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Sánchez-Pintos P, Camba-Garea MJ, López-Pardo BM, Couce ML. Odimet ®: A Pioneering Tele-Health Tool to Empower Dietary Treatment and the Acute Management of Inborn Errors of Metabolism-An Assessment of Its Effectiveness during the COVID Pandemic. Nutrients 2024; 16:423. [PMID: 38337708 PMCID: PMC10856987 DOI: 10.3390/nu16030423] [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: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Strict adherence to a diet is an essential pillar of long-term treatment for many inborn errors of metabolism (IEMs). Tools that educate patients about dietary management can positively condition adherence and prevent morbidity. We designed a free online dietary calculation program (Odimet®, version 2.1.) for IEMs patients in 2008, updated in 2022, that provides detailed information on the content of amino acids, protein, lipids, carbohydrates, vitamins and minerals in >3000 food products, including specific medical foods for IEM. We analyzed the statistics on visits to Odimet® to evaluate its usefulness for long-term dietary management during a 5-year period focusing on three periods: pre-pandemic (15 March 2018-14 March 2020); pandemic 1 (15 March 2020-14 March 2021); and pandemic 2 period (15 March 2021-15 March 2023), in 120 patients with the following distribution: 84 patients with phenylketonuria (PKU); 12 with maple syrup urine disease (MSUD); 11 with urea cycle disorders (UCDs); and 13 with classical galactosemia. The evolutionary levels of their specific metabolic markers were evaluated, showing that globally, both pediatric and adult patients maintain a good metabolic control, even during a pandemic (median levels of phenylalanine in pediatric PKU patients 213.4 µmol/L and 482.3 µmol/L in adults; of leucine in MSUD patients: 144.2 µmol/L; of glutamine in UCDs: 726.8 µmol/L; and of galactose 1-phosphate levels in galactosemia: 0.08 µmol/L). The proportion of patients using Odimet® ranges from 78-100%. An increase in the number of diets being calculated was observed during COVID-19 pandemic. Currently, 14,825 products have been introduced (3094 from the general database, and 11,731 added by users to their own profiles). In 2023 63 emergency dietary adjustments in the studied intoxication-type pathologies were calculated in Odimet®. Our results suggest that its regular use contributes to maintaining metabolic stability in IEMs patients, allowing them to adapt their menus to their lifestyle, and represents a powerful complementary tele-health tool which can be used to perform remote real-time dietary follow-up.
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Affiliation(s)
- Paula Sánchez-Pintos
- Metabolic Diseases Unit, Neonatology Department, Clinical University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (B.M.L.-P.)
- IDIS—Health Research Institute of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Instituto Salud Carlos III, 28029 Madrid, Spain
- European Reference Network for Hereditary Metabolic Disorders (MetabERN), Via Pozzuolo, 330, 33100 Udine, Italy
- Faculty of Medicine, Santiago de Compostela University, 15704 Santiago de Compostela, Spain
| | - María José Camba-Garea
- Metabolic Diseases Unit, Neonatology Department, Clinical University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (B.M.L.-P.)
- IDIS—Health Research Institute of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Instituto Salud Carlos III, 28029 Madrid, Spain
- European Reference Network for Hereditary Metabolic Disorders (MetabERN), Via Pozzuolo, 330, 33100 Udine, Italy
| | - Beatriz Martin López-Pardo
- Metabolic Diseases Unit, Neonatology Department, Clinical University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (B.M.L.-P.)
- European Reference Network for Hereditary Metabolic Disorders (MetabERN), Via Pozzuolo, 330, 33100 Udine, Italy
| | - María L. Couce
- Metabolic Diseases Unit, Neonatology Department, Clinical University Hospital of Santiago de Compostela, 15706 Santiago de Compostela, Spain; (B.M.L.-P.)
- IDIS—Health Research Institute of Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Instituto Salud Carlos III, 28029 Madrid, Spain
- European Reference Network for Hereditary Metabolic Disorders (MetabERN), Via Pozzuolo, 330, 33100 Udine, Italy
- Faculty of Medicine, Santiago de Compostela University, 15704 Santiago de Compostela, Spain
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Carou-Senra P, Rodríguez-Pombo L, Monteagudo-Vilavedra E, Awad A, Alvarez-Lorenzo C, Basit AW, Goyanes A, Couce ML. 3D Printing of Dietary Products for the Management of Inborn Errors of Intermediary Metabolism in Pediatric Populations. Nutrients 2023; 16:61. [PMID: 38201891 PMCID: PMC10780524 DOI: 10.3390/nu16010061] [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: 11/27/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The incidence of Inborn Error of Intermediary Metabolism (IEiM) diseases may be low, yet collectively, they impact approximately 6-10% of the global population, primarily affecting children. Precise treatment doses and strict adherence to prescribed diet and pharmacological treatment regimens are imperative to avert metabolic disturbances in patients. However, the existing dietary and pharmacological products suffer from poor palatability, posing challenges to patient adherence. Furthermore, frequent dose adjustments contingent on age and drug blood levels further complicate treatment. Semi-solid extrusion (SSE) 3D printing technology is currently under assessment as a pioneering method for crafting customized chewable dosage forms, surmounting the primary limitations prevalent in present therapies. This method offers a spectrum of advantages, including the flexibility to tailor patient-specific doses, excipients, and organoleptic properties. These elements are pivotal in ensuring the treatment's efficacy, safety, and adherence. This comprehensive review presents the current landscape of available dietary products, diagnostic methods, therapeutic monitoring, and the latest advancements in SSE technology. It highlights the rationale underpinning their adoption while addressing regulatory aspects imperative for their seamless integration into clinical practice.
