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Differences in MPS I and MPS II Disease Manifestations. Int J Mol Sci 2021; 22:ijms22157888. [PMID: 34360653 PMCID: PMC8345985 DOI: 10.3390/ijms22157888] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Mucopolysaccharidosis (MPS) type I and II are two closely related lysosomal storage diseases associated with disrupted glycosaminoglycan catabolism. In MPS II, the first step of degradation of heparan sulfate (HS) and dermatan sulfate (DS) is blocked by a deficiency in the lysosomal enzyme iduronate 2-sulfatase (IDS), while, in MPS I, blockage of the second step is caused by a deficiency in iduronidase (IDUA). The subsequent accumulation of HS and DS causes lysosomal hypertrophy and an increase in the number of lysosomes in cells, and impacts cellular functions, like cell adhesion, endocytosis, intracellular trafficking of different molecules, intracellular ionic balance, and inflammation. Characteristic phenotypical manifestations of both MPS I and II include skeletal disease, reflected in short stature, inguinal and umbilical hernias, hydrocephalus, hearing loss, coarse facial features, protruded abdomen with hepatosplenomegaly, and neurological involvement with varying functional concerns. However, a few manifestations are disease-specific, including corneal clouding in MPS I, epidermal manifestations in MPS II, and differences in the severity and nature of behavioral concerns. These phenotypic differences appear to be related to different ratios between DS and HS, and their sulfation levels. MPS I is characterized by higher DS/HS levels and lower sulfation levels, while HS levels dominate over DS levels in MPS II and sulfation levels are higher. The high presence of DS in the cornea and its involvement in the arrangement of collagen fibrils potentially causes corneal clouding to be prevalent in MPS I, but not in MPS II. The differences in neurological involvement may be due to the increased HS levels in MPS II, because of the involvement of HS in neuronal development. Current treatment options for patients with MPS II are often restricted to enzyme replacement therapy (ERT). While ERT has beneficial effects on respiratory and cardiopulmonary function and extends the lifespan of the patients, it does not significantly affect CNS manifestations, probably because the enzyme cannot pass the blood-brain barrier at sufficient levels. Many experimental therapies, therefore, aim at delivery of IDS to the CNS in an attempt to prevent neurocognitive decline in the patients.
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Kubaski F, Vairo F, Baldo G, de Oliveira Poswar F, Corte AD, Giugliani R. Therapeutic Options for Mucopolysaccharidosis II (Hunter Disease). Curr Pharm Des 2020; 26:5100-5109. [PMID: 33138761 DOI: 10.2174/1381612826666200724161504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Mucopolysaccharidosis type II (Hunter syndrome, or MPS II) is an X-linked lysosomal disorder caused by the deficiency of iduronate-2-sulfatase, which leads to the accumulation of glycosaminoglycans (GAGs) in a variety of tissues, resulting in a multisystemic disease that can also impair the central nervous system (CNS). OBJECTIVE This review focuses on providing the latest information and expert opinion about the therapies available and under development for MPS II. METHODS We have comprehensively revised the latest studies about hematopoietic stem cell transplantation (HSCT), enzyme replacement therapy (ERT - intravenous, intrathecal, intracerebroventricular, and intravenous with fusion proteins), small molecules, gene therapy/genome editing, and supportive management. RESULTS AND DISCUSSION Intravenous ERT is a well-established specific therapy, which ameliorates the somatic features but not the CNS manifestations. Intrathecal or intracerebroventricular ERT and intravenous ERT with fusion proteins, presently under development, seem to be able to reduce the levels of GAGs in the CNS and have the potential of reducing the impact of the neurological burden of the disease. Gene therapy and/or genome editing have shown promising results in preclinical studies, bringing hope for a "one-time therapy" soon. Results with HSCT in MPS II are controversial, and small molecules could potentially address some disease manifestations. In addition to the specific therapeutic options, supportive care plays a major role in the management of these patients. CONCLUSION At this time, the treatment of individuals with MPS II is mainly based on intravenous ERT, whereas HSCT can be a potential alternative in specific cases. In the coming years, several new therapy options that target the neurological phenotype of MPS II should be available.
