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Adang LA, Bonkowsky JL, Boelens JJ, Mallack E, Ahrens-Nicklas R, Bernat JA, Bley A, Burton B, Darling A, Eichler F, Eklund E, Emrick L, Escolar M, Fatemi A, Fraser JL, Gaviglio A, Keller S, Patterson MC, Orchard P, Orthmann-Murphy J, Santoro JD, Schöls L, Sevin C, Srivastava IN, Rajan D, Rubin JP, Van Haren K, Wasserstein M, Zerem A, Fumagalli F, Laugwitz L, Vanderver A. Consensus guidelines for the monitoring and management of metachromatic leukodystrophy in the United States. Cytotherapy 2024; 26:739-748. [PMID: 38613540 DOI: 10.1016/j.jcyt.2024.03.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/15/2024]
Abstract
Metachromatic leukodystrophy (MLD) is a fatal, progressive neurodegenerative disorder caused by biallelic pathogenic mutations in the ARSA (Arylsulfatase A) gene. With the advent of presymptomatic diagnosis and the availability of therapies with a narrow window for intervention, it is critical to define a standardized approach to diagnosis, presymptomatic monitoring, and clinical care. To meet the needs of the MLD community, a panel of MLD experts was established to develop disease-specific guidelines based on healthcare resources in the United States. This group developed a consensus opinion for best-practice recommendations, as follows: (i) Diagnosis should include both genetic and biochemical testing; (ii) Early diagnosis and treatment for MLD is associated with improved clinical outcomes; (iii) The panel supported the development of newborn screening to accelerate the time to diagnosis and treatment; (iv) Clinical management of MLD should include specialists familiar with the disease who are able to follow patients longitudinally; (v) In early onset MLD, including late infantile and early juvenile subtypes, ex vivo gene therapy should be considered for presymptomatic patients where available; (vi) In late-onset MLD, including late juvenile and adult subtypes, hematopoietic cell transplant (HCT) should be considered for patients with no or minimal disease involvement. This document summarizes current guidance on the presymptomatic monitoring of children affected by MLD as well as the clinical management of symptomatic patients. Future data-driven evidence and evolution of these recommendations will be important to stratify clinical treatment options and improve clinical care.
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Affiliation(s)
- Laura A Adang
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | | | - Jaap Jan Boelens
- Department of Pediatrics, Stem Cell Transplantation and Cellular Therapies, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Eric Mallack
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | | | - John A Bernat
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Annette Bley
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Barbara Burton
- Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | | | | | - Lisa Emrick
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Maria Escolar
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Forge Biologics, Grove City, Ohio, USA
| | - Ali Fatemi
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jamie L Fraser
- Children's National Hospital, Washington, District of Columbia, USA
| | - Amy Gaviglio
- Division of Laboratory Services, Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; Association of Public Health Laboratories, Silver Spring, Maryland, USA
| | | | - Marc C Patterson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA; Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul Orchard
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Jonathan D Santoro
- University of Southern California, Children's Hospital Los Angeles, Keck School of Medicine, Los Angeles, California, USA
| | - Ludger Schöls
- Department of Neurology and Hertie-Institute for Clinical Brain Research German Center of Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | | | - Isha N Srivastava
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Deepa Rajan
- University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Keith Van Haren
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Melissa Wasserstein
- Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore, Bronx, New York, USA
| | - Ayelet Zerem
- Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Lucia Laugwitz
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Adeline Vanderver
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Simeon R, Berardi A, Valente D, Volpi T, Vagni S, Galeoto G. Occupational Therapy Intervention in the Child with Leukodystrophy: Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1257. [PMID: 37508754 PMCID: PMC10377904 DOI: 10.3390/children10071257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND There are many different types of Leukodystrophies. Specifically, children with hypomyelination and congenital cataract syndrome (HCC) in addition to motor retardation development, hypotonia and progressive spastic paraplegia, associated with cerebellar ataxia and peripheral neuropathy, have early bilateral cataracts and intellectual disability as pathognomonic symptoms. HCC rehabilitation treatment is not well defined, but a significant amount of evidence in the literature has demonstrated the effectiveness of occupational therapy (OT) treatment in children with similar symptomatology. For this reason, the aim of this study was to describe the improvement in the autonomies and social participation of a child with HCC following OT treatment. METHODS A.E. was a 9-year-old child with HCC with severe intellectual disability. OT intervention lasted 3 months biweekly and each session lasted 45 min. Each session was divided into two parts: The first part aimed to increase the child's active involvement through activities; the second part involved training in Activities of Daily living (ADL). The outcome measures were: ABILHAND-Kids; Pediatric Evaluation of Disability Inventory; Comprehensive OT Evaluation Scale; ADL and Instrumental Activities of Daily Living. RESULTS A.E.'s outcome measure reported an improvement from an autonomy standpoint and in the child's general activity participation; there was also an increase in A.E.'s interpersonal skills. CONCLUSION OT treatment improved A.E.'s autonomy.
