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Shell RD, McGrattan KE, Hurst-Davis R, Young SD, Baranello G, Lavrov A, O'Brien E, Wallach S, LaMarca N, Reyna SP, Darras BT. Onasemnogene abeparvovec preserves bulbar function in infants with presymptomatic spinal muscular atrophy: a post-hoc analysis of the SPR1NT trial. Neuromuscul Disord 2023; 33:670-676. [PMID: 37455203 DOI: 10.1016/j.nmd.2023.06.005] [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] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
Bulbar function in spinal muscular atrophy has been defined as the ability to meet nutritional needs by mouth while maintaining airway protection and communicate verbally. The effects of disease-modifying treatment on bulbar function are not clear. A multidisciplinary team conducted post-hoc analyses of phase 3 SPR1NT trial data to evaluate bulbar function of infants at risk for spinal muscular atrophy who received one-time gene replacement therapy (onasemnogene abeparvovec) before symptom onset. Three endpoints represented adequate bulbar function in SPR1NT: (1) absence of physiologic swallowing impairment, (2) full oral nutrition, and (3) absence of adverse events indicating pulmonary instability. Communication was not assessed in SPR1NT. We descriptively assessed numbers/percentages of children who achieved each endpoint and all three collectively. SPR1NT included infants <6 postnatal weeks with two (n = 14) or three (n = 15) copies of the survival motor neuron 2 gene. At study end (18 [two-copy cohort] or 24 [three-copy cohort] months of age), 100% (29/29) of patients swallowed normally, achieved full oral nutrition, maintained pulmonary stability, and achieved the composite endpoint. When administered to infants before clinical symptom onset, onasemnogene abeparvovec allowed children at risk for spinal muscular atrophy to achieve milestones within published normal ranges of development and preserve bulbar function.
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Affiliation(s)
- Richard D Shell
- Nationwide Children's Hospital, Columbus, OH, USA; Department of Pediatrics, The Ohio State University, Columbus, OH, USA.
| | | | | | | | - Giovanni Baranello
- The Dubowitz Neuromuscular Centre, Developmental Neuroscience Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre & Great Ormond Street Hospital NHS Foundation Trust, London, UK
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McGrattan KE, Shell RD, Hurst-Davis R, Young SD, O'Brien E, Lavrov A, Wallach S, LaMarca N, Reyna SP, Darras BT. Erratum to: Patients with Spinal Muscular Atrophy Type 1 Achieve and Maintain Bulbar Function Following Onasemnogene Abeparvovec Treatment. J Neuromuscul Dis 2023; 10:985-986. [PMID: 37661906 PMCID: PMC10578245 DOI: 10.3233/jnd-239002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
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McGrattan KE, Shell RD, Hurst-Davis R, Young SD, O’Brien E, Lavrov A, Wallach S, LaMarca N, Reyna SP, Darras BT. Patients with Spinal Muscular Atrophy Type 1 Achieve and Maintain Bulbar Function Following Onasemnogene Abeparvovec Treatment. J Neuromuscul Dis 2023; 10:531-540. [PMID: 37092232 PMCID: PMC10357176 DOI: 10.3233/jnd-221531] [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] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Improvement and maintenance of bulbar function are goals of disease-modifying treatments for spinal muscular atrophy (SMA). Lack of standardized measures and a widely accepted definition of bulbar function represents a gap in SMA care. OBJECTIVE A multidisciplinary team conducted post-hoc analyses of pooled data from one phase 1 (START) and two phase 3 (STR1VE-US, STR1VE-EU) studies to define and evaluate bulbar function of infants with SMA type 1 after receiving one-time gene replacement therapy, onasemnogene abeparvovec. METHODS We defined bulbar function as the ability to meet nutritional needs while maintaining airway protection and the ability to communicate verbally. Four endpoints represented adequate bulbar function: (1) absence of clinician-identified physiologic swallowing impairment, (2) receiving full oral nutrition, (3) absence of adverse events indicating pulmonary instability, and (4) the ability to vocalize at least two different, distinct vowel sounds. We descriptively assessed numbers/percentages of patients who achieved each endpoint and all four collectively. Patients were followed until 18 months old (STR1VE-US and STR1VE-EU) or 24 months (START) post-infusion. RESULTS Overall, 65 patients were analyzed for swallowing, nutrition intake, and adverse events, and 20 were analyzed for communication. At study end, 92% (60/65) of patients had a normal swallow, 75% (49/65) achieved full oral nutrition, 92% (60/65) had no evidence of pulmonary instability, 95% (19/20) met the communication endpoint, and 75% (15/20) achieved all four bulbar function components in the composite endpoint. CONCLUSIONS In these three clinical trials, patients with SMA type 1 who received onasemnogene abeparvovec achieved and maintained the bulbar function criteria utilized within this investigation.
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Affiliation(s)
| | - Richard D. Shell
- Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | | | | | - Basil T. Darras
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
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Day JW, Mendell JR, Mercuri E, Finkel RS, Strauss KA, Kleyn A, Tauscher-Wisniewski S, Tukov FF, Reyna SP, Chand DH. Correction to: Clinical Trial and Postmarketing Safety of Onasemnogene Abeparvovec Therapy. Drug Saf 2021; 45:191-192. [PMID: 34940960 PMCID: PMC8857087 DOI: 10.1007/s40264-021-01130-7] [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] [Indexed: 11/28/2022]
Affiliation(s)
- John W Day
- Department of Neurology, Stanford University Medical Center, MC 5979, 213 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Jerry R Mendell
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, Ohio State University, Columbus, OH, USA.,Department of Neurology, Ohio State University, Columbus, OH, USA
| | - Eugenio Mercuri
- Department of Paediatric Neurology and Nemo Clinical Centre, Catholic University, Rome, Italy.,Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Richard S Finkel
- Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA.,Center for Experimental Neurotherapeutics, St. Jude's Children's Research Hospital, Memphis, TN, USA
| | - Kevin A Strauss
- Clinic for Special Children, Strasburg, PA, USA.,Penn Medicine-Lancaster General Hospital, Lancaster, PA, USA.,Department of Pediatrics, University of Massachusetts School of Medicine, Worcester, MA, USA.,Department of Molecular, Cell & Cancer Biology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Aaron Kleyn
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
| | | | | | | | - Deepa H Chand
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA.,Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
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Day JW, Mendell JR, Mercuri E, Finkel RS, Strauss KA, Kleyn A, Tauscher-Wisniewski S, Tukov FF, Reyna SP, Chand DH. Clinical Trial and Postmarketing Safety of Onasemnogene Abeparvovec Therapy. Drug Saf 2021; 44:1109-1119. [PMID: 34383289 PMCID: PMC8473343 DOI: 10.1007/s40264-021-01107-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Abstract
Introduction This is the first description of safety data for intravenous onasemnogene abeparvovec, the only approved systemically administered gene-replacement therapy for spinal muscular atrophy. Objective We comprehensively assessed the safety of intravenous onasemnogene abeparvovec from preclinical studies, clinical studies, and postmarketing data. Methods Single-dose toxicity studies were performed in neonatal mice and juvenile or neonatal cynomolgus nonhuman primates (NHPs). Data presented are from a composite of preclinical studies, seven clinical trials, and postmarketing sources (clinical trials, n = 102 patients; postmarketing surveillance, n = 665 reported adverse event [AE] cases). In clinical trials, safety was assessed through AE monitoring, vital-sign and cardiac assessments, laboratory evaluations, physical examinations, and concomitant medication use. AE reporting and available objective clinical data from postmarketing programs were evaluated. Results The main target organs of toxicity in mice were the heart and liver. Dorsal root ganglia (DRG) inflammation was observed in NHPs. Patients exhibited no evidence of sensory neuropathy upon clinical examination. In clinical trials, 101/102 patients experienced at least one treatment-emergent AE. In total, 50 patients experienced serious AEs, including 11 considered treatment related. AEs consistent with hepatotoxicity resolved with prednisolone in clinical trials. Transient decreases in mean platelet count were detected but were without bleeding complications. Thrombotic microangiopathy (TMA) was observed in the postmarketing setting. No evidence of intracardiac thrombi was observed for NHPs or patients. Conclusions Risks associated with onasemnogene abeparvovec can be anticipated, monitored, and managed. Hepatotoxicity events resolved with prednisolone. Thrombocytopenia was transient. TMA may require medical intervention. Important potential risks include cardiac AEs and DRG toxicity. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-021-01107-6.
