1
|
Mistry PK, Kishnani PS, Balwani M, Charrow JM, Hull J, Weinreb NJ, Cox TM. The Two Substrate Reduction Therapies for Type 1 Gaucher Disease Are Not Equivalent. Comment on Hughes et al. Switching between Enzyme Replacement Therapies and Substrate Reduction Therapies in Patients with Gaucher Disease: Data from the Gaucher Outcome Survey (GOS). J. Clin. Med. 2022, 11, 5158. J Clin Med 2023; 12:jcm12093269. [PMID: 37176709 PMCID: PMC10179580 DOI: 10.3390/jcm12093269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 05/15/2023] Open
Abstract
In their paper, Hughes et al. [...].
Collapse
Affiliation(s)
- Pramod K Mistry
- Department of Medicine, Pediatrics, and Cellular & Molecular Physiology, Yale University School of Medicine, 20 York Street, New Haven, CT 06510, USA
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
| | - Manisha Balwani
- Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Joel M Charrow
- Division of Genetics, Genomics, and Metabolism, Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Judy Hull
- Gaucher Disease, US Medical Affairs, Sanofi, Cambridge, MA 02141, USA
| | - Neal J Weinreb
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL 33433, USA
| | - Timothy M Cox
- Lysosomal Disorders Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| |
Collapse
|
2
|
Fan J, Hale VL, Lelieveld LT, Whitworth LJ, Busch-Nentwich EM, Troll M, Edelstein PH, Cox TM, Roca FJ, Aerts JMFG, Ramakrishnan L. Gaucher disease protects against tuberculosis. Proc Natl Acad Sci U S A 2023; 120:e2217673120. [PMID: 36745788 PMCID: PMC7614233 DOI: 10.1073/pnas.2217673120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/31/2022] [Indexed: 02/08/2023] Open
Abstract
Biallelic mutations in the glucocerebrosidase (GBA1) gene cause Gaucher disease, characterized by lysosomal accumulation of glucosylceramide and glucosylsphingosine in macrophages. Gaucher and other lysosomal diseases occur with high frequency in Ashkenazi Jews. It has been proposed that the underlying mutations confer a selective advantage, in particular conferring protection against tuberculosis. Here, using a zebrafish Gaucher disease model, we find that the mutation GBA1 N370S, predominant among Ashkenazi Jews, increases resistance to tuberculosis through the microbicidal activity of glucosylsphingosine in macrophage lysosomes. Consistent with lysosomal accumulation occurring only in homozygotes, heterozygotes remain susceptible to tuberculosis. Thus, our findings reveal a mechanistic basis for protection against tuberculosis by GBA1 N370S and provide biological plausibility for its selection if the relatively mild deleterious effects in homozygotes were offset by significant protection against tuberculosis, a rampant killer of the young in Europe through the Middle Ages into the 19th century.
Collapse
Affiliation(s)
- Jingwen Fan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| | | | - Lindsey T. Lelieveld
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University2333 CC, Leiden, The Netherlands
| | - Laura J. Whitworth
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| | - Elisabeth M. Busch-Nentwich
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- School of Biological and Behavioral Sciences, Queen Mary University of London, LondonE1 4NS, UK
| | - Mark Troll
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| | - Paul H. Edelstein
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PhiladelphiaPA19104
| | - Timothy M. Cox
- Department of Medicine, University of Cambridge, CambridgeCB2 0QQ, UK
| | - Francisco J. Roca
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- Department of Biochemistry and Molecular Biology B and Immunology, University of Murcia, Murcia30120, Spain
- Biomedical Research Institute of Murcia Pascual Parrilla (IMIB-Arrixaca), Murcia30120, Spain
| | - Johannes M. F. G. Aerts
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University2333 CC, Leiden, The Netherlands
| | - Lalita Ramakrishnan
- Molecular Immunity Unit, Cambridge Institute of Therapeutic Immunology and Infectious Diseases, Department of Medicine, University of Cambridge, CambridgeCB2 0QH, UK
- MRC Laboratory of Molecular Biology, CambridgeCB2 0QH, UK
| |
Collapse
|
3
|
Schiffmann R, Cox TM, Dedieu JF, Gaemers SJM, Hennermann JB, Ida H, Mengel E, Minini P, Mistry P, Musholt PB, Scott D, Sharma J, Peterschmitt MJ. Venglustat combined with imiglucerase for neurological disease in adults with Gaucher disease type 3: the LEAP trial. Brain 2023; 146:461-474. [PMID: 36256599 PMCID: PMC9924909 DOI: 10.1093/brain/awac379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/15/2022] [Accepted: 09/11/2022] [Indexed: 11/14/2022] Open
Abstract
Gaucher disease type 3 is a chronic neuronopathic disorder with wide-ranging effects, including hepatosplenomegaly, anaemia, thrombocytopenia, skeletal disease and diverse neurological manifestations. Biallelic mutations in GBA1 reduce lysosomal acid β-glucosidase activity, and its substrates, glucosylceramide and glucosylsphingosine, accumulate. Enzyme replacement therapy and substrate reduction therapy ameliorate systemic features of Gaucher disease, but no therapies are approved for neurological manifestations. Venglustat is an investigational, brain-penetrant, glucosylceramide synthase inhibitor with potential to improve the disease by rebalancing influx of glucosylceramide with impaired lysosomal recycling. The Phase 2, open-label LEAP trial (NCT02843035) evaluated orally administered venglustat 15 mg once-daily in combination with maintenance dose of imiglucerase enzyme replacement therapy during 1 year of treatment in 11 adults with Gaucher disease type 3. Primary endpoints were venglustat safety and tolerability and change in concentration of glucosylceramide and glucosylsphingosine in CSF from baseline to Weeks 26 and 52. Secondary endpoints included change in plasma concentrations of glucosylceramide and glucosylsphingosine, venglustat pharmacokinetics in plasma and CSF, neurologic function, infiltrative lung disease and systemic disease parameters. Exploratory endpoints included changes in brain volume assessed with volumetric MRI using tensor-based morphometry, and resting functional MRI analysis of regional brain activity and connectivity between resting state networks. Mean (SD) plasma venglustat AUC0-24 on Day 1 was 851 (282) ng•h/ml; Cmax of 58.1 (26.4) ng/ml was achieved at a median tmax 2.00 h. After once-daily venglustat, plasma concentrations (4 h post-dose) were higher compared with Day 1, indicating ∼2-fold accumulation. One participant (Patient 9) had low-to-undetectable venglustat exposure at Weeks 26 and 52. Based on mean plasma and CSF venglustat concentrations (excluding Patient 9), steady state appeared to be reached on or before Week 4. Mean (SD) venglustat concentration at Week 52 was 114 (65.8) ng/ml in plasma and 6.14 (3.44) ng/ml in CSF. After 1 year of treatment, median (inter-quartile range) glucosylceramide decreased 78% (72, 84) in plasma and 81% (77, 83) in CSF; median (inter-quartile range) glucosylsphingosine decreased 56% (41, 60) in plasma and 70% (46, 76) in CSF. Ataxia improved slightly in nine patients: mean (SD, range) total modified Scale for Assessment and Rating of Ataxia score decreased from 2.68 [1.54 (0.0 to 5.5)] at baseline to 1.55 [1.88 (0.0 to 5.0)] at Week 52 [mean change: -1.14 (95% CI: -2.06 to -0.21)]. Whole brain volume increased slightly in patients with venglustat exposure and biomarker reduction in CSF (306.7 ± 4253.3 mm3) and declined markedly in Patient 9 (-13894.8 mm3). Functional MRI indicated stronger connectivity at Weeks 26 and 52 relative to baseline between a broadly distributed set of brain regions in patients with venglustat exposure and biomarker reduction but not Patient 9, although neurocognition, assessed by Vineland II, deteriorated in all domains over time, which illustrates disease progression despite the intervention. There were no deaths, serious adverse events or discontinuations. In adults with Gaucher disease type 3 receiving imiglucerase, addition of once-daily venglustat showed acceptable safety and tolerability and preliminary evidence of clinical stability with intriguing but intrinsically inconsistent signals in selected biomarkers, which need to be validated and confirmed in future research.
Collapse
Affiliation(s)
- Raphael Schiffmann
- Correspondence to: Raphael Schiffmann, MD, MHSc, FAAN Texas Neurology 6080 N Central Expy, Ste 100, Dallas, TX 75246, USA E-mail:
| | - Timothy M Cox
- Department of Medicine, University of Cambridge and Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | | | | | - Julia B Hennermann
- Center for Pediatric and Adolescent Medicine Villa Metabolica, University Medical Center Mainz, 55131 Mainz, Germany
| | - Hiroyuki Ida
- Department of Pediatrics, The Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Eugen Mengel
- Center for Pediatric and Adolescent Medicine Villa Metabolica, University Medical Center Mainz, 55131 Mainz, Germany
- Clinical Science for LSD, SphinCS, 65239 Hochheim, Germany
| | - Pascal Minini
- Biostatistics and Programming, Sanofi, 91385 Chilly-Mazarin, France
| | - Pramod Mistry
- Yale Lysosomal Disease Center and Gaucher Disease Treatment Center, Yale School of Medicine, New Haven, CT 06510, USA
| | | | - David Scott
- Medical and Scientific Affairs, Neuroscience, Clario, San Mateo, CA 94404, USA
| | - Jyoti Sharma
- Pharmacokinetics, Dynamics and Metabolism, Sanofi, Bridgewater, NJ 08807, USA
| | | |
Collapse
|
4
|
D'Amore S, Sano H, Chappell DDG, Chiarugi D, Baker O, Page K, Ramaswami U, Johannesdottir F, Cox TM, Deegan P, Poole KE, Banka S, Chakrapani A, Deegan PB, Geberhiwot T, Hughes DA, Jones S, Lachmann RH, Santra S, Sharma R, Vellodi A. Radiographic Cortical Thickness Index Predicts Fragility Fracture in Gaucher Disease. Radiology 2022; 307:e212779. [PMID: 36537898 PMCID: PMC7614382 DOI: 10.1148/radiol.212779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Patients with Gaucher disease (GD) have a high risk of fragility fractures. Routine evaluation of bone involvement in these patients includes radiography and repeated dual-energy x-ray absorptiometry (DXA). However, osteonecrosis and bone fracture may affect the accuracy of DXA. Purpose To assess the utility of DXA and radiographic femoral cortical thickness measurements as predictors of fragility fracture in patients with GD with long-term follow-up (up to 30 years). Materials and Methods Patients with GD age 16 years and older with a detailed medical history, at least one bone image (DXA and/or radiographs), and minimum 2 years follow-up were retrospectively identified using three merged UK-based registries (Gaucherite study, enrollment 2015-2017; Clinical Bone Registry, enrollment 2003-2006; and Mortality Registry, enrollment 1993-2019). Cortical thickness index (CTI) and canal-to-calcar ratio (CCR) were measured by two independent observers, and inter- and intraobserver reliability was calculated. The fracture-predictive value of DXA, CTI, CCR, and cutoff values were calculated using receiver operating characteristic curves. Statistical differences were assessed using univariable and multivariable analysis. Results Bone imaging in 247 patients (123 men, 124 women; baseline median age, 39 years; IQR, 27-50 years) was reviewed. The median follow-up period was 11 years (IQR, 7-19 years; range, 2-30 years). Thirty-five patients had fractures before or at first bone imaging, 23 patients had fractures after first bone imaging, and 189 patients remained fracture-free. Inter- and intraobserver reproducibility for CTI/CCR measurements was substantial (range, 0.96-0.98). In the 212 patients with no baseline fracture, CTI (cutoff, ≤0.50) predicted future fractures with higher sensitivity and specificity (area under the receiver operating characteristic curve [AUC], 0.96; 95% CI: 0.84, 0.99; sensitivity, 92%; specificity, 96%) than DXA T-score at total hip (AUC, 0.78; 95% CI: 0.51, 0.91; sensitivity, 64%; specificity, 93%), femoral neck (AUC, 0.73; 95% CI: 0.50, 0.86; sensitivity, 64%; specificity, 73%), lumbar spine (AUC, 0.69; 95% CI: 0.49, 0.82; sensitivity, 57%; specificity, 63%), and forearm (AUC, 0.78; 95% CI: 0.59, 0.89; sensitivity, 70%; specificity, 70%). Conclusion Radiographic cortical thickness index of 0.50 or less was a reliable independent predictor of fracture risk in Gaucher disease. Clinical trial registration no. NCT03240653 © RSNA, 2022 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Simona D'Amore
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Hiroshige Sano
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Daniel David George Chappell
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Davide Chiarugi
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Olivia Baker
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Kathleen Page
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Uma Ramaswami
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Fjola Johannesdottir
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Timothy M Cox
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Patrick Deegan
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | - Kenneth E Poole
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | -
- From the Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge CB2 0QQ, UK (S.D., H.S., D.D.G.C., O.B., K.P., F.J., T.M.C., P.D., K.E.P.); The Wellcome-MRC Institute of Metabolic Science-Metabolic Research Laboratories, Cambridge, UK (D.C.); and Royal Free London NHS Foundation Trust, London, UK (U.R.)
| | | | | | | | | | | | | | | | - Robin H. Lachmann
- National Hospital for Neurology and Neurosurgery, Queen’s Square London
| | | | | | | | | |
Collapse
|
5
|
Cachón-González MB, Zhao C, Franklin RJ, Cox TM. Upregulation of non-canonical and canonical inflammasome genes associates with pathological features in Krabbe disease and related disorders. Hum Mol Genet 2022; 32:1361-1379. [PMID: 36519759 PMCID: PMC10077509 DOI: 10.1093/hmg/ddac299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Abstract
Infantile Krabbe disease is a rapidly progressive and fatal disorder of myelin, caused by inherited deficiency of the lysosomal enzyme β-galactocerebrosidase. Affected children lose their motor skills and other faculties; uncontrolled seizures are a frequent terminal event. Overexpression of the sphingolipid metabolite psychosine is a pathogenic factor, but does not fully account for the pleiotropic manifestations and there is a clear need to investigate additional pathological mechanisms. We examined innate immunity, caspase-11 and associated inflammatory pathways in twitcher mice, an authentic model of Krabbe disease. Combined use of molecular tools, RNAscope in situ hybridization and immunohistochemical staining established that the expression of pro-inflammatory non-canonical caspase-11, canonical caspase-1, gasdermin D and cognate genes is induced in nervous tissue. Early onset and progressive upregulation of these genes accompanies demyelination and gliosis and while the molecules are scant in healthy tissue, abundance of the respective translation products is greatly increased in diseased animals. Caspase-11 is found in reactive microglia/macrophages as well as astrocytes but caspase-1 and gasdermin D are restricted to reactive microglia/macrophages. The inflammasome signature is not unique to Krabbe disease; to varying degrees, this signature is also prominent in other lysosomal diseases, Sandhoff and Niemann-Pick Type-C1, and the lysolecithin toxin model of focal demyelination. Given the potent inflammatory response here identified in Krabbe disease and the other neurodegenerative disorders studied, a broad induction of inflammasomes is likely to be a dominant factor in the pathogenesis, and thus represents a platform for therapeutic exploration.
