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Muenzer J, Burton BK, Harmatz P, Gutiérrez‐Solana LG, Ruiz‐Garcia M, Jones SA, Guffon N, Inbar‐Feigenberg M, Bratkovic D, Rust S, Hale M, Wu Y, Yee KS, Whiteman DAH, Alexanderian D. Evaluation of early treatment with intravenous idursulfase and intrathecal idursulfase-IT on cognitive function in siblings with neuronopathic mucopolysaccharidosis II. J Inherit Metab Dis 2025; 48:e12790. [PMID: 39252529 PMCID: PMC12041835 DOI: 10.1002/jimd.12790] [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: 05/07/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/11/2024]
Abstract
Mucopolysaccharidosis II (MPS II; Hunter syndrome; OMIM 309900) is a rare, X-linked, heterogeneous lysosomal storage disease. Approximately two-thirds of patients develop cognitive impairment, which is difficult to assess in clinical trials, partly owing to the variable nature of cognitive impairment. Analyzing data from siblings can help to minimize this heterogeneity. We report analyses of cognitive function from siblings with MPS II enrolled in clinical trials: a natural history study (NCT01822184), a randomized, open-label, phase 2/3 study of intravenous (IV) idursulfase with or without intrathecal idursulfase (idursulfase-IT; NCT02055118), and its extension (NCT2412787). Cognitive function was assessed using Differential Abilities Scales, Second Edition General Conceptual Ability (DAS-II GCA) scores; Bayley Scales of Infant and Toddler Development, Third Edition; and Vineland Adaptive Behavior Scales, Second Edition Adaptive Behavior Composite (VABS-II ABC). Seven sets of siblings (six pairs and one set of three) were included. All patients received IV idursulfase and 10 received subsequent idursulfase-IT. Younger siblings initiated IV idursulfase at an earlier age than their older sibling(s) in six of the sets; the younger sibling started treatment before 1 year of age in three sets. Monthly idursulfase-IT was generally associated with a stabilization of cognitive function: DAS-II GCA and VABS-II ABC scores were higher at age-matched assessments in the majority of those who either received idursulfase-IT earlier than their sibling or who received idursulfase-IT versus no idursulfase-IT. These data suggest that early initiation of intrathecal enzyme replacement therapy may stabilize or slow cognitive decline in some patients with neuronopathic MPS II.
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Affiliation(s)
- Joseph Muenzer
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Barbara K. Burton
- Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern UniversityChicagoIllinoisUSA
| | - Paul Harmatz
- UCSF Benioff Children's Hospital OaklandOaklandCaliforniaUSA
| | | | | | - Simon A. Jones
- St Mary's Hospital, Manchester University NHS Foundation TrustUniversity of ManchesterManchesterUK
| | - Nathalie Guffon
- Reference Centre for Inherited Metabolic DisorderHospices Civils de LyonLyonFrance
| | | | - Drago Bratkovic
- Women's and Children's HospitalNorth AdelaideSouth AustraliaAustralia
| | - Stewart Rust
- Manchester University NHS Foundation TrustManchesterUK
| | - Michael Hale
- Takeda Development Center Americas, Inc.CambridgeMassachusettsUSA
- Hale Scientific Statistics, LLCBeavertonOregonUSA
| | - Yuna Wu
- Takeda Development Center Americas, Inