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Hwang-Wong E, Amar G, Das N, Zhang X, Aaron N, Gale K, Rothman N, Fante M, Baik A, Bhargava A, Fricker A, McAlister M, Rabinowitz J, Lees-Shepard J, Nannuru K, Economides AN, Cygnar KD. Skeletal phenotype amelioration in mucopolysaccharidosis VI requires intervention at the earliest stages of postnatal development. JCI Insight 2023; 8:e171312. [PMID: 37751300 PMCID: PMC10721280 DOI: 10.1172/jci.insight.171312] [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: 04/11/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open
Abstract
Mucopolysaccharidosis VI (MPS VI) is a rare lysosomal disease arising from impaired function of the enzyme arylsulfatase B (ARSB). This impairment causes aberrant accumulation of dermatan sulfate, a glycosaminoglycan (GAG) abundant in cartilage. While clinical severity varies along with age at first symptom manifestation, MPS VI usually presents early and strongly affects the skeleton. Current enzyme replacement therapy (ERT) does not provide effective treatment for the skeletal manifestations of MPS VI. This lack of efficacy may be due to an inability of ERT to reach affected cells or to the irreversibility of the disease. To address the question of reversibility of skeletal phenotypes, we generated a conditional by inversion (COIN) mouse model of MPS VI, ArsbCOIN/COIN, wherein Arsb is initially null and can be restored to WT using Cre. We restored Arsb at different times during postnatal development, using a tamoxifen-dependent global Cre driver. By restoring Arsb at P7, P21, and P56-P70, we determined that skeletal phenotypes can be fully rescued if Arsb restoration occurs at P7, while only achieving partial rescue at P21 and no significant rescue at P56-P70. This work has highlighted the importance of early intervention in patients with MPS VI to maximize therapeutic impact.
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Numan A, Alruwaili AN, Ali R, Alsharari H, Alanazi M, Alazmi NN, Alsaati AA. Mucopolysaccharidosis Type VI with Recurrent Chest Infection. Cureus 2023; 15:e35229. [PMID: 36968901 PMCID: PMC10032617 DOI: 10.7759/cureus.35229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
Mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome) is a progressive multi-systemic autosomal recessive disease resulting from a deficiency of arylsulfatase B (N-acetylgalactosamine-4-sulfatase). Here we report the case of a three-year-old male child born full-term via normal vaginal delivery. He had frequent admissions due to a chest infection that started at two months of age. At the age of 23 months, he was admitted after complaining of shortness of breath (SOB) due to asthma and aspiration pneumonia; additionally, dysmorphic features were noticed (single palmar crease, short round toes, coarse facial features such as a flat nose, big lips). A genetic study showed mucopolysaccharidosis VI (MPS VI). At three years of age, he was complaining of cough and SOB. Examination showed wheezing all over the chest, normal first and second heart sounds (S1 and S2), a murmur with no clicks, hepatosplenomegaly, and a palpable left kidney. However, the central nervous system (CNS) and eye examinations were normal. Echocardiography revealed a thickened bicuspid aortic valve, mild aortic regurgitation, and mitral regurgitation. Therefore, the patient presented with different clinical symptoms of MPS VI. It is important to increase the physicians' awareness about MPS by focusing on increasing the probability of MPS as a differential diagnosis whenever patients present with abnormal appearance, limb deformities, and recurrent unexplained infections; hence, making early diagnosis and treatment decisions, leading to a slowing down of the progression of the disease and enhancing the patient's quality of life.
