to this publication. Results indicate that 1) Cognition as measured by GSVs was the most sensitive to decline; 2) GSVs showed significant decline in the range of 4 to 6 years of age; 3) For children under 4 years of age, positive growth occurs on most scales and most metrics, with the exception of language which slows somewhat earlier; 4) Other than the Cognitive scale, Receptive Language on the BSID-III and Receptive Communication on the VABS-II showed the most sensitivity to change; 5) Gross Motor skills showed the least decline over time and appeared to lack sensitivity to MPS IIIA motor concerns; and 6) No evidence for sensitivity to change for any metric was found in time intervals less than one year. We conclude that GSVs are a precise measurement of change to detect decline in function, and they are a valuable method for future clinical trials in MPS IIIA. Evidence continues to support cognition as a primary endpoint. Additional work is needed to identify sensitive measures of meaningful endpoints to families.
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Affiliation(s)
- Elsa G Shapiro
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Shapiro Neuropsychology Consulting, LLC, Portland, OR, USA
| | - Julie B Eisengart
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | | | - Chester B Whitley
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Advanced Therapies Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Deltuvaite-Thomas V, De Backer M, Parker S, Deneux M, Polgreen LE, O'Neill C, Salvaggio S, Buyse M. Generalized pairwise comparisons of prioritized outcomes are a powerful and patient-centric analysis of multi-domain scores. Orphanet J Rare Dis 2023; 18:321. [PMID: 37828533 PMCID: PMC10571482 DOI: 10.1186/s13023-023-02943-8] [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: 05/31/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Generalized pairwise comparisons (GPC) can be used to assess the net benefit of new treatments for rare diseases. We show the potential of GPC through simulations based on data from a natural history study in mucopolysaccharidosis type IIIA (MPS IIIA). METHODS Using data from a historical series of untreated children with MPS IIIA aged 2 to 9 years at the time of enrolment and followed for 2 years, we performed simulations to assess the operating characteristics of GPC to detect potential (simulated) treatment effects on a multi-domain symptom assessment. Two approaches were used for GPC: one in which the various domains were prioritized, the other with all domains weighted equally. The net benefit was used as a measure of treatment effect. We used increasing thresholds of clinical relevance to reflect the magnitude of the desired treatment effects, relative to the standard deviation of the measurements in each domain. RESULTS GPC were shown to have adequate statistical power (80% or more), even with small sample sizes, to detect treatment effects considered to be clinically worthwhile on a symptom assessment covering five domains (expressive language, daily living skills, and gross-motor, sleep and pain). The prioritized approach generally led to higher power as compared with the non-prioritized approach. CONCLUSIONS GPC of prioritized outcomes is a statistically powerful as well as a patient-centric approach for the analysis of multi-domain scores in MPS IIIA and could be applied to other heterogeneous rare diseases.
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Affiliation(s)
- Vaiva Deltuvaite-Thomas
- International Drug Development Institute, Avenue Provinciale 30, 1340, Louvain-la-Neuve, Belgium.
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Diepenbeek, Belgium.