Collapse
Affiliation(s)
- María B Cachón-González
- Department of Medicine , University of Cambridge, Level 5, PO Box 157, Cambridge CB2 0QQ , UK
| | - Chao Zhao
- Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute , University of Cambridge, Cambridge , UK
- Department of Clinical Neurosciences , University of Cambridge, Cambridge , UK
| | - Robin J Franklin
- Wellcome Trust-Medical Research Council Cambridge Stem Cell Institute , University of Cambridge, Cambridge , UK
- Department of Clinical Neurosciences , University of Cambridge, Cambridge , UK
| | - Timothy M Cox
- Department of Medicine , University of Cambridge, Level 5, PO Box 157, Cambridge CB2 0QQ , UK
| |
Collapse
|
6
|
Pavlova EV, Lev D, Michelson M, Yosovich K, Michaeli HG, Bright NA, Manna PT, Dickson VK, Tylee KL, Church HJ, Luzio JP, Cox TM. Juvenile mucopolysaccharidosis plus disease caused by a missense mutation in VPS33A. Hum Mutat 2022; 43:2265-2278. [PMID: 36153662 PMCID: PMC10091966 DOI: 10.1002/humu.24479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 01/25/2023]
Abstract
A rare and fatal disease resembling mucopolysaccharidosis in infants, is caused by impaired intracellular endocytic trafficking due to deficiency of core components of the intracellular membrane-tethering protein complexes, HOPS, and CORVET. Whole exome sequencing identified a novel VPS33A mutation in a patient suffering from a variant form of mucopolysaccharidosis. Electron and confocal microscopy, immunoblotting, and glycosphingolipid trafficking experiments were undertaken to investigate the effects of the mutant VPS33A in patient-derived skin fibroblasts. We describe an attenuated juvenile form of VPS33A-related syndrome-mucopolysaccharidosis plus in a man who is homozygous for a hitherto unknown missense mutation (NM_022916.4: c.599 G>C; NP_075067.2:p. Arg200Pro) in a conserved region of the VPS33A gene. Urinary glycosaminoglycan (GAG) analysis revealed increased heparan, dermatan sulphates, and hyaluronic acid. We showed decreased abundance of VPS33A in patient derived fibroblasts and provided evidence that the p.Arg200Pro mutation leads to destablization of the protein and proteasomal degradation. As in the infantile form of mucopolysaccharidosis plus, the endocytic compartment in the fibroblasts also expanded-a phenomenon accompanied by increased endolysosomal acidification and impaired intracellular glycosphingolipid trafficking. Experimental treatment of the patient's cultured fibroblasts with the proteasome inhibitor, bortezomib, or exposure to an inhibitor of glucosylceramide synthesis, eliglustat, improved glycosphingolipid trafficking. To our knowledge this is the first report of an attenuated juvenile form of VPS33A insufficiency characterized by appreciable residual endosomal-lysosomal trafficking and a milder mucopolysaccharidosis plus than the disease in infants. Our findings expand the proof of concept of redeploying clinically approved drugs for therapeutic exploitation in patients with juvenile as well as infantile forms of mucopolysaccharidosis plus disease.
Collapse
Affiliation(s)
- Elena V Pavlova
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Dorit Lev
- Wolfson Medical Centre, Institute of Medical Genetics, Holon, Israel.,The Rina Mor Institute of Medical Genetics, Holon, Israel.,The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Michelson
- Wolfson Medical Centre, Institute of Medical Genetics, Holon, Israel
| | - Keren Yosovich
- Wolfson Medical Centre, Institute of Medical Genetics, Holon, Israel
| | - Hila Gur Michaeli
- Wolfson Medical Centre, Institute of Medical Genetics, Holon, Israel
| | - Nicholas A Bright
- Department of Clinical Biochemistry, Cambridge Institute for Medical Research, The Keith Peters Building, University of Cambridge, Cambridge, UK
| | - Paul T Manna
- Department of Clinical Biochemistry, Cambridge Institute for Medical Research, The Keith Peters Building, University of Cambridge, Cambridge, UK.,Department of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Veronica Kane Dickson
- Department of Clinical Biochemistry, Cambridge Institute for Medical Research, The Keith Peters Building, University of Cambridge, Cambridge, UK
| | - Karen L Tylee
- Willink Biochemical Genetics Unit, Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust St Mary's Hospital, Manchester, UK
| | - Heather J Church
- Willink Biochemical Genetics Unit, Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust St Mary's Hospital, Manchester, UK
| | - J Paul Luzio
- Department of Clinical Biochemistry, Cambridge Institute for Medical Research, The Keith Peters Building, University of Cambridge, Cambridge, UK
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
7
|
Cox TM, Tylki-Szymańska A, Aymé S, Dooms M. Editorial: Prevention, diagnosis and treatment of rare disorders. Front Pharmacol 2022; 13:1026064. [PMID: 36249823 PMCID: PMC9554627 DOI: 10.3389/fphar.2022.1026064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Ségolène Aymé
- Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France
| | - Marc Dooms
- University of Cambridge, Cambridge, United Kingdom
- *Correspondence: Marc Dooms, ,
| |
Collapse
|
8
|
Donald A, Björkvall CK, Vellodi A, Cox TM, Hughes D, Jones SA, Wynn R, Machaczka M. Thirty-year clinical outcomes after haematopoietic stem cell transplantation in neuronopathic Gaucher disease. Orphanet J Rare Dis 2022; 17:234. [PMID: 35717194 PMCID: PMC9206376 DOI: 10.1186/s13023-022-02378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neuronopathic Gaucher Disease (nGD) describes the condition of a subgroup of patients with the Lysosomal Storage Disorder (LSD), Gaucher disease with involvement of the central nervous system (CNS) which results from inherited deficiency of β-glucosylceramidase. Although systemic manifestations of disease are now corrected by augmentation with macrophage-targeted therapeutic enzyme (enzyme replacement therapy, ERT), neurological disease progresses unpredictably as a result of failure of therapeutic enzyme to cross the blood–brain barrier (BBB). Without therapy, the systemic and neurological effects of the disease progress and shorten life: investigators, principally in Sweden and the UK, pioneered bone marrow transplantation (BMT; Haematopoietic Stem Cell Transplantation HSCT) to supply healthy marrow-derived macrophages and other cells, to correct the peripheral disease. Here we report the first long-term follow-up (over 20 years in all cases) of nine patients in the UK and Sweden who underwent HSCT in the 1970s and 1980s. This retrospective, multicentre observational study was undertaken to determine whether there are neurological features of Gaucher disease that can be corrected by HSCT and the extent to which deterioration continues after the procedure. Since intravenous administration of ERT is approved for patients with the neuronopathic disease and ameliorates many of the important systemic manifestations but fails to correct the neurological features, we also consider the current therapeutic positioning of HSCT in this disorder. Results In the nine patients here reported, neurological disease continued to progress after transplantation, manifesting as seizures, cerebellar disease and abnormalities of tone and reflexes. Conclusions Although neurological disease progressed in this cohort of patients, there may be a future role for HSCT in the treatment of nGD. The procedure has the unique advantage of providing a life-long source of normally functioning macrophages in the bone marrow, and possibly other sites, after a single administration. HSCT moreover, clearly ameliorates systemic disease and this may be advantageous—especially where sustained provision of high-cost ERT cannot be guaranteed. Given the remaining unmet needs of patients with neuronopathic Gaucher disease and the greatly improved safety profile of the transplant procedure, HSCT could be considered to provide permanent correction of systemic disease, including bone disease not ameliorated by ERT, when combined with emerging therapies directed at the neurological manifestations of disease; this could include ex-vivo gene therapy approaches.
Collapse
Affiliation(s)
- Aimee Donald
- Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester, UK.
| | | | | | | | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Derralyn Hughes
- Lysosomal Storage Disorder Unit, Royal Free Hospital, UCL, London, UK
| | - Simon A Jones
- Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester, UK
| | - Robert Wynn
- Royal Manchester Children's Hospital, Manchester, UK
| | - Maciej Machaczka
- Department of Human Pathophysiology, Institute of Medical Sciences, University of Rzeszow, Rzeszow, Poland.,Division of Internal Medicine, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Zaccariotto E, Cachón-González MB, Wang B, Lim S, Hirth B, Park H, Fezoui M, Sardi SP, Mason P, Barker RH, Cox TM. A novel brain-penetrant oral UGT8 inhibitor decreases in vivo galactosphingolipid biosynthesis in murine Krabbe disease. Biomed Pharmacother 2022; 149:112808. [PMID: 35290889 DOI: 10.1016/j.biopha.2022.112808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Krabbe disease is a rare, inherited neurodegenerative disease due to impaired lysosomal β-galactosylceramidase (GALC) activity and formation of neurotoxic β-galactosylsphingosine ('psychosine'). We investigated substrate reduction therapy with a novel brain-penetrant inhibitor of galactosylceramide biosynthesis, RA 5557, in twitcher mice that lack GALC activity and model Krabbe disease. This thienopyridine derivative selectively inhibits uridine diphosphate-galactose glycosyltransferase 8 (UGT8), the final step in the generation of galactosylceramides which are precursors of sulphatide and, in the pathological lysosome, the immediate source of psychosine. Administration of RA 5557, reduced pathologically elevated psychosine concentrations (72-86%) in the midbrain and cerebral cortex in twitcher mice: the inhibitor decreased galactosylceramides by about 70% in midbrain and cerebral cortex in mutant and wild type animals. Exposure to the inhibitor significantly decreased several characteristic inflammatory response markers without causing apparent toxicity to myelin-producing cells in wild type and mutant mice; transcript abundance of oligodendrocyte markers MBP (myelin basic protein) and murine UGT8 was unchanged. Administration of the inhibitor before conception and during several breeding cycles to mice did not impair fertility and gave rise to healthy offspring. Nevertheless, given the unchanged lifespan, it appears that GALC has critical functions in the nervous system beyond the hydrolysis of galactosylceramide and galactosylsphingosine. Our findings support further therapeutic exploration of orally active UGT8 inhibitors in Krabbe disease and related galactosphingolipid disorders. The potent thienopyridine derivative with effective target engagement here studied appears to have an acceptable safety profile in vivo; judicious dose optimization will be needed to ensure efficacious clinical translation.
Collapse
Affiliation(s)
- Eva Zaccariotto
- Department of Medicine, University of Cambridge, Cambridge, UK.
| | | | - Bing Wang
- Early Development, Sanofi R&D, Waltham, MA, United States
| | - Sungtaek Lim
- Integrated Drug Discovery, Sanofi R&D, Waltham, MA, United States
| | - Bradford Hirth
- Integrated Drug Discovery, Sanofi R&D, Waltham, MA, United States
| | - Hyejung Park
- Early Development, Sanofi R&D, Waltham, MA, United States
| | - Malika Fezoui
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - S Pablo Sardi
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - Paul Mason
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - Robert H Barker
- Rare and Neurologic Disease Research, Sanofi R&D, Framingham, MA, United States
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK.