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Uribe‐Ardila A, Ramirez‐Borda J, Ayala A. Twenty years of Colombian experience with enzymatic screening in patients with features of mucopolysaccharidosis. JIMD Rep 2022; 63:475-483. [PMID: 36101826 PMCID: PMC9458599 DOI: 10.1002/jmd2.12313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Mucopolysaccharidoses (MPSs) are a group of genetic alterations whose effect is the progressive intralysosomal accumulation of glycosaminoglycans. Affected individuals are deficient in one or more lysosomal enzymes which, depending on the MPS, may cause coarse facial features, short stature, multiple skeletal dysplasia, joint stiffness, or developmental delay. Their diagnosis is mostly performed late or incorrectly, and it represents a challenge since it requires specialized tests only performed in major cities. This makes it difficult for patients to have access to physicians since their geographical location is distant and therefore, the use of samples collected in solid‐phase represents an advantage for the study of high‐risk populations. In addition, epidemiological information about rare diseases, especially in Latin America, is scarce or inconsistent. Our aim was to report the experience of 20 years of selective screening by assessing enzyme activity and reporting incidence values of MPS in Colombia. This study validated a group of fluorometric endpoint techniques in 8239 patients. The samples were dried blood spots (DBS) collected on filter paper and leukocyte extracts. Reference values in the Colombian population for α‐l‐iduronidase, iduronate 2‐sulfatase, α‐N‐acetylglucosaminidase, N‐acetylglucosamine‐6‐sulfate sulfatase, β‐galactosidase, arylsulfatase B, and β‐glucuronidase were established in leukocyte extracts, and patients reference ranges were updated in the case of DBS samples. Incidence values were calculated for each MPS and the distribution of cases across the country is also shown. This study offers very useful information for the health system, the scientific community, and it facilitates the diagnosis of these disorders. This is indispensable when seeking to develop new diagnostic or treatment approaches for patients.
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Affiliation(s)
- Alfredo Uribe‐Ardila
- Faculty of Sciences, Biochemistry Research Center Universidad de Los Andes Bogota Colombia
| | - Johana Ramirez‐Borda
- Faculty of Sciences, Biochemistry Research Center Universidad de Los Andes Bogota Colombia
| | - Adis Ayala
- Faculty of Sciences and Education, Biochemistry and Molecular Biology Group Universidad Distrital Francisco José de Caldas Bogota Colombia
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Fateen E, Abdallah ZY, Nazim WS, Ibrahim M, Radwan A. Mucopolysaccharidoses diagnosis in the era of enzyme replacement therapy in Egypt. Heliyon 2021; 7:e07830. [PMID: 34471711 PMCID: PMC8387752 DOI: 10.1016/j.heliyon.2021.e07830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Undegraded glycosaminoglycans (GAGs) induced by deficiency of enzymes are the primary cause of mucopolyscchardoses. Mucopolysacchardoses (MPS) are a group of rare lysosomal storage diseases (LSD). The quantification of a specific enzymatic activity is needed for accurate diagnosis. The objectives of this work were: first, to continue the study of mucopolysacchardoses disease in Egypt after the start of using the enzyme replacement therapy (ERT). Second, to define the commonest types among our population after 18 years experience with the disease. Third, to compare the different MPS types' distribution, diagnosed after the start of the ERT, to identify the impact of using ERT on the number and type of diagnosed patients. METHOD Urinary GAGs were measured for all referred cases followed by two-dimensional electrophoretic separation for cases with high levels of GAGs; the specific enzyme activity was assayed for each type depending on the abnormal electrophoretic pattern obtained. Clinically suspected cases of Morquio syndrome were directly subjected to measuring the specific enzyme. RESULTS Out of 1448 suspected cases, 622 (42.9%) MPS patients were diagnosed revealing the following distribution: MPS I (172, 27.7%), MPS II (57, 9.1%), MPS III [(177, 28.5%: 134 type B and 43 types A, C or D)], MPS IVA (124, 19.9%), MPS VI (90, 14.5%) and MPS VII (2, 0.3%). MPS III was the most commonly diagnosed type followed by MPS I and MPS IVA. MPS IVA represented the most common type receiving treatment, followed by MPS I, MPS II and MPS VI. CONCLUSION The presence of treatment encouraged the affected families and physicians to seek diagnosis. MPS III was the commonest type among our studied group after 7 years of diagnosis, while MPS IVA was the commonest type receiving treatment.
