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Dauber A, Zhang A, Kanakatti Shankar R, Boucher K, McCarthy T, Shafaei N, Seaforth R, Castro MG, Dham N, Merchant N. Vosoritide treatment for children with hypochondroplasia: a phase 2 trial. EClinicalMedicine 2024; 71:102591. [PMID: 38813446 PMCID: PMC11133798 DOI: 10.1016/j.eclinm.2024.102591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 05/31/2024] Open
Abstract
Background Hypochondroplasia is a rare autosomal dominant skeletal dysplasia due to activating variants in FGFR3. It presents with disproportionate short stature with a wide range of clinical severity. There are currently no approved medications to treat short stature in children with hypochondroplasia. Vosoritide is a C-type natriuretic peptide analog that was recently approved for improving growth in children with achondroplasia. We aimed to evaluate the safety and efficacy of vosoritide in children with hypochondroplasia. Methods We conducted a single-arm, phase 2, open-label trial at a single centre in the USA and enrolled 26 children with hypochondroplasia. The trial consists of a 6-month observation period to establish a baseline annualized growth velocity followed by a 12-month intervention period during which vosoritide is administered daily via subcutaneous injection at a dose of 15 μg/kg/day. The trial's co-primary endpoints included the incidence of adverse events and the change from baseline in age-sex standardized annualized growth velocity and height standardized deviation score (SDS) after 12 months of treatment. This trial is registered with ClinicalTrials.gov (NCT04219007). Findings Twenty-four participants with a mean age of 5.86 years received vosoritide therapy. The first participant was enrolled on August 4, 2020, and the final participant completed the 18-month trial on September 8, 2023. Vosoritide was well tolerated with no treatment-related serious adverse events. Injection site reactions occurred in 83.3% of participants. No participants discontinued therapy due to an adverse event. Annualized growth velocity increased by 2.26 standard deviations (SD) and height SDS increased by 0.36 SD during the treatment period versus the observation period. Hypochondroplasia specific height SDS increased by 0.38 SD. There was a 1.81 cm/year increase in absolute annualized growth velocity. Interpretation Vosoritide was safe and effective in increasing growth velocity in children with hypochondroplasia. Efficacy was similar to what has been reported in children with achondroplasia. Funding This study was supported by an investigator-initiated grant from BioMarin Pharmaceutical.
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Affiliation(s)
- Andrew Dauber
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Anqing Zhang
- Division of Biostatistics, Children's National Hospital, Washington, DC 20010, USA
| | - Roopa Kanakatti Shankar
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
| | - Kimberly Boucher
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
| | - Tara McCarthy
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
| | - Niusha Shafaei
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
| | - Raheem Seaforth
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
| | - Meryll Grace Castro
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
| | - Niti Dham
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
- Division of Cardiology, Children's National Hospital, Washington, DC 20010, USA
| | - Nadia Merchant
- Division of Endocrinology, Children's National Hospital, Washington, DC 20010, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC 20052, USA
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Ramos-Mejia R, Isoldi G, Ireland PJ, Rodriguez Celin M, Fano V. Evaluation of functionality-mobility in patients with skeletal dysplasias. Application of the STEMS tool ("everyday symptoms and mobility screening tool for skeletal dysplasias"). Am J Med Genet A 2024; 194:e63538. [PMID: 38214061 DOI: 10.1002/ajmg.a.63538] [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: 11/03/2023] [Revised: 12/14/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024]
Abstract
Individuals with differing forms of skeletal dysplasias (SD) frequently report impaired mobility and symptoms. With the objetive to evaluate mobility and associated symptoms in people with SD at an Argentinian pediatric hospital, using an Argentinian version of the Screening Tool for Everyday Mobility and Symptoms (STEMS), a simple questionnaire that allows clinicians to quickly identify the presence of symptoms associated with mobility in people with SD, while considering different environmental settings and the use of assistive devices, an analytical study of a consecutive sample of patients older than 5 years with SD and their affected relatives was carried out.Diagnosis, comorbidities, socioenvironmental, therapeutic, auxological and mobility variables were recorded. The presence and intensity of symptoms was noted through use of both the STEMS and validated scales. Descriptive, association and correlation analyzes were performed. One hundred and nineteen individuals with SD were enrolled in the study and divided into groups: Osteogenesis Imperfecta (OI, n = 55), Achondroplasia (ACH, n = 36) and Other SD resulting in disproportionate short stature (n = 28). Mobility assistive devices were almost exclusively used by individuals with OI. They were more frequently used by individuals with overweight and obesity, more severe form of the disease and in the outdoor settings. Two thirds (66.4%) of the individuals assessed in this study reported pain, 87.4% reported fatigue, and 58.8% reported both pain and fatigue. The intensity of symptoms was similar between groups and correlated with age and auxological variables. The STEMS was clear, easy and quick to use for identifying presence of pain and fatigue in this population group. The STEMS proved to be a simple and useful tool for evaluating functional mobility and associated symptoms in our population of individuals with SD.
