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Valero-Tena E, Roca-Espiau M, Verdú-Díaz J, Diaz-Manera J, Andrade-Campos M, Giraldo P. Advantages of digital technology in the assessment of bone marrow involvement in Gaucher's disease. Front Med (Lausanne) 2023; 10:1098472. [PMID: 37250646 PMCID: PMC10213682 DOI: 10.3389/fmed.2023.1098472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Gaucher disease (GD) is a genetic lysosomal disorder characterized by high bone marrow (BM) involvement and skeletal complications. The pathophysiology of these complications is not fully elucidated. Magnetic resonance imaging (MRI) is the gold standard to evaluate BM. This study aimed to apply machine-learning techniques in a cohort of Spanish GD patients by a structured bone marrow MRI reporting model at diagnosis and follow-up to predict the evolution of the bone disease. In total, 441 digitalized MRI studies from 131 patients (M: 69, F:62) were reevaluated by a blinded expert radiologist who applied a structured report template. The studies were classified into categories carried out at different stages as follows: A: baseline; B: between 1 and 4 y of follow-up; C: between 5 and 9 y; and D: after 10 years of follow-up. Demographics, genetics, biomarkers, clinical data, and cumulative years of therapy were included in the model. At the baseline study, the mean age was 37.3 years (1-80), and the median Spanish MRI score (S-MRI) was 8.40 (male patients: 9.10 vs. female patients: 7.71) (p < 0.001). BM clearance was faster and deeper in women during follow-up. Genotypes that do not include the c.1226A>G variant have a higher degree of infiltration and complications (p = 0.017). A random forest machine-learning model identified that BM infiltration degree, age at the start of therapy, and femur infiltration were the most important factors to predict the risk and severity of the bone disease. In conclusion, a structured bone marrow MRI reporting in GD is useful to standardize the collected data and facilitate clinical management and academic collaboration. Artificial intelligence methods applied to these studies can help to predict bone disease complications.
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Affiliation(s)
- Esther Valero-Tena
- Departamento de Medicina Interna y Reumatología, Hospital MAZ, Zaragoza, Spain
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
| | - Mercedes Roca-Espiau
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
| | - Jose Verdú-Díaz
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jordi Diaz-Manera
- John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marcio Andrade-Campos
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal de la SEHH (GEEDL), Madrid, Spain
- Grupo de Investigación en Hematología, Instituto de Investigación Hospital del Mar, IMIM-Parc de Salut Mar, Barcelona, Spain
| | - Pilar Giraldo
- Fundación Española para el Estudio y Terapéutica de la Enfermedad de Gaucher y otras Lisosomales (FEETEG), Zaragoza, Spain
- Grupo Español de Enfermedades de Depósito Lisosomal de la SEHH (GEEDL), Madrid, Spain
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Mourad C, Cosentino A, Nicod Lalonde M, Omoumi P. Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective. Semin Musculoskelet Radiol 2023; 27:3-21. [PMID: 36868241 PMCID: PMC9984270 DOI: 10.1055/s-0043-1761612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Conventional magnetic resonance imaging (MRI) remains the modality of choice to image bone marrow. However, the last few decades have witnessed the emergence and development of novel MRI techniques, such as chemical shift imaging, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and whole-body MRI, as well as spectral computed tomography and nuclear medicine techniques. We summarize the technical bases behind these methods, in relation to the common physiologic and pathologic processes involving the bone marrow. We present the strengths and limitations of these imaging methods and consider their added value compared with conventional imaging in assessing non-neoplastic disorders like septic, rheumatologic, traumatic, and metabolic conditions. The potential usefulness of these methods to differentiate between benign and malignant bone marrow lesions is discussed. Finally, we consider the limitations hampering a more widespread use of these techniques in clinical practice.
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Affiliation(s)
- Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui- CHU, Beyrouth, Lebanon
| | - Aurelio Cosentino
- Department of Radiology, Hôpital Riviera-Chablais, Vaud-Valais, Rennaz, Switzerland
| | - Marie Nicod Lalonde
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Weinreb NJ, Goker-Alpan O, Kishnani PS, Longo N, Burrow TA, Bernat JA, Gupta P, Henderson N, Pedro H, Prada CE, Vats D, Pathak RR, Wright E, Ficicioglu C. The diagnosis and management of Gaucher disease in pediatric patients: Where do we go from here? Mol Genet Metab 2022; 136:4-21. [PMID: 35367141 DOI: 10.1016/j.ymgme.2022.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
Gaucher disease (GD) is an autosomal recessive inherited lysosomal storage disease that often presents in early childhood and is associated with damage to multiple organ systems. Many challenges associated with GD diagnosis and management arise from the considerable heterogeneity of disease presentations and natural history. Phenotypic classification has traditionally been based on the absence (in type 1 GD) or presence (in types 2 and 3 GD) of neurological involvement of varying severity. However, patient management and prediction of prognosis may be best served by a dynamic, evolving definition of individual phenotype rather than by a rigid system of classification. Patients may experience considerable delays in diagnosis, which can potentially be reduced by effective screening programs; however, program implementation can involve ethical and practical challenges. Variation in the clinical course of GD and an uncertain prognosis also complicate decisions concerning treatment initiation, with differing stakeholder perspectives around efficacy and acceptable cost/benefit ratio. We review the challenges faced by physicians in the diagnosis and management of GD in pediatric patients. We also consider future directions and goals, including acceleration of accurate diagnosis, improvements in the understanding of disease heterogeneity (natural history, response to treatment, and prognosis), the need for new treatments to address unmet needs for all forms of GD, and refinement of the tools for monitoring disease progression and treatment efficacy, such as specific biomarkers.