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Affiliation(s)
- John W Day
- Department of Neurology, Stanford University Medical Center, MC 5979, 213 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Jerry R Mendell
- Center for Gene Therapy, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
- Department of Neurology, Ohio State University, Columbus, OH, USA
| | - Eugenio Mercuri
- Department of Paediatric Neurology and Nemo Clinical Centre, Catholic University, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - Richard S Finkel
- Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA
- Center for Experimental Neurotherapeutics, St. Jude's Children's Research Hospital, Memphis, TN, USA
| | - Kevin A Strauss
- Clinic for Special Children, Strasburg, PA, USA
- Penn Medicine-Lancaster General Hospital, Lancaster, PA, USA
- Department of Pediatrics, University of Massachusetts School of Medicine, Worcester, MA, USA
- Department of Molecular, Cell & Cancer Biology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Aaron Kleyn
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
| | | | | | | | - Deepa H Chand
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
- Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, MO, USA
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Belter L, Jarecki J, Reyna SP, Cruz R, Jones CC, Schroth M, O'Toole CM, O'Brien S, Hall SA, Johnson NB, Paradis AD. The Cure SMA Membership Surveys: Highlights of Key Demographic and Clinical Characteristics of Individuals with Spinal Muscular Atrophy. J Neuromuscul Dis 2020; 8:109-123. [PMID: 33104036 PMCID: PMC7902958 DOI: 10.3233/jnd-200563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 01/26/2023]
Abstract
Background: Cure SMA maintains the largest patient-reported database for people affected with spinal muscular atrophy (SMA). In 2017, Cure SMA initiated annual surveys with their membership to collect demographic and disease characteristics, healthcare, and burden of disease information from patients and caregivers. Objective: To summarize results from two large-scale Cure SMA surveys in 2017 and 2018. Methods: Cure SMA database members were invited to complete surveys; these were completed by caregivers for living or deceased individuals with SMA and/or affected adults. Results: In 2017, 726 surveys were completed for 695 individuals with SMA; in 2018, 796 surveys were completed for 760 individuals with SMA. Data from both survey years are available for 313 affected individuals. Age at symptom onset, distribution of SMN2 gene copy number, and representation of each SMA type in the surveys were consistent with that expected in the SMA population. In the 2018 survey, the average age at diagnosis was 5.2 months for SMA type I and the reported mean age at death for this subgroup was 27.8 months. Between survey years, there was consistency in responses for factors that should not change within individuals over time (e.g., reported age at diagnosis). Conclusions: Results from the Cure SMA surveys advance the understanding of SMA and facilitate advocacy efforts and healthcare services planning. Longitudinal surveys are important for evaluating the impact of effective treatments on changing phenotypes, and burden of disease and care in individuals with SMA.
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Jones CC, Cook SF, Jarecki J, Belter L, Reyna SP, Staropoli J, Farwell W, Hobby K. Spinal Muscular Atrophy (SMA) Subtype Concordance in Siblings: Findings From the Cure SMA Cohort. J Neuromuscul Dis 2020; 7:33-40. [PMID: 31707372 PMCID: PMC7029365 DOI: 10.3233/jnd-190399] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background: Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disorder caused by homozygous survival of motor neuron 1 (SMN1) gene disruption. Despite a genetic etiology, little is known about subtype concordance among siblings. Objective: To investigate subtype concordance among siblings with SMA. Methods: Cure SMA maintains a database of newly diagnosed patients with SMA, which was utilized for this research. Results: Among 303 sibships identified between 1996 and 2016, 84.8% were subtype concordant. Of concordant sibships, subtype distribution was as follows: Type I, 54.5%; Type II, 31.9%; Type III, 13.2%; Type IV, 0.4%. Subtype and concordance/discordance association was significant (Fisher’s exact test; p < 0.0001). Among discordant sibships (chi-square test, p < 0.0001), Types II/III (52.2%) and Types I/II (28.3%) were the most common pairs. No association was found between sibling sex and concordance. Our findings show that most siblings with SMA shared the same subtype concordance (most commonly Type I). Conclusions: These data are valuable for understanding familial occurrence of SMA subtypes, enabling better individual treatment and management planning in view of new treatment options and newborn screening initiatives.
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Elsheikh B, King W, Peng J, Swoboda KJ, Reyna SP, LaSalle B, Prior TW, Arnold WD, Kissel JT, Kolb SJ. Outcome measures in a cohort of ambulatory adults with spinal muscular atrophy. Muscle Nerve 2019; 61:187-191. [DOI: 10.1002/mus.26756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Bakri Elsheikh
- Department of Neurology, Division of Neuromuscular MedicineThe Ohio State University Wexner Medical Center Columbus Ohio
| | - Wendy King
- Department of Neurology, Division of Neuromuscular MedicineThe Ohio State University Wexner Medical Center Columbus Ohio
| | - Juan Peng
- Department of Biomedical Informatics, Center for BiostatisticsThe Ohio State University Wexner Medical Center Columbus Ohio
| | - Kathy J. Swoboda
- Department of NeurologyMassachusetts General Hospital Boston Massachusetts
| | | | - Bernard LaSalle
- Department of Biomedical InformaticsUniversity of Utah School of Medicine Salt Lake City Utah
| | - Thomas W. Prior
- Department of Molecular PathologyThe Ohio State University Wexner Medical Center Columbus Ohio
| | - W. David Arnold
- Department of Neurology, Division of Neuromuscular MedicineThe Ohio State University Wexner Medical Center Columbus Ohio
| | - John T. Kissel
- Department of Neurology, Division of Neuromuscular MedicineThe Ohio State University Wexner Medical Center Columbus Ohio
| | - Stephen J. Kolb
- Department of Neurology, Division of Neuromuscular MedicineThe Ohio State University Wexner Medical Center Columbus Ohio
- Department of Biological Chemistry & PharmacologyThe Ohio State University Wexner Medical Center Columbus Ohio
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De Vivo DC, Bertini E, Swoboda KJ, Hwu WL, Crawford TO, Finkel RS, Kirschner J, Kuntz NL, Parsons JA, Ryan MM, Butterfield RJ, Topaloglu H, Ben-Omran T, Sansone VA, Jong YJ, Shu F, Staropoli JF, Kerr D, Sandrock AW, Stebbins C, Petrillo M, Braley G, Johnson K, Foster R, Gheuens S, Bhan I, Reyna SP, Fradette S, Farwell W. Nusinersen initiated in infants during the presymptomatic stage of spinal muscular atrophy: Interim efficacy and safety results from the Phase 2 NURTURE study. Neuromuscul Disord 2019; 29:842-856. [PMID: 31704158 PMCID: PMC7127286 DOI: 10.1016/j.nmd.2019.09.007] [Citation(s) in RCA: 347] [Impact Index Per Article: 69.4] [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: 02/26/2019] [Revised: 08/08/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022]
Abstract
NURTURE is an ongoing study of nusinersen started in a presymptomatic stage of SMA. All infants were ≥25 months old, and alive without permanent ventilation. All infants achieved independent sitting and 88% (22/25) were walking alone. Nusinersen demonstrated durability of effect with a median 2.9 years of follow up. Nusinersen was well tolerated with no new safety concerns over extended follow up.
Spinal muscular atrophy (SMA) is a neurodegenerative disease associated with severe muscle atrophy and weakness in the limbs and trunk. We report interim efficacy and safety outcomes as of March 29, 2019 in 25 children with genetically diagnosed SMA who first received nusinersen in infancy while presymptomatic in the ongoing Phase 2, multisite, open-label, single-arm NURTURE trial. Fifteen children have two SMN2 copies and 10 have three SMN2 copies. At last visit, children were median (range) 34.8 [25.7–45.4] months of age and past the expected age of symptom onset for SMA Types I or II; all were alive and none required tracheostomy or permanent ventilation. Four (16%) participants with two SMN2 copies utilized respiratory support for ≥6 h/day for ≥7 consecutive days that was initiated during acute, reversible illnesses. All 25 participants achieved the ability to sit without support, 23/25 (92%) achieved walking with assistance, and 22/25 (88%) achieved walking independently. Eight infants had adverse events considered possibly related to nusinersen by the study investigators. These results, representing a median 2.9 years of follow up, emphasize the importance of proactive treatment with nusinersen immediately after establishing the genetic diagnosis of SMA in presymptomatic infants and emerging newborn screening efforts.
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Affiliation(s)
- Darryl C De Vivo
- Departments of Neurology and Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA.
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Post-Graduate Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Kathryn J Swoboda
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Wuh-Liang Hwu
- Departments of Medical Genetics and Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Thomas O Crawford
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard S Finkel
- Division of Neurology, Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Neuropediatrics, University Medical Hospital, Bonn, Germany
| | - Nancy L Kuntz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Julie A Parsons
- Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monique M Ryan
- Royal Children's Hospital, University of Melbourne, Murdoch Children's Research Institute, Melbourne, Australia
| | | | - Haluk Topaloglu
- Department of Pediatric Neurology, Hacettepe University, Ankara, Turkey
| | - Tawfeg Ben-Omran
- Sidra Medicine, Department of Pediatrics, Qatar Foundation, Doha, Qatar; Division of Clinical and Metabolic Genetics, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Valeria A Sansone
- NEMO Clinical Center - NEuroMuscular Omniservice, Milan, Italy; Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Yuh-Jyh Jong
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University; Departments of Pediatrics and Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Francy Shu
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Bartlett A, Kolb SJ, Kingsley A, Swoboda KJ, Reyna SP, Sakonju A, Darras BT, Shell R, Kuntz N, Castro D, Iannaccone ST, Parsons J, Connolly AM, Chiriboga CA, McDonald C, Burnette WB, Werner K, Thangarajh M, Shieh PB, Finanger E, Coffey CS, Yankey JW, Cudkowicz ME, McGovern MM, McNeil DE, Arnold WD, Kissel JT. Recruitment & retention program for the NeuroNEXT SMA Biomarker Study: Super Babies for SMA! Contemp Clin Trials Commun 2018; 11:113-119. [PMID: 30094386 PMCID: PMC6072892 DOI: 10.1016/j.conctc.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/26/2018] [Accepted: 07/12/2018] [Indexed: 01/09/2023] Open
Abstract
Background/Aims Recruitment and retention of research participants are challenging and critical components of successful clinical trials and natural history studies. Infants with spinal muscular atrophy (SMA) have been a particularly challenging population to study due to their fragile and complex medical issues, poor prognosis and, until 2016, a lack of effective therapies. Recruitment of healthy infants into clinical trials and natural history studies is also challenging and sometimes assumed to not be feasible. Methods In 2011, our group initiated a two-year, longitudinal natural history study of infants with SMA and healthy infant controls to provide data to assist in the analysis and interpretation of planned clinical trials in infants with SMA. The recruitment goal was to enroll 27 infants less than 6 months of age with SMA and 27 age-matched healthy infants within the two-year enrollment period. A detailed recruitment and retention plan was developed for this purpose. In addition, a survey was administered to participant families to understand the determinants of participation in the study. Results All healthy infants were recruited within the study's first year and 26 SMA infants were recruited within the two-year recruitment period. Thirty-eight participant families responded to the recruitment determinants survey. Nearly half of respondents (18/38, 48%) reported that they first heard of the study from their physician or neurologist. The most common reason to decide to enroll their infant (22/38, 58%) and to remain in the study (28/38, 74%) was their understanding of the importance of the study. Thematic recruitment tools such as a study brochure, video on social media, and presentations at advocacy meetings were reported to positively influence the decision to enroll. Conclusions A proactive, thematic and inclusive recruitment and retention plan that effectively communicates the rationale of a clinical study and partners with patients, advocacy groups and the local communities can effectively recruit participants in vulnerable populations. Recommendations for the proactive integration of recruitment and retention plans into clinical trial protocol development are provided.
