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Torri F, Buchignani B, Unluturk Z, Vadi G, Loprieno S, Battini R, Mancuso M, Siciliano G. The involvement of central nervous system across the phenotypic spectrum of Pompe disease: a systematic review. Neuromuscul Disord 2025; 51:105362. [PMID: 40413934 DOI: 10.1016/j.nmd.2025.105362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 03/08/2025] [Accepted: 04/07/2025] [Indexed: 05/27/2025]
Abstract
Pompe disease is an inherited lysosomal disorder which results in glycogen buildup in various organs and tissues. The phenotypic spectrum of this disorder encompasses infantile and late-onset forms, with variable multisystem involvement. Affection of the central nervous system is known to variably present in infantile forms, while the incidence of disease-related alterations in older patients is more debated. PubMed, Web of Science and Scopus databases were searched for papers regarding brain and spinal cord abnormalities at imaging and pathology, neuropsychological assessment and clinical reports in Pompe disease, without chronological restrictions. The database search identified 609 records, then 282 full-text articles were retrieved for detailed examination. Of these records, 81 were selected, which presented heterogeneity in methodology and overall analyzed small cohorts. Our search highlights the current fragmented evidence presented in the field. It would be advisable to perform a routine CNS assessment at least by imaging and neuropsychological evaluation at the time of diagnosis and as part of a regular follow-up, for IOPD but also for LOPD patients, to better characterize the prevalence and clinical significance of CNS abnormalities and provide a tailored follow-up.
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Affiliation(s)
- Francesca Torri
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy.
| | - Bianca Buchignani
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy; IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Zeynep Unluturk
- Neurology Clinic, University of Health Sciences Kocaeli Derince Training Hospital, Derince, Kocaeli, Turkey
| | - Gabriele Vadi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Loprieno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberta Battini
- IRCCS Fondazione Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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2
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Lu Y, Tian J, Deng J, Peng Q, Zhang W, Yuan Y, Yu M, Wang Z. Metabolic and proteomic profiles provide insights on mechanism of late onset Pompe disease. Mol Genet Metab 2025; 144:109045. [PMID: 39914294 DOI: 10.1016/j.ymgme.2025.109045] [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: 08/15/2024] [Revised: 11/22/2024] [Accepted: 01/28/2025] [Indexed: 03/04/2025]
Abstract
Late onset Pompe disease (LOPD) is caused by a deficiency of the enzyme acid α-glucosidase, resulting in glycogen accumulation in lysosomes. The mechanism of LOPD has been less explored. In this study, we used an integrative analysis of the proteomics and metabolomics of LOPD muscle samples to reveal the potential mechanisms. Proteomic analysis identified 635 upregulated proteins and 89 downregulated proteins in the LOPD group. Similarly, metabolomic analysis revealed 15 upregulated and 143 downregulated metabolites; notably, L-arginine levels were significantly decreased in the LOPD group. Lysosome-related GO terms were significantly upregulated, while GO terms related to neurofilament, cytoskeleton, axon ensheathment, and myelin sheath were significantly downregulated. KEGG pathway analysis demonstrated that the lysosome, autophagy, and mTOR pathways were distinctly upregulated. Correlation analysis indicated that CALML3 showed a potential correlation with LOPD severity. Our study highlighted the potential crosstalk among these LOPD-related pathways. Supplementation with L-arginine could represent a promising therapeutic approach for LOPD, and CALML3 could serve as a potential biomarker for LOPD severity. These findings provide valuable insights into the pathogenesis of LOPD and suggest avenues for future therapeutic development.
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Affiliation(s)
- Yuxuan Lu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Jiayu Tian
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Jianwen Deng
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Qing Peng
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Wei Zhang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Meng Yu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China.
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China.
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van der Beek NAME, Theunissen MTM, van den Hout JMP, Pijnappel WWM, Schoser B, Laforêt P, Parenti G, van Doorn PA, van der Ploeg AT. Clinical insights in enzyme replacement therapy for metabolic storage disorders: lessons from Pompe disease. Lancet Neurol 2025; 24:230-245. [PMID: 39986311 DOI: 10.1016/s1474-4422(24)00518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 12/11/2024] [Accepted: 12/12/2024] [Indexed: 02/24/2025]
Abstract
Metabolic storage disorders, including lysosomal storage disorders, pose complex challenges in management due to their progressive and life-threatening nature. Although enzyme replacement therapy has substantially improved outcomes for patients with lysosomal storage disorders, limitations of this therapy have become apparent throughout two decades of use. New clinical features of these diseases have emerged as patients live longer, leading to unresolved questions regarding ongoing treatment and long-term care. Innovative therapies are emerging that aim to improve targeting of tissues, particularly for previously inaccessible areas such as the CNS. These next-generation treatments hold promise for enhancing patient outcomes beyond what enzyme replacement therapy can do. Continued exploration of novel therapeutic strategies will be crucial for providing more effective and personalised care for these complex diseases.
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Affiliation(s)
- Nadine A M E van der Beek
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands.
| | - Maudy T M Theunissen
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands; Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
| | - Johanna M P van den Hout
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
| | - Wilhelmus W M Pijnappel
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands; Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
| | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, Ludwig Maximilians University, Munich, Germany
| | - Pascal Laforêt
- Nord/Est/Île-de-France Neuromuscular Reference Center, FHU PHENIX, AP-HP, Raymond-Poincaré Hospital, Department of Neurology, Garches, France
| | - Giancarlo Parenti
- Federico II University, Department of Translational Medicine, Naples, Italy; Telethon Institute of Genetics and Medicine, Pozzuoli, Italy
| | - Pieter A van Doorn
- Department of Neurology, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
| | - Ans T van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, University Medical Center Rotterdam, Erasmus MC, Rotterdam, Netherlands
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Chen YL, Chung BHY, Mimaki M, Uchino S, Chien YH, Mak CCY, Peng SSF, Wang WC, Lin YL, Hwu WL, Lee SJ, Lee NC. NDUFB7 mutations cause brain neuronal defects, lactic acidosis, and mitochondrial dysfunction in humans and zebrafish. Cell Death Discov 2025; 11:82. [PMID: 40025060 PMCID: PMC11873233 DOI: 10.1038/s41420-025-02369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Revised: 01/24/2025] [Accepted: 02/20/2025] [Indexed: 03/04/2025] Open
Abstract
Complex I of the mitochondrial electron transfer chain is one of the largest membrane protein assemblies ever discovered. A patient carrying a homozygous NDUFB7 intronic mutation died within two months after birth due to cardiorespiratory defects, preventing further study. Here, we report another patient with compound heterozygous mutations in NDUFB7 who suffers from pons abnormality, lactic acidosis, prematurity, prenatal and postnatal growth deficiency, incomplete closure of the abdominal wall (ventral hernia), and a poorly functioning gastrointestinal tract (pseudo-obstruction). We demonstrated that the patient's skin fibroblasts are deficient in Complex I assembly and reduced supercomplex formation. This report further broadens the spectrum of mitochondrial disorders. The patient has had several surgeries. After receiving treatment with Coenzyme Q10 and vitamin B complex, she has remained stable up to this point. To further explore the functionality of NDUFB7 in vivo, we knocked down Ndufb7 in zebrafish embryos. This resulted in brain ventricle and neuronal defects, elevated lactic acid levels, and reduced oxygen consumption, indicating defective mitochondrial respiration. These phenotypes can be specifically rescued by ectopic expression of ndufb7. More importantly, Mitoquinone mesylate (MitoQ), a common remedy for mitochondrial disorders, can ameliorate these conditions. These results suggest a role for NDUFB7 in mitochondrial activity and the suitability of the zebrafish model for further drug screening and the development of therapeutic strategies for this rare disease.
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Affiliation(s)
- Yen-Lin Chen
- Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - Brian Hon-Yin Chung
- Department of Pediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, 999077, China
| | - Masakazu Mimaki
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, 173-8605, Japan
| | - Shumpei Uchino
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, 173-8605, Japan
- Department of Pediatrics, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, 10041, Taiwan
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10041, Taiwan
| | - Christopher Chun-Yun Mak
- Department of Pediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, 999077, China
| | - Steven Shinn-Forng Peng
- Department of Radiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10002, Taiwan
| | - Wei-Chen Wang
- Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - Yu-Li Lin
- Department of Medical Research, National Taiwan University Hospital, Taipei, 10041, Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, 10041, Taiwan
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10041, Taiwan
| | - Shyh-Jye Lee
- Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan.
- Center for Biotechnology, National Taiwan University, Taipei, 10617, Taiwan.
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, 10617, Taiwan.
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, 10041, Taiwan.
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, 10041, Taiwan.
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5
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Spiridigliozzi GA, Regmi N, Zimmerman K, Stefanescu M, Jung SH, Kishnani PS. Exploring the use of the National Institutes of Health Toolbox Cognition Battery with children and adolescents with Pompe disease: Preliminary findings. Mol Genet Metab 2025; 144:109043. [PMID: 39983297 DOI: 10.1016/j.ymgme.2025.109043] [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: 07/09/2024] [Revised: 01/17/2025] [Accepted: 01/23/2025] [Indexed: 02/23/2025]
Abstract
BACKGROUND Although Pompe disease (PD) was originally characterized as a metabolic myopathy, there is now emerging evidence of neurological involvement in children and adolescents with infantile-onset Pompe disease (IOPD). Therefore, assessing cognition and detecting cognitive changes in these individuals over time have become important components of their care. The National Institutes of Health Toolbox Cognition Battery (NIHT-CB, Version 2) is a brief, standardized instrument designed to measure cognitive processes in individuals 3-85 years of age. With its availability and ease of administration by a trained provider, the NIHT-CB could potentially be used in a clinical health care setting to help screen/monitor cognition in individuals with PD. This is the first study to report the use of the NIHT-CB in children and adolescents with IOPD and late-onset Pompe disease (LOPD) and their performance on this instrument in comparison to traditional neuropsychological measures. METHODS Fourteen children with IOPD (median age = 10.5, range = 6-19 years) and eight with LOPD (median age = 12.5, range = 7-17 years) were administered the NIHT-CB and a neuropsychological battery by the same psychologist with expertise in PD. RESULTS On the NIHT-CB and selected neuropsychological measures, nearly all median scores for the IOPD group were lower than those of the LOPD group. However, none of the differences between the IOPD and LOPD groups were statistically significant. Consistent with previous reports, there was a wide range of scores among the IOPD and LOPD participants on both the neuropsychological measures and the NIHT-CB. The lowest median NIHT-CB score for both groups was on the Flanker Inhibitory Control and Attention Test (IOPD = 77.5, LOPD = 84), a measure of executive function and selective attention. Positive, significant relationships were found between the NIHT-CB and neuropsychological measures of overall cognition, reading decoding, and short-term working memory on the Wechsler Intelligence Test scales and the Woodcock-Johnson Tests of Achievement subtest for the IOPD group only. CONCLUSIONS Though not a replacement for an established neuropsychological battery, the NIHT-CB could potentially be used as a screening measure to provide a baseline level of cognitive functioning in children and adolescents with IOPD. Observed changes in the NIHT-CB Cognitive Function Composite or selected subtests over time may also signal the need for a more comprehensive neuropsychological battery and/or brain imaging studies as indicated. Longitudinal studies examining the performance of a larger cohort of IOPD and LOPD children and adults at multiple time points are needed.