| |
Collapse
|
10
|
Cheon IS, Li C, Son YM, Goplen NP, Wu Y, Cassmann T, Wang Z, Wei X, Tang J, Li Y, Marlow H, Hughes S, Hammel L, Cox TM, Goddery E, Ayasoufi K, Weiskopf D, Boonyaratanakornkit J, Dong H, Li H, Chakraborty R, Johnson AJ, Edell E, Taylor JJ, Kaplan MH, Sette A, Bartholmai BJ, Kern R, Vassallo R, Sun J. Immune signatures underlying post-acute COVID-19 lung sequelae. Sci Immunol 2021; 6:eabk1741. [PMID: 34591653 DOI: 10.1126/sciimmunol.abk1741] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- I S Cheon
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - C Li
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y M Son
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - N P Goplen
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y Wu
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - T Cassmann
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Z Wang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - X Wei
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - J Tang
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Y Li
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - H Marlow
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - S Hughes
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - L Hammel
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - T M Cox
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - E Goddery
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - K Ayasoufi
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - D Weiskopf
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA
| | - J Boonyaratanakornkit
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - H Dong
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - H Li
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905, USA
| | - R Chakraborty
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - A J Johnson
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - E Edell
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - J J Taylor
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - M H Kaplan
- Department of Microbiology and Immunology, Indiana University of School of Medicine, Indianapolis, IN 46202, USA
| | - A Sette
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology (LJI), La Jolla, CA 92037, USA.,Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego (UCSD), La Jolla, CA 92037, USA
| | - B J Bartholmai
- Department of Radiology, Mayo Clinic, Rochester, MN 5590, USA
| | - R Kern
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - R Vassallo
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - J Sun
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA.,Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN 55905, USA.,Carter Immunology Center, University of Virginia, Charlottesville, VA 22908, USA.,Division of Infectious Disease and International Health, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| |
Collapse
|
11
|
Castejón-Vega B, Rubio A, Pérez-Pulido AJ, Quiles JL, Lane JD, Fernández-Domínguez B, Cachón-González MB, Martín-Ruiz C, Sanz A, Cox TM, Alcocer-Gómez E, Cordero MD. L-Arginine Ameliorates Defective Autophagy in GM2 Gangliosidoses by mTOR Modulation. Cells 2021; 10:cells10113122. [PMID: 34831346 PMCID: PMC8619250 DOI: 10.3390/cells10113122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/21/2022] Open
Abstract
Aims: Tay–Sachs and Sandhoff diseases (GM2 gangliosidosis) are autosomal recessive disorders of lysosomal function that cause progressive neurodegeneration in infants and young children. Impaired hydrolysis catalysed by β-hexosaminidase A (HexA) leads to the accumulation of GM2 ganglioside in neuronal lysosomes. Despite the storage phenotype, the role of autophagy and its regulation by mTOR has yet to be explored in the neuropathogenesis. Accordingly, we investigated the effects on autophagy and lysosomal integrity using skin fibroblasts obtained from patients with Tay–Sachs and Sandhoff diseases. Results: Pathological autophagosomes with impaired autophagic flux, an abnormality confirmed by electron microscopy and biochemical studies revealing the accelerated release of mature cathepsins and HexA into the cytosol, indicating increased lysosomal permeability. GM2 fibroblasts showed diminished mTOR signalling with reduced basal mTOR activity. Accordingly, provision of a positive nutrient signal by L-arginine supplementation partially restored mTOR activity and ameliorated the cytopathological abnormalities. Innovation: Our data provide a novel molecular mechanism underlying GM2 gangliosidosis. Impaired autophagy caused by insufficient lysosomal function might represent a new therapeutic target for these diseases. Conclusions: We contend that the expression of autophagy/lysosome/mTOR-associated molecules may prove useful peripheral biomarkers for facile monitoring of treatment of GM2 gangliosidosis and neurodegenerative disorders that affect the lysosomal function and disrupt autophagy.
Collapse
Affiliation(s)
- Beatriz Castejón-Vega
- Research Laboratory, Oral Medicine Department, University of Sevilla, 41009 Sevilla, Spain;
| | - Alejandro Rubio
- Centro Andaluz de Biologia del Desarrollo (CABD, UPO-CSIC-JA), Facultad de Ciencias Experimentales (Área de Genética), Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.R.); (A.J.P.-P.)
| | - Antonio J. Pérez-Pulido
- Centro Andaluz de Biologia del Desarrollo (CABD, UPO-CSIC-JA), Facultad de Ciencias Experimentales (Área de Genética), Universidad Pablo de Olavide, 41013 Sevilla, Spain; (A.R.); (A.J.P.-P.)
| | - José L. Quiles
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix Verdú”, Biomedical Research Center, University of Granada, 18071 Granada, Spain;
| | - Jon D. Lane
- Cell Biology Laboratories, School of Biochemistry, University of Bristol, Bristol BS8 1TD, UK;
| | | | | | - Carmen Martín-Ruiz
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE4 5 PL, UK;
| | - Alberto Sanz
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Timothy M. Cox
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK; (M.B.C.-G.); (T.M.C.)
| | - Elísabet Alcocer-Gómez
- Departamento de Psicología Experimental, Facultad de Psicología, Universidad de Sevilla, 41009 Seville, Spain;
| | - Mario D. Cordero
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), 11009 Cadiz, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
- Correspondence:
| |
Collapse
|
12
|
Cachón-González MB, Wang S, Cox TM. Expression of Ripk1 and DAM genes correlates with severity and progression of Krabbe disease. Hum Mol Genet 2021; 30:2082-2099. [PMID: 34172992 PMCID: PMC8561423 DOI: 10.1093/hmg/ddab159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/22/2021] [Accepted: 06/08/2021] [Indexed: 01/02/2023] Open
Abstract
Krabbe disease, an inherited leukodystrophy, is a sphingolipidosis caused by deficiency of β-galactocerebrosidase: it is characterized by myelin loss, and pathological activation of macrophage/microglia and astrocytes. To define driving pathogenic factors, we explored the expression repertoire of candidate neuroinflammatory genes: upregulation of receptor interacting protein kinase 1 (Ripk1) and disease-associated microglia (DAM) genes, including Cst7 and Ch25h, correlated with severity of Krabbe disease genetically modelled in the twitcher mouse. Upregulation of Ripk1 in Iba1/Mac2-positive microglia/macrophage associated with the pathognomic hypertrophic/globoid phenotype of this disease. Widespread accumulation of ubiquitinin1 in white and grey matter co-localised with p62. In Sandhoff disease, another sphingolipid disorder, neuroinflammation, accumulation of p62 and increased Ripk1 expression was observed. The upregulated DAM genes and macrophage/microglia expression of Ripk1 in the authentic model of Krabbe disease strongly resemble those reported in Alzheimer disease associating with disturbed autophagosomal/lysosomal homeostasis. Activation of this shared molecular repertoire, suggests the potential for therapeutic interdiction at a common activation step, irrespective of proximal causation. To clarify the role of Ripk1 in the pathogenesis of Krabbe disease, we first explored the contribution of its kinase function, by intercrossing twitcher and the K45A kinase-dead Ripk1 mouse and breeding to homozygosity. Genetic ablation of Ripk1 kinase activity neither altered the neuropathological features nor the survival of twitcher mice. We conclude that Ripk1 kinase-dependent inflammatory and degenerative capabilities play no instrumental role in Krabbe disease; however, putative kinase-independent functions of Ripk1 remain formally to be explored in its molecular pathogenesis.
Collapse
Affiliation(s)
- María B Cachón-González
- Department of Medicine, University of Cambridge, Level 5, PO Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Susan Wang
- Department of Medicine, University of Cambridge, Level 5, PO Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Level 5, PO Box 157, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| |
Collapse
|
13
|
Boer DE, Mirzaian M, Ferraz MJ, Zwiers KC, Baks MV, Hazeu MD, Ottenhoff R, Marques ARA, Meijer R, Roos JCP, Cox TM, Boot RG, Pannu N, Overkleeft HS, Artola M, Aerts JM. Human glucocerebrosidase mediates formation of xylosyl-cholesterol by β-xylosidase and transxylosidase reactions. J Lipid Res 2021; 62:100018. [PMID: 33361282 PMCID: PMC7903134 DOI: 10.1194/jlr.ra120001043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022] Open
Abstract
Deficiency of glucocerebrosidase (GBA), a lysosomal β-glucosidase, causes Gaucher disease. The enzyme hydrolyzes β-glucosidic substrates and transglucosylates cholesterol to cholesterol-β-glucoside. Here we show that recombinant human GBA also cleaves β-xylosides and transxylosylates cholesterol. The xylosyl-cholesterol formed acts as an acceptor for the subsequent formation of di-xylosyl-cholesterol. Common mutant forms of GBA from patients with Gaucher disease with reduced β-glucosidase activity were similarly impaired in β-xylosidase, transglucosidase, and transxylosidase activities, except for a slightly reduced xylosidase/glucosidase activity ratio of N370S GBA and a slightly reduced transglucosylation/glucosidase activity ratio of D409H GBA. XylChol was found to be reduced in spleen from patients with Gaucher disease. The origin of newly identified XylChol in mouse and human tissues was investigated. Cultured human cells exposed to exogenous β-xylosides generated XylChol in a manner dependent on active lysosomal GBA but not the cytosol-facing β-glucosidase GBA2. We later sought an endogenous β-xyloside acting as donor in transxylosylation reactions, identifying xylosylated ceramide (XylCer) in cells and tissues that serve as donor in the formation of XylChol. UDP-glucosylceramide synthase (GCS) was unable to synthesize XylChol but could catalyze the formation of XylCer. Thus, food-derived β-D-xyloside and XylCer are potential donors for the GBA-mediated formation of XylChol in cells. The enzyme GCS produces XylCer at a low rate. Our findings point to further catalytic versatility of GBA and prompt a systematic exploration of the distribution and role of xylosylated lipids.
Collapse
Affiliation(s)
- Daphne E Boer
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Mina Mirzaian
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Maria J Ferraz
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Kimberley C Zwiers
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Merel V Baks
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Marc D Hazeu
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Roelof Ottenhoff
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - André R A Marques
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Rianne Meijer
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Jonathan C P Roos
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Rolf G Boot
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Navraj Pannu
- Department of Biophysical Structural Chemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Herman S Overkleeft
- Department of Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Marta Artola
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands
| | - Johannes M Aerts
- Department of Medical Biochemistry, Leiden Institute of Chemistry, Leiden University, The Netherlands.
| |
Collapse
|
14
|
Adusumilli G, Kaggie JD, D’Amore S, Cox TM, Deegan P, MacKay JW, McDonald S. Improving the quantitative classification of Erlenmeyer flask deformities. Skeletal Radiol 2021; 50:361-369. [PMID: 32734372 PMCID: PMC7736022 DOI: 10.1007/s00256-020-03561-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 02/02/2023]
Abstract
The Erlenmeyer flask deformity is a common skeletal modeling deformity, but current classification systems are binary and may restrict its utility as a predictor of associated skeletal conditions. A quantifiable 3-point system of severity classification could improve its predictive potential in disease. Ratios were derived from volumes of regions of interests drawn in 50 Gaucher's disease patients. ROIs were drawn from the distal physis to 2 cm proximal, 2 cm to 4 cm, and 4 cm to 6 cm. Width was also measured at each of these boundaries. Two readers rated these 100 femurs using a 3-point scale of severity classification. Weighted kappa indicated reliability and one-way analysis of variance characterized ratio differences across the severity scale. Accuracy analyses allowed determination of clinical cutoffs for each ratio. Pearson's correlations assessed the associations of volume and width with a shape-based concavity metric of the femur. The volume ratio incorporating the metaphyseal region from 0 to 2 cm and the diametaphyseal region at 4-6 cm was most accurate at distinguishing femurs on the 3-point scale. Receiver operating characteristic curves for this ratio indicated areas of 0.95 to distinguish normal and mild femurs and 0.93 to distinguish mild and severe femurs. Volume was moderately associated with the degree of femur concavity. The proposed volume ratio method is an objective, proficient method at distinguishing severities of the Erlenmeyer flask deformity with the potential for automation. This may have application across diseases associated with the deformity and deficient osteoclast-mediated modeling of growing bone.
Collapse
Affiliation(s)
- Gautam Adusumilli
- grid.5335.00000000121885934Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK ,Present Address: St. Louis, USA
| | - Joshua D. Kaggie
- grid.5335.00000000121885934Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Simona D’Amore
- grid.5335.00000000121885934Department of Medicine, Addenbrookes Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge, CB2 0QQ UK
| | - Timothy M. Cox
- grid.5335.00000000121885934Department of Medicine, Addenbrookes Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge, CB2 0QQ UK
| | - Patrick Deegan
- grid.5335.00000000121885934Department of Medicine, Addenbrookes Hospital, University of Cambridge, Box 157, Hills Rd, Cambridge, CB2 0QQ UK
| | - James W. MacKay
- grid.5335.00000000121885934Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | - Scott McDonald
- grid.5335.00000000121885934Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ UK
| | | |
Collapse
|
15
|
Abstract
The brain is the physical organ of the mind but efforts to understand mental illness within a neurobiological context have hitherto been unavailing. Mental disorders (anxiety, depression, bipolar disorder, and schizophrenia) affect about one fifth of the population and present an almost endless societal challenge at the frontier of human sciences. Prodigious technological advances in functional neuroimaging and large-scale genetics have not yet delivered the prospect of refined molecular understanding of mental illness beyond early anatomical descriptions of brain metabolism. However, intensive clinical phenotyping and quantitative metabolic studies using sophisticated radio-ligands in positron-emission tomography, persistently favor the neurobiological approach. This Perspective pursues a familiar maxim in Medicine, aptly summarized in the words of Arthur Koestler: “Nature is generous in her senseless experiments on mankind.” Hitherto, studies in neuropsychiatry have largely ignored rare genetic disorders but derangements of specific components within the cerebral laboratory offer rich opportunities for mechanistic exploration. Aberrant psychic behavior is characteristic of many inborn errors of metabolism and although each disorder represents a universe of its own, we are at a threshold for understanding, since contemporary genetics and cell biology furnish abundant materials to take on the perturbing enigma of mental derangement. A further development relates to orphan drugs with actions on defined molecular targets: these represent new ways to study the pathogenesis of psychiatric phenomena associated with rare diseases and in a manner not formerly possible. Here we introduce the frontier of schizophrenia and its strong association with late-onset Tay-Sachs disease as a paradigm to explore.
Collapse
Affiliation(s)
- Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
16
|
Affiliation(s)
- Michael Beck
- Institute of Human Genetics, University of Mainz, Mainz, Germany
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
17
|
Pavlova EV, Shatunov A, Wartosch L, Moskvina AI, Nikolaeva LE, Bright NA, Tylee KL, Church HJ, Ballabio A, Luzio JP, Cox TM. The lysosomal disease caused by mutant VPS33A. Hum Mol Genet 2019; 28:2514-2530. [PMID: 31070736 PMCID: PMC6644154 DOI: 10.1093/hmg/ddz077] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
A rare lysosomal disease resembling a mucopolysaccharidosis with unusual systemic features, including renal disease and platelet dysfunction, caused by the defect in a conserved region of the VPS33A gene on human chromosome 12q24.31, occurs in Yakuts-a nomadic Turkic ethnic group of Southern Siberia. VPS33A is a core component of the class C core vacuole/endosome tethering (CORVET) and the homotypic fusion and protein sorting (HOPS) complexes, which have essential functions in the endocytic pathway. Here we show that cultured fibroblasts from patients with this disorder have morphological changes: vacuolation with disordered endosomal/lysosomal compartments and-common to sphingolipid diseases-abnormal endocytic trafficking of lactosylceramide. Urine glycosaminoglycan studies revealed a pathological excess of sialylated conjugates as well as dermatan and heparan sulphate. Lipidomic screening showed elevated β-D-galactosylsphingosine with unimpaired activity of cognate lysosomal hydrolases. The 3D crystal structure of human VPS33A predicts that replacement of arginine 498 by tryptophan will de-stabilize VPS33A folding. We observed that the missense mutation reduced the abundance of full-length VPS33A and other components of the HOPS and CORVET complexes. Treatment of HeLa cells stably expressing the mutant VPS33A with a proteasome inhibitor rescued the mutant protein from degradation. We propose that the disease is due to diminished intracellular abundance of intact VPS33A. Exposure of patient-derived fibroblasts to the clinically approved proteasome inhibitor, bortezomib, or inhibition of glucosylceramide synthesis with eliglustat, partially corrected the impaired lactosylceramide trafficking defect and immediately suggest therapeutic avenues to explore in this fatal orphan disease.
