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Chan MY, Nelson AJ, Ngu LH. Long-term experience with idursulfase beta (Hunterase) in two adolescent patients with MPS II: A case series. Mol Genet Metab Rep 2023; 36:100991. [PMID: 37670899 PMCID: PMC10475840 DOI: 10.1016/j.ymgmr.2023.100991] [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: 02/01/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 09/07/2023] Open
Abstract
Mucopolysaccharidosis (MPS) type II (Hunter syndrome) is a rare X-linked, recessive, lysosomal storage disorder caused by the deficit of the enzyme iduronate 2-sulfatase (IDS), resulting in accumulation of glycosaminoglycans (GAGs) impairing cellular function in multiple organ systems. Idursulfase (Elaprase, Takeda Pharmaceuticals) and idursulfase beta (Hunterase, GC Biopharma Corp.) are the two currently available enzyme replacement therapies (ERT) for MPS II in Malaysia. ERT in patients with MPS II is associated with improvements in somatic symptoms, pulmonary function, endurance, joint mobility, and quality of life. Though mostly well tolerated, infusion-associated reactions (IARs), such as allergic (IgE-mediated) or nonallergic (non- immunologic) reactions can develop during ERT. In certain cases, when patients develop recurrent IARs despite reduced infusion rate and premedication, either interruption or cessation of ERT might be necessary. However, interruption of ERT is associated with worsening of clinical symptoms such as recurrent respiratory infections, difficulty in standing and walking, and increased joint stiffness, emphasizing the need for continuation of ERT. Here we report successful long-term experience with the use of idursulfase beta in two adolescent Malaysian patients with MPS II, who experienced recurrent infusion-associated reactions warranting discontinuation of ERT with idursulfase.
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Affiliation(s)
- Mei-Yan Chan
- Department of Genetics, Hospital Kuala Lumpur, Malaysia
| | | | - Lock-Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Malaysia
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Stephan BDO, Quaio CR, Spolador GM, de Paula AC, Curiati MA, Martins AM, Leal GN, Tenorio A, Finzi S, Chimelo FT, Matas CG, Honjo RS, Bertola DR, Kim CA. Impact of ERT and follow-up of 17 patients from the same family with a mild form of MPS II. Clinics (Sao Paulo) 2022; 77:100082. [PMID: 35882106 PMCID: PMC9326110 DOI: 10.1016/j.clinsp.2022.100082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Mucopolysaccharidosis type II, also known as Hunter syndrome, is a rare X-linked recessive disorder caused by deficiency of the lysosomal enzyme Iduronate-2- Sulfatase (IDS), leading to progressive accumulation of Glycosaminoglycans (GAGs) in several organs. Over the years, Enzyme Replacement Therapy (ERT) has provided significant benefits for patients, retarding the natural progression of the disease. RESULTS The authors evaluated 17 patients from the same family with a mild form of MPS type II; the proband had developed acute decompensated heart failure refractory to clinical measurements at 23 years and needed a rather urgent heart transplant; however, he died from surgical complications shortly after the procedure. Nevertheless, subsequent to his tragic death, 16 affected male relatives were detected after biochemical tests identifying the low or absent activity of the IDS enzyme and confirmed by molecular analysis of the IDS gene. Following diagnosis, different options of treatment were chosen: 6 patients started ERT with Elaprase® (Idursulfase) soon after, while the other 10 remained without ERT. Eventually, 4 patients in the latter group began ERT with Hunterase® (Idursulfase Beta). None presented adverse effects to either form of the enzyme. Among the 6 individuals without any ERT, two died of natural causes, after reaching 70 years. Despite the variable phenotype within the same family (mainly heart dysfunctions and carpal tunnel syndrome), all 14 remaining patients were alive with an independent lifestyle. CONCLUSION Here, the authors report the variable progress of the disease with and without ERT in a large Brazilian family with a slowly progressive form of MPS II, harboring the same missense variant in the IDS gene.
