1
|
Jackson DG, Case LE, Huggins E, Holland M, Blount J, Webb LH, Kishnani PS. Muscle ultrasound in patients with late-onset Pompe disease identified by newborn screening. Mol Genet Metab Rep 2023; 36:100989. [PMID: 37670900 PMCID: PMC10475841 DOI: 10.1016/j.ymgmr.2023.100989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/07/2023] Open
Abstract
Importance Implementation of newborn screening (NBS) in the United States now detects infants with late-onset Pompe disease (LOPD), a lysosomal storage disease characterized by slowly progressive muscle weakness, and detailed clinical evaluation has identified early muscle weakness. Biomarkers may be uninformative; thus, non-invasive imaging is needed to assess early LOPD muscle changes. Muscle ultrasound (US) measuring echointensity (EI) is a non-invasive measure of muscle health. Objective In this study, we aimed to evaluate if EI can identify characteristic patterns of muscle involvement in LOPD patients identified by NBS. Design/setting Prospective, cross-sectional, single time point study. Setting One-center study. Participants We examined 20 infants with NBS-identified LOPD (ages 5-20 months). All had standardized physical therapy assessments. Exposures Creatine Kinase (CK) and Urine Hexose Tetrasaccharide (Glc4) were obtained. Muscle US of deltoid, biceps brachii, forearm flexors, thoracic paraspinals, gluteus maximus, quadriceps, tibialis anterior and medial gastrocnemius was performed. Main outcomes and measures Mean EI was calculated for all involved muscle groups. Quantitative EI Sum Scores were calculated as total EI divided by number of muscle groups assessed. We performed a comprehensive literature review to compare our results to previous LOPD muscle ultrasound studies. Results Six of 20 participants had elevated CK and 15 had ≥ 50% of the most common concerning kinematic physical findings; with normal urine Glc4 in all except one. Based upon muscle EI, the most affected muscles were quadriceps and medial gastrocnemius, with notable elevated EI in thoracic paraspinals. Biceps brachii was the most frequently affected upper extremity muscle. EI sum scores correlated moderately with increasing CK. Statistically significant positive correlation was found between posterior pelvic tilt in sitting and EI of gluteus maximus. Sonographic pattern of muscle involvement was similar to previous studies assessing older patients with LOPD. Conclusions and relevance In this study, muscle EI was elevated most often in the quadriceps, tibialis anterior, medial gastrocnemius, thoracic paraspinals, and biceps brachii. Involved muscles generally fit the profile of physical and muscle ultrasound/MRI exam findings in LOPD patients. Muscle ultrasound is recommended for rapid, focused muscle assessment in LOPD, especially those identified via NBS. Future studies should focus on this pattern of ultrasonographic abnormality and changes over time.
Collapse
Affiliation(s)
- David G. Jackson
- Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| | - Laura E. Case
- Doctor of Physical Therapy Division, Duke University Medical Center, Durham, NC, USA
| | - Erin Huggins
- Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| | - Maggie Holland
- Doctor of Physical Therapy Division, Duke University Medical Center, Durham, NC, USA
| | - Janet Blount
- Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| | - Lisa Hobson Webb
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Priya S. Kishnani
- Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
2
|
Pillai NR, Fabie NAV, Kaye TV, Rosendahl SD, Ahmed A, Hietala AD, Jorgenson AB, Lanpher BC, Whitley CB. Disparities in late and lost: Pediatricians' role in following Pompe disease identified by newborn screening. Mol Genet Metab 2023; 140:107633. [PMID: 37414610 DOI: 10.1016/j.ymgme.2023.107633] [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: 01/19/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Pompe disease (PD) results from a deficiency of lysosomal acid α-glucosidase that leads to glycogen accumulation in lysosomes in multiple tissues. There are two phenotypes: infantile-onset Pompe disease (IOPD) and late-onset Pompe disease (LOPD). The objective was to evaluate the diagnostic and follow-up outcomes of children identified with PD through newborn screening (NBS) in the state of Minnesota over a 4-year period. METHODS This study is a retrospective analysis of infants born in Minnesota between August 1, 2017, and July 31, 2021, by the Minnesota Department of Health NBS Program for Pompe disease. Newborn screening and clinical diagnostic data are summarized for all newborns with positive newborn screens for Pompe disease. RESULTS Children with IOPD had abnormal biomarkers necessitating immediate initiation of treatment. Children with LOPD are asymptomatic to date (1.25-4.58 years) with normal biomarkers including creatine kinase, urine glucotetrasaccharides, liver function tests, and echocardiogram. The estimated birth prevalence of PD is 1:15,160. The positive predictive value for PD was 81% with a false positive rate of 1.9 per 10 positive screens. 32% of the children with LOPD were lost to follow up among which 66% were from minority ethnic groups. CONCLUSION This emphasizes the disparity in access to health care among specific demographics, as well as the importance of a primary care provider's early involvement in educating these families. To accomplish this, and ensure equality in follow-up care, the Minnesota Pompe Disease Consortium has been formed.