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Affiliation(s)
- Gail A Spiridigliozzi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2608 Erwin Road, Suite 300, Durham, NC 27705, United States of America; Department of Pediatrics, Duke University Medical Center, DUMC Box 103856 905 S. LaSalle St. GSRB1, Durham, NC 27710, United States of America.
| | - Neha Regmi
- Department of Pediatrics, Duke University Medical Center, DUMC Box 103856 905 S. LaSalle St. GSRB1, Durham, NC 27710, United States of America
| | - Kanecia Zimmerman
- Department of Pediatrics, Duke University Medical Center, DUMC Box 103856 905 S. LaSalle St. GSRB1, Durham, NC 27710, United States of America; Duke Clinical Research Institute, 300 W. Morgan Street, Durham, NC 27701, United States of America
| | - Mihaela Stefanescu
- Department of Pediatrics, Duke University Medical Center, DUMC Box 103856 905 S. LaSalle St. GSRB1, Durham, NC 27710, United States of America
| | - Seung-Hye Jung
- Department of Pediatrics, Duke University Medical Center, DUMC Box 103856 905 S. LaSalle St. GSRB1, Durham, NC 27710, United States of America
| | - Priya S Kishnani
- Department of Pediatrics, Duke University Medical Center, DUMC Box 103856 905 S. LaSalle St. GSRB1, Durham, NC 27710, United States of America
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6
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Luettel DM, Terluk MR, Roh J, Weinreb NJ, Kartha RV. Emerging biomarkers in Gaucher disease. Adv Clin Chem 2025; 124:1-56. [PMID: 39818434 DOI: 10.1016/bs.acc.2024.11.001] [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] [Indexed: 01/18/2025]
Abstract
Gaucher disease (GD) is a rare lysosomal disorder characterized by the accumulation of glycosphingolipids in macrophages resulting from glucocerebrosidase (GCase) deficiency. The accumulation of toxic substrates, which causes the hallmark symptoms of GD, is dependent on the extent of enzyme dysfunction. Accordingly, three distinct subtypes have been recognized, with type 1 GD (GD1) as the common and milder form, while types 2 (GD2) and 3 (GD3) are categorized as neuronopathic and severe. Manifestations variably include hepatosplenomegaly, anemia, thrombocytopenia, easy bruising, inflammation, bone pain and other skeletal pathologies, abnormal eye movements and neuropathy. Although the molecular basis of GD is relatively well understood, currently used biomarkers are nonspecific and inadequate for making finer distinctions between subtypes and in evaluating changes in disease status and guiding therapy. Thus, there is continued effort to investigate and identify potential biomarkers to improve GD diagnosis, monitoring and potential identification of novel therapeutic targets. Here, we provide a comprehensive review of emerging biomarkers in GD that can enhance current understanding and improve quality of life through better testing, disease management and treatment.
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Affiliation(s)
- Danielle M Luettel
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Marcia R Terluk
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Jaehyeok Roh
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States
| | - Neal J Weinreb
- Department of Human Genetics, Leonard Miller School of Medicine of University of Miami, Miami, FL, United States
| | - Reena V Kartha
- Center for Orphan Drug Research, Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN, United States.
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7
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Cheng JC, Yang CF, Chou CC, Shu YM, Liu PC, Lo KW, Chen CW. The lived experience of mothers caring for school-age children with Pompe disease: A qualitative study. J Pediatr Nurs 2024; 79:24-31. [PMID: 39190967 DOI: 10.1016/j.pedn.2024.08.008] [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: 02/18/2024] [Revised: 08/06/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE To explore the lived experiences of mothers caring for school-age children with Pompe disease. DESIGN AND METHODS A qualitative study using a descriptive phenomenology approach. Semi-structured interviews were conducted from October to December 2022 with 10 mothers of school-age children diagnosed with Pompe disease, which were identified through the Taiwan Pompe Disease Association. Colaizzi's phenomenological method was employed for data analysis. RESULTS The study identified five themes in the caregiving experiences of mothers: 1. unwavering parenting beliefs; 2. child-centric approach; 3. focus on peer relationships and coping strategies; 4. integration of learning, treatment, and rehabilitation; and 5. embracing and navigating life's challenges. Mothers balanced education, treatment, and rehabilitation for their children with Pompe disease, offering perspectives into the caregiving experience. CONCLUSIONS This study highlights the complex experiences of mothers caring for children with Pompe disease, emphasizing the importance of comprehensive support. PRACTICE IMPLICATIONS Insights into the perspectives of mothers can aid health-care professionals in understanding the challenges faced by families with children diagnosed with Pompe disease and can enable the development of strategies for providing comprehensive psychological support to improve mental health outcomes for these children and their families. Increased awareness among health-care professionals and in the society leads to an informed and empathetic approach to addressing the unique challenges faced by children with Pompe disease and their families.
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Affiliation(s)
- Ju-Chun Cheng
- Department of Nursing, Cathay General Hospital Hsinchu, Hsinchu, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Chen Chou
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Ying-Mei Shu
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Pei-Ching Liu
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Kao-Wen Lo
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
| | - Chi-Wen Chen
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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8
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Parenti G, Fecarotta S, Alagia M, Attaianese F, Verde A, Tarallo A, Gragnaniello V, Ziagaki A, Guimaraes MJ, Aguiar P, Hahn A, Azevedo O, Donati MA, Kiec-Wilk B, Scarpa M, van der Beek NAME, Del Toro Riera M, Germain DP, Huidekoper H, van den Hout JMP, van der Ploeg AT. The European reference network for metabolic diseases (MetabERN) clinical pathway recommendations for Pompe disease (acid maltase deficiency, glycogen storage disease type II). Orphanet J Rare Dis 2024; 19:408. [PMID: 39482698 PMCID: PMC11529438 DOI: 10.1186/s13023-024-03373-w] [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: 01/02/2024] [Accepted: 09/18/2024] [Indexed: 11/03/2024] Open
Abstract
Clinical pathway recommendations (CPR) are based on existing guidelines and deliver a short overview on how to deal with a specific diagnosis, resulting therapy and follow-up. In this paper we propose a methodology for developing CPRs for Pompe disease, a metabolic myopathy caused by deficiency of lysosomal acid alpha-glucosidase. The CPR document was developed within the activities of the MetabERN, a non-profit European Reference Network for Metabolic Diseases established by the European Union. A working group was selected among members of the MetabERN lysosomal storage disease subnetwork, with specific expertise in the care of Pompe disease, and patient support group representatives. The working strategy was based on a systematic literature search to develop a database, followed by quality assessment of the studies selected from the literature, and by the development of the CPR document according to a matrix provided by MetabERN. Quality assessment of the literature and collection of citations was conducted according to the AGREE II criteria and Grading of Recommendations, Assessment, Development and Evaluation methodology. General aspects were addressed in the document, including pathophysiology, genetics, frequency, classification, manifestations and clinical approach, laboratory diagnosis and multidisciplinary evaluation, therapy and supportive measures, follow-up, monitoring, and pregnancy. The CPR document that was developed was intended to be a concise and easy-to-use tool for standardization of care for patients among the healthcare providers that are members of the network or are involved in the care for Pompe disease patients.
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Affiliation(s)
- Giancarlo Parenti
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands.
- Telethon Institute of Genetics and Medicine, Via Campi Flegrei 34, Pozzuoli, Naples, Italy.
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples, Italy.
- Azienda Ospedaliera Universitaria Federico II, Naples, Italy.
| | - Simona Fecarotta
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples, Italy
- Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Marianna Alagia
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples, Italy
- Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Federica Attaianese
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples, Italy
| | - Alessandra Verde
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples, Italy
- Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Antonietta Tarallo
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Telethon Institute of Genetics and Medicine, Via Campi Flegrei 34, Pozzuoli, Naples, Italy
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples, Italy
| | - Vincenza Gragnaniello
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, Naples, Italy
| | - Athanasia Ziagaki
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Endocrinology and Metabolism, Center of Excellence for Rare Metabolic Diseases in Adults, Charite-Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Jose' Guimaraes
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Pneumology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal
| | - Patricio Aguiar
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Clinica Universitaria de Medicina I, Universidade de Lisboa, Lisbon, Portugal
| | - Andreas Hahn
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Child Neurology, Justus-Liebig University, Giessen, Germany
| | - Olga Azevedo
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Cardiology Department, Reference Center on Lysosomal Storage Disorders, Hospital Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3Bs PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Maria Alice Donati
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Metabolic and Neuromuscular Unit, Meyer Children Hospital-University of Florence, Florence, Italy
| | - Beata Kiec-Wilk
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Unit of Rare Metabolic Diseases, Jagiellonian University Medical College, Kraków, Poland
- The John Paul II Specjalist Hospital in Kraków, Kraków, Poland
| | - Maurizio Scarpa
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Centro Coordinamento Regionale Malattie Rare, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Nadine A M E van der Beek
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Center for Lysosomal and Metabolic Diseases, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Mireja Del Toro Riera
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Metabolic Unit, Department of Pediatric Neurology, Hospital Universitario Vall d'Hebron Barcelona, Barcelona, Spain
| | - Dominique P Germain
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Division of Medical Genetics, University of Versailles, Montigny, France
| | - Hidde Huidekoper
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Johanna M P van den Hout
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- MetabERN Subnetwork for Lysosomal Disorders, Rotterdam, The Netherlands.
- Center for Lysosomal and Metabolic Diseases, Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands.
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Najac C, van der Beek NAME, Boer VO, van Doorn PA, van der Ploeg AT, Ronen I, Kan HE, van den Hout JMP. Brain glycogen build-up measured by magnetic resonance spectroscopy in classic infantile Pompe disease. Brain Commun 2024; 6:fcae303. [PMID: 39309683 PMCID: PMC11416038 DOI: 10.1093/braincomms/fcae303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 06/04/2024] [Accepted: 09/12/2024] [Indexed: 09/25/2024] Open
Abstract
Classic infantile Pompe disease is caused by abnormal lysosomal glycogen accumulation in multiple tissues, including the brain due to a deficit in acid α-glucosidase. Although treatment with recombinant human acid α-glucosidase has dramatically improved survival, recombinant human acid α-glucosidase does not reach the brain, and surviving classic infantile Pompe patients develop progressive cognitive deficits and white matter lesions. We investigated the feasibility of measuring non-invasively glycogen build-up and other metabolic alterations in the brain of classic infantile Pompe patients. Four classic infantile patients (8-16 years old) and 4 age-matched healthy controls were scanned on a 7 T MRI scanner. We used T2-weighted MRI to assess the presence of white matter lesions as well as 1H magnetic resonance spectroscopy and magnetic resonance spectroscopy imaging to obtain the neurochemical profile and its spatial distribution, respectively. All patients had widespread white matter lesions on T2-weighted images. Magnetic resonance spectroscopy data from a single volume of interest positioned in the periventricular white matter showed a clear shift in the neurochemical profile, particularly a significant increase in glycogen (result of acid α-glucosidase deficiency) and decrease in N-acetyl-aspartate (marker of neuronal damage) in patients. Magnetic resonance spectroscopy imaging results were in line and showed a widespread accumulation of glycogen and a significant lower level of N-acetyl-aspartate in patients. Our results illustrate the unique potential of 1H magnetic resonance spectroscopy (imaging) to provide a non-invasive readout of the disease pathology in the brain. Further study will assess its potential to monitor disease progression and the correlation with cognitive decline.