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Affiliation(s)
- Bruno de Oliveira Stephan
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil.
| | - Caio Robledo Quaio
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Gustavo Marquezani Spolador
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Ana Carolina de Paula
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Marco Antônio Curiati
- Centro de Referência em Erros Inatos do Metabolismo (CREIM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ana Maria Martins
- Centro de Referência em Erros Inatos do Metabolismo (CREIM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Gabriela Nunes Leal
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Artur Tenorio
- Oftalmologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Simone Finzi
- Oftalmologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Flavia Teixeira Chimelo
- Fonoaudiologia da Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Carla Gentile Matas
- Fonoaudiologia da Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Rachel Sayuri Honjo
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Debora Romeo Bertola
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Chong Ae Kim
- Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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Seo JH, Kosuga M, Hamazaki T, Shintaku H, Okuyama T. Impact of intracerebroventricular enzyme replacement therapy in patients with neuronopathic mucopolysaccharidosis type II. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2021; 21:67-75. [PMID: 33768130 PMCID: PMC7957024 DOI: 10.1016/j.omtm.2021.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/23/2021] [Indexed: 11/26/2022]
Abstract
This open-label, phase 1/2 study (JMACCT CTR JMA-IIA00350) evaluated the efficacy and safety of intracerebroventricular idursulfase beta in patients with mucopolysaccharidosis II (MPS II). Herein, we report the 100-week results. Six patients with severe MPS II aged 23-65 months were enrolled. Idursulfase beta (increasing from 1 to 30 mg between weeks 0 and 24, followed by a 30-mg final dose) was administered intracerebroventricularly once every 4 weeks using an implanted cerebrospinal fluid (CSF) reservoir; intravenous administration of idursulfase was also continued throughout the study. Efficacy endpoints included developmental age by the Kyoto Scale of Psychological Development 2001 and heparan sulfate (HS) concentration in CSF (primary outcome). In all six patients, HS concentrations decreased (40%-80%) from baseline to week 100. For overall developmental age, the difference in change from baseline to week 100 in each patient compared with patients treated by intravenous idursulfase administration (n = 13) was +8.0, +14.5, +4.5, +3.7, +8.2, and -8.3 months (mean, +5.1 months). Idursulfase beta was well tolerated. The most common adverse events were pyrexia, upper respiratory tract infection, and vomiting. The results suggest that intracerebroventricular idursulfase beta is well tolerated and can be effective at preventing and stabilizing developmental decline in patients with neuronopathic MPS II.
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Affiliation(s)
- Joo-Hyun Seo
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Motomichi Kosuga
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Takashi Hamazaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Haruo Shintaku
- Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan
| | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
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Epidemiology of Mucopolysaccharidoses Update. Diagnostics (Basel) 2021; 11:diagnostics11020273. [PMID: 33578874 PMCID: PMC7916572 DOI: 10.3390/diagnostics11020273] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022] Open
Abstract
Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders caused by a lysosomal enzyme deficiency or malfunction, which leads to the accumulation of glycosaminoglycans in tissues and organs. If not treated at an early stage, patients have various health problems, affecting their quality of life and life-span. Two therapeutic options for MPS are widely used in practice: enzyme replacement therapy and hematopoietic stem cell transplantation. However, early diagnosis of MPS is crucial, as treatment may be too late to reverse or ameliorate the disease progress. It has been noted that the prevalence of MPS and each subtype varies based on geographic regions and/or ethnic background. Each type of MPS is caused by a wide range of the mutational spectrum, mainly missense mutations. Some mutations were derived from the common founder effect. In the previous study, Khan et al. 2018 have reported the epidemiology of MPS from 22 countries and 16 regions. In this study, we aimed to update the prevalence of MPS across the world. We have collected and investigated 189 publications related to the prevalence of MPS via PubMed as of December 2020. In total, data from 33 countries and 23 regions were compiled and analyzed. Saudi Arabia provided the highest frequency of overall MPS because of regional or consanguineous marriages (or founder effect), followed by Portugal, Brazil, the Netherlands, and Australia. The newborn screening is an efficient and early diagnosis for MPS. MPS I has been approved for newborn screening in the United States. After the newborn screening of MPS I, the frequency of MPS I increased, compared with the past incidence rates. Overall, we conclude that the current identification methods are not enough to recognize all MPS patients, leading to an inaccurate incidence and status. Differences in ethnic background and/or founder effects impact on the frequency of MPS, which affects the prevalence of MPS. Two-tier newborn screening has accelerated early recognition of MPS I, providing an accurate incidence of patients.
