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Sheth J, Nair A, Bhavsar R, Godbole K, Datar C, Nampoothiri S, Panigrahi I, Shah H, Bajaj S, Tayade N, Bhardwaj N, Sheth H. Lysosomal storage disorders identified in adult population from India: Experience of a tertiary genetic centre and review of literature. JIMD Rep 2024; 65:85-101. [PMID: 38444573 PMCID: PMC10910243 DOI: 10.1002/jmd2.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 03/07/2024] Open
Abstract
Lysosomal storage disorders (LSDs) in adults have milder phenotype and variable age at presentation. Several studies have described the phenotype, genotype and treatment outcomes for adult-onset LSDs like Gaucher, Fabry, Pompe disease and others. We describe the first systematic study on the occurrence of LSDs in an adult population from India. It describes, the key clinical signs seen in these patients and those from literature review that can aid in early detection. Of 2102 biochemically diagnosed LSDs cases, 32 adult patients were identified with LSDs. Based on the clinical suspicion, screening test and enzyme study was carried out. Twenty-two patients were subjected to a genetic study to identify the causative variant in a respective gene. Of the 32 adult patients, we observed a maximum percentage of 37.5% (n = 12) cases with Gaucher disease, followed by 13% (n = 4) with Fabry disease. We found 10% of cases with MPS IVA and MPS I, and 9% cases with Pompe. Single case of adult mucolipidosis III and two cases each of Type 1 Sialidosis, Niemann-Pick disease B and metachromatic leukodystrophy were identified. We observed two common variants p.Leu483Pro and p.Ala487Thr in the GBA1 gene in 23% of Indian patients with adult Gaucher disease. No common variants were observed in other aforementioned LSDs. Study identified 50% of Fabry patients and 4% of Gaucher patients diagnosed at our centre to be adults. The prevalence of adult Pompe patients was low (3.4%) as compared to 80% reported in the Caucasian population. Adult LSDs such as, MPS III, GM1/GM2 gangliosidosis and Krabbe disease were not identified in our cohort.
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Affiliation(s)
- Jayesh Sheth
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
| | - Aadhira Nair
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
| | - Riddhi Bhavsar
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
| | - Koumudi Godbole
- Department of Clinical GeneticsDeenanath Mangeshkar Hospital & Research CentrePuneIndia
| | - Chaitanya Datar
- Department of Clincial GeneticsBharati Hospital and Research CentrePuneIndia
| | | | - Inusha Panigrahi
- Department of PediatricsPostgraduate Institute of Medical Education and Research, PGIMERChandigarhIndia
| | - Heli Shah
- Department of PediatricsSmt. NHL Municipal Medical CollegeAhmedabadIndia
| | | | - Naresh Tayade
- Department of PediatricsDr. Panjabrao Deshmukh Memorial Medical CollegeAmravatiIndia
| | | | - Harsh Sheth
- Department of Molecular and Biochemical GeneticsFRIGE's Institute of Human GeneticsAhmedabadIndia
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Toscano A, Pollissard L, Msihid J, van der Beek N, Kishnani PS, Dimachkie MM, Berger KI, DasMahapatra P, Thibault N, Hamed A, Zhou T, Haack KA, Schoser B. Effect of avalglucosidase alfa on disease-specific and general patient-reported outcomes in treatment-naïve adults with late-onset Pompe disease compared with alglucosidase alfa: Meaningful change analyses from the Phase 3 COMET trial. Mol Genet Metab 2024; 141:108121. [PMID: 38184428 DOI: 10.1016/j.ymgme.2023.108121] [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: 07/03/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND The Phase 3 COMET trial (NCT02782741) comparing avalglucosidase alfa and alglucosidase alfa included health-related quality of life (HRQoL) assessments in treatment-naïve patients with late-onset Pompe disease (LOPD). Here, we further characterize results from disease-specific and general patient-reported outcome (PRO) measures. METHODS Adults who participated in the COMET trial receiving avalglucosidase alfa or alglucosidase alfa (both 20 mg/kg biweekly) during the 49-week double-blind treatment period were included in the analysis. Proportions of patients exceeding meaningful change thresholds at Week 49 were compared post hoc between treatment groups. PROs and their meaningful change thresholds included: Pompe Disease Severity Scale (PDSS; decrease 1.0-1.5 points), Pompe Disease Impact Scale (PDIS; decrease 1.0-1.5 points), Rasch-built Pompe-specific Activity Scale (R-PAct; change from unable to able to