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Affiliation(s)
- Chloé Najac
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Nadine A M E van der Beek
- Center for Lysosomal and Metabolic Diseases, Department of Neurology, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Vincent O Boer
- Danish Research Center for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, DK2650 Copenhagen, Denmark
| | - Pieter A van Doorn
- Center for Lysosomal and Metabolic Diseases, Department of Neurology, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Itamar Ronen
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, East Sussex BN1 9RR, UK
| | - Hermien E Kan
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Duchenne Center Netherlands, 2333 ZA Leiden, The Netherlands
| | - Johanna M P van den Hout
- Center for Lysosomal and Metabolic Diseases, Department of Pediatrics, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
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10
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Fiumara A, Sapuppo A, Gasperini S, Crescitelli V, Sacchini M, Procopio E, Gragnaniello V, Burlina A. Avalglucosidase alfa in infantile-onset Pompe disease: A snapshot of real-world experience in Italy. Mol Genet Metab Rep 2024; 40:101126. [PMID: 39161458 PMCID: PMC11332206 DOI: 10.1016/j.ymgmr.2024.101126] [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: 10/10/2023] [Revised: 07/22/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
Introduction Infantile-onset Pompe disease (IOPD) is due to mutations in the GAA gene leading to profound deficiency of the lysosomal enzyme α-1,4-glucosidase. The disease is characterized by severe hypotonia, hypertrophic cardiomyopathy, macroglossia, and liver enlargement with onset in the first months of life. In the late-onset form (LOPD), muscle signs predominate with a clinical picture resembling muscle dystrophies. Enzyme replacement therapy with alglucosidase alfa (rhGAA) has been available since 2006 and patients treated with the enzyme show improved outcomes. Nevertheless, there is evidence that some patients have a suboptimal response or, after an initial improvement, reach a plateau with stabilization of the clinical picture. Thus, a new enzyme formulation, avalglucosidase alfa (neoGAA), with a higher degree of mannosylation, was developed. Methods We conducted a multicenter survey that collected data on four patients with IOPD, aged 6 to 16 years, who were switched to neoGAA thanks to a compassionate use program, after being treated for an average of 11.5 years with rhGAA. Follow-up data, including biochemical parameters and clinical features, were analyzed to determine clinical outcomes and the safety profile after a mean of 9 months. Results Patients with IOPD who were treated with neoGAA showed a positive change in biomarker levels. Moreover, the clinical picture revealed improved motor performance and cardiac parameters in patients who previously responded poorly. Conclusion This study highlights the improved efficacy of neoGAA, as a next generation enzyme replacement therapy, in 4 Italian patients with IOPD. Several clinical parameters showed a positive response to the new formulation suggesting that, if used at diagnosis, neoGAA may result in better outcomes for patients with IOPD.
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Affiliation(s)
- Agata Fiumara
- Regional Referral Centre for Inherited Metabolic Disorders, Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Annamaria Sapuppo
- Regional Referral Centre for Inherited Metabolic Disorders, Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Serena Gasperini
- Unit of Inherited Metabolic Diseases, Pediatric Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Viola Crescitelli
- Unit of Inherited Metabolic Diseases, Pediatric Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Michele Sacchini
- Metabolic Diseases and Neuromuscular Unit, Neuroscience Department, IRCCS Meyer Children Hospital, Florence, Italy
| | - Elena Procopio
- Metabolic Diseases and Neuromuscular Unit, Neuroscience Department, IRCCS Meyer Children Hospital, Florence, Italy
| | - Vincenza Gragnaniello
- Division of Inherited Metabolic Diseases, Department of Diagnostic Service, Padua University Hospital, Padua, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Department of Diagnostic Service, Padua University Hospital, Padua, Italy
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11
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Kishnani PS, Chien YH, Berger KI, Thibault N, Sparks S. Clinical insight meets scientific innovation to develop a next generation ERT for Pompe disease. Mol Genet Metab 2024; 143:108559. [PMID: 39154400 DOI: 10.1016/j.ymgme.2024.108559] [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: 06/03/2024] [Revised: 07/24/2024] [Accepted: 07/31/2024] [Indexed: 08/20/2024]
Abstract
Years of research into the structure, processing, and function of acid alpha-glucosidase led to the development and 2006 approval of alglucosidase alfa (recombinant human acid alpha-glucosidase, Myozyme®/Lumizyme®), an enzyme replacement therapy and the first approved treatment for Pompe disease. Alglucosidase alfa has been a lifesaving treatment for patients with infantile-onset Pompe disease and radically improved daily life for patients with late-onset Pompe disease; however, long-term experience with alglucosidase alfa unraveled key unmet needs in these populations. Despite treatment, Pompe disease continues to progress, especially from a skeletal muscle perspective, resulting in a multitude of functional limitations. Strong collaboration between the scientific and patient communities led to increased awareness of Pompe disease, a better understanding of disease pathophysiology, knowledge of the clinical course of the disease as patients surpassed the first decade of life, and the strengths and limitations of enzyme replacement therapy. Taken together, these advancements spurred the need for development of a next generation of enzyme replacement therapy and provided a framework for progress toward other novel treatments. This review provides an overview of the development of avalglucosidase alfa as a model to highlight the interaction between clinical experience with existing treatments, the role of the clinician scientist, translational research at both system and cellular levels, and the iterative and collaborative process that optimizes the development of therapeutics.
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Affiliation(s)
- Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - Yin-Hsiu Chien
- Department of Medical Genetics and Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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12
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Colpaert M, Singh PK, Donohue KJ, Pires NT, Fuller DD, Corti M, Byrne BJ, Sun RC, Vander Kooi CW, Gentry MS. Neurological glycogen storage diseases and emerging therapeutics. Neurotherapeutics 2024; 21:e00446. [PMID: 39277505 PMCID: PMC11581880 DOI: 10.1016/j.neurot.2024.e00446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/29/2024] [Accepted: 08/30/2024] [Indexed: 09/17/2024] Open
Abstract
Glycogen storage diseases (GSDs) comprise a group of inherited metabolic disorders characterized by defects in glycogen metabolism, leading to abnormal glycogen accumulation in multiple tissues, most notably affecting the liver, skeletal muscle, and heart. Recent findings have uncovered the importance of glycogen metabolism in the brain, sustaining a myriad of physiological functions and linking its perturbation to central nervous system (CNS) pathology. This link resulted in classification of neurological-GSDs (n-GSDs), a group of diseases with shared deficits in neurological glycogen metabolism. The n-GSD patients exhibit a spectrum of clinical presentations with common etiology while requiring tailored therapeutic approaches from the traditional GSDs. Recent research has elucidated the genetic and biochemical mechanisms and pathophysiological basis underlying different n-GSDs. Further, the last decade has witnessed some promising developments in novel therapeutic approaches, including enzyme replacement therapy (ERT), substrate reduction therapy (SRT), small molecule drugs, and gene therapy targeting key aspects of glycogen metabolism in specific n-GSDs. This preclinical progress has generated noticeable success in potentially modifying disease course and improving clinical outcomes in patients. Herein, we provide an overview of current perspectives on n-GSDs, emphasizing recent advances in understanding their molecular basis, therapeutic developments, underscore key challenges and the need to deepen our understanding of n-GSDs pathogenesis to develop better therapeutic strategies that could offer improved treatment and sustainable benefits to the patients.
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Affiliation(s)
- Matthieu Colpaert
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Pankaj K Singh
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | | | - David D Fuller
- Department of Physical Therapy and Breathing Research and Therapeutics Center, University of Florida, Gainesville, FL, USA
| | - Manuela Corti
- Department of Pediatrics, Powell Gene Therapy Center, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Barry J Byrne
- Department of Pediatrics, Powell Gene Therapy Center, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ramon C Sun
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, FL, USA; Center for Advanced Spatial Biomolecule Research (CASBR), University of Florida, Gainesville, FL, USA
| | - Craig W Vander Kooi
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, FL, USA; Center for Advanced Spatial Biomolecule Research (CASBR), University of Florida, Gainesville, FL, USA
| | - Matthew S Gentry
- Department of Biochemistry and Molecular Biology, College of Medicine, University of Florida, Gainesville, FL, USA; Center for Advanced Spatial Biomolecule Research (CASBR), University of Florida, Gainesville, FL, USA.
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13
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van den Dorpel JJA, Mackenbach MJ, Dremmen MHG, van der Vlugt WMC, Rizopoulos D, van Doorn PA, van der Ploeg AT, Muetzel R, van der Beek NAME, van den Hout JMP. Long term survival in patients with classic infantile Pompe disease reveals a spectrum with progressive brain abnormalities and changes in cognitive functioning. J Inherit Metab Dis 2024; 47:716-730. [PMID: 38584574 DOI: 10.1002/jimd.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
The aim of this longitudinal cohort study, is to provide more insight into the pattern of brain abnormalities, and possible consequences for cognitive functioning, in patients with classic infantile Pompe disease. We included 19 classic infantile Pompe patients (median age last assessment 8.9 years, range 1.5-22.5 years; 5/19 CRIM negative), treated with ERT. Using MR imaging of the brain (T1, T2, and FLAIR acquisitions), we classified progression of brain abnormalities on a 12-point rating scale at multiple time points throughout follow-up. Additionally we noted specific white matter patterns and examined atrophy. Cognitive development was studied using Wechsler IQ assessments obtained by certified neuropsychologists. The association between age and cognitive functioning, and MRI ratings and cognitive functioning was assessed by linear regression models. All but one patient developed brain abnormalities. The abnormalities progressed in a similar pattern throughout the brain, with early involvement of periventricular white matter, later followed by subcortical white matter, gray matter structures, and juxtacortical U-fibers. We found a significant decline (p < 0.01), with increasing age for full scale IQ, performance IQ and processing speed, but not for verbal IQ (p = 0.17). Each point increment in the 12-point MRI rating scale was associated with a significant decline (3.1-6.0 points) in all the IQ index scores (p < 0.05). The majority of long-term surviving patients in our cohort develop incremental brain MRI abnormalities and decline in cognitive functioning. This highlights the need for new therapies that can cross the blood-brain barrier in order to treat this CNS phenotype.