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Affiliation(s)
- Amy Bartlett
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephen J. Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Corresponding author. Department of Neurology, Wexner Medical Center at The Ohio State University, Rightmire Hall, Rm 226A, 1060 Carmack Road, Columbus, OH, 43210, United States.
| | - Allison Kingsley
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Kathryn J. Swoboda
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Sandra P. Reyna
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- Biogen, Boston, MA, United States
| | - Ai Sakonju
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- SUNY Upstate Medical Center, Syracuse, NY, United States
| | - Basil T. Darras
- Department of Neurology, Boston Children's Hospital, Boston, MA, United States
| | - Richard Shell
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Nancy Kuntz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Diana Castro
- UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Julie Parsons
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Anne M. Connolly
- Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Claudia A. Chiriboga
- Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY, United States
| | - Craig McDonald
- University of California - Davis, Davis, CA, United States
| | | | - Klaus Werner
- Duke University Medical Center, Durham, NC, United States
| | | | - Perry B. Shieh
- University of California - Los Angeles, Los Angeles, CA, United States
| | - Erika Finanger
- Dorenbecher Children's Hospital, Portland, OR, United States
| | - Christopher S. Coffey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA, United States
| | - Jon W. Yankey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA, United States
| | - Merit E. Cudkowicz
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA, United States
| | - Michelle M. McGovern
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA, United States
| | - D. Elizabeth McNeil
- Biogen, Boston, MA, United States
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States
| | - W. David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Physical Medical and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - John T. Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Kolb SJ, Coffey CS, Yankey JW, Krosschell K, Arnold WD, Rutkove SB, Swoboda KJ, Reyna SP, Sakonju A, Darras BT, Shell R, Kuntz N, Castro D, Parsons J, Connolly AM, Chiriboga CA, McDonald C, Burnette WB, Werner K, Thangarajh M, Shieh PB, Finanger E, Cudkowicz ME, McGovern MM, McNeil DE, Finkel R, Iannaccone ST, Kaye E, Kingsley A, Renusch SR, McGovern VL, Wang X, Zaworski PG, Prior TW, Burghes AHM, Bartlett A, Kissel JT. Natural history of infantile-onset spinal muscular atrophy. Ann Neurol 2017; 82:883-891. [PMID: 29149772 DOI: 10.1002/ana.25101] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Infantile-onset spinal muscular atrophy (SMA) is the most common genetic cause of infant mortality, typically resulting in death preceding age 2. Clinical trials in this population require an understanding of disease progression and identification of meaningful biomarkers to hasten therapeutic development and predict outcomes. METHODS A longitudinal, multicenter, prospective natural history study enrolled 26 SMA infants and 27 control infants aged <6 months. Recruitment occurred at 14 centers over 21 months within the NINDS-sponsored NeuroNEXT (National Network for Excellence in Neuroscience Clinical Trials) Network. Infant motor function scales (Test of Infant Motor Performance Screening Items [TIMPSI], The Children's Hospital of Philadelphia Infant Test for Neuromuscular Disorders, and Alberta Infant Motor Score) and putative physiological and molecular biomarkers were assessed preceding age 6 months and at 6, 9, 12, 18, and 24 months with progression, correlations between motor function and biomarkers, and hazard ratios analyzed. RESULTS Motor function scores (MFS) and compound muscle action potential (CMAP) decreased rapidly in SMA infants, whereas MFS in all healthy infants rapidly increased. Correlations were identified between TIMPSI and CMAP in SMA infants. TIMPSI at first study visit was associated with risk of combined endpoint of death or permanent invasive ventilation in SMA infants. Post-hoc analysis of survival to combined endpoint in SMA infants with 2 copies of SMN2 indicated a median age of 8 months at death (95% confidence interval, 6, 17). INTERPRETATION These data of SMA and control outcome measures delineates meaningful change in clinical trials in infantile-onset SMA. The power and utility of NeuroNEXT to provide "real-world," prospective natural history data sets to accelerate public and private drug development programs for rare disease is demonstrated. Ann Neurol 2017;82:883-891.
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Affiliation(s)
- Stephen J Kolb
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Christopher S Coffey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA
| | - Jon W Yankey
- Department of Biostatistics, NeuroNEXT Data Coordinating Center, University of Iowa, Iowa City, IA
| | - Kristin Krosschell
- Departments of Physical Therapy and Human Movement Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - W David Arnold
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH.,Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Kathryn J Swoboda
- Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, UT.,Department of Neurology, Boston Children's Hospital, Boston, MA
| | - Sandra P Reyna
- Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, UT.,Biogen, Boston, MA
| | - Ai Sakonju
- Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, UT.,SUNY Upstate Medical Center, Syracuse, NY
| | - Basil T Darras
- Department of Neurology, Boston Children's Hospital, Boston, MA
| | | | - Nancy Kuntz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Julie Parsons
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Anne M Connolly
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Claudia A Chiriboga
- Department of Neurology, Columbia College of Physicians and Surgeons, New York, NY
| | | | | | | | | | - Perry B Shieh
- University of California-Los Angeles, Los Angeles, CA
| | | | - Merit E Cudkowicz
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA
| | - Michelle M McGovern
- Department of Neurology, NeuroNEXT Clinical Coordinating Center, Massachusetts General Hospital, Boston, MA
| | - D Elizabeth McNeil
- Biogen, Boston, MA.,National Institute of Neurological Disorders and Stroke, Bethesda, MD
| | | | | | | | - Allison Kingsley
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Samantha R Renusch
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Vicki L McGovern
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Xueqian Wang
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Thomas W Prior
- Department of Molecular Pathology, Ohio State Wexner Medical Center, Columbus, OH
| | - Arthur H M Burghes
- Department of Biological Chemistry & Pharmacology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Amy Bartlett
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - John T Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
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- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
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Lally C, Jones C, Farwell W, Reyna SP, Cook SF, Flanders WD. Indirect estimation of the prevalence of spinal muscular atrophy Type I, II, and III in the United States. Orphanet J Rare Dis 2017; 12:175. [PMID: 29183396 PMCID: PMC5704427 DOI: 10.1186/s13023-017-0724-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/15/2017] [Indexed: 01/06/2023] Open
Abstract
Background Spinal muscular atrophy (SMA) is a progressive, devastating disease and a leading inherited cause of infant mortality. The limited population-based literature is confined to small regional studies. Estimates of prevalence are needed to characterize the burden of SMA and to understand trends in prevalence by disease type as new treatments become available. The reported estimates of SMA genotype prevalence at birth consistently range from 8.5–10.3 per 100,000 live births, with a mid-range estimate of 9.4 per 100,000. Among infants born with an SMA genotype, it is reported that ~58% will develop SMA Type I, 29% will develop Type II, and 13% will develop Type III, respectively. Results Using evidence from peer-reviewed literature for SMA birth prevalence, age at symptom onset, and SMA type-specific survival, and incorporating United States vital statistics, we constructed life tables to estimate prevalence for SMA Types I, II, and III in the United States. We estimated the number of prevalent cases in the US to be 8526, 9429, and 10,333 based on a birth prevalence of 8.5, 9.4, and 10.3, respectively (the lower, midpoint, and upper ends of the reported range). Assuming the midpoint of 9.4 and US-reported survival, the type-specific population prevalence estimates were 1610 for SMA Type I, 3944 for SMA Type II, and 3875 for SMA Type III. Evidence-based estimates of the number of people living with SMA in the United States in the published literature were previously unavailable. Conclusions In the absence of a survey or other means to directly estimate prevalence in the US population, estimates can be calculated indirectly using a life table. Electronic supplementary material The online version of this article (10.1186/s13023-017-0724-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cathy Lally
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | | | | | | | - W Dana Flanders
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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13
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Krosschell KJ, Kissel JT, Townsend EL, Simeone SD, Zhang RZ, Reyna SP, Crawford TO, Schroth MK, Acsadi G, Kishnani PS, Von Kleist-Retzow JC, Hero B, D'Anjou G, Smith EC, Elsheikh B, Simard LR, Prior TW, Scott CB, Lasalle B, Sakonju A, Wirth B, Swoboda KJ. Clinical trial of L-Carnitine and valproic acid in spinal muscular atrophy type I. Muscle Nerve 2017; 57:193-199. [PMID: 28833236 DOI: 10.1002/mus.25776] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 02/07/2017] [Revised: 08/10/2017] [Accepted: 08/12/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of this study was to determine the safety and therapeutic potential of L-carnitine and valproic acid (VPA) in infants with spinal muscular atrophy (SMA). METHODS Our investigation was an open-label phase 2 multicenter trial of L-carnitine and VPA in infants with SMA type I with retrospective comparison to an untreated, matched cohort. Primary outcomes were: safety and adverse events; secondary outcomes were survival, time to death/>16 hours/day of ventilator support; motor outcomes; and maximum ulnar compound motor action potential amplitude. RESULTS A total of 245 AEs were observed in 35 of the 37 treated subjects (95%). Respiratory events accounted for 49% of all adverse events, resulting in 14 deaths. Survival was not significantly different between treated and untreated cohorts. DISCUSSION This trial provides evidence that, in infants with SMA type I, L-carnitine/VPA is ineffective at altering survival. The substantial proportion of infants reaching end-points within 6 months of enrollment underscores the urgent need for pre-symptomatic treatment in SMA type I. Muscle Nerve 57: 193-199, 2018.