complete activity), 12-item Short Form Health Survey (SF-12; physical component summary [PCS] score: increase ≥6 points, mental component summary [MCS] score: increase ≥7 points), EuroQol 5 Dimension 5 Level (EQ-5D-5L; improvement of ≥1 category), and Patient Global Impression of Change (PGIC; any improvement). RESULTS The analysis included 99 adult patients (avalglucosidase alfa n = 50; alglucosidase alfa n = 49). Patients who received avalglucosidase alfa had significantly greater odds of achieving a meaningful change versus alglucosidase alfa for the PDSS Shortness of Breath (OR [95% CI] 11.79 [2.24; 62.18]), Fatigue/Pain (6.24 [1.20; 32.54]), Morning Headache (13.98 [1.71; 114.18]), and Overall Fatigue (5.88 [1.37; 25.11]) domains, and were significantly more likely to meet meaningful change thresholds across multiple PDSS domains (all nominal p < 0.05). A numerically greater proportion of patients in the avalglucosidase alfa group were able to complete selected activities of the R-PAct compared with the alglucosidase alfa group. Significantly greater proportions of patients who received avalglucosidase alfa achieved meaningful improvements for EQ-5D-5L usual activities dimension, EQ visual analog scale, and all four PGIC domains. The proportion of patients with improvements in SF-12 PCS and MCS was greater in the avalglucosidase alfa group versus alglucosidase alfa group, but was not significant (p > 0.05). CONCLUSIONS These analyses show that avalglucosidase alfa improves multiple symptoms and aspects of daily functioning, including breathing and mobility. This supports the clinical relevance of the effects of avalglucosidase alfa on HRQoL for patients with LOPD.
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Affiliation(s)
- Antonio Toscano
- ERN-NMD Center of Messina for Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Nadine van der Beek
- Center for Lysosomal and Metabolic Diseases, and Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Priya S Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas, KS, USA
| | - Kenneth I Berger
- Division of Pulmonary, Critical Care and Sleep Medicine, NYU Grossman School of Medicine, and the André Cournand Pulmonary Physiology Laboratory, Bellevue Hospital, New York, NY, USA
| | | | | | | | | | | | - Benedikt Schoser
- Department of Neurology, Friedrich-Baur-Institute, LMU Klinikum München, München, Germany
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López-Rodríguez M, Torralba-Cabeza MA, de Pedro IP, Rivera A, Gil RS, Gómez-Belda A, de la Peña JLP, de Los Santos Moreno A, Selva-O'Callaghan A, Gárate IG, García AG, Hurtado R, de Ureta PT, Barba-Romero MÁ, Milisenda JC, Grau-Junyent JM. Screening for late-onset Pompe disease in Internal Medicine departments in Spain. Orphanet J Rare Dis 2023; 18:256. [PMID: 37653444 PMCID: PMC10472593 DOI: 10.1186/s13023-023-02887-z] [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: 02/01/2023] [Accepted: 08/25/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The screening of high-risk populations using dried blood spots (DBS) has allowed the rapid identification of patients with Pompe disease, mostly in Neurology departments. The aim of the study was to determine the prevalence of late-onset Pompe disease (LOPD) among patients not previously diagnosed or tested for this entity despite presenting possible signs or symptoms of the disease in Internal Medicine departments in Spain. METHODS This epidemiological, observational, cross-sectional, multicenter study included a single cohort of individuals with clinical suspicion of LOPD seen at Internal Medicine departments in Spain. The diagnosis of LOPD was initially established on the basis of the result of DBS. If decreased enzyme acid-alpha-1,4-glucosidase (GAA) activity was detected in DBS, additional confirmatory diagnostic measurements were conducted, including GAA activity in lymphocytes, fibroblasts, or muscle and/or genetic testing. RESULTS The diagnosis of LOPD was confirmed in 2 out of 322 patients (0.6%). Reasons for suspecting LOPD diagnosis were polymyositis or any type of myopathy of unknown etiology (in one patient), and asymptomatic or pauci-symptomatic hyperCKemia (in the other). The time between symptom onset and LOPD diagnosis was 2.0 and 0.0 years. Both patients were asymptomatic, with no muscle weakness. Additionally, 19.7% of the non-LOPD cases received an alternative diagnosis. CONCLUSIONS Our study highlights the existence of a hidden population of LOPD patients in Internal Medicine departments who might benefit from early diagnosis and early initiation of potential treatments.