Collapse
Affiliation(s)
- Elena V Pavlova
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Aleksey Shatunov
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London, UK
| | - Lena Wartosch
- Cambridge Institute for Medical Research and Department of Clinical Biochemistry, Wellcome Trust/MRC Building, University of Cambridge, Cambridge, UK
| | - Alena I Moskvina
- Paediatric Centre, National Medical Centre of the Republic of Sakha, Yakutsk, Russia
| | - Lena E Nikolaeva
- Paediatric Centre, National Medical Centre of the Republic of Sakha, Yakutsk, Russia
| | - Nicholas A Bright
- Cambridge Institute for Medical Research and Department of Clinical Biochemistry, Wellcome Trust/MRC Building, University of Cambridge, Cambridge, UK
| | - Karen L Tylee
- Willink Biochemical Genetics Unit, Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK
| | - Heather J Church
- Willink Biochemical Genetics Unit, Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, St Mary's Hospital, Manchester, UK
| | - Andrea Ballabio
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - J Paul Luzio
- Cambridge Institute for Medical Research and Department of Clinical Biochemistry, Wellcome Trust/MRC Building, University of Cambridge, Cambridge, UK
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
18
|
Mistry PK, Balwani M, Baris HN, Turkia HB, Burrow TA, Charrow J, Cox GF, Danda S, Dragosky M, Drelichman G, El-Beshlawy A, Fraga C, Freisens S, Gaemers S, Hadjiev E, Kishnani PS, Lukina E, Maison-Blanche P, Martins AM, Pastores G, Petakov M, Peterschmitt MJ, Rosenbaum H, Rosenbloom B, Underhill LH, Cox TM. Addendum to Letter to the Editor: Safety, efficacy, and authorization of eliglustat as a first-line therapy in Gaucher disease type 1. Blood Cells Mol Dis 2019; 77:101-102. [PMID: 31029022 DOI: 10.1016/j.bcmd.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Hagit N Baris
- The Genetics Institute, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | | | - T Andrew Burrow
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joel Charrow
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Gerald F Cox
- Editas, Cambridge, MA, USA (formerly Sanofi Genzyme), Cambridge, MA, USA
| | | | | | | | | | | | | | | | | | - Priya S Kishnani
- Duke University School of Medicine, Department of Pediatrics, Durham, NC, USA
| | - Elena Lukina
- National Research Center for Hematology, Moscow, Russia
| | | | | | | | - Milan Petakov
- Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | | | | | | | | | - Timothy M Cox
- University of Cambridge, Department of Medicine, Box 157, Level 5, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| |
Collapse
|
19
|
Pohl S, Angermann A, Jeschke A, Hendrickx G, Yorgan TA, Makrypidi-Fraune G, Steigert A, Kuehn SC, Rolvien T, Schweizer M, Koehne T, Neven M, Winter O, Velho RV, Albers J, Streichert T, Pestka JM, Baldauf C, Breyer S, Stuecker R, Muschol N, Cox TM, Saftig P, Paganini C, Rossi A, Amling M, Braulke T, Schinke T. The Lysosomal Protein Arylsulfatase B Is a Key Enzyme Involved in Skeletal Turnover. J Bone Miner Res 2018; 33:2186-2201. [PMID: 30075049 DOI: 10.1002/jbmr.3563] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 06/10/2018] [Accepted: 06/20/2018] [Indexed: 12/24/2022]
Abstract
Skeletal pathologies are frequently observed in lysosomal storage disorders, yet the relevance of specific lysosomal enzymes in bone remodeling cell types is poorly defined. Two lysosomal enzymes, ie, cathepsin K (Ctsk) and Acp5 (also known as tartrate-resistant acid phosphatase), have long been known as molecular marker proteins of differentiated osteoclasts. However, whereas the cysteine protease Ctsk is directly involved in the degradation of bone matrix proteins, the molecular function of Acp5 in osteoclasts is still unknown. Here we show that Acp5, in concert with Acp2 (lysosomal acid phosphatase), is required for dephosphorylation of the lysosomal mannose 6-phosphate targeting signal to promote the activity of specific lysosomal enzymes. Using an unbiased approach we identified the glycosaminoglycan-degrading enzyme arylsulfatase B (Arsb), mutated in mucopolysaccharidosis type VI (MPS-VI), as an osteoclast marker, whose activity depends on dephosphorylation by Acp2 and Acp5. Similar to Acp2/Acp5-/- mice, Arsb-deficient mice display lysosomal storage accumulation in osteoclasts, impaired osteoclast activity, and high trabecular bone mass. Of note, the most prominent lysosomal storage accumulation was observed in osteocytes from Arsb-deficient mice, yet this pathology did not impair production of sclerostin (Sost) and Fgf23. Because the influence of enzyme replacement therapy (ERT) on bone remodeling in MPS-VI is still unknown, we additionally treated Arsb-deficient mice by weekly injection of recombinant human ARSB from 12 to 24 weeks of age. We found that the high bone mass phenotype of Arsb-deficient mice and the underlying bone cell deficits were fully corrected by ERT in the trabecular compartment. Taken together, our results do not only show that the function of Acp5 in osteoclasts is linked to dephosphorylation and activation of lysosomal enzymes, they also provide an important proof-of-principle for the feasibility of ERT to correct bone cell pathologies in lysosomal storage disorders. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
Collapse
Affiliation(s)
- Sandra Pohl
- Department of Biochemistry, Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Angermann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anke Jeschke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gretl Hendrickx
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timur A Yorgan
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georgia Makrypidi-Fraune
- Department of Biochemistry, Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anita Steigert
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sonja C Kuehn
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michaela Schweizer
- Department of Electron Microscopy, Center of Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Koehne
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Orthodontics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mona Neven
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olga Winter
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Renata Voltolini Velho
- Department of Biochemistry, Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Albers
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Streichert
- Department of Clinical Chemistry, University Hospital Cologne, Cologne, Germany
| | - Jan M Pestka
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Baldauf
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Breyer
- Department of Orthopedics, Children's Hospital Hamburg-Altona, Hamburg, Germany
| | - Ralf Stuecker
- Department of Orthopedics, Children's Hospital Hamburg-Altona, Hamburg, Germany
| | - Nicole Muschol
- Department of Electron Microscopy, Center of Molecular Neurobiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Paul Saftig
- Institute of Biochemistry, Christian-Albrechts-University, Kiel, Germany
| | - Chiara Paganini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Antonio Rossi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Braulke
- Department of Biochemistry, Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
20
|
Mistry PK, Balwani M, Baris HN, Turkia HB, Burrow TA, Charrow J, Cox GF, Danda S, Dragosky M, Drelichman G, El-Beshlawy A, Fraga C, Freisens S, Gaemers S, Hadjiev E, Kishnani PS, Lukina E, Maison-Blanche P, Martins AM, Pastores G, Petakov M, Peterschmitt MJ, Rosenbaum H, Rosenbloom B, Underhill LH, Cox TM. Safety, efficacy, and authorization of eliglustat as a first-line therapy in Gaucher disease type 1. Blood Cells Mol Dis 2018; 71:71-74. [PMID: 29680197 DOI: 10.1016/j.bcmd.2018.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Affiliation(s)
| | | | - Hagit N Baris
- The Genetics Institute, Rambam Health Care Campus, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, - Israel Institute of Technology, Haifa, Israel
| | | | - T Andrew Burrow
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joel Charrow
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Gerald F Cox
- Editas, Cambridge, MA, USA (formerly Sanofi Genzyme, Cambridge, MA, USA)
| | | | | | | | | | | | | | | | | | - Priya S Kishnani
- Duke University School of Medicine, Department of Pediatrics, Durham, NC, USA
| | - Elena Lukina
- National Research Center for Hematology, Moscow, Russia
| | | | | | | | - Milan Petakov
- Clinical Center of Serbia, University of Belgrade School of Medicine, Belgrade, Serbia
| | | | | | | | | | - Timothy M Cox
- University of Cambridge, Department of Medicine, Box 157, Level 5, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK.
| |
Collapse
|
21
|
|
22
|
Roos JCP, Daniels MJ, Morris E, Hyry HI, Cox TM. Heterogeneity in a large pedigree with Danon disease: Implications for pathogenesis and management. Mol Genet Metab 2018; 123:177-183. [PMID: 28822614 PMCID: PMC6588538 DOI: 10.1016/j.ymgme.2017.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Danon disease is an X-linked disturbance of autophagy manifesting with cognitive impairment and disordered heart and skeletal muscle. After a period of relative stability, patients deteriorate rapidly and may quickly become ineligible for elective heart transplantation - the only life-saving therapy. METHODS We report a large pedigree with diverse manifestations of Danon disease in hemizygotes and female heterozygotes. RESULTS Malignant cardiac arrhythmias requiring amiodarone treatment induced thyroid disease in two patients; intractable thyrotoxicosis, which enhances autophagy, caused the death of a 21year-old man. Our patients also had striking elevation of serum troponin I during the accelerated phase of their illness (p<0.01) and rising concentrations heralded cardiac decompensation. We argue for changes to cardiac transplantation eligibility criteria. CONCLUSION Danon disease causes hypertrophic cardiomyopathy - here we propose a common pathophysiological basis for the metabolic and structural effects of this descriptive class of heart disorders. We also contend that troponin I may have prognostic value and merits exploration for clinical decision-making including health warning bracelets. Rapamycin (Sirolimus®), an approved immunosuppressant which also influences autophagy, may prove beneficial. In the interim, while new treatments are developed, a revaluation of cardiac transplantation eligibility criteria is warranted.
Collapse
Affiliation(s)
| | | | | | - Hanna I Hyry
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK.
| |
Collapse
|
23
|
Smith NJ, Fuller M, Saville JT, Cox TM. Reduced cerebral vascularization in experimental neuronopathic Gaucher disease. J Pathol 2018; 244:120-128. [PMID: 28981147 DOI: 10.1002/path.4992] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/15/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022]
Abstract
The glycosphingolipidosis, Gaucher disease, in which a range of neurological manifestations occur, results from a deficiency of acid β-glucocerebrosidase, with subsequent accumulation of β-glucocerebroside, its upstream substrates, and the non-acylated congener β-glucosylsphingosine. However, the mechanisms by which end-organ dysfunction arise are poorly understood. Here, we report strikingly diminished cerebral microvascular density in a murine model of disease, and provide a detailed analysis of the accompanying cerebral glycosphingolipidome in these animals, with marked elevations of β-glucosylsphingosine. Further in vitro studies confirmed a concentration-dependent impairment of endothelial cytokinesis upon exposure to quasi-pathological concentrations of β-glucosylsphingosine. These findings support a premise for pathogenic disruption of cerebral angiogenesis as an end-organ effect, with potential for therapeutic modulation in neuronopathic Gaucher disease. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Nicholas Jc Smith
- Department of Neurology and Clinical Neurophysiology, Women's and Children's Health Network, Adelaide, South Australia, Australia.,School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Maria Fuller
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.,Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer T Saville
- Genetics and Molecular Pathology, SA Pathology at Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
24
|
Lecommandeur E, Baker D, Cox TM, Nicholls AW, Griffin JL. Alterations in endo-lysosomal function induce similar hepatic lipid profiles in rodent models of drug-induced phospholipidosis and Sandhoff disease. J Lipid Res 2017; 58:1306-1314. [PMID: 28377426 DOI: 10.1194/jlr.m073395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/28/2017] [Indexed: 12/21/2022] Open
Abstract
Drug-induced phospholipidosis (DIPL) is characterized by an increase in the phospholipid content of the cell and the accumulation of drugs and lipids inside the lysosomes of affected tissues, including in the liver. Although of uncertain pathological significance for patients, the condition remains a major impediment for the clinical development of new drugs. Human Sandhoff disease (SD) is caused by inherited defects of the β subunit of lysosomal β-hexosaminidases (Hex) A and B, leading to a large array of symptoms, including neurodegeneration and ultimately death by the age of 4 in its most common form. The substrates of Hex A and B, gangliosides GM2 and GA2, accumulate inside the lysosomes of the CNS and in peripheral organs. Given that both DIPL and SD are associated with lysosomes and lipid metabolism in general, we measured the hepatic lipid profiles in rodent models of these two conditions using untargeted LC/MS to examine potential commonalities. Both model systems shared a number of perturbed lipid pathways, notably those involving metabolism of cholesteryl esters, lysophosphatidylcholines, bis(monoacylglycero)phosphates, and ceramides. We report here profound alterations in lipid metabolism in the SD liver. In addition, DIPL induced a wide range of lipid changes not previously observed in the liver, highlighting similarities with those detected in the model of SD and raising concerns that these lipid changes may be associated with underlying pathology associated with lysosomal storage disorders.