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Affiliation(s)
- Rachele Simeon
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy
| | | | - Samuele Vagni
- School of Occupational Therapy, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCSS Neuromed, Via Atinense, 18, 86077 Pozzilli, Italy
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Wong MST, Thomas T, Lim JY, Kam S, Teo JX, Ching J, Goh CYJ, Jamuar SS, Lim WK, Koh AL. DEGS1 -related leukodystrophy: a clinical report and review of literature. Clin Dysmorphol 2023; 32:106-111. [PMID: 37195341 DOI: 10.1097/mcd.0000000000000457] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Leukodystrophies are a heterogeneous group of disorders affecting the white matter of the central nervous system, with or without affecting the peripheral nervous system. Biallelic variants in DEGS1 , coding for desaturase 1 (Des1) protein, were recently reported to be associated with hypomyelinating leukodystrophy (HLD), a subclass of leukodystrophies where the formation of the myelin sheath is affected. METHODS Genomic sequencing was performed on our index patient with severe developmental delay, severe failure to thrive, dystonia, seizures, and hypomyelination on brain imaging. Sphingolipid analysis was performed and dihydroceramide/ceramide (dhCer/Cer) ratios were obtained by the measurement of ceramide and dihydroceramide species. RESULTS A homozygous missense variant was identified in DEGS1 (c.565A > G:p Asn189Asp). The identified DEGS1 variant has been annotated as "conflicting reports of pathogenicity" on ClinVar. Follow-up sphingolipid analysis on our patient showed significantly raised dhCer/Cer and this was consistent with dysfunction of the Des1 protein, providing additional evidence to support the pathogenicity of this variant. CONCLUSION While rare, pathogenic variants in DEGS1 should be considered in patients with HLD phenotype. To date, 25 patients have been reported across four studies on DEGS1 -related HLD, and, in this report, we summarize the literature. More such reports will enable deeper phenotypic characterization of this disorder.
