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Macnamara EF, Loydpierson A, Latour YL, D'Souza P, Murphy J, Wolfe L, Estwick T, Johnston JM, Yang J, Acosta MT, Lee PR, Pierson TM, Soldatos A, Toro C, Markello T, Adams DR, Gahl WA, Yousef M, Tifft CJ. Risks and benefits of anesthesia for combined pediatric procedures in the NIH undiagnosed diseases program. Mol Genet Metab 2023; 140:107707. [PMID: 37883914 DOI: 10.1016/j.ymgme.2023.107707] [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: 07/07/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE The NIH Undiagnosed Diseases Program (UDP) aims to provide diagnoses to patients who have previously received exhaustive evaluations yet remain undiagnosed. Patients undergo procedural anesthesia for deep phenotyping for analysis with genomic testing. METHODS A retrospective chart review was performed to determine the safety and benefit of procedural anesthesia in pediatric patients in the UDP. Adverse perioperative events were classified as anesthesia-related complications or peri-procedural complications. The contribution of procedures performed under anesthesia to arriving at a diagnosis was also determined. RESULTS From 2008 to 2020, 249 pediatric patients in the UDP underwent anesthesia for diagnostic procedures. The majority had a severe systemic disease (American Society for Anesthesiology status III, 79%) and/or a neurologic condition (91%). Perioperative events occurred in 45 patients; six of these were attributed to anesthesia. All patients recovered fully without sequelae. Nearly half of the 249 patients (49%) received a diagnosis, and almost all these diagnoses (88%) took advantage of information gleaned from procedures performed under anesthesia. CONCLUSIONS The benefits of anesthesia involving multiple diagnostic procedures in a well-coordinated, multidisciplinary, research setting, such as in the pediatric UDP, outweigh the risks.
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Affiliation(s)
- Ellen F Macnamara
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - Amelia Loydpierson
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Yvonne L Latour
- Medical Genetics Branch, National Human Genome Research Institute, NIH, Bethesda, MD, United States of America; Department of Pathology, Immunology, and Microbiology, Vanderbilt University, Nashville, TN, United States of America
| | - Precilla D'Souza
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; Hummingbird House Children's Hospice, 60 Curwen Terrace, Chermside, Queensland 4032, Australia
| | - Jennifer Murphy
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; Hummingbird House Children's Hospice, 60 Curwen Terrace, Chermside, Queensland 4032, Australia
| | - Lynne Wolfe
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - Tyra Estwick
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, United States of America
| | - Jean M Johnston
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - John Yang
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - Maria T Acosta
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - Paul R Lee
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; Division of Neurology 2, Office of Neuroscience, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States of America
| | - Tyler Mark Pierson
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; Departments of Pediatrics and Neurology & The Board of Governors, Regenerative Medicine Institute and the Cedars Sinai Center for the Undiagnosed Patient, Cedars Sinai Medical Center, Los Angeles, CA, United States of America
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, United States of America
| | - Camilo Toro
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - Tom Markello
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - David R Adams
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; National Human Genome Research Institute, NIH, Bethesda, MD, United States of America
| | - William A Gahl
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America
| | - Muhammad Yousef
- National Institutes of Health Clinical Center, Department of Perioperative Medicine, Pediatric Anesthesiology, Bethesda, MD, United States of America
| | - Cynthia J Tifft
- National Institutes of Health Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, MD, United States of America; National Human Genome Research Institute, NIH, Bethesda, MD, United States of America.
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Holzmann C, Witt M, Rolfs A, Antipova V, Wree A. Gender-Specific Effects of Two Treatment Strategies in a Mouse Model of Niemann-Pick Disease Type C1. Int J Mol Sci 2021; 22:ijms22052539. [PMID: 33802605 PMCID: PMC7962008 DOI: 10.3390/ijms22052539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/16/2022] Open
Abstract
In a mouse model of Niemann-Pick disease type C1 (NPC1), a combination therapy (COMBI) of miglustat (MIGLU), the neurosteroid allopregnanolone (ALLO) and the cyclic oligosaccharide 2-hydroxypropyl-β-cyclodextrin (HPßCD) has previously resulted in, among other things, significantly improved motor function. The present study was designed to compare the therapeutic effects of the COMBI therapy with that of MIGLU or HPßCD alone on body and brain weight and the behavior of NPC1−/− mice in a larger cohort, with special reference to gender differences. A total of 117 NPC1−/− and 123 NPC1+/+ mice underwent either COMBI, MIGLU only, HPßCD only, or vehicle treatment (Sham), or received no treatment at all (None). In male and female NPC1−/− mice, all treatments led to decreased loss of body weight and, partly, brain weight. Concerning motor coordination, as revealed by the accelerod test, male NPC1−/− mice benefited from COMBI treatment, whereas female mice benefited from COMBI, MIGLU, and HPßCD treatment. As seen in the open field test, the reduced locomotor activity of male and female NPC1−/− mice was not significantly ameliorated in either treatment group. Our results suggest that in NPC1−/− mice, each drug treatment scheme had a beneficial effect on at least some of the parameters evaluated compared with Sham-treated mice. Only in COMBI-treated male and female NPC+/+ mice were drug effects seen in reduced body and brain weights. Upon COMBI treatment, the increased dosage of drugs necessary for anesthesia in Sham-treated male and female NPC1−/− mice was almost completely reduced only in the female groups.
