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Hemostatic Abnormalities in Gaucher Disease: Mechanisms and Clinical Implications. J Clin Med 2022; 11:jcm11236920. [PMID: 36498496 PMCID: PMC9735904 DOI: 10.3390/jcm11236920] [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: 10/14/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Gaucher disease (GD) is a rare inherited lysosomal metabolism disorder, characterized by an accumulation into lysosomes of reticuloendothelial cells, especially in the bone marrow, spleen, and liver of β-glucosylceramide and glucosyl sphingosine, which is its deacylated product. Impaired storage is responsible for a chronic inflammatory state at the sites of accumulation and together represents the pathophysiological cause of GD. GD is a progressive, multi-organ chronic disorder. Type 1 GD is the most prevalent form, with heterogeneous multisystem involvement and different severity of symptoms at any age. Hematological involvement is consistent, and a bleeding tendency is frequent, particularly at diagnosis. Several coagulation and primary hemostasis abnormalities are observed in GD. Bleeding manifestations are rarely severe and usually mucocutaneous. Post-operative, delivery, and post-partum hemorrhages are also common. Thrombocytopenia, platelet function defects, and clotting abnormalities, alone or variably associated, contribute to increase the risk of bleeding in GD. Enzyme replacement therapy (ERT) or substrate reduction therapy (SRT) are the two specific available treatments effective in improving typical hematological symptoms and abnormalities, including those of hemostasis. However, the use of medication to potentiate hemostasis may be also useful in defined clinical situations: recent starting of ERT/SRT, surgery, delivery, and life-threatening bleeding.
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2
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Gold JI, Gold NB, DeLeon DD, Ganetzky R. Contraceptive use in women with inherited metabolic disorders: a retrospective study and literature review. Orphanet J Rare Dis 2022; 17:41. [PMID: 35135572 PMCID: PMC8822780 DOI: 10.1186/s13023-022-02188-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reproductive planning is an emerging concern for women with inherited metabolic disease (IMD). Anticipatory guidance on contraception is necessary to prevent unintended pregnancies in this population. Few resources exist to aid informed decision-making on contraceptive choice. A retrospective case-control study was performed to examine trends in reproductive planning for adolescent and adult women seen at the Children's Hospital of Philadelphia (CHOP). Literature review on contraception and IMD was performed to assess global use. RESULTS In a cohort of 221 reproductive-aged female IMD patients, 29.4% reported routine contraceptive use. Anticipatory guidance on contraception was provided by metabolic physicians to 36.8% of patients during the study period. Contraception discussion was more likely to occur in women older than 21 years, who lived independently and were followed by gynecology. Women who received contraception counseling from their metabolic physician were 40-fold more likely to use regular contraception. Use of combined hormonal contraceptives was most commonly reported, but contraception choice varied by age and IMD. CONCLUSION Metabolic physicians are ideally suited to provide guidance on contraception to women with IMD. Reproductive planning should be addressed routinely using shared decision-making. Contraceptives should be selected for their efficacy, effects on metabolism, and likelihood of patient adherence.
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Affiliation(s)
- Jessica I Gold
- Division of Human Genetics, Section of Biochemical Genetics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Nina B Gold
- Division of Medical Genetics and Metabolism, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Diva D DeLeon
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Ganetzky
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Division of Human Genetics, Section of Biochemical Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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3
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Cohen Y, Frydman D, Rotem R, Kofman R, Zimran A, Revel-Vilk S, Grisaru-Granovsky S. Risk of postpartum hemorrhage in multiparous women with Gaucher disease: A call for reconsidering enzyme replacement therapy in all pregnant patients. J Inherit Metab Dis 2021; 44:1165-1173. [PMID: 33829536 DOI: 10.1002/jimd.12382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022]
Abstract
For the last three decades, enzyme replacement therapy (ERT) for Gaucher disease (GD) has been available. We aimed to evaluate the effect of ERT on the pregnancy and obstetric outcome in a unique group of multiparous women with type 1 GD (GD1) who had pregnancies with and without ERT. The Gaucher Unit database (1987-2019) was searched for multiparous women who had pregnancies before and after the institution of ERT. Data were collected from the clinic files and study-specific questionnaires. Descriptive, correlation analysis and generalized estimating equations (GEE) were used to study the effect of ERT and confounding variables on study outcomes. We identified 19 women with 105 pregnancies, among which 26 (24.7%) terminated in first-trimester miscarriage. The risk for miscarriage was associated with the severity of GD1 genotype and phenotype, but not with ERT usage. Early postpartum hemorrhage (PPH) was reported in 16 (84%) women after 25 deliveries (31.6%, 95% CI 21.6%-43.1%). The risks of early PPH and red blood cell (RBC) transfusions were significantly lower when ERT was used during pregnancy, OR (95% CI) 0.13 (0.03-0.54) and 0.27 (0.08-0.94), respectively, compared to pregnancies without the use of ERT. Enzyme replacement therapy during pregnancy is risk reducing for early PPH and RBC transfusions in women with GD1. We suggest considering ERT for the benefit of all pregnant women with GD1, including mild GD1.
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Affiliation(s)
- Yael Cohen
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dafna Frydman
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Roei Kofman
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ari Zimran
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shoshana Revel-Vilk
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
- Gaucher Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Lukina E, Balwani M, Belmatoug N, Watman N, Hughes D, Gaemers SJM, Foster MC, Lewis G, Peterschmitt MJ. Pregnancy outcome in women with Gaucher disease type 1 who had unplanned pregnancies during eliglustat clinical trials. JIMD Rep 2021; 57:76-84. [PMID: 33473343 PMCID: PMC7802626 DOI: 10.1002/jmd2.12172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/12/2020] [Accepted: 09/16/2020] [Indexed: 11/20/2022] Open
Abstract
Gaucher disease type 1 (GD1) is an inherited lysosomal storage disorder caused by deficient enzymatic activity of acid β-glucosidase, resulting in accumulation of its substrate glucosylceramide, leading to debilitating visceral, hematologic, and skeletal manifestations. Women with GD1 are at increased risk for complications during pregnancy, delivery, and postpartum. Treatment with enzyme replacement therapy is generally recommended before and during pregnancy to reduce risks. Eliglustat, an oral substrate-reduction therapy, is a first-line treatment for adults with GD1 adults who have extensive, intermediate, or poor CYP2D6-metabolizer phenotypes (>90% of patients). We report on pregnancy outcomes among women in eliglustat trials who had unplanned pregnancies and female partners of men in the trials. In four phase 2 and 3 eliglustat trials of 393 adults with GD1, women of childbearing potential were required to use contraception, have monthly pregnancy tests, and discontinue eliglustat promptly if pregnant. In phase 2 and 3 trials, 18 women had 19 pregnancies, resulting in 14 healthy infants from 13 pregnancies (one set of twins), three elective terminations, one ectopic pregnancy, one spontaneous abortion, and one in utero death. Median estimated eliglustat exposure duration during pregnancy was 38 days. In phase 1 trials (non-GD1 subjects), one woman had a spontaneous abortion. Partners of 16 eliglustat-treated men with GD1 had 18 pregnancies, all resulting in healthy infants. Eliglustat is not approved during pregnancy due to limited data. Guidelines for clinicians and patients with GD that address use of eliglustat in women of childbearing potential are needed.
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Affiliation(s)
- Elena Lukina
- National Research Center for HematologyMoscowRussia
| | | | - Nadia Belmatoug
- Beaujon Hospital, University of Paris, Assistance Publique‐Hopitaux de ParisParisFrance
| | | | - Derralynn Hughes
- Royal Free London NHS Foundation Trust, University College LondonLondonUK
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Komninaka V, Flevari P, Marinakis T, Karkaletsis G, Malakou L, Repa K. Outcomes of pregnancies in patients with Gaucher Disease: The experience of a center of excellence on rare metabolic Disease-Gaucher Disease, in Greece. Eur J Obstet Gynecol Reprod Biol 2020; 254:181-187. [PMID: 33032100 DOI: 10.1016/j.ejogrb.2020.09.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Pregnancy is reported to exacerbate manifestations in women with Gaucher Disease (GD). The objective of our study was to examine the outcome of pregnancies of Caucasian women with GD in a Greek Center of Excellence on GD. STUDY DESIGN Fifteen GD women were enrolled. All data were collected by questionnaire: fertility, normal pregnancies, spontaneous-elective-therapeutic abortions, maternal -neonatal status, birth weight and chromosomal abnormalities. RESULTS Forty-one pregnancies were reported among 15 women: mean conception age (±SD) 27.7 ± 5.8years (range 17-42years). Thirty-seven conceptions were spontaneous, 4 were after in vitro fertilization (IVF). Twenty three out of the 41 (56.1 %) pregnancies were normal. Eleven out of the 41 (26.8 %) pregnancies resulted in spontaneous abortions, 3 out of 41 (7.3 %) in elective and 3 out of 41 (7.3 %) in therapeutic abortions. Therapeutic abortions were due to worsening of GD manifestations, fetal chromosomal abnormalities and GD type 2 embryo. Nine out of 15 women had maternal complications: gestational diabetes, splenomegaly, hepatomegaly, thrombocytopenia, osteoporosis and postpartum hemorrhage. Twenty three out of the 41 pregnancies resulted in live births. Nine out of the 23 (39.1 %) deliveries were caesarian sections and 14 out of 23 (60.9 %) were vaginal. The total number of neonates was 24 (14 females / 10 males). Mean gestational age on delivery (± SD) was 35.9 ± 3.1 weeks (range 26-38 w). Average female birth weight (±SD) was 2671.4 ± 851.6 g (range 900-4100 grams) and male was 3333 ± 996.4 g (range 1930-4700 grams). Nine out of 24 (37.5 %) neonates had low birth weight. Average low birth weight (±SD) was 1931.1 ± 420.52 g (range 900-2300 grams). Twenty out of the 24 (83.3 %) neonates were healthy. Four out of 24 neonates had neonatal complications: two neonates had GD type 1, one had GD type 3 and one neonate died two days after delivery (it was born at 26 weeks). Four neonates were hospitalized in incubators at the intensive neonatal care unit due to low birth weight. Thirty-nine women did not receive enzyme replacement therapy for GD during pregnancy, while, in two pregnancies, treatment was discontinued during the first trimester and re-administered after that. Mean first menarche age (±SD) was 13.6 ± 0.7 years. Thirteen out of 15 women were menopausal, mean menopausal age (± SD) 466 ± 2.6 years. CONCLUSION Most of GD women experience uncomplicated pregnancies and deliver normal, healthy infants, although the rate of complications and the rate of abortions is high in this population.
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Affiliation(s)
- Veroniki Komninaka
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, Athens, Greece.
| | - Pagona Flevari
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, Athens, Greece
| | | | | | - Lina Malakou
- Department of Haematology, G.Gennimatas General Hospital, Athens, Greece
| | - Konstantina Repa
- Centre of Excellence in Rare Haematological (Haemoglobinopathies) & Rare Metabolic (Gaucher Disease) Diseases, Laiko General Hospital, Athens, Greece
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Hughes D, Mikosch P, Belmatoug N, Carubbi F, Cox T, Goker-Alpan O, Kindmark A, Mistry P, Poll L, Weinreb N, Deegan P. Gaucher Disease in Bone: From Pathophysiology to Practice. J Bone Miner Res 2019; 34:996-1013. [PMID: 31233632 PMCID: PMC6852006 DOI: 10.1002/jbmr.3734] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/28/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
Gaucher disease (GD) is a rare, genetic lysosomal disorder leading to lipid accumulation and dysfunction in multiple organs. Involvement of the skeleton is one of the most prevalent aspects of GD and a major cause of pain, disability, and reduced quality of life. Uniform recommendations for contemporary evaluation and management are needed. To develop practical clinical recommendations, an international group of experienced physicians conducted a comprehensive review of 20 years' of the literature, defining terms according to pathophysiological understanding and pointing out best practice and unmet needs related to the skeletal features of this disorder. Abnormalities of bone modeling, reduced bone density, bone infarction, and plasma cell dyscrasias accompany the displacement of healthy adipocytes in adult marrow. Exposure to excess bioactive glycosphingolipids appears to affect hematopoiesis and the balance of osteoblast and osteoclast numbers and activity. Imbalance between bone formation and breakdown induces disordered trabecular and cortical bone modeling, cortical bone thinning, fragility fractures, and osteolytic lesions. Regular assessment of bone mineral density, marrow infiltration, the axial skeleton and searching for potential malignancy are recommended. MRI is valuable for monitoring skeletal involvement: It provides semiquantitative assessment of marrow infiltration and the degree of bone infarction. When MRI is not available, monitoring of painful acute bone crises and osteonecrosis by plain X-ray has limited value. In adult patients, we recommend DXA of the lumbar spine and left and right hips, with careful protocols designed to exclude focal disease; serial follow-up should be done using the same standardized instrument. Skeletal health may be improved by common measures, including adequate calcium and vitamin D and management of pain and orthopedic complications. Prompt initiation of specific therapy for GD is crucial to optimizing outcomes and preventing irreversible skeletal complications. Investing in safe, clinically useful, and better predictive methods for determining bone integrity and fracture risk remains a need. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Derralynn Hughes
- Royal Free London NHS Foundation Trust and University College London, UK
| | - Peter Mikosch
- Department of Internal Medicine 2, Landesklinikum Mistelbach, Austria, and Medical University Vienna, Externe Lehre, Vienna, Austria
| | - Nadia Belmatoug
- Referral Center for Lysosomal Diseases, Department of Internal Medicine, University Hospital Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Francesca Carubbi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, NOCSAE Hospital, AOU Modena, Italy
| | - TimothyM Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Andreas Kindmark
- Department of Endocrinology and Diabetology, Uppsala University Hospital, Uppsala, Sweden
| | - PramodK Mistry
- Department of Internal Medicine (Digestive Diseases), Yale University School of Medicine, New Haven, CT, USA
| | - Ludger Poll
- Practice of Radiology and Nuclear Medicine Duisburg-Moers, Heinrich-Heine University Düsseldorf, Duisburg, Germany
| | - Neal Weinreb
- Departments of Human Genetics and Medicine (Hematology), Miller School of Medicine, University of Miami, FL, USA
| | - Patrick Deegan
- Lysosomal Disorders Unit, Addenbrooke's Hospital, Cambridge, UK
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7
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Abstract
Importance Inherited metabolic disorders, or inborn errors of metabolism, can result in significant morbidity and mortality. Advances in genetic testing, including newborn screening and prenatal carrier screening, continue to increase awareness and highlight the importance of these conditions. Increasingly, women born with these conditions are surviving to adulthood, and many become pregnant. The practicing obstetrician-gynecologist should be familiar with the most common and the most relevant inherited metabolic disorders affecting women. Objective The objective of this review is to define inherited metabolic disorders that have relevance to the obstetrician-gynecologist. We discuss the diagnosis, presentation, epidemiology, and special concerns to the obstetrician-gynecologist managing patients affected by these conditions. Evidence Acquisition A MEDLINE search of "inherited metabolic disorders" and "inborn errors of metabolism" and specific conditions reported in the review was performed. Results The evidence cited in this review includes 8 case reports or case series, 4 text books, 1 systematic review, 1 American College of Obstetricians and Gynecologists committee opinion, and 18 additional peer-reviewed journal articles that were original research or expert opinion summaries. Conclusions and Relevance Inherited metabolic disorders manifest in diverse ways that have clinical implications for the obstetrician-gynecologist. Knowledge of these disorders and their pathophysiology and genetic basis can improve care provided for women affected by this diverse group of conditions. It is critical to assemble a multidisciplinary team of providers to optimize care for patients with inherited metabolic disorders.
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Abstract
INTRODUCTION Gaucher disease, the autosomal recessive deficiency of the lysosomal enzyme glucocerebrosidase, is associated with wide phenotypic diversity including non-neuronopathic, acute neuronopathic, and chronic neuronopathic forms. Overlap between types can render definitive diagnoses difficult. However, differentiating between the different phenotypes is essential due to the vast differences in clinical outcomes and response to therapy. Genotypic information is helpful, but cannot always be used to make clinical predictions. Current treatments for Gaucher disease, including enzyme replacement therapy and substrate reduction therapy, can reverse many of the non-neurological manifestations, but these therapies must be administered continually and are extremely costly. AREAS COVERED We reviewed the literature concerning the varied clinical presentations of Gaucher disease throughout the lifetime, along with treatment options, management goals, and current and future research challenges. A PubMed literature search was performed for relevant publications between 1991 to January 2018. EXPERT COMMENTARY Interest and research in the field of Gaucher disease is rapidly expanding. However, significant barriers remain in our ability to predict phenotype, assess disease progression using objective biomarkers, and determine optimal treatment strategy on an individual basis. As the field grows, we anticipate identification of genetic modifiers, new biomarkers, and small-molecule chaperone therapies, which may improve patient quality of life.
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Affiliation(s)
- Sam E Gary
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
| | - Emory Ryan
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
| | - Alta M Steward
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
| | - Ellen Sidransky
- a Medical Genetics Branch , NHGRI, NIH , Bethesda , MD , USA
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Lau H, Belmatoug N, Deegan P, Goker-Alpan O, Schwartz IVD, Shankar SP, Panahloo Z, Zimran A. Reported outcomes of 453 pregnancies in patients with Gaucher disease: An analysis from the Gaucher outcome survey. Blood Cells Mol Dis 2018; 68:226-231. [DOI: 10.1016/j.bcmd.2016.10.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022]
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10
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Ibrahim J, Call R. Letter to the Editor on “Enzyme Replacement or Substrate Reduction? A Review of Gaucher Disease Treatment Options”. Hosp Pharm 2017; 52:725-726. [DOI: 10.1177/0018578717735641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer Ibrahim
- Senior US Medical Director, Rare Disease Sanofi Genzyme, Cambridge, MA, USA
| | - Rebecca Call
- Medical Affairs/Medical Science Liaison (MSL): Rare Disease Fellow Sanofi Genzyme, Cambridge, MA, USA
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11
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Belmatoug N, Di Rocco M, Fraga C, Giraldo P, Hughes D, Lukina E, Maison-Blanche P, Merkel M, Niederau C, Plӧckinger U, Richter J, Stulnig TM, Vom Dahl S, Cox TM. Management and monitoring recommendations for the use of eliglustat in adults with type 1 Gaucher disease in Europe. Eur J Intern Med 2017; 37:25-32. [PMID: 27522145 DOI: 10.1016/j.ejim.2016.07.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In Gaucher disease, diminished activity of the lysosomal enzyme, acid β-glucosidase, leads to accumulation of glucosylceramides and related substrates, primarily in the spleen, liver, and bone marrow. Eliglustat is an oral substrate reduction therapy approved in the European Union and the United States as a first-line treatment for adults with type 1 Gaucher disease who have compatible CYP2D6 metabolism phenotypes. A European Advisory Council of experts in Gaucher disease describes the characteristics of eliglustat that are distinct from enzyme augmentation therapy (the standard of care) and miglustat (the other approved substrate reduction therapy) and recommends investigations and monitoring for patients on eliglustat therapy within the context of current recommendations for Gaucher disease management. RESULTS Eliglustat is a selective, potent inhibitor of glucosylceramide synthase, the enzyme responsible for biosynthesis of glucosylceramides which accumulate in Gaucher disease. Extensive metabolism of eliglustat by CYP2D6, and, to a lesser extent, CYP3A of the cytochrome P450 pathway, necessitates careful consideration of the patient's CYP2D6 metaboliser status and use of concomitant medications which share metabolism by these pathways. Guidance on specific assessments and monitoring required for eliglustat therapy, including an algorithm to determine eligibility for eliglustat, are provided. CONCLUSIONS As a first-line therapy for type 1 Gaucher disease, eliglustat offers eligible patients a daily oral therapy alternative to biweekly infusions of enzyme therapy. Physicians will need to carefully assess individual Gaucher patients to determine their appropriateness for eliglustat therapy. The therapeutic response to eliglustat and use of concomitant medications will require long-term monitoring.