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Affiliation(s)
- J J A van den Dorpel
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - M J Mackenbach
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - M H G Dremmen
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - W M C van der Vlugt
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - D Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - P A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - A T van der Ploeg
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - R Muetzel
- Department of Child and Adolescent Psychiatry/Psychology, Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - N A M E van der Beek
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
| | - J M P van den Hout
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Center for Lysosomal and Metabolic Diseases, The Netherlands
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14
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Kenney-Jung D, Korlimarla A, Spiridigliozzi GA, Wiggins W, Malinzak M, Nichting G, Jung SH, Sun A, Wang RY, Al Shamsi A, Phornphutkul C, Owens J, Provenzale JM, Kishnani PS. Severe CNS involvement in a subset of long-term treated children with infantile-onset Pompe disease. Mol Genet Metab 2024; 141:108119. [PMID: 38184429 PMCID: PMC11080415 DOI: 10.1016/j.ymgme.2023.108119] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION The standard of care for patients with infantile-onset Pompe disease (IOPD) is enzyme replacement therapy (ERT), which does not cross the blood brain barrier. While neuromuscular manifestations of IOPD are well-described, central nervous system (CNS) manifestations of this disorder are far less characterized. Here we describe severe CNS-related neurological manifestations including seizures and encephalopathy in six individuals with IOPD. METHOD We identified six children with IOPD who developed CNS manifestations such as seizures and/or encephalopathy. We studied their brain magnetic resonance imaging scans (MRIs) and graded the severity of white matter hyperintensities (WMHI) using the Fazekas scale scoring system as previously published. Longitudinal cognitive measures were available from 4/6 children. RESULTS All six IOPD patients (4 males/2 females) had been treated with ERT for 12-15 years. Seizures and/or encephalopathy were noted at a median age at onset of 11.9 years (range 9-15 years). All were noted to have extensive WMHI in the brain MRIs and very high Fazekas scores which preceded the onset of neurological symptoms. Longitudinal IQ scores from four of these children suggested developmental plateauing. DISCUSSION Among a subset of IOPD patients on long-term ERT, CNS manifestations including hyperreflexia, encephalopathy and seizures may become prominent, and there is likely an association between these symptoms and significant WMHI on MRI. Further study is needed to identify risk factors for CNS deterioration among children with IOPD and develop interventions to prevent neurological decline.
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Affiliation(s)
- Daniel Kenney-Jung
- Division of Neurology, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States of America
| | - Aditi Korlimarla
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States of America
| | - Gail A Spiridigliozzi
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States of America; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Walter Wiggins
- Department of Neuroradiology, Duke University Medical Center, Durham, NC, United States of America
| | - Michael Malinzak
- Department of Neuroradiology, Duke University Medical Center, Durham, NC, United States of America
| | - Gretchen Nichting
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States of America
| | - Seung-Hye Jung
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States of America
| | - Angela Sun
- Division of Genetic Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States of America
| | - Raymond Y Wang
- Division of Metabolic Disorders, Children's Hospital of Orange County, Orange, CA, United States of America
| | - Aisha Al Shamsi
- Genetic Metabolic Division, Pediatrics Department, Tawam Hospital, Al Ain, United Arab Emirates
| | - Chanika Phornphutkul
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - James Owens
- Division of Genetic Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, United States of America
| | - James M Provenzale
- Department of Neuroradiology, Duke University Medical Center, Durham, NC, United States of America
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States of America.
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15
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Koeberl DD, Koch RL, Lim JA, Brooks ED, Arnson BD, Sun B, Kishnani PS. Gene therapy for glycogen storage diseases. J Inherit Metab Dis 2024; 47:93-118. [PMID: 37421310 PMCID: PMC10874648 DOI: 10.1002/jimd.12654] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 05/24/2023] [Accepted: 07/05/2023] [Indexed: 07/10/2023]
Abstract
Glycogen storage disorders (GSDs) are inherited disorders of metabolism resulting from the deficiency of individual enzymes involved in the synthesis, transport, and degradation of glycogen. This literature review summarizes the development of gene therapy for the GSDs. The abnormal accumulation of glycogen and deficiency of glucose production in GSDs lead to unique symptoms based upon the enzyme step and tissues involved, such as liver and kidney involvement associated with severe hypoglycemia during fasting and the risk of long-term complications including hepatic adenoma/carcinoma and end stage kidney disease in GSD Ia from glucose-6-phosphatase deficiency, and cardiac/skeletal/smooth muscle involvement associated with myopathy +/- cardiomyopathy and the risk for cardiorespiratory failure in Pompe disease. These symptoms are present to a variable degree in animal models for the GSDs, which have been utilized to evaluate new therapies including gene therapy and genome editing. Gene therapy for Pompe disease and GSD Ia has progressed to Phase I and Phase III clinical trials, respectively, and are evaluating the safety and bioactivity of adeno-associated virus vectors. Clinical research to understand the natural history and progression of the GSDs provides invaluable outcome measures that serve as endpoints to evaluate benefits in clinical trials. While promising, gene therapy and genome editing face challenges with regard to clinical implementation, including immune responses and toxicities that have been revealed during clinical trials of gene therapy that are underway. Gene therapy for the glycogen storage diseases is under development, addressing an unmet need for specific, stable therapy for these conditions.
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Affiliation(s)
- Dwight D. Koeberl
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, United States
| | - Rebecca L. Koch
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Jeong-A Lim
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Elizabeth D. Brooks
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Benjamin D. Arnson
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, United States
| | - Baodong Sun
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
| | - Priya S. Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical School, Durham, NC, United States
- Department of Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, United States
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16
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Elvidge KL, Christodoulou J, Farrar MA, Tilden D, Maack M, Valeri M, Ellis M, Smith NJC. The collective burden of childhood dementia: a scoping review. Brain 2023; 146:4446-4455. [PMID: 37471493 PMCID: PMC10629766 DOI: 10.1093/brain/awad242] [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: 04/11/2023] [Revised: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023] Open
Abstract
Childhood dementia is a devastating and under-recognized group of disorders with a high level of unmet need. Typically monogenic in origin, this collective of individual neurodegenerative conditions are defined by a progressive impairment of neurocognitive function, presenting in childhood and adolescence. This scoping review aims to clarify definitions and conceptual boundaries of childhood dementia and quantify the collective disease burden. A literature review identified conditions that met the case definition. An expert clinical working group reviewed and ratified inclusion. Epidemiological data were extracted from published literature and collective burden modelled. One hundred and seventy genetic childhood dementia disorders were identified. Of these, 25 were analysed separately as treatable conditions. Collectively, currently untreatable childhood dementia was estimated to have an incidence of 34.5 per 100 000 (1 in 2900 births), median life expectancy of 9 years and prevalence of 5.3 per 100 000 persons. The estimated number of premature deaths per year is similar to childhood cancer (0-14 years) and approximately 70% of those deaths will be prior to adulthood. An additional 49.8 per 100 000 births are attributable to treatable conditions that would cause childhood dementia if not diagnosed early and stringently treated. A relational database of the childhood dementia disorders has been created and will be continually updated as new disorders are identified (https://knowledgebase.childhooddementia.org/). We present the first comprehensive overview of monogenic childhood dementia conditions and their collective epidemiology. Unifying these conditions, with consistent language and definitions, reinforces motivation to advance therapeutic development and health service supports for this significantly disadvantaged group of children and their families.
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Affiliation(s)
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children's Hospital, Parkville, Victoria 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital Network, Randwick, NSW 2031, Australia
- Discipline of Paediatrics, School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW 2052, Australia
| | | | - Megan Maack
- Childhood Dementia Initiative, Brookvale, NSW 2100, Australia
| | | | - Magda Ellis
- THEMA Consulting Pty Ltd, Pyrmont, NSW 2009, Australia
| | - Nicholas J C Smith
- Discipline of Paediatrics, University of Adelaide, Women's and Children's Hospital, North Adelaide, South Australia 5006, Australia
- Department of Neurology and Clinical Neurophysiology, Women’s and Children’s Health Network, North Adelaide, South Australia 5006, Australia
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17
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Gómez-Cebrián N, Gras-Colomer E, Poveda Andrés JL, Pineda-Lucena A, Puchades-Carrasco L. Omics-Based Approaches for the Characterization of Pompe Disease Metabolic Phenotypes. BIOLOGY 2023; 12:1159. [PMID: 37759559 PMCID: PMC10525434 DOI: 10.3390/biology12091159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Lysosomal storage disorders (LSDs) constitute a large group of rare, multisystemic, inherited disorders of metabolism, characterized by defects in lysosomal enzymes, accessory proteins, membrane transporters or trafficking proteins. Pompe disease (PD) is produced by mutations in the acid alpha-glucosidase (GAA) lysosomal enzyme. This enzymatic deficiency leads to the aberrant accumulation of glycogen in the lysosome. The onset of symptoms, including a variety of neurological and multiple-organ pathologies, can range from birth to adulthood, and disease severity can vary between individuals. Although very significant advances related to the development of new treatments, and also to the improvement of newborn screening programs and tools for a more accurate diagnosis and follow-up of patients, have occurred over recent years, there exists an unmet need for further understanding the molecular mechanisms underlying the progression of the disease. Also, the reason why currently available treatments lose effectiveness over time in some patients is not completely understood. In this scenario, characterization of the metabolic phenotype is a valuable approach to gain insights into the global impact of lysosomal dysfunction, and its potential correlation with clinical progression and response to therapies. These approaches represent a discovery tool for investigating disease-induced modifications in the complete metabolic profile, including large numbers of metabolites that are simultaneously analyzed, enabling the identification of novel potential biomarkers associated with these conditions. This review aims to highlight the most relevant findings of recently published omics-based studies with a particular focus on describing the clinical potential of the specific metabolic phenotypes associated to different subgroups of PD patients.
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Affiliation(s)
- Nuria Gómez-Cebrián
- Drug Discovery Unit, Instituto de Investigación Sanitaria La Fe, 46026 Valencia, Spain
| | - Elena Gras-Colomer
- Pharmacy Department, Hospital Manises of Valencia, 46940 Valencia, Spain
| | | | - Antonio Pineda-Lucena
- Molecular Therapeutics Program, Centro de Investigación Médica Aplicada, 31008 Pamplona, Spain
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18
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Tsai MJM, Chen MH, Chien YH, Tung YC. Precocious puberty in patients with Pompe disease. Front Endocrinol (Lausanne) 2023; 14:1150498. [PMID: 37654562 PMCID: PMC10465365 DOI: 10.3389/fendo.2023.1150498] [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: 01/25/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction The life expectancy of Pompe disease patients has increased due to improved neonatal screening and enzyme replacement therapy. Nevertheless, the potential effect of frequent medical device exposure on pubertal development in these patients is not well understood, so further investigation is warranted. Methods In this cross-sectional study, we assessed the growth and puberty of nine Pompe disease patients. In addition, to determine the effects of frequent plastic medical device exposure in these patients, we measured urinary phthalate metabolites before and one day after enzyme replacement therapy. Results Five out of nine patients (55%) with Pompe disease on enzyme replacement therapy had precocious puberty. Patients with precocious puberty had significantly shorter predicted adult heights compared to those with normal puberty (p = 0.014). The levels of mono-2-ethylhexyl phthalate (MEHP) and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) increased after enzyme replacement therapy, but the average levels of phthalate metabolites did not significantly differ between patients with normal and precocious puberty. Conclusion Pompe disease patients on enzyme replacement therapy tend to have precocious puberty, which may reduce their adult height. There are no significant differences in urinary phthalate metabolites between normal and precocious puberty patients. Regular follow-up of growth and puberty in Pompe disease patients is important to improve their health outcomes.
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Affiliation(s)
- Meng-Ju Melody Tsai
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pediatrics, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - Mei-Huei Chen
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yin-Hsiu Chien
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ching Tung
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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