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Anaesthesia-Relevant Disease Manifestations and Perianaesthetic Complications in Patients with Mucolipidosis—A Retrospective Analysis of 44 Anaesthetic Cases in 12 Patients. J Clin Med 2022; 11:jcm11133650. [PMID: 35806935 PMCID: PMC9267794 DOI: 10.3390/jcm11133650] [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: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
Mucolipidosis (ML) type II, intermediate, and III are lysosomal storage disorders with progressive multiorgan manifestations predisposing patients to a high risk of perioperative morbidity. The aims of the study were to systematically assess disease manifestations relevant to anaesthesia as well as anaesthesia-related complications. This retrospective study includes ML patients who underwent anaesthesia in two centres between 2008 and 2022. We reviewed patients’ demographics, medical history, disease manifestations, as well as procedure- and outcome-related data. A total of 12 patients (7 MLII, 2 ML intermediate, 3 MLIII) underwent 44 anaesthesia procedures (per patient: median 3, range 1–11). The median age was 3.3 years (range 0.1–19.1). At least one complication occurred in 27.3% of the anaesthesia procedures. The vast majority of complications (94%) occurred in children with MLII and ML intermediate. A predicted difficult airway was found in 100% and 80% of the MLII and ML intermediate patients, respectively. Accordingly, most complications (59%) occurred during the induction of anaesthesia. Altogether, respiratory complications were the most frequent (18%), followed by difficult airway management (14%). The risk for anaesthesia-related complications is alarmingly high in patients with ML, particularly in those with MLII and ML intermediate. Multidisciplinary risk–benefit analysis and thoughtful anaesthesia planning are crucial in these patients.
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Nakaoka S, Kondo H, Matsuoka K, Shibuya T, Otomo T, Hamada Y, Sakamoto K, Ozono K, Sakai N. Mucolipidosis Ⅱ and III with neurological symptoms due to spinal cord compression. Brain Dev 2021; 43:867-872. [PMID: 33965289 DOI: 10.1016/j.braindev.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
In mucopolysaccharidoses (MPS), spinal cord compression (SCC) resulting from glycosaminoglycan (GAG) accumulation is a critical complication that can cause significant neurological and respiratory morbidities. However, clinically similar disorders such as mucolipidosis types II and III (ML) with SCC have been scarcely reported. Herein, we report four patients with ML who had SCC. Brain MRI revealed progressive spinal canal stenosis and SCC. In addition, T2-weighted high signal changes in the cervical cord were detected in two cases. Severe cases of SCC were detected as early as 1 year of age. All cases had respiratory problems. One case showed severe hypoxia and another, severe sleep apnea. In two cases, respiratory insufficiency and tetraplegia rapidly progressed as SCC progressed. Then, the patients became bedridden and needed artificial ventilation. In addition, two of the four patients died of respiratory failure. The autopsy of one patient revealed a compressed cervical cord and marked dura mater thickening due to GAG accumulation. These findings suggest that the accumulation of substrates in the dura mater caused SCC in the patients with ML. Our cases indicate that SCC is expected to be a common and critical complication of ML and MPS. MRI evaluation of cervical involvements and careful clinical observation are required in patients with ML.
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Affiliation(s)
- Sachiko Nakaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Pediatrics, Faculty of Medicine, University of Toyama, Japan
| | - Hidehito Kondo
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Pediatrics and Neonatology, Japanese Red Cross Kyoto Daiichi Hospital, Japan.
