1
|
Ormazabal ME, Pavan E, Vaena E, Ferino D, Biasizzo J, Mucci JM, Serra F, Cifù A, Scarpa M, Rozenfeld PA, Dardis AE. Exploring the Pathophysiologic Cascade Leading to Osteoclastogenic Activation in Gaucher Disease Monocytes Generated via CRISPR/Cas9 Technology. Int J Mol Sci 2023; 24:11204. [PMID: 37446383 DOI: 10.3390/ijms241311204] [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: 05/18/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Gaucher disease (GD) is caused by biallelic pathogenic variants in the acid β-glucosidase gene (GBA1), leading to a deficiency in the β-glucocerebrosidase (GCase) enzyme activity resulting in the intracellular accumulation of sphingolipids. Skeletal alterations are one of the most disabling features in GD patients. Although both defective bone formation and increased bone resorption due to osteoblast and osteoclast dysfunction contribute to GD bone pathology, the molecular bases are not fully understood, and bone disease is not completely resolved with currently available specific therapies. For this reason, using editing technology, our group has developed a reliable, isogenic, and easy-to-handle cellular model of GD monocytes (GBAKO-THP1) to facilitate GD pathophysiology studies and high-throughput drug screenings. In this work, we further characterized the model showing an increase in proinflammatory cytokines (Interleukin-1β and Tumor Necrosis Factor-α) release and activation of osteoclastogenesis. Furthermore, our data suggest that GD monocytes would display an increased osteoclastogenic potential, independent of their interaction with the GD microenvironment or other GD cells. Both proinflammatory cytokine production and osteoclastogenesis were restored at least, in part, by treating cells with the recombinant human GCase, a substrate synthase inhibitor, a pharmacological chaperone, and an anti-inflammatory compound. Besides confirming that this model would be suitable to perform high-throughput screening of therapeutic molecules that act via different mechanisms and on different phenotypic features, our data provided insights into the pathogenic cascade, leading to osteoclastogenesis exacerbation and its contribution to bone pathology in GD.
Collapse
Affiliation(s)
- Maximiliano Emanuel Ormazabal
- Regional Coordinator Centre for Rare Diseases, Academic Hospital of Udine, 33100 Udine, Italy
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), UNLP, CONICET, Asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, La Plata 1900, Argentina
| | - Eleonora Pavan
- Regional Coordinator Centre for Rare Diseases, Academic Hospital of Udine, 33100 Udine, Italy
| | - Emilio Vaena
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), UNLP, CONICET, Asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, La Plata 1900, Argentina
| | - Dania Ferino
- Institute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, 33100 Udine, Italy
| | - Jessica Biasizzo
- Institute of Clinical Pathology, Department of Laboratory Medicine, University Hospital of Udine, 33100 Udine, Italy
| | - Juan Marcos Mucci
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), UNLP, CONICET, Asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, La Plata 1900, Argentina
| | - Fabrizio Serra
- Regional Coordinator Centre for Rare Diseases, Academic Hospital of Udine, 33100 Udine, Italy
| | - Adriana Cifù
- Dipartimento di Area Medica, Università degli Studi di Udine, 33100 Udine, Italy
| | - Maurizio Scarpa
- Regional Coordinator Centre for Rare Diseases, Academic Hospital of Udine, 33100 Udine, Italy
| | - Paula Adriana Rozenfeld
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), UNLP, CONICET, Asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, La Plata 1900, Argentina
| | - Andrea Elena Dardis
- Regional Coordinator Centre for Rare Diseases, Academic Hospital of Udine, 33100 Udine, Italy
| |
Collapse
|
2
|
Aşantoğrol F, Dursun H, Canger EM, Bayram F. Clinical and radiological evaluation of dentomaxillofacial involvement in Type I Gaucher disease. Oral Radiol 2022; 38:210-223. [PMID: 34302573 DOI: 10.1007/s11282-021-00546-2] [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: 05/04/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to evaluate the oral findings and dentomaxillofacial involvement of patients diagnosed with Type I Gaucher Disease (GD), and to compare these findings with the control group. METHODS A total of 32 patients, 5 males, and 11 females in both the study (range 19-60, mean age 34.56) and control group (range 18-49, mean age 34.63) were included in the study. The file records of all patients obtained in the first evaluation were examined, and the hematological, visceral, and bone examination findings were recorded. Subsequently, oral examinations were performed for oral findings and dentomaxillofacial involvement, and radiological examinations were performed in panoramic images and cone-beam computed tomography (CBCT) images. RESULTS There was mandible involvement in 9 (56.3%), and involvement in both jaws in 4 (25.0%) of the patients with Type I GD. According to the CBCT findings, generalized rarefaction in 10 (62.5%) patients, enlarged marrow spaces in 12 (75.0%) patients, thinning of the lamina dura in 10 (62.5%) patients, and loss in the cortical borders of the mandibular canal in 7 (43.8%) patients were among the common radiographic findings. When the control and study group were compared, in panoramic images, a significant difference was found in terms of generalized rarefaction and enlarged marrow spaces, while significant differences were found in CBCT images regarding generalized rarefaction, enlarged marrow spaces, loss in the cortical margins of the mandibular canal and widening in the periodontal ligament space. CONCLUSIONS The roadmap for the diagnosis of Gaucher lesions in the jawbones includes a comprehensive medical history and a clinical and radiological examination. In conclusion, dentists should be familiar with the dentomaxillofacial findings of GD and be aware of possible oral and dental complications that may develop.