Collapse
Affiliation(s)
- Nishitha R Pillai
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, MN, USA.
| | | | - Tory V Kaye
- Minnesota Department of Health (MDH), Public Health Laboratory, Newborn Screening, MN, USA
| | - Sondra D Rosendahl
- Minnesota Department of Health (MDH), Public Health Laboratory, Newborn Screening, MN, USA
| | - Alia Ahmed
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, MN, USA
| | - Amy D Hietala
- Minnesota Department of Health (MDH), Public Health Laboratory, Newborn Screening, MN, USA
| | | | | | - Chester B Whitley
- Division of Genetics and Metabolism, Department of Pediatrics, University of Minnesota, MN, USA
| |
Collapse
|
3
|
Prakash S, Penn JD, Jackson KE, Dean LW. Newborn screening for Pompe disease: Parental experiences and follow-up care for a late-onset diagnosis. J Genet Couns 2022; 31:1404-1420. [PMID: 35915971 DOI: 10.1002/jgc4.1615] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 12/14/2022]
Abstract
Newborn screening (NBS) for Pompe disease (PD) was added to the Recommended Uniform Screening Panel (RUSP) in the United States in 2015 because there was compelling evidence of health benefits for early diagnosis of Infantile-onset Pompe disease (IOPD). However, one limitation of NBS for PD is its inability to distinguish IOPD and late onset forms of Pompe disease (LOPD). Management of LOPD is challenging because of uncertainty around progression of LOPD and determining the appropriate time for treatment initiation. The aims of this study were to understand the impact of LOPD identified through NBS, by exploring the differences in attitudes, emotions and opinions among parents and identify their needs for follow-up care. Study participants were recruited from states that included PD on their NBS panel. Semi-structured interviews were conducted with parents of nine children who were diagnosed with LOPD after an abnormal NBS result. Predominantly, parents reported a lack of adequate information, guidance, and psychosocial support from the very beginning and through the course of their diagnosis. This caused uncertainty, anxiety, frustration, and fear of the unknown. Parents live in a 'worry or not to worry' phase, balancing between coping methods to avoid over medicalization of their child, but also preparing concrete follow-up plans to be on the lookout for any signs of PD-related symptoms. Understanding parents' experiences allows genetic counselors and NBS programs to proactively design care plan for parents during this difficult period.
Collapse
Affiliation(s)
- Supraja Prakash
- Department of Genetics and Metabolism, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Department of Genetic Counseling, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jeremy D Penn
- College of Education, University of Iowa, Iowa City, Iowa, USA
| | - Kelly E Jackson
- The University of Louisville School of Medicine, Norton Children's Genetics Group, Louisville, Kentucky, USA
| | - Lori Williamson Dean
- Department of Genetic Counseling, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
4
|
Goomber S, Huggins E, Rehder CW, Cohen JL, Bali DS, Kishnani PS. Development of a clinically validated in vitro functional assay to assess pathogenicity of novel GAA variants in patients with Pompe disease identified via newborn screening. Front Genet 2022; 13:1001154. [PMID: 36246652 PMCID: PMC9562992 DOI: 10.3389/fgene.2022.1001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: The addition of Pompe disease (Glycogen Storage Disease Type II) to the Recommended Uniform Screening Panel in the United States has led to an increase in the number of variants of uncertain significance (VUS) and novel variants identified in the GAA gene. This presents a diagnostic challenge, especially in the setting of late-onset Pompe disease when symptoms are rarely apparent at birth. There is an unmet need for validated functional studies to aid in classification of GAA variants. Methods: We developed an in vitro mammalian cell expression and functional analysis system based on guidelines established by the Clinical Genome Resource (ClinGen) Sequence Variant Interpretation Working Group for PS3/BS3. We validated the assay with 12 control variants and subsequently analyzed eight VUS or novel variants in GAA identified in patients with a positive newborn screen for Pompe disease without phenotypic evidence of infantile-onset disease. Results: The control variants were analyzed in our expression system and an activity range was established. The pathogenic controls had GAA activity between 0% and 11% of normal. The benign or likely benign controls had an activity range of 54%–100%. The pseudodeficiency variant had activity of 17%. These ranges were then applied to the variants selected for functional studies. Using the threshold of <11%, we were able to apply PS3_ supporting to classify two variants as likely pathogenic (c.316C > T and c.1103G > A) and provide further evidence to support the classification of likely pathogenic for two variants (c.1721T > C and c.1048G > A). One variant (c.1123C > T) was able to be reclassified based on other supporting evidence. We were unable to reclassify three variants (c.664G > A, c.2450A > G, and c.1378G > A) due to insufficient or conflicting evidence. Conclusion: We investigated eight GAA variants as proof of concept using our validated and reproducible in vitro expression and functional analysis system. While additional work is needed to further refine our system with additional controls and different variant types in order to apply the PS3/BS3 criteria at a higher level, this tool can be utilized for variant classification to meet the growing need for novel GAA variant classification in the era of newborn screening for Pompe disease.
Collapse
Affiliation(s)
- Shelly Goomber
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Erin Huggins
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Catherine W. Rehder
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Jennifer L. Cohen
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
| | - Deeksha S. Bali
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- Biochemical Genetics Laboratory, Duke University Medical Center, Durham, NC, United States
| | - Priya S. Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States
- *Correspondence: Priya S. Kishnani,
| |
Collapse
|
5
|
Benefit of 5 years of enzyme replacement therapy in advanced late onset Pompe. A case report of misdiagnosis for three decades with acute respiratory failure at presentation. Mol Genet Metab Rep 2022; 32:100896. [PMID: 36046397 PMCID: PMC9421430 DOI: 10.1016/j.ymgmr.2022.100896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
We report on a 57 year old female patient who presented in acute respiratory failure with severe generalized weakness. She was previously misdiagnosed for over three decades as polymyositis. She was treated with enzyme replacement therapy (ERT) for over five years, after being diagnosed with late onset Pompe Disease (LOPD). She returned to independent living with the use of non invasive ventilation at nights. ERT should be considered in the management of patients with advanced LOPD and the effects of ERT closely monitored.