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Affiliation(s)
- Paola Carou-Senra
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
| | - Lucía Rodríguez-Pombo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
| | - Einés Monteagudo-Vilavedra
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, RICORS, CIBERER, MetabERN, 15706 Santiago de Compostela, Spain;
| | - Atheer Awad
- Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, College Lane, Hatfield AL10 9AB, UK;
| | - Carmen Alvarez-Lorenzo
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
| | - Abdul W. Basit
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
- FABRX Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK
- FABRX Artificial Intelligence, 27543 O Saviñao, Spain
| | - Alvaro Goyanes
- Departamento de Farmacología, Farmacia y Tecnología Farmacéutica, I+D Farma (GI-1645), Facultad de Farmacia, Materials Institute (iMATUS) and Health Research Institute of Santiago de Compostela (IDIS), Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain; (P.C.-S.); (L.R.-P.); (C.A.-L.)
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London WC1N 1AX, UK;
- FABRX Ltd., Henwood House, Henwood, Ashford, Kent TN24 8DH, UK
- FABRX Artificial Intelligence, 27543 O Saviñao, Spain
| | - María L. Couce
- Servicio de Neonatología, Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, RICORS, CIBERER, MetabERN, 15706 Santiago de Compostela, Spain;
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Çıkı K, Yıldız Y, Kahraman AB, Özgül RK, Coşkun T, Dursun A, Tokatlı A, Sivri S. Predictors of eventual requirement of phenylalanine-restricted diet in young infants with phenylalanine hydroxylase deficiency initially managed with sapropterin monotherapy. Mol Genet Metab 2023; 140:107706. [PMID: 37837865 DOI: 10.1016/j.ymgme.2023.107706] [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: 08/20/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Phenylalanine (Phe)-restricted diet is associated with lower quality of life for patients with phenylketonuria (PKU), and a concern for caregivers of recently-diagnosed infants. Sapropterin is an oral drug used as an alternative or adjunct to dietary treatment. We have observed that some of the young infants initially managed successfully with sapropterin monotherapy have required dietary treatment in long-term follow-up. We aimed to determine the baseline factors associated with future initiation of dietary treatment in these patients. METHODS Data were obtained retrospectively from the medical records of 80 PKU patients started on sapropterin monotherapy before 3 months of age between 2011 and 2021. RESULTS The patients were followed for a median of 3.9 years (Q1-Q3: 2.5-5.75 years). Sapropterin was tapered down and discontinued in 5 patients (6.3%) as their Phe levels remained below 360 μmol/L without treatment. Sapropterin monotherapy was sufficient in 62 patients (77.5%), while 13 (16.2%) required dietary treatment. Phe and tyrosine (Tyr) levels, and Phe:Tyr ratios differed significantly among the patients maintained on sapropterin monotherapy and those started on dietary treatment, but the Phe:Tyr ratio at diagnosis was the most important independent baseline variable (OR: 1.61, 95% CI: 1.15-2.27, p = 0.006), with Phe:Tyr ratio at diagnosis >5.25 associated with dietary treatment (sensitivity: 90.0%, specificity: 81.8%). Genotypic phenotype value (GPV), unavailable at baseline, was also associated with dietary treatment (median GPV 9.2 vs. 3.8, p = 0.006), but some genotypes were not specific to the final treatment modality. DISCUSSION We propose that the Phe:Tyr ratio at diagnosis is an important indicator to predict dietary requirement in young infants initially managed with sapropterin monotherapy.
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Affiliation(s)
- Kısmet Çıkı
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Yılmaz Yıldız
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ayça Burcu Kahraman
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - R Köksal Özgül
- Hacettepe University Institute of Child Health, Ankara, Turkey.
| | - Turgay Coşkun
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ali Dursun
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ayşegül Tokatlı
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Rovira-Remisa MM, Moreira M, Ventura PS, Gonzalez-Alvarez P, Mestres N, Graterol Torres F, Joaquín C, Seuma ARP, Del Mar Martínez-Colls M, Roche A, Ibáñez-Micó S, López-Laso E, Méndez-Hernández MJ, Murillo M, Monlleó-Neila L, Maqueda-Castellote E, Del Toro Riera M, Felipe-Rucián A, Giralt-López M, Cortès-Saladelafont E. Impact of COVID19 pandemic on patients with rare diseases in Spain, with a special focus on inherited metabolic diseases. Mol Genet Metab Rep 2023; 35:100962. [PMID: 36909454 PMCID: PMC9986135 DOI: 10.1016/j.ymgmr.2023.100962] [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: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction The Covid-19 pandemic soon became an international health emergency raising concern about its impact not only on physical health but also on quality of life and mental health. Rare diseases are chronically debilitating conditions with challenging patient care needs. We aimed to assess the quality of life and mental health of patients with rare diseases in Spain, with a special focus on inherited metabolic disorders (IMD). Methods A prospective case-control study was designed, comparing 459 patients suffering from a rare disease (including 53 patients with IMD) and 446 healthy controls. Quality of life (QoL) and mental health were assessed using validated scales according to age: KINDL-R and the Pediatric Symptom Checklist (PSC) for children and the WhoQoL-Bref questionnaire, GAD and PHQ-9 in adults. Results First, children and adults (but not adolescents) with IMD showed greater psychological effects than controls (p = 0.022, p = 0.026 respectively). Second, when comparing QoL, only adult patients with IMD showed worse score than controls (66/100 vs 74,6/100 respectively, p = 0.017). Finally, IMD had better quality of life than other rare neurological and genetic diseases (p = 0.008) or other rare diseases (p < 0.001 respectively) but similar alteration of the mental status. Conclusions Our data show that the pandemic had a negative impact on mental health that is more evident in the group of patients with IMD. Young age would behave as a protective factor on the perception of QoL. Furthermore, patients with IMD show a better QoL than other rare diseases.
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Affiliation(s)
- M Mar Rovira-Remisa
- Unit of Inherited Metabolic Disorders and Pediatric Neurology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona., Spain
| | - Mónica Moreira
- Department of Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona, Spain
| | - Paula Sol Ventura
- Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Spain.,Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Núria Mestres
- Unit of Inherited Metabolic Disorders and Pediatric Neurology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona., Spain
| | | | - Clara Joaquín
- Unit of Adults Inherited Metabolic Disorders, Department of Endocrinology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Agustí Rodríguez-Palmero Seuma
- Unit of Inherited Metabolic Disorders and Pediatric Neurology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona., Spain
| | - Maria Del Mar Martínez-Colls
- Unit of Pediatric Pneumology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ana Roche
- Unit of Pediatric Neurology, Department of Pediatrics, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - Salvador Ibáñez-Micó
- Unit of Pediatric Neurology, Department of Pediatrics, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, IMIBIC, CIBERER, Córdoba, Spain
| | - María Jesús Méndez-Hernández
- Unit of Pediatric Infectious Diseases and Immunological Disorders, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marta Murillo
- Unit of Pediatric Endocrinology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Laura Monlleó-Neila
- Unit of Inherited Metabolic Disorders and Pediatric Neurology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona., Spain
| | - Elena Maqueda-Castellote
- Unit of Inherited Metabolic Disorders and Pediatric Neurology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona., Spain
| | | | - Ana Felipe-Rucián
- Pediatric Neurology Department, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Maria Giralt-López
- Department of Psychiatry, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona, Spain
| | - Elisenda Cortès-Saladelafont
- Unit of Inherited Metabolic Disorders and Pediatric Neurology, Department of Pediatrics, Hospital Universitari Germans Trias i Pujol, Badalona., Spain.,Universitat Autònoma de Barcelona, Campus Can Ruti, Badalona, Spain
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Coene JR, Reeves PT. Key Factors Affecting Parental Quality of Life in Families of Children with Inborn Errors of Metabolism Requiring a Restrictive Diet. J Pediatr 2023; 254:1-3. [PMID: 36228681 DOI: 10.1016/j.jpeds.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Jacob R Coene
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, Texas
| | - Patrick T Reeves
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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Abstract
PURPOSE OF REVIEW To present new therapeutic modalities for inborn errors of metabolism that are in clinical trials or recently approved by the US Food and Drug Administration (FDA) and to improve pediatricians' understanding of therapies their patients with inborn errors of metabolism receive. RECENT FINDINGS New therapies that move beyond the old standard modalities of recombinant human enzyme therapies, diet and medications have been recently approved by the US FDA to include nonhuman enzyme therapies, gene therapy and chaperone therapies. SUMMARY These new therapies offer more therapeutic options for individuals with inborn errors of metabolism. These new therapies have the potential to improve patient compliance and outcomes. Many other novel modalities are in the development pipeline, and are likely to transform the management of inborn errors of metabolism over the coming decade.
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