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Affiliation(s)
- Carsten Holzmann
- Institute of Medical Genetics, Rostock University Medical Center, D-18057 Rostock, Germany;
- Centre of Transdisciplinary Neuroscience Rostock, D-18147 Rostock, Germany;
| | - Martin Witt
- Centre of Transdisciplinary Neuroscience Rostock, D-18147 Rostock, Germany;
- Institute of Anatomy, Rostock University Medical Center, D-18057 Rostock, Germany;
| | - Arndt Rolfs
- Centogene AG, Rostock, Am Strande 7, 18055 Rostock, Germany;
- University of Rostock, 18055 Rostock, Germany
| | - Veronica Antipova
- Institute of Anatomy, Rostock University Medical Center, D-18057 Rostock, Germany;
- Gottfried Schatz Research Center for Cell Signaling, Metabolism and Aging, Macroscopic and Clinical Anatomy, Medical University of Graz, A-8010 Graz, Austria
| | - Andreas Wree
- Centre of Transdisciplinary Neuroscience Rostock, D-18147 Rostock, Germany;
- Institute of Anatomy, Rostock University Medical Center, D-18057 Rostock, Germany;
- Correspondence: ; Tel.: +49-381-494-8429
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3
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Ulloa ML, Froyshteter AB, Kret LN, Chang DP, Sarah GE, McCarthy RJ, Barnes SD, Berry-Kravis EM. Anesthetic management of pediatric patients with Niemann-Pick disease type C for intrathecal 2-hydroxypropyl-β-cyclodextrin injection. Paediatr Anaesth 2020; 30:766-772. [PMID: 32349180 DOI: 10.1111/pan.13902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Niemann-Pick disease type C is an autosomal-recessive, lysosomal storage disorder with variable age of onset and a heterogeneous clinical presentation that includes neurological, psychiatric, and visceral findings. Serial intrathecal injections of 2-hydroxypropyl-beta-cyclodextrin are being evaluated as a treatment modality for Niemann-Pick disease type C with a subset of patients requiring anesthesia for this procedure. AIMS The aim of this study was to evaluate the safety of anesthesia provided for patients undergoing intrathecal injection of 2-hydroxypropyl-beta-cyclodextrin. METHODS A retrospective review of pediatric patients who received serial intrathecal injections of 2-hydroxypropyl-beta-cyclodextrin with anesthesia at two tertiary care centers was conducted from December 2015 through April 2019. Data were extracted for analysis included preoperative comorbidities, demographics, vital signs, intraoperative anesthesia course, airway management technique, venous access, postoperative course, and perioperative complications. In total, 19 patients were identified and a total of 394 anesthetic encounters were included in this study. RESULTS All 394 2-hydroxypropyl-beta-cyclodextrin administration procedures were successfully performed, and there were no changes made in the anesthetic plan during the anesthesia encounters. Three hundred forty-nine anesthetics were performed utilizing inhalation induction and mask maintenance, and 45 anesthetics were performed with placement of a supraglottic airway device due to patient body habitus and provider preference. The incidence of a major adverse event (aspirations, arterial desaturation) was 5/394 (1.3%, 95% CI 0.05%-3.1%). Minor adverse events (emesis, delirium, hypotension, seizure, and airway obstruction) were observed in 19/394 encounters (4.8%, 95% CI 3.0%-7.5%). CONCLUSIONS Our findings suggest that general anesthesia induced via inhalation induction and maintained with volatile anesthetic via mask or supraglottic airway is a safe and effective option for pediatric patients with Niemann-Pick disease type C undergoing serial intrathecal injections of 2-hydroxypropyl-beta-cyclodextrin, supporting this technique as a viable option for anesthetic care in these patients.