Collapse
|
6
|
Zhang T, Duong P, Dayuha R, Collins CJ, Beckman E, Thies J, Chang I, Lam C, Sun A, Scott AI, Thompson J, Singh A, Khaledi H, Gelb MH, Hahn SH. A rapid and non-invasive proteomic analysis using DBS and buccal swab for multiplexed second-tier screening of Pompe disease and Mucopolysaccharidosis type I. Mol Genet Metab 2022; 136:296-305. [PMID: 35787971 PMCID: PMC10387444 DOI: 10.1016/j.ymgme.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Current newborn screening programs for Pompe disease (PD) and mucopolysaccharidosis type I (MPS I) suffer from a high false positive rate and long turnaround time for clinical follow up. This study aimed to develop a novel proteomics-based assay for rapid and accurate second-tier screening of PD and MPS I. A fast turnaround assay would enable the identification of severe cases who need immediate clinical follow up and treatment. METHODS We developed an immunocapture coupled with mass spectrometry-based proteomics (Immuno-SRM) assay to quantify GAA and IDUA proteins in dried blood spots (DBS) and buccal swabs. Sensitivity, linearity, reproducibility, and protein concentration range in healthy control samples were determined. Clinical performance was evaluated in known PD and MPS I patients as well as pseudodeficiency and carrier cases. RESULTS Using three 3.2 mm punches (~13.1 μL of blood) of DBS, the assay showed reproducible and sensitive quantification of GAA and IDUA. Both proteins can also be quantified in buccal swabs with high reproducibility and sensitivity. Infantile onset Pompe disease (IOPD) and severe MPS I cases are readily identifiable due to the absence of GAA and IDUA, respectively. In addition, late onset Pompe disease (LOPD) and attenuated MPS I patients showed much reduced levels of the target protein. By contrast, pseudodeficiency and carrier cases exhibited significant higher target protein levels compared to true patients. CONCLUSION Direct quantification of endogenous GAA and IDUA peptides in DBS by Immuno-SRM can be used for second-tier screening to rapidly identify severe PD and MPS I patients with a turnaround time of <1 week. Such patients could benefit from immediate clinical follow up and possibly earlier treatment.
Collapse
Affiliation(s)
- Tong Zhang
- Seattle Children's Research Institute, Seattle, WA, United States of America
| | - Phi Duong
- Seattle Children's Research Institute, Seattle, WA, United States of America
| | - Remwilyn Dayuha
- Seattle Children's Research Institute, Seattle, WA, United States of America
| | | | - Erika Beckman
- Division of Genetic Medicine, Seattle Children's Hospital, Seattle, WA, United States of America
| | - Jenny Thies
- Division of Genetic Medicine, Seattle Children's Hospital, Seattle, WA, United States of America
| | - Irene Chang
- Biochemical Genetics Clinic, Seattle Children's Hospital, Seattle, WA, United States of America; Department of Pediatrics, Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Christina Lam
- Biochemical Genetics Clinic, Seattle Children's Hospital, Seattle, WA, United States of America; Department of Pediatrics, Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Angela Sun
- Biochemical Genetics Clinic, Seattle Children's Hospital, Seattle, WA, United States of America; Department of Pediatrics, Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Anna I Scott
- Department of Laboratory, Seattle Children's Hospital, Seattle, WA, United States of America
| | - John Thompson
- WA State Department of Health, Seattle, WA, United States of America
| | - Aranjeet Singh
- WA State Department of Health, Seattle, WA, United States of America
| | - Hamid Khaledi
- Department of Chemistry, University of Washington, Seattle, WA, United States of America
| | - Michael H Gelb
- Department of Chemistry, University of Washington, Seattle, WA, United States of America
| | - Si Houn Hahn
- Seattle Children's Research Institute, Seattle, WA, United States of America; Biochemical Genetics Clinic, Seattle Children's Hospital, Seattle, WA, United States of America; Department of Pediatrics, Division of Genetic Medicine, University of Washington School of Medicine, Seattle, WA, United States of America.
| |
Collapse
|
7
|
Tocan V, Mushimoto Y, Kojima-Ishii K, Matsuda A, Toda N, Toyomura D, Hirata Y, Sanefuji M, Sawada T, Sakai Y, Nakamura K, Ohga S. The earliest enzyme replacement for infantile-onset Pompe disease in Japan. Pediatr Int 2022; 64:e15286. [PMID: 36074069 DOI: 10.1111/ped.15286] [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: 02/10/2022] [Revised: 06/15/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infantile-onset Pompe disease (IOPD) is the most severe phenotype of a lysosomal storage disorder caused by acid alpha-glucosidase (GAA) deficiency. An enzymatic newborn screening (NBS) program started regionally in Japan in 2013 for early enzyme replacement therapy (ERT). We report the ERT responses of the first NBS-identified Japanese IOPD case and of another case diagnosed prior to NBS, to discuss the problems of promptly starting ERT in Japan. METHODS Acid alpha-glucosidase activity was measured by fluorometric assay in both patients. The diagnosis of IOPD was confirmed by next-generation followed by Sanger-method sequencing (patient 1) or direct sequencing of polymerase chain reaction (PCR)-amplified products (patient 2) of the GAA gene. RESULTS A female infant identified by NBS had a novel out-of-frame (p.F181Dfs*6) variant and a reported pathogenic (p.R600C) variant, along with two pseudodeficiency variants. Enzyme replacement therapy was started at age 58 days when the infant had increased serum levels of creatine kinase and slight myocardial hypertrophy. Clinical and biochemical markers improved promptly. She has been alive and well without delayed development at age 14 months. Patient 2, a Japanese male, received a diagnosis of IOPD at age 5 months before the NBS era. He had a homozygotic variant of GAA (p.R608X), later registered as a cross-reactive immunological material (CRIM)-negative genotype, and developed a high titer of anti-rhGAA antibodies. The patient has survived myocardial hypertrophy with continuous respiratory support for 12 years of ERT. CONCLUSIONS Enzyme replacement therapy should not be delayed over the age of 2 months for reversible cardiac function, although CRIM-negative cases may hamper turnaround time reduction.
Collapse
Affiliation(s)
- Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Yuichi Mushimoto
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Kanako Kojima-Ishii
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Akane Matsuda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Naoko Toda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Daisuke Toyomura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Yuichiro Hirata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Masafumi Sanefuji
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan.,Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Takaaki Sawada
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| | - Kimitoshi Nakamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto City, Kumamoto, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka City, Fukuoka, Japan
| |
Collapse
|
8
|
Fatehi F, Ashrafi MR, Babaee M, Ansari B, Beiraghi Toosi M, Boostani R, Eshraghi P, Fakharian A, Hadipour Z, Haghi Ashtiani B, Moravej H, Nilipour Y, Sarraf P, Sayadpour Zanjani K, Nafissi S. Recommendations for Infantile-Onset and Late-Onset Pompe Disease: An Iranian Consensus. Front Neurol 2021; 12:739931. [PMID: 34621239 PMCID: PMC8490649 DOI: 10.3389/fneur.2021.739931] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/16/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Pompe disease, also denoted as acid maltase or acid α-glucosidase deficiency or glycogen storage disease type II, is a rare, autosomal recessive lysosomal storage disorder. Several reports have previously described Pompe disease in Iran and considering increased awareness of related subspecialties and physicians, the disease's diagnosis is growing. Objective: This guideline's main objective was to develop a national guideline for Pompe disease based on national and international evidence adapting with national necessities. Methods: A group of expert clinicians with particular interests and experience in diagnosing and managing Pompe disease participated in developing this guideline. This group included adult neurologists, pediatric neurologists, pulmonologists, endocrinologists, cardiologists, pathologists, and physiatrists. After developing search terms, four authors performed an extensive literature review, including Embase, PubMed, and Google Scholar, from 1932 to current publications before the main meeting. Before the main consensus session, each panel member prepared an initial draft according to pertinent data in diagnosis and management and was presented in the panel discussion. Primary algorithms for the diagnosis and management of patients were prepared in the panel discussion. The prepared consensus was finalized after agreement and concordance between the panel members. Conclusion: Herein, we attempted to develop a consensus based on Iran's local requirements. The authors hope that disseminating these consensuses will help healthcare professionals in Iran achieve the diagnosis, suitable treatment, and better follow-up of patients with infantile-onset Pompe disease and late-onset Pompe disease.
Collapse
Affiliation(s)
- Farzad Fatehi
- Department of Neurology, Neuromuscular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Babaee
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Ansari
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Reza Boostani
- Neurology Department, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peyman Eshraghi
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Hadipour
- Medical Genetic Department, Atieh Hospital, Pars Hospital and Research Center, Tehran, Iran
| | | | - Hossein Moravej
- Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Yalda Nilipour
- Pediatric Pathology Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyhan Sayadpour Zanjani
- Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Nafissi
- Department of Neurology, Neuromuscular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
9
|
Saville JT, Fuller M. Experience with the Urinary Tetrasaccharide Metabolite for Pompe Disease in the Diagnostic Laboratory. Metabolites 2021; 11:metabo11070446. [PMID: 34357340 PMCID: PMC8305466 DOI: 10.3390/metabo11070446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 11/20/2022] Open
Abstract
Following clinical indications, the laboratory diagnosis of the inherited metabolic myopathy, Pompe disease (PD), typically begins with demonstrating a reduction in acid alpha-glucosidase (GAA), the enzyme required for lysosomal glycogen degradation. Although simple in concept, a major challenge is defining reference intervals, as even carriers can have reduced GAA, and pseudodeficiencies complicate interpretation. Here, we developed a mass spectrometric assay for quantification of a urinary glycogen metabolite (tetrasaccharide) and reported on its utility as a confirmatory test for PD in a diagnostic laboratory. Using two age-related reference intervals, eight returned tetrasaccharide concentrations above the calculated reference interval but did not have PD, highlighting non-specificity. However, retrospective analysis revealed elevated tetrasaccharide in seven infantile-onset (IOPD) cases and sixteen late-onset (LOPD) cases, and normal concentrations in one heterozygote. Prospective tetrasaccharide analysis in nine individuals with reduced GAA confirmed IOPD in one, LOPD in six and identified two heterozygotes. Using this metabolite as a biomarker of therapeutic response was not overly informative; although most patients showed an initial drop following therapy initiation, tetrasaccharide concentrations fluctuated considerably and remained above reference intervals in all patients. While useful as a confirmation of PD, its utility as a biomarker for monitoring treatment warrants further investigation.
Collapse
Affiliation(s)
- Jennifer T. Saville
- Genetics and Molecular Pathology, SA Pathology at Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia;
| | - Maria Fuller
- Genetics and Molecular Pathology, SA Pathology at Women’s and Children’s Hospital, 72 King William Road, North Adelaide, SA 5006, Australia;
- Adelaide Medical School, University of Adelaide, North Terrace, Adelaide, SA 5000, Australia
- Correspondence: ; Tel.: +61-(0)8-8161-6741
| |
Collapse
|
10
|
Pain Phenotypes in Rare Musculoskeletal and Neuromuscular Diseases. Neurosci Biobehav Rev 2021; 124:267-290. [PMID: 33581222 DOI: 10.1016/j.neubiorev.2021.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/18/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
For patients diagnosed with a rare musculoskeletal or neuromuscular disease, pain may transition from acute to chronic; the latter yielding additional challenges for both patients and care providers. We assessed the present understanding of pain across a set of ten rare, noninfectious, noncancerous disorders; Osteogenesis Imperfecta, Ehlers-Danlos Syndrome, Achondroplasia, Fibrodysplasia Ossificans Progressiva, Fibrous Dysplasia/McCune-Albright Syndrome, Complex Regional Pain Syndrome, Duchenne Muscular Dystrophy, Infantile- and Late-Onset Pompe disease, Charcot-Marie-Tooth Disease, and Amyotrophic Lateral Sclerosis. Through the integration of natural history, cross-sectional, retrospective, clinical trials, & case studies we described pathologic and genetic factors, pain sources, phenotypes, and lastly, existing therapeutic approaches. We highlight that while rare diseases possess distinct core pathologic features, there are a number of shared pain phenotypes and mechanisms that may be prospectively examined and therapeutically targeted in a parallel manner. Finally, we describe clinical and research approaches that may facilitate more accurate diagnosis, monitoring, and treatment of pain as well as elucidation of the evolving nature of pain phenotypes in rare musculoskeletal or neuromuscular illnesses.