Collapse
Affiliation(s)
- Emmanuelle Lecommandeur
- Department of Biochemistry, Cambridge Systems Biology Centre, University of Cambridge, Cambridge, United Kingdom
| | | | - Timothy M Cox
- Department of Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Julian L Griffin
- Department of Biochemistry, Cambridge Systems Biology Centre, University of Cambridge, Cambridge, United Kingdom.
| |
Collapse
|
25
|
Hyry HI, Cox TM, Roos JCP. Brexit and rare diseases: big risk, bigger opportunity? Curr Med Res Opin 2017; 33:783-784. [PMID: 28100081 DOI: 10.1080/03007995.2017.1284053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The UK's planned exit from the EU will leave its national health sector in a very dangerous position. It will also have profound consequences for domestic UK law. The impact may be particularly drastic for patients for whom EU law protects the right to treatment. At a particular risk are patients with rare, 'orphan', diseases whose treatments are uniquely enabled at the EU level. We examine the potential effects of Brexit on the orphan sector and identify an opportunity to solve long-standing and intensifying difficulties, especially the pricing of orphan drugs.
Collapse
Affiliation(s)
- Hanna I Hyry
- a Department of Medicine , University of Cambridge , Cambridge , UK
| | - Timothy M Cox
- a Department of Medicine , University of Cambridge , Cambridge , UK
| | | |
Collapse
|
26
|
Marques ARA, Willems LI, Herrera Moro D, Florea BI, Scheij S, Ottenhoff R, van Roomen CPAA, Verhoek M, Nelson JK, Kallemeijn WW, Biela-Banas A, Martin OR, Cachón-González MB, Kim NN, Cox TM, Boot RG, Overkleeft HS, Aerts JMFG. A Specific Activity-Based Probe to Monitor Family GH59 Galactosylceramidase, the Enzyme Deficient in Krabbe Disease. Chembiochem 2017; 18:402-412. [DOI: 10.1002/cbic.201600561] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Indexed: 11/07/2022]
Affiliation(s)
- André R. A. Marques
- Department of Biochemistry; Academic Medical Center; University of Amsterdam; Meibergdreef 15 1105 AZ Amsterdam The Netherlands
- Present address: Institute of Biochemistry; Christian-Albrechts-University of Kiel; Otto-Hahn-Platz 9 24098 Kiel Germany
| | - Lianne I. Willems
- Department of Bio-organic Synthesis; Leiden Institute of Chemistry; Leiden University; Einsteeinweg 55 2300 RA Leiden The Netherlands
- Present address: Department of Chemistry; Simon Fraser University; 8888 University Drive Burnaby V5A 1S6 BC Canada
| | - Daniela Herrera Moro
- Department of Biochemistry; Academic Medical Center; University of Amsterdam; Meibergdreef 15 1105 AZ Amsterdam The Netherlands
| | - Bogdan I. Florea
- Department of Bio-organic Synthesis; Leiden Institute of Chemistry; Leiden University; Einsteeinweg 55 2300 RA Leiden The Netherlands
| | - Saskia Scheij
- Department of Biochemistry; Academic Medical Center; University of Amsterdam; Meibergdreef 15 1105 AZ Amsterdam The Netherlands
| | - Roelof Ottenhoff
- Department of Biochemistry; Academic Medical Center; University of Amsterdam; Meibergdreef 15 1105 AZ Amsterdam The Netherlands
| | - Cindy P. A. A. van Roomen
- Department of Biochemistry; Academic Medical Center; University of Amsterdam; Meibergdreef 15 1105 AZ Amsterdam The Netherlands
| | - Marri Verhoek
- Department of Biochemistry; Leiden Institute of Chemistry; Leiden University; Einsteinweg 55 2300 RA Leiden The Netherlands
| | - Jessica K. Nelson
- Department of Biochemistry; Academic Medical Center; University of Amsterdam; Meibergdreef 15 1105 AZ Amsterdam The Netherlands
| | - Wouter W. Kallemeijn
- Department of Biochemistry; Leiden Institute of Chemistry; Leiden University; Einsteinweg 55 2300 RA Leiden The Netherlands
| | - Anna Biela-Banas
- Institute of Organic and Analytical Chemistry; Université D'Orléans; Rue de Chartres B. P. 6759 45100 Orléans France
| | - Olivier R. Martin
- Institute of Organic and Analytical Chemistry; Université D'Orléans; Rue de Chartres B. P. 6759 45100 Orléans France
| | - M. Begoña Cachón-González
- Department of Medicine; University of Cambridge; Addenbrooke's Hospital; Hills Road Cambridge CB2 2QQ UK
| | - Nee Na Kim
- Department of Medicine; University of Cambridge; Addenbrooke's Hospital; Hills Road Cambridge CB2 2QQ UK
| | - Timothy M. Cox
- Department of Medicine; University of Cambridge; Addenbrooke's Hospital; Hills Road Cambridge CB2 2QQ UK
| | - Rolf G. Boot
- Department of Biochemistry; Leiden Institute of Chemistry; Leiden University; Einsteinweg 55 2300 RA Leiden The Netherlands
| | - Herman S. Overkleeft
- Department of Bio-organic Synthesis; Leiden Institute of Chemistry; Leiden University; Einsteeinweg 55 2300 RA Leiden The Netherlands
| | - Johannes M. F. G. Aerts
- Department of Biochemistry; Academic Medical Center; University of Amsterdam; Meibergdreef 15 1105 AZ Amsterdam The Netherlands
- Department of Biochemistry; Leiden Institute of Chemistry; Leiden University; Einsteinweg 55 2300 RA Leiden The Netherlands
| |
Collapse
|
27
|
Aerts JM, Cox TM. Roscoe O. Brady: Physician whose pioneering discoveries in lipid biochemistry revolutionized treatment and understanding of lysosomal diseases. Blood Cells Mol Dis 2017; 68:4-8. [PMID: 28118958 DOI: 10.1016/j.bcmd.2016.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Johannes M Aerts
- Department of Medical Biochemistry, Leiden University, The Netherlands
| | - Timothy M Cox
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, United Kingdom.
| |
Collapse
|
28
|
Belmatoug N, Di Rocco M, Fraga C, Giraldo P, Hughes D, Lukina E, Maison-Blanche P, Merkel M, Niederau C, Plӧckinger U, Richter J, Stulnig TM, Vom Dahl S, Cox TM. Management and monitoring recommendations for the use of eliglustat in adults with type 1 Gaucher disease in Europe. Eur J Intern Med 2017; 37:25-32. [PMID: 27522145 DOI: 10.1016/j.ejim.2016.07.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE In Gaucher disease, diminished activity of the lysosomal enzyme, acid β-glucosidase, leads to accumulation of glucosylceramides and related substrates, primarily in the spleen, liver, and bone marrow. Eliglustat is an oral substrate reduction therapy approved in the European Union and the United States as a first-line treatment for adults with type 1 Gaucher disease who have compatible CYP2D6 metabolism phenotypes. A European Advisory Council of experts in Gaucher disease describes the characteristics of eliglustat that are distinct from enzyme augmentation therapy (the standard of care) and miglustat (the other approved substrate reduction therapy) and recommends investigations and monitoring for patients on eliglustat therapy within the context of current recommendations for Gaucher disease management. RESULTS Eliglustat is a selective, potent inhibitor of glucosylceramide synthase, the enzyme responsible for biosynthesis of glucosylceramides which accumulate in Gaucher disease. Extensive metabolism of eliglustat by CYP2D6, and, to a lesser extent, CYP3A of the cytochrome P450 pathway, necessitates careful consideration of the patient's CYP2D6 metaboliser status and use of concomitant medications which share metabolism by these pathways. Guidance on specific assessments and monitoring required for eliglustat therapy, including an algorithm to determine eligibility for eliglustat, are provided. CONCLUSIONS As a first-line therapy for type 1 Gaucher disease, eliglustat offers eligible patients a daily oral therapy alternative to biweekly infusions of enzyme therapy. Physicians will need to carefully assess individual Gaucher patients to determine their appropriateness for eliglustat therapy. The therapeutic response to eliglustat and use of concomitant medications will require long-term monitoring.
Collapse
Affiliation(s)
- Nadia Belmatoug
- Referral Center for Lysosomal Diseases, University Beaujon Hospital Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Department of Internal Medicine, 100 Boulevard du Général Leclerc, 92110 Clichy, France.
| | - Maja Di Rocco
- Unit of Rare Diseases, Department Pediatrics, Gaslini Institute, Largo Gaslini 3, 16147 Genoa, Italy.
| | - Cristina Fraga
- Department of Haematology, HDES Hospital, Ponta Delgada, Av. D. Manuel I, PDL, Açores, Portugal.
| | - Pilar Giraldo
- Translational Research Unit, Instituto Investigación Sanitaria Aragon, CIBER Enfermedades Raras (CIBERER), Zaragoza, Spain.
| | - Derralynn Hughes
- Royal Free London NHS Foundation Trust, University College London, Department of Haematology, Pond St., London NW1 2QG, United Kingdom
| | - Elena Lukina
- Department of Orphan Diseases, Hematology Research Center, 4 Novy Zykovsky Lane, 125167 Moscow, Russia.
| | - Pierre Maison-Blanche
- Bichat University Hospital, Cardiology Unit, 46 Rue Henri Huchard, 75018 Paris, France.
| | - Martin Merkel
- Department of Internal Medicine, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.
| | - Claus Niederau
- Katholisches Klinikum Oberhausen GmbH, St. Josef Hospital, Department of Medicine, Academic Teaching Hospital, Universität Duisburg-Essen, Mülheimer Str. 83, 46045 Oberhausen, Germany.
| | - Ursula Plӧckinger
- Interdisziplinares Stoffwechsel-Centrum: Diabetes, Endokrinologie und Stoffwechsel, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13352 Berlin, Germany.
| | - Johan Richter
- Department of Hematology and Vascular Diseases, Skåne University Hospital, 221 85 Lund, Sweden.
| | - Thomas M Stulnig
- Clinical Division of Endocrinology and Metabolism, Department of Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Stephan Vom Dahl
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital, University of Duesseldorf, Moorenstrasse 5, D-40225, Germany.
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Box 157, Level 5, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
| |
Collapse
|
29
|
Eichler FS, Cox TM, Crombez E, Dali CÍ, Kohlschütter A. Metachromatic Leukodystrophy: An Assessment of Disease Burden. J Child Neurol 2016; 31:1457-1463. [PMID: 27389394 DOI: 10.1177/0883073816656401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/04/2016] [Indexed: 11/16/2022]
Abstract
Metachromatic leukodystrophy is accompanied by severe motor and cognitive dysfunction. This is the first survey of metachromatic leukodystrophy caregiver perspectives to identify relevant clinical/quality-of-life outcomes for patients/caregivers. Interviews and 1 focus group were conducted with 30 caregivers representing 23 patients. Caregivers were asked about their experiences, including diagnostic process, signs/symptoms, symptoms affecting caregivers' and patients' lives, and treatment priorities. Caregivers reported loss of physical autonomy, weight loss, limited social relationships, frequent crying, and challenging sibling relationships. Most troublesome symptoms were immobility (9/30) and respiratory difficulties (6/30). Health care visits were frequent: 8/22 patients had experienced ≥11 hospitalizations since diagnosis, and 14/22 caregivers reported that these lasted ≥4 days. Caregivers also experienced work problems, feelings of fear/sadness, and loss of social relationships. Caregivers/physicians consider a therapy that could improve decline in mobility, pain, cognitive ability, communication, or food intake as conferring the greatest benefit. In conclusion, a so-far-unreported physical/economic burden in these families is presented.
Collapse
Affiliation(s)
- Florian S Eichler
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Addenbrooke's Cambridge University Hospital, Cambridge, UK
| | | | - Christine Í Dali
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Alfried Kohlschütter
- Department of Pediatrics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
30
|
Biegstraaten M, Cox TM, Belmatoug N, Berger MG, Collin-Histed T, Vom Dahl S, Di Rocco M, Fraga C, Giona F, Giraldo P, Hasanhodzic M, Hughes DA, Iversen PO, Kiewiet AI, Lukina E, Machaczka M, Marinakis T, Mengel E, Pastores GM, Plöckinger U, Rosenbaum H, Serratrice C, Symeonidis A, Szer J, Timmerman J, Tylki-Szymańska A, Weisz Hubshman M, Zafeiriou DI, Zimran A, Hollak CEM. Management goals for type 1 Gaucher disease: An expert consensus document from the European working group on Gaucher disease. Blood Cells Mol Dis 2016; 68:203-208. [PMID: 28274788 DOI: 10.1016/j.bcmd.2016.10.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023]
Abstract
Gaucher Disease type 1 (GD1) is a lysosomal disorder that affects many systems. Therapy improves the principal manifestations of the condition and, as a consequence, many patients show a modified phenotype which reflects manifestations of their disease that are refractory to treatment. More generally, it is increasingly recognised that information as to how a patient feels and functions [obtained by patient- reported outcome measurements (PROMs)] is critical to any comprehensive evaluation of treatment. A new set of management goals for GD1 in which both trends are reflected is needed. To this end, a modified Delphi procedure among 25 experts was performed. Based on a literature review and with input from patients, 65 potential goals were formulated as statements. Consensus was considered to be reached when ≥75% of the participants agreed to include that specific statement in the management goals. There was agreement on 42 statements. In addition to the traditional goals concerning haematological, visceral and bone manifestations, improvement in quality of life, fatigue and social participation, as well as early detection of long-term complications or associated diseases were included. When applying this set of goals in medical practice, the clinical status of the individual patient should be taken into account.