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Affiliation(s)
| | | | - Iván Pérez de Pedro
- Internal Medicine Department, Málaga Regional University Hospital, Málaga, Spain
| | - Alberto Rivera
- Internal Medicine Department, University Hospital Complex of Vigo, Vigo, Spain
| | - Roi Suarez Gil
- Internal Medicine Department, Lucus Augusti University Hospital, Lugo, Spain
| | - Ana Gómez-Belda
- Internal Medicine Department, Dr. Peset University Hospital, Valencia, Spain
| | | | | | | | - Igor Gómez Gárate
- Internal Medicine Department, Araba University Hospital, Álaba, Spain
| | | | - Roberto Hurtado
- Internal Medicine Department, Vega Baja Hospital, Alicante, Spain
| | - Pablo Tutor de Ureta
- Internal Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Madrid, Spain
| | | | - José C Milisenda
- Internal Medicine Department, Hospital Clínic, University of Barcelona and CIBERER (Madrid), C/Villarroel 170, 08036, Barcelona, Spain
| | - Josep M Grau-Junyent
- Internal Medicine Department, Hospital Clínic, University of Barcelona and CIBERER (Madrid), C/Villarroel 170, 08036, Barcelona, Spain.
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Divakar MK, Jain A, Bhoyar RC, Senthivel V, Jolly B, Imran M, Sharma D, Bajaj A, Gupta V, Scaria V, Sivasubbu S. Whole-genome sequencing of 1029 Indian individuals reveals unique and rare structural variants. J Hum Genet 2023; 68:409-417. [PMID: 36813834 DOI: 10.1038/s10038-023-01131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Abstract
Structural variants contribute to genetic variability in human genomes and they can be presented in population-specific patterns. We aimed to understand the landscape of structural variants in the genomes of healthy Indian individuals and explore their potential implications in genetic disease conditions. For the identification of structural variants, a whole genome sequencing dataset of 1029 self-declared healthy Indian individuals from the IndiGen project was analysed. Further, these variants were evaluated for potential pathogenicity and their associations with genetic diseases. We also compared our identified variations with the existing global datasets. We generated a compendium of total 38,560 high-confident structural variants, comprising 28,393 deletions, 5030 duplications, 5038 insertions, and 99 inversions. Particularly, we identified around 55% of all these variants were found to be unique to the studied population. Further analysis revealed 134 deletions with predicted pathogenic/likely pathogenic effects and their affected genes were majorly enriched for neurological disease conditions, such as intellectual disability and neurodegenerative diseases. The IndiGenomes dataset helped us to understand the unique spectrum of structural variants in the Indian population. More than half of identified variants were not present in the publicly available global dataset on structural variants. Clinically important deletions identified in IndiGenomes might aid in improving the diagnosis of unsolved genetic diseases, particularly in neurological conditions. Along with basal allele frequency data and clinically important deletions, IndiGenomes data might serve as a baseline resource for future studies on genomic structural variant analysis in the Indian population.
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Affiliation(s)
- Mohit Kumar Divakar
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Abhinav Jain
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Rahul C Bhoyar
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India
| | - Vigneshwar Senthivel
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Bani Jolly
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Mohamed Imran
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Disha Sharma
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Anjali Bajaj
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vishu Gupta
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India.,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Vinod Scaria
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India. .,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
| | - Sridhar Sivasubbu
- CSIR-Institute of Genomics and Integrative Biology (CSIR-IGIB), Mathura Road, New Delhi, 110025, India. .,Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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Verma IC, El-Beshlawy A, Tylki-Szymańska A, Martins A, Duan YL, Collin-Histed T, van der Linde MS, Mansour R, Dũng VC, Mistry PK. Transformative effect of a Humanitarian Program for individuals affected by rare diseases: building support systems and creating local expertise. Orphanet J Rare Dis 2022; 17:87. [PMID: 35369888 PMCID: PMC8977120 DOI: 10.1186/s13023-022-02192-1] [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: 11/08/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractRare diseases affect > 400 million people globally with a disproportionate burden falling on children, resulting in high morbidity and mortality rates. Affected individuals in some under-resourced countries have limited access to expert care or treatments; moreover, they suffer long diagnostic journeys during which debilitating and life-threatening complications occur. Lysosomal storage disorders (LSD) are prototype rare diseases due, in the main, to inherited deficiencies of lysosomal enzymes/transporters that affect up to 1 in 5000 newborns. Recognizing the need to provide treatment access to people with LSDs everywhere, a collaborative partnership was pioneered and set up 30 years ago. Partnering with local authorities, non-government organizations across six continents, local as well as international experts, a robust, sustainable Humanitarian Program emerged that now represents the most enduring charitable access program for LSD treatment. Here we present the history, process, lasting beneficial effect of the program to develop healthcare systems and infrastructures, and the lessons learned from addressing major unmet needs for LSDs.
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