Collapse
Affiliation(s)
- Firdevs Aşantoğrol
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38060, Kayseri, Turkey.
| | - Hüseyin Dursun
- Department of Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Emin Murat Canger
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38060, Kayseri, Turkey
| | - Fahri Bayram
- Department of Endocrinology and Metabolism, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| |
Collapse
|
3
|
Ivanova MM, Dao J, Kasaci N, Friedman A, Noll L, Goker-Alpan O. Wnt signaling pathway inhibitors, sclerostin and DKK-1, correlate with pain and bone pathology in patients with Gaucher disease. Front Endocrinol (Lausanne) 2022; 13:1029130. [PMID: 36506070 PMCID: PMC9730525 DOI: 10.3389/fendo.2022.1029130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/25/2022] [Indexed: 11/25/2022] Open
Abstract
Patients with Gaucher disease (GD) have progressive bone involvement that clinically presents with debilitating bone pain, structural bone changes, bone marrow infiltration (BMI), Erlenmeyer (EM) flask deformity, and osteoporosis. Pain is referred by the majority of GD patients and continues to persist despite the type of therapy. The pain in GD is described as chronic deep penetrating pain; however, sometimes, patients experience severe acute pain. The source of bone pain is mainly debated as nociceptive pain secondary to bone pathology or neuropathic or inflammatory origins. Osteocytes constitute a significant source of secreted molecules that coordinate bone remodeling. Osteocyte markers, sclerostin (SOST) and Dickkopf-1 (DKK-1), inactivate the canonical Wnt signaling pathway and lead to the inhibition of bone formation. Thus, circulated sclerostin and DKK-1 are potential biomarkers of skeletal abnormalities. This study aimed to assess the circulating levels of sclerostin and DKK-1 in patients with GD and their correlation with clinical bone pathology parameters: pain, bone mineral density (BMD), and EM deformity. Thirty-nine patients with GD were classified into cohorts based on the presence and severity of bone manifestations. The serum levels of sclerostin and DKK-1 were quantified by enzyme-linked immunosorbent assays. The highest level of sclerostin was measured in GD patients with pain, BMI, and EM deformity. The multiparameter analysis demonstrated that 95% of GD patients with pain, BMI, and EM deformity had increased levels of sclerostin. The majority of patients with elevated sclerostin also have osteopenia or osteoporosis. Moreover, circulating sclerostin level increase with age, and GD patients have elevated sclerostin levels when compared with healthy control from the same age group. Pearson's linear correlation analysis showed a positive correlation between serum DKK-1 and sclerostin in healthy controls and GD patients with normal bone mineral density. However, the balance between sclerostin and DKK-1 waned in GD patients with osteopenia or osteoporosis. In conclusion, the osteocyte marker, sclerostin, when elevated, is associated with bone pain, BMI, and EM flask deformity in GD patients. The altered sclerostin/DKK-1 ratio correlates with the reduction of bone mineral density. These data confirm that the Wnt signaling pathway plays a role in GD-associated bone disease. Sclerostin and bone pain could be used as biomarkers to assess patients with a high risk of BMI and EM flask deformities.
Collapse
|
4
|
Gulati V, Chalian M, Yi J, Thakur U, Chhabra A. Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings. Skeletal Radiol 2021; 50:847-869. [PMID: 33040177 DOI: 10.1007/s00256-020-03644-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 02/02/2023]
Abstract
Bone sclerosis is a focal, multifocal, or diffuse increase in the density of the bone matrix on radiographs or computed tomography (CT) imaging. This radiological finding can be caused by a broad spectrum of diseases, such as congenital and developmental disorders, depositional disorders, and metabolic diseases. The differential diagnosis can be effectively narrowed by an astute radiologist in the light of the clinical picture and typical findings on imaging. Some of these lesions are rare and have been described as case reports and series in the literature. This article aims to collate the clinical-radiologic findings of non-infectious and non-neoplastic causes of bone sclerosis with relevant imaging illustrations.
Collapse
Affiliation(s)
| | - Majid Chalian
- Department of Radiology, Musculoskeletal Imaging and Intervention, University of Washington, Seattle, WA, USA
| | - Jaehyuck Yi
- Department of Radiology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Uma Thakur
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Radiology, UT Southwestern Medical Center, Dallas, TX, USA.
- Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
- Musculoskeletal Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA.
- Johns Hopkins University, Baltimore, MD, USA.
- Walton Centre of Neurosciences, Liverpool, UK.
| |
Collapse
|
5
|
Crivaro A, Bondar C, Mucci JM, Ormazabal M, Feldman RA, Delpino MV, Rozenfeld PA. Gaucher disease-associated alterations in mesenchymal stem cells reduce osteogenesis and favour adipogenesis processes with concomitant increased osteoclastogenesis. Mol Genet Metab 2020; 130:274-282. [PMID: 32536424 DOI: 10.1016/j.ymgme.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 01/18/2023]
Abstract
Gaucher disease (GD) is caused by pathogenic mutations in GBA1, the gene that encodes the lysosomal enzyme β-glucocerebrosidase. Until now, treatments for GD cannot completely reverse bone problems. The aim of this work was to evaluate the potential of MSCs from GD patients (GD MSCs) to differentiate towards the osteoblast (GD Ob) and adipocyte (GD Ad) lineages, and their role in osteoclastogenesis. We observed that GD Ob exhibited reduced mineralization, collagen deposition and alkaline phosphatase activity (ALP), as well as decreased gene expression of RUNX2, COLA1 and ALP. We also evaluated the process of osteoclastogenesis and observed that conditioned media from GD MSCs supernatants induced an increase in the number of osteoclasts. In this model, osteoclastogenesis was induced by RANKL and IL-1β. Furthermore, results showed that in GD MSCs there was a promotion in NLRP3 and PPAR-γ gene expression. Adipogenic differentiation revealed that GD Ad had an increase in PPAR-γ and a reduced RUNX2 gene expression, promoting adipocyte differentiation. In conclusion, our results show that GD MSCs exhibited deficient GD Ob differentiation and increased adipogenesis. In addition, we show that GD MSCs promoted increased osteoclastogenesis through RANKL and IL-1β. These changes in GD MSCs are likely to contribute to skeletal imbalance observed in GD patients.
Collapse
Affiliation(s)
- A Crivaro
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Universidad Nacional de La Plata, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Bv. 120 N(o)1489 (1900), La Plata, Argentina
| | - C Bondar
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Universidad Nacional de La Plata, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Bv. 120 N(o)1489 (1900), La Plata, Argentina
| | - J M Mucci
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Universidad Nacional de La Plata, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Bv. 120 N(o)1489 (1900), La Plata, Argentina
| | - M Ormazabal
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Universidad Nacional de La Plata, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Bv. 120 N(o)1489 (1900), La Plata, Argentina
| | - R A Feldman
- Instituto de Inmunología, Genética y Metabolismo (INIGEM), Hospital de Clínicas "José de San Martín", Facultad de Medicina, CONICET-Universidad de Buenos Aires, Paraguay 2155, (C1121ABG), Buenos Aires, Argentina
| | - M V Delpino
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - P A Rozenfeld
- Instituto de Estudios Inmunológicos y Fisiopatológicos (IIFP), Universidad Nacional de La Plata, CONICET, asociado CIC PBA, Facultad de Ciencias Exactas, Departamento de Ciencias Biológicas, Bv. 120 N(o)1489 (1900), La Plata, Argentina.
| |
Collapse
|
6
|
Cohen D, Kogan D, Rubin A, Zimran A, Lebel E. Longevity of total hip arthroplasty implants in patients with Gaucher disease. Hip Int 2020; 30:147-151. [PMID: 31507221 DOI: 10.1177/1120700019834919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Total hip replacement (THR) is performed for arthritic hip joints, which in Gaucher disease results from osteonecrosis of the femoral head. This procedure was recommended as valid and safe for this group of patients. Nevertheless, long term outcome has not been evaluated in a large cohort. METHODS Data regarding all patients having hip replacement in a relatively large Gaucher clinic was collected. Specifically, details such as patient background and quality of life, implant types, radiographic signs of implant-loosening, and success of implant revision were gathered. RESULTS The cohort included 48 patients (females 42%, mean age at operation 42 ± 14 years), having 54 hip implants. 15 years survival was 60% and an average implant life was 12.8 years. Longevity was related to implant type, with cementless implants using ceramic-on-ceramic bearing surfaces performing better than other types (no revisions so-far). Older age at surgery also involved a lower revision risk. Gender, disease genotype, and use of cement during the procedure did not have significant effect on longevity. As expected, quality of life and hip related function were better for patients who did not undergo revision. This implies the importance of long-term implant survival. CONCLUSION Based on these results we recommend THR as a viable treatment for symptomatic hip arthrosis, especially at older age. Specifically, the utilisation of ceramic on ceramic bearing surfaced shows promising result in patients with Gauchers disease.
Collapse
Affiliation(s)
- Daniel Cohen
- Department of Orthopaedic surgery, Shaare-Zedek Medical Centre, affiliated with the Hebrew University, Jerusalem, Israel
| | - Dina Kogan
- Department of Pediatrics, Soroka Medical Centre affiliated with Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Amir Rubin
- Department of Orthopaedic surgery, Shaare-Zedek Medical Centre, affiliated with the Hebrew University, Jerusalem, Israel
| | - Ari Zimran
- Gaucher Clinic, Shaare-Zedek Medical Centre affiliated with the Hebrew University, Jerusalem, Israel
| | - Ehud Lebel
- Department of Orthopaedic surgery, Shaare-Zedek Medical Centre, affiliated with the Hebrew University, Jerusalem, Israel.,Gaucher Clinic, Shaare-Zedek Medical Centre affiliated with the Hebrew University, Jerusalem, Israel
| |
Collapse
|
7
|
d'Avila Paskulin L, Starosta RT, Zizemer VS, Basgalupp S, Bertholdo D, Vairo FPE, Siebert M, Michelin-Tirelli K, Schwartz IVD. Rare GBA1 genotype associated with severe bone disease in Gaucher disease type 1. Mol Genet Metab Rep 2019; 21:100544. [PMID: 31799121 PMCID: PMC6881662 DOI: 10.1016/j.ymgmr.2019.100544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction Gaucher disease (GD) type 1 is a lysosomal disease characterised by hepatosplenomegaly, anemia, thrombocytopenia, bone changes, and bone marrow infiltration. The disease is caused by biallelic pathogenic variants in GBA1 which codes for glucocerebrosidase, an enzyme involved in the catabolic pathway of complex lipids. Aims To report on the case of two sisters with GD type 1 who bear a genotype never reported in the literature. Case report Patient 1 is a 47-year-old female diagnosed at 42 years of age with chronic lumbar pain, mild splenomegaly, slightly reduced platelets and normal hemoglobin values, severe Bone Marrow Burden (BMB) score, high chitotriosidase activity, and low glucocerebrosidase. Patient 2 is a 50-year-old female, sister of patient 1, who was diagnosed after familial screening. At 45 years of age, she had osteonecrosis of the left femur and a total hysterectomy because of uncontrollable bleeding. At first evaluation, she had bone pain with a high BMB score, mild splenomegaly, normal hemoglobin, normal platelets count, elevated chitotriosidase activity, and low glucocerebrosidase activity. Both patients were found to be compound heterozygotes for the p.Glu388Lys and the p.Ser405Asn variants in GBA1. Conclusions This is the first family with GD and this combination of variants which causes a phenotype remarkable for severe bone disease with no or mild hematological manifestations.
Collapse
Affiliation(s)
- Livia d'Avila Paskulin
- Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rodrigo Tzovenos Starosta
- Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vitória Schütt Zizemer
- Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Filippo Pinto E Vairo
- Center of Individualized Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Marina Siebert
- Molecular and Protein Analyses Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Kristiane Michelin-Tirelli
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ida Vanessa Doederlein Schwartz
- Post-Graduation Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Post-Graduation Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
8
|
Degnan AJ, Ho-Fung VM, Ahrens-Nicklas RC, Barrera CA, Serai SD, Wang DJ, Ficicioglu C. Imaging of non-neuronopathic Gaucher disease: recent advances in quantitative imaging and comprehensive assessment of disease involvement. Insights Imaging 2019; 10:70. [PMID: 31289964 PMCID: PMC6616606 DOI: 10.1186/s13244-019-0743-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022] Open
Abstract
Gaucher disease is an inherited metabolic disorder resulting in deficiency of lysosomal enzyme β-glucocerebrosidase causing the accumulation of abnormal macrophages (“Gaucher cells”) within multiple organs, most conspicuously affecting the liver, spleen, and bone marrow. As the most common glycolipid metabolism disorder, it is important for radiologists encountering these patients to be familiar with advances in imaging of organ and bone marrow involvement and understand the role of imaging in clinical decision-making. The recent advent of commercially available, reliable, and reproducible quantitative MRI acquisitions to measure fat fractions prompts revisiting the role of quantitative assessment of bone marrow involvement. This manuscript reviews the diverse imaging manifestations of Gaucher disease and discusses more optimal quantitative approaches to ascertain solid organ and bone marrow involvement with an emphasis on future applications of other quantitative methods including elastography.
Collapse
Affiliation(s)
- Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. .,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Victor M Ho-Fung
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Rebecca C Ahrens-Nicklas
- Division of Human Genetics, The Children's Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Blvd, Floor 9, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Christian A Barrera
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Suraj D Serai
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Dah-Jyuu Wang
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Can Ficicioglu
- Division of Human Genetics, The Children's Hospital of Philadelphia, Colket Translational Research Building, 3501 Civic Center Blvd, Floor 9, Philadelphia, PA, 19104, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA, 19104, USA
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Drelichman G, Fernández Escobar N, Basack N, Aversa L, Larroude MS, Aguilar G, Szlago M, Schenone A, Fynn A, Cuello MF, Aznar M, Fernández R, Ruiz A, Reichel P, Guelbert N, Robledo H, Watman N, Bolesina M, Elena G, Veber SE, Pujal G, Galván G, Chain JJ, Arizo A, Bietti J, Bar D, Dragosky M, Marquez M, Feldman L, Muller K, Zirone S, Buchovsky G, Lanza V, Sanabria A, Fernández I, Jaureguiberry R, Contte M, Barbieri María A, Maro A, Zárate G, Fernández G, Rapetti MC, Donato H, Degano A, Kantor G, Albina R, Álvarez Bollea M, Brun M, Bacciedoni V, Del Río F, Soberón B, Boido N, Schweri M, Borchichi S, Welsh V, Corrales M, Cedola A, Carvani A, Diez B, Richard L, Baduel C, Nuñez G, Colimodio R, Barazzutti L, Medici H, Meschengieser S, Damiani G, Nucifora M, Girardi B, Gómez S, Papucci M, Verón D, Quiroga L, Carro G, De Ambrosio P, Ferro J, Pujol M, Castella CC, Franco L, Nisnovich G, Veloso M, Pacheco I, Savarino M, Marino A, Saavedra JL. Skeletal involvement in Gaucher disease: An observational multicenter study of prognostic factors in the Argentine Gaucher disease patients. Am J Hematol 2016; 91:E448-53. [PMID: 27420181 DOI: 10.1002/ajh.24486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022]
Abstract
Patients with Gaucher type 1 (GD1) throughout Argentina were enrolled in the Argentine bone project to evaluate bone disease and its determinants. We focused on presence and predictors of bone lesions (BL) and their relationship to therapeutic goals (TG) with timing and dose of enzyme replacement therapy (ERT). A total of 124 patients on ERT were enrolled in a multi-center study. All six TG were achieved by 82% of patients: 70.1% for bone pain and 91.1% for bone crisis. However, despite the fact that bone TGs were achieved, residual bone disease was present in 108 patients on ERT (87%) at time 0. 16% of patients showed new irreversible BL (bone infarcts and avascular osteonecrosis) despite ERT, suggesting that they appeared during ERT or were not detected at the moment of diagnosis. We observed 5 prognostic factors that predicted a higher probability of being free of bone disease: optimal ERT compliance; early diagnosis; timely initiation of therapy; ERT initiation dose ≥45 UI/kg/EOW; and the absence of history of splenectomy. Skeletal involvement was classified into 4 major phenotypic groups according to BL: group 1 (12.9%) without BL; group 2 (28.2%) with reversible BL; group 3 (41.9%) with reversible BL and irreversible chronic BL; and group 4 (16.9%) with acute irreversible BL. Our study identifies prognostic factors for achieving best therapeutic outcomes, introduces new risk stratification for patients and suggests the need for a redefinition of bone TG. Am. J. Hematol. 91:E448-E453, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Marina Szlago
- Laboratorio de Neuroquímica “Dr. N.A Chamoles”, CABA
| | | | - Alcyra Fynn
- Hospital de Niños “Sor María Ludovica”, La Plata; Prov. Buenos Aires
| | | | - Marcela Aznar
- Hospital de Niños “Sor María Ludovica”, La Plata; Prov. Buenos Aires
- Hospital CEPSI Eva Perón; Santiago del Estero
- Hospital Provincial de Niños “Santa Trinidad”; Córdoba
- Hospital Ramos Mejía, CABA
- Hospital de Niños “Pedro de Elizalde”, CABA. Hospital “Dr. Julio C. Perrando”; Chaco. Hospital del Niño Jesús; Tucumán. Hospital Iturraspe; Santa Fe. Instituto Médico Platense; La Plata
| | - Ramiro Fernández
- Hospital de Niños “Sor María Ludovica”, La Plata; Prov. Buenos Aires
| | - Alba Ruiz
- Hospital CEPSI Eva Perón; Santiago del Estero
| | | | | | - Hugo Robledo
- Hospital Provincial de Niños “Santa Trinidad”; Córdoba
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Victoria Lanza
- Hospital Materno Infantil de Mar del Plata, Pcia. Buenos Aires
| | - Alba Sanabria
- Hospital Materno Infantil de Mar del Plata, Pcia. Buenos Aires
| | | | | | | | | | | | | | | | | | - Hugo Donato
- Hospital de Niños de San Justo, Pcia. Buenos Aires
| | | | | | - Roberto Albina
- Consultorio Particular, Mar del Plata; Prov. Buenos Aires
| | | | - María Brun
- Hospital Centenario, Gualeguaychu, Entre Ríos
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - David Verón
- Hospital Nacional “Profesor Alejandro Posadas”, L
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Pathogenesis of Bone Alterations in Gaucher Disease: The Role of Immune System. J Immunol Res 2015; 2015:192761. [PMID: 26064996 PMCID: PMC4433682 DOI: 10.1155/2015/192761] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/09/2015] [Accepted: 01/11/2015] [Indexed: 01/23/2023] Open
Abstract
Gaucher, the most prevalent lysosomal disorder, is an autosomal recessive inherited disorder due to a deficiency of glucocerebrosidase. Glucocerebrosidase deficiency leads to the accumulation of glucosylceramide primarily in cells of mononuclear-macrophage lineage. Clinical alterations are visceral, hematological, and skeletal. Bone disorder in Gaucher disease produces defects on bone metabolism and structure and patients suffer from bone pain and crisis. Skeletal problems include osteopenia, osteoporosis, osteolytic lesions, and osteonecrosis. On the other hand a chronic stimulation of the immune system is a well-accepted hallmark in this disease. In this review we summarize the latest findings in the mechanisms leading to the bone pathology in Gaucher disease in relationship with the proinflammatory state.
Collapse
|
12
|
Ahmadieh A, Farnad F, Sedghizadeh PP. Gaucher disease with jawbone involvement: a case report. J Med Case Rep 2014; 8:360. [PMID: 25370695 PMCID: PMC4234523 DOI: 10.1186/1752-1947-8-360] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/15/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction Gaucher disease is an autosomal recessive systemic condition, and the most common of the lysosomal storage disorders. It is characterized by lipid accumulation in certain cells and organs, particularly macrophages, which appear on light microscopy as ’Gaucher cells’ or vacuolated lipid-laden reticuloendothelial cells. Long bone involvement is common in Gaucher disease, whereas craniofacial bone involvement is extremely rare. Reports confirming the diagnoses of Gaucher disease involving craniofacial bones by histopathologic evidence are even rarer. Case presentation A 46-year-old Caucasian Ashkenazi Jewish woman with Gaucher disease presented with jawbone pain and lytic radiographic lesions of her mandible. Surgical biopsy of a mandibular lesion revealed Gaucher cells infiltrating the mandible, which correlated with radiographic and clinical findings, supporting a diagnosis of Gaucher disease with jawbone involvement. Conclusions Lysosomal storage diseases can have head and neck manifestations, and bone involvement in Gaucher disease is common. Therefore, careful consideration of signs and symptoms and medical history, with a thorough review of systems, is important when evaluating patients with lysosomal storage disorders to rule out head and neck involvement of disease. Biopsy may be warranted in some cases for more definitive diagnosis of painful jawbone lesions and to rule out other odontogenic and non-odontogenic conditions in the differential diagnosis.
Collapse
Affiliation(s)
| | | | - Parish P Sedghizadeh
- Ostrow School of Dentistry of USC, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
13
|
Meyer BJ, Mills AM, Gaskin CM. Extraosseous Gaucher cell deposition without adjacent bone involvement. Skeletal Radiol 2014; 43:1495-8. [PMID: 24952923 DOI: 10.1007/s00256-014-1927-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/25/2014] [Accepted: 05/26/2014] [Indexed: 02/02/2023]
Abstract
Extraosseous Gaucher cell deposits are a rare complication of Gaucher disease that can mimic malignancy. We describe a case of Gaucher cell deposition in the subcutaneous soft tissues overlying the lower thoracic spine in an 18-year-old woman with known type III Gaucher disease. This case is unique in the literature because this subcutaneous Gaucher mass was not associated with extension from underlying bone involvement or clear lymph node origin. It demonstrated no discernible continuity with the adjacent thoracic spinous processes, the cortices of which appeared intact. Although patients with Gaucher disease are at increased risk of malignancy, Gaucher cell deposition should remain a differential consideration for soft tissue masses with or without adjacent bone involvement in patients with known Gaucher disease.