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Affiliation(s)
- Rosario Ramos-Mejia
- Growth and Development Department, Hospital Garrahan, Buenos Aires, Argentina
| | - G Isoldi
- Growth and Development Department, Hospital Garrahan, Buenos Aires, Argentina
| | - P J Ireland
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Australia
| | - M Rodriguez Celin
- Shriners Hospital for Children, Chicago, Illinois, USA
- Medical College of Wisconsin Marquette University, Milwaukee, Wisconsin, USA
| | - V Fano
- Growth and Development Department, Hospital Garrahan, Buenos Aires, Argentina
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Del Pino M, Fano V. Growth in puberty in girls with hypochondroplasia, p.Asn540Lys-related mutations. Am J Med Genet A 2024; 194:394-396. [PMID: 37789665 DOI: 10.1002/ajmg.a.63423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Affiliation(s)
- Mariana Del Pino
- Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
| | - Virginia Fano
- Growth and Development, Hospital Garrahan, Buenos Aires, Argentina
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Cheung MS, Cole TJ, Arundel P, Bridges N, Burren CP, Cole T, Davies JH, Hagenäs L, Högler W, Hulse A, Mason A, McDonnell C, Merker A, Mohnike K, Sabir A, Skae M, Rothenbuhler A, Warner J, Irving M. Growth reference charts for children with hypochondroplasia. Am J Med Genet A 2024; 194:243-252. [PMID: 37814549 DOI: 10.1002/ajmg.a.63431] [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: 09/04/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
Hypochondroplasia (HCH) is a rare skeletal dysplasia causing mild short stature. There is a paucity of growth reference charts for this population. Anthropometric data were collected to generate height, weight, and head circumference (HC) growth reference charts for children with a diagnosis of HCH. Mixed longitudinal anthropometric data and genetic analysis results were collected from 14 European specialized skeletal dysplasia centers. Growth charts were generated using Generalized Additive Models for Location, Scale, and Shape. Measurements for height (983), weight (896), and HC (389) were collected from 188 (79 female) children with a diagnosis of HCH aged 0-18 years. Of the 84 children who underwent genetic testing, a pathogenic variant in FGFR3 was identified in 92% (77). The data were used to generate growth references for height, weight, and HC, plotted as charts with seven centiles from 2nd to 98th, for ages 0-4 and 0-16 years. HCH-specific growth charts are important in the clinical care of these children. They help to identify if other comorbidities are present that affect growth and development and serve as an important benchmark for any prospective interventional research studies and trials.
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Affiliation(s)
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Paul Arundel
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Nicola Bridges
- Department of Paediatric Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - Christine P Burren
- Paediatric Endocrinology and Diabetes Department, Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Trevor Cole
- Birmingham Health Partners, West Midlands Regional Genetics Service, Birmingham Women's and Children's National Health Service (NHS) Foundation Trust, Birmingham, UK
| | - Justin Huw Davies
- Regional Centre for Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton Children's Hospital, University of Southampton, Southampton, UK
| | - Lars Hagenäs
- Paediatric Endocrine Unit, Paediatric Clinic, Karolinska Hospital, Stockholm, Sweden
| | - Wolfgang Högler
- Institute of Metabolism & Systems Research, University of Birmingham, Birmingham, UK
| | - Anthony Hulse
- Evelina Children's Hospital, St. Thomas' Hospital, London, UK
| | - Avril Mason
- Department of Endocrinology (E.M.F.), Queen Elizabeth University Hospital, Glasgow, UK
| | - Ciara McDonnell
- Department of Paediatric Endocrinology & Diabetes, Children's Health Ireland, Dublin, Ireland
- Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Andrea Merker
- Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden
| | - Klaus Mohnike
- Department of Paediatrics, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Ataf Sabir
- Birmingham Health Partners, West Midlands Regional Genetics Service, Birmingham Women's and Children's National Health Service (NHS) Foundation Trust, Birmingham, UK
| | - Mars Skae
- Department of Pediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK
| | - Anya Rothenbuhler
- Department of Endocrinology and Diabetology for Children, Bicetre Paris-Saclay University Hospital, Le Kremlin Bicetre, France
| | - Justin Warner
- Noah's Ark Children's Hospital for Wales, University Hospital of Wales, Cardiff, UK
| | - Melita Irving
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kim HY, Ko JM. Clinical management and emerging therapies of FGFR3-related skeletal dysplasia in childhood. Ann Pediatr Endocrinol Metab 2022; 27:90-97. [PMID: 35793999 PMCID: PMC9260370 DOI: 10.6065/apem.2244114.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022] Open
Abstract
Skeletal dysplasia is a diverse group of disorders that affect bone development and morphology. Currently, approximately 461 different genetic skeletal disorders have been identified, with over 430 causative genes. Among these, fibroblast growth factor receptor 3 (FGFR3)-related skeletal dysplasia is a relatively common subgroup of skeletal dysplasia. Pediatric endocrinologists may encounter a suspected case of skeletal dysplasia in their practice, especially when evaluating children with short stature. Early and accurate diagnosis of FGFR3-related skeletal dysplasia is essential for timely management of complications and genetic counseling. This review summarizes 5 representative and distinct entities of skeletal dysplasia caused by pathogenic variants in FGFR3 and discusses emerging therapies for FGFR3-related skeletal dysplasias.
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Affiliation(s)
- Hwa Young Kim
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Min Ko
- Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea,Rare Disease Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea,Address for correspondence: Jung Min Ko Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Jongno-gu Daehak-ro 101, Seoul 03080, Korea
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Sun H, Li N, Wan N. Molecular genetic analysis and growth hormone response in patients with syndromic short stature. BMC Med Genomics 2021; 14:261. [PMID: 34740356 PMCID: PMC8570008 DOI: 10.1186/s12920-021-01113-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Syndromic short stature is a genetic and phenotypic heterogeneous disorder with multiple causes. This study aims to identify genetic causes in patients with syndromic short stature of unknown cause and evaluate the efficacy of the growth hormone response. METHODS Trio-whole-exome sequencing was applied to identify pathogenic gene mutations in seven patents with short stature, multiple malformations, and/or intellectual disability. Whole-genome low-coverage sequencing was also performed to identify copy number variants in three patients with concurrent intellectual disability. Recombinant human growth hormone was administered to improve height in patients with an identified cause of syndromic short stature. RESULTS Of the seven patients, three pathogenic/likely pathogenic gene mutations, including one FGFR3 mutation (c.1620C>A p.N540K), one novel GNAS mutation (c.2288C>T p.A763V), and one novel TRPS1 mutation (c.2527_c.2528dupTA p.S843fsX72), were identified in three patients. No copy number variants were identified in the three patients with concurrent intellectual disability. The proband with an FGFR3 mutation, a female 4 and 3/12 years of age, was diagnosed with hypochondroplasia. Long-acting growth hormone improved her height from 85.8 cm [- 5.05 standard deviation (SD)] to 100.4 cm (- 4.02 SD), and her increased height SD score (SDS) was 1.03 after 25 months of treatment. The proband with a GNAS mutation, a female 12 and 9/12 years of age, was diagnosed with pseudohypoparathyroidism Ia. After 14 months of treatment with short-acting growth hormone, her height improved from 139.3 cm (- 2.69 SD) to 145.0 cm (- 2.36 SD), and her increased height SDS was 0.33. CONCLUSIONS Trio-whole-exome sequencing was an important approach to confirm genetic disorders in patients with syndromic short stature of unknown etiology. Short-term growth hormone was effective in improving height in patients with hypochondroplasia and pseudohypoparathyroidism Ia.
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Affiliation(s)
- Huihui Sun
- Department of Paediatrics, Beijing Jishuitan Hospital, No. 31 of Xinjiekou Dongjie Street, Xi Cheng District, Beijing, 100035, People's Republic of China
| | - Na Li
- Department of Radiology, Beijing Jishuitan Hospital, No. 31 of Xinjiekou Dongjie Street, Xi Cheng District, Beijing, 100035, People's Republic of China
| | - Naijun Wan
- Department of Paediatrics, Beijing Jishuitan Hospital, No. 31 of Xinjiekou Dongjie Street, Xi Cheng District, Beijing, 100035, People's Republic of China.
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Sabir AH, Cole T. The evolving therapeutic landscape of genetic skeletal disorders. Orphanet J Rare Dis 2019; 14:300. [PMID: 31888683 PMCID: PMC6937740 DOI: 10.1186/s13023-019-1222-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rare bone diseases account for 5% of all birth defects yet very few have personalised treatments. Developments in genetic diagnosis, molecular techniques and treatment technologies however, are leading to unparalleled therapeutic advance. This review explores the evolving therapeutic landscape of genetic skeletal disorders (GSDs); the key conditions and there key differentials. METHODS A retrospective literature based review was conducted in December 2018 using a systematic search strategy for relevant articles and trials in Pubmed and clinicaltrials.gov respectively. Over 140 articles and 80 trials were generated for review. RESULTS Over 20 personalised therapies are discussed in addition to several novel disease modifying treatments in over 25 GSDs. Treatments discussed are at different stages from preclinical studies to clinical trials and approved drugs, including; Burosumab for X-linked hypophosphatemia, Palovarotene for Hereditary Multiple Exostoses, Carbamazepine for Metaphyseal Chondrodysplasia (Schmid type), Lithium carbonate and anti-sclerostin therapy for Osteoporosis Pseudoglioma syndrome and novel therapies for Osteopetrosis. We also discuss therapeutic advances in Achondroplasia, Osteogenesis Imperfecta (OI), Hypophosphotasia (HPP), Fibrodysplasia Ossificans Progressiva, and RNA silencing therapies in preclinical studies for OI and HPP. DISCUSSION It is an exciting time for GSD therapies despite the challenges of drug development in rare diseases. In discussing emerging therapies, we explore novel approaches to drug development from drug repurposing to in-utero stem cell transplants. We highlight the improved understanding of bone pathophysiology, genetic pathways and challenges of developing gene therapies for GSDs.
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Affiliation(s)
- Ataf Hussain Sabir
- West Midlands Clinical Genetics Unit, Birmingham Women's and Children's NHS FT and Birmingham Health Partners, Birmingham, UK.
| | - Trevor Cole
- West Midlands Clinical Genetics Unit, Birmingham Women's and Children's NHS FT and Birmingham Health Partners, Birmingham, UK
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