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Affiliation(s)
- Ekram Fateen
- Biochemical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, 12622, Egypt
| | - Zeinab Y. Abdallah
- Biochemical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, 12622, Egypt
| | - Walaa S. Nazim
- Biochemical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, 12622, Egypt
| | - Mona Ibrahim
- Biochemical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, 12622, Egypt
| | - Amira Radwan
- Biochemical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, 12622, Egypt
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Epidemiology of Mucopolysaccharidoses Update. Diagnostics (Basel) 2021; 11:diagnostics11020273. [PMID: 33578874 PMCID: PMC7916572 DOI: 10.3390/diagnostics11020273] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/26/2022] Open
Abstract
Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders caused by a lysosomal enzyme deficiency or malfunction, which leads to the accumulation of glycosaminoglycans in tissues and organs. If not treated at an early stage, patients have various health problems, affecting their quality of life and life-span. Two therapeutic options for MPS are widely used in practice: enzyme replacement therapy and hematopoietic stem cell transplantation. However, early diagnosis of MPS is crucial, as treatment may be too late to reverse or ameliorate the disease progress. It has been noted that the prevalence of MPS and each subtype varies based on geographic regions and/or ethnic background. Each type of MPS is caused by a wide range of the mutational spectrum, mainly missense mutations. Some mutations were derived from the common founder effect. In the previous study, Khan et al. 2018 have reported the epidemiology of MPS from 22 countries and 16 regions. In this study, we aimed to update the prevalence of MPS across the world. We have collected and investigated 189 publications related to the prevalence of MPS via PubMed as of December 2020. In total, data from 33 countries and 23 regions were compiled and analyzed. Saudi Arabia provided the highest frequency of overall MPS because of regional or consanguineous marriages (or founder effect), followed by Portugal, Brazil, the Netherlands, and Australia. The newborn screening is an efficient and early diagnosis for MPS. MPS I has been approved for newborn screening in the United States. After the newborn screening of MPS I, the frequency of MPS I increased, compared with the past incidence rates. Overall, we conclude that the current identification methods are not enough to recognize all MPS patients, leading to an inaccurate incidence and status. Differences in ethnic background and/or founder effects impact on the frequency of MPS, which affects the prevalence of MPS. Two-tier newborn screening has accelerated early recognition of MPS I, providing an accurate incidence of patients.
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Josahkian JA, Trapp FB, Burin MG, Michelin-Tirelli K, Magalhães APPSD, Sebastião FM, Bender F, Mari JFD, Brusius-Facchin AC, Leistner-Segal S, Málaga DR, Giugliani R. Updated birth prevalence and relative frequency of mucopolysaccharidoses across Brazilian regions. Genet Mol Biol 2021; 44:e20200138. [PMID: 33503199 PMCID: PMC7839630 DOI: 10.1590/1678-4685-gmb-2020-0138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/04/2020] [Indexed: 11/21/2022] Open
Abstract
The mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders caused
by 11 enzyme deficiencies, classified into seven types. Data on the birth
prevalence of each MPS type are available for only a few countries, and the
totality of cases may be underestimated. To determine the epidemiological
profile of MPS in each Brazilian region, we analyzed data collected between 1982
and 2019 by a national reference laboratory and identified 1,652 patients. Using
data between 1994 and 2018, the birth prevalence (by 100,000 live births) for
MPS was 1.57. MPS II was the most common type of MPS in Brazil, and its birth
prevalence was 0.48 (0.94 considering only male births). Regarding the number of
cases per region, MPS II was the most frequent in the North and Center-West
(followed by MPS VI), and also in the Southeast (followed by MPS I); MPS I and
MPS II were the most common types in the South; and MPS VI was the most common
in the Northeast (followed by MPS II). The differences observed in the relative
frequencies of MPS types across Brazilian regions are likely linked to founder
effect, endogamy, and consanguinity, but other factors may be present and need
further investigation.