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Affiliation(s)
- Francyne Kubaski
- Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Brazil
| | - Filippo Vairo
- Center for Individualized Medicine, Mayo Clinic, Rochester, MN, United States
| | - Guilherme Baldo
- Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Brazil
| | | | - Amauri Dalla Corte
- Postgraduation Program in Medicine: Medical Sciences, UFRGS, Porto Alegre, Brazil
| | - Roberto Giugliani
- Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, Brazil
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Sampayo-Cordero M, Miguel-Huguet B, Malfettone A, Pérez-García JM, Llombart-Cussac A, Cortés J, Pardo A, Pérez-López J. The Value of Case Reports in Systematic Reviews from Rare Diseases. The Example of Enzyme Replacement Therapy (ERT) in Patients with Mucopolysaccharidosis Type II (MPS-II). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6590. [PMID: 32927819 PMCID: PMC7558586 DOI: 10.3390/ijerph17186590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Case reports are usually excluded from systematic reviews. Patients with rare diseases are more dependent on novel individualized strategies than patients with common diseases. We reviewed and summarized the novelties reported by case reports in mucopolysaccharidosis type II (MPS-II) patients treated with enzyme replacement therapy (ERT). METHODS We selected the case reports included in a previous meta-analysis of patients with MPS-II treated with ERT. Later clinical studies evaluating the same topic of those case reports were reported. Our primary aim was to summarize novelties reported in previous case reports. Secondary objectives analyzed the number of novelties evaluated in subsequent clinical studies and the time elapsed between the publication of the case report to the publication of the clinical study. RESULTS We identified 11 innovative proposals in case reports that had not been previously considered in clinical studies. Only two (18.2%) were analyzed in subsequent nonrandomized cohort studies. The other nine novelties (81.8%) were analyzed in later case reports (five) or were not included in ulterior studies (four) after more than five years from their first publication. CONCLUSIONS Case reports should be included in systematic reviews of rare disease to obtain a comprehensive summary of the state of research and offer valuable information for healthcare practitioners.
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Affiliation(s)
- Miguel Sampayo-Cordero
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
| | - Bernat Miguel-Huguet
- Department of Surgery, Hospital de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Andrea Malfettone
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
| | - José Manuel Pérez-García
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
- Institute of Breast Cancer, Quiron Group, 08023 Barcelona, Spain
| | - Antonio Llombart-Cussac
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
- Hospital Arnau de Vilanova, Universidad Católica de Valencia “San Vicente Mártir”, 46015 Valencia, Spain
| | - Javier Cortés
- Medica Scientia Innovation Research (MedSIR), Ridgewood, NJ 07450, USA; (A.M.); (J.M.P.-G.); (A.L.-C.); (J.C.)
- Medica Scientia Innovation Research (MedSIR), 08018 Barcelona, Spain
- Institute of Breast Cancer, Quiron Group, 08023 Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), 08035 Barcelona, Spain
| | - Almudena Pardo
- Albiotech Consultores y Redacción Científica S.L., 28035 Madrid, Spain;
| | - Jordi Pérez-López
- Department of Internal Medicine, Hospital Vall d’Hebron, 08035 Barcelona, Spain;
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Bhalla A, Ravi R, Fang M, Arguello A, Davis SS, Chiu CL, Blumenfeld JR, Nguyen HN, Earr TK, Wang J, Astarita G, Zhu Y, Fiore D, Scearce-Levie K, Diaz D, Cahan H, Troyer MD, Harris JM, Escolar ML. Characterization of Fluid Biomarkers Reveals Lysosome Dysfunction and Neurodegeneration in Neuronopathic MPS II Patients. Int J Mol Sci 2020; 21:ijms21155188. [PMID: 32707880 PMCID: PMC7432645 DOI: 10.3390/ijms21155188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/19/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
Mucopolysaccharidosis type II is a lysosomal storage disorder caused by a deficiency of iduronate-2-sulfatase (IDS) and characterized by the accumulation of the primary storage substrate, glycosaminoglycans (GAGs). Understanding central nervous system (CNS) pathophysiology in neuronopathic MPS II (nMPS II) has been hindered by the lack of CNS biomarkers. Characterization of fluid biomarkers has been largely focused on evaluating GAGs in cerebrospinal fluid (CSF) and the periphery; however, GAG levels alone do not accurately reflect the broad cellular dysfunction in the brains of MPS II patients. We utilized a preclinical mouse model of MPS II, treated with a brain penetrant form of IDS (ETV:IDS) to establish the relationship between markers of primary storage and downstream pathway biomarkers in the brain and CSF. We extended the characterization of pathway and neurodegeneration biomarkers to nMPS II patient samples. In addition to the accumulation of CSF GAGs, nMPS II patients show elevated levels of lysosomal lipids, neurofilament light chain, and other biomarkers of neuronal damage and degeneration. Furthermore, we find that these biomarkers of downstream pathology are tightly correlated with heparan sulfate. Exploration of the responsiveness of not only CSF GAGs but also pathway and disease-relevant biomarkers during drug development will be crucial for monitoring disease progression, and the development of effective therapies for nMPS II.