| | - Mickaël De Backer
- Institut de Statistique, Biostatistique et Sciences Actuarielles, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | | | - Lynda E Polgreen
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | - Samuel Salvaggio
- International Drug Development Institute, Avenue Provinciale 30, 1340, Louvain-la-Neuve, Belgium
| | - Marc Buyse
- International Drug Development Institute, Avenue Provinciale 30, 1340, Louvain-la-Neuve, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Hasselt University, Diepenbeek, Belgium
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Nevin SM, McGill BC, Kelada L, Hilton G, Maack M, Elvidge KL, Farrar MA, Baynam G, Katz NT, Donovan L, Grattan S, Signorelli C, Bhattacharya K, Nunn K, Wakefield CE. The psychosocial impact of childhood dementia on children and their parents: a systematic review. Orphanet J Rare Dis 2023; 18:277. [PMID: 37679855 PMCID: PMC10486052 DOI: 10.1186/s13023-023-02859-3] [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] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Childhood dementias are a group of rare and ultra-rare paediatric conditions clinically characterised by enduring global decline in central nervous system function, associated with a progressive loss of developmentally acquired skills, quality of life and shortened life expectancy. Traditional research, service development and advocacy efforts have been fragmented due to a focus on individual disorders, or groups classified by specific mechanisms or molecular pathogenesis. There are significant knowledge and clinician skill gaps regarding the shared psychosocial impacts of childhood dementia conditions. This systematic review integrates the existing international evidence of the collective psychosocial experiences of parents of children living with dementia. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched four databases to identify original, peer-reviewed research reporting on the psychosocial impacts of childhood dementia, from the parent perspective. We synthesised the data into three thematic categories: parents' healthcare experiences, psychosocial impacts, and information and support needs. RESULTS Nineteen articles met review criteria, representing 1856 parents. Parents highlighted extensive difficulties connecting with an engaged clinical team and navigating their child's rare, life-limiting, and progressive condition. Psychosocial challenges were manifold and encompassed physical, economic, social, emotional and psychological implications. Access to coordinated healthcare and community-based psychosocial supports was associated with improved parent coping, psychological resilience and reduced psychological isolation. Analysis identified a critical need to prioritize access to integrated family-centred psychosocial supports throughout distinct stages of their child's condition trajectory. CONCLUSION This review will encourage and guide the development of evidence-based and integrated psychosocial resources to optimise quality of life outcomes for of children with dementia and their families.
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Affiliation(s)
- Suzanne M Nevin
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia.
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia.
| | - Brittany C McGill
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Lauren Kelada
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Gail Hilton
- Childhood Dementia Initiative, Sydney, NSW, Australia
| | - Megan Maack
- Childhood Dementia Initiative, Sydney, NSW, Australia
| | | | - Michelle A Farrar
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Gareth Baynam
- Faculty of Health and Medical Sciences, Division of Paediatrics, University of Western Australia, Western Australia, Australia
- Rare Care Centre, Perth Children's Hospital, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Naomi T Katz
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Leigh Donovan
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Sarah Grattan
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
| | - Christina Signorelli
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
| | - Kaustuv Bhattacharya
- Genetic Metabolic Disorders Service, Sydney Children's Hospitals' Network, Randwick and Westmead, Australia
- Faculty of Medicine and Health, Discipline of Genomics, Sydney University, Westmead, Australia
| | - Kenneth Nunn
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Claire E Wakefield
- School of Clinical Medicine, UNSW Medicine and Health, Discipline of Paediatrics and Child Health, Sydney, Australia
- Behavioral Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
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9
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Pericleous K, McIntyre C, Fuller M. Neurocognitive testing in a murine model of mucopolysaccharidosis type IIIA. Mol Genet Metab Rep 2023; 36:100985. [PMID: 37332488 PMCID: PMC10276283 DOI: 10.1016/j.ymgmr.2023.100985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/20/2023] Open
Abstract
Mucopolysaccharidosis type IIIA (MPS IIIA) is an inherited metabolic disorder caused by a lysosomal enzyme deficiency resulting in heparan sulphate (HS) accumulation and manifests with a progressive neurodegenerative phenotype. A naturally occurring MPS IIIA mouse model is invaluable for preclinical evaluation of potential treatments but the ability to effectively assess neurological function has proved challenging. Here, the aim was to evaluate a set of behaviour tests for their reliability in assessing disease progression in the MPS IIIA mouse model. Compared to wild-type (WT) mice, MPS IIIA mice displayed memory and learning deficits in the water crossmaze from mid-stage disease and locomotor impairment in the hind-limb gait assessment at late-stage disease, supporting previous findings. Declined wellbeing was also observed in the MPS IIIA mice via burrowing and nest building evaluation at late-stage disease compared to WT mice, mirroring the progressive nature of neurological disease. Excessive HS accumulation observed in the MPS IIIA mouse brain from 1 month of age did not appear to manifest as abnormal behaviours until at least 6 months of age suggesting there may be a threshold of HS accumulation before measurable neurocognitive decline. Results obtained from the open field and three-chamber sociability test are inconsistent with previous studies and do not reflect MPS IIIA patient disease progression, suggesting these assessments are not reliable. In conclusion, water cross-maze, hind-limb gait, nest building and burrowing, are promising assessments in the MPS IIIA mouse model, which produce consistent results that mimic the human disease.