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Affiliation(s)
- Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - John T Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elise L Townsend
- Department of Physical Therapy, Institute of Health Professions, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah D Simeone
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches 5-240, Boston, Massachusetts, 02114, USA
| | - Ren Zhe Zhang
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches 5-240, Boston, Massachusetts, 02114, USA
| | - Sandra P Reyna
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Thomas O Crawford
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mary K Schroth
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
| | - Gyula Acsadi
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | - Priya S Kishnani
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | | | - Barbara Hero
- Department of Pediatrics, Hospital of the University of Cologne, Cologne, Germany
| | - Guy D'Anjou
- Department of Pediatrics, Saint-Justine Hospital, Montreal, Quebec, Canada
| | - Edward C Smith
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Bakri Elsheikh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Louise R Simard
- Biochemistry and Medical Genetics, University of Manitoba, Winnepeg, Manitoba, Canada
| | - Thomas W Prior
- Department of Molecular Pathology, The Ohio State University, Columbus, Ohio, USA
| | | | - Bernard Lasalle
- Department of Bioinformatics, University of Utah, Salt Lake City, Utah, USA
| | - Ai Sakonju
- Department of Neurology, State University of New York, Syracuse, New York
| | - Brunhilde Wirth
- Institute of Human Genetics, Center for Molecular Medicine Cologne, Center for Rare Diseases Cologne.,Institute of Genetics, University of Cologne, Cologne, Germany
| | - Kathryn J Swoboda
- Department of Neurology, Center for Genomic Medicine, Massachusetts General Hospital, 185 Cambridge Street, Simches 5-240, Boston, Massachusetts, 02114, USA
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Abstract
OBJECTIVES To expand the limited available knowledge about pregnancy and delivery in women with spinal muscular atrophy (SMA) using a cohort of genetically proven SMA patients from USA. METHODS This was a cross-sectional questionnaire-based study. We mailed questionnaires to 58 women with confirmed SMA. RESULTS Thirty-two women responded, reporting 35 pregnancies, including 19 women with at least one pregnancy. In this cohort, preterm labor and delivery by cesarean section were more common in mothers with SMA particularly SMA type 2. Seventy-four percent of mothers reported increased weakness during pregnancy that persisted after delivery in 42%. SMA mothers generally had a positive experience and good outcomes and elected to have more than one pregnancy. CONCLUSION This information regarding pregnancy in women with genetically confirmed 5q SMA will prove useful in guiding future research and in providing counseling to women with SMA.
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Affiliation(s)
- Bakri H Elsheikh
- a Neurology , Johns Hopkins Aramco Healthcare , Dhahran , Saudi Arabia
| | - Xiaoli Zhang
- b Center for Biostatistics , The Ohio State University Wexner Medical Center , Columbus , OH , USA
| | - Kathryn J Swoboda
- c Department of Neurology , Massachusetts General Hospital , Boston , MA , USA
| | - Sharon Chelnick
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
| | - Sandra P Reyna
- e Neurology Clinical Research Institute , Massachusetts General Hospital , Boston , MA , USA
| | - Stephen J Kolb
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
| | - John T Kissel
- d Department of Neurology , The Ohio State University Wexner Medical Center, Columbus , OH , USA
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15
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Kolb SJ, Coffey CS, Yankey JW, Krosschell K, Arnold WD, Rutkove SB, Swoboda KJ, Reyna SP, Sakonju A, Darras BT, Shell R, Kuntz N, Castro D, Iannaccone ST, Parsons J, Connolly AM, Chiriboga CA, McDonald C, Burnette WB, Werner K, Thangarajh M, Shieh PB, Finanger E, Cudkowicz ME, McGovern MM, McNeil DE, Finkel R, Kaye E, Kingsley A, Renusch SR, McGovern VL, Wang X, Zaworski PG, Prior TW, Burghes AHM, Bartlett A, Kissel JT. Baseline results of the NeuroNEXT spinal muscular atrophy infant biomarker study. Ann Clin Transl Neurol 2016; 3:132-45. [PMID: 26900585 PMCID: PMC4748311 DOI: 10.1002/acn3.283] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 10/30/2015] [Accepted: 12/10/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study prospectively assessed putative promising biomarkers for use in assessing infants with spinal muscular atrophy (SMA). METHODS This prospective, multi-center natural history study targeted the enrollment of SMA infants and healthy control infants less than 6 months of age. Recruitment occurred at 14 centers within the NINDS National Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT) Network. Infant motor function scales and putative electrophysiological, protein and molecular biomarkers were assessed at baseline and subsequent visits. RESULTS Enrollment began November, 2012 and ended September, 2014 with 26 SMA infants and 27 healthy infants enrolled. Baseline demographic characteristics of the SMA and control infant cohorts aligned well. Motor function as assessed by the Test for Infant Motor Performance Items (TIMPSI) and the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) revealed significant differences between the SMA and control infants at baseline. Ulnar compound muscle action potential amplitude (CMAP) in SMA infants (1.4 ± 2.2 mV) was significantly reduced compared to controls (5.5 ± 2.0 mV). Electrical impedance myography (EIM) high-frequency reactance slope (Ohms/MHz) was significantly higher in SMA infants than controls SMA infants had lower survival motor neuron (SMN) mRNA levels in blood than controls, and several serum protein analytes were altered between cohorts. INTERPRETATION By the time infants were recruited and presented for the baseline visit, SMA infants had reduced motor function compared to controls. Ulnar CMAP, EIM, blood SMN mRNA levels, and serum protein analytes were able to distinguish between cohorts at the enrollment visit.
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Affiliation(s)
- Stephen J Kolb
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio; Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Christopher S Coffey
- Department of Biostatistics Neuro NEXT Data Coordinating Center University of Iowa Iowa City Iowa
| | - Jon W Yankey
- Department of Biostatistics Neuro NEXT Data Coordinating Center University of Iowa Iowa City Iowa
| | - Kristin Krosschell
- Departments of Physical Therapy and Human Movement Sciences and Pediatrics Northwestern University Feinberg School of Medicine Chicago Illinois
| | - W David Arnold
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio; Department of Physical Medicine and Rehabilitation The Ohio State University Wexner Medical Center Columbus Ohio
| | - Seward B Rutkove
- Department of Neurology Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Kathryn J Swoboda
- Departments of Neurology and Pediatrics University of Utah Salt Lake City Utah; Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - Sandra P Reyna
- Departments of Neurology and Pediatrics University of Utah Salt Lake City Utah; Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - Ai Sakonju
- Departments of Neurology and Pediatrics University of Utah Salt Lake City Utah
| | - Basil T Darras
- Department of Neurology Boston Children's Hospital Boston Massachusetts
| | | | - Nancy Kuntz
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | | | | | - Julie Parsons
- Children's Hospital Colorado, University of Colorado School of Medicine Aurora Colorado
| | - Anne M Connolly
- Washington University School of Medicine in St. Louis St. Louis Missouri
| | - Claudia A Chiriboga
- Department of Neurology Columbia College of Physicians and Surgeons New York New York
| | | | | | | | | | - Perry B Shieh
- University of California - Los Angeles Los Angeles California
| | | | - Merit E Cudkowicz
- Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - Michelle M McGovern
- Department of Neurology Neuro NEXT Clinical Coordinating Center Massachusetts General Hospital Boston Massachusetts
| | - D Elizabeth McNeil
- National Institute of Neurological Disorders and Stroke Bethesda Maryland
| | | | - Edward Kaye
- Sarepta Therapeutics Cambridge Massachusetts
| | - Allison Kingsley
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Samantha R Renusch
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Vicki L McGovern
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Xueqian Wang
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | | | - Thomas W Prior
- Department of Molecular Pathology Ohio State Wexner Medical Center Columbus Ohio
| | - Arthur H M Burghes
- Department of Biological Chemistry & Pharmacology The Ohio State University Wexner Medical Center Columbus Ohio
| | - Amy Bartlett
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio
| | - John T Kissel
- Department of Neurology The Ohio State University Wexner Medical Center Columbus Ohio
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16
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Viollet L, Glusman G, Murphy KJ, Newcomb TM, Reyna SP, Sweney M, Nelson B, Andermann F, Andermann E, Acsadi G, Barbano RL, Brown C, Brunkow ME, Chugani HT, Cheyette SR, Collins A, DeBrosse SD, Galas D, Friedman J, Hood L, Huff C, Jorde LB, King MD, LaSalle B, Leventer RJ, Lewelt AJ, Massart MB, Mérida MR, Ptáček LJ, Roach JC, Rust RS, Renault F, Sanger TD, Sotero de Menezes MA, Tennyson R, Uldall P, Zhang Y, Zupanc M, Xin W, Silver K, Swoboda KJ. Alternating Hemiplegia of Childhood: Retrospective Genetic Study and Genotype-Phenotype Correlations in 187 Subjects from the US AHCF Registry. PLoS One 2015; 10:e0127045. [PMID: 25996915 PMCID: PMC4440742 DOI: 10.1371/journal.pone.0127045] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 12/12/2014] [Accepted: 04/11/2015] [Indexed: 11/21/2022] Open
Abstract
Mutations in ATP1A3 cause Alternating Hemiplegia of Childhood (AHC) by disrupting function of the neuronal Na+/K+ ATPase. Published studies to date indicate 2 recurrent mutations, D801N and E815K, and a more severe phenotype in the E815K cohort. We performed mutation analysis and retrospective genotype-phenotype correlations in all eligible patients with AHC enrolled in the US AHC Foundation registry from 1997-2012. Clinical data were abstracted from standardized caregivers’ questionnaires and medical records and confirmed by expert clinicians. We identified ATP1A3 mutations by Sanger and whole genome sequencing, and compared phenotypes within and between 4 groups of subjects, those with D801N, E815K, other ATP1A3 or no ATP1A3 mutations. We identified heterozygous ATP1A3 mutations in 154 of 187 (82%) AHC patients. Of 34 unique mutations, 31 (91%) are missense, and 16 (47%) had not been previously reported. Concordant with prior studies, more than 2/3 of all mutations are clustered in exons 17 and 18. Of 143 simplex occurrences, 58 had D801N (40%), 38 had E815K (26%) and 11 had G937R (8%) mutations. Patients with an E815K mutation demonstrate an earlier age of onset, more severe motor impairment and a higher prevalence of status epilepticus. This study further expands the number and spectrum of ATP1A3 mutations associated with AHC and confirms a more deleterious effect of the E815K mutation on selected neurologic outcomes. However, the complexity of the disorder and the extensive phenotypic variability among subgroups merits caution and emphasizes the need for further studies.