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Affiliation(s)
- Nadia Belmatoug
- Referral Center for Lysosomal Diseases, University Beaujon Hospital Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Department of Internal Medicine, 100 Boulevard du Général Leclerc, 92110 Clichy, France.
| | - Maja Di Rocco
- Unit of Rare Diseases, Department Pediatrics, Gaslini Institute, Largo Gaslini 3, 16147 Genoa, Italy.
| | - Cristina Fraga
- Department of Haematology, HDES Hospital, Ponta Delgada, Av. D. Manuel I, PDL, Açores, Portugal.
| | - Pilar Giraldo
- Translational Research Unit, Instituto Investigación Sanitaria Aragon, CIBER Enfermedades Raras (CIBERER), Zaragoza, Spain.
| | - Derralynn Hughes
- Royal Free London NHS Foundation Trust, University College London, Department of Haematology, Pond St., London NW1 2QG, United Kingdom
| | - Elena Lukina
- Department of Orphan Diseases, Hematology Research Center, 4 Novy Zykovsky Lane, 125167 Moscow, Russia.
| | - Pierre Maison-Blanche
- Bichat University Hospital, Cardiology Unit, 46 Rue Henri Huchard, 75018 Paris, France.
| | - Martin Merkel
- Department of Internal Medicine, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.
| | - Claus Niederau
- Katholisches Klinikum Oberhausen GmbH, St. Josef Hospital, Department of Medicine, Academic Teaching Hospital, Universität Duisburg-Essen, Mülheimer Str. 83, 46045 Oberhausen, Germany.
| | - Ursula Plӧckinger
- Interdisziplinares Stoffwechsel-Centrum: Diabetes, Endokrinologie und Stoffwechsel, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13352 Berlin, Germany.
| | - Johan Richter
- Department of Hematology and Vascular Diseases, Skåne University Hospital, 221 85 Lund, Sweden.
| | - Thomas M Stulnig
- Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Stephan Vom Dahl
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, University of Duesseldorf, Moorenstrasse 5, D-40225, Germany.
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Box 157, Level 5, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
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Serratrice C, Carballo S, Serratrice J, Stirnemann J. Imiglucerase in the management of Gaucher disease type 1: an evidence-based review of its place in therapy. CORE EVIDENCE 2016; 11:37-47. [PMID: 27790078 PMCID: PMC5072572 DOI: 10.2147/ce.s93717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Gaucher disease is the first lysosomal disease to benefit from enzyme replacement therapy, thus serving as model for numerous other lysosomal diseases. Alglucerase was the first glucocerebrosidase purified from placental extracts, and this was then replaced by imiglucerase – a Chinese hamster ovary cell-derived glucocerebrosidase. Aim The aim was to review the evidence underlying the use of imiglucerase in Gaucher disease type 1 Evidence review Data from clinical trials and Gaucher Registries were analyzed. Conclusion Imiglucerase has been prescribed and found to have an excellent efficacy and safety profile. We report herein the evidence-based data published for 26 years justifying the use of imiglucerase.
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Affiliation(s)
- Christine Serratrice
- Department of Internal Medicine and Rehabilitation, Geneva University Hospital, Thonex, Switzerland
| | - Sebastian Carballo
- Department of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Jacques Serratrice
- Department of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Jérome Stirnemann
- Department of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
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13
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Re-evaluation of bone pain in patients with type 1 Gaucher disease suggests that bone crises occur in small bones as well as long bones. Blood Cells Mol Dis 2016; 60:65-72. [DOI: 10.1016/j.bcmd.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
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14
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Stewart F, Bentley A, Burton BK, Guffon N, Hale SL, Harmatz PR, Kircher SG, Kochhar PK, Mitchell JJ, Plöckinger U, Semotok J, Graham S, Sande S, Sisic Z, Johnston TA. Expert Opinions on Managing Fertility and Pregnancy in Patients With Mucopolysaccharidosis. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816669375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Fiona Stewart
- Belfast City Hospital, Belfast, Northern Ireland, United Kingdom
| | - Andrew Bentley
- University Hospital South Manchester NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | - Susanne G. Kircher
- Institute of Medical Chemistry and Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - Pavan K. Kochhar
- Central Manchester University Hospitals, Manchester, United Kingdom
| | | | | | - Jennifer Semotok
- Adult Metabolic Genetics Clinic, University Health Network, Toronto, Canada
| | - Sue Graham
- BioMarin Pharmaceutical Inc, Novato, CA, USA
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Machine learning based analytics of micro-MRI trabecular bone microarchitecture and texture in type 1 Gaucher disease. J Biomech 2016; 49:1961-1968. [DOI: 10.1016/j.jbiomech.2016.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/29/2016] [Accepted: 04/07/2016] [Indexed: 11/21/2022]
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16
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Abstract
Heavy menstrual bleeding (HMB) is a common gynecological complaint with multiple etiologies and diverse pathophysiological origins. This review discusses HMB with reference to the recently proposed PALM-COEIN classification system for abnormal uterine bleeding, initially describing the endometrial events in normal menstruation followed by discussion of the perturbations of normal endometrial shedding that can result in HMB. Our present understanding of the mechanisms of menstrual bleeding as well as many of the pathological aberrations of HMB is incomplete. Further research into the pathophysiology of HMB is urgently needed, as clear knowledge of the mechanisms of this disorder will provide new therapeutic targets to formulate more effective treatments.