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Affiliation(s)
- Morgan L Ulloa
- Department of Anesthesiology, Rush University, Chicago, USA
| | | | - Lauren N Kret
- Department of Anesthesiology, Rush University, Chicago, USA
| | - Denise P Chang
- Department of Anesthesia and Perioperative Care, UCSF Benioff Children's Hospital, San Francisco, USA
| | - Gabriel E Sarah
- Department of Anesthesia and Perioperative Care, UCSF Benioff Children's Hospital, San Francisco, USA
| | | | - Steve D Barnes
- Department of Anesthesiology, Rush University, Chicago, USA
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4
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Geberhiwot T, Moro A, Dardis A, Ramaswami U, Sirrs S, Marfa MP, Vanier MT, Walterfang M, Bolton S, Dawson C, Héron B, Stampfer M, Imrie J, Hendriksz C, Gissen P, Crushell E, Coll MJ, Nadjar Y, Klünemann H, Mengel E, Hrebicek M, Jones SA, Ory D, Bembi B, Patterson M. Consensus clinical management guidelines for Niemann-Pick disease type C. Orphanet J Rare Dis 2018; 13:50. [PMID: 29625568 PMCID: PMC5889539 DOI: 10.1186/s13023-018-0785-7] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/13/2018] [Indexed: 01/30/2023] Open
Abstract
Niemann-Pick Type C (NPC) is a progressive and life limiting autosomal recessive disorder caused by mutations in either the NPC1 or NPC2 gene. Mutations in these genes are associated with abnormal endosomal-lysosomal trafficking, resulting in the accumulation of multiple tissue specific lipids in the lysosomes. The clinical spectrum of NPC disease ranges from a neonatal rapidly progressive fatal disorder to an adult-onset chronic neurodegenerative disease. The age of onset of the first (beyond 3 months of life) neurological symptom may predict the severity of the disease and determines life expectancy. NPC has an estimated incidence of ~ 1: 100,000 and the rarity of the disease translate into misdiagnosis, delayed diagnosis and barriers to good care. For these reasons, we have developed clinical guidelines that define standard of care for NPC patients, foster shared care arrangements between expert centres and family physicians, and empower patients. The information contained in these guidelines was obtained through a systematic review of the literature and the experiences of the authors in their care of patients with NPC. We adopted the Appraisal of Guidelines for Research & Evaluation (AGREE II) system as method of choice for the guideline development process. We made a series of conclusive statements and scored them according to level of evidence, strengths of recommendations and expert opinions. These guidelines can inform care providers, care funders, patients and their carers of best practice of care for patients with NPC. In addition, these guidelines have identified gaps in the knowledge that must be filled by future research. It is anticipated that the implementation of these guidelines will lead to a step change in the quality of care for patients with NPC irrespective of their geographical location.
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Affiliation(s)
- Tarekegn Geberhiwot
- Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK.
| | | | | | | | | | | | - Marie T Vanier
- INSERM U820, Université de Lyon, Faculté de Médecine Lyon-Est, Lyon, 69372, France
| | | | - Shaun Bolton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Charlotte Dawson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Bénédicte Héron
- Department of Pediatric Neurology, Reference Center of Lysosomal Diseases, Trousseau Hospital, APHP, GRC ConCer-LD, Sorbonne Universities, UPMC University 06, Paris, France
| | - Miriam Stampfer
- Universitatsklinikum Tubingen Institut fur Medizinische Genetik undangewandte Genomik, Tubingen, Germany
| | | | | | - Paul Gissen
- MRC Laboratory for Molecular Cell Biology, London, UK
| | - Ellen Crushell
- Children's University Hospital, Dublin, Republic of Ireland
| | | | - Yann Nadjar
- Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Hans Klünemann
- Universitatsklinikum Regensburg Klinik und Poliklinik fur Chirurgie, Regensburg, Germany
| | | | | | - Simon A Jones
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Daniel Ory
- University of Washington School of Medicine, Seattle, USA
| | | | - Marc Patterson
- Mayo 1290 Clinic Department of Pediatric and Adolescent Medicine, Minnesota, USA
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5
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Arpacı AH. Anesthetic approach to Niemann-Pick Type C patient for dental treatment. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:25. [PMID: 28413422 PMCID: PMC5377967 DOI: 10.4103/1735-1995.200276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Ayşe Hande Arpacı
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Besevler, Ankara, Turkey
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6
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Espahbodi E, Yaghooti AA, Ostadalipour A, Marashi S. Anesthetic Management in a Child With Niemann-Pick Disease. IRANIAN JOURNAL OF PEDIATRICS 2016; 26:e5479. [PMID: 28203333 PMCID: PMC5294925 DOI: 10.5812/ijp.5479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/05/2016] [Accepted: 03/14/2016] [Indexed: 12/02/2022]
Abstract
Niemann-Pick is a lipid storage disease that results from a lysosomal enzyme deficiency (sphingomyelinase). It has different presentations, and it may affect various organs such as the central nervous system, kidney, liver, and spleen. Due to the complexity of the disease, careful perianesthetic management is necessary in order to reduce the risks and sequels. As there is little evidence available in the literature regarding the anesthetic implications of such patients, in this case report we describe the anesthetic management of a two-year-old female with Niemann-Pick disease.