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Affiliation(s)
- Louis Viollet
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Gustavo Glusman
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Kelley J. Murphy
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Tara M. Newcomb
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Sandra P. Reyna
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Matthew Sweney
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Benjamin Nelson
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Frederick Andermann
- Neurogenetics Unit, Montreal Neurologic Institute and Hospital, McGill University, Montreal Quebec, Canada
| | - Eva Andermann
- Neurogenetics Unit, Montreal Neurologic Institute and Hospital, McGill University, Montreal Quebec, Canada
| | - Gyula Acsadi
- Departments of Pediatrics and Neurology, Connecticut Children's Medical Center and University of Connecticut School of Medicine, Hartford, CT, United States of America
| | - Richard L. Barbano
- Department of Neurology, University of Rochester School of Medicine, Rochester, New York, United States of America
| | - Candida Brown
- Diablo Valley Child Neurology, an affiliate of Stanford Health Alliance, Pleasant Hill, California, United States of America
| | - Mary E. Brunkow
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Harry T. Chugani
- Division of Pediatric Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, United States of America
| | - Sarah R. Cheyette
- Department of Child Neurology, Palo Alto Medical Foundation Redwood City Clinic, Redwood City, California, United States of America
| | - Abigail Collins
- Department of Pediatric Neurology, Children’s Hospital Colorado, University of Colorado Hospital, Aurora, Colorado, United States of America
| | - Suzanne D. DeBrosse
- Departments of Genetics and Genome Sciences, Pediatrics, and Neurology, Case Western Reserve University and University Hospitals Case Medical Center, Cleveland, Ohio, United States of America
| | - David Galas
- Pacific Northwest Diabetes Research Institute, Seattle, Washington, United States of America
| | - Jennifer Friedman
- Departments of Neuroscience and Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Lee Hood
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Chad Huff
- Department of Epidemiology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Lynn B. Jorde
- Department of Human Genetics, University of Utah, Salt Lake City, Utah, United States of America
| | - Mary D. King
- Departments of Pediatrics and Neurology, University College Dublin School of Medicine and Medical Science, Dublin, Ireland
| | - Bernie LaSalle
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Richard J. Leventer
- Children’s Neuroscience Centre, Murdoch Childrens Research Institute, University of Melbourne Department of Paediatrics, The Royal Children’s Hospital Melbourne, Parkville Victoria, Australia
| | - Aga J. Lewelt
- Department of Pediatrics, College of Medicine Jacksonville, University of Florida, Jacksonville, Florida, United States of America
| | - Mylynda B. Massart
- Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Mario R. Mérida
- Stevens Henager College, Salt Lake City, Utah, United States of America
| | - Louis J. Ptáček
- Department of Neurology, University of California San Francisco, San Francisco, California, United States of America
| | - Jared C. Roach
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Robert S. Rust
- Center for Medical Ethics and Humanities in Medicine, University Of Virginia UVA health system, Charlottesville, Virginia, United States of America
| | - Francis Renault
- Departement de Neurophysiologie. Hopital Armand Trousseau APHP, Paris, France
| | - Terry D. Sanger
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California, United States of America
| | | | - Rachel Tennyson
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
| | - Peter Uldall
- Department of Paediatrics and Adolescent Medicine, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Yue Zhang
- Study Design and Biostatistics Center, University of Utah, Salt Lake City, Utah, United States of America
| | - Mary Zupanc
- Department of Neurology, Children’s Hospital Orange County, and Department of Pediatrics, University of California, Orange, California, United States of America
| | - Winnie Xin
- Center for Human Genetic Research, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Kenneth Silver
- Departments of Pediatrics and Neurology, University of Chicago and Comer Children's Hospital, Chicago, Illinois, United States of America
| | - Kathryn J. Swoboda
- Pediatric Motor Disorders Research Program, Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, United States of America
- * E-mail:
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17
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Kissel JT, Elsheikh B, King WM, Freimer M, Scott CB, Kolb SJ, Reyna SP, Crawford TO, Simard LR, Krosschell KJ, Acsadi G, Schroth MK, D'Anjou G, LaSalle B, Prior TW, Sorenson S, Maczulski JA, Swoboda KJ. SMA valiant trial: a prospective, double-blind, placebo-controlled trial of valproic acid in ambulatory adults with spinal muscular atrophy. Muscle Nerve 2014; 49:187-92. [PMID: 23681940 DOI: 10.1002/mus.23904] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2013] [Indexed: 12/15/2022]
Abstract
INTRODUCTION An open-label trial suggested that valproic acid (VPA) improved strength in adults with spinal muscular atrophy (SMA). We report a 12-month, double-blind, cross-over study of VPA in ambulatory SMA adults. METHODS There were 33 subjects, aged 20–55 years, included in this investigation. After baseline assessment, subjects were randomized to receive VPA (10–20 mg/kg/day) or placebo. At 6 months, patients were switched to the other group. Assessments were performed at 3, 6, and 12 months. The primary outcome was the 6-month change in maximum voluntary isometric contraction testing with pulmonary, electrophysiological, and functional secondary outcomes. RESULTS Thirty subjects completed the study. VPA was well tolerated, and compliance was good. There was no change in primary or secondary outcomes at 6 or 12 months. CONCLUSIONS VPA did not improve strength or function in SMA adults. The outcomes used are feasible and reliable and can be employed in future trials in SMA adults.
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Poruk KE, Davis RH, Smart AL, Chisum BS, LaSalle BA, Chan GM, Gill G, Reyna SP, Swoboda KJ. Observational study of caloric and nutrient intake, bone density, and body composition in infants and children with spinal muscular atrophy type I. Neuromuscul Disord 2012; 22:966-73. [PMID: 22832342 PMCID: PMC3484247 DOI: 10.1016/j.nmd.2012.04.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 04/18/2012] [Accepted: 04/23/2012] [Indexed: 11/19/2022]
Abstract
Clinical experience supports a critical role for nutrition in patients with spinal muscular atrophy (SMA). Three-day dietary intake records were analyzed for 156 visits in 47 SMA type I patients, 25 males and 22 females, ages 1month to 13years (median 9.8months) and compared to dietary reference intakes for gender and age along with anthropometric measures and dual-energy X-ray absorptiometry (DEXA) data. Using standardized growth curves, twelve patients met criteria for failure to thrive (FTT) with weight for age <3rd percentile; eight met criteria based on weight for height. Percentage of body fat mass was not correlated with weight for height and weight for age across percentile categories. DEXA analysis further demonstrated that SMA type I children have higher fat mass and lower fat free mass than healthy peers (p<0.001). DEXA and dietary analysis indicates a strong correlation with magnesium intake and bone mineral density (r=0.65, p<0.001). Average caloric intake for 1-3years old was 68.8±15.8kcal/kg - 67% of peers' recommended intake. Children with SMA type I may have lower caloric requirements than healthy age-matched peers, increasing risk for over and undernourished states and deficiencies of critical nutrients. Standardized growth charts may overestimate FTT status in SMA type I.
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Affiliation(s)
- Katherine E Poruk
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rebecca Hurst Davis
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Abby L Smart
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Benjamin S Chisum
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Bernie A LaSalle
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Gary M Chan
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Gurmail Gill
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Sandra P Reyna
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kathryn J Swoboda
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Kissel JT, Scott CB, Reyna SP, Crawford TO, Simard LR, Krosschell KJ, Acsadi G, Elsheik B, Schroth MK, D'Anjou G, LaSalle B, Prior TW, Sorenson S, Maczulski JA, Bromberg MB, Chan GM, Swoboda KJ. SMA CARNIVAL TRIAL PART II: a prospective, single-armed trial of L-carnitine and valproic acid in ambulatory children with spinal muscular atrophy. PLoS One 2011; 6:e21296. [PMID: 21754985 PMCID: PMC3130730 DOI: 10.1371/journal.pone.0021296] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 05/27/2011] [Indexed: 01/19/2023] Open
Abstract
Background Multiple lines of evidence have suggested that valproic acid (VPA) might benefit patients with spinal muscular atrophy (SMA). The SMA CARNIVAL TRIAL was a two part prospective trial to evaluate oral VPA and l-carnitine in SMA children. Part 1 targeted non-ambulatory children ages 2–8 in a 12 month cross over design. We report here Part 2, a twelve month prospective, open-label trial of VPA and L-carnitine in ambulatory SMA children. Methods This study involved 33 genetically proven type 3 SMA subjects ages 3–17 years. Subjects underwent two baseline assessments over 4–6 weeks and then were placed on VPA and L-carnitine for 12 months. Assessments were performed at baseline, 3, 6 and 12 months. Primary outcomes included safety, adverse events and the change at 6 and 12 months in motor function assessed using the Modified Hammersmith Functional Motor Scale Extend (MHFMS-Extend), timed motor tests and fine motor modules. Secondary outcomes included changes in ulnar compound muscle action potential amplitudes (CMAP), handheld dynamometry, pulmonary function, and Pediatric Quality of Life Inventory scores. Results Twenty-eight subjects completed the study. VPA and carnitine were generally well tolerated. Although adverse events occurred in 85% of subjects, they were usually mild and transient. Weight gain of 20% above body weight occurred in 17% of subjects. There was no significant change in any primary outcome at six or 12 months. Some pulmonary function measures showed improvement at one year as expected with normal growth. CMAP significantly improved suggesting a modest biologic effect not clinically meaningful. Conclusions This study, coupled with the CARNIVAL Part 1 study, indicate that VPA is not effective in improving strength or function in SMA children. The outcomes used in this study are feasible and reliable, and can be employed in future trials in SMA. Trial Regsitration Clinicaltrials.gov NCT00227266
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Affiliation(s)
- John T Kissel
- Department of Neurology, The Ohio State University, Columbus, Ohio, United States of America.
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Krosschell KJ, Scott CB, Maczulski JA, Lewelt AJ, Reyna SP, Swoboda KJ. Reliability of the Modified Hammersmith Functional Motor Scale in young children with spinal muscular atrophy. Muscle Nerve 2011; 44:246-51. [PMID: 21698647 DOI: 10.1002/mus.22040] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [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] [Accepted: 01/11/2011] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The test-retest reliability of the Modified Hammersmith Functional Motor Scale (MHFMS) in children with spinal muscular atrophy (SMA) ≤30 months of age was assessed. The age at which typically developing children (TD) achieve maximum MHFMS scores was also studied. METHODS Twenty-two children with SMA type II [mean age (SD) = 20 (5) months, range 9-30 months) were tested twice using the MHFMS. Twenty-five TD children [mean age (SD) = 18 (7) months, range 9-30 months) were tested once. RESULTS The average difference between MHFMS scores for SMA children was 0.18 [first assessment: mean (SD) = 12.8 (9.8); second assessment: mean (SD) = 13.0 (8.8)]. Reliability was excellent (ICC(1,3) = 0.96, SEM 1.86). TD participants had MHFMS scores ranging from 36 to 40 [mean (SD) = 39.2 (1.2)] and achieved maximum test scores at 12 months of age. DISCUSSION MHFMS scores in young children with SMA type II showed excellent test-retest stability. This suggests that the MHFMS can be used reliably in this younger population for clinical trials and follow-up.
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Affiliation(s)
- Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Suite 1100, 645 North Michigan Avenue, Chicago, Illinois 60611, USA.
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Lewelt A, Krosschell KJ, Scott C, Sakonju A, Kissel JT, Crawford TO, Acsadi G, D'anjou G, Elsheikh B, Reyna SP, Schroth MK, Maczulski JA, Stoddard GJ, Elovic E, Swoboda KJ. Compound muscle action potential and motor function in children with spinal muscular atrophy. Muscle Nerve 2010; 42:703-8. [PMID: 20737553 DOI: 10.1002/mus.21838] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Reliable outcome measures that reflect the underlying disease process and correlate with motor function in children with SMA are needed for clinical trials. Maximum ulnar compound muscle action potential (CMAP) data were collected at two visits over a 4-6-week period in children with SMA types II and III, 2-17 years of age, at four academic centers. Primary functional outcome measures included the Modified Hammersmith Functional Motor Scale (MHFMS) and MHFMS-Extend. CMAP negative peak amplitude and area showed excellent discrimination between the ambulatory and non-ambulatory SMA cohorts (ROC = 0.88). CMAP had excellent test-retest reliability (ICC = 0.96-0.97, n = 64) and moderate to strong correlation with the MHFMS and MHFMS-Extend (r = 0.61-0.73, n = 68, P < 0.001). Maximum ulnar CMAP amplitude and area is a feasible, valid, and reliable outcome measure for use in pediatric multicenter clinical trials in SMA. CMAP correlates well with motor function and has potential value as a relevant surrogate for disease status.
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Affiliation(s)
- Aga Lewelt
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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Swoboda KJ, Scott CB, Crawford TO, Simard LR, Reyna SP, Krosschell KJ, Acsadi G, Elsheik B, Schroth MK, D'Anjou G, LaSalle B, Prior TW, Sorenson SL, Maczulski JA, Bromberg MB, Chan GM, Kissel JT. SMA CARNI-VAL trial part I: double-blind, randomized, placebo-controlled trial of L-carnitine and valproic acid in spinal muscular atrophy. PLoS One 2010; 5:e12140. [PMID: 20808854 PMCID: PMC2924376 DOI: 10.1371/journal.pone.0012140] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 07/13/2010] [Indexed: 01/21/2023] Open
Abstract
Background Valproic acid (VPA) has demonstrated potential as a therapeutic candidate for spinal muscular atrophy (SMA) in vitro and in vivo. Methods Two cohorts of subjects were enrolled in the SMA CARNIVAL TRIAL, a non-ambulatory group of “sitters” (cohort 1) and an ambulatory group of “walkers” (cohort 2). Here, we present results for cohort 1: a multicenter phase II randomized double-blind intention-to-treat protocol in non-ambulatory SMA subjects 2–8 years of age. Sixty-one subjects were randomized 1∶1 to placebo or treatment for the first six months; all received active treatment the subsequent six months. The primary outcome was change in the modified Hammersmith Functional Motor Scale (MHFMS) score following six months of treatment. Secondary outcomes included safety and adverse event data, and change in MHFMS score for twelve versus six months of active treatment, body composition, quantitative SMN mRNA levels, maximum ulnar CMAP amplitudes, myometry and PFT measures. Results At 6 months, there was no difference in change from the baseline MHFMS score between treatment and placebo groups (difference = 0.643, 95% CI = −1.22–2.51). Adverse events occurred in >80% of subjects and were more common in the treatment group. Excessive weight gain was the most frequent drug-related adverse event, and increased fat mass was negatively related to change in MHFMS values (p = 0.0409). Post-hoc analysis found that children ages two to three years that received 12 months treatment, when adjusted for baseline weight, had significantly improved MHFMS scores (p = 0.03) compared to those who received placebo the first six months. A linear regression analysis limited to the influence of age demonstrates young age as a significant factor in improved MHFMS scores (p = 0.007). Conclusions This study demonstrated no benefit from six months treatment with VPA and L-carnitine in a young non-ambulatory cohort of subjects with SMA. Weight gain, age and treatment duration were significant confounding variables that should be considered in the design of future trials. Trial Registry Clinicaltrials.gov NCT00227266
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Affiliation(s)
- Kathryn J. Swoboda
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Charles B. Scott
- CBS Squared, Inc, Fort Washington, Pennsylvania, United States of America
| | - Thomas O. Crawford
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Louise R. Simard
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandra P. Reyna
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Kristin J. Krosschell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Gyula Acsadi
- Departments of Neurology and Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Bakri Elsheik
- Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, United States of America
| | - Mary K. Schroth
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Guy D'Anjou
- Division of Pediatric Neurology, Ste-Justine Hospital, Montréal, Québec, Canada
| | - Bernard LaSalle
- General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Thomas W. Prior
- Department of Molecular Pathology, Ohio State University, Columbus, Ohio, United States of America
| | - Susan L. Sorenson
- Primary Children's Medical Center, Salt Lake City, Utah, United States of America
| | - Jo Anne Maczulski
- Pediatric Occupational Therapy Services, Chicago, Illinois, United States of America
| | - Mark B. Bromberg
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Gary M. Chan
- Department of Pediatric Neonatology, University of Utah, Salt Lake City, Utah, United States of America
| | - John T. Kissel
- Department of Neurology, Ohio State University Medical Center, Columbus, Ohio, United States of America
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Swoboda KJ, Scott CB, Reyna SP, Prior TW, LaSalle B, Sorenson SL, Wood J, Acsadi G, Crawford TO, Kissel JT, Krosschell KJ, D'Anjou G, Bromberg MB, Schroth MK, Chan GM, Elsheikh B, Simard LR. Phase II open label study of valproic acid in spinal muscular atrophy. PLoS One 2009; 4:e5268. [PMID: 19440247 PMCID: PMC2680034 DOI: 10.1371/journal.pone.0005268] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Accepted: 03/18/2009] [Indexed: 12/11/2022] Open
Abstract
Preliminary in vitro and in vivo studies with valproic acid (VPA) in cell lines and patients with spinal muscular atrophy (SMA) demonstrate increased expression of SMN, supporting the possibility of therapeutic benefit. We performed an open label trial of VPA in 42 subjects with SMA to assess safety and explore potential outcome measures to help guide design of future controlled clinical trials. Subjects included 2 SMA type I ages 2–3 years, 29 SMA type II ages 2–14 years and 11 type III ages 2–31 years, recruited from a natural history study. VPA was well-tolerated and without evident hepatotoxicity. Carnitine depletion was frequent and temporally associated with increased weakness in two subjects. Exploratory outcome measures included assessment of gross motor function via the modified Hammersmith Functional Motor Scale (MHFMS), electrophysiologic measures of innervation including maximum ulnar compound muscle action potential (CMAP) amplitudes and motor unit number estimation (MUNE), body composition and bone density via dual-energy X-ray absorptiometry (DEXA), and quantitative blood SMN mRNA levels. Clear decline in motor function occurred in several subjects in association with weight gain; mean fat mass increased without a corresponding increase in lean mass. We observed an increased mean score on the MHFMS scale in 27 subjects with SMA type II (p≤0.001); however, significant improvement was almost entirely restricted to participants <5 years of age. Full length SMN levels were unchanged and Δ7SMN levels were significantly reduced for 2 of 3 treatment visits. In contrast, bone mineral density (p≤0.0036) and maximum ulnar CMAP scores (p≤0.0001) increased significantly. Conclusions While VPA appears safe and well-tolerated in this initial pilot trial, these data suggest that weight gain and carnitine depletion are likely to be significant confounding factors in clinical trials. This study highlights potential strengths and limitations of various candidate outcome measures and underscores the need for additional controlled clinical trials with VPA targeting more restricted cohorts of subjects. Trial Registration ClinicalTrials.gov
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Affiliation(s)
- Kathryn J. Swoboda
- Departments of Neurology, Pediatrics, Neonatology and General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Charles B. Scott
- CBS Squared, Inc, Fort Washington, Pennsylvania, United States of America
| | - Sandra P. Reyna
- Departments of Neurology, Pediatrics, Neonatology and General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Thomas W. Prior
- Departments of Molecular Pathology and Neurology, Ohio State University Medical Center, Columbus, Ohio, United States of America
| | - Bernard LaSalle
- Departments of Neurology, Pediatrics, Neonatology and General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Susan L. Sorenson
- Departments of Neurology, Pediatrics, Neonatology and General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Janine Wood
- Departments of Neurology, Pediatrics, Neonatology and General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Gyula Acsadi
- Departments of Neurology and Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Thomas O. Crawford
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - John T. Kissel
- Departments of Molecular Pathology and Neurology, Ohio State University Medical Center, Columbus, Ohio, United States of America
| | - Kristin J. Krosschell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Guy D'Anjou
- Division of Pediatric Neurology, Hôpital Sainte-Justine Montréal, Montréal, Québec, Canada
| | - Mark B. Bromberg
- Departments of Neurology, Pediatrics, Neonatology and General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Mary K. Schroth
- Department of Pediatrics, University of Wisconsin School of Medicine, Madison, Wisconsin, United States of America
| | - Gary M. Chan
- Departments of Neurology, Pediatrics, Neonatology and General Clinical Research Center, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Bakri Elsheikh
- Departments of Molecular Pathology and Neurology, Ohio State University Medical Center, Columbus, Ohio, United States of America
| | - Louise R. Simard
- Department of Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
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Sweney MT, Silver K, Gerard-Blanluet M, Pedespan JM, Renault F, Arzimanoglou A, Schlesinger-Massart M, Lewelt AJ, Reyna SP, Swoboda KJ. Alternating hemiplegia of childhood: early characteristics and evolution of a neurodevelopmental syndrome. Pediatrics 2009; 123:e534-41. [PMID: 19254988 DOI: 10.1542/peds.2008-2027] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Alternating hemiplegia of childhood is a predominantly sporadic neurodevelopmental syndrome of uncertain etiology. In more than 3 decades since its description, little progress has been made in understanding its etiology or in identifying effective treatments. In 1998, in collaboration with the Alternating Hemiplegia of Childhood Foundation, an international registry was established to help document clinical outcomes and promote research efforts. PATIENTS AND METHODS We present phenotypic data on 103 patients who met existing diagnostic criteria for alternating hemiplegia of childhood. Although some of these subjects may have been included in previously published reviews, our focus was directed toward the earliest manifestations of symptoms and evolution of features over time. Data sources included written questionnaires, face-to-face and telephone interviews, clinical examination, and medical charts. Characteristics of disease onset, medical comorbidities, episode triggers, diagnostic workup, and treatment are presented. RESULTS Paroxysmal eye movements were the most frequent early symptom, manifesting in the first 3 months of life in 83% of patients. Hemiplegic episodes appeared by 6 months of age in 56% of infants. Background slowing shown by electroencephalography during typical paroxysmal events, including hemiplegic, tonic, or dystonic episodes was frequent (21 of 42 cases). Distinct convulsive episodes with altered consciousness believed to be epileptic in nature were reported in 41% of patients. Ataxia (96%) and cognitive impairment (100%) were frequent nonepisodic symptoms. Empiric pharmacologic treatment approaches offered little benefit in most subjects and resulted in adverse effects in 20% of patients. Prolonged episodes were completely or temporarily aborted during sleep in all subjects. CONCLUSIONS This descriptive analysis of a large cohort of children indicates that paroxysmal ocular movements are an early, highly suggestive symptom, followed by paroxysmal episodes of focal dystonia or flaccid, alternating hemiplegia in early infancy in the majority of subjects. Current challenges in diagnosis and management contribute to poor outcomes. Early diagnosis and multicenter collaboration are needed to facilitate trials to identify more effective therapies.
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Affiliation(s)
- Matthew T Sweney
- University of Utah School of Medicine, 30 N 1900 East, SOM Room 3R413, Salt Lake City, UT 84132, USA.
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Swoboda KJ, Kissel JT, Crawford TO, Bromberg MB, Acsadi G, D'Anjou G, Krosschell KJ, Reyna SP, Schroth MK, Scott CB, Simard LR. Perspectives on clinical trials in spinal muscular atrophy. J Child Neurol 2007; 22:957-66. [PMID: 17761650 PMCID: PMC3260051 DOI: 10.1177/0883073807305665] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [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] [Indexed: 01/02/2023]
Abstract
Spinal muscular atrophy is one of the most heterogeneous of the single-gene neuromuscular disorders. The broad spectrum of severity, with onset from the prenatal period to adulthood, presents unique challenges in the design and implementation of clinical trials. The clinical classification of subjects into severe (type 1), intermediate (type 2), and mild (type 3) subtypes has proved useful both in enhancing communication among clinicians internationally and in forging the collaborative development of outcome measures for clinical trials. Ideally, clinical trial design in spinal muscular atrophy must take into account the spinal muscular atrophy type, patient age, severity-of-affection status, nature of the therapeutic approach, timing of the proposed intervention relative to disease progression, and relative homogeneity of the cohort to be studied. Following is an overview of the challenges and opportunities, current and future therapeutic strategies, and progress to date in clinical trials in spinal muscular atrophy.
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Affiliation(s)
- Kathryn J Swoboda
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah 84132, USA.
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May HT, Alharethi R, Anderson JL, Muhlestein JB, Reyna SP, Bair TL, Horne BD, Kfoury AG, Carlquist JF, Renlund DG. Homocysteine levels are associated with increased risk of congestive heart failure in patients with and without coronary artery disease. Cardiology 2006; 107:178-84. [PMID: 16940722 DOI: 10.1159/000095344] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 05/08/2006] [Indexed: 01/04/2023]
Abstract
BACKGROUND Increased homocysteine (HCY) is associated with increased risk of vascular disease. Whether HCY affects development of congestive heart failure (CHF) independent of coronary artery disease (CAD) is uncertain. We evaluated whether increased HCY predicts low ejection fraction or clinical CHF. METHODS Patients (n = 2,842) undergoing coronary angiography had HCY measured between 1994 and 1999 and were prospectively studied. Left ventricular dysfunction (LVD) was defined as ejection fraction < or =40%. Multivariable regressions assessed predictive strength of HCY for LVD or LVD/CHF. RESULTS The average age was 64 +/- 12 years; 69% were men, and 74% had CAD. LVD was present in 12% and the combination of either LVD or clinical CHF was present in 21.9%. Quartiles of HCY were: < or =10.5 (Q1), 10.5-13.2 (Q2), 13.3-17.0 (Q3) and > or =17.1 micromol/l (Q4). LVD and LVD/CHF were more prevalent in Q3 (15, 25%) and Q4 (15, 27%) than in Q1 HCY (8.4, 18%; p < 0.001 vs. Q4). After adjustment, Q3 and Q4 HCY independently predicted LVD (OR = 1.7, 95% CI 1.2-2.5, p = 0.004; OR = 1.8, 95% CI 1.3-2.6, p = 0.002) or LVD/CHF (OR = 1.4, 95% CI 1.04-1.8, p = 0.03; OR = 1.7, 95% CI 1.3-2.2, p < 0.001). Findings did not differ by disease etiology: for Q4 among non-CAD patients, OR = 1.7 for LVD and OR = 1.7 for LVD/CHF. Further, there was no interaction of results with gender. CONCLUSION High HCY levels (Q3/4 > or =13.3 micromol/l) are associated with LVD and combined endpoint of LVD/clinical CHF. This relationship is independent of CHF etiology and gender. Further research is indicated to distinguish between a causal or noncausal mechanism for this association.