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Affiliation(s)
- Dharani K Hapangama
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool Women's Hospital, Crown Street, Liverpool, L8 7SS, UK
| | - Judith N Bulmer
- Reproductive & Vascular Biology Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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17
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18
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Flash-Luzzatti S, Weil C, Shalev V, Oron T, Chodick G. Long-term secular trends in the age at menarche in Israel: a systematic literature review and pooled analysis. Horm Res Paediatr 2015; 81:266-71. [PMID: 24504328 DOI: 10.1159/000357444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 11/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS A worldwide decline in the age at menarche (AAM) has been reported in recent decades. This trend has been also clinically observed among Israeli women and was reported in our previous study. METHODS We reviewed the literature reporting the mean AAM in Israel during the past century. Studies were excluded if participants had been investigated due to illness or any condition which could affect sexual maturation. Mean AAM was analyzed using a simple linear regression weighted for number of participants in each birth cohort and stratified to birth cohorts before and after 1970, based on the outcome of our previous study. RESULTS AAM varied little among women born between 1875 and 1970, but there was a clear downwards trend from 13.4 in 1970 to 12.8 two decades later. In a stratified analysis we found a significant negative association between birth year and AAM in the birth cohort after 1970 (standardized β coefficient = -0.94 per year, R(2) = 0.87; p < 0.001). CONCLUSION These results suggest a significant decline in mean AAM in Israeli women born in 1970 or later.
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Affiliation(s)
- Shira Flash-Luzzatti
- Medical Division, Maccabi Healthcare Services, Tel Aviv University, Tel Aviv, Israel
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19
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Complexity of Genotype-Phenotype Correlations in Mendelian Disorders: Lessons from Gaucher Disease. Rare Dis 2015. [DOI: 10.1007/978-94-017-9214-1_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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20
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Marcucci G, Zimran A, Bembi B, Kanis J, Reginster JY, Rizzoli R, Cooper C, Brandi ML. Gaucher disease and bone manifestations. Calcif Tissue Int 2014; 95:477-94. [PMID: 25377906 DOI: 10.1007/s00223-014-9923-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/17/2014] [Indexed: 01/25/2023]
Abstract
Gaucher disease is a relatively rare metabolic disease caused by the inherited deficiency of the lysosomal enzyme glucocerebrosidase. Gaucher disease affects multiple organs, among which is the skeleton. Bone involvement occurs frequently in Gaucher disease, and is one of its most debilitating features, reducing the quality of life of patients. Bone status is an important consideration for treatment to ameliorate symptoms and reduce the risk of irreversible complications. We have conducted a systematic review of all the various aspects of Gaucher disease, focusing on different skeletal manifestations, pathophysiology of bone alterations, clinical symptoms, and current diagnostic and therapeutic approaches.
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Affiliation(s)
- Gemma Marcucci
- Head, Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139, Florence, Italy
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21
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Anderson LJ, Henley W, Wyatt KM, Nikolaou V, Hughes DA, Waldek S, Logan S. Long-term effectiveness of enzyme replacement therapy in adults with Gaucher disease: results from the NCS-LSD cohort study. J Inherit Metab Dis 2014; 37:953-60. [PMID: 24515873 DOI: 10.1007/s10545-014-9680-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/17/2014] [Accepted: 01/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine the effectiveness of enzyme replacement therapies (ERT) for adults with Gaucher disease (GD). DESIGN A longitudinal, multi-centre cohort study, including prospective and retrospective clinical data. Age- and gender-adjusted treatment effects were estimated using generalised linear mixed models. Treated patients contributed data before and during treatment. Untreated patients contributed natural history data. PARTICIPANTS Consenting adults (N = 150, aged 16 to 83 years) with a diagnosis of GD who attended a specialist treatment centre in England. At recruitment, 131 patients were receiving ERT (mean treatment duration, 10.8 years; range 0-18 years). OUTCOME MEASURES Clinical outcomes chosen to reflect disease progression, included platelet count; haemoglobin; absence/presence of bone pain; spleen and liver volumes and AST levels. RESULTS One hundred and fifty adults were recruited. Duration of ERT was associated with statistically significant improvements in platelet count (p < 0.001), haemoglobin (p < 0.001), liver and spleen volumes (p < 0.001) and AST levels (p = 0.02). CONCLUSIONS These data provide further evidence of the long-term effectiveness of ERT in adults with GD.
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Affiliation(s)
- L J Anderson
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, Devon, UK, EX2 4SG
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22
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Žnidar I, Collin-Histed T, Niemeyer P, Parkkinen J, Lauridsen AG, Zariņa S, Cohen Y, Manuel J. The European Gaucher Alliance: a survey of member patient organisations' activities, healthcare environments and concerns. Orphanet J Rare Dis 2014; 9:134. [PMID: 25178161 PMCID: PMC4158124 DOI: 10.1186/s13023-014-0134-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
Background The European Gaucher Alliance (EGA) was established in 1994 and constituted in 2008 as an umbrella group supporting patient organisations for Gaucher disease. Every two years, the EGA conducts a questionnaire survey of member associations to help develop its priorities and annual work programme. Results of the latest survey are presented. Methods Between June 2012 and April 2013, the 36 members and associate members of the EGA were asked to complete a questionnaire detailing membership numbers, disease specific treatments used by patients, means of access to treatment, availability of treatment centres and home infusions, sources of support for patients with Gaucher disease, patient organisations’ activities, collaborations, funding sources and any issues of concern. Questionnaires completed in 2012 were revised in January 2013 and responses analysed between July and September 2013. Results Thirty three members returned data on one or more questions. Findings identified inequalities in access to treatment both within and between members’ countries. Three of 27 countries, for which data were available, relied totally on humanitarian aid for treatment and 6% of untreated patients in 20 countries were untreated because of funding issues, a situation many feared would worsen with deteriorating economic climates. Access to treatment and reimbursement represented 45% of members’ concerns, while 35% related to access to specialist treatment centres, home infusions and doctors with expertise in Gaucher disease. Member associations’ main activities centred on patient support (59% of responses) and raising awareness of Gaucher disease and patients’ needs amongst the medical community, government and healthcare decision makers and the general public (34% of responses). Twenty one (78% of respondents) indicated they were the only source of help for Gaucher disease patients in their country. For many, activities were constrained by funds; two members had no external funding source. Activities were maximised through collaboration with other patient organisations and umbrella organisations for rare diseases. Conclusion The survey provided a ‘snapshot’ of the situation for patients and families affected by Gaucher disease, helping the EGA direct its activities into areas of greatest need.