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Affiliation(s)
- Neal J Weinreb
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Ozlem Goker-Alpan
- Lysosomal and Rare Disorders Research and Treatment Center, Fairfax, VA, USA.
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - Nicola Longo
- Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA.
| | - T Andrew Burrow
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, USA.
| | - John A Bernat
- Division of Medical Genetics and Genomics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
| | - Punita Gupta
- St Joseph's University Hospital, Paterson, NJ, USA.
| | - Nadene Henderson
- Division of Genetic and Genomic Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Helio Pedro
- Center for Genetic and Genomic Medicine, Hackensack University Medical Center, Hackensack, NJ, USA.
| | - Carlos E Prada
- Division of Genetics, Birth Defects & Metabolism, Ann & Robert H. Lurie Children's Hospital and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Divya Vats
- Kaiser Permanente Southern California, Los Angeles, CA, USA.
| | - Ravi R Pathak
- Takeda Pharmaceuticals USA, Inc., Lexington, MA, USA.
| | | | - Can Ficicioglu
- Division of Human Genetics and Metabolism, The Children's Hospital of Philadelphia, Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, PA, USA.
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Razek AAKA, Taman S, Gamal W, El Ayouty M, Ali KM, Barakat TE. Diffusion tensor imaging of vertebral bone marrow in children with Gaucher's disease type I and III: Pre- and post-therapy. Clin Imaging 2021; 79:207-212. [PMID: 34116297 DOI: 10.1016/j.clinimag.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess diffusion tensor imaging (DTI) of the vertebral bone marrow (BM) in children with Gaucher's disease (GD) types I and III before and after therapy. METHODS Prospective study was conducted upon 25 children with GD type I (n = 17) and III (n = 8) and 13 age and sex-matched controls underwent DTI of vertebral BM. Mean diffusivity (MD) and fractional anisotropy (FA) of vertebral BM was calculated and correlated with genotyping, chitotriosidase, hemoglobin (HB) and, platelet count. RESULTS There was a statistically significant difference in MD and FA of BM between patients and controls (P = 0.001 and 0.02). The area under the curve (AUC) of MD and FA used to differentiate untreated patients from controls was 0.902 and 0.68 with sensitivity, specificity, and, accuracy 92%, 84.6%, and, 89.5% respectively. There was a significant difference in MD and FA of BM between untreated and treated patients (P = 0.001 and 0.02). AUC of MD and FA used to differentiate untreated from treated patients was 0.93 and 0.649 with sensitivity, specificity, and accuracy of 92%, 80%, and 86% respectively. There was a significant difference in MD and FA (P = 0.03, 0.001 respectively) of BM in GD with homozygous L444P mutation (n = 9) and other mutations (n = 14). Chiotriptase, HB and platelet count of patients was correlated with MD (r = -0.36, 0.42, -0.41) and FA (r = -0.47, -0.37, -0.46) respectively. CONCLUSION DTI of vertebral BM can help in diagnosis and monitoring patients with GD after therapy and correlated with genotyping, and hematological biomarkers of GD.
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Affiliation(s)
| | - Saher Taman
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Walaa Gamal
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Mostafa El Ayouty
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Khadiga M Ali
- Department of Pathology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Tarik Elsayed Barakat
- Gastroenterology and Hepatology Unit, Department of Pediatrics, Mansoura Faculty of Medicine, Mansoura, Egypt
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Faouzi A, Roullin VG. Think Big, Start Small: How Nanomedicine Could Alleviate the Burden of Rare CNS Diseases. Pharmaceuticals (Basel) 2021; 14:109. [PMID: 33573213 PMCID: PMC7912386 DOI: 10.3390/ph14020109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022] Open
Abstract
The complexity and organization of the central nervous system (CNS) is widely modulated by the presence of the blood-brain barrier (BBB) and the blood-cerebrospinal fluid barrier (BCSFB), which both act as biochemical, dynamic obstacles impeding any type of undesirable exogenous exchanges. The disruption of these barriers is usually associated with the development of neuropathologies which can be the consequence of genetic disorders, local antigenic invasions, or autoimmune diseases. These disorders can take the shape of rare CNS-related diseases (other than Alzheimer's and Parkinson's) which a exhibit relatively low or moderate prevalence and could be part of a potential line of treatments from current nanotargeted therapies. Indeed, one of the most promising therapeutical alternatives in that field comes from the development of nanotechnologies which can be divided between drug delivery systems and diagnostic tools. Unfortunately, the number of studies dedicated to treating these rare diseases using nanotherapeutics is limited, which is mostly due to a lack of interest from industrial pharmaceutical companies. In the present review, we will provide an overview of some of these rare CNS diseases, discuss the physiopathology of these disorders, shed light on how nanotherapies could be of interest as a credible line of treatment, and finally address the major issues which can hinder the development of efficient therapies in that area.
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Affiliation(s)
- Abdelfattah Faouzi
- Center for Clinical Pharmacology, St. Louis College of Pharmacy and Washington University School of Medicine, St. Louis, MO 63131, USA;
| | - Valérie Gaëlle Roullin
- Laboratoire de Nanotechnologies Pharmaceutiques, Faculté de Pharmacie, Université de Montréal, Montréal, QC H3T 1J4, Canada
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