Collapse
Affiliation(s)
- M Biegstraaten
- Department of Internal Medicine, Division Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands.
| | - T M Cox
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
| | - N Belmatoug
- Referral Center for Lysosomal Diseases, Department of Internal Medicine, University Hospital Paris Nord Val de Seine, Beaujon, France.
| | - M G Berger
- Department of Biological Haematology, Hospital Estaing, CHU Clermont-Ferrand, Clermont-Ferrand; EA CREaT 7283, Auvergne University, Clermont-Ferrand, France.
| | | | - S Vom Dahl
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
| | - M Di Rocco
- Department of Pediatrics, Unit of Rare Diseases, Giannina Gaslini Institute, Genoa, Italy.
| | - C Fraga
- Department of Haematology, HDES Hospital, Ponta Delgada, Av. D. Manuel I, PDL, Açores, Portugal.
| | - F Giona
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Via Benevento 6, 00161 Rome, Italy.
| | - P Giraldo
- Translational Research Unit, IIS Aragón, CIBERER, Zaragoza, Spain.
| | - M Hasanhodzic
- Department of Endocrinology, Metabolic Diseases and Genetics, University Clinical Center Tuzla, Children's hospital, Tuzla, Bosnia & Herzegovina.
| | - D A Hughes
- University College London, Royal Free London NHS Foundation Trust, London, UK.
| | - P O Iversen
- Department of Nutrition, IMB, University of Oslo, Department of Hematology, Oslo University Hospital, Oslo, Norway.
| | - A I Kiewiet
- Department of Internal Medicine, Division Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands.
| | - E Lukina
- Department of Orphan Diseases, National Research Center for Hematology, 4 Novy Zykovsky pr., 125167, Moscow, Russia.
| | - M Machaczka
- Hematology Center Karolinska, Department of Medicine at Huddinge, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.
| | - T Marinakis
- Department of Clinical Haematology, General Hospital of Athens "G. Gennimatas", Athens, Greece.
| | - E Mengel
- Villa Metabolica, Center of Pediatric and Adolescent Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - G M Pastores
- Department of Medicine, National Centre for Inherited Metabolic Disorders, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - U Plöckinger
- Interdisciplinary Centre of Metabolism: Endocrinology, Diabetes and Metabolism, Charité-University Medicine Berlin, Berlin, Germany.
| | - H Rosenbaum
- Hematology Day Care Unit, Gaucher Clinic, The Center for Consultant Medicine, Nazareth Towers, Nazareth, Israel.
| | - C Serratrice
- Department of Internal Medicine, University Hospital Geneva Trois Chene, Geneva, Switzerland.
| | - A Symeonidis
- Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
| | - J Szer
- Department of Clinical Haematology & BMT Service, The Royal Melbourne Hospital, Melbourne, Australia.
| | - J Timmerman
- 'Volwassenen, Kinderen, Stofwisselingsziekten', Dutch Patient Organization for Children and Adults with Metabolic Disorders, Zwolle, The Netherlands.
| | | | - M Weisz Hubshman
- Pediatric Genetics Unit, Schneider Children's Medical Center of Israel, Petach Tikva, and Raphael Recanati Genetic Institute, Rabin Medical Center, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - D I Zafeiriou
- First Department of Pediatrics, "Hippokratio" General Hospital, Aristotle University, Thessaloniki, Greece.
| | - A Zimran
- Gaucher Clinic, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - C E M Hollak
- Department of Internal Medicine, Division Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
31
|
Abstract
Orphan-drug sales are rocketing, with revenue expected to total $176 billion annually by 2020. As a share of the industry, orphan drugs now account for close to 15% of all prescription revenue globally (excluding generics) and the sector is set to grow at more than twice the rate (10.5%) of the overall prescription market (4.3%). But this success also equates to costs--borne by individual patients and cash-strapped health systems. Prices for orphan drugs can be 19 times higher than for other medications, hampering access for patients, many of whom are children. With ever more such expensive drugs reaching the market, the situation is becoming unsustainable and putting the survival of the orphan drug legislation itself at risk. Here the authors consider why there has been an increase in orphan drug designations, how orphan drug prices are set and regulated, before discussing proposals for how changes which could save the legislation.
Collapse
Affiliation(s)
- Hanna I Hyry
- a Department of Medicine , University of Cambridge , Cambridge , United Kingdom
| | - Timothy M Cox
- a Department of Medicine , University of Cambridge , Cambridge , United Kingdom
| | - Jonathan C P Roos
- a Department of Medicine , University of Cambridge , Cambridge , United Kingdom
| |
Collapse
|
32
|
Pleat R, Cox TM, Burrow TA, Giraldo P, Goker-Alpan O, Rosenbloom BE, Croal LR, Underhill LH, Gaemers SJM, Peterschmitt MJ. Stability is maintained in adults with Gaucher disease type 1 switched from velaglucerase alfa to eliglustat or imiglucerase: A sub-analysis of the eliglustat ENCORE trial. Mol Genet Metab Rep 2016; 9:25-28. [PMID: 27722092 PMCID: PMC5050260 DOI: 10.1016/j.ymgmr.2016.08.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 11/01/2022] Open
Abstract
Gaucher disease type 1 is an autosomal recessive disorder caused by deficient activity of the lysosomal enzyme acid β-glucosidase resulting in accumulation of glucosylceramide and clinical manifestations of anemia, thrombocytopenia, hepatosplenomegaly, and skeletal disease. The historic standard of care is intravenous recombinant enzyme therapy with imiglucerase. Eliglustat, an oral substrate reduction therapy, is a first-line treatment for adults with Gaucher disease type 1 who have a compatible CYP2D6-metabolizer phenotype (≈ 95% of patients). The 12-month ENCORE trial (NCT00943111) found eliglustat non-inferior to imiglucerase in maintaining stability in adult Gaucher patients previously stabilized after ≥ 3 years of enzyme therapy (imiglucerase or velaglucerase alfa). This post-hoc analysis examined safety and efficacy in the 30 ENCORE patients who were receiving velaglucerase alfa at study entry and were randomized to eliglustat (n = 22) or imiglucerase (n = 8). Efficacy and safety in velaglucerase alfa-transitioned patients were consistent with the full ENCORE trial population; 90% of patients switched to eliglustat and 88% of patients switched to imiglucerase met the composite endpoint (stable hemoglobin concentration, platelet count, spleen volume, and liver volume). Clinical stability was maintained for 12 months in Gaucher disease type 1 patients in the ENCORE trial who switched from velaglucerase alfa to either eliglustat or imiglucerase.
Collapse
Affiliation(s)
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - T Andrew Burrow
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Pilar Giraldo
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), IISAragón, Zaragoza, Spain
| | - Ozlem Goker-Alpan
- Lysosomal Disorders Research and Treatment Unit, Center for Clinical Trials, O&O Alpan, LLC, Fairfax, VA, USA
| | | | | | | | | | | |
Collapse
|
33
|
Hyry HI, Roos JC, Cox TM. Orphan drugs: expensive yet necessary. QJM 2016; 109:361. [PMID: 26337658 PMCID: PMC4888322 DOI: 10.1093/qjmed/hcv150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H I Hyry
- From the Department of Medicine, University of Cambridge, Cambridge, UK
| | - J C Roos
- From the Department of Medicine, University of Cambridge, Cambridge, UK
| | - T M Cox
- From the Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
34
|
Marques ARA, Mirzaian M, Akiyama H, Wisse P, Ferraz MJ, Gaspar P, Ghauharali-van der Vlugt K, Meijer R, Giraldo P, Alfonso P, Irún P, Dahl M, Karlsson S, Pavlova EV, Cox TM, Scheij S, Verhoek M, Ottenhoff R, van Roomen CPAA, Pannu NS, van Eijk M, Dekker N, Boot RG, Overkleeft HS, Blommaart E, Hirabayashi Y, Aerts JM. Glucosylated cholesterol in mammalian cells and tissues: formation and degradation by multiple cellular β-glucosidases. J Lipid Res 2016; 57:451-63. [PMID: 26724485 PMCID: PMC4766994 DOI: 10.1194/jlr.m064923] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Indexed: 12/20/2022] Open
Abstract
The membrane lipid glucosylceramide (GlcCer) is continuously formed and degraded. Cells express two GlcCer-degrading β-glucosidases, glucocerebrosidase (GBA) and GBA2, located in and outside the lysosome, respectively. Here we demonstrate that through transglucosylation both GBA and GBA2 are able to catalyze in vitro the transfer of glucosyl-moieties from GlcCer to cholesterol, and vice versa. Furthermore, the natural occurrence of 1-O-cholesteryl-β-D-glucopyranoside (GlcChol) in mouse tissues and human plasma is demonstrated using LC-MS/MS and 13C6-labeled GlcChol as internal standard. In cells, the inhibition of GBA increases GlcChol, whereas inhibition of GBA2 decreases glucosylated sterol. Similarly, in GBA2-deficient mice, GlcChol is reduced. Depletion of GlcCer by inhibition of GlcCer synthase decreases GlcChol in cells and likewise in plasma of inhibitor-treated Gaucher disease patients. In tissues of mice with Niemann-Pick type C disease, a condition characterized by intralysosomal accumulation of cholesterol, marked elevations in GlcChol occur as well. When lysosomal accumulation of cholesterol is induced in cultured cells, GlcChol is formed via lysosomal GBA. This illustrates that reversible transglucosylation reactions are highly dependent on local availability of suitable acceptors. In conclusion, mammalian tissues contain GlcChol formed by transglucosylation through β-glucosidases using GlcCer as donor. Our findings reveal a novel metabolic function for GlcCer.
Collapse
Affiliation(s)
- André R A Marques
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Mina Mirzaian
- Departments of Medical Biochemistry Leiden Institute of Chemistry, Leiden, The Netherlands
| | | | - Patrick Wisse
- Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden, The Netherlands
| | - Maria J Ferraz
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Paulo Gaspar
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Rianne Meijer
- Departments of Medical Biochemistry Leiden Institute of Chemistry, Leiden, The Netherlands
| | - Pilar Giraldo
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Unidad de Investigación Traslacional, Zaragoza, Spain
| | - Pilar Alfonso
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Unidad de Investigación Traslacional, Zaragoza, Spain
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Unidad de Investigación Traslacional, Zaragoza, Spain
| | - Maria Dahl
- Department of Molecular Medicine and Gene Therapy, Lund University, Lund, Sweden
| | - Stefan Karlsson
- Department of Molecular Medicine and Gene Therapy, Lund University, Lund, Sweden
| | - Elena V Pavlova
- Addenbrooke's Hospital, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Timothy M Cox
- Addenbrooke's Hospital, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Saskia Scheij
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Marri Verhoek
- Departments of Medical Biochemistry Leiden Institute of Chemistry, Leiden, The Netherlands
| | - Roelof Ottenhoff
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Navraj S Pannu
- Departments of Medical Biochemistry Leiden Institute of Chemistry, Leiden, The Netherlands
| | - Marco van Eijk
- Departments of Medical Biochemistry Leiden Institute of Chemistry, Leiden, The Netherlands
| | - Nick Dekker
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | - Rolf G Boot
- Departments of Medical Biochemistry Leiden Institute of Chemistry, Leiden, The Netherlands
| | - Herman S Overkleeft
- Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden, The Netherlands
| | - Edward Blommaart
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Johannes M Aerts
- Department of Medical Biochemistry, Academic Medical Center, Amsterdam, The Netherlands Departments of Medical Biochemistry Leiden Institute of Chemistry, Leiden, The Netherlands
| |
Collapse
|
35
|
Abstract
OBJECTIVE This study surveyed all UK medical schools regarding their Bachelor of Medicine (MB), Doctor of Philosophy (PhD) (MB/PhD) training policy in order to map the current training landscape and to provide evidence for further research and policy development. SETTING Deans of all UK medical schools registered with the Medical Schools Council were invited to participate in this survey electronically. PRIMARY The number of medical schools that operate institutional MB/PhD programmes or permit self-directed student PhD intercalation. SECONDARY Medical school recruitment procedures and attitudes to policy guidance. FINDINGS 27 of 33 (81%) registered UK medical schools responded. Four (14%) offer an institutional MB/PhD programme. However, of those without institutional programmes, 17 (73%) permit study interruption and PhD intercalation: two do not (one of whom had discontinued their programme in 2013), three were unsure and one failed to answer the question. Regarding student eligibility, respondents cited high academic achievement in medical studies and a bachelor's or master's degree. Of the Medical schools without institutional MB/PhD programmes, 5 (21%) have intentions to establish a programme, 8 (34%) do not and 3 were unsure, seven did not answer. 19 medical schools (70%) considered national guidelines are needed for future MB/PhD programme development. CONCLUSIONS We report the first national survey of MB/PhD training in the UK. Four medical schools have operational institutional MB/PhD programmes, with a further five intending to establish one. Most medical schools permit study interruption and PhD intercalation. The total number MB/PhD students yet to graduate from medical school could exceed 150, with 30 graduating per year. A majority of medical school respondents to this survey believe national guidelines are required for MB/PhD programme development and implementation. Further research should focus on the MB/PhD student experience. Discussion regarding local and national MB/PhD policies between medical schools and academic stakeholders are needed.
Collapse
Affiliation(s)
- Ashton Barnett-Vanes
- Faculty of Medicine, Imperial College London, London, UK
- Faculty of Medicine, St George's University of London, London, UK
| | - Guiyi Ho
- Faculty of Medicine, Imperial College London, London, UK
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| |
Collapse
|
36
|
Abstract
BACKGROUND EU regulation 726/2004 authorises manufacturers to provide drugs to patients on a temporary basis when marketing authorisation sought centrally for the entire EU is still pending. Individual Member States retain the right to approve and implement such 'compassionate use' programmes which companies will usually provide for free. Nevertheless some companies have opted not to partake in such programmes, in effect restricting access to drugs for patients in need. Here we survey the state of compassionate use programmes in the EU with particular reference to the rare disease field, and provide legal and ethical arguments to encourage their increased compassionate use in the EU and beyond. We contend that if enacted, these recommendations will be mutually beneficial to companies as well as patients. METHODS Requests for information from the European Medicines Agency were made under the UK Freedom of Information Act 2000. Legal, ethical and economic/pragmatic analysis identified means by which provision of therapy in compassionate use programmes might be increased. RESULTS More than 50 notifications of compassionate use programmes have been submitted to the EMA by Member States since 2006. About 40 % relate to orphan drugs. As there is a compulsory register of programmes but not of outcomes, their success is difficult to evaluate but, for example, the French programme expedited treatment for more than 20,000 (orphan and non-orphan) patients over a period of three years. CONCLUSION Compelling self-interested, legal and ethical arguments can be mounted to encourage manufacturers to offer therapies on a compassionate use basis and these are often equally applicable to provision on a humanitarian aid basis. The EU's compassionate use programmes are instrumental in ensuring continuity of access to drugs until approval and reimbursement decisions are finalised. We propose the creation of a registry of drugs offered on a compassionate use basis; further transparency would allow such programmes to be evaluated and direct patients to sources of treatment.