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Affiliation(s)
- Kleopatra Pericleous
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, Australia
- School of Biological Sciences, University of Adelaide, Adelaide 5000, Australia
| | - Chantelle McIntyre
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, Australia
| | - Maria Fuller
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, Australia
- School of Biological Sciences, University of Adelaide, Adelaide 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide 5000, Australia
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10
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Bingaman A, Waggoner C, Andrews SM, Pangonis D, Trad M, Giugliani R, Giorgino R, Jarnes J, Vakili R, Ballard V, Peay HL. GM1-gangliosidosis: The caregivers' assessments of symptom impact and most important symptoms to treat. Am J Med Genet A 2023; 191:408-423. [PMID: 36541412 PMCID: PMC10107815 DOI: 10.1002/ajmg.a.63038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/09/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022]
Abstract
GM1-gangliosidosis (GM1) is a rare neurodegenerative disorder leading to early mortality and causing progressive decline of physical skills and cerebral functioning. No approved treatment for GM1 exists. In this study-the first to explore priorities of parents of subjects with pediatric onset forms of GM1-we address a crucial gap by characterizing symptoms most critical to caregivers of children with GM1 to treat. Our two-part, mixed-methods approach began with focus groups, followed by interviews with a distinct set of parents. Interviews included a prioritization activity that used best-worst scaling. Quantitative data were analyzed descriptively. Qualitative data were analyzed using thematic analysis and rapid analysis process. Parents prioritized the symptoms they believed would increase their child's lifespan and improve their perceived quality of life (QoL); these symptoms focused on communicating wants/needs, preventing pain/discomfort, getting around and moving one's body, and enhancing eating/feeding. Although lifespan was highly valued, almost all parents would not desire a longer lifespan without acceptable child QoL. Parents indicated high caregiver burden and progressive reduction in QoL for children with GM1. This novel study of caregiver priorities identified important symptoms for endpoints' selection in patient-focused drug development in the context of high disease impact and unmet treatment needs.
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Affiliation(s)
- Amanda Bingaman
- RTI International, Research Triangle, North Carolina, United States
| | | | - Sara M Andrews
- RTI International, Research Triangle, North Carolina, United States
| | - Diana Pangonis
- National Tay-Sachs & Allied Diseases Association (NTSAD), Brighton, Massachusetts, United States
| | | | - Roberto Giugliani
- PPGBM UFRGS, DASA Genomics and Casa dos Raros, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Jeanine Jarnes
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | | | | | - Holly L Peay
- RTI International, Research Triangle, North Carolina, United States
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11