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Affiliation(s)
- Akhil Bhalla
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
- Correspondence: (A.B.); (M.L.E.)
| | - Ritesh Ravi
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Meng Fang
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Annie Arguello
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Sonnet S. Davis
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Chi-Lu Chiu
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Jessica R. Blumenfeld
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
- Department of Neuroscience, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Hoang N. Nguyen
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Timothy K. Earr
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Junhua Wang
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Giuseppe Astarita
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Yuda Zhu
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Damian Fiore
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Kimberly Scearce-Levie
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Dolores Diaz
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Heather Cahan
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Matthew D. Troyer
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Jeffrey M. Harris
- Denali Therapeutics Inc., South San Francisco, CA 94080, USA; (R.R.); (M.F.); (A.A.); (S.S.D.); (C.-L.C.); (J.R.B.); (H.N.N.); (T.K.E.); (J.W.); (G.A.); (Y.Z.); (D.F.); (K.S.-L.); (D.D.); (H.C.); (M.D.T.); (J.M.H.)
| | - Maria L. Escolar
- Department of Pediatrics, Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA
- Correspondence: (A.B.); (M.L.E.)
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D’Avanzo F, Rigon L, Zanetti A, Tomanin R. Mucopolysaccharidosis Type II: One Hundred Years of Research, Diagnosis, and Treatment. Int J Mol Sci 2020; 21:E1258. [PMID: 32070051 PMCID: PMC7072947 DOI: 10.3390/ijms21041258] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022] Open
Abstract
Mucopolysaccharidosis type II (MPS II, Hunter syndrome) was first described by Dr. Charles Hunter in 1917. Since then, about one hundred years have passed and Hunter syndrome, although at first neglected for a few decades and afterwards mistaken for a long time for the similar disorder Hurler syndrome, has been clearly distinguished as a specific disease since 1978, when the distinct genetic causes of the two disorders were finally identified. MPS II is a rare genetic disorder, recently described as presenting an incidence rate ranging from 0.38 to 1.09 per 100,000 live male births, and it is the only X-linked-inherited mucopolysaccharidosis. The complex disease is due to a deficit of the lysosomal hydrolase iduronate 2-sulphatase, which is a crucial enzyme in the stepwise degradation of heparan and dermatan sulphate. This contributes to a heavy clinical phenotype involving most organ-systems, including the brain, in at least two-thirds of cases. In this review, we will summarize the history of the disease during this century through clinical and laboratory evaluations that allowed its definition, its correct diagnosis, a partial comprehension of its pathogenesis, and the proposition of therapeutic protocols. We will also highlight the main open issues related to the possible inclusion of MPS II in newborn screenings, the comprehension of brain pathogenesis, and treatment of the neurological compartment.
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Affiliation(s)
- Francesca D’Avanzo
- Laboratory of Diagnosis and Therapy of Lysosomal Disorders, Department of Women’s and Children ‘s Health, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (F.D.); (A.Z.)
- Fondazione Istituto di Ricerca Pediatrica “Città della Speranza”, Corso Stati Uniti 4, 35127 Padova, Italy;
| | - Laura Rigon
- Fondazione Istituto di Ricerca Pediatrica “Città della Speranza”, Corso Stati Uniti 4, 35127 Padova, Italy;
- Molecular Developmental Biology, Life & Medical Science Institute (LIMES), University of Bonn, 53115 Bonn, Germany
| | - Alessandra Zanetti
- Laboratory of Diagnosis and Therapy of Lysosomal Disorders, Department of Women’s and Children ‘s Health, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (F.D.); (A.Z.)
- Fondazione Istituto di Ricerca Pediatrica “Città della Speranza”, Corso Stati Uniti 4, 35127 Padova, Italy;
| | - Rosella Tomanin
- Laboratory of Diagnosis and Therapy of Lysosomal Disorders, Department of Women’s and Children ‘s Health, University of Padova, Via Giustiniani 3, 35128 Padova, Italy; (F.D.); (A.Z.)