Collapse
Affiliation(s)
- Brendan J Meyer
- Department of Radiology and Medical Imaging, University of Virginia Health System, Virginia, USA
| | | | | |
Collapse
|
14
|
Abstract
Gaucher disease is an inborn error of metabolism due to a deficiency of the lysosomal enzyme glucocerebrosidase. As a result of this deficiency, the substrate glucocerebroside accumulates in the liver, spleen, bone and bone marrow. Bone involvement can lead to abnormalities in bone growth, bone remodeling, bone infarcts, aseptic necrosis, osteonecrosis, increased fracture risk and lytic bone lesions. Patients may experience bone pain and bone crises related to bone infarcts. There is evidence of abnormal bone metabolism in both bone resorption and bone formation based upon biochemical abnormalities found in patients. In addition, both immunological and coagulation abnormalities have in part been implicated in the causation of bone disease. Treatment with enzyme replacement therapy and substrate reduction therapy has led to improvement in both the symptoms and the radiographic abnormalities seen in these patients. It is unknown whether these treatments lower fracture risk.
Collapse
Affiliation(s)
- Barry E Rosenbloom
- a Cedars-Sinai Medical Center, Tower Hematology Oncology, 9090 Wilshire Blvd, #200, Beverly Hills, CA 90211, USA
| | - Neal J Weinreb
- b University Research Foundation for Lysosomal Diseases, Dr John T. Macdonald Foundation, University of Miami Miller School of Medicine, 8170 Royal Palm Blvd, Coral Springs, FL 33065, USA
| |
Collapse
|
15
|
Binnetoglu E, Komurcu E, Sen H, Kizildag B. Gaucher disease with pathological femoral neck fracture. BMJ Case Rep 2013; 2013:bcr-2013-200260. [PMID: 23997081 DOI: 10.1136/bcr-2013-200260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Fractures of the femoral neck are rare and usually result from serious and high-energy trauma in the skeleton in young adults. Gaucher's disease (GD) is a lysosomal storage disorder that has progressive course and is rarely seen. Research has shown that a pathological femoral neck fracture with GD mostly emerges in childhood. But in adults, there are no reports of pathological femoral neck fractures with GD. We present a unique case of GD with a pathological femoral neck fracture in a 54-year-old woman who did not undergo surgery because of haematological problems including thrombocytopaenia.
Collapse
Affiliation(s)
- Emine Binnetoglu
- Department of Internal Medicine, Faculty of Medicine, Onsekiz Mart University, Canakkale, Turkey
| | | | | | | |
Collapse
|
16
|
Zeevi I, Anavi Y, Kaplan I, Zadik Y. Jaws features in Type 1 Gaucher disease. J Oral Maxillofac Surg 2012; 71:694-701. [PMID: 23265852 DOI: 10.1016/j.joms.2012.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 09/12/2012] [Accepted: 09/15/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Our aims were to present 2 new cases of Gaucher disease involving the jaws and to review the literature. MATERIALS AND METHODS Two new cases and the literature from 1982-2011 were reviewed. RESULTS Ten articles describing 35 cases (for a total of 37 with 2 new cases presented) were analyzed. The mandible and maxilla were affected in 97.3% and 24.3% of the reported cases, respectively. Generalized rarefaction of bone (osteopenia) was present in 83.8%, and well-defined radiolucent lesions in 40.5%. The effects on the surrounding structures included loss of cortication of the mandibular canal (56.7%), cortical bone thinning (27%), expansion, root resorption (24.3%), mandibular canal displacement (18.9%), cortical perforation, maxillary sinus obliteration, and tooth displacement (10.8%). CONCLUSIONS Two distinct bone abnormalities with separate pathophysiologies, radiographic presentation, and effects on the surrounding structures are suggested: 1) generalized mandibular/maxillary osteopenia and 2) a well-defined radiolucent lesion, which appears only in the mandible. This review refutes 2 accepted assumptions; according to the results, 1) the most common manifestation is generalized osteopenia (and the resulting mandibular canal changes), whereas the well-defined radiolucent lesion is the next most common, and 2) cortical bone thinning/perforations and lamina dura thinning are not uncommon in these patients.
Collapse
Affiliation(s)
- Itai Zeevi
- Department of Oral and Maxillofacial Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | | |
Collapse
|
17
|
Abstract
Gaucher disease is a systemic lysosomal storage disorder with a high prevalence among Ashkenazi Jews. It is caused by an inherited deficiency of the lysosomal enzyme glucocerebrosidase. Common signs and symptoms include hepatosplenomegaly, anemia, thrombocytopenia, and skeletal involvement. Oral and dental manifestations are less commonly seen. These manifestations are often asymptomatic, although they may be detected by routine dental x-rays. There are several case reports and a few larger series published describing patients with Gaucher disease who have mandibulo-maxillofacial involvement. This review aims to examine the oral manifestations observed in Gaucher disease and to suggest practical guidelines for dealing with these often worrisome signs. Among the critical issues are the benign nature of Gaucher cell infiltration of the mandible and the critical importance of being prepared for postprocedure bleeding and/or infections. Therefore, it is essential that dental practitioners be aware of the possible oral and dental complications of Gaucher disease, as well as the available treatment modalities.