| | - Keiko Matsuoka
- Department of Pathology, Osaka Women's and Children's Hospital, Japan
| | - Toko Shibuya
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan
| | - Takanobu Otomo
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Molecular and Genetic Medicine, Kawasaki Medical School, Japan
| | - Yusuke Hamada
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Department of Pediatrics, Toyonaka Municipal Hospital, Japan
| | - Kenichi Sakamoto
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan
| | - Norio Sakai
- Department of Pediatrics, Osaka University Graduate School of Medicine, Japan; Child Healthcare and Genetic Science Laboratory, Division of Health Sciences, Osaka University Graduate School of Medicine, Japan
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Mucolipidoses Overview: Past, Present, and Future. Int J Mol Sci 2020; 21:ijms21186812. [PMID: 32957425 PMCID: PMC7555117 DOI: 10.3390/ijms21186812] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022] Open
Abstract
Mucolipidosis II and III (ML II/III) are caused by a deficiency of uridine-diphosphate N-acetylglucosamine: lysosomal-enzyme-N-acetylglucosamine-1-phosphotransferase (GlcNAc-1-phosphotransferase, EC2.7.8.17), which tags lysosomal enzymes with a mannose 6-phosphate (M6P) marker for transport to the lysosome. The process is performed by a sequential two-step process: first, GlcNAc-1-phosphotransferase catalyzes the transfer of GlcNAc-1-phosphate to the selected mannose residues on lysosomal enzymes in the cis-Golgi network. The second step removes GlcNAc from lysosomal enzymes by N-acetylglucosamine-1-phosphodiester α-N-acetylglucosaminidase (uncovering enzyme) and exposes the mannose 6-phosphate (M6P) residues in the trans-Golgi network, in which the enzymes are targeted to the lysosomes by M6Preceptors. A deficiency of GlcNAc-1-phosphotransferase causes the hypersecretion of lysosomal enzymes out of cells, resulting in a shortage of multiple lysosomal enzymes within lysosomes. Due to a lack of GlcNAc-1-phosphotransferase, the accumulation of cholesterol, phospholipids, glycosaminoglycans (GAGs), and other undegraded substrates occurs in the lysosomes. Clinically, ML II and ML III exhibit quite similar manifestations to mucopolysaccharidoses (MPSs), including specific skeletal deformities known as dysostosis multiplex and gingival hyperplasia. The life expectancy is less than 10 years in the severe type, and there is no definitive treatment for this disease. In this review, we have described the updated diagnosis and therapy on ML II/III.
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Tabone L, Caillaud C, Amaddeo A, Khirani S, Michot C, Couloigner V, Brassier A, Cormier-Daire V, Baujat G, Fauroux B. Sleep-disordered breathing in children with mucolipidosis. Am J Med Genet A 2019; 179:1196-1204. [PMID: 31038846 DOI: 10.1002/ajmg.a.61167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/01/2019] [Accepted: 04/07/2019] [Indexed: 11/06/2022]
Abstract
Mucolipidosis (ML) is a rare lysosomal storage disorder with a wide spectrum of disease severity according to the type. Sleep-disordered breathing is recognized as a characteristic feature of ML but objective data are scarce. The aim of the study was to describe sleep data and medical management in children with ML α/β. All patients with ML α/β followed at a national reference center of ML were included. Five patients had ML II, one patient had ML III and one patient had ML II-III. One patient was started on noninvasive ventilation (NIV) to allow extubation after prolonged invasive mechanical ventilation. The six other patients underwent sleep study at a median age of 1.8 years (range 4 months-17.4 years). Obstructive sleep apnea (OSA) was observed in all patients with a median apnea-hypopnea index (AHI) of 36 events/hr (range 5-52) requiring continuous positive airway pressure (CPAP) or NIV. CPAP/NIV resulted in an improvement of nocturnal gas exchange and was continued in all patients with an excellent compliance. Two patients died. Systematic sleep studies are recommended at time of diagnosis in ML. CPAP or NIV are effective treatments of OSA, well tolerated, and may contribute to improve the quality of life of patients and caregivers.
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Affiliation(s)
| | - Catherine Caillaud
- AP-HP, Hôpital Necker Enfants-Malades, Biochemical, Metabolomical and Proteonomical Departement, Institut Imagine, INSERM U1151, Paris, France
| | - Alessandro Amaddeo
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,EA 7330 VIFASOM (Vigilance, Fatigue, Sommeil et Santé Publique), Paris Descartes University, Paris, France
| | - Sonia Khirani
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,EA 7330 VIFASOM (Vigilance, Fatigue, Sommeil et Santé Publique), Paris Descartes University, Paris, France.,ASV Santé, Gennevilliers, France
| | - Caroline Michot
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Departement, Centre of Reference for Skeletal Dysplasia, INSERM UMR 1163, University Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Vincent Couloigner
- AP-HP, Hôpital Necker-Enfants malades, Head and Neck Surgery and Otorhinolaryngology Department, Paris, France
| | - Anais Brassier
- Reference Center for Inherited Metabolic Disease (MeMEA) and Institut Imagine, Hôpital Necker Enfants-Malades, Paris, France
| | - Valerie Cormier-Daire
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Departement, Centre of Reference for Skeletal Dysplasia, INSERM UMR 1163, University Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Geneviève Baujat
- AP-HP, Hôpital Necker-Enfants Malades, Genetics Departement, Centre of Reference for Skeletal Dysplasia, INSERM UMR 1163, University Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Brigitte Fauroux
- AP-HP, Hôpital Necker Enfants-Malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,EA 7330 VIFASOM (Vigilance, Fatigue, Sommeil et Santé Publique), Paris Descartes University, Paris, France
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