- Fondazione Istituto di Ricerca Pediatrica “Città della Speranza”, Corso Stati Uniti 4, 35127 Padova, Italy;
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Giugliani R, Vairo F, Kubaski F, Poswar F, Riegel M, Baldo G, Saute JA. Neurological manifestations of lysosomal disorders and emerging therapies targeting the CNS. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 2:56-68. [PMID: 30169196 DOI: 10.1016/s2352-4642(17)30087-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 12/18/2022]
Abstract
Lysosomal disorders have been an area of interest since intravenous enzyme replacement therapy was successfully introduced for the treatment of Gaucher's disease in the early 1990s. This treatment approach has also been developed for several other lysosomal disorders, including Fabry's disease, Pompe's disease, lysosomal acid lipase deficiency, and five types of mucopolysaccharidosis. Despite the benefits of enzyme replacement therapy, it has limitations-most importantly, its ineffectiveness in treating the neurological components of lysosomal disorders, as only a small proportion of recombinant enzymes can cross the blood-brain barrier. Development of strategies to improve drug delivery to the CNS is now the primary focus in lysosomal disorder research. This Review discusses the neurological manifestations and emerging therapies for the CNS component of these diseases. The therapies in development (which are now in phase 1 or phase 2 clinical trials) might be for specific lysosomal disorders (enzyme replacement therapy via intrathecal or intracerebroventricular routes or with fusion proteins, or gene therapy) or applicable to more than one lysosomal disorder (haemopoietic stem cell transplantation, pharmacological chaperones, substrate reduction therapy, or stop codon readthrough). The combination of early diagnosis with effective therapies should change the outlook for patients with lysosomal disorders with neurological involvement in the next 5-10 years.
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Affiliation(s)
- Roberto Giugliani
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | - Fabiano Poswar
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mariluce Riegel
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Baldo
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Postgraduate Program in Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jonas Alex Saute
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Postgraduate Program in Medicine: Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Cho SY, Lee J, Ko AR, Kwak MJ, Kim S, Sohn YB, Park SW, Jin DK. Effect of systemic high dose enzyme replacement therapy on the improvement of CNS defects in a mouse model of mucopolysaccharidosis type II. Orphanet J Rare Dis 2015; 10:141. [PMID: 26520066 PMCID: PMC4628320 DOI: 10.1186/s13023-015-0356-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/16/2015] [Indexed: 12/13/2022] Open
Abstract
Background Mucopolysaccharidosis type II (MPS II, Hunter syndrome), is caused by a deficiency of iduronate-2-sulfatase (IDS). Despite the therapeutic effect of intravenous enzyme replacement therapy (ERT), the central nervous system (CNS) defects persist because the enzyme cannot cross the blood-brain barrier (BBB). There have been several trials of direct infusion to the cerebrospinal space showing promising results; however, this approach may have limitations in clinical situations such as CNS infection. The objective of this study was to improve the CNS defect with systemic high-dose ERT. Methods Systemic ERT was performed using three doses (1, 5, and 10 mg/kg weekly) of IDS for three different durations (1, 3, and 6 months) in IDS knock out (KO) mice of two age groups (2 months, 8 months). GAG measurement in tissues, brain pathology, and behavioral assessment were analyzed. Results Brain IDS activities increased in parallel with the concentrations of IDS injected. The glycosaminoglycan (GAG) level and histopathology in the brains of the young mice improved in a dose- and duration-dependent manner; however, those were not improved in the old mice, even at higher doses of IDS. The spontaneous alternation behavior was recovered in young KO mice treated with ≥ 5 mg/kg IDS; however, no significant improvement was observed in old KO mice. Conclusions These results suggest that high-dose ERT given to mice of earlier ages may play a role in preventing GAG accumulation and preventing CNS damage in IDS KO mice. Therefore, ERT above the present standard dose, starting in early childhood, could be a promising treatment regimen for reducing neurological impairment in Hunter syndrome. Electronic supplementary material The online version of this article (doi:10.1186/s13023-015-0356-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea
| | - Ah-Ra Ko
- Clinical Research Center, Samsung Biomedical Research Institute, Seoul, Republic of Korea
| | - Min Jung Kwak
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Sujin Kim
- Department of Pediatrics, Myongji Hospital, Seonam Univeristy College of Medicine, Goyang, Republic of Korea
| | - Young Bae Sohn
- Department of Medical Genetics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sung Won Park
- Department of Pediatrics, Dankook University College of Medicine, Cheil General Hospital & Woman's Health Care Center, Seoul, Republic of Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.