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Affiliation(s)
| | - Terrence Thomas
- Neurology Service, Department of Paediatrics, KK Women's and Children's Hospital
- SingHealth Duke-NUS Paediatric Academic Clinical Programme
| | - Jiin Ying Lim
- SingHealth Duke-NUS Paediatric Academic Clinical Programme
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital
- SingHealth Duke-NUS Genomic Medicine Centre
| | - Sylvia Kam
- SingHealth Duke-NUS Paediatric Academic Clinical Programme
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital
- SingHealth Duke-NUS Genomic Medicine Centre
| | | | - Jianhong Ching
- Cardiovascular and Metabolic Disorders Programme, Duke-NUS Medical School
- KK Research Centre, KK Women's and Children's Hospital
| | - Chew Yin Jasmine Goh
- Division of Nursing - Nursing Clinical Services, Genetics Specialty Nurse, KK Women's and Children's Hospital, Singapore, Singapore
| | - Saumya Shekhar Jamuar
- Lee Kong Chian School of Medicine, Nanyang Technological University
- SingHealth Duke-NUS Paediatric Academic Clinical Programme
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital
- SingHealth Duke-NUS Genomic Medicine Centre
- SingHealth Duke-NUS Institute of Precision Medicine
| | - Weng Khong Lim
- SingHealth Duke-NUS Genomic Medicine Centre
- SingHealth Duke-NUS Institute of Precision Medicine
| | - Ai Ling Koh
- Lee Kong Chian School of Medicine, Nanyang Technological University
- SingHealth Duke-NUS Paediatric Academic Clinical Programme
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital
- SingHealth Duke-NUS Genomic Medicine Centre
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Sevin C, Barth M, Wilds A, Afriyie A, Walz M, Dillon A, Howie K, Pang F. An international study of caregiver-reported burden and quality of life in metachromatic leukodystrophy. Orphanet J Rare Dis 2022; 17:329. [PMID: 36056437 PMCID: PMC9438185 DOI: 10.1186/s13023-022-02501-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal disorder caused by mutations in the arylsulfatase A gene. Until now, there has been little information on the burden of MLD on patients and their caregivers. This multinational study aims to quantify caregiver-related impacts of MLD across several key domains including symptoms, treatment burden, time investment, social and emotional well-being, and professional and financial impact. Results Data were collected through moderator-assisted web survey and telephone interviews. The survey was developed with extensive input from clinical experts and MLD patient advocacy groups. The EQ-5D-5L questionnaire was administered during follow-up interviews. The total sample consisted of parents of MLD patients in the US (n = 10), France (n = 10), Germany (n = 6), UK (n = 5), Belgium (n = 1), and Norway (n = 2). The impact of MLD is evident from the EQ-5D-5L scores, which indicate utility values for caregivers below respective national population norms and a higher proportion of caregivers reporting problems with anxiety/depression. Time involved for care was demonstrated by a mean of 4.1 inpatient and 29.6 outpatient hospital visits in the previous 12-month period. These commitments place stress on familial relationships with 50% of caregivers reporting their child’s MLD diagnosis had negatively impacted their relationship with their spouse/partner. Professionally, 76.5% of caregivers stopped working or switched to part-time employment following their child’s MLD diagnosis, and most acknowledged caring for their child had affected their potential for career progression or promotion. Differences are also observed based on late infantile versus juvenile onset MLD, time since diagnosis, and for transplanted patients versus those who received palliative care only. Conclusions This multinational study demonstrates that MLD consistently negatively affects many aspects of caregivers’ lives including health, relationships, and professional status, irrespective of location. We expect that the results of this study are generalizable to other countries. This study enhances our understanding of MLD caregiver impacts, which could improve patient care and assist in identifying support for individuals with MLD and their families. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02501-8.
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Affiliation(s)
- Caroline Sevin
- Service de Neuropédiatrie, Centre de Référence des Leucodystrophies et Leucoencéphalopathies Génétiques de cause rare, CHU Paris-Sud-Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Magalie Barth
- Service de Génétique, Hôpital Universitaire d'Angers, Angers, France
| | | | | | | | | | | | - Francis Pang
- Orchard Therapeutics, 245 Hammersmith Road, London, W6 8PW, UK.
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Sadek AA, Aladawy MA, Mansour TMM, Ibrahim MF, Mohamed MM, Gad EF, Othman AA, Ahmed HA, Kasim AK, Wagdy WM, Hasan MHT, Abdelkreem E. Clinicoradiologic Correlation in 22 Egyptian Children With Megalencephalic Leukoencephalopathy With Subcortical Cysts. J Child Neurol 2022; 37:380-389. [PMID: 35322718 DOI: 10.1177/08830738221078683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a rare genetic form of cerebral white matter disease whose clinicoradiologic correlation has not been completely understood. In this study, we investigated the association between clinical and brain magnetic resonance imaging (MRI) features in 22 Egyptian children (median age 7 years) with MLC. Gross motor function was assessed using the Gross Motor Function Classification System, and evaluation of brain MRI followed a consistent scoring system. Each parameter of extensive cerebral white matter T2 hyperintensity, moderate-to-severe wide ventricle/enlarged subarachnoid space, and greater than 2 temporal subcortical cysts was significantly associated (P < .05) with worse Gross Motor Function Classification System score, language abnormality, and ataxia. Having >2 parietal subcortical cysts was significantly related to a worse Gross Motor Function Classification System score (P = .04). The current study indicates that patients with MLC manifest signification association between certain brain MRI abnormalities and neurologic features, but this should be confirmed in larger studies.