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Affiliation(s)
| | | | | | | | | | | | | | - Jeremy Manuel
- European Gaucher Alliance, Evesham House Business Centre, 48-52 Silver Street, Dursley GL11 4ND, Gloucestershire, UK.
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23
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Elstein D, Hughes D, Goker-Alpan O, Stivel M, Baris HN, Cohen IJ, Granovsky-Grisaru S, Samueloff A, Mehta A, Zimran A. Outcome of pregnancies in women receiving velaglucerase alfa for Gaucher disease. J Obstet Gynaecol Res 2014; 40:968-75. [DOI: 10.1111/jog.12254] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Deborah Elstein
- Gaucher Clinic; Shaare Zedek Medical Center, affiliated with the Hadassah Medical Center-Hebrew University Medical School; Jerusalem Israel
| | - Derralynn Hughes
- Hematology Service; Royal Free Hospital; University College London School of Medicine; London UK
| | - Ozlem Goker-Alpan
- Lysosomal Disorders Research and Treatment Unit; O & O Alpan LLC; Fairfax Virginia USA
| | - Miriam Stivel
- Hematology Service; Hospital Guillermo Rawson; San Juan Argentina
| | - Hagit N. Baris
- Gaucher Center; The Raphael Recanati Genetic Institute; Rabin Medical Center; Beilinson Hospital; Petach Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ian J. Cohen
- Gaucher Center; The Raphael Recanati Genetic Institute; Rabin Medical Center; Beilinson Hospital; Petach Tikva Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Sorina Granovsky-Grisaru
- Department of Obstetrics and Gynecology; Shaare Zedek Medical Center, affiliated with the Hadassah Medical Center-Hebrew University Medical School; Jerusalem Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology; Shaare Zedek Medical Center, affiliated with the Hadassah Medical Center-Hebrew University Medical School; Jerusalem Israel
| | - Atul Mehta
- Hematology Service; Royal Free Hospital; University College London School of Medicine; London UK
| | - Ari Zimran
- Gaucher Clinic; Shaare Zedek Medical Center, affiliated with the Hadassah Medical Center-Hebrew University Medical School; Jerusalem Israel
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24
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Boufettal H, Quessar A, Jeddaoui Z, Mahdoui S, Noun M, Hermas S, Samouh N. [Pregnancy in Gaucher disease]. ACTA ACUST UNITED AC 2013; 43:397-400. [PMID: 23578492 DOI: 10.1016/j.jgyn.2012.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 10/30/2012] [Accepted: 11/21/2012] [Indexed: 11/28/2022]
Abstract
Gaucher disease is a lysosomal storage disorder due to deficiency of glucocerebrosidase. The association with pregnancy exposes the worsening of the disease and complications of pregnancy and puerperium. We report a case of pregnancy in a woman of 35 years, suffering from Gaucher disease type 1. Pregnancy had a favorable outcome. Complications occurred. They were kept under control. The outcome was favorable. The authors discuss the evolution of the disease during pregnancy and management of complications. They can occur during pregnancy, post-partum and breastfeeding. Support begins with preconception consultation. It involves finding and correcting the biological problems and deficiencies, and management of complications. Genetic counseling is important, it helps prevent inbreeding.
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Affiliation(s)
- H Boufettal
- Service de gynécologie-obstétrique, faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc.
| | - A Quessar
- Service d'hématologie et d'oncologie pédiatrique, faculté de médecine et de pharmacie, université Ain Chok, hôpital du 20-Août, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - Z Jeddaoui
- Service de gynécologie-obstétrique, faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - S Mahdoui
- Service de gynécologie-obstétrique, faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - M Noun
- Service de gynécologie-obstétrique, faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - S Hermas
- Service de gynécologie-obstétrique, faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
| | - N Samouh
- Service de gynécologie-obstétrique, faculté de médecine et de pharmacie, université Ain Chok, centre hospitalier universitaire Ibn Rochd, Casablanca, Maroc
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25
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Hollak CEM, Belmatoug N, Cole JA, vom Dahl S, Deegan PB, Goldblatt J, Rosenbloom B, Dussen L, Tylki-Szymańska A, Weinreb NJ, Zimran A, Cappellini MD. Characteristics of type I Gaucher disease associated with persistent thrombocytopenia after treatment with imiglucerase for 4-5 years. Br J Haematol 2012; 158:528-38. [DOI: 10.1111/j.1365-2141.2012.09175.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/20/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Carla E. M. Hollak
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Academic Medical Centre; University of Amsterdam; Amsterdam; The Netherlands
| | - Nadia Belmatoug
- Reference Centre for Lysosomal Diseases; Beaujon Hospital; Assistance Publique-Hôpitaux de Paris; Clichy; France
| | | | - Stephan vom Dahl
- Department of Internal Medicine; St Franziskus Hospital; Teaching Hospital; University of Cologne; Cologne; Germany
| | | | - Jack Goldblatt
- Genetic Services of Western Australia; School of Paediatrics and Child Health; University of Western Australia; Perth; WA; Australia
| | | | - Laura Dussen
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Academic Medical Centre; University of Amsterdam; Amsterdam; The Netherlands
| | - Anna Tylki-Szymańska
- Department of Metabolic Diseases; The Children's Memorial Health Institute; Warsaw; Poland
| | - Neal J. Weinreb
- University Research Foundation for Lysosomal Storage Disorders; Coral Springs; FL; USA
| | - Ari Zimran
- Gaucher Clinic; Shaare Zedek Medical Centre; Hebrew University; Jerusalem; Israel
| | - Maria Domenica Cappellini
- Department of Internal Medicine; “Ca Granda” Policlinico Foundation IRCCS; University of Milan; Milan; Italy
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Abstract
The scientific and therapeutic development of imiglucerase (Cerezyme(®)) by the Genzyme Corporation is a paradigm case for a critical examination of current trends in biotechnology. In this article the authors argue that contemporary interest in treatments for rare diseases by major pharmaceutical companies stems in large part from an exception among rarities: the astonishing commercial success of Cerezyme. The fortunes of the Genzyme Corporation, latterly acquired by global giant Sanofi SA, were founded on the evolution of a blockbuster therapy for a single but, as it turns out, propitious ultra-orphan disorder: Gaucher disease.