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Mucopolysaccharidoses I and II: Brief Review of Therapeutic Options and Supportive/Palliative Therapies. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2408402. [PMID: 33344633 PMCID: PMC7732385 DOI: 10.1155/2020/2408402] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 12/30/2022]
Abstract
Purpose. Mucopolysaccharidoses (MPS) are group of inherited lysosomal storage diseases caused by mutations of enzymes involved in catalyzing different glycosaminoglycans (GAGs). MPS I and MPS II exhibit both somatic and neurological symptoms with a relatively high disease incidence. Hematopoietic stem cell therapy (HSCT) and intravenous enzyme replacement therapy (ERT) have had a significant impact on the treatment and comprehension of disease. This review is aimed at providing a comprehensive evaluation of the pros and cons of HSCT and ERT, as well as an up-to-date knowledge of new drugs under development. In addition, multiple disease management strategies for the uncontrollable manifestations of MPS I and MPS II to improve patients' quality of life are presented. Findings. Natural history of MPS I and MPS II shows that somatic and neurological symptoms occur earlier in severe forms of MPS I than in MPS II. ERT increases life expectancy and alleviates some of the somatic symptoms, but musculoskeletal, ophthalmological, and central nervous system (CNS) manifestations are not controlled. Additionally, life-long treatment burdens and immunogenicity restriction are unintended consequences of ERT application. HSCT, another treatment method, is effective in controlling the CNS symptoms and hence has been adopted as the standard treatment for severe types of MPS I. However, it is ineffective in MPS II, which can be explained by the relatively late diagnosis. In addition, several factors such as transplant age limits or graft-versus-host disease in HSCT have limited its application for patients. Novel therapies, including BBB-penetrable-ERT, gene therapy, and substrate reduction therapy, are under development to control currently unmanageable manifestations. BBB-penetrable-ERT is being studied comprehensively in the hopes of being used in the near future as a method to effectively control CNS symptoms. Gene therapy has the potential to “cure” the disease with a one-time treatment rather than just alleviate symptoms, which makes it an attractive treatment strategy. Several clinical studies on gene therapy reveal that delivering genes directly into the brain achieves better results than intravenous administration in patients with neurological symptoms. Considering new drugs are still in clinical stage, disease management with close monitoring and supportive/palliative therapy is of great importance for the time being. Proper rehabilitation therapy, including physical and occupational therapy, surgical intervention, or medications, can benefit patients with uncontrolled musculoskeletal, respiratory, ophthalmological, and neurological manifestations.
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Wikman-Jorgensen PE, López Amorós A, Peris García J, Esteve Atienzar PJ, Cañizares Navarro R, Asensio Tomás ML, Seguí Ripoll JM, Bonet D, Esteban-Giner MJ, Robert J, Giner-Galvañ V. Enzyme replacement therapy for the treatment of Hunter disease: A systematic review with narrative synthesis and meta-analysis. Mol Genet Metab 2020; 131:206-210. [PMID: 32773276 DOI: 10.1016/j.ymgme.2020.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/15/2020] [Accepted: 07/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the last 10 years enzyme replacement therapy (ERT) has become an alternative for the treatment of patients with Hunter disease (HD). Nevertheless, the information regarding efficacy and safety is scarce and mainly based on the pivotal trials. This scarcity is especially evident for adults and severe forms of HD. METHODS A systematic review of publications in the electronic databases PUBMED, EMBASE and Cochrane Central was undertaken. Clinical trials and observational studies were included. The data about efficacy and security were retrieved and analysed with Review Manager version 5.3. RESULTS 677 records were found, 559 remaining after the removal of duplicates. By title and abstract review, 427 were excluded. Full reading of the rest was made (122 publications) and 42 were finally included. It was not possible to perform meta-analysis of all the endpoints due to high heterogeneity in the reporting and measuring of variables in each publication. Eight clinical trials were included, 6 with high risk of bias. The quality of the other studies was low in 12%, average in 68% and good in 21%. Main findings were: a reduction in the elimination of glycosaminoglycans (GAG) in urine in all the studies (26/26), decrease in liver and spleen size (18/18), increase of 52.59 m (95% CI, 36, 42-68.76, p < .001) in the 6-min walk test (TM6M), increase in forced vital capacity (FVC) of 9.59% (95% CI 4.77-14.51, p < .001), reduction of the left ventricular mass index of 3.57% (95% CI 1.2-5.93) and reduction in mortality (OR) of 0.44 (0.27-0.71). DISCUSSION The data suggests a clear and consistent effect of ERT in HD reducing the accumulation of GAGs in the body, demonstrated by the reduction of its urinary excretion, as well as by the reduction of its deposits (spleen, liver and heart). Likewise, there is an improvement in physical and respiratory function. In addition, a reduction in mortality has been observed. Lack of studies, small size of the samples, and methodological deficiencies are the main limitations to establish definite conclusions. CONCLUSIONS The data suggests that ERT is effective and safe in the treatment of HD. There is a need to evaluate patient-centred outcomes and the impact on quality of life.