Collapse
Affiliation(s)
- Hamid R. Saranjam
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ellen Sidransky
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Ari Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Deborah Elstein
- Gaucher Clinic, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| |
Collapse
|
18
|
Samuels N, Elstein D, Lebel E, Zimran A, Oberbaum M. Acupuncture for symptoms of Gaucher disease. Complement Ther Med 2012; 20:131-4. [PMID: 22500662 DOI: 10.1016/j.ctim.2011.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 11/24/2011] [Accepted: 12/14/2011] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the effect of acupuncture on bone/joint pain, headache and fatigue, as well as quality of life in patients with Gaucher disease (GD), within the framework of an integrated treatment programme. METHODS Patients with GD suffering from any of the above symptoms were offered a series of 10-12 weekly acupuncture treatment sessions. Prior to initiation of treatment, participants were asked to score the severity of pain, as well as to complete the Functional Assessment of Chronic Illness Therapy-Fatigue measure (FACIT-F) and the Medical Outcomes Study (MOS) Short-Form (SF) questionnaire. These tools were evaluated again at the end of the treatment period. RESULTS A total of 12 patients were evaluated. While the only pain outcome reduced by acupuncture was knee pain, a significant improvement was observed with respect to nearly all FACIT-Fatigue measures, including the Physical Well Being (PWB) subscales and the SF-12 Physical Composite Score (PCS), though not for the Mental Composite Score (MCS). Patients reported satisfaction with the treatment process, and no significant side effects were reported. CONCLUSION Acupuncture may play a beneficial role for patients with GD when used in conjunction with conventional therapy, reducing fatigue and improving physical function. The preliminary finding of this observational study should encourage further research.
Collapse
Affiliation(s)
- Noah Samuels
- Center for Integrative Complementary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
| | | | | | | | | |
Collapse
|
19
|
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.
Collapse
Affiliation(s)
- Ozlem Goker-Alpan
- Lysosomal Disorders Research and Treatment Unit, Center for Clinical Trials, Springfield, VA 22152, USA.
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Lebel E, Ioscovich A, Itzchaki M, Zimran A, Elstein D. Hip arthroplasty in patients with Gaucher disease. Blood Cells Mol Dis 2011; 46:60-5. [DOI: 10.1016/j.bcmd.2010.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 09/01/2010] [Indexed: 10/18/2022]
|
22
|
Bubbar V, Heras FL, Amato D, Pritzker KPH, Gross AE. Total hip replacement in Gaucher's disease: effects of enzyme replacement therapy. ACTA ACUST UNITED AC 2010; 91:1623-7. [PMID: 19949128 DOI: 10.1302/0301-620x.91b12.22515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Total hip replacement in patients with Gaucher's disease with symptomatic osteonecrosis of the femoral head is controversial because of the high early failure rates. We describe four patients who had an uncemented total hip replacement following enzyme replacement therapy for a median of two years and one month (1 to 9.8 years) prior to surgery, and who remained on treatment. At operation, the bone had a normal appearance and consistency. Histopathological examination showed that, compared with previous biopsies of untreated Gaucher's disease, the Gaucher cell infiltrate had decreased progressively with therapy, being replaced by normal adipose tissue. The surfaces of viable bone beyond the osteonecrotic areas showed osteoblasts, indicating remodelling. In one case acetabular revision was carried out after 11 years and eight months. The three remaining patients had a mean follow-up of six years and four months (3.3 to 12 years). We recommend initiating enzyme replacement therapy at least one to two years prior to total hip replacement to facilitate bone remodelling and to allow implantation of uncemented components in these young patients.
Collapse
Affiliation(s)
- V Bubbar
- Division of Orthopaedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | | | | | | | | |
Collapse
|
23
|
Severe skeletal involvement in a patient with Gaucher's disease. J Orthop Sci 2009; 14:465-8. [PMID: 19662484 DOI: 10.1007/s00776-009-1340-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 01/20/2009] [Indexed: 10/20/2022]
|
24
|
Lebel E, Phillips M, Elstein D, Zimran A, Itzchaki M. Poor results of drilling in early stages of juxta-articular osteonecrosis in 12 joints affected by Gaucher disease. Acta Orthop 2009; 80:201-4. [PMID: 19404804 PMCID: PMC2823173 DOI: 10.3109/17453670902930032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Gaucher disease is heterogeneous. One of the most devastating complications is bone involvement, ranging from mild osteopenia to osteonecrosis, but no markers have been discovered to predict onset and/or progression. We describe our experience in a large referral center using drilling for juxta-articular osteonecrosis in young patients with Gaucher disease. PATIENTS AND METHODS We retrospectively reviewed medical data from all patients who were recommended to undergo drilling for osteonecrosis of juxta-articular bone of the femoral head, the humeral head, or upper tibia for acute osteonecrosis at a pre-collapse stage. RESULTS 11 patients (mean age 34 years) underwent drilling of 12 joints with juxta-articular osteonecrosis; 3 (mean age 51 years) refused intervention. 9 joints that were drilled showed advancing joint degeneration within 0.5 to 4 years. 3 joints have undergone replacement. Of the 3 joints that did not undergo drilling, 2 have undergone replacement and 1 has collapsed with osteoarthritis. INTERPRETATION We found equally poor outcome with and without drilling. Effective intervention can only be achieved by improving our understanding of bone physiology and pathophysiology in Gaucher disease.
