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Sato VN, Moriwaki TL, do Amaral E Castro A, da Rocha Correa Fernandes A, Guimaraes JB. Capsular and retinaculum thickening in type II mucopolysaccharidosis: a novel MRI finding. Skeletal Radiol 2024; 53:1211-1217. [PMID: 37930378 DOI: 10.1007/s00256-023-04499-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
Mucopolysaccharidoses (MPS) are a group of inherited lysosomal storage diseases caused by a deficiency of glycosaminoglycan (GAG) catalytic enzymes, resulting in an accumulation of unprocessed or partly degraded GAGs in different tissues, including bones and joints. Notably, skeletal and joint abnormalities may be the first complaint that prompts patients to seek medical attention, especially in the milder forms of the disease. To our knowledge, there are no prior imaging reports that have documented capsuloligamentous thickening in patients with MPS on MRI. In this study, we present four cases of patients with clinically and genetically confirmed diagnosis of type II MPS, encompassing seven MRI examination of different joints, including cervical spine, hip, wrist, knee, and shoulder. All of the patients were male, aged between 14 and 35 years, and exhibited varying degrees of joint stiffness in the clinical examination and carpal tunnel syndrome in cases of the wrist joint was affected. None of the patients had a history of surgical procedures on the affected joint, other metabolic or deposit diseases, or sports activity practice. The MRI revealed significant capsuloligamentous and retinaculum thickening, up to eight times greater than the normal capsular thickness reported in the literature.
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Affiliation(s)
- Vitor Neves Sato
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil.
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil.
- Department of Radiology, Hospital Do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil.
| | - Tatiane Lumi Moriwaki
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Division of Musculoskeletal Radiology, Diagnóstico das Américas (DASA), São Paulo, SP, Brazil
| | - Adham do Amaral E Castro
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Artur da Rocha Correa Fernandes
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Radiology Department - Grupo de Radiologia e Diagnóstico por Imagem da Rede D'or, São Paulo, SP, Brazil
| | - Julio Brandao Guimaraes
- Department of Radiology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800 - Vila Clementino, São Paulo, SP, 04024-002, Brazil
- Department of Musculoskeletal Radiology, Fleury Medicina E Saúde, São Paulo, SP, Brazil
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2
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Santhoshkumar R, Mahale RR, Kishore PK, Chickabasaviah YT. Child Neurology: Mucopolysaccharidosis IIID: Evidence From Ultrastructural and Genomic Study. Neurology 2023; 101:e1572-e1576. [PMID: 37487748 PMCID: PMC10585691 DOI: 10.1212/wnl.0000000000207647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/31/2023] [Indexed: 07/26/2023] Open
Abstract
Mucopolysaccharidosis IIID (MPS IIID/Sanfilippo syndrome D, OMIM # 252940) is an autosomal recessive lysosomal storage disorder (LSD) and the rarest form of the mucopolysaccharidosis (MPS) III subtypes. It is caused by sequence variations in the gene encoding lysosomal enzyme N-acetyl glucosamine-6-sulphatase (GNS). Deficiency of GNS impairs catabolism of glycosaminoglycans causing accumulation of heparan sulphate within lysosomes of various tissues, which is visualized as membranous cytoplasmic bodies (MCBs) on electron microscopy. The recognition of this ultrastructural feature in a muscle biopsy instigated genetic evaluation for LSD in our case resulting in the detection of a novel pathogenic GNS gene variant. The patient also exhibited intellectual disability since childhood, reduced vision due to pigmentary retinopathy, and behavioral abnormalities without other systemic features of MPS. In this study, we report a patient of Indian origin with MPS IIID based on a novel pathogenic variant c.1078 G>T (p.G360C) in the GNS and the presence of MCBs in muscle biopsy, characterized by several novel findings including the occurrence of pigmentary retinopathy, which extends the clinical spectrum of MPS IIID.
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Affiliation(s)
- Rashmi Santhoshkumar
- From the Departments of Neuropathology (R.S., Y.T.C.) and Neurology (R.R.M., P.K.K.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rohan R Mahale
- From the Departments of Neuropathology (R.S., Y.T.C.) and Neurology (R.R.M., P.K.K.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Pakina Krishna Kishore
- From the Departments of Neuropathology (R.S., Y.T.C.) and Neurology (R.R.M., P.K.K.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Yasha T Chickabasaviah
- From the Departments of Neuropathology (R.S., Y.T.C.) and Neurology (R.R.M., P.K.K.), National Institute of Mental Health and Neurosciences, Bengaluru, India.
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Cantú-Reyna C, Vazquez-Cantu DL, Cruz-Camino H, Narváez-Díaz YA, Flores-Caloca Ó, González-Llano Ó, Araiza-Lozano C, Gómez-Gutiérrez R. Mucopolysaccharidosis Type I in Mexico: Case-Based Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040642. [PMID: 37189891 DOI: 10.3390/children10040642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disease present in 1:100,000 newborns. Variants in the IDUA (alpha-L-iduronidase) gene decrease the enzyme activity for glycosaminoglycans metabolism. MPS I patients exhibit clinical manifestations that fall on the Hurler, Hurler-Scheie, and Scheie syndrome spectrum. CASE PRESENTATION We present a male Mexican patient with respiratory exacerbations requiring recurrent hospitalizations. He showed macrocephaly, coarse facies, hepatomegaly, umbilical hernia, and dorsal kyphosis. The sequencing of the IDUA gene revealed the following genotype: c.46_57del12/c.1205G>A. He received combined therapy with hematopoietic stem cell transplantation and enzyme replacement. Mexican case reports were analyzed to estimate the prevalence of the associated genetic variants. CONCLUSION Despite the challenges of managing this rare disease in Mexico, our patient benefited from the combined therapy. The discrete clinical manifestations and prompt evaluation by a geneticist were crucial in establishing a diagnosis, enabling an early intervention by a multidisciplinary team. The combination of ERT before and after HSCT provided health benefits to our patient.
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Affiliation(s)
- Consuelo Cantú-Reyna
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey 64710, Mexico
- Medical Department, Genomi-k, Monterrey 64060, Mexico
- Centro Médico, ISSSTELEON, Monterrey 64000, Mexico
| | | | - Héctor Cruz-Camino
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey 64710, Mexico
- Medical Department, Genomi-k, Monterrey 64060, Mexico
| | | | | | - Óscar González-Llano
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey 64710, Mexico
- Centro Médico, ISSSTELEON, Monterrey 64000, Mexico
| | | | - René Gómez-Gutiérrez
- Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, Monterrey 64710, Mexico
- Medical Department, Genomi-k, Monterrey 64060, Mexico
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Padash S, Obaid H, Henderson RDE, Padash Y, Adams SJ, Miller SF, Babyn P. A pictorial review of the radiographic skeletal findings in Morquio syndrome (mucopolysaccharidosis type IV). Pediatr Radiol 2023; 53:971-983. [PMID: 36627376 DOI: 10.1007/s00247-022-05585-3] [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] [Received: 06/16/2022] [Revised: 11/18/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
Morquio syndrome, also known as Morquio-Brailsford syndrome or mucopolysaccharidosis type IV (MPS IV), is a subgroup of mucopolysaccharidosis. It is an autosomal recessive lysosomal storage disorder. Two subtypes of Morquio syndrome have been identified. In MPS IVA, a deficiency in N-acetylgalactosamine-6-sulfate sulfatase interrupts the normal metabolic pathway of degrading glycosaminoglycans. Accumulated undigested glycosaminoglycans in the tissue and bones result in complications leading to severe skeletal deformity. In MPS IVB, a deficiency in beta-galactosidase results in a milder phenotype than in MPS IVA. Morquio syndrome presents a variety of clinical manifestations in a spectrum of mild to severe. It classically has been considered a skeletal dysplasia with significant skeletal involvement. However, the extraskeletal features can also provide valuable information to guide further work-up to assess the possibility of the disorder. Although the disease involves almost all parts of the body, it most commonly affects the axial skeleton, specifically the vertebrae. The characteristic radiologic findings in MPS IV, such as paddle-shaped ribs, odontoid hypoplasia, vertebral deformity, metaphyseal and epiphyseal bone dysplasia, and steep acetabula, are encompassed in the term "dysostosis multiplex," which is a common feature among other types of MPS and storage disorders. Myelopathy due to spinal cord compression and respiratory airway obstruction are the most critical complications related to mortality and morbidity. The variety of clinical features, as well as overlapping of radiological findings with other disorders, make diagnosis challenging, and delays in diagnosis and treatment may lead to critical complications. Timely imaging and radiologic expertise are important components for diagnosis. Gene therapies may provide robust treatment, particularly if genetic variations can be screened in utero.
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Affiliation(s)
- Sirwa Padash
- Department of Medical Imaging, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada
| | - Haron Obaid
- Department of Medical Imaging, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada
| | - Robert D E Henderson
- Department of Medical Imaging, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada.
| | - Yaseen Padash
- Department of Radiology, Kurdistan University of Medical Sciences, Kurdistan, Iran
| | - Scott J Adams
- Department of Medical Imaging, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada
| | - Stephen F Miller
- Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paul Babyn
- Department of Medical Imaging, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan, S7N 0W8, Canada
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Circulatory C-type natriuretic peptide reduces mucopolysaccharidosis-associated craniofacial hypoplasia in vivo. PLoS One 2022; 17:e0277140. [DOI: 10.1371/journal.pone.0277140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Skeletal alterations in the head and neck region, such as midfacial hypoplasia, foramen magnum stenosis and spinal canal stenosis, are commonly observed in patients with mucopolysaccharidosis (MPS). However, enzyme replacement therapy (ERT), one of the major treatment approaches for MPS, shows limited efficacy for skeletal conditions. In this study, we analysed the craniofacial morphology of mice with MPS type VII, and investigated the underlying mechanisms promoting jaw deformities in these animals. Furthermore, we investigated the effects of C-type natriuretic peptide (CNP), a potent endochondral ossification promoter, on growth impairment of the craniofacial region in MPS VII mice when administered alone or in combination with ERT. MPS VII mice exhibited midfacial hypoplasia caused by impaired endochondral ossification, and histological analysis revealed increased number of swelling cells in the resting zone of the spheno-occipital synchondrosis (SOS), an important growth centre for craniomaxillofacial skeletogenesis. We crossed MPS VII mice with transgenic mice in which CNP was expressed in the liver under the control of the human serum amyloid-P component promoter, resulting in elevated levels of circulatory CNP. The maxillofacial morphological abnormalities associated with MPS VII were ameliorated by CNP expression, and further prevented by a combination of CNP and ERT. Histological analysis showed that ERT decreased the swelling cell number, and CNP treatment increased the width of the proliferative and hypertrophic zones of the SOS. Furthermore, the foramen magnum and spinal stenoses observed in MPS VII mice were significantly alleviated by CNP and ERT combination. These results demonstrate the therapeutic potential of CNP, which can be used to enhance ERT outcome for MPS VII-associated head and neck abnormalities.
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Xiao C, Koziura M, Cope H, Spillman R, Tan K, Hisama FM, Tifft CJ, Toro C. Adults with lysosomal storage diseases in the undiagnosed diseases network. Mol Genet Genomic Med 2022; 10:e2013. [PMID: 35848209 PMCID: PMC9482386 DOI: 10.1002/mgg3.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/17/2022] [Accepted: 06/15/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To review the referral and clinical characteristics of adult patients diagnosed with lysosomal storage diseases (LSD) through the Undiagnosed Diseases Network (UDN). METHODS Retrospective review of both application and evaluation records for adults admitted to the UDN with a final diagnosis of a lysosomal storage disease. RESULTS Ten patients were identified. Final diagnoses included late onset Tay Sachs, attenuated MPS I, MPS IIIA, MPS IIIB, and MPS IIIC. Most patients presented with neurocognitive changes. Prior to referral, all patients had been evaluated by neurology, four patients underwent phenotype specific panel testing that did not include the causative gene, and four patients had non-diagnostic clinical exome sequencing. CONCLUSIONS LSDs figure highly in the differential diagnosis of neurometabolic disorders in pediatric onset progressive diseases. In adults, their subtle initial presentations overlap with symptoms of more common disorders and less practitioner awareness may lead to prolonged diagnostic challenges.
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Affiliation(s)
- Changrui Xiao
- National Human Genome Research InstituteBethesdaMarylandUSA
| | - Mary Koziura
- Department of PediatricsDivision of Medical Genetics and Genomic MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Heidi Cope
- Department of Pediatrics, Medical GeneticsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Rebecca Spillman
- Department of Pediatrics, Medical GeneticsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Khoon Tan
- Department of Pediatrics, Medical GeneticsDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Fuki M. Hisama
- Department of MedicineDivision of Medical GeneticsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | | | - Camilo Toro
- National Human Genome Research InstituteBethesdaMarylandUSA
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7
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Wiśniewska K, Wolski J, Gaffke L, Cyske Z, Pierzynowska K, Węgrzyn G. Misdiagnosis in mucopolysaccharidoses. J Appl Genet 2022; 63:475-495. [PMID: 35562626 DOI: 10.1007/s13353-022-00703-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023]
Abstract
Mucopolysaccharidosis (MPS) is a group of 13 hereditary metabolic diseases identified in humans (or 14 diseases if considering one MPS type described to date only in mice) in which an enzymatic defect results in the accumulation of glycosaminoglycans (GAG) in the lysosomes of cells. First of all, as a result of GAG storage, the proper functioning of the lysosome is disturbed; then, the cells, and finally, tissue, organs, and the whole organism malfunctions are observed. Due to the rarity, heterogeneity, and multi-systemic and progressive nature of MPS, they present a major diagnostic challenge. Due to the wide variation in symptoms and their similarity to other diseases, MPS is often misdiagnosed, usually as neurological diseases (like autism spectrum disorders, psychomotor hyperactivity, and intellectual disability) or rheumatology and orthopedic disorders (like juvenile idiopathic arthritis, Perthes disease, rickets, and muscular dystrophy). In this review article, we present the problems associated with the possibility of misdiagnosing MPS, discuss what diseases they can be confused with, and suggest ways to reduce these problems in the future.
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Affiliation(s)
- Karolina Wiśniewska
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Jakub Wolski
- Psychiatry Ward, 7th Navy Hospital in Gdańsk, Polanki 117, 80-305, Gdańsk, Poland
| | - Lidia Gaffke
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Zuzanna Cyske
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Karolina Pierzynowska
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland
| | - Grzegorz Węgrzyn
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308, Gdańsk, Poland.
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8
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Imaging in the study of macrocephaly: Why?, when?, how? RADIOLOGIA 2022; 64:26-40. [DOI: 10.1016/j.rxeng.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
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9
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Schonstedt Geldres V, Stecher Guzmán X, Manterola Mordojovich C, Rovira À. Radiología en el estudio de la macrocefalia. ¿Por qué?, ¿cuándo?, ¿cómo? RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Pontesilli S, Baldoli C, Rosa PAD, Cattoni A, Bernardo ME, Meregalli P, Gasperini S, Motta S, Fumagalli F, Tucci F, Baciga F, Consiglieri G, Canonico F, De Lorenzo P, Chiapparini L, Gentner B, Aiuti A, Biondi A, Rovelli A, Parini R. Evidence of Treatment Benefits in Patients with Mucopolysaccharidosis Type I-Hurler in Long-term Follow-up Using a New Magnetic Resonance Imaging Scoring System. J Pediatr 2022; 240:297-301.e5. [PMID: 34547335 DOI: 10.1016/j.jpeds.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 09/03/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
We developed a brain and spine magnetic resonance scoring system based on a magnetic resonance assessment of 9 patients with mucopolysaccharidosis type I-Hurler who underwent hematopoietic stem-cell transplantation. The score is reliable and correlates with long-term clinical and cognitive outcome in patients with mucopolysaccharidosis type I-Hurler.
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Affiliation(s)
- Silvia Pontesilli
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Cristina Baldoli
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | | | - Alessandro Cattoni
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Maria Ester Bernardo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University of Milano, Milano, Italy
| | - Pamela Meregalli
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Gasperini
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Serena Motta
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Federica Baciga
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Giulia Consiglieri
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Canonico
- Department of Radiology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Paola De Lorenzo
- Centro Operativo di Ricerca Statistica, Fondazione Tettamanti, University of Milano-Bicocca, Monza, Italy
| | - Luisa Chiapparini
- Neuroradiology Unit, IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University of Milano, Milano, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy; Vita-Salute San Raffaele University of Milano, Milano, Italy
| | - Andrea Biondi
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Attilio Rovelli
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Rossella Parini
- Pediatric Department, Fondazione MBBM, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milano, Italy.
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van Gool R, Tucker-Bartley A, Yang E, Todd N, Guenther F, Goodlett B, Al-Hertani W, Bodamer OA, Upadhyay J. Targeting neurological abnormalities in lysosomal storage diseases. Trends Pharmacol Sci 2021; 43:495-509. [PMID: 34844772 DOI: 10.1016/j.tips.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 01/07/2023]
Abstract
Central nervous system (CNS) abnormalities and corresponding neurological and psychiatric symptoms are frequently observed in lysosomal storage disorders (LSDs). The genetic background of individual LSDs is indeed unique to each illness. However, resulting defective lysosomal function within the CNS can transition normal cellular processes (i.e., autophagy) into aberrant mechanisms, facilitating overlapping downstream consequences including neurocircuitry dysfunction, neurodegeneration as well as sensory, motor, cognitive, and psychological symptoms. Here, the neurological and biobehavioral phenotypes of major classes of LSDs are discussed alongside therapeutic strategies in development that aim to tackle neuropathology among other disease elements. Finally, focused ultrasound blood-brain barrier opening is proposed to enhance therapeutic delivery thereby overcoming the key hurdle of central distribution of disease modifying therapies in LSDs.
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Affiliation(s)
- Raquel van Gool
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Anthony Tucker-Bartley
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas Todd
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank Guenther
- Department of Speech, Language and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Benjamin Goodlett
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Walla Al-Hertani
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olaf A Bodamer
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
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12
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Sharma R, Sharma V, Tiwari T, Goyal S. Hurler holes in Hunter syndrome. BMJ Case Rep 2021; 14:e246765. [PMID: 34764130 PMCID: PMC8587361 DOI: 10.1136/bcr-2021-246765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rajaram Sharma
- Department of Radio-diagnosis, Pacific Institute of Medical Sciences Umarda Campus, Udaipur, Rajasthan, India
- Department of Radio-diagnosis, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Vikash Sharma
- Department of Radio-diagnosis, Pacific Institute of Medical Sciences Umarda Campus, Udaipur, Rajasthan, India
| | - Tapendra Tiwari
- Department of Radio-diagnosis, Pacific Institute of Medical Sciences Umarda Campus, Udaipur, Rajasthan, India
| | - Saurabh Goyal
- Department of Radio-diagnosis, Pacific Institute of Medical Sciences Umarda Campus, Udaipur, Rajasthan, India
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Klostranec JM, Vucevic D, Bhatia KD, Kortman HGJ, Krings T, Murphy KP, terBrugge KG, Mikulis DJ. Current Concepts in Intracranial Interstitial Fluid Transport and the Glymphatic System: Part II-Imaging Techniques and Clinical Applications. Radiology 2021; 301:516-532. [PMID: 34698564 DOI: 10.1148/radiol.2021204088] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The glymphatic system is a recently discovered network unique to the central nervous system that allows for dynamic exchange of interstitial fluid (ISF) and cerebrospinal fluid (CSF). As detailed in part I, ISF and CSF transport along paravascular channels of the penetrating arteries and possibly veins allow essential clearance of neurotoxic solutes from the interstitium to the CSF efflux pathways. Imaging tests to investigate this neurophysiologic function, although challenging, are being developed and are reviewed herein. These include direct visualization of CSF transport using postcontrast imaging techniques following intravenous or intrathecal administration of contrast material and indirect glymphatic assessment with detection of enlarged perivascular spaces. Application of MRI techniques, including intravoxel incoherent motion, diffusion tensor imaging, and chemical exchange saturation transfer, is also discussed, as are methods for imaging dural lymphatic channels involved with CSF efflux. Subsequently, glymphatic function is considered in the context of proteinopathies associated with neurodegenerative diseases and traumatic brain injury, cytotoxic edema following acute ischemic stroke, and chronic hydrocephalus after subarachnoid hemorrhage. These examples highlight the substantial role of the glymphatic system in neurophysiology and the development of certain neuropathologic abnormalities, stressing the importance of its consideration when interpreting neuroimaging investigations. © RSNA, 2021.
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Affiliation(s)
- Jesse M Klostranec
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Diana Vucevic
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kartik D Bhatia
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Hans G J Kortman
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Timo Krings
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Kieran P Murphy
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - Karel G terBrugge
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
| | - David J Mikulis
- From the Department of Diagnostic and Interventional Neuroradiology, Montréal Neurologic Institute and Hospital, McGill University Health Centre, 3801 Rue University, Montréal, QC, Canada H3A 2B4 (J.M.K.); Department of Medical Imaging (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.), Department of Materials Science & Engineering, Faculty of Applied Science & Engineering (D.V.), and Division of Neurosurgery, Department of Surgery (T.K., K.G.t.B.), University of Toronto, Toronto, Canada; Division of Neuroradiology, Toronto Western Hospital, University Health Network, Toronto, Canada (J.M.K., D.V., K.D.B., H.G.J.K., T.K., K.P.M., K.G.t.B., D.J.M.); Centre Hospitalier de l'Université de Montréal (CHUM), Department of Radiology, Service of Neuroradiology, l'Université de Montréal, Montréal, Canada (J.M.K.); and Department of Medical Imaging, Sydney Children's Hospitals Network, Westmead, Australia (K.D.B.)
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Llanos C, Rau F, Uriarte A. Radiographic and MRI characteristics of diffuse idiopathic skeletal hyperostosis in a cat presented with a painful chronic ambulatory paraparesis. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Cesar Llanos
- Diagnostic Imaging, Southfields Veterinary Specialists Basildon Essex UK
| | - Friederike Rau
- Diagnostic Imaging, Southfields Veterinary Specialists Basildon Essex UK
| | - Ane Uriarte
- Department of Neurology, Southfields Veterinary Specialists Basildon Essex UK
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THAP1 modulates oligodendrocyte maturation by regulating ECM degradation in lysosomes. Proc Natl Acad Sci U S A 2021; 118:2100862118. [PMID: 34312226 DOI: 10.1073/pnas.2100862118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Mechanisms controlling myelination during central nervous system (CNS) maturation play a pivotal role in the development and refinement of CNS circuits. The transcription factor THAP1 is essential for timing the inception of myelination during CNS maturation through a cell-autonomous role in the oligodendrocyte lineage. Here, we demonstrate that THAP1 modulates the extracellular matrix (ECM) composition by regulating glycosaminoglycan (GAG) catabolism within oligodendrocyte progenitor cells (OPCs). Thap1 -/- OPCs accumulate and secrete excess GAGs, inhibiting their maturation through an autoinhibitory mechanism. THAP1 controls GAG metabolism by binding to and regulating the GusB gene encoding β-glucuronidase, a GAG-catabolic lysosomal enzyme. Applying GAG-degrading enzymes or overexpressing β-glucuronidase rescues Thap1 -/- OL maturation deficits in vitro and in vivo. Our studies establish lysosomal GAG catabolism within OPCs as a critical mechanism regulating oligodendrocyte development.
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Reichert R, Pérez JA, Dalla‐Corte A, Pinto e Vairo F, de Souza CFM, Giugliani R, Isolan GR, Stefani MA. Magnetic resonance imaging findings of the posterior fossa in 47 patients with mucopolysaccharidoses: A cross-sectional analysis. JIMD Rep 2021; 60:32-41. [PMID: 34258139 PMCID: PMC8260483 DOI: 10.1002/jmd2.12212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mucopolysaccharidoses (MPS) is a group of hereditary multisystemic lysosomal disorders. Most neuroimaging studies in MPS have focused on the supratentorial compartment and craniocervical junction abnormalities, and data regarding posterior fossa findings are scarce in the literature. Thus, our purpose is to describe posterior fossa findings on magnetic resonance imaging (MRI) of MPS patients. METHODS We reviewed routine MRI scans of MPS patients being followed up at our institution (types I, II, III, IV, and VI), focusing on posterior fossa structures. RESULTS Forty-seven MPS patients were included. MRI-visible perivascular spaces were commonly found in the midbrain and adjacent to the dentate nuclei (85% and 55% of patients, respectively). White-matter lesion was not identified in most cases. Its most frequent localizations were in the pons and cerebellum (34% and 30% of patients, respectively). Enlargement of cerebrospinal fluid (CSF) spaces in the posterior fossa was present in 55% of individuals and was more frequent in neuronopathic patients (73% vs 40%; P = .02). Cerebellar volume was classified as normal, apparent macrocerebellum, atrophic, and hypoplastic in 38%, 38%, 21%, and 3% of patients, respectively. A depression of the posterior fossa floor in the midline sagittal plane was found in 22 patients (47%), which was statistical significantly associated with enlargement of CSF spaces (P = .02) and with apparent macrocerebellum (P = .03). CONCLUSION The present study compiled the main posterior fossa findings in MPS patients. Classically described in the supratentorial compartment, MRI-visible perivascular spaces, white matter lesions, and enlarged perivascular spaces were also found in the posterior fossa. However, atrophy, which commonly affects cerebral hemispheres, was not the most frequent cerebellar morphology found in our study. Moreover, potential findings for future research were described.
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Affiliation(s)
- Roberta Reichert
- Graduate Program in Medicine: Surgical SciencesUniversidade Federal do Rio Grande do Sul (UFRGS)Porto AlegreBrazil
| | | | | | - Filippo Pinto e Vairo
- Center for Individualized Medicine and Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
| | | | | | - Gustavo R. Isolan
- Graduate Program in Medicine: Surgical SciencesUFRGSPorto AlegreBrazil
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Yu Y, Sugiyama A, Kuniya T, Hasegawa D. CT and MRI characteristics of presumptive hypervitaminosis A in a cat. JFMS Open Rep 2021; 7:2055116921990301. [PMID: 33796325 PMCID: PMC7970248 DOI: 10.1177/2055116921990301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Case summary A rescued stray cat with an unknown history was examined for non-ambulatory paraparesis
in the hindlimbs. Survey radiographs revealed typical findings of hypervitaminosis A,
characterised by vertebral exostoses and extensive osteophytes, mainly in the
cervicothoracic spine. CT findings were consistent with the radiographic findings, and
CT-based volume rendering and virtual endoscopy into the vertebral canal were created
for three-dimensional visualisation of the lesion. MRI revealed a focal and mild
dilation of the central canal of the spinal cord. Although the clinical diagnosis of
hypervitaminosis A is based on an unusual dietary history and characteristic
radiographic findings, the history of this cat was unknown and serum concentrations of
vitamin A were unremarkable, when measured >1 month after rescue. However, other
possible differential diagnoses were thought to be unlikely and clinical signs never
worsened, and thus, hypervitaminosis A was presumed. Relevance and novel information To our knowledge, this is the first report to present the CT and MRI characteristics of
a cat with suspected hypervitaminosis A.
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Affiliation(s)
- Yoshihiko Yu
- Laboratory of Veterinary Radiology, Nippon Veterinary and Life Science University, Musashino, Tokyo, Japan
| | | | | | - Daisuke Hasegawa
- Laboratory of Veterinary Radiology, Nippon Veterinary and Life Science University, Musashino, Tokyo, Japan.,The Research Center for Animal Life Science, Nippon Veterinary and Life Science University, Musashino, Tokyo, Japan
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Abstract
Hereditary myelopathies are an important and likely underappreciated component of neurogenetic disease. While previously distinctions have been made by age of onset, the growing power and availability of high-quality neuroimaging and next-generation sequencing are increasingly expanding classical phenotypes and diminishing the utility of age-based classifications. Increasingly, cases of "atypical" disease presentations are challenging past assumptions regarding the age of onset and survival in many disorders and identifying allelic syndromes in others. Despite this, there is poor awareness of the potential for spinal involvement in many diseases that typically affect the brain. Broadly speaking, congenital myelopathies can be neuroanatomically grouped into motor neuron, axonopathy, spinocerebellar, cerebroleukodystrophy, and pan-neuraxis (generally central nervous system predominant with associated axonopathy) disorders.Here, we review hereditary causes of myelopathy, organized by neuroanatomy, and highlight atypical presentations. We discuss findings concerning an underlying genetic etiology for myelopathy, as well as practical, technical, and ethical considerations of diagnostic genetic testing.
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Affiliation(s)
- Melissa A Walker
- Division of Child Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Intraoperative Neurological Monitoring in Lower Limb Surgery for Patients With Mucopolysaccharidoses. J Pediatr Orthop 2021; 41:182-189. [PMID: 33323879 DOI: 10.1097/bpo.0000000000001720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are reports of spinal cord injury (SCI) occurring after lower extremity (LE) surgery in children with mucopolysaccharidoses (MPS). Intraoperative neurological monitoring (IONM) has been adopted in some centers to assess real-time spinal cord function during these procedures. The aim of this investigation was to review 3 specialty centers' experiences with MPS patients undergoing LE surgery. We report how IONM affected care and the details of spinal cord injuries in these patients. METHODS All pediatric MPS patients who underwent LE surgery between 2001 and 2018 were reviewed at 3 children's orthopaedic specialty centers. Demographic and surgical details were reviewed. Estimated blood loss (EBL), surgical time, positioning, use of IONM, and changes in management as a result of IONM were recorded. Details of any spinal cord injuries were examined in detail. RESULTS During the study period, 92 patients with MPS underwent 252 LE surgeries. IONM was used in 83 of 252 (32.9%) surgeries, and intraoperative care was altered in 17 of 83 (20.5%) cases, including serial repositioning (n=7), aggressive blood pressure management (n=6), and abortion of procedures (n=8). IONM was utilized in cases with larger EBL (279 vs. 130 mL) and longer operative time (274 vs. 175 min) compared with procedures without IONM. Three patients without IONM sustained complete thoracic SCI postoperatively, all from cord infarction in the upper thoracic region. These 3 cases were characterized by long surgical time (328±41 min) and substantial EBL (533±416 mL or 30.5% of total blood volume; range, 11% to 50%). No LE surgeries accompanied by IONM experienced SCI. CONCLUSIONS Patients with MPS undergoing LE orthopaedic surgery may be at risk for SCI, particularly if the procedures are long or are expected to have large EBL. One hypothesis for the etiology of SCI in this setting is hypoperfusion of the upper thoracic spinal cord due to prolonged intraoperative or postoperative hypotension. IONM during these procedures may mitigate the risk of SCI by identifying real-time changes in spinal cord function during surgery, inciting a change in the surgical plan. LEVEL OF EVIDENCE Level III-retrospective comparative series.
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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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Derrick-Roberts A, Kaidonis X, Jackson MR, Liaw WC, Ding X, Ong C, Ranieri E, Sharp P, Fletcher J, Byers S. Comparative analysis of brain pathology in heparan sulphate storing mucopolysaccharidoses. Mol Genet Metab 2020; 131:197-205. [PMID: 32739280 DOI: 10.1016/j.ymgme.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/22/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
The cause of neurodegeneration in MPS mouse models is the focus of much debate and what the underlying cause of disease pathology in MPS mice is. The timing of development of pathology and when this can be reversed or impacted is the key to developing suitable therapies in MPS. This study is the first of its kind to correlate the biochemical changes with the functional outcome as assessed using non-invasive behaviour testing across multiple mucopolysaccharidosis (MPS) mouse models. In the MPS brain, the primary lysosomal enzyme dysfunction leads to accumulation of primary glycosaminoglycans (GAGs) with gangliosides (GM2 and GM3) being the major secondary storage products. With a focus on the neuropathology, a time course experiment was conducted in MPS I, MPS IIIA, MPS VII (severe and attenuated models) in order to understand the relative timing and level of GAG and ganglioside accumulation and how this correlates to behaviour deficits. Time course analysis from 1 to 6 months of age was conducted on brain samples to assess primary GAG (uronic acid), β-hexosaminidase enzyme activity and levels of GM2 and GM3 gangliosides. This was compared to a battery of non-invasive behaviour tests including open field, inverted grid, rotarod and water cross maze were assessed to determine effects on motor function, activity and learning ability. The results show that the GAG and ganglioside accumulation begins prior to the onset of detectable changes in learning ability and behaviour. Interestingly, the highest levels of GAG and ganglioside accumulation was observed in the MPS IIIA mouse despite having 3% residual enzyme activity. Deficits in motor function were clearly observed in the severe Gusmps/mps, which were significantly delayed in the attenuated Gustm(L175F)Sly model despite their minimal increase in detectable enzyme activity. This suggests that genotype and residual enzyme activity are not indicative of severity of disease pathology in MPS disease and there exists a window when there are considerable storage products without detectable functional deficits which may allow an alteration to occur with therapy.
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Affiliation(s)
- Ainslie Derrick-Roberts
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia; Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia.
| | - Xenia Kaidonis
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia; Discipline of Genetics and Evolution, University of Adelaide, Australia
| | - Matilda R Jackson
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia; Discipline of Genetics and Evolution, University of Adelaide, Australia
| | - Wan Chin Liaw
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia
| | - XiaoDan Ding
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia
| | - Chun Ong
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia
| | - Enzo Ranieri
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia
| | - Peter Sharp
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia
| | - Janice Fletcher
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia
| | - Sharon Byers
- Genetics and Molecular Pathology, SA Pathology (WCH site), Adelaide, Australia; Discipline of Paediatrics, The University of Adelaide, Adelaide, Australia; Discipline of Genetics and Evolution, University of Adelaide, Australia
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Damar Ç, Derinkuyu BE, Olgaç Kiliçkaya MAB, Öztürk M, Öztunali Ç, Alimli AG, Boyunaga ÖL, Uçar M, Ezgü FS, Tümer L, Börcek AÖ, Siğirci A. Posterior fossa horns; a new calvarial finding of mucopolysaccharidoses with well-known cranial MRI features. Turk J Med Sci 2020; 50:1048-1061. [PMID: 32011835 PMCID: PMC7379437 DOI: 10.3906/sag-1908-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 02/02/2020] [Indexed: 12/05/2022] Open
Abstract
Background/aim Mucopolysaccharidoses (MPS) are a group of hereditary metabolic diseases. The aim of this study was to share the previously unreported calvarial finding of internal hypertrophy of the occipitomastoid sutures (IHOMS) together with some other well-known cranial MRI findings in this patient series. Materials and methods A retrospective evaluation was conducted of 80 cranial MRIs of patients who had been diagnosed and followed up with MPS from 2008 to 2019 in our center. Of these patients, 11 had Hurler, 14 had Hunter, 24 had Sanfilippo, 15 had Morquio, 14 had Maroteaux–Lamy, and 2 had Sly disease. The cranial MRIs were assessed in two main groups as parenchymal intradural cranial MRI findings and extradural calvarial findings. Results The most common parenchymal intradural cranial MRI findings were white matter signal alterations (n = 51, 63%) and perivascular space enlargements (n = 39, 48%). The most common extradural calvarial findings were J-shaped sella (n = 45, 56%) and tympanic effusion (n = 44, 55%). Although IHOMS was defined in a relatively small number of the patients (n = 12, 15%), the prevalence rate was high in MPS type I (n = 6, 54%). Conclusion The abnormal cranial MRI findings of the MPS patients, including the newly identified IHOMS, may provide diagnostic clues to differentiate the type of the disease in radiological imaging.
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Affiliation(s)
- Çağri Damar
- Department of Radiology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Betül Emine Derinkuyu
- Department of Pediatric Radiology, Dr. Sami Ulus Maternity and Children’s Research and Education Hospital, Ankara, Turkey
| | - Muazzez Asburçe Bike Olgaç Kiliçkaya
- Department of Pediatrics, Division of Inborn Errors of Metabolism and Nutrition,Dr. Sami Ulus Maternity and Children’s Research and Education Hospital, Ankara, Turkey
| | - Mehmet Öztürk
- Department of Radiology, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Çiğdem Öztunali
- Department of Radiology, Faculty of Medicine, Osmangazi University, Eskişehir, Turkey
| | - Ayşe Gül Alimli
- Department of Pediatric Radiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | | | - Murat Uçar
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fatih Süheyl Ezgü
- Department of Pediatrics, Division of Inborn Errors of Metabolism and Nutrition, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Leyla Tümer
- Department of Pediatrics, Division of Inborn Errors of Metabolism and Nutrition, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Alp Özgün Börcek
- Department of Neurosurgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ahmet Siğirci
- Department of Radiology, Faculty of Medicine, İnönü University, Malatya, Turkey
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Cognitive Abilities of Dogs with Mucopolysaccharidosis I: Learning and Memory. Animals (Basel) 2020; 10:ani10030397. [PMID: 32121123 PMCID: PMC7143070 DOI: 10.3390/ani10030397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 02/24/2020] [Indexed: 02/08/2023] Open
Abstract
Mucopolysaccharidosis I (MPS I) results from a deficiency of a lysosomal enzyme, alpha-L-iduronidase (IDUA). IDUA deficiency leads to glycosaminoglycan (GAG) accumulation resulting in cellular degeneration and multi-organ dysfunction. The primary aims of this pilot study were to determine the feasibility of cognitive testing MPS I affected dogs and to determine their non-social cognitive abilities with and without gene therapy. Fourteen dogs were tested: 5 MPS I untreated, 5 MPS I treated, and 4 clinically normal. The treated group received intrathecal gene therapy as neonates to replace the IDUA gene. Cognitive tests included delayed non-match to position (DNMP), two-object visual discrimination (VD), reversal learning (RL), attention oddity (AO), and two-scent discrimination (SD). Responses were recorded as correct, incorrect, or no response, and analyzed using mixed effect logistic regression analysis. Significant differences were not observed among the three groups for DNMP, VD, RL, or AO. The MPS I untreated dogs were excluded from AO testing due to failing to pass acquisition of the task, potentially representing a learning or executive function deficit. The MPS I affected group (treated and untreated) was significantly more likely to discriminate between scents than the normal group, which may be due to an age effect. The normal group was comprised of the oldest dogs, and a mixed effect logistic model indicated that older dogs were more likely to respond incorrectly on scent discrimination. Overall, this study found that cognition testing of MPS I affected dogs to be feasible. This work provides a framework to refine future cognition studies of dogs affected with diseases, including MPS I, in order to assess therapies in a more comprehensive manner.
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Lins CF, de Carvalho TL, de Moraes Carneiro ER, da Costa Mariz Filho PJ, Dias Mansur MC, Dos Santos Moraes R, Matos MA. MRI findings of the cervical spine in patients with mucopolysaccharidosis type VI: relationship with neurological physical examination. Clin Radiol 2020; 75:441-447. [PMID: 32061396 DOI: 10.1016/j.crad.2020.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
AIM To describe the magnetic resonance imaging (MRI) findings of the cervical spine of patients with mucopolysaccharidosis type VI (MPS VI) and correlate them with clinical manifestations. MATERIALS AND METHODS This is a cross-sectional study involving 12 patients with MPS VI. A limited neurological examination was undertaken in each patient including Tinel's test, assessment of muscle tone, and the evaluation of deep tendon reflexes. Additionally, each patient underwent cervical spine MRI to evaluate platybasia, odontoid dysplasia, periodontoid soft-tissue thickening, spinal canal stenosis, myelopathy, basilar invagination, platyspondyly, and reduction of nasopharyngeal airway. RESULTS Nine patients were male (75%). The average age was 12.5 (±3.5 years). Tinel's test was negative in all patients. No muscle tone abnormalities were observed. Approximately 48% of the tested reflexes were considered abnormal, 10 of which (8.3%) were pathological occurring in five different patients (41.6%). At MRI, all patients showed periodontoid soft-tissue thickening and cervical spinal stenosis; six showed spinal cord compression and two showed myelopathy. Odontoid hypoplasia and basilar invagination were observed in nine patients. All patients with cervical stenosis on MRI had abnormal reflexes; however, only two of the six patients with evidence of cord compression on MRI had abnormal reflexes on clinical examination. CONCLUSIONS The present study of 12 patients with MPS VI demonstrated that a normal neurological examination cannot confidently exclude potential cord compression in patients with this condition. MRI may aid in the timely identification of cervical spine abnormalities, and potentially play a role in lessening morbidity and mortality in patients with MPS.
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Affiliation(s)
- C Freitas Lins
- Bahiana School of Medicine and Public Health, Av. Dom João VI, 275, 40290-000, Salvador-Bahia, Brazil; Delfin Medicina Diagnóstica, Av. Antônio Carlos Magalhães, 442, 41800-700, Salvador-Bahia, Brazil.
| | - T Lacerda de Carvalho
- Bahiana School of Medicine and Public Health, Av. Dom João VI, 275, 40290-000, Salvador-Bahia, Brazil
| | | | - P J da Costa Mariz Filho
- Delfin Medicina Diagnóstica, Av. Antônio Carlos Magalhães, 442, 41800-700, Salvador-Bahia, Brazil
| | - M C Dias Mansur
- Delfin Medicina Diagnóstica, Av. Antônio Carlos Magalhães, 442, 41800-700, Salvador-Bahia, Brazil
| | - R Dos Santos Moraes
- Delfin Medicina Diagnóstica, Av. Antônio Carlos Magalhães, 442, 41800-700, Salvador-Bahia, Brazil
| | - M Almeida Matos
- Bahiana School of Medicine and Public Health, Av. Dom João VI, 275, 40290-000, Salvador-Bahia, Brazil
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Ashrafi MR, Amanat M, Garshasbi M, Kameli R, Nilipour Y, Heidari M, Rezaei Z, Tavasoli AR. An update on clinical, pathological, diagnostic, and therapeutic perspectives of childhood leukodystrophies. Expert Rev Neurother 2019; 20:65-84. [PMID: 31829048 DOI: 10.1080/14737175.2020.1699060] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Leukodystrophies constitute heterogenous group of rare heritable disorders primarily affecting the white matter of central nervous system. These conditions are often under-appreciated among physicians. The first clinical manifestations of leukodystrophies are often nonspecific and can occur in different ages from neonatal to late adulthood periods. The diagnosis is, therefore, challenging in most cases.Area covered: Herein, the authors discuss different aspects of leukodystrophies. The authors used MEDLINE, EMBASE, and GOOGLE SCHOLAR to provide an extensive update about epidemiology, classifications, pathology, clinical findings, diagnostic tools, and treatments of leukodystrophies. Comprehensive evaluation of clinical findings, brain magnetic resonance imaging, and genetic studies play the key roles in the early diagnosis of individuals with leukodystrophies. No cure is available for most heritable white matter disorders but symptomatic treatments can significantly decrease the burden of events. New genetic methods and stem cell transplantation are also under investigation to further increase the quality and duration of life in affected population.Expert opinion: The improvements in molecular diagnostic tools allow us to identify the meticulous underlying etiology of leukodystrophies and result in higher diagnostic rates, new classifications of leukodystrophies based on genetic information, and replacement of symptomatic managements with more specific targeted therapies.Abbreviations: 4H: Hypomyelination, hypogonadotropic hypogonadism and hypodontia; AAV: Adeno-associated virus; AD: autosomal dominant; AGS: Aicardi-Goutieres syndrome; ALSP: Axonal spheroids and pigmented glia; APGBD: Adult polyglucosan body disease; AR: autosomal recessive; ASO: Antisense oligonucleotide therapy; AxD: Alexander disease; BAEP: Brainstem auditory evoked potentials; CAA: Cerebral amyloid angiopathy; CADASIL: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy; CARASAL: Cathepsin A-related arteriopathy with strokes and leukoencephalopathy; CARASIL: Cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy; CGH: Comparative genomic hybridization; ClC2: Chloride Ion Channel 2; CMTX: Charcot-Marie-Tooth disease, X-linked; CMV: Cytomegalovirus; CNS: central nervous system; CRISP/Cas9: Clustered regularly interspaced short palindromic repeat/CRISPR-associated 9; gRNA: Guide RNA; CTX: Cerebrotendinous xanthomatosis; DNA: Deoxyribonucleic acid; DSB: Double strand breaks; DTI: Diffusion tensor imaging; FLAIR: Fluid attenuated inversion recovery; GAN: Giant axonal neuropathy; H-ABC: Hypomyelination with atrophy of basal ganglia and cerebellum; HBSL: Hypomyelination with brainstem and spinal cord involvement and leg spasticity; HCC: Hypomyelination with congenital cataracts; HEMS: Hypomyelination of early myelinated structures; HMG CoA: Hydroxy methylglutaryl CoA; HSCT: Hematopoietic stem cell transplant; iPSC: Induced pluripotent stem cells; KSS: Kearns-Sayre syndrome; L-2-HGA: L-2-hydroxy glutaric aciduria; LBSL: Leukoencephalopathy with brainstem and spinal cord involvement and elevated lactate; LCC: Leukoencephalopathy with calcifications and cysts; LTBL: Leukoencephalopathy with thalamus and brainstem involvement and high lactate; MELAS: Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke; MERRF: Myoclonic epilepsy with ragged red fibers; MLC: Megalencephalic leukoencephalopathy with subcortical cysts; MLD: metachromatic leukodystrophy; MRI: magnetic resonance imaging; NCL: Neuronal ceroid lipofuscinosis; NGS: Next generation sequencing; ODDD: Oculodentodigital dysplasia; PCWH: Peripheral demyelinating neuropathy-central-dysmyelinating leukodystrophy-Waardenburg syndrome-Hirschprung disease; PMD: Pelizaeus-Merzbacher disease; PMDL: Pelizaeus-Merzbacher-like disease; RNA: Ribonucleic acid; TW: T-weighted; VWM: Vanishing white matter; WES: whole exome sequencing; WGS: whole genome sequencing; X-ALD: X-linked adrenoleukodystrophy; XLD: X-linked dominant; XLR: X-linked recessive.
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Affiliation(s)
- Mahmoud Reza Ashrafi
- Myelin Disorders Clinic, Department of Pediatric Neurology, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Man Amanat
- Faculty of Medicine, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Garshasbi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Reyhaneh Kameli
- Myelin Disorders Clinic, Department of Pediatric Neurology, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Yalda Nilipour
- Pediatric pathology research center, research institute for children's health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Heidari
- Myelin Disorders Clinic, Department of Pediatric Neurology, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rezaei
- Myelin Disorders Clinic, Department of Pediatric Neurology, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Tavasoli
- Myelin Disorders Clinic, Department of Pediatric Neurology, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
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Gigliobianco MR, Di Martino P, Deng S, Casadidio C, Censi R. New Advanced Strategies for the Treatment of Lysosomal Diseases Affecting the Central Nervous System. Curr Pharm Des 2019; 25:1933-1950. [DOI: 10.2174/1381612825666190708213159] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 06/19/2019] [Indexed: 11/22/2022]
Abstract
Lysosomal Storage Disorders (LSDs), also known as lysosomal diseases (LDs) are a group of serious genetic diseases characterized by not only the accumulation of non-catabolized compounds in the lysosomes due to the deficiency of specific enzymes which usually eliminate these compounds, but also by trafficking, calcium changes and acidification. LDs mainly affect the central nervous system (CNS), which is difficult to reach for drugs and biological molecules due to the presence of the blood-brain barrier (BBB). While some therapies have proven highly effective in treating peripheral disorders in LD patients, they fail to overcome the BBB. Researchers have developed many strategies to circumvent this problem, for example, by creating carriers for enzyme delivery, which improve the enzyme’s half-life and the overexpression of receptors and transporters in the luminal or abluminal membranes of the BBB. This review aims to successfully examine the strategies developed during the last decade for the treatment of LDs, which mainly affect the CNS. Among the LD treatments, enzyme-replacement therapy (ERT) and gene therapy have proven effective, while nanoparticle, fusion protein, and small molecule-based therapies seem to offer considerable promise to treat the CNS pathology. This work also analyzed the challenges of the study to design new drug delivery systems for the effective treatment of LDs. Polymeric nanoparticles and liposomes are explored from their technological point of view and for the most relevant preclinical studies showing that they are excellent choices to protect active molecules and transport them through the BBB to target specific brain substrates for the treatment of LDs.
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Affiliation(s)
- Maria R. Gigliobianco
- School of Pharmacy, University of Camerino, Via A. D'Accoiso, 16, 62032, Camerino MC, Italy
| | - Piera Di Martino
- School of Pharmacy, University of Camerino, Via A. D'Accoiso, 16, 62032, Camerino MC, Italy
| | - Siyuan Deng
- School of Pharmacy, University of Camerino, Via A. D'Accoiso, 16, 62032, Camerino MC, Italy
| | - Cristina Casadidio
- School of Pharmacy, University of Camerino, Via A. D'Accoiso, 16, 62032, Camerino MC, Italy
| | - Roberta Censi
- School of Pharmacy, University of Camerino, Via A. D'Accoiso, 16, 62032, Camerino MC, Italy
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Akyol MU, Alden TD, Amartino H, Ashworth J, Belani K, Berger KI, Borgo A, Braunlin E, Eto Y, Gold JI, Jester A, Jones SA, Karsli C, Mackenzie W, Marinho DR, McFadyen A, McGill J, Mitchell JJ, Muenzer J, Okuyama T, Orchard PJ, Stevens B, Thomas S, Walker R, Wynn R, Giugliani R, Harmatz P, Hendriksz C, Scarpa M. Recommendations for the management of MPS IVA: systematic evidence- and consensus-based guidance. Orphanet J Rare Dis 2019; 14:137. [PMID: 31196221 PMCID: PMC6567385 DOI: 10.1186/s13023-019-1074-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/17/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Mucopolysaccharidosis (MPS) IVA or Morquio A syndrome is an autosomal recessive lysosomal storage disorder (LSD) caused by deficiency of the N-acetylgalactosamine-6-sulfatase (GALNS) enzyme, which impairs lysosomal degradation of keratan sulphate and chondroitin-6-sulphate. The multiple clinical manifestations of MPS IVA present numerous challenges for management and necessitate the need for individualised treatment. Although treatment guidelines are available, the methodology used to develop this guidance has come under increased scrutiny. This programme was conducted to provide evidence-based, expert-agreed recommendations to optimise management of MPS IVA. METHODS Twenty six international healthcare professionals across multiple disciplines, with expertise in managing MPS IVA, and three patient advocates formed the Steering Committee (SC) and contributed to the development of this guidance. Representatives from six Patient Advocacy Groups (PAGs) were interviewed to gain insights on patient perspectives. A modified-Delphi methodology was used to demonstrate consensus among a wider group of healthcare professionals with experience managing patients with MPS IVA and the manuscript was evaluated against the validated Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument by three independent reviewers. RESULTS A total of 87 guidance statements were developed covering five domains: (1) general management principles; (2) recommended routine monitoring and assessments; (3) disease-modifying interventions (enzyme replacement therapy [ERT] and haematopoietic stem cell transplantation [HSCT]); (4) interventions to support respiratory and sleep disorders; (5) anaesthetics and surgical interventions (including spinal, limb, ophthalmic, cardio-thoracic and ear-nose-throat [ENT] surgeries). Consensus was reached on all statements after two rounds of voting. The overall guideline AGREE II assessment score obtained for the development of the guidance was 5.3/7 (where 1 represents the lowest quality and 7 represents the highest quality of guidance). CONCLUSION This manuscript provides evidence- and consensus-based recommendations for the management of patients with MPS IVA and is for use by healthcare professionals that manage the holistic care of patients with the intention to improve clinical- and patient-reported outcomes and enhance patient quality of life. It is recognised that the guidance provided represents a point in time and further research is required to address current knowledge and evidence gaps.
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Affiliation(s)
| | - Tord D. Alden
- Department of Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Hernan Amartino
- Child Neurology Department, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Jane Ashworth
- Department of Paediatric Ophthalmology, Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kumar Belani
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN USA
| | - Kenneth I. Berger
- Departments of Medicine and Neuroscience and Physiology, New York University School of Medicine, André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY USA
| | - Andrea Borgo
- Orthopaedics Clinic, Padova University Hospital, Padova, Italy
| | - Elizabeth Braunlin
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN USA
| | - Yoshikatsu Eto
- Advanced Clinical Research Centre, Institute of Neurological Disorders, Kanagawa, Japan and Department of Paediatrics/Gene Therapy, Tokyo Jikei University School of Medicine, Tokyo, Japan
| | - Jeffrey I. Gold
- Keck School of Medicine, Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioural Sciences, Children’s Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, 4650 Sunset Boulevard, Los Angeles, CA USA
| | - Andrea Jester
- Hand and Upper Limb Service, Department of Plastic Surgery, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - Simon A. Jones
- Willink Biochemical Genetic Unit, Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Cengiz Karsli
- Department of Anesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, Canada
| | - William Mackenzie
- Department of Orthopedics, Nemours/Alfred I, Dupont Hospital for Children, Wilmington, DE USA
| | - Diane Ruschel Marinho
- Department of Ophthalmology, UFRGS, and Ophthalmology Service, HCPA, Porto Alegre, Brazil
| | | | - Jim McGill
- Department of Metabolic Medicine, Queensland Children’s Hospital, Brisbane, Australia
| | - John J. Mitchell
- Division of Pediatric Endocrinology, Montreal Children’s Hospital, Montreal, QC Canada
| | - Joseph Muenzer
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Centre for Child Health and Development, Tokyo, Japan
| | - Paul J. Orchard
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN USA
| | | | | | - Robert Walker
- Department of Paediatric Anaesthesia, Royal Manchester Children’s Hospital, Manchester, UK
| | - Robert Wynn
- Department of Paediatric Haematology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Roberto Giugliani
- Department of Genetics, UFRGS, and Medical Genetics Service, HCPA, Porto Alegre, Brazil
| | - Paul Harmatz
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA USA
| | - Christian Hendriksz
- Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Maurizio Scarpa
- Center for Rare Diseases at Host Schmidt Kliniken, Wiesbaden, Germany and Department of Paediatrics University of Padova, Padova, Italy
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Gilani A, Adang LA, Vanderver A, Collins A, Kleinschmidt-DeMasters BK. Neuropathological Findings in a Case of IFIH1-Related Aicardi-Goutières Syndrome. Pediatr Dev Pathol 2019; 22:566-570. [PMID: 30952201 PMCID: PMC8130830 DOI: 10.1177/1093526619837797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Aicardi-Goutières syndrome (AGS) is a rare syndrome characterized by calcification, diffuse demyelination, and variable degree of brain atrophy. The syndrome is genetically heterogeneous with mutations in 7 genes, including TREX1, RNASEH2A, RNASEH2B, RNASEH2C, SAMHD1, ADAR1, and IFIH1 (interferon-induced helicase c domain-containing protein 1) associated with the syndrome, so far. These mutations lead to the overproduction of α-interferon within the central nervous system. Mutations in IFIH1 have been recently described in a subset of AGS, with only 1 previous report of neuropathological findings. We report neuropathological findings in a second case of AGS with a known mutation in IFIH1 gene. The patient is a 16-year-old adolescent boy with early-onset symptoms that progressed to profound loss of cognitive and motor functions. The patient experienced sudden cardiopulmonary arrest at the age of 16 years. At autopsy, the cause of death was determined to be pulmonary thromboembolism. Neuropathological examination revealed microcephaly (brain weight: 916 g) with relatively mild brain atrophy on gross examination. Microscopic examination revealed multifocal calcifications limited to small to medium central nervous system arteries (no evidence of calcification in other organs), involving bilateral cerebral cortex, basal ganglia, thalamus, and cerebellum. Ultrastructural examination showed Calcospherules limited to the vessel walls and the perivasulcar area without evidence of neuronal ferrugination or tubuloreticular bodies. The extent of calcifications was variable across different brain regions, resembling findings in previously reported cases and correlated with the extent of IFIH1 protein expression (data derived from Allen Brain Institute). AGS is a rare cause of brain calcifications that can closely mimic congenital and neonatal infections such as Rubella and similar infections.
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Affiliation(s)
- Ahmed Gilani
- Department of Pathology, Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Laura A Adang
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Adeline Vanderver
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Abigail Collins
- Division of Pediatric Neurology, Colorado Children’s Hospital, Aurora, Colorado
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Abstract
The mucopolysaccharidoses (MPS) are a heterogeneous group of inherited metabolic disorders, each associated with a deficiency in one of the enzymes involved in glycosaminoglycan (GAG) catabolism. Over time, GAGs accumulate in cells and tissues causing progressive damage, a variety of multi-organ clinical manifestations, and premature death. Ear, nose, and throat (ENT) disorders affect more than 90% of MPS patients and appear in the early stage of MPS; also reported are recurrent otitis media and persistent otitis media with effusion, macroglossia, adenotonsillar hypertrophy, nasal obstruction, obstructive sleep apnoea syndrome (OSAS), hearing loss, and progressive respiratory disorders. Undiagnosed MPS patients are frequently referred to otolaryngologists before the diagnosis of MPS is confirmed. Otolaryngologists thus have an early opportunity to recognize MPS and they can play an increasingly integral role in the multidisciplinary approach to the diagnosis and management of many children with MPS. The ENT commitment is therefore to suspect MPS when non-specific ENT pathologies are associated with repeated surgical treatments, unexplainable worsening of diseases despite correct treatment, and with signs, symptoms, and pathological conditions such as hepatomegaly, inguinal hernia, macrocephaly, macroglossia, coarse facial features, hydrocephalous, joint stiffness, bone deformities, valvular cardiomyopathy, carpal tunnel syndrome, and posture and visual disorders.
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Affiliation(s)
- Pier Marco Bianchi
- Surgery Department, Otorhinolaryngology Unit, Bambino Gesù Paediatric Hospital, Scientific Research Institute, P.zza S.Onofrio, 4-00165 Rome, Italy
| | - Renato Gaini
- ENT Department, S. Gerardo Hospital, Monza, Italy
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Tan AP, Mankad K, Gonçalves FG, Talenti G, Alexia E. Macrocephaly: Solving the Diagnostic Dilemma. Top Magn Reson Imaging 2018; 27:197-217. [PMID: 30086108 DOI: 10.1097/rmr.0000000000000170] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Macrocephaly is a relatively common clinical condition affecting up to 5% of the pediatric population. It is defined as an abnormally large head with an occipitofrontal circumference greater than 2 standard deviations above the mean for a given age and sex. Megalencephaly refers exclusively to brain overgrowth exceeding twice the standard deviation. Macrocephaly can be isolated and benign or may be the first indication of an underlying congenital, genetic, or acquired disorder, whereas megalencephaly is more often syndromic. Megalencephaly can be divided into 2 subtypes: metabolic and developmental, caused by genetic defects in cellular metabolism and alterations in signaling pathways, respectively. Neuroimaging plays an important role in the evaluation of macrocephaly, especially in the metabolic subtype which may not be overtly apparent clinically. This article outlines the diverse etiologies of macrocephaly, delineates their clinical and radiographic features, and suggests a clinicoradiological algorithm for evaluation.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Radiology, National University Health System, Singapore, Singapore
| | - Kshitij Mankad
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | | | - Giacomo Talenti
- Neuroradiology Unit, Padua University Hospital, Padua, Italy
| | - Egloff Alexia
- Perinatal Imaging and Health Department, St Thomas' Hospital, London, United Kingdom
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Dhamija R, Weindling SM, Porter AB, Hu LS, Wood CP, Hoxworth JM. Neuroimaging abnormalities in patients with Cowden syndrome: Retrospective single-center study. Neurol Clin Pract 2018; 8:207-213. [PMID: 30105160 DOI: 10.1212/cpj.0000000000000463] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 11/15/2022]
Abstract
Background We retrospectively reviewed the neuroimaging findings of patients with Cowden syndrome and determined their frequency in a single cohort. Methods Electronic medical records were queried from January 1999 to January 2017 to identify patients who fit the clinical criteria for diagnosis of Cowden syndrome with or without a documented PTEN mutation. Patients with brain MRI examinations were then identified. Results We retrospectively identified 44 patients with Cowden syndrome, 22 of whom had neuroimaging for review. Eleven (50%) had Lhermitte-Duclos disease, 4 (18.1%) had meningiomas, 13 (59.1%) had at least one developmental venous anomaly, 3 had cavernous malformations, 2 had evidence of dural arteriovenous fistula, 7 had increased white matter signal abnormalities relative to age (31.8%), 4 had prominent perivascular spaces, cerebellar tonsillar ectopia was present in 7 of 21 (33.3%), and 1 had cortical malformation. Conclusions It is important to recognize that in addition to Lhermitte-Duclos disease, other intracranial findings such as multiple venous anomalies, meningiomas, greater than expected white matter signal abnormality, prominent perivascular spaces, and cortical malformations may warrant a thorough evaluation for Cowden syndrome in the appropriate clinical setting. We further recommend that this broader spectrum of intracranial abnormalities be considered for addition to the Cowden syndrome diagnostic criteria at the time of next revision.
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Affiliation(s)
- Radhika Dhamija
- Departments of Clinical Genomics (RD), Neurology (RD, ABP), and Radiology (Division of Neuroradiology) (LSH, JMH), Mayo Clinic, Phoenix, AZ; Department of Radiology (Division of Neuroradiology) (SMW), Mayo Clinic, Jacksonville, FL; and Department of Radiology (Division of Neuroradiology) (CPW), Mayo Clinic, Rochester, MN
| | - Steven M Weindling
- Departments of Clinical Genomics (RD), Neurology (RD, ABP), and Radiology (Division of Neuroradiology) (LSH, JMH), Mayo Clinic, Phoenix, AZ; Department of Radiology (Division of Neuroradiology) (SMW), Mayo Clinic, Jacksonville, FL; and Department of Radiology (Division of Neuroradiology) (CPW), Mayo Clinic, Rochester, MN
| | - Alyx B Porter
- Departments of Clinical Genomics (RD), Neurology (RD, ABP), and Radiology (Division of Neuroradiology) (LSH, JMH), Mayo Clinic, Phoenix, AZ; Department of Radiology (Division of Neuroradiology) (SMW), Mayo Clinic, Jacksonville, FL; and Department of Radiology (Division of Neuroradiology) (CPW), Mayo Clinic, Rochester, MN
| | - Leland S Hu
- Departments of Clinical Genomics (RD), Neurology (RD, ABP), and Radiology (Division of Neuroradiology) (LSH, JMH), Mayo Clinic, Phoenix, AZ; Department of Radiology (Division of Neuroradiology) (SMW), Mayo Clinic, Jacksonville, FL; and Department of Radiology (Division of Neuroradiology) (CPW), Mayo Clinic, Rochester, MN
| | - Christopher P Wood
- Departments of Clinical Genomics (RD), Neurology (RD, ABP), and Radiology (Division of Neuroradiology) (LSH, JMH), Mayo Clinic, Phoenix, AZ; Department of Radiology (Division of Neuroradiology) (SMW), Mayo Clinic, Jacksonville, FL; and Department of Radiology (Division of Neuroradiology) (CPW), Mayo Clinic, Rochester, MN
| | - Joseph M Hoxworth
- Departments of Clinical Genomics (RD), Neurology (RD, ABP), and Radiology (Division of Neuroradiology) (LSH, JMH), Mayo Clinic, Phoenix, AZ; Department of Radiology (Division of Neuroradiology) (SMW), Mayo Clinic, Jacksonville, FL; and Department of Radiology (Division of Neuroradiology) (CPW), Mayo Clinic, Rochester, MN
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Ahrens-Nicklas R, Schlotawa L, Ballabio A, Brunetti-Pierri N, De Castro M, Dierks T, Eichler F, Ficicioglu C, Finglas A, Gaertner J, Kirmse B, Klepper J, Lee M, Olsen A, Parenti G, Vossough A, Vanderver A, Adang LA. Complex care of individuals with multiple sulfatase deficiency: Clinical cases and consensus statement. Mol Genet Metab 2018; 123:337-346. [PMID: 29397290 PMCID: PMC6856873 DOI: 10.1016/j.ymgme.2018.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022]
Abstract
Multiple sulfatase deficiency (MSD) is an ultra-rare neurodegenerative disorder that results in defective sulfatase post-translational modification. Sulfatases in the body are activated by a unique protein, formylglycine-generating enzyme (FGE) that is encoded by SUMF1. When FGE is absent or insufficient, all 17 known human sulfatases are affected, including the enzymes associated with metachromatic leukodystrophy (MLD), several mucopolysaccharidoses (MPS II, IIIA, IIID, IVA, VI), chondrodysplasia punctata, and X-linked ichthyosis. As such, individuals demonstrate a complex and severe clinical phenotype that has not been fully characterized to date. In this report, we describe two individuals with distinct clinical presentations of MSD. Also, we detail a comprehensive systems-based approach to the management of individuals with MSD, from the initial diagnostic evaluation to unique multisystem issues and potential management options. As there have been no natural history studies to date, the recommendations within this report are based on published studies and consensus opinion and underscore the need for future research on evidence-based outcomes to improve management of children with MSD.
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Affiliation(s)
- Rebecca Ahrens-Nicklas
- Division of Human Genetics and Metabolism, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Lars Schlotawa
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK; Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Germany.
| | - Andrea Ballabio
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Nicola Brunetti-Pierri
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy; Department of Translational Medicine, Federico II University of Naples, Italy
| | - Mauricio De Castro
- United States Air Force Medical Genetics Center, 81st Medical Group, Keesler AFB, MS, USA
| | - Thomas Dierks
- Faculty of Chemistry, Biochemistry I, Bielefeld University, Bielefeld, Germany
| | - Florian Eichler
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Can Ficicioglu
- Division of Human Genetics and Metabolism, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jutta Gaertner
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Germany
| | - Brian Kirmse
- Department of Pediatrics, Genetic and Metabolism, University of Mississippi Medical Center, USA
| | - Joerg Klepper
- Department of Pediatrics and Neuropediatrics, Children's Hospital, Klinikum Aschaffenburg-Alzenau, Germany
| | - Marcus Lee
- Division of Pediatric Neurology, Children's of Mississippi, University of Mississippi Medical Center, Biloxi, MS, USA
| | | | - Giancarlo Parenti
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy; Department of Translational Medicine, Federico II University of Naples, Italy
| | - Arastoo Vossough
- Division of Neuroradiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Laura A Adang
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Bulut E, Pektas E, Sivri HS, Bilginer B, Umaroglu MM, Ozgen B. Evaluation of spinal involvement in children with mucopolysaccharidosis VI: the role of MRI. Br J Radiol 2018; 91:20170744. [PMID: 29376740 DOI: 10.1259/bjr.20170744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate spinal MRI features of mucopolysaccharidosis (MPS) VI and to assess the correlation with clinical findings. METHODS We retrospectively evaluated spinal MRI scans and clinical findings at the time of imaging in 14 patients (8 male, 6 female) with MPS VI. Craniometric measurements were performed and the images were assessed for bony anomalies, spinal stenosis and spinal cord compression. The degree of cervical cord compression was scored and correlated with neurological examination findings at the time of imaging. Vertebral alignment, structural changes in spinal ligaments and intervertebral discs were also assessed. RESULTS All patients had cervical stenosis due to bony stenosis and thickened retrodental tissue (median: 6.05 mm, range 3.3-8 mm). Retrodental tissue thickness was found to increase with age (p = 0.042). Compressive myelopathy was detected at upper cervical level in 11 (79%) and lower thoracic level in 2 patients (14%). Significant inverse correlation was found between cervical myelopathy scores and neurological strength scores. The most common bony changes were hypo/dysplastic odontoid; cervical platyspondyly with anterior inferior beaking; thoracic posterior end plate depressions and lumbar posterior scalloping. Kyphosis due to retrolisthesis of the beaked lumbar vertebrae and acute sacrococcygeal angulations were other remarkable findings. CONCLUSION MRI is an essential component in evaluation of spinal involvement in MPS VI, and scanning of the entire spine is recommended to rule out thoracic cord compression. Advances in knowledge: This study provides a detailed description of spinal MRI findings in MPS VI and underlines the role of MRI in management of cord compression.
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Affiliation(s)
- Elif Bulut
- 1 Department of Radiology, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Emine Pektas
- 2 Department of Pediatric Metabolism, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Hatice S Sivri
- 2 Department of Pediatric Metabolism, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Burcak Bilginer
- 3 Department of Neurosurgery, Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mumtaz M Umaroglu
- 4 Department of Biostatistics, Hacettepe University , Ankara , Turkey
| | - Burce Ozgen
- 1 Department of Radiology, Hacettepe University Faculty of Medicine , Ankara , Turkey
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Abstract
PURPOSE OF REVIEW The purpose of this review is to outline those systemic disorders that are associated with pediatric retinal dystrophy, summarize important retinal, and nonretinal clues that aid in syndromic diagnosis, provide an approach for ophthalmic and systematic systemic examination, describe the important systemic findings seen in pediatric syndromic retinal dystrophies and highlight the role of genetic testing. RECENT FINDINGS With profound advances being made in the field of molecular genetics, a definitive molecular etiology is increasingly being made even in rare and unusual forms of retinal dystrophies. Early recognition and precise diagnosis of a syndromic association has major clinical implications. It not only ensures early and holistic care to the child but also provides an opportunity for the parents in better understanding the nature and course of the disorder. It greatly aids in genetic counseling. SUMMARY Many syndromic retinal dystrophies may present initially to the ophthalmologist long before they present to the pediatrician with systemic symptoms. The intent of this article is to act as a resource in assisting the ophthalmologist to arrive at an early systemic diagnosis.
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