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Porter KA, O'Neill C, Drake E, Andrews SM, Delaney K, Parker S, Escolar ML, Montgomery S, Moon W, Worrall C, Peay HL. Caregivers' assessment of meaningful and relevant clinical outcome assessments for Sanfilippo syndrome. J Patient Rep Outcomes 2022; 6:40. [PMID: 35467223 PMCID: PMC9038975 DOI: 10.1186/s41687-022-00447-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Sanfilippo syndrome is a rare multisystem disease with no approved treatments. This study explores caregiver perspectives on the most impactful symptoms and patient-relevant clinical outcomes assessments. The pediatric onset and progressive neurodegenerative nature of Sanfilippo limits use of self-report in clinical research. This study obtains Sanfilippo caregiver data to support the selection of fit-for-purpose and patient-relevant clinical outcome assessments (COAs). METHODS We conducted an asynchronous online focus group (n = 11) followed by individual interviews with caregivers (n = 19) of children with Sanfilippo syndrome. All participants reported on the impact of disease symptoms and level of unmet treatment need across Sanfilippo symptom domains. Focus group participants reviewed existing assessments relating to 8 symptom domains (15 total assessments) and provided feedback on meaningfulness and relevance. Focus group data were used to reduce the number of assessments included in subsequent interviews to 8 COAs across 7 symptom domains: communication, eating, sleep, mobility, pain, behavior and adapting. Interview respondents provided data on meaningfulness and relevance of assessments. Data were coded using an item-tracking matrix. Data summaries were analyzed by caregivers' responses regarding meaningfulness; relevance to Sanfilippo syndrome; and based on caregiver indication of missing or problematic subdomains and items. RESULTS Participants' children were 2-24 years in age and varied in disease progression. Caregivers reported communication and mobility as highly impactful domains with unmet treatment needs, followed closely by pain and sleep. Domains such as eating, adaptive skills, and behaviors were identified as impactful but with relatively less priority, by comparison. Participants endorsed the relevance of clinical outcome assessments associated with communication, eating, sleep, and pain, and identified them as highly favorable for use in a clinical trial. Participants specified some refinements in existing assessments to best reflect Sanfilippo symptoms and disease course. DISCUSSION The identification of impactful symptoms to treat and relevant and meaningful clinical outcome assessments supports patient-focused drug development. Our results inform targets for drug development and the selection of primary and secondary outcome assessments with high meaningfulness and face validity to Sanfilippo syndrome caregivers. Assessments identified as less optimal might be refined, replaced, or remain if the clinical trial necessitates.
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Affiliation(s)
- Katherine Ackerman Porter
- Center for Genomics, Bioinformatics, and Translational Research, RTI International, Research Triangle Park, NC, USA
| | | | - Elise Drake
- Cure Sanfilippo Foundation, Columbia, SC, USA
| | - Sara M Andrews
- Center for Genomics, Bioinformatics, and Translational Research, RTI International, Research Triangle Park, NC, USA
| | - Kathleen Delaney
- Global Patient Advocacy and Engagement, BioMarin Pharmaceutical Inc., San Rafael, CA, USA
| | - Samantha Parker
- Patient and Policy Affairs, Lysogene, Neuilly sur Seine, France
| | - Maria L Escolar
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | | | - William Moon
- Cure Sanfilippo Foundation Parent Advocates, Columbia, SC, USA
| | - Carolyn Worrall
- Cure Sanfilippo Foundation Parent Advocates, Columbia, SC, USA
| | - Holly L Peay
- Center for Genomics, Bioinformatics, and Translational Research, RTI International, Research Triangle Park, NC, USA.