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Affiliation(s)
- Juliana Alves Josahkian
- Hospital Universitário de Santa Maria, Unidade de Clínica Médica, Santa Maria, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
| | - Franciele Barbosa Trapp
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Maira Graeff Burin
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Kristiane Michelin-Tirelli
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Ana Paula Pereira Scholz de Magalhães
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Fernanda Medeiros Sebastião
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Fernanda Bender
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Jurema Fátima De Mari
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Ana Carolina Brusius-Facchin
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Sandra Leistner-Segal
- Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil
| | - Diana Rojas Málaga
- Grupo Fleury, Pesquisa e Desenvolvimento - Biologia Molecular, São Paulo, SP, Brazil
| | - Roberto Giugliani
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil.,Rede MPS Brasil, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Grupo de Pesquisa BIODISCOVERY, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Grupo de Pesquisa DRBRASIL, Porto Alegre, RS, Brazil
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Almeida Matos M, Silva Lopes P, Rodrigues Corsini A, Rodi J, Fong CT. Applying the functional independence measure to the assessment of patients with mucopolysaccharidosis. Colomb Med (Cali) 2020; 51:e213996. [PMID: 33402755 PMCID: PMC7744111 DOI: 10.25100/cm.v51i3.3996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To assess the functional independence of a group of patients with mucopolysaccharidosis using the Functional Independence Measure as a tool that accomplishes this purpose. Methods This is a cross-sectional study of patients with mucopolysaccharidosis. Our data was collected between June 2015 and July 2016. In addition to history of present illness and physical examination each study participant was asked to answer a questionnaire to specifically evaluate their functional independence using the functional independence measure. the internal consistency of the functional independence measure was assessed using Cronbach's alpha coefficient. Results We collected data on 20 patients with mucopolysaccharidosis. The average age was 10.8 (8.67-13.03) years, the average weight was 23.6 (19.91-27.37) kg and the average height was 1 (0.83-1.17) m. The most prevalent type of mucopolysaccharidosis in the study was type VI (n= 14). The average total functional independence measure score was 104.4 (97.61-111.19), the average for the mobility domain was 73.50 (68.22-78.78) and the average for the cognitive function domain was 30.90 (28.68-33.13). The internal consistency of the entire questionnaire was 0.859, with values of 0.966 for the mobility domain and 0.624 for the cognitive function domain. Conclusion The lowest functional independence measure scores were obtained in the following sub-domains: self-care, locomotion and cognitive function. The functional independence measure questionnaire demonstrated internal consistency for the evaluation of functional independence in patients with mucopolysaccharidosis, being able to value all the affected sub-domains separately.
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Affiliation(s)
| | | | | | - Julia Rodi
- University of Rochester Medical Center, Rochester-NY, USA
| | - Chin-To Fong
- University of Rochester Medical Center, Rochester-NY, USA
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Kubaski F, de Oliveira Poswar F, Michelin-Tirelli K, Burin MG, Rojas-Málaga D, Brusius-Facchin AC, Leistner-Segal S, Giugliani R. Diagnosis of Mucopolysaccharidoses. Diagnostics (Basel) 2020; 10:E172. [PMID: 32235807 PMCID: PMC7151013 DOI: 10.3390/diagnostics10030172] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/13/2022] Open
Abstract
The mucopolysaccharidoses (MPSs) include 11 different conditions caused by specific enzyme deficiencies in the degradation pathway of glycosaminoglycans (GAGs). Although most MPS types present increased levels of GAGs in tissues, including blood and urine, diagnosis is challenging as specific enzyme assays are needed for the correct diagnosis. Enzyme assays are usually performed in blood, with some samples (as leukocytes) providing a final diagnosis, while others (such as dried blood spots) still being considered as screening methods. The identification of variants in the specific genes that encode each MPS-related enzyme is helpful for diagnosis confirmation (when needed), carrier detection, genetic counseling, prenatal diagnosis (preferably in combination with enzyme assays) and phenotype prediction. Although the usual diagnostic flow in high-risk patients starts with the measurement of urinary GAGs, it continues with specific enzyme assays and is completed with mutation identification; there is a growing trend to have genotype-based investigations performed at the beginning of the investigation. In such cases, confirmation of pathogenicity of the variants identified should be confirmed by measurement of enzyme activity and/or identification and/or quantification of GAG species. As there is a growing number of countries performing newborn screening for MPS diseases, the investigation of a low enzyme activity by the measurement of GAG species concentration and identification of gene mutations in the same DBS sample is recommended before the suspicion of MPS is taken to the family. With specific therapies already available for most MPS patients, and with clinical trials in progress for many conditions, the specific diagnosis of MPS as early as possible is becoming increasingly necessary. In this review, we describe traditional and the most up to date diagnostic methods for mucopolysaccharidoses.
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Affiliation(s)
- Francyne Kubaski
- Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre 91501-970, Brazil; (F.K.); (F.d.O.P.); (D.R.-M.)
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
- INAGEMP, Porto Alegre 90035-903, Brazil
- Biodiscovery Research Group, Experimental Research Center, HCPA, Porto Alegre 90035-903, Brazil
| | - Fabiano de Oliveira Poswar
- Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre 91501-970, Brazil; (F.K.); (F.d.O.P.); (D.R.-M.)