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Affiliation(s)
- Patrick B Deegan
- Department of Medicine, University of Cambridge, Lysosomal Disorders Unit, Addenbrooke's NHS Foundation Hospitals Trust, Cambridge, UK.
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27
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Benedik-Dolničar M, Kitanovski L. Individualized long-term enzyme therapy for Gaucher disease type 1 in Slovenia. Pediatr Int 2011; 53:1018-22. [PMID: 21883686 DOI: 10.1111/j.1442-200x.2011.03451.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gaucher disease type 1 (GD1) was the first lysosomal storage disorder for which an effective enzyme replacement therapy was developed. We describe the management of eight GD1 patients in Slovenia who were diagnosed between the ages of 2 and 15 years. METHODS Patients were individually assessed to establish initial enzyme doses and monitored frequently to determine the effects of long-term enzyme dose regimens. Outcomes up to 10 years after long-term treatment are described by changes in the Zimran severity score index, chitotriosidase and acid phosphatase levels, and after 2001, bone parameters (DEXA bone mineral density scores and the MRI bone marrow burden score). RESULTS Following the initiation of enzyme therapy with individualized dose regimens (range 25-56 U/kg/14 days) and followed by a gradual reduction of doses (range 12-35 U/kg/14 days) during long-term maintenance, disease status improved in all patients as measured by the Zimran severity score index (from a mean of 11.25 [median 11.5] before therapy to a mean of 4.12 [median 3.5] at last report). Anemia and leucopenia resolved in all patients, chitotriosidase and acid phosphatase levels decreased in all patients (and by over 75% in six patients) within 1 year of treatment. Bone marrow burden scores improved in all monitored patients and DXA scores improved in six of seven monitored patients. CONCLUSIONS We conclude that enzyme therapy with relatively low, individualized dose regimens is well-tolerated and effective in children and young adults with GD1 disease, who are regularly monitored for changes in disease status.
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Affiliation(s)
- Majda Benedik-Dolničar
- Division of Pediatrics, Unit of Hemato-oncology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Goker-Alpan O. Therapeutic approaches to bone pathology in Gaucher disease: past, present and future. Mol Genet Metab 2011; 104:438-47. [PMID: 21889384 DOI: 10.1016/j.ymgme.2011.08.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 12/20/2022]
Abstract
Enzyme replacement therapy (ERT) is effective for the treatment of the systemic manifestations of Gaucher disease (GD) and can have a significant impact on skeletal manifestations. Bone involvement is broad and can occur in otherwise clinically asymptomatic individuals. The heterogeneity in GD-related bone disease may implicate multiple pathological processes such as disruption of coordinated bone cell activity, in addition to the physical impact of Gaucher cells causing vascular occlusion. Accumulated data suggests that earlier treatment initiation decreases skeletal complications and that bone disease may require a longer duration of treatment and higher dose than is necessary for organ involvement and hematopoietic manifestations. However, in some patients, bone manifestations persist and even worsen despite ERT, regardless of dose or duration of treatment. Treating skeletal disease should be considered of equal importance as treating visceral and hematologic manifestations. When treatment decisions involve multiple enzyme preparations and other therapeutic modalities such small molecules, the choice should be tailored on an individual basis with continuing evaluation.
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Affiliation(s)
- Ozlem Goker-Alpan
- Lysosomal Disorders Research and Treatment Unit, Center for Clinical Trials, Springfield, VA 22152, USA.
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29
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Management of Pregnancy in Women With Genetic Disorders: Part 2: Inborn Errors of Metabolism, Cystic Fibrosis, Neurofibromatosis Type 1, and Turner Syndrome in Pregnancy. Obstet Gynecol Surv 2011; 66:765-76. [DOI: 10.1097/ogx.0b013e31823cdd7d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Abstract
This review presents a cohesive approach to treating patients with Gaucher disease. The spectrum of the clinical presentation of the disease is broad, yet heretofore there was only one disease-specific treatment. In the past 2 years, a global shortage of this product has resulted in reassessment of the “one enzyme–one disease–one therapy” mantra. It has also showcased the multiple levels that engage the patient, the treating physician, and the third-party insurer in providing adequate treatment to all symptomatic patients. The key points summarizing the way I manage my patients include accurate enzymatic diagnosis with mutation analysis (for some prognostication and better carrier detection in the family), a detailed follow-up every 6-12 months (with an option to see consultants and attention to comorbidities), and initiation of enzyme replacement therapy according to symptoms or deterioration in clinically significant features or both. I do not treat patients with very mild disease, but I consider presymptomatic therapy for patients at risk, including young women with poor obstetric history. I prefer the minimal-effective dose rather than the maximally tolerated dose, and when the difference between high-dose and lower-dose regimens is (merely statistically significant but) clinically meaningless, minimizing the burden on society by advocating less-expensive treatments is ethically justified.
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31
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The management of pregnancy in Gaucher disease. Eur J Obstet Gynecol Reprod Biol 2011; 156:3-8. [DOI: 10.1016/j.ejogrb.2010.12.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 12/03/2010] [Accepted: 12/22/2010] [Indexed: 11/18/2022]
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Maladie de Gaucher de type 1 : difficultés pour la transition enfants-adultes. Arch Pediatr 2011; 18:165-9. [DOI: 10.1016/j.arcped.2010.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/02/2010] [Accepted: 11/26/2010] [Indexed: 11/19/2022]
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Sekijima Y, Ohashi T, Ohira S, Kosho T, Fukushima Y. Successful pregnancy and lactation outcome in a patient with Gaucher disease receiving enzyme replacement therapy, and the subsequent distribution and excretion of imiglucerase in human breast milk. Clin Ther 2010; 32:2048-52. [DOI: 10.1016/j.clinthera.2010.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2010] [Indexed: 11/16/2022]
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Mastaglia SR, Watman NP, Oliveri B. Intravenous bisphosphonate treatment and pregnancy: its effects on mother and infant bone health. Osteoporos Int 2010; 21:1959-62. [PMID: 20535608 DOI: 10.1007/s00198-009-1138-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 10/27/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Type 1 Gaucher's disease (GD1) is a lysosomal storage disorder associated with disabling bone involvement. The choice treatment for Gaucher's disease is enzyme replacement therapy (ERT). The use of bisphosphonate treatment for osteopenia and osteoporosis has been suggested. CASE A 22-year-old woman diagnosed with GD1 had received ERT intermittently, depending on availability of the enzyme since the enzyme was not always available. Due to severe bone involvement and multiple vertebral fractures, intravenous administration of 60 mg of pamidronate every 3 months and safe contraception were indicated. Fifteen days after receiving the fourth infusion, the patient informed us she was pregnant. A baby girl was born by cesarean delivery at week 37, showing no evidence of skeletal abnormality or clinical signs of hypocalcemia. The baby developed normally, presenting no significant pathology. At present (age 15 months), height, body weight, and bone mineral density by DXA are within normal range. The mother showed stable total skeleton and right femoral neck bone mineral density (BMD) values, no new fractures, and only ~3% decrease in lumbar spine BMD 15 months post-delivery and after a 1 year breastfeeding period (expected average ~7-8%). CONCLUSION It could be posited that pamidronate exerted a positive protective effect on the mother's skeleton with no evidence of adverse effects on pregnancy or on the baby's health to date.