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Grant N, Sohn YB, Ellinwood NM, Okenfuss E, Mendelsohn BA, Lynch LE, Braunlin EA, Harmatz PR, Eisengart JB. Timing is everything: Clinical courses of Hunter syndrome associated with age at initiation of therapy in a sibling pair. Mol Genet Metab Rep 2022; 30:100845. [PMID: 35242576 PMCID: PMC8856919 DOI: 10.1016/j.ymgmr.2022.100845] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
Hunter syndrome, or mucopolysaccharidosis (MPS) II, is a rare lysosomal disorder characterized by progressive, multi-system disease. As most symptoms cannot be reversed once established, early detection and treatment prior to the onset of clinical symptoms are critical. However, it is difficult to identify affected individuals early in disease, and therefore the long-term outcomes of initiating treatment during this optimal time period are incompletely described. We report long-term clinical outcomes of treatment when initiated prior to obvious clinical signs by comparing the courses of two siblings with neuronopathic Hunter syndrome (c.1504 T > G[p.W502G]), one who was diagnosed due to clinical disease (Sibling-O, age 3.7 years) and the other who was diagnosed before disease was evident (Sibling-Y, age 12 months), due to his older sibling's findings. The brothers began enzyme replacement therapy within a month of diagnosis. Around the age of 5 years, Sibling-O had a cognitive measurement score in the impaired range of <55 (average range 85–115), whereas Sibling-Y at this age received a score of 91. Sibling-O has never achieved toilet training and needs direct assistance with toileting, dressing, and washing, while Sibling-Y is fully toilet-trained and requires less assistance with daily activities. Both siblings have demonstrated sensory-seeking behaviors, hyperactivity, impulsivity, and sleep difficulties; however, Sibling-O demonstrates physical behaviors that his brother does not, namely biting, pushing, and frequent elopement. Since the time of diagnosis, Sibling-O has had significant joint contractures and a steady deterioration in mobility leading to the need for an adaptive stroller at age 11, while Sibling-Y at age 10.5 could hike more than 6 miles without assistance. After nearly a decade of therapy, there were more severe and life-limiting disease manifestations for Sibling-O; data from caregiver interview indicated substantial differences in Quality of Life for the child and the family, dependent on timing of ERT. The findings from this sibling pair provide evidence of superior somatic and neurocognitive outcomes associated with presymptomatic treatment of Hunter syndrome, aligned with current considerations for newborn screening.
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Affiliation(s)
- Nathan Grant
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Young Bae Sohn
- Department of Medical Genetics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | | | | | | | | | | | | | - Julie B. Eisengart
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- Corresponding author at: Department of Pediatrics, 717 Delaware St SE, Ste. 353, Minneapolis, MN 55414, USA.
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13
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Wijburg FA, Aiach K, Chakrapani A, Eisengart JB, Giugliani R, Héron B, Muschol N, O'Neill C, Olivier S, Parker S. An observational, prospective, multicenter, natural history study of patients with mucopolysaccharidosis type IIIA. Mol Genet Metab 2022; 135:133-142. [PMID: 34991944 DOI: 10.1016/j.ymgme.2021.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/04/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
Mucopolysaccharidosis type IIIA (MPS IIIA, also known as Sanfilippo syndrome) is a rare genetic lysosomal storage disease characterized by early and progressive neurodegeneration resulting in a rapid decline in cognitive function affecting speech and language, adaptive behavior, and motor skills. We carried out a prospective observational study to assess the natural history of patients with MPS IIIA, using both standardized tests and patient-centric measures to determine the course of disease progression over a 2-year period. A cohort of 23 patients (7 girls, 16 boys; mean age 28-105 months at baseline) with a confirmed diagnosis of MPS IIIA were assessed and followed up at intervals of 3-6 months; cognitive function was measured using Bayley Scales of Infant and Toddler Development 3rd edition (BSID-III) to derive cognitive development quotients (DQ). Daily living, speech/language development and motor skills were measured using the Vineland Adaptive Behavior Scale (VABS-II). Sleep-wake patterns, behavior and quality-of-life questionnaires were also reported at each visit using parent/caregiver reported outcome tools. All patients had early onset severe MPS IIIA, were diagnosed before 74 months of age, and had cognitive scores below normal developmental levels at baseline. Patients less than 40 months of age at baseline were more likely to continue developing new skills over the first 6-12 months of follow-up. There was a high variability in cognitive developmental age (DA) in patients between 40 and 70 months of age; two-thirds of these patients already had profound cognitive decline, with a DA ≤10 months. The highest cognitive DA achieved in the full study cohort was 34 months. Post hoc, patients were divided into two groups based on baseline cognitive DQ (DQ ≥50 or <50). Cognitive DQ decreased linearly over time, with a decrease from baseline of 30.1 and 9.0 points in patients with cognitive DQ ≥50 at baseline and cognitive DQ <50 at baseline, respectively. Over the 2-year study, VABS-II language scores declined progressively. Motor skills, including walking, declined over time, although significantly later than cognitive decline. No clear pattern of sleep disturbance was observed, but night waking was common in younger patients. Pain scores, as measured on the quality-of-life questionnaire, increased over the study period. The findings of this study strengthen the natural history data on cognitive decline in MPS IIIA and importantly provide additional data on endpoints, validated by the patient community as important to treat, that may form the basis of a multidomain endpoint capturing the disease complexity.