Collapse
Affiliation(s)
- Hanna I Hyry
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - Jeremy Manuel
- European Gaucher Alliance, UK Gaucher's Association, 340 West End Lane, London, NW6 1LN, UK.
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.
| | - Jonathan C P Roos
- Department of Medicine, University of Cambridge, Cambridge, CB2 0QQ, UK.
| |
Collapse
|
37
|
Abstract
Data emerging from the International Collaborative Gaucher Group (ICGG) Gaucher Registry together with other contemporary clinical surveys have revealed a close association between Gaucher disease and non-Hodgkin's B-cell lymphoma and myeloma and Gaucher disease and Parkinson's disease. Several possible explanations for increased B-cell proliferation and neoplasia in Gaucher disease have been proposed, including the possible influence of sphingosine (derived from the extra lysosomal metabolism of glucosylceramide), gene modifiers, splenectomy and immune system deregulation induced by cytokines, chemokines, and hydrolases released from Gaucher cells. Parkinson's disease is frequently seen in the otherwise-healthy relatives of Gaucher disease patients leading to the finding that GBA mutations represent a genetic risk factor for Parkinson's disease. The mechanism of the association between GBA mutations and Parkinson's disease has yet to be elucidated but the pathogenesis appears distinct from that of Gaucher disease. Several pathogenic pathways have been proposed including lysosomal and/or mitochondrial dysfunction. The effect of Gaucher disease specific therapies on the incidence of cancer or Parkinson's disease are not clear and will likely be evaluated in future ICGG Gaucher Registry studies.
Collapse
Affiliation(s)
- Timothy M. Cox
- Department of Medicine; University of Cambridge; United Kingdom
| | | | - Roger A. Barker
- Department of Clinical Neurosciences; University of Cambridge; United Kingdom
| |
Collapse
|
38
|
Cox TM, Drelichman G, Cravo R, Balwani M, Burrow TA, Martins AM, Lukina E, Rosenbloom B, Ross L, Angell J, Puga AC. Eliglustat compared with imiglucerase in patients with Gaucher's disease type 1 stabilised on enzyme replacement therapy: a phase 3, randomised, open-label, non-inferiority trial. Lancet 2015; 385:2355-62. [PMID: 25819691 DOI: 10.1016/s0140-6736(14)61841-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The mainstay of treatment for Gaucher's disease type 1 is alternate-week infusion of enzyme replacement therapy (ERT). We investigated whether patients stable on such treatment would remain so after switching to oral eliglustat, a selective inhibitor of glucosylceramide synthase. METHODS In this phase 3, randomised, multinational, open-label, non-inferiority trial, we enrolled adults (aged ≥18 years) who had received ERT for 3 years or more for Gaucher's disease. Patients were randomly allocated 2:1 at 39 clinics (stratified by ERT dose; block sizes of four; computer-generated centrally) to receive either oral eliglustat or imiglucerase infusions for 12 months. Participants and investigators were aware of treatment assignment, but the central reader who assessed organ volumes was masked. The composite primary efficacy endpoint was percentage of patients whose haematological variables and organ volumes remained stable for 12 months (ie, haemoglobin decrease not more than 15 g/L, platelet count decrease not more than 25%, spleen volume increase not more than 25%, and liver volume increase not more than 20%, in multiples of normal from baseline). The non-inferiority margin was 25% for eliglustat relative to imiglucerase, assessed in all patients who completed 12 months of treatment. This trial is registered with ClinicalTrials.gov, number NCT00943111, and EudraCT, number 2008-005223-28. FINDINGS Between Sept 15, 2009, and Nov 9, 2011, we randomly allocated 106 (66%) patients to eliglustat and 54 (34%) to imiglucerase. In the per-protocol population, 84 (85%) of 99 patients who completed eliglustat treatment and 44 (94%) of 47 patients who completed imiglucerase treatment met the composite primary endpoint (between-group difference -8·8%; 95% CI -17·6 to 4·2). The lower bound of the 95% CI of -17·6% was within the prespecified threshold for non-inferiority. Dropouts occurred due to palpitations (one patient on eliglustat), myocardial infarction (one patient on eliglustat), and psychotic disorder (one patient on imiglucerase). No deaths occurred. 97 (92%) of 106 patients in the eliglustat group had treatment-emergent adverse events, as did 42 (79%) of 53 in the imiglucerase group (mostly mild or moderate in severity). INTERPRETATION Oral eliglustat maintained haematological and organ volume stability in adults with Gaucher's disease type 1 already controlled by intravenous ERT and could be a useful therapeutic option. FUNDING Genzyme, a Sanofi company.
Collapse
Affiliation(s)
- Timothy M Cox
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
| | | | - Renata Cravo
- State Institute of Haematology 'Arthur de Siqueira Cavalcanti', Rio de Janeiro, Brazil
| | | | | | | | | | - Barry Rosenbloom
- Cedars-Sinai Oncology, and Tower Hematology Oncology, Beverly Hills, CA, USA
| | - Leorah Ross
- Genzyme, a Sanofi company, Cambridge, MA, USA
| | | | | |
Collapse
|
39
|
Abstract
Whether the prices of certain orphan treatments are justified is highly controversial. One argument is that such therapies should not be funded through the public purse or private health plans because a patient with a rare disease requires more than their 'fair share' of a limited health care budget. Orphan medications can also be denied because they fare poorly in the cost-effectiveness assessments of drugs. This paper takes the unusual line that life-saving treatments should be provided regardless of their cost. This contention is based on the Harvard philosopher John Rawls' theory of justice. We offer three rules to limit the use of cost-effectiveness approaches: efficiency assessments should not be deployed (i) when the choice is between an only treatment and no treatment, or to (ii) prioritise between different patients and patient groups. However a well considered cost efficiency calculation may have its place (iii) where a patient has a choice between two or more equally safe and effective treatments. We rebut potential objections to this analysis, and conclude that there has been a tendency to classify appeals for orphan treatments as a minority interest and in conflict with the aims of public health and society at large. Rawls' concept of societal justice shows that a distinction between the individual and society in this context is bogus. The funding of orphan therapies is as much a matter for public health as the funding of treatments for other conditions. Treatment must not be withheld on economic grounds.
Collapse
Affiliation(s)
- H I Hyry
- From the Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - J C P Roos
- From the Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| | - T M Cox
- From the Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
| |
Collapse
|
40
|
Abstract
BACKGROUND Gaucher disease, a rare disorder, is caused by inherited deficiency of the enzyme glucocerebrosidase. It is unique among the ultra-orphan disorders in that four treatments are currently approved by various regulatory authorities for use in routine clinical practice. Hitherto, because of the relatively few people affected worldwide, many of whom started therapy during a prolonged period when there were essentially no alternatives to imiglucerase, these treatments have not been systematically evaluated in studies such as randomized controlled trials now considered necessary to generate the highest level of clinical evidence. OBJECTIVES To summarize all available randomized controlled study data on the efficacy and safety of enzyme replacement therapies and substrate reduction therapy for treating Gaucher disease. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Trials Register. Additional searches were conducted on ClinicalTrials.gov for any ongoing studies with potential interim results, and through PubMed. We also searched the reference lists of relevant articles and reviews.Date of last search: 07 August 2014. SELECTION CRITERIA All randomized and quasi-randomized controlled studies (including open-label studies and cross-over studies) assessing enzyme replacement therapy or substrate reduction therapy, or both, in all types of Gaucher disease were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed the risk of bias in the included studies, and extracted relevant data. MAIN RESULTS Of the 488 studies retrieved by the electronic searches, eight met the inclusion criteria and were analysed (300 participants). Response parameters were restricted to haemoglobin concentration, platelet count, spleen and liver volume and serum biomarkers (chitotriosidase and CCL18). Only one publication reported a 'low risk of bias' score in all parameters assessed, and all studies included were randomized.Four studies reported the responses to enzyme replacement therapy of previously untreated individuals with type 1 Gaucher disease. Two studies investigated maintenance enzyme replacement therapy in people with stable type 1 Gaucher disease previously treated for at least two years. One study compared substrate reduction therapy, enzyme replacement therapy and a combination thereof as maintenance therapy in people with type 1 Gaucher disease previously treated with enzyme replacement therapy. One study examined substrate reduction therapy in people with chronic neuronopathic (type 3) Gaucher disease who continued to receive enzyme replacement therapy.Treatment-naïve participants had similar increases in haemoglobin when comparing those receiving imiglucerase or alglucerase at 60 units/kg, imiglucerase or velaglucerase alfa at 60 U/kg, taliglucerase alfa at 30 units/kg or 60 units/kg, and velaglucerase alfa at 45 units/g or 60 units/kg. For platelet count response in participants with intact spleens, a benefit for imiglucerase over velaglucerase alfa at 60 units/kg was observed, mean difference -79.87 (95% confidence interval -137.57 to -22.17). There were no other significant differences in platelet count response when comparing different doses of velaglucerase alfa and of taliglucerase alfa, and when comparing imiglucerase to alglucerase. Spleen and liver volume reductions were not significantly different in any enzyme replacement therapy product or dose comparison study. Although a dose effect on serum biomarkers was not seen after nine months, a significantly greater reduction with higher dose was reported after 12 months in the velaglucerase study, mean difference 16.70 (95% confidence intervaI 1.51 to 31.89). In the two enzyme replacement therapy maintenance studies comparing infusions every two weeks and every four weeks, there were no significant differences in haemoglobin concentration, platelet count, and spleen and liver volumes over a 6 to 12 month period when participants were treated with the same cumulative dose.A total of 25 serious adverse events were reported, nearly all deemed unrelated to treatment.There are, as yet, no randomized trials of substrate reduction therapy in treatment-naïve patients that can be evaluated. Miglustat monotherapy appeared as effective as continued enzyme replacement therapy for maintenance of hematological, organ and biomarker responses in people with type 1 Gaucher disease previously treated with imiglucerase for at least two years. In those with neuronopathic Gaucher disease, no significant improvements in haemoglobin concentration, platelet count or organ volumes occurred when enzyme replacement therapy was augmented with miglustat.One randomized controlled study assessing substrate reduction therapy was published immediately prior to producing the final version of this review, and this, along with a further ongoing study (expected to be published in the near future), will be assessed for eligibility in a future update of the review. AUTHORS' CONCLUSIONS The results reflect the limitations of analysing evidence restricted to prospective randomized controlled trials, especially when dealing with chronic rare diseases. This analysis suggests that, during the first year of treatment, different recombinant glucocerebrosidases are bio-similar and non-inferior in safety and efficacy for surrogate biological response parameters. Enzyme replacement therapy given at 30 to 45 units/kg body weight every two to four weeks was generally as effective as the 60 unit/kg dose for the assessed clinical outcomes. The analysis emphasise the need to determine whether it is realistic to carry out multi-decade prospective clinical trials for rare diseases such as type 1 Gaucher disease. With large treatment effects on the classical manifestations of the disorder, therapeutic investigations in Gaucher disease mandate innovative trial designs and methodology to secure decisive data concerning long-term efficacy and safety - with the realization that knowledge about disease-modifying actions that are sustained are of crucial importance to people with this chronic condition.
Collapse
Affiliation(s)
| | - Laura Deroma
- University Hospital "Santa Maria della Misericordia"Regional Coordinator Centre for Rare DiseasesPiazzale Santa Maria della Misericordia 15UdineItaly33100
| | - Bruno Bembi
- University Hospital "Santa Maria della Misericordia"Regional Coordinator Centre for Rare DiseasesPiazzale Santa Maria della Misericordia 15UdineItaly33100
| | - Patrick Deegan
- University of Cambridge and Lysosomal Disorders UnitDepartment of MedicineAddenbrooke's Hospital (PO Box 157)CambridgeUKCB2 0QQ
| | - Carla Hollak
- Academic Medical CenterDepartment of Internal Medicine, Division of Endocrinology & MetabolismPostbus 22660AmsterdamNetherlands1100 DD
| | - Neal J Weinreb
- Northwest Oncology Hematology Associates PAUniversity Research Foundation for Lysosomal Storage Diseases8170 Royal Palm BoulevardCoral SpringsFloridaUSA33433
- University of Miami Miller School of MedicineMiamiFloridaUSA
| | - Timothy M Cox
- Addenbrooke's Hospital (Box 157)Department of MedicineLevel 5, Hills RoadCambridgeCambridgeshireUKCB2 0QQ
| | | |
Collapse
|
41
|
Abstract
Striking therapeutic advances for lysosomal diseases have harnessed the biology of this organelle and illustrate its central rôle in the dynamic economy of the cell. Further Innovation will require improved protein-targetting or realization of therapeutic gene- and cell transfer stratagems. Rescuing function before irreversible injury, mandates a deep knowledge of clinical behaviour as well as molecular pathology – and frequently requires an understanding of neuropathology. Whether addressing primary causes, or rebalancing the effects of disordered cell function, true therapeutic innovation depends on continuing scientific exploration of the lysosome. Genuine partnerships between biotech and the patients affected by this extraordinary family of disorders continue to drive productive pharmaceutical discovery.