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
| | - Kristiane Michelin-Tirelli
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
- Biodiscovery Research Group, Experimental Research Center, HCPA, Porto Alegre 90035-903, Brazil
| | - Maira Graeff Burin
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
- Biodiscovery Research Group, Experimental Research Center, HCPA, Porto Alegre 90035-903, Brazil
| | - Diana Rojas-Málaga
- Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre 91501-970, Brazil; (F.K.); (F.d.O.P.); (D.R.-M.)
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
| | - Ana Carolina Brusius-Facchin
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
- INAGEMP, Porto Alegre 90035-903, Brazil
- Biodiscovery Research Group, Experimental Research Center, HCPA, Porto Alegre 90035-903, Brazil
- Postgraduate Program in Medicine, Clinical Sciences, UFRGS, Porto Alegre 90035-003, Brazil
| | - Sandra Leistner-Segal
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
- INAGEMP, Porto Alegre 90035-903, Brazil
- Biodiscovery Research Group, Experimental Research Center, HCPA, Porto Alegre 90035-903, Brazil
- Postgraduate Program in Medicine, Clinical Sciences, UFRGS, Porto Alegre 90035-003, Brazil
| | - Roberto Giugliani
- Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre 91501-970, Brazil; (F.K.); (F.d.O.P.); (D.R.-M.)
- Medical Genetics Service, HCPA, Porto Alegre 90035-903, Brazil; (K.M.-T.); (M.G.B.); (A.C.B.-F.); (S.L.-S.)
- INAGEMP, Porto Alegre 90035-903, Brazil
- Biodiscovery Research Group, Experimental Research Center, HCPA, Porto Alegre 90035-903, Brazil
- Postgraduate Program in Medicine, Clinical Sciences, UFRGS, Porto Alegre 90035-003, Brazil
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Michaud M, Belmatoug N, Catros F, Ancellin S, Touati G, Levade T, Gaches F. Mucopolysaccharidoses : quand y penser ? Rev Med Interne 2020; 41:180-188. [DOI: 10.1016/j.revmed.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/08/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
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10
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Le VDM, Simoni P. 4-year-old boy referring for diffuse joint stiffness and progressive bilateral visual impairment. Skeletal Radiol 2019; 48:475-476. [PMID: 30255193 DOI: 10.1007/s00256-018-3077-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Vinh Dat-Minh Le
- "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, 15, Avenue Jean Joseph Crocq, 1020, Brussels, Belgium
| | - Paolo Simoni
- "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, 15, Avenue Jean Joseph Crocq, 1020, Brussels, Belgium.
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Tomanin R, Karageorgos L, Zanetti A, Al-Sayed M, Bailey M, Miller N, Sakuraba H, Hopwood JJ. Mucopolysaccharidosis type VI (MPS VI) and molecular analysis: Review and classification of published variants in the ARSB gene. Hum Mutat 2018; 39:1788-1802. [PMID: 30118150 PMCID: PMC6282714 DOI: 10.1002/humu.23613] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 01/26/2023]
Abstract
Maroteaux–Lamy syndrome (MPS VI) is an autosomal recessive lysosomal storage disorder caused by pathogenic ARSB gene variants, commonly diagnosed through clinical findings and deficiency of the arylsulfatase B (ASB) enzyme. Detection of ARSB pathogenic variants can independently confirm diagnosis and render genetic counseling possible. In this review, we collect and summarize 908 alleles (201 distinct variants, including 3 polymorphisms previously considered as disease‐causing variants) from 478 individuals diagnosed with MPS VI, identified from literature and public databases. Each variant is further analyzed for clinical classification according to American College of Medical Genetics and Genomics (ACMG) guidelines. Results highlight the heterogeneity of ARSB alleles, with most unique variants (59.5%) identified as missense and 31.7% of unique alleles appearing once. Only 18% of distinct variants were previously recorded in public databases with supporting evidence and clinical significance. ACMG recommends publishing clinical and biochemical data that accurately characterize pathogenicity of new variants in association with reporting specific alleles. Variants analyzed were sent to ClinVar (https://www.ncbi.nlm.nih.gov/clinvar/), and MPS VI locus‐specific database (http://mps6-database.org) where they will be available. High clinical suspicion coupled with diagnostic testing for deficient ASB activity and timely submission and classification of ARSB variants with biochemical and clinical data in public databases is essential for timely diagnosis of MPS VI.