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Affiliation(s)
- Abdelrahim A Sadek
- Neuropsychiatry Unit, Department of Pediatrics, 68890Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohammed A Aladawy
- Neurology Unit, Department of Pediatrics, Faculty of Medicine, 195495Al-Azhar University, Assiut, Egypt
| | - Tarek M M Mansour
- Department of Radio-diagnosis, Faculty of Medicine, 68820Al-Azhar University, Assiut, Egypt
| | - Mohamed F Ibrahim
- Neurology Unit, Department of Pediatrics, Faculty of Medicine, 195495Al-Azhar University, Assiut, Egypt
| | - Montaser M Mohamed
- Department of Pediatrics, 68890Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Eman F Gad
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Amr A Othman
- Neuropsychiatry Unit, Department of Pediatrics, 68890Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hosny A Ahmed
- Neurology Unit, Department of Pediatrics, Faculty of Medicine, 195495Al-Azhar University, Assiut, Egypt
| | - Abdin K Kasim
- Department of Neurosurgery, 68890Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Wael M Wagdy
- Department of Radio-diagnosis, 113328Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohamed H T Hasan
- Department of Radio-diagnosis, Faculty of Medicine, 68820Al-Azhar University, Cairo, Egypt
| | - Elsayed Abdelkreem
- Department of Pediatrics, 68890Faculty of Medicine, Sohag University, Sohag, Egypt
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Bradbury AM, Ream MA. Recent Advancements in the Diagnosis and Treatment of Leukodystrophies. Semin Pediatr Neurol 2021; 37:100876. [PMID: 33892849 DOI: 10.1016/j.spen.2021.100876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/08/2021] [Accepted: 01/17/2021] [Indexed: 11/26/2022]
Abstract
Leukodystrophies and genetic leukoencephalopathies comprise a growing group of inherited white matter disorders. Diagnostic rates have improved with increased utilization of next generation sequencing. As treatment options continue to advance for leukodystrophies, so will candidacy for inclusion in the United States' newborn Recommended Universal Screening Panel as was achieved for X-linked adrenoleukodystrophy. Stem cell therapies have become standard of care for selected leukodystrophies. However, transplantation-related risks remain high and outcomes are not fully satisfactory. Transduction of autologous hematopoietic stem cells with lentiviral vectors, referred to as ex vivo gene therapy, circumvents some, but not all, of the risks of traditional transplantation and has recently been demonstrated to be safe and efficective in clinical studies of X-linked adrenoleukodystrophy and metachromatic leukodystrophy. Gene therapy, through direct infusion of adeno-associated virus vectors, has emerged as a safer alternative for many monogenetic pediatric neurological disorders. Numerous preclinical studies have shown safety and efficacy of adeno-associated virus gene therapy in leukodystrophies allowing expanded access treatment for Canavan disease prior to initiation of a clinical trial. For inherited white matter disorders resulting from overexpression of a protein, such as Pelizaeus-Merzbacher disease, emerging RNA therapies have shown success in preclinical studies and promise for rapid translation to the clinic. Lastly, small molecule and protein therapies remain a long-term treatment option for a number of leukodystrophies, including intrathecal enzyme replacement therapy for metachromatic leukodystrophy. Herein we review recent advances in diagnosis and treatment of inherited white matter disorders.
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Affiliation(s)
| | - Margie A Ream
- Division of Neurology, Nationwide Children's Hospital, Columbus, OH.
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