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Affiliation(s)
- Frits A Wijburg
- Department of Pediatric Metabolic Diseases, Emma Children's Hospital, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Lysosome Center "Sphinx", University of Amsterdam, Amsterdam, Netherlands.
| | | | - Anupam Chakrapani
- Metabolic Medicine Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Julie B Eisengart
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Roberto Giugliani
- Department of Genetics, UFRGS, Medical Genetics Service and DR Brazil, HCPA, Porto Alegre, Brazil
| | - Bénédicte Héron
- Reference Center for Lysosomal Diseases, Pediatric Neurology Department, Armand Trousseau University Hospital, APHP, Paris, France
| | - Nicole Muschol
- Department of Pediatrics, International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Bruno LP, Fava F, Baldassarri M, Salvati VM, Scandurra V, Canitano R, Valentino F, Doddato G, Tita R, Giliberti A, Renieri A, Ariani F. Identification of a Novel Pathogenic Variant in the NAGLU Gene in a Child with Neurodevelopmental Delay. J Autism Dev Disord 2021; 52:4605-4607. [PMID: 34709531 DOI: 10.1007/s10803-021-05332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Lucia Pia Bruno
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Francesca Fava
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Margherita Baldassarri
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Virginia M Salvati
- UOSD Pediatria Cava de' Tirreni- AOU S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Valeria Scandurra
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Roberto Canitano
- Division of Child and Adolescent Neuropsychiatry, University Hospital of Siena, Siena, Italy
| | - Floriana Valentino
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gabriella Doddato
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Rossella Tita
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Annarita Giliberti
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alessandra Renieri
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesca Ariani
- Medical Genetics Unit, University of Siena, Policlinico Le Scotte, Viale Bracci, 2, 53100, Siena, Italy.
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy.
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy.
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15
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Gastrointestinal Manifestations in Mucopolysaccharidosis Type III: Review of Death Certificates and the Literature. J Clin Med 2021; 10:jcm10194445. [PMID: 34640463 PMCID: PMC8509825 DOI: 10.3390/jcm10194445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/23/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mucopolysaccharidosis type III (MPS III, Sanfilippo disease) is a life-limiting recessive lysosomal storage disorder caused by a deficiency in the enzymes involved in degrading glycosaminoglycan heparan sulfate. MPS III is characterized by progressive deterioration of the central nervous system. Respiratory tract infections have been reported as frequent and as the most common cause of death, but gastrointestinal (GI) manifestations have not been acknowledged as a cause of concern. The aim of this study was to determine the incidence of GI problems as a primary cause of death and to review GI symptoms reported in published studies. METHODS Causes of death from 221 UK death certificates (1957-2020) were reviewed and the literature was searched to ascertain reported GI symptoms. RESULTS GI manifestations were listed in 5.9% (n = 13) of death certificates. Median (IQR) age at death was 16.7 (5.3) years. Causes of death included GI failure, GI bleed, haemorrhagic pancreatitis, perforation due to gastrostomies, paralytic ileus and emaciation. Twenty-one GI conditions were reported in 30 studies, mostly related to functional GI disorders, including diarrhoea, dysphagia, constipation, faecal incontinence, abdominal pain/distension and cachexia. CONCLUSIONS GI manifestations may be an under-recognized but important clinical feature of MPS III. Early recognition of GI symptoms and timely interventions is an important part of the management of MPS III patients.
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