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Damme M, Stroobants S, Lüdemann M, Rothaug M, Lüllmann-Rauch R, Beck HC, Ericsson A, Andersson C, Fogh J, D'Hooge R, Saftig P, Blanz J. Chronic enzyme replacement therapy ameliorates neuropathology in alpha-mannosidosis mice. Ann Clin Transl Neurol 2015; 2:987-1001. [PMID: 26817023 PMCID: PMC4693626 DOI: 10.1002/acn3.245] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/03/2015] [Accepted: 08/03/2015] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The lysosomal storage disease alpha-mannosidosis is caused by the deficiency of the lysosomal acid hydrolase alpha-mannosidase (LAMAN) leading to lysosomal accumulation of neutral mannose-linked oligosaccharides throughout the body, including the brain. Clinical findings in alpha-mannosidosis include skeletal malformations, intellectual disabilities and hearing impairment. To date, no curative treatment is available. We previously developed a beneficial enzyme replacement therapy (ERT) regimen for alpha-mannosidase knockout mice, a valid mouse model for the human disease. However, humoral immune responses against the injected recombinant human alpha-mannosidase (rhLAMAN) precluded long-term studies and chronic treatment. METHODS Here, we describe the generation of an immune-tolerant alpha-mannosidosis mouse model that allowed chronic injection of rhLAMAN by transgenic expression of a catalytically inactive variant of human LAMAN in the knockout background. RESULTS Chronic ERT of rhLAMAN revealed pronounced effects on primary substrate storage throughout the brain, normalization of lysosomal enzyme activities and morphology as well as a decrease in microglia activation. The positive effect of long-term ERT on neuronal lysosomal function was reflected by an improvement of cognitive deficits and exploratory activity. in vivo and in vitro uptake measurements indicate rapid clearance of rhLAMAN from circulation and a broad uptake into different cell types of the nervous system. INTERPRETATION Our data contribute to the understanding of neurological disorders treatment by demonstrating that lysosomal enzymes such as rhLAMAN can penetrate into the brain and is able to ameliorate neuropathology.
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Affiliation(s)
- Markus Damme
- Biochemical Institute University of Kiel D-24098 Kiel Germany
| | - Stijn Stroobants
- Laboratory of Biological Psychology University of Leuven B-3000 Leuven Belgium
| | - Meike Lüdemann
- Biochemical Institute University of Kiel D-24098 Kiel Germany
| | | | | | - Hans Christian Beck
- Department of Biochemistry and Pharmacology Centre for Clinical Proteomics Odense University Hospital Sdr Boulevard 29 DK-5000 Odense C Denmark
| | | | | | - Jens Fogh
- Zymenex A/S Roskildevej 12C 3400 Hillerød Denmark
| | - Rudi D'Hooge
- Laboratory of Biological Psychology University of Leuven B-3000 Leuven Belgium
| | - Paul Saftig
- Biochemical Institute University of Kiel D-24098 Kiel Germany
| | - Judith Blanz
- Biochemical Institute University of Kiel D-24098 Kiel Germany
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Cho SY, Sohn YB, Jin DK. An overview of Korean patients with mucopolysaccharidosis and collaboration through the Asia Pacific MPS Network. Intractable Rare Dis Res 2014; 3:79-86. [PMID: 25364648 PMCID: PMC4214241 DOI: 10.5582/irdr.2014.01013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/13/2014] [Indexed: 11/05/2022] Open
Abstract
Mucopolysaccharidosis (MPS) is a constellation of disorders characterized by the accumulation of mucopolysaccharides in tissues and organs. This accumulation results in the deterioration and degeneration of multiple organs. This paper describes the general distribution of types of MPS in patients, their clinical characteristics and genotypes, the development of animal studies and preclinical studies, enzyme replacement therapy in South Korea, and the development of idursulfase beta and clinical trials on idursulfase beta in South Korea. In addition, this paper discusses academic collaboration among specialists in MPS care in the Asia-Pacific region, which includes Japan, Taiwan, Malaysia, and South Korea, through an organization called the Asia-Pacific MPS Network (APMN). The Asia-Pacific MPS Registry, an electronic remote data entry system, has been developed by key doctors in the APMN. Rare diseases require international cooperation and collaboration to elucidate their mechanisms and carry out clinical trials; therefore, an organization such as the APMN is required. Furthermore, international collaboration among Asian countries and countries around the world will be of utmost importance in the future.
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Affiliation(s)
- Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bae Sohn
- Department of Medical Genetics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Address correspondence to: Dr. Dong-Kyu Jin, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea. E-mail:
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A commentary on high-dose enzyme replacement therapy attenuates cerebroventriculomegaly in a mouse model of mucopolysaccharidosis type II. J Hum Genet 2013; 58:767-8. [PMID: 24225991 DOI: 10.1038/jhg.2013.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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