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Affiliation(s)
- Philip Erick Wikman-Jorgensen
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain; Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), Spain.
| | - Ana López Amorós
- General Internal Medicine Department, Hospital Universitario de Elda, Elda, Alicante, Spain
| | - Jorge Peris García
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Pedro Jesús Esteve Atienzar
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Ruth Cañizares Navarro
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Maria Luisa Asensio Tomás
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Jose Miguel Seguí Ripoll
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - David Bonet
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - María José Esteban-Giner
- Rare Diseases Unit, General Internal Medicine Department, Hospital General de Alcoy, Alicante, Spain
| | - Jaqueline Robert
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Vicente Giner-Galvañ
- Rare Diseases Unit, General Internal Medicine Department, Hospital Clínico Universitario San Juan de Alicante, San Juan de Alicante, Alicante, Spain; Alianza de Investigación Traslacional de Enfermedades Raras de la Comunidad Valenciana, Generalitat Valenciana, Spain; Departamento de Medicina Clínica, Facultad de Medicina, Universidad Miguel Hernández, Elche (Alicante), Spain
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Omar A, Jalil JA, Shakrin NM, Ngu LH, Yunus ZM. Selective screening for detection of mucopolysaccharidoses in Malaysia; A two-year study (2014-2016). Mol Genet Metab Rep 2019; 19:100469. [PMID: 31193155 PMCID: PMC6517573 DOI: 10.1016/j.ymgmr.2019.100469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/14/2019] [Accepted: 03/28/2019] [Indexed: 01/30/2023] Open
Abstract
Introduction Mucopolysaccharidoses (MPS) are a group of inherited disorders caused by the deficiency of a specific lysosomal enzyme involved in glycosaminoglycans (GAGs) degradation. This enzyme deficiency leads to accumulation of GAGs in the lysosomes, resulting in organ dysfunction and enlargement. We aimed to detect cases of MPS in patients with suggestive signs and symptoms. Methods This was a 2-year cross-sectional study conducted during June 2014 to May 2016. Urine and whole blood samples were taken from high-risk MPS patients. All urine samples were analysed for GAGs and characterised by high resolution electrophoresis (HRE). Whole blood was collected in ethylenediaminetetraacetic acid (EDTA) tube and analysed for specific enzymes based on the clinical history and HRE findings. Results From the 60 samples tested, 15 were positive for MPS; (Type I = 1), (Type II = 4), (Type IIIA = 3), (Type IVA = 1), (Type VI = 6). The overall prevalence of MPS among high-risk Malaysian patients was 26% (95% CI 14.72% to 37.86%). One patient had mucolipidosis. The mean age of patients when diagnosed was 5 years old. Patients with MPS were more likely to present with hepatosplenomegaly compared to other symptoms (OR = 0.974, p < .05). Conclusion One in 4 high-risk patients was diagnosed with MPS being MPS type VI the most common among Malaysian patients. Hepatosplenomegaly was the most common symptom. Patients with suspected MPS should be screened by urinary GAGs analysis and diagnosis confirmed by enzyme activity analysis.
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Affiliation(s)
- Affandi Omar
- Biochemistry Unit, Specialised Diagnostic Centre, Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - Julaina A Jalil
- Biochemistry Unit, Specialised Diagnostic Centre, Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - Norashareena M Shakrin
- Biochemistry Unit, Specialised Diagnostic Centre, Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
| | - Lock H Ngu
- Genetic Department, Kuala Lumpur Hospital, Ministry of Health Malaysia, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - Zabedah M Yunus
- Biochemistry Unit, Specialised Diagnostic Centre, Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
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Ghosh S, Alam S, Rathore AS, Khare SK. Stability of Therapeutic Enzymes: Challenges and Recent Advances. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1148:131-150. [DOI: 10.1007/978-981-13-7709-9_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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