Collapse
Affiliation(s)
- Timothy M Cox
- Department of Medicine, University of Cambridge, UK.
| |
Collapse
|
42
|
Luzzatto L, Hollak CEM, Cox TM, Schieppati A, Licht C, Kääriäinen H, Merlini G, Schaefer F, Simoens S, Pani L, Garattini S, Remuzzi G. Rare diseases and effective treatments: are we delivering? Lancet 2015; 385:750-2. [PMID: 25752159 DOI: 10.1016/s0140-6736(15)60297-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | - Carla E M Hollak
- Department of Endocrinology and Metabolism, Academic Medical Center, Amsterdam, the Netherlands
| | - Timothy M Cox
- University Department of Medicine, University of Cambridge, Cambridge, UK
| | - Arrigo Schieppati
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, 24126 Bergamo, Italy; Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, Canada
| | - Helena Kääriäinen
- European Platform for Patients' Organizations Science and Industry, Brussels, Belgium
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Department of Molecular Medicine, University of Pavia, Italy
| | - Franz Schaefer
- Pediatric Nephrology Division, Heidelberg University Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Steven Simoens
- KU Leuven Department of Pharmaceutical and Pharmacological Sciences, Leuven, Belgium
| | - Luca Pani
- AIFA Italian Medicine Agency, Rome, Italy
| | - Silvio Garattini
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, 24126 Bergamo, Italy
| | - Giuseppe Remuzzi
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, 24126 Bergamo, Italy.
| |
Collapse
|
43
|
Pavlova EV, Archer J, Wang S, Dekker N, Aerts JM, Karlsson S, Cox TM. Inhibition of UDP-glucosylceramide synthase in mice prevents Gaucher disease-associated B-cell malignancy. J Pathol 2015; 235:113-24. [PMID: 25256118 DOI: 10.1002/path.4452] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/01/2014] [Accepted: 09/19/2014] [Indexed: 02/02/2023]
Abstract
Clonal B-cell proliferation is a frequent manifestation of Gaucher disease - a sphingolipidosis associated with a high risk of multiple myeloma and non-Hodgkin lymphoma. Gaucher disease is caused by genetic deficiency of acid β-glucosidase, the natural substrates of which (β-d-glucosylceramide and β-d-glucosylsphingosine) accumulate, principally in macrophages. Mice with inducible deficiency of β-glucosidase [Gba(tm1Karl/tm1Karl)Tg(MX1-cre)1Cgn/0] serve as an authentic model of human Gaucher disease; we have recently reported clonal B-cell proliferation accompanied by monoclonal serum paraproteins and cognate tumours in these animals. To explore the relationship between B-cell malignancy and the biochemical defect, we treated Gaucher mice with eliglustat tartrate (GENZ 112638), a potent and selective inhibitor of the first committed step in glycosphingolipid biosynthesis. Twenty-two Gaucher mice received 300 mg/kg of GENZ 112638 daily for 3-10 months from 6 weeks of age. Plasma concentrations of β-d-glucosylceramide and the unacylated glycosphingolipid, β-d-glucosylsphingosine, declined. After administration of GENZ 112638 to Gaucher mice for 3-10 months, serum paraproteins were not detected and there was a striking reduction in the malignant lymphoproliferation: neither lymphomas nor plasmacytomas were found in animals that had received the investigational agent. In contrast, 14 out of 60 Gaucher mice without GENZ 112638 treatment developed these tumours; monoclonal paraproteins were detected in plasma from 18 of the 44 age-matched mice with Gaucher disease that had not received GENZ 112638. Long-term inhibition of glycosphingolipid biosynthesis suppresses the development of spontaneous B-cell lymphoma and myeloma in Gaucher mice.
Collapse
Affiliation(s)
- Elena V Pavlova
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
INTRODUCTION Gaucher disease (GD) is an inherited metabolic disorder caused by mutations in the glucocerebrosidase (GBA1) gene. Although infusions of recombinant GBA ameliorate the systemic effects of GD, this therapy has no effect on the neurological manifestations. Patients with the neuronopathic forms of GD (nGD) are often severely disabled and die prematurely. The search for innovative drugs is thus urgent for the neuronopathic forms. AREAS COVERED Here we briefly summarize the available treatments for GD. We then review recent studies of the molecular pathogenesis of GD, which suggest new avenues for therapeutic development. EXPERT OPINION Existing treatments for GD are designed to target the primary consequence of the inborn defects of sphingolipid metabolism, that is, lysosomal accumulation of glucosylceramide (GlcCer). Here we suggest that targeting other pathways, such as those that are activated as a consequence of GlcCer accumulation, may also have salutary clinical effects irrespective of whether excess substrate persists. These pathways include those implicated in neuroinflammation, and specifically, receptor-interacting protein kinase-3 (RIP3) and related components of this pathway, which appear to play a vital role in the pathogenesis of nGD. Once available, inhibitors to components of the RIP kinase pathway will hopefully offer new therapeutic opportunities in GD.
Collapse
Affiliation(s)
- Einat B Vitner
- Weizmann Institute of Science, Department of Biological Chemistry , Rehovot 76100 , Israel +972 8 9342353 ; +972 8 9344112 ;
| | | | | | | |
Collapse
|
45
|
Boyde A, Davis GR, Mills D, Zikmund T, Cox TM, Adams VL, Niker A, Wilson PJ, Dillon JP, Ranganath LR, Jeffery N, Jarvis JC, Gallagher JA. On fragmenting, densely mineralised acellular protrusions into articular cartilage and their possible role in osteoarthritis. J Anat 2014; 225:436-46. [PMID: 25132002 DOI: 10.1111/joa.12226] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 12/11/2022] Open
Abstract
High density mineralised protrusions (HDMP) from the tidemark mineralising front into hyaline articular cartilage (HAC) were first described in Thoroughbred racehorse fetlock joints and later in Icelandic horse hock joints. We now report them in human material. Whole femoral heads removed at operation for joint replacement or from dissection room cadavers were imaged using magnetic resonance imaging (MRI) dual echo steady state at 0.23 mm resolution, then 26-μm resolution high contrast X-ray microtomography, sectioned and embedded in polymethylmethacrylate, blocks cut and polished and re-imaged with 6-μm resolution X-ray microtomography. Tissue mineralisation density was imaged using backscattered electron SEM (BSE SEM) at 20 kV with uncoated samples. HAC histology was studied by BSE SEM after staining block faces with ammonium triiodide solution. HDMP arise via the extrusion of an unknown mineralisable matrix into clefts in HAC, a process of acellular dystrophic calcification. Their formation may be an extension of a crack self-healing mechanism found in bone and articular calcified cartilage. Mineral concentration exceeds that of articular calcified cartilage and is not uniform. It is probable that they have not been reported previously because they are removed by decalcification with standard protocols. Mineral phase morphology frequently shows the agglomeration of many fine particles into larger concretions. HDMP are surrounded by HAC, are brittle, and show fault lines within them. Dense fragments found within damaged HAC could make a significant contribution to joint destruction. At least larger HDMP can be detected with the best MRI imaging ex vivo.
Collapse
Affiliation(s)
- A Boyde
- Biophysics, Oral Growth and Development, Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
te Vruchte D, Speak AO, Wallom KL, Al Eisa N, Smith DA, Hendriksz CJ, Simmons L, Lachmann RH, Cousins A, Hartung R, Mengel E, Runz H, Beck M, Amraoui Y, Imrie J, Jacklin E, Riddick K, Yanjanin NM, Wassif CA, Rolfs A, Rimmele F, Wright N, Taylor C, Ramaswami U, Cox TM, Hastings C, Jiang X, Sidhu R, Ory DS, Arias B, Jeyakumar M, Sillence DJ, Wraith JE, Porter FD, Cortina-Borja M, Platt FM. Relative acidic compartment volume as a lysosomal storage disorder-associated biomarker. J Clin Invest 2014; 124:1320-8. [PMID: 24487591 DOI: 10.1172/jci72835] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 11/14/2013] [Indexed: 01/08/2023] Open
Abstract
Lysosomal storage disorders (LSDs) occur at a frequency of 1 in every 5,000 live births and are a common cause of pediatric neurodegenerative disease. The relatively small number of patients with LSDs and lack of validated biomarkers are substantial challenges for clinical trial design. Here, we evaluated the use of a commercially available fluorescent probe, Lysotracker, that can be used to measure the relative acidic compartment volume of circulating B cells as a potentially universal biomarker for LSDs. We validated this metric in a mouse model of the LSD Niemann-Pick type C1 disease (NPC1) and in a prospective 5-year international study of NPC patients. Pediatric NPC subjects had elevated acidic compartment volume that correlated with age-adjusted clinical severity and was reduced in response to therapy with miglustat, a European Medicines Agency–approved drug that has been shown to reduce NPC1-associated neuropathology. Measurement of relative acidic compartment volume was also useful for monitoring therapeutic responses of an NPC2 patient after bone marrow transplantation. Furthermore, this metric identified a potential adverse event in NPC1 patients receiving i.v. cyclodextrin therapy. Our data indicate that relative acidic compartment volume may be a useful biomarker to aid diagnosis, clinical monitoring, and evaluation of therapeutic responses in patients with lysosomal disorders.
Collapse
|
47
|
Abstract
Funding of expensive treatments for rare (orphan) diseases is contentious. These agents fare poorly on 'efficiency' or health economic measures, such as the quality-adjusted life years, because of high cost and frequently poor gains in quality of life and survival. We show that cost-effectiveness assessments are flawed, and have only a limited role to play in reimbursement decisions for orphan drugs and beyond.
Collapse
Affiliation(s)
- H I Hyry
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK.
| | | | | | | |
Collapse
|
48
|
Affiliation(s)
- Marco Presta
- Department of Molecular & Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Mirella Belleri
- Department of Molecular & Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Box 157, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| |
Collapse
|
49
|
Cachón-González MB, Wang SZ, Ziegler R, Cheng SH, Cox TM. Reversibility of neuropathology in Tay-Sachs-related diseases. Hum Mol Genet 2014; 23:730-48. [PMID: 24057669 PMCID: PMC3888261 DOI: 10.1093/hmg/ddt459] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/16/2013] [Indexed: 01/22/2023] Open
Abstract
The GM2 gangliosidoses are progressive neurodegenerative disorders due to defects in the lysosomal β-N-acetylhexosaminidase system. Accumulation of β-hexosaminidases A and B substrates is presumed to cause this fatal condition. An authentic mouse model of Sandhoff disease (SD) with pathological characteristics resembling those noted in infantile GM2 gangliosidosis has been described. We have shown that expression of β-hexosaminidase by intracranial delivery of recombinant adeno-associated viral vectors to young adult SD mice can prevent many features of the disease and extends lifespan. To investigate the nature of the neurological injury in GM2 gangliosidosis and the extent of its reversibility, we have examined the evolution of disease in the SD mouse; we have moreover explored the effects of gene transfer delivered at key times during the course of the illness. Here we report greatly increased survival only when the therapeutic genes are expressed either before the disease is apparent or during its early manifestations. However, irrespective of when treatment was administered, widespread and abundant expression of β-hexosaminidase with consequent clearance of glycoconjugates, α-synuclein and ubiquitinated proteins, and abrogation of inflammatory responses and neuronal loss was observed. We also show that defects in myelination occur in early life and cannot be easily resolved when treatment is given to the adult brain. These results indicate that there is a limited temporal opportunity in which function and survival can be improved-but regardless of resolution of the cardinal pathological features of GM2 gangliosidosis, a point is reached when functional deterioration and death cannot be prevented.
Collapse
Affiliation(s)
| | - Susan Z. Wang
- Department of Medicine, University of Cambridge, Cambridge, UK and
| | | | | | - Timothy M. Cox
- Department of Medicine, University of Cambridge, Cambridge, UK and
| |
Collapse
|
50
|
Vitner EB, Salomon R, Farfel-Becker T, Meshcheriakova A, Ali M, Klein AD, Platt FM, Cox TM, Futerman AH. RIPK3 as a potential therapeutic target for Gaucher's disease. Nat Med 2014; 20:204-8. [PMID: 24441827 DOI: 10.1038/nm.3449] [Citation(s) in RCA: 230] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 12/12/2013] [Indexed: 02/02/2023]
Abstract
Gaucher's disease (GD), an inherited metabolic disorder caused by mutations in the glucocerebrosidase gene (GBA), is the most common lysosomal storage disease. Heterozygous mutations in GBA are a major risk factor for Parkinson's disease. GD is divided into three clinical subtypes based on the absence (type 1) or presence (types 2 and 3) of neurological signs. Type 1 GD was the first lysosomal storage disease (LSD) for which enzyme therapy became available, and although infusions of recombinant glucocerebrosidase (GCase) ameliorate the systemic effects of GD, the lack of efficacy for the neurological manifestations, along with the considerable expense and inconvenience of enzyme therapy for patients, renders the search for alternative or complementary therapies paramount. Glucosylceramide and glucosylsphingosine accumulation in the brain leads to massive neuronal loss in patients with neuronopathic GD (nGD) and in nGD mouse models. However, the mode of neuronal death is not known. Here, we show that modulating the receptor-interacting protein kinase-3 (Ripk3) pathway markedly improves neurological and systemic disease in a mouse model of GD. Notably, Ripk3 deficiency substantially improved the clinical course of GD mice, with increased survival and motor coordination and salutary effects on cerebral as well as hepatic injury.
Collapse
Affiliation(s)
- Einat B Vitner
- 1] Department of Biological Chemistry, Weizmann Institute of Science, Rehovot, Israel. [2]
| | - Ran Salomon
- 1] Department of Biological Chemistry, Weizmann Institute of Science, Rehovot, Israel. [2]
| | - Tamar Farfel-Becker
- Department of Biological Chemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Anna Meshcheriakova
- Department of Biological Chemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Mohammad Ali
- Department of Biological Chemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Andrés D Klein
- Department of Biological Chemistry, Weizmann Institute of Science, Rehovot, Israel
| | - Frances M Platt
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Timothy M Cox
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Anthony H Futerman
- Department of Biological Chemistry, Weizmann Institute of Science, Rehovot, Israel
| |
Collapse
|