Collapse
|
11
|
Abstract
Glycogen storage disease type II (also known as Pompe disease (PD)) is an autosomal recessive disorder caused by defects in α-glucosidase (AαGlu), resulting in lysosomal glycogen accumulation in skeletal and heart muscles. Accumulation and tissue damage rates depend on residual enzyme activity. Enzyme replacement therapy (ERT) should be started before symptoms are apparent in order to achieve optimal outcomes. Early initiation of ERT in infantile-onset PD improves survival, reduces the need for ventilation, results in earlier independent walking, and enhances patient quality of life. Newborn screening (NBS) is the optimal approach for early diagnosis and treatment of PD. In NBS for PD, measurement of AαGlu enzyme activity in dried blood spots (DBSs) is conducted using fluorometry, tandem mass spectrometry, or digital microfluidic fluorometry. The presence of pseudodeficiency alleles, which are frequent in Asian populations, interferes with NBS for PD, and current NBS systems cannot discriminate between pseudodeficiency and cases with PD or potential PD. The combination of GAA gene analysis with NBS is essential for definitive diagnoses of PD. In this review, we introduce our experiences and discuss NBS programs for PD implemented in various countries.
Collapse
|
12
|
Smith LD, Bainbridge MN, Parad RB, Bhattacharjee A. Second Tier Molecular Genetic Testing in Newborn Screening for Pompe Disease: Landscape and Challenges. Int J Neonatal Screen 2020; 6:32. [PMID: 32352041 PMCID: PMC7189780 DOI: 10.3390/ijns6020032] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Pompe disease (PD) is screened by a two tier newborn screening (NBS) algorithm, the first tier of which is an enzymatic assay performed on newborn dried blood spots (DBS). As first tier enzymatic screening tests have false positive results, an immediate second tier test on the same sample is critical in resolving newborn health status. Two methodologies have been proposed for second tier testing: (a) measurement of enzymatic activities such as of Creatine/Creatinine over alpha-glucosidase ratio, and (b) DNA sequencing (a molecular genetics approach), such as targeted next generation sequencing. (tNGS). In this review, we discuss the tNGS approach, as well as the challenges in providing second tier screening and follow-up care. While tNGS can predict genotype-phenotype effects when known, these advantages may be diminished when the variants are novel, of unknown significance or not discoverable by current test methodologies. Due to the fact that criticisms of screening algorithms that utilize tNGS are based on perceived complexities, including variant detection and interpretation, we clarify the actual limitations and present the rationale that supports optimizing a molecular genetic testing approach with tNGS. Second tier tNGS can benefit clinical decision-making through the use of the initial NBS DBS punch and rapid turn-around time methodology for tNGS, that includes copy number variant analysis, variant effect prediction, and variant 'cut-off' tools for the reduction of false positive results. The availability of DNA sequence data will contribute to the improved understanding of genotype-phenotype associations and application of treatment. The ultimate goal of second tier testing should enable the earliest possible diagnosis for the earliest initiation of the most effective clinical interventions in infants with PD.
Collapse
Affiliation(s)
- Laurie D. Smith
- Department of Pediatrics, UNC Hospitals, Chapel Hill, NC 27599, USA;
- Laboratory Services Division, Baebies, Inc., Durham, NC 27709, USA
| | - Matthew N. Bainbridge
- Codified Genomics, Houston, TX 77004, USA;
- Rady Children’s Institute for Genomic Medicine, San Diego, CA 92123, USA
| | - Richard B. Parad
- Department of Pediatric Newborn Medicine, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | |
Collapse
|
13
|
Abstract
Newborn screening (NBS) is the largest public health program in the United States, affecting every newborn. The purpose of newborn screening is to identify newborns at risk for selected disorders during the presymptomatic phase, with the hope that early intervention can prevent disease progression. NBS began in the early 1960s following the pioneering work of Robert Guthrie with phenylketonuria. Since then, NBS has expanded, with testing available for more than 50 disorders in most states. Screening tests need to be highly automated, with high sensitivity and specificity to avoid missing patients with disease, and ensuring manageable false-positive rates. Current initiatives in NBS include timeliness to ensure that results of the screen are available by 5 days after birth for a core set of critical conditions. This has resulted in the current recommendation for NBS specimens to be collected at 24 to 48 hours after birth. False-positive rates are higher in the NICU, because of the metabolic instability of sick neonates and the immaturity of premature enzyme systems. The recommended uniform screen panel (RUSP) contains the current list of disorders screened for by most states. Additional disorders continue to be added to the RUSP as medical progress allows previously untreatable disorders to be managed successfully, and thus the need to screen emerges. The costs associated with NBS continue to climb, because despite state-mandated screening, the diagnostic evaluation and treatment of these conditions has no such mandate. This is a particular concern for disorders with annual treatment costs of several hundred thousand dollars.