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Affiliation(s)
- Ebrahim Espahbodi
- Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Amir Abbas Yaghooti
- Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abbas Ostadalipour
- Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Shaqayeq Marashi
- Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Shaqayeq Marashi, Anesthesiology and Critical Care, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9123257790, E-mail:
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7
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Dalal PG, Coleman M, Horst M, Rocourt D, Ladda RL, Janicki PK. Case Report: Genetic analysis and anesthetic management of a child with Niemann-Pick disease Type A. F1000Res 2015; 4:1423. [PMID: 26913189 PMCID: PMC4743149 DOI: 10.12688/f1000research.7470.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/20/2022] Open
Abstract
A 14-month-old child, recently diagnosed with Niemann-Pick disease type A, presented for a laparoscopic placement of a gastrostomy tube under general anesthesia. The disease was confirmed and further characterized by genetic testing, which revealed evidence of the presence of two known pathogenic mutations in the
SMPD1 gene, and enzyme studies showed a corresponding very low level of enzymatic activity of acidic sphingomyelinase. The anesthetic management involved strategies to manage an anticipated difficult intubation and avoid post-operative ventilation.
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Affiliation(s)
- Priti G Dalal
- Department of Anesthesiology, Penn State Hershey Medical Center, Penn State Hershey Children's Hospital, Hershey, PA, 17033, USA
| | - Melissa Coleman
- Department of Anesthesiology, Penn State Hershey Medical Center, Penn State Hershey Children's Hospital, Hershey, PA, 17033, USA
| | - Meagan Horst
- Department of Anesthesiology, Penn State Hershey Medical Center, Penn State Hershey Children's Hospital, Hershey, PA, 17033, USA
| | - Dorothy Rocourt
- Department of Surgery, Division of Pediatric Surgery, Penn State Hershey Children's Hospital, Hershey, PA, 17033, USA
| | - Roger L Ladda
- Department of Pediatrics, Department of Pediatrics, Division of Human Genetics, Penn State Hershey Children's Hospital, Hershey, PA, 17033, USA
| | - Piotr K Janicki
- Department of Pediatrics, Department of Pediatrics, Division of Human Genetics, Penn State Hershey Children's Hospital, Hershey, PA, 17033, USA
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8
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García DE, Maggi G, Gredilla E, Gilsanz F. [Airway management in a patient with Niemann-Pick disease]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2014; 61:583. [PMID: 24581933 DOI: 10.1016/j.redar.2014.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/04/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Affiliation(s)
- D E García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España.
| | - G Maggi
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España
| | - E Gredilla
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España
| | - F Gilsanz
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario La Paz, Madrid, España
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Siva K, Covello G, Denti MA. Exon-skipping antisense oligonucleotides to correct missplicing in neurogenetic diseases. Nucleic Acid Ther 2014; 24:69-86. [PMID: 24506781 DOI: 10.1089/nat.2013.0461] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Alternative splicing is an important regulator of the transcriptome. However, mutations may cause alteration of splicing patterns, which in turn leads to disease. During the past 10 years, exon skipping has been looked upon as a powerful tool for correction of missplicing in disease and progress has been made towards clinical trials. In this review, we discuss the use of antisense oligonucleotides to correct splicing defects through exon skipping, with a special focus on diseases affecting the nervous system, and the latest stage achieved in its progress.
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Affiliation(s)
- Kavitha Siva
- 1 Center for Integrative Biology (CIBIO), University of Trento , Trento, Italy
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