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Affiliation(s)
- Heidi T May
- LDS Hospital, Salt Lake City, Utah 84143, USA
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Ronnow BS, Reyna SP, Muhlestein JB, Horne BD, Allen Maycock CA, Bair TL, Carlquist JF, Kfoury AG, Anderson JL, Renlund DG. C-Reactive Protein Predicts Death in Patients with Non-Ischemic Cardiomyopathy. Cardiology 2005; 104:196-201. [PMID: 16155394 DOI: 10.1159/000088138] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2005] [Accepted: 04/22/2005] [Indexed: 11/19/2022]
Abstract
C-reactive protein (CRP) has been associated with atherosclerotic complications, and we hypothesized that CRP levels might also predict death in non-ischemic patients with left ventricular dysfunction. Two hundred and three patients with non-ischemic left ventricular dysfunction undergoing cardiac catheterization were included and were followed for 2.4 +/- 1.4 years to determine the incidence of fatal events. Death occurred in 15% of patients with low CRP (1st and 2nd tertiles) and 30% of patients with high CRP (3rd tertile). After adjustment for 11 covariates, high CRP (p = 0.037, hazard ratio = 2.0) significantly and independently predicted mortality. Even in the absence of coronary artery disease, patients with left ventricular dysfunction are at increased risk of mortality based on their baseline CRP concentrations.
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Affiliation(s)
- Brianna S Ronnow
- Cardiovascular Department, LDS Hospital, Salt Lake City, Utah 84143, USA
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Swoboda KJ, Prior TW, Scott CB, McNaught TP, Wride MC, Reyna SP, Bromberg MB. Natural history of denervation in SMA: relation to age, SMN2 copy number, and function. Ann Neurol 2005; 57:704-12. [PMID: 15852397 PMCID: PMC4334582 DOI: 10.1002/ana.20473] [Citation(s) in RCA: 334] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Denervation was assessed in 89 spinal muscular atrophy (SMA) 1, 2, and 3 subjects via motor unit number estimation (MUNE) and maximum compound motor action potential amplitude (CMAP) studies, and results correlated with SMN2 copy, age, and function. MUNE and maximum CMAP values were distinct among SMA subtypes (p < 0.05). Changes in MUNE and maximum CMAP values over time were dependent on age, SMA type, and SMN2 copy number. SMN2 copy number less than 3 correlated with lower MUNE and maximum CMAP values (p < 0.0001) and worse functional outcomes. As SMN2 copy number increases, so does functional status (p < 0.0001). Change in MUNE longitudinally over the time intervals examined in this study was not statistically significant for any SMA cohort. However, a decline in maximum CMAP over time was apparent in SMA2 subjects (p = 0.049). Age-dependent decline in MUNE and maximum CMAP was apparent in both SMA 1 (p < 0.0001) and SMA 2 (p < 0.0001) subjects, with age as an independent factor regardless of type. Maximum CMAP at the time of the initial assessment was most predictive of functional outcome (p < 0.0001). Prospective longitudinal studies in four prenatally diagnosed infants demonstrated significant progressive denervation in association with symptomatic onset or functional decline. These data highlight the potential value of such measures in increasing our understanding of pathophysiological factors involved in denervation in SMA.
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Affiliation(s)
- Kathryn J Swoboda
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
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Olson TM, Michels VV, Ballew JD, Reyna SP, Karst ML, Herron KJ, Horton SC, Rodeheffer RJ, Anderson JL. Sodium channel mutations and susceptibility to heart failure and atrial fibrillation. JAMA 2005; 293:447-54. [PMID: 15671429 PMCID: PMC2039897 DOI: 10.1001/jama.293.4.447] [Citation(s) in RCA: 383] [Impact Index Per Article: 20.2] [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: 12/19/2022]
Abstract
CONTEXT Dilated cardiomyopathy (DCM), a genetically heterogeneous disorder, causes heart failure and rhythm disturbances. The majority of identified DCM genes encode structural proteins of the contractile apparatus and cytoskeleton. Recently, genetic defects in calcium and potassium regulation have been discovered in patients with DCM, implicating an alternative disease mechanism. The full spectrum of genetic defects in DCM, however, has not been established. OBJECTIVES To identify a novel gene for DCM at a previously mapped locus, define the spectrum of mutations in this gene within a DCM cohort, and determine the frequency of DCM among relatives inheriting a mutation in this gene. DESIGN, SETTING, AND PARTICIPANTS Refined mapping of a DCM locus on chromosome 3p in a multigenerational family and mutation scanning in 156 unrelated probands with DCM, prospectively identified at the Mayo Clinic between 1987 and 2004. Relatives underwent screening echocardiography and electrocardiography and DNA sample procurement. MAIN OUTCOME MEASURE Correlation of identified mutations with cardiac phenotype. RESULTS Refined locus mapping revealed SCN5A, encoding the cardiac sodium channel, as a candidate gene. Mutation scans identified a missense mutation (D1275N) that cosegregated with an age-dependent, variably expressed phenotype of DCM, atrial fibrillation, impaired automaticity, and conduction delay. In the DCM cohort, additional missense (T220I, R814W, D1595H) and truncation (2550-2551insTG) SCN5A mutations, segregating with cardiac disease or arising de novo, were discovered in unrelated probands. Among individuals with an SCN5A mutation 27% had early features of DCM (mean age at diagnosis, 20.3 years), 38% had DCM (mean age at diagnosis, 47.9 years), and 43% had atrial fibrillation (mean age at diagnosis, 27.8 years). CONCLUSIONS Heritable SCN5A defects are associated with susceptibility to early-onset DCM and atrial fibrillation. Similar or even identical mutations may lead to heart failure, arrhythmia, or both.
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Affiliation(s)
- Timothy M Olson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
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Reyna SP, Anderson JL, Horne BD, Bair TL, Jones J, Robinson KM, Pearson RR, Moore SA, Muhlestein JB, Renlund DG. 1163-112 Homocysteine levels predict risk for congestive heart failure in patients with and without coronary artery disease. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)90965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anderson JL, Horne BD, Jones HU, Reyna SP, Carlquist JF, Bair TL, Pearson RR, Lappé DL, Muhlestein JB. Which Features of the Metabolic Syndrome Predict the Prevalence and Clinical Outcomes of Angiographic Coronary Artery Disease? Cardiology 2004; 101:185-93. [PMID: 14967961 DOI: 10.1159/000076695] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Accepted: 10/20/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of the metabolic syndrome (MS) is growing. The Adult Treatment Panel (ATP) III provided a uniform definition of MS but no information on its predictive ability. METHODS We tested the ability of MS and its components to predict angiographic coronary artery disease (CAD) and incident death/myocardial infarction (D/MI) over 2.8 +/- 2.3 years in a large cohort of patients undergoing angiography. ATP-III criteria were used for fasting glucose (FG), triglyceride (TG), high-density lipoprotein cholesterol (HDL), and blood pressure (BP); body mass index (BMI) >27 kg/m(2) was used as a surrogate for waist circumference. RESULTS 3,128 subjects were studied; 65% had advanced CAD (>/=70% stenosis), and 35%, no CAD. MS was present in 64% (high FG 40%; high TG 52%; low HDL 71%; high BP 76%; high BMI 58%). Presence of CAD was predicted by MS [adjusted odds ratio (OR) = 1.30, 95% CI 1.10-1.55, p = 0.003] and, individually, by high FG (OR = 1.90, CI 1.63-2.23) and low HDL (OR = 1.38, CI 1.18-1.62). In multivariable modeling, CAD was predicted by high FG (OR = 1.80, CI 1.51-2.16) and low HDL (OR = 1.57, CI 1.31-1.89) as well as by age, gender, family history, smoking, and LDL cholesterol (all p < 0.001). For secondary risk of incident D/MI, only high FG of MS features was predictive (adjusted hazard ratio 1.46, CI 1.17-1.82, p = 0.001), and this risk was carried by diabetes (adjusted hazard ratio 1.71, p < 0.001); other predictors were age, heart failure, revascularization strategy, renal insufficiency, prior MI, and number of diseased vessels. CONCLUSION MS has primary predictive ability for CAD, carried primarily by high FG and low HDL. Secondary predictive ability of MS features for clinical outcomes, in the setting of established CAD, is carried by diabetes alone. Dysglycemia deserves specific attention as a target for prevention and treatment.
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Affiliation(s)
- Jeffrey L Anderson
- Cardiovascular Department, LDS Hospital and University of Utah, Salt Lake City, Utah, USA.
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Whiting BM, Anderson JL, King CA, McKinney J, Muhlestein JB, Chaichana K, Bair TL, Reyna SP, Horne BD, Carlquist JF. Does the −514T gene promoter variant of hepatic lipase predict increased high-density lipoprotein levels and reduced risk of angiographic coronary artery disease? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81710-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Allen Maycock CA, Lappé DL, Crandall BG, Muhlestein JB, Horne BD, Bair TL, Li Q, Reyna SP, Renlund DG, Anderson JL. Is atrial fibrillation an inflammatory disease reflected by elevated C-reactive protein? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81044-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jones HU, Muhlestein JB, Carlquist JF, Horne BD, Pearson RR, Allen Maycock CA, Reyna SP, Bair TL, Lappé DL, Renlund DG, Anderson JL. Which features of the metabolic syndrome predict clinical outcomes (death/myocardial infarction) in patients with angiographic coronary artery disease? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reyna SP, Horne BD, Pearson RR, Bair TL, Allen Maycock CA, Rasmusson KD, Hall J, Moore SV, Anderson JL, Muhlestein JB, Renlund DG. Do statins provide clinical benefit in high-risk coronary artery disease patients with advanced left ventricular dysfunction? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bair TL, Muhlestein JB, Carlquist JF, Allen Maycock CA, Pearson RR, Reyna SP, Horne BD, Anderson JL. Which lipid/lipoprotein ratio best predicts angiographic coronary artery disease? J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reyna SP, Muhlestein JB, Horne BD, Bair TL, Allen Maycock CA, Pearson RR, Moore SV, Renlund DG, Anderson JL. Low socioeconomic status is more predictive of increased hazard in women than men after angiographic diagnosis of coronary artery disease. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)82846-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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