Collapse
Affiliation(s)
- David Kronn
- Department of Pathology and Pediatrics, New York Medical College, Valhalla, NY
| |
Collapse
|
14
|
Tchan M, Henderson R, Kornberg A, Kairaitis K, Fuller M, Davis M, Ellaway C, Reardon K, Corbett A, Needham M, McKelvie P. Is it Pompe Disease? Australian diagnostic considerations. Neuromuscul Disord 2020; 30:389-399. [PMID: 32418839 DOI: 10.1016/j.nmd.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 12/29/2022]
Abstract
Pompe Disease is a spectrum disorder with an evolving phenotype in which diagnostic delay is common. Contributing factors include the rarity of the disorder, its wide clinical spectrum, signs and symptoms that overlap with those of other neuromuscular disorders, variable diagnostic approaches, lack of awareness of the clinical manifestations and difficulties in completing the diagnostic inventory. International updates and recommendations have been published providing diagnostic guidelines and management criteria. However, questions remain in the Australian setting. A panel (two neurologists, one clinical geneticist) reviewed the literature, examined clinical questions of relevance to the Australian setting, and developed a framework for the guidance. A wider panel, comprising the initial panel plus eight additional members, critiqued the framework and contributed clinical guidance within the scope of their respective areas of clinical expertise. The resultant expert consensus recommendations build on currently available data to propose an appropriate management framework incorporating the diagnosis, classification, therapeutic approach, multidisciplinary care, and on-going monitoring of patients with Pompe Disease in the Australian setting. It is hoped that diagnostic delay can be reduced with appropriate recourse to evidence-based insights and practical advice on diagnosis and management tailored to the Australian setting.
Collapse
Affiliation(s)
- Michel Tchan
- Genetic Medicine, Westmead Hospital, The University of Sydney, Westmead, NSW, Australia.
| | - Robert Henderson
- Neurology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Andrew Kornberg
- Neurology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Kristina Kairaitis
- Department of Respiratory and Sleep Medicine, and University of Sydney at Westmead Hospital, the Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Maria Fuller
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, Adelaide, SA, Australia
| | - Mark Davis
- Neurogenetics Unit, Department of Diagnostic Genomics, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Carolyn Ellaway
- Paediatrician, Clinical Geneticist Genetic Metabolic Disorders Service, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | | | - Alastair Corbett
- Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Merrilee Needham
- Neurology, Fiona Stanley Hospital, Institute for Immunology and Infectious Diseases, Murdoch University, Notre Dame University, WA, Australia
| | - Penny McKelvie
- Neuropathology, St Vincent's Hospital, Fitzroy, VIC, Australia
| |
Collapse
|
15
|
Saich R, Brown R, Collicoat M, Jenner C, Primmer J, Clancy B, Holland T, Krinks S. Is Newborn Screening the Ultimate Strategy to Reduce Diagnostic Delays in Pompe Disease? The Parent and Patient Perspective. Int J Neonatal Screen 2020; 6:1. [PMID: 33073001 PMCID: PMC7422966 DOI: 10.3390/ijns6010001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
Pompe disease (PD) is a rare, autosomal-recessively inherited deficiency in the enzyme acid α-glucosidase. It is a spectrum disorder; age at symptom onset and rate of deterioration can vary considerably. In affected infants prognosis is poor, such that without treatment most infants die within the first year of life. To lose a baby in their first year of life to a rare disease causes much regret, guilt, and loneliness to parents, family, and friends. To lose a baby needlessly when there is an effective treatment amplifies this sadness. With so little experience of rare disease in the community, once a baby transfers to their home they are subject to a very uncertain and unyielding diagnostic journey while their symptomology progresses and their health deteriorates. With a rare disease like PD, the best opportunity to diagnose a baby is at birth. PD is not yet included in the current newborn screening (NBS) panel in Australia. Should it be? In late 2018 the Australian Pompe Association applied to the Australian Standing committee on Newborn Screening to have PD included. The application was not upheld. Here we provide an overview of the rationale for NBS, drawing on the scientific literature and perspectives from The Australian Pompe Association, its patients and their families. In doing so, we hope to bring a new voice to this very important debate.
Collapse
Affiliation(s)
- Raymond Saich
- Australian Pompe Association Inc., Kellyville, NSW 2155, Australia
| | | | | | | | | | | | | | | |
Collapse
|
16
|
In 't Groen SLM, de Faria DOS, Iuliano A, van den Hout JMP, Douben H, Dijkhuizen T, Cassiman D, Witters P, Barba Romero MÁ, de Klein A, Somers-Bolman GM, Saris JJ, Hoefsloot LH, van der Ploeg AT, Bergsma AJ, Pijnappel WWMP. Novel GAA Variants and Mosaicism in Pompe Disease Identified by Extended Analyses of Patients with an Incomplete DNA Diagnosis. MOLECULAR THERAPY-METHODS & CLINICAL DEVELOPMENT 2020; 17:337-348. [PMID: 32071926 PMCID: PMC7013133 DOI: 10.1016/j.omtm.2019.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/31/2019] [Indexed: 12/20/2022]
Abstract
Pompe disease is a metabolic disorder caused by a deficiency of the glycogen-hydrolyzing lysosomal enzyme acid α-glucosidase (GAA), which leads to progressive muscle wasting. This autosomal-recessive disorder is the result of disease-associated variants located in the GAA gene. In the present study, we performed extended molecular diagnostic analysis to identify novel disease-associated variants in six suspected Pompe patients from four different families for which conventional diagnostic assays were insufficient. Additional assays, such as a generic-splicing assay, minigene analysis, SNP array analysis, and targeted Sanger sequencing, allowed the identification of an exonic deletion, a promoter deletion, and a novel splicing variant located in the 5′ UTR. Furthermore, we describe the diagnostic process for an infantile patient with an atypical phenotype, consisting of left ventricular hypertrophy but no signs of muscle weakness or motor problems. This led to the identification of a genetic mosaicism for a very severe GAA variant caused by a segmental uniparental isodisomy (UPD). With this study, we aim to emphasize the need for additional analyses to detect new disease-associated GAA variants and non-Mendelian genotypes in Pompe disease where conventional DNA diagnostic assays are insufficient.
