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Groulx-Boivin E, Oliveira-Carneiro A, Carlson H, Floer A, Kirton A, Mah J, Saint-Martin C, La Piana R, Oskoui M. Macrostructural Brain Abnormalities in Spinal Muscular Atrophy: A Case-Control Study. Neurol Genet 2024; 10:e200193. [PMID: 39308455 PMCID: PMC11415185 DOI: 10.1212/nxg.0000000000200193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/26/2024] [Indexed: 09/25/2024]
Abstract
Background and Objectives Most individuals with spinal muscular atrophy (SMA) on disease-modifying therapies continue to have chronic motor impairment. Insights into brain involvement in SMA may open new pathways for adjunctive therapies to optimize outcomes. We aimed to characterize macrostructural brain abnormalities detected by MRI in individuals with SMA compared with peer controls. Methods We conducted a cross-sectional case-control study of children and adults with a confirmed genetic diagnosis of 5q SMA, and peer controls matched by age and sex. Brain MRIs acquired on a 3T MRI scanner through a standardized research protocol were reviewed to qualitatively assess the presence of macrostructural changes. The primary outcome was the presence of any structural brain anomaly on MRI. In addition, the total volume of each participant's lateral ventricles was quantified by volumetry using MRIcron. Genetic and clinical variables, including SMN2 copy number and motor function (Hammersmith Functional Motor Scale Expanded and Revised Upper Limb Module scores), were then correlated with neuroimaging findings. Results A total of 42 participants completed the study (mean age 17.4, range 7-40; 67% male). Of the 21 individuals with 5q SMA, 9 (43%) had macrostructural brain abnormalities identified on MRI compared with 2 of 21 (10%) peer controls (odds ratio 7.1, 95% confidence interval 1.4-34.0). In patients with SMA, the most common structural changes were widening of the arachnoid spaces (n = 4) and ventriculomegaly (n = 4). Individuals with SMA had larger median lateral ventricular volume than their normally developing peers (9.3 mL, interquartile range [IQR] 5.5-13.1 vs 5.3 mL, IQR 3.8-9.8; p = 0.034). Structural brain abnormalities were more frequent in those with 2 SMN2 copies (3/5, 60%) compared with 3 or 4 SMN2 copies (4/10, 40% and 2/6, 33% respectively), not reaching significance. We found no association between structural changes and motor function scores. Discussion Individuals with SMA have higher rates of macrostructural brain abnormalities than their neurotypical peers, suggesting CNS involvement in SMA. Understanding changes in the brain architecture of the SMA population can inform the development of adjunct therapies targeting the CNS and potentially guide rehabilitation strategies.
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Affiliation(s)
- Emilie Groulx-Boivin
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Andrea Oliveira-Carneiro
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Helen Carlson
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Amalia Floer
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Adam Kirton
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Jean Mah
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Roberta La Piana
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
| | - Maryam Oskoui
- From the Departments of Pediatrics and Neurology and Neurosurgery (E.G.-B., M.O.), Montreal Children's Hospital, McGill University; Research Institute (A.O.-C., M.O.), McGill University Health Centre, Montreal, Quebec; Alberta Children's Hospital Research Institute (H.C., A.F., A.K., J.M.); Department of Pediatrics (H.C., A.F., A.K., J.M.), Cumming School of Medicine, University of Calgary, Alberta; Division of Pediatric Medical Imaging (C.S.-M.), Department of Radiology, Montreal Children's Hospital; Department of Neurology and Neurosurgery (R.L.P.), Montreal Neurological Institute; and Department of Diagnostic Radiology (R.L.P.), McGill University, Montreal, Quebec, Canada
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Mackels L, Mariot V, Buscemi L, Servais L, Dumonceaux J. Impact of Disease Severity and Disease-Modifying Therapies on Myostatin Levels in SMA Patients. Int J Mol Sci 2024; 25:8763. [PMID: 39201450 PMCID: PMC11354404 DOI: 10.3390/ijms25168763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Clinical trials with treatments inhibiting myostatin pathways to increase muscle mass are currently ongoing in spinal muscular atrophy. Given evidence of potential myostatin pathway downregulation in Spinal Muscular Atrophy (SMA), restoring sufficient myostatin levels using disease-modifying treatments (DMTs) might arguably be necessary prior to considering myostatin inhibitors as an add-on treatment. This retrospective study assessed pre-treatment myostatin and follistatin levels' correlation with disease severity and explored their alteration by disease-modifying treatment in SMA. We retrospectively collected clinical characteristics, motor scores, and mysotatin and follistatin levels between 2018 and 2020 in 25 Belgian patients with SMA (SMA1 (n = 13), SMA2 (n = 6), SMA 3 (n = 6)) and treated by nusinersen. Data were collected prior to treatment and after 2, 6, 10, 18, and 30 months of treatment. Myostatin levels correlated with patients' age, weight, SMA type, and motor function before treatment initiation. After treatment, we observed correlations between myostatin levels and some motor function scores (i.e., MFM32, HFMSE, 6MWT), but no major effect of nusinersen on myostatin or follistatin levels over time. In conclusion, further research is needed to determine if DMTs can impact myostatin and follistatin levels in SMA, and how this could potentially influence patient selection for ongoing myostatin inhibitor trials.
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Affiliation(s)
- Laurane Mackels
- Adult Neurology Department, Citadelle Hospital, 1 Boulevard Du 12e De Ligne, 4000 Liege, Belgium
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK;
| | - Virginie Mariot
- NIHR Great Ormond Street Hospital Biomedical Research Centre and Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK;
| | - Laura Buscemi
- Neuromuscular Center, Citadelle Hospital, 1 Boulevard Du 12e De Ligne, 4000 Liege, Belgium;
| | - Laurent Servais
- MDUK Oxford Neuromuscular Center, Department of Paediatrics, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford OX3 9DU, UK;
- Neuromuscular Center, Division of Paediatrics, University Hospital of Liège, University of Liège, Boulevard Du 12e De Ligne, 4000 Liege, Belgium
| | - Julie Dumonceaux
- NIHR Great Ormond Street Hospital Biomedical Research Centre and Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK;
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Ramdas S, Oskoui M, Servais L. Treatment Options in Spinal Muscular Atrophy: A Pragmatic Approach for Clinicians. Drugs 2024; 84:747-762. [PMID: 38878146 DOI: 10.1007/s40265-024-02051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 07/31/2024]
Abstract
Spinal muscular atrophy (SMA) is a rare neurodegenerative neuromuscular disorder with a wide phenotypic spectrum of severity. SMA was previously life limiting for patients with the most severe phenotype and resulted in progressive disability for those with less severe phenotypes. This has changed dramatically in the past few years with the approvals of three disease-modifying treatments. We review the evidence supporting the use of currently approved SMA treatments (nusinersen, onasemnogene abeparvovec, and risdiplam), focusing on mechanisms of action, side effect profiles, published clinical trial data, health economics, and pending questions. Whilst there is robust data from clinical trials of efficacy and side effect profile for individual drugs in select SMA populations, there are no comparative head-to-head clinical trials. This presents a challenge for clinicians who need to make recommendations on the best treatment option for an individual patient and we hope to provide a pragmatic approach for clinicians across each SMA profile based on current evidence.
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Affiliation(s)
- Sithara Ramdas
- Department of Paediatrics, MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Maryam Oskoui
- Departments of Pediatrics and Neurology and Neurosurgery, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Laurent Servais
- Department of Paediatrics, MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
- Division of Child Neurology, Department of Pediatrics, Centre de Référence des Maladies Neuromusculaires, University Hospital Liège and University of Liège, Liège, Belgium.
- Academic Paediatric Department, Level 2 Children Hospital-John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK.
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Buchignani B, Cicala G, Cumbo F, Ricci M, Capasso A, Ticci C, Mazzanti S, Brolatti N, Tosi M, Dosi C, Antonaci L, Coratti G, Pera MC, Leone D, Palermo C, Berti B, Frongia AL, Sacchini M, Bruno C, Masson R, D'Amico A, Battini R, Pane M, Mercuri E. Communicative development inventory in type 1 and presymptomatic infants with spinal muscular atrophy: a cohort study. Arch Dis Child 2024; 109:395-401. [PMID: 38290776 DOI: 10.1136/archdischild-2023-326613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The aim of this study was to assess early language acquisitions in treated individuals with spinal muscular atrophy (SMA) type 1 and in infants identified by newborn screening (NBS). METHODS Parents of SMA individuals aged between 8 and 36 months were asked to fill in the MacArthur-Bates Communicative Development Inventory (MB-CDI) that assesses comprehension, gesture and expressive skills. A follow-up assessment was performed in 21 of the 36. RESULTS The MB-CDI was completed by parents of 24 type 1 and 12 infants identified by NBS. Comprehension skills were preserved in 81% of the type 1 SMA and in 87% infants identified by NBS. Gesture abilities were <5th centile in 55% of the type 1 SMA and in none of those identified by NBS. Lexical expressions were <5th centile in more than 80% type 1 SMA and in 50% of infants identified by NBS. At follow-up, despite an increase in lexical expression skills, the scores remained below the fifth centile in 43% type 1 SMA and in 86% of infants identified by NBS. CONCLUSIONS These results suggest that language and communication development may follow a similar pattern to that observed in motor function with the possibility to develop skills (eg, ability to say clear words) that are not usually present in untreated infants but with a level of performance that does not reach that of their typically developing peers.
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Affiliation(s)
- Bianca Buchignani
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Gianpaolo Cicala
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesca Cumbo
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martina Ricci
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Capasso
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Chiara Ticci
- SOC Malattie Metaboliche e Muscolari Ereditarie, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Sara Mazzanti
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Noemi Brolatti
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Michele Tosi
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudia Dosi
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Laura Antonaci
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Giorgia Coratti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Maria Carmela Pera
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Daniela Leone
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Concetta Palermo
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Beatrice Berti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Anna Lia Frongia
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Michele Sacchini
- SOC Malattie Metaboliche e Muscolari Ereditarie, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
| | - Riccardo Masson
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Calambrone, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marika Pane
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Eugenio Mercuri
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Roma, Italy
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