Collapse
Affiliation(s)
- Ehud Lebel
- Department of Orthopaedic SurgeryJerusalemIsrael
| | - Mici Phillips
- Department of Orthopaedic Gaucher Clinic, Shaare Zedek Medical CenterJerusalemIsrael
| | - Deborah Elstein
- Department of Orthopaedic Gaucher Clinic, Shaare Zedek Medical CenterJerusalemIsrael
| | - Ari Zimran
- Department of Orthopaedic Gaucher Clinic, Shaare Zedek Medical CenterJerusalemIsrael
| | | |
Collapse
|
25
|
Zimran A, Ilan Y, Elstein D. Enzyme replacement therapy for mild patients with Gaucher disease. Am J Hematol 2009; 84:202-4. [PMID: 19229987 DOI: 10.1002/ajh.21369] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
|
27
|
Weinreb NJ. Imiglucerase and its use for the treatment of Gaucher's disease. Expert Opin Pharmacother 2008; 9:1987-2000. [DOI: 10.1517/14656566.9.11.1987] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
28
|
Javier RM, Hachulla E. Atteintes ostéoarticulaires de la maladie de Gaucher chez l'adulte: de la physiopathologie au traitement. Presse Med 2007; 36:1971-84. [PMID: 17498916 DOI: 10.1016/j.lpm.2007.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Gaucher disease frequently has severe osteoarticular manifestations that may be disabling. Ischemic phenomena cause the most serious complications and lead to irreversible lesions. Aseptic osteonecrosis of the hip is the most disabling complication; it causes intense early bone pain and often joint collapse and secondary osteoarthritis in young adults. Localized or systemic bone fragility explains osteopenia, osteoporosis, and fractures (vertebral collapse with irreversible kyphosis causing chronic morbidity). Although no double-blind randomized studies have assessed the bone effects of enzyme replacement therapy, it has been shown effective in reducing bone pain in about half of all treatment-naive patients within 1 to 2 years and in improving bone mineral density after 3 years. In open-label trials, substrate reduction therapy (miglustat) reduced both bone pain and bone marrow infiltration. Specific treatment for bone fragility, with bisphosphonates for example, should be considered after rigorous individualized evaluation and assessment of other risk factors.
Collapse
Affiliation(s)
- Rose-Marie Javier
- Service de Rhumatologie, Hôpital de Hautepierre, Avenue Molière, Strasbourg, France.
| | | |
Collapse
|
29
|
Rubio-Retama J, Mariño FT, López-Cabarcos E. Enzymatic biodegradable micro-reactors for therapeutic applications. J Biomed Mater Res B Appl Biomater 2007; 83:145-52. [PMID: 17318827 DOI: 10.1002/jbm.b.30778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Poly(epsilon-caprolactone) is a well known biocompatible polymer, widely used as drug immobilization systems. In this work poly(epsilon-caprolactone) microparticles with average size between 5 and 25 microm have been prepared by O/W emulsion evaporation method. Inside the microparticles, we have encapsulated Glucose Oxidase with the aim of preparing micro-reactors for enzymatic therapy. These microparticles were structurally characterized and its enzymatic activity analyzed in order to improve the enzyme entrapment. Thus, at the optimum synthesis conditions the enzyme entrapped in the microparticles showed an enzymatic activity of (29.9 +/- 2.1)% comparing with the same amount of free enzyme. Moreover the microparticles maintained a (70.4 +/- 3.2)% of their initial enzymatic activity after placing them in buffer solution for two weeks.
Collapse
Affiliation(s)
- J Rubio-Retama
- Department of Pharmaceutical Chemical-Physics, University Complutense of Madrid, 28040 Madrid, Spain.
| | | | | |
Collapse
|
30
|
Vom Dahl S, Poll L, Di Rocco M, Ciana G, Denes C, Mariani G, Maas M. Evidence-based recommendations for monitoring bone disease and the response to enzyme replacement therapy in Gaucher patients. Curr Med Res Opin 2006; 22:1045-64. [PMID: 16846538 DOI: 10.1185/030079906x104623] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bone disease is a serious complication of Gaucher disease. Untreated, it can result in pain, permanent bone damage and disability. Enzyme replacement therapy reverses many of the clinical signs of Gaucher bone disease but early assessment and treatment, and regular monitoring, are essential in optimising outcomes. SCOPE In September 2005, a group of European experts met to review current knowledge and identify best practice and unmet needs in the monitoring of Gaucher bone disease and the response to enzyme replacement therapy. METHODS Medline searches of peer-reviewed literature (no date restrictions) were conducted and supplemented by additional information considered relevant by panellists to furthering discussions. FINDINGS AND CONCLUSIONS The group's recommendations included: currently used biochemical bone markers are not clinically practical or reliable; plain X-rays should not be the sole method of assessing bone disease; MRI is the most sensitive method for monitoring bone marrow infiltration by Gaucher cells; semi-quantitative methods for assessing bone marrow infiltration in routine clinical practice should use readily available technology, include an assessment of Gaucher cell infiltration in the lumbar spine and femur, and be validated for inter-rater reliability and in comparison to other methods; a multidisciplinary approach is required for the treatment of Gaucher patients; all Gaucher patients should receive a comprehensive initial radiologic evaluation for bone disease and ongoing radiological monitoring at least once every 2 years.
Collapse
Affiliation(s)
- Stephan Vom Dahl
- Department of Internal Medicine, St Franziskus Hospital, Cologne, Germany.
| | | | | | | | | | | | | |
Collapse
|