Collapse
Affiliation(s)
- Stijn L M In 't Groen
- Department of Pediatrics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Douglas O S de Faria
- Department of Pediatrics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Alessandro Iuliano
- Department of Pediatrics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Johanna M P van den Hout
- Department of Pediatrics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Hannie Douben
- Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Trijnie Dijkhuizen
- Department of Genetics, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands
| | - David Cassiman
- Center for Metabolic Diseases, UZ and KU Leuven, 3000 Leuven, Belgium
| | - Peter Witters
- Center for Metabolic Diseases, UZ and KU Leuven, 3000 Leuven, Belgium
| | | | - Annelies de Klein
- Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Galhana M Somers-Bolman
- Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Jasper J Saris
- Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Lies H Hoefsloot
- Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Ans T van der Ploeg
- Department of Pediatrics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - Atze J Bergsma
- Department of Pediatrics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| | - W W M Pim Pijnappel
- Department of Pediatrics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, 3015 GE Rotterdam, the Netherlands
| |
Collapse
|
17
|
Powell CM. What Genomic Sequencing Can Offer Universal Newborn Screening Programs. Hastings Cent Rep 2019; 48 Suppl 2:S18-S19. [PMID: 30133725 DOI: 10.1002/hast.878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Massively parallel sequencing, also known as next-generation sequencing, has the potential to significantly improve newborn screening programs in the United States and around the world. Compared to genetic tests whose use is well established, sequencing allows for the analysis of large amounts of DNA, providing more comprehensive and rapid results at a lower cost. It is already being used in limited ways by some public health newborn screening laboratories in the United States and other countries-and it is under study for broader and more widespread use, including as a core part of newborn screening programs. Sequencing technology has the potential to significantly improve these essential public health programs. For many of the conditions that newborns are already screened for, sequencing can return more specific and more sensitive results. The technology could also enable newborn screening programs to expand the list of rare pediatric conditions that they look for, thereby identifying more infants who can benefit from immediate care.
Collapse
|
18
|
Baker M, Griggs R, Byrne B, Connolly AM, Finkel R, Grajkowska L, Haidet-Phillips A, Hagerty L, Ostrander R, Orlando L, Swoboda K, Watson M, Howell RR. Maximizing the Benefit of Life-Saving Treatments for Pompe Disease, Spinal Muscular Atrophy, and Duchenne Muscular Dystrophy Through Newborn Screening. JAMA Neurol 2019; 76:978-983. [DOI: 10.1001/jamaneurol.2019.1206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mei Baker
- University of Wisconsin School of Medicine, Madison
| | - Robert Griggs
- University of Rochester School of Medicine, Rochester, New York
| | | | - Anne M. Connolly
- Washington University School of Medicine in St Louis, St Louis, Missouri
| | | | | | | | | | - Robert Ostrander
- State University of New York Upstate Medical University, Rushville
| | | | - Kathryn Swoboda
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael Watson
- American College of Medical Genetics and Genomics, Bethesda, Maryland
| | | |
Collapse
|
19
|
Byrne BJ, Fuller DD, Smith BK, Clement N, Coleman K, Cleaver B, Vaught L, Falk DJ, McCall A, Corti M. Pompe disease gene therapy: neural manifestations require consideration of CNS directed therapy. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:290. [PMID: 31392202 DOI: 10.21037/atm.2019.05.56] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pompe disease is a neuromuscular disease caused by a deficiency of the lysosomal enzyme acid alpha-glucosidase leading to lysosomal and cytoplasmic glycogen accumulation in neurons and striated muscle. In the decade since availability of first-generation enzyme replacement therapy (ERT) a better understanding of the clinical spectrum of disease has emerged. The most severe form of early onset disease is typically identified with symptoms in the first year of life, known as infantile-onset Pompe disease (IOPD). Infants are described at floppy babies with cardiac hypertrophy in the first few months of life. A milder form with late onset (LOPD) of symptoms is mostly free of cardiac involvement with slower rate of progression. Glycogen accumulation in the CNS and skeletal muscle is observed in both IOPD and LOPD. In both circumstances, multi-system disease (principally motoneuron and myopathy) leads to progressive weakness with associated respiratory and feeding difficulty. In IOPD the untreated natural history leads to cardiorespiratory failure and death in the first year of life. In the current era of ERT clinical outcomes are improved, yet, many patients have an incomplete response and a substantial unmet need remains. Since the neurological manifestations of the disease are not amenable to peripheral enzyme replacement, we set out to better understand the pathophysiology and potential for treatment of disease manifestations using adeno-associated virus (AAV)-mediated gene transfer, with the first clinical gene therapy studies initiated by our group in 2006. This review focuses on the preclinical studies and clinical study findings which are pertinent to the development of a comprehensive gene therapy strategy for both IOPD and LOPD. Given the advent of newborn screening, a significant focus of our recent work has been to establish the basis for repeat administration of AAV vectors to enhance neuromuscular therapeutic efficacy over the life span.
Collapse
Affiliation(s)
- Barry J Byrne
- Department of Pediatrics and Powell Gene Therapy Center, Gainesville, University of Florida, Gainesville, FL, USA
| | - David D Fuller
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Barbara K Smith
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Nathalie Clement
- Department of Pediatrics and Powell Gene Therapy Center, Gainesville, University of Florida, Gainesville, FL, USA
| | - Kirsten Coleman
- Department of Pediatrics and Powell Gene Therapy Center, Gainesville, University of Florida, Gainesville, FL, USA
| | - Brian Cleaver
- Department of Pediatrics and Powell Gene Therapy Center, Gainesville, University of Florida, Gainesville, FL, USA
| | - Lauren Vaught
- Department of Pediatrics and Powell Gene Therapy Center, Gainesville, University of Florida, Gainesville, FL, USA
| | | | - Angela McCall
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Manuela Corti
- Department of Pediatrics and Powell Gene Therapy Center, Gainesville, University of Florida, Gainesville, FL, USA
| |
Collapse
|
20
|
Abstract
Pompe disease is a rare and deadly muscle disorder. As a clinical entity, the disease has been known for over 75 years. While an optimist might be excited about the advances made during this time, a pessimist would note that we have yet to find a cure. However, both sides would agree that many findings in basic science-such as the Nobel prize-winning discoveries of glycogen metabolism, the lysosome, and autophagy-have become the foundation of our understanding of Pompe disease. The disease is a glycogen storage disorder, a lysosomal disorder, and an autophagic myopathy. In this review, we will discuss how these past discoveries have guided Pompe research and impacted recent therapeutic developments.
Collapse
Affiliation(s)
- Lara Kohler
- Cell Biology and Physiology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rosa Puertollano
- Cell Biology and Physiology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Nina Raben
- Cell Biology and Physiology Center, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| |
Collapse
|
21
|
Gelb MH. Newborn Screening for Lysosomal Storage Diseases: Methodologies, Screen Positive Rates, Normalization of Datasets, Second-Tier Tests, and Post-Analysis Tools. Int J Neonatal Screen 2018; 4:23. [PMID: 30882045 PMCID: PMC6419971 DOI: 10.3390/ijns4030023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
All of the worldwide newborn screening (NBS) for lysosomal storage diseases (LSDs) is done by measurement of lysosomal enzymatic activities in dried blood spots (DBS). Substrates used for these assays are discussed. While the positive predictive value (PPV) is the gold standard for evaluating medical tests, current PPVs for NBS of LSDs cannot be used as a performance metric due to statistical sampling errors and uncertainty in the onset of disease symptoms. Instead, we consider the rate of screen positives as the only currently reliable way to compare LSD NBS results across labs worldwide. It has been suggested that the expression of enzymatic activity data as multiple-of-the-mean is a way to normalize datasets obtained using different assay platforms, so that results can be compared, and universal cutoffs can be developed. We show that this is often not the case, and normalization is currently not feasible. We summarize the recent use of pattern matching statistical analysis together with measurement of an expanded group of enzymatic activities and biomarkers to greatly reduce the number of false positives for NBS of LSDs. We provide data to show that these post-enzymatic activity assay methods are more powerful than genotype analysis for the stratification of NBS for LSDs.
Collapse
Affiliation(s)
- Michael H Gelb
- Departments of Chemistry, University of Washington, Seattle, WA 98195, USA;
- Departments of Biochemistry, University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
22
|
Tortorelli S, Eckerman JS, Orsini JJ, Stevens C, Hart J, Hall PL, Alexander JJ, Gavrilov D, Oglesbee D, Raymond K, Matern D, Rinaldo P. Moonlighting newborn screening markers: the incidental discovery of a second-tier test for Pompe disease. Genet Med 2017; 20:840-846. [PMID: 29095812 DOI: 10.1038/gim.2017.190] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/20/2017] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To describe a novel biochemical marker in dried blood spots suitable to improve the specificity of newborn screening for Pompe disease. METHODS The new marker is a ratio calculated between the creatine/creatinine (Cre/Crn) ratio as the numerator and the activity of acid α-glucosidase (GAA) as the denominator. Using Collaborative Laboratory Integrated Reports (CLIR), the new marker was incorporated in a dual scatter plot that can achieve almost complete segregation between Pompe disease and false-positive cases. RESULTS The (Cre/Crn)/GAA ratio was measured in residual dried blood spots of five Pompe cases and was found to be elevated (range 4.41-13.26; 99%ile of neonatal controls: 1.10). Verification was by analysis of 39 blinded specimens that included 10 controls, 24 samples with a definitive classification (16 Pompe, 8 false positives), and 5 with genotypes of uncertain significance. The CLIR tool showed 100% concordance of classification for the 24 known cases. Of the remaining five cases, three p.V222M homozygotes, a benign variant, were classified by CLIR as false positives; two with genotypes of unknown significance, one likely informative, were categorized as Pompe disease. CONCLUSION The CLIR tool inclusive of the new ratio could have prevented at least 12 of 13 (92%) false-positive outcomes.
Collapse
Affiliation(s)
- Silvia Tortorelli
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
| | - Jason S Eckerman
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joseph J Orsini
- Laboratory of Human Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Colleen Stevens
- Laboratory of Human Genetics, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Jeremy Hart
- Division of Laboratory Services, Kentucky Department for Public Health, Frankfort, Kentucky, USA.,Department of Pathology & Laboratory Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Patricia L Hall
- EGL Genetics, Tucker, Georgia, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John J Alexander
- EGL Genetics, Tucker, Georgia, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dimitar Gavrilov
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Devin Oglesbee
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kimiyo Raymond
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Dietrich Matern
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Piero Rinaldo
- Biochemical Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|