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Affiliation(s)
- S R Mastaglia
- Sección Osteopatías Médicas, Hospital de Clínicas, Universidad de Buenos Aires, Av. Córdoba 2351(1120), Buenos Aires, Argentina.
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35
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Affiliation(s)
- Nadia Belmatoug
- Service de Médecine Interne, Centre de Référence des Maladies Lysosomales, Hôpital Beaujon AP-HP, 100 Boulevard du Général-Leclerc, 92100 Clichy, France.
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36
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Affiliation(s)
- Michel Leporrier
- Service d'Hématologie Clinique, CHU Caen, avenue Georges-Clemenceau, 14033 Caen cedex 9 France.
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37
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Elstein D, Gellman A, Altarescu G, Abrahamov A, Hadas-Halpern I, Phillips M, Margalit M, Lebel E, Itzchaki M, Zimran A. Disease severity in sibling pairs with type 1 Gaucher disease. J Inherit Metab Dis 2010; 33:79-83. [PMID: 20049528 DOI: 10.1007/s10545-009-9024-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 11/19/2009] [Accepted: 11/20/2009] [Indexed: 01/23/2023]
Abstract
The only prognostic markers in Gaucher disease, the most common lysosomal storage disorder, are young age at first symptom/sign and the presence of null/severe mutations, both being predictive of more severe phenotypes. Therefore, it would be helpful to know whether siblings with the same genotype can be expected to experience comparable phenotypic expression. All non-neuronopathic sibling pairs in our referral clinic (1993-2008) with the same genotype were included. For each pair, gender, date of birth, severity score index at presentation, age at diagnosis and first symptom/sign, presence of bone involvement, spleen status, and use of enzyme replacement therapy were tabulated. There were 90 pairs of siblings: two sets of identical twins; 24 pairs of brothers, 24 pairs of sisters, and 42 pairs of mixed gender. For all measures of disease severity used, only in sibling pairs with an older sister and a younger brother were phenotypes significantly different between siblings. Thus, this large cohort of sibling pairs with type 1 Gaucher disease confirmed that, in general, the phenotypic expression in the younger sibling will be similar enough to that of an older affected sibling that genetic counseling may use those findings in a prognostic way.
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Affiliation(s)
- Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel.
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39
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Elstein D, Zimran A. Review of the safety and efficacy of imiglucerase treatment of Gaucher disease. Biologics 2009; 3:407-17. [PMID: 19774208 PMCID: PMC2747339 DOI: 10.2147/btt.2009.3497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Most patients who suffer from symptomatic Gaucher disease will benefit from enzyme replacement therapy (ERT) with imiglucerase. The safety profile is excellent, only a small percentage of those exposed developing antibodies; similarly, very few patients require pre-medication for allergic reactions. Within 3 to 5 years of imiglucerase therapy, best documented at doses of 30 to 60 units/kg/infusion, hepatosplenomegaly can be expected to be reduced so that the liver volume will be maintained at 1 to 1.5 times normal (30% to 40% reduction from advent of ERT) and spleen volume to </= 2 to 8 times normal (50% to 60% reduction from advent of ERT). For anemic and thrombocytopenic patients, with 2 to 5 years of imiglucerase, hemoglobin levels are expected to be >/= 11 g/dL for women and children and >/= 12 g/dL for men; and platelet counts in patients with an intact spleen, depending on the baseline value, should approximately be doubled. Bone crises and bone pain but not irreversible skeletal damage will improve in most patients. Nonetheless, some features and some symptomatic patients apparently do not respond equally well and/or perhaps inadequately. The benefit for patients with the neuronopathic forms is primarily in improved visceral and hematological signs and symptoms. There are still several unresolved issues, the high per-unit cost being an important one, which have spurred the development of biosimilar enzymes as well as chaperone therapies currently in clinical trials.
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Affiliation(s)
- Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel.
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Elstein D, Zimran A. Review of the safety and efficacy of imiglucerase treatment of Gaucher disease. Biologics 2009. [PMID: 19774208 DOI: 10.2147/btt.s3769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Most patients who suffer from symptomatic Gaucher disease will benefit from enzyme replacement therapy (ERT) with imiglucerase. The safety profile is excellent, only a small percentage of those exposed developing antibodies; similarly, very few patients require pre-medication for allergic reactions. Within 3 to 5 years of imiglucerase therapy, best documented at doses of 30 to 60 units/kg/infusion, hepatosplenomegaly can be expected to be reduced so that the liver volume will be maintained at 1 to 1.5 times normal (30% to 40% reduction from advent of ERT) and spleen volume to </= 2 to 8 times normal (50% to 60% reduction from advent of ERT). For anemic and thrombocytopenic patients, with 2 to 5 years of imiglucerase, hemoglobin levels are expected to be >/= 11 g/dL for women and children and >/= 12 g/dL for men; and platelet counts in patients with an intact spleen, depending on the baseline value, should approximately be doubled. Bone crises and bone pain but not irreversible skeletal damage will improve in most patients. Nonetheless, some features and some symptomatic patients apparently do not respond equally well and/or perhaps inadequately. The benefit for patients with the neuronopathic forms is primarily in improved visceral and hematological signs and symptoms. There are still several unresolved issues, the high per-unit cost being an important one, which have spurred the development of biosimilar enzymes as well as chaperone therapies currently in clinical trials.
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Affiliation(s)
- Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel.
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