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Affiliation(s)
- Rosella Tomanin
- Laboratory of Diagnosis and Therapy of Lysosomal Disorders, Department of Women's and Children's Health, University of Padova and "Fondazione Istituto di Ricerca Pediatrica Città della Speranza", Padova, Italy
| | - Litsa Karageorgos
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Alessandra Zanetti
- Laboratory of Diagnosis and Therapy of Lysosomal Disorders, Department of Women's and Children's Health, University of Padova and "Fondazione Istituto di Ricerca Pediatrica Città della Speranza", Padova, Italy
| | | | - Mitch Bailey
- BioMarin Pharmaceutical Inc., Novato, CA, United States
| | - Nicole Miller
- BioMarin Pharmaceutical Inc., Novato, CA, United States
| | - Hitoshi Sakuraba
- Department of Clinical Genetics, Meiji Pharmaceutical University, Tokyo, Japan
| | - John J Hopwood
- Hopwood Centre for Neurobiology, South Australian Health and Medical Research Institute, Adelaide, Australia
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12
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Peracha H, Sawamoto K, Averill L, Kecskemethy H, Theroux M, Thacker M, Nagao K, Pizarro C, Mackenzie W, Kobayashi H, Yamaguchi S, Suzuki Y, Orii K, Orii T, Fukao T, Tomatsu S. Molecular genetics and metabolism, special edition: Diagnosis, diagnosis and prognosis of Mucopolysaccharidosis IVA. Mol Genet Metab 2018; 125:18-37. [PMID: 29779902 PMCID: PMC6175643 DOI: 10.1016/j.ymgme.2018.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 01/03/2023]
Abstract
Mucopolysaccharidosis IVA (MPS IVA, Morquio A syndrome) is an autosomal recessive disorder caused by the deficiency of N-acetylgalactosamine-6-sulfate sulfatase. Deficiency of this enzyme leads to the accumulation of specific glycosaminoglycans (GAGs), chondroitin-6-sulfate (C6S) and keratan sulfate (KS), which are mainly synthesized in the cartilage. Therefore, the substrates are stored primarily in the cartilage and its extracellular matrix (ECM), leading to a direct impact on bone development and successive systemic skeletal spondylepiphyseal dysplasia. The skeletal-related symptoms for MPS IVA include short stature with short neck and trunk, odontoid hypoplasia, spinal cord compression, tracheal obstruction, obstructive airway, pectus carinatum, restrictive lung, kyphoscoliosis, platyspondyly, coxa valga, genu valgum, waddling gait, and laxity of joints. The degree of imbalance of growth in bone and other organs and tissues largely contributes to unique skeletal dysplasia and clinical severity. Diagnosis of MPS IVA needs clinical, radiographic, and laboratory testing to make a complete conclusion. To diagnose MPS IVA, total urinary GAG analysis which has been used is problematic since the values overlap with those in age-matched controls. Currently, urinary and blood KS and C6S, the enzyme activity of GALNS, and GALNS molecular analysis are used for diagnosis and prognosis of clinical phenotype in MPS IVA. MPS IVA can be diagnosed with unique characters although this disorder relates closely to other disorders in some characteristics. In this review article, we comprehensively describe clinical, radiographic, biochemical, and molecular diagnosis and clinical assessment tests for MPS IVA. We also compare MPS IVA to other closely related disorders to differentiate MPS IVA. Overall, imbalance of growth in MPS IVA patients underlies unique skeletal manifestations leading to a critical indicator for diagnosis.
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Affiliation(s)
- Hira Peracha
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Biological Sciences, University of Delaware, Newark, DE, United States
| | - Kazuki Sawamoto
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Lauren Averill
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Heidi Kecskemethy
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Mary Theroux
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States
| | - Mihir Thacker
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - Kyoko Nagao
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Linguistics and Cognitive Science, University of Delaware, Newark, DE, United States; College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Christian Pizarro
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | - William Mackenzie
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States
| | | | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University, Shimane, Japan
| | - Yasuyuki Suzuki
- Medical Education Development Center, Gifu University, Japan
| | - Kenji Orii
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Tadao Orii
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Toshiyuki Fukao
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Shunji Tomatsu
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, United States; Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, United States; Department of Pediatrics, Shimane University, Shimane, Japan; Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan.
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13
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Hinderer C, Katz N, Louboutin JP, Bell P, Tolar J, Orchard PJ, Lund TC, Nayal M, Weng L, Mesaros C, de Souza CFM, Dalla Corte A, Giugliani R, Wilson JM. Abnormal polyamine metabolism is unique to the neuropathic forms of MPS: potential for biomarker development and insight into pathogenesis. Hum Mol Genet 2018; 26:3837-3849. [PMID: 28934395 DOI: 10.1093/hmg/ddx277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/11/2017] [Indexed: 12/20/2022] Open
Abstract
The mucopolysaccharidoses (MPS) are rare genetic disorders marked by severe somatic and neurological symptoms. Development of treatments for the neurological manifestations of MPS has been hindered by the lack of objective measures of central nervous system disease burden. Identification of biomarkers for central nervous system disease in MPS patients would facilitate the evaluation of new agents in clinical trials. High throughput metabolite screening of cerebrospinal fluid (CSF) samples from a canine model of MPS I revealed a marked elevation of the polyamine, spermine, in affected animals, and gene therapy studies demonstrated that reduction of CSF spermine reflects correction of brain lesions in these animals. In humans, CSF spermine was elevated in neuropathic subtypes of MPS (MPS I, II, IIIA, IIIB), but not in subtypes in which cognitive function is preserved (MPS IVA, VI). In MPS I patients, elevated CSF spermine was restricted to patients with genotypes associated with CNS disease and was reduced following hematopoietic stem cell transplantation, which is the only therapy currently capable of improving cognitive outcomes. Additional studies in cultured neurons from MPS I mice showed that elevated spermine was essential for the abnormal neurite overgrowth exhibited by MPS neurons. These findings offer new insights into the pathogenesis of CNS disease in MPS patients, and support the use of spermine as a new biomarker to facilitate the development of next generation therapeutics for MPS.
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Affiliation(s)
- Christian Hinderer
- Gene Therapy Program, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nathan Katz
- Gene Therapy Program, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jean-Pierre Louboutin
- Section of Anatomy, Department of Basic Medical Sciences, University of the West Indies, Kingston, Jamaica
| | - Peter Bell
- Gene Therapy Program, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jakub Tolar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Paul J Orchard
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Troy C Lund
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Mohamad Nayal
- Gene Therapy Program, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Liwei Weng
- Department of Pharmacology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Clementina Mesaros
- Department of Pharmacology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Carolina F M de Souza
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, RS Porto Alegre 90035-903, Brazil
| | - Amauri Dalla Corte
- Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, RS Porto Alegre 90035-903, Brazil.,Post-Graduate Course in Medical Sciences, UFRGS, Porto Alegre, RS 90035-003, Brazil
| | - Roberto Giugliani
- Medical Genetics Service, HCPA.,Post-Graduate Course in Medical Sciences, UFRGS, Porto Alegre, RS 90035-003, Brazil
| | - James M Wilson
- Gene Therapy Program, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Vairo FP, Boczek NJ, Cousin MA, Kaiwar C, Blackburn PR, Conboy E, Lanpher BC, Gavrilova RH, Pichurin PN, Lazaridis KN, Babovic-Vuksanovic D, Klee EW. The prevalence of diseases caused by lysosome-related genes in a cohort of undiagnosed patients. Mol Genet Metab Rep 2017; 13:46-51. [PMID: 28831385 PMCID: PMC5554961 DOI: 10.1016/j.ymgmr.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023] Open
Abstract
Lysosomal diseases (LD) comprise a group of approximately 60 hereditary conditions caused by progressive accumulation of metabolites due to defects in lysosomal enzymes and degradation pathways, which lead to a wide range of clinical manifestations. The estimated combined incidence of LD is between 1 in 4000 to 1 in 13,000 live births, with recent data from pilot newborn screening studies showing even higher incidence. We aimed to determine the prevalence of the classical LD and other diseases caused by lysosome-related genes in our cohort of diagnostic odyssey patients. The Individualized Medicine Clinic at Mayo Clinic is increasingly utilizing whole exome sequencing (WES) to determine the genetic etiology of undiagnosed Mendelian disease. From September 2012 to April 2017, WES results from 350 patients with unexplained symptoms were reviewed. Disease-causing variants were identified in MYO6, CLN6, LRBA, KCTD7, and ARSB revealing a genetic diagnosis of a LD in 8 individuals from 5 families. Based on our findings, lysosome-related disorders may be collectively common, reaching up to 1.5% prevalence in a cohort of patients with undiagnosed diseases presenting to a genetics clinic.
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Affiliation(s)
- Filippo Pinto Vairo
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Nicole J. Boczek
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Margot A. Cousin
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Charu Kaiwar
- Center for Individualized Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Patrick R. Blackburn
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Erin Conboy
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Brendan C. Lanpher
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Ralitza H. Gavrilova
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Pavel N. Pichurin
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Konstantinos N. Lazaridis
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Dusica Babovic-Vuksanovic
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Eric W. Klee
- Center for Individualized Medicine, Health Sciences Research, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Biomedical Informatics, Mayo Clinic, Rochester, MN, USA
- Corresponding author at: 200 First Street SW, Rochester, MN, 55905, USA.200 First Street SWRochesterMN55905USA
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15
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Colón C, Alvarez JV, Castaño C, Gutierrez-Solana LG, Marquez AM, O’Callaghan M, Sánchez-Valverde F, Yeste C, Couce ML. A selective screening program for the early detection of mucopolysaccharidosis: Results of the FIND project - a 2-year follow-up study. Medicine (Baltimore) 2017; 96:e6887. [PMID: 28489793 PMCID: PMC5428627 DOI: 10.1097/md.0000000000006887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 12/04/2022] Open
Abstract
The mucopolysaccharidoses (MPSs) are underdiagnosed but they are evaluated in few newborn screening programs, probably due to the many challenges remaining, such as the identification of late-onset phenotypes. Systematic screening at the onset of clinical symptoms could help to early identify patients who may benefit from specific treatments. The aim of this prospective study was to assess a novel selective screening program, the FIND project, targeting patients aged 0 to 16 years with clinical manifestations of MPS. The project was designed to increase awareness of these diseases among pediatricians and allow early diagnosis.From July 2014 to June 2016, glycosaminoglycan (GAG) levels normalized to creatinine levels were determined in urine-impregnated analytical paper submitted by pediatricians who had patients with clinical signs and/or symptoms compatible with MPS. When high GAG concentrations were detected, a new liquid urine sample was requested to confirm and identify the GAG present. When a specific form of MPS was suspected, enzyme activity was analyzed using blood-impregnated paper to determine MPS type (I, IIIB, IIIC, IVA, IVB, VI, or VII). Age-specific reference values for GAG were previously established using 145 urine samples from healthy children.GAG levels were normal in 147 (81.7%) of the 180 initial samples received. A liquid sample was requested for the other 33 cases (18.3%); GAG levels were normal in 13 of these and slightly elevated in 12, although the electrophoresis study showed no evidence of MPS. Elevated levels with corresponding low enzymatic activity were confirmed in 8 cases. The mean time from onset of clinical symptoms to detection of MPS was 22 months, and just 2 cases were detected at the beginning of the project were detected with 35 and 71 months of evolution of clinical symptoms. Our screening strategy for MPS had a sensitivity of 100%, a specificity of 85%, and a positive predictive value of 24%.The FIND project is a useful and cost-effective screening method for increasing awareness of MPS among pediatricians and enabling the detection of MPS at onset of clinical symptoms.
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Affiliation(s)
- Cristóbal Colón
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Service of Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela
| | - J. Victor Alvarez
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Service of Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela
| | | | - Luís G. Gutierrez-Solana
- Section of Pediatric Neurology, Service of Pediatrics, Hospital Infantil Universitario Niño Jesús, CIBERER, Madrid
| | - Ana M. Marquez
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Service of Pediatrics Gastroenterology, Department of Pediatrics, Hospital Materno Infantil de Badajoz
| | - María O’Callaghan
- Department of Neuropaediatrics, Hospital Sant Joan de Déu, Esplugues, Barcelona
| | | | - Carmen Yeste
- Department of Pediatrics, Hospital Costa del Sol de Marbella, Spain
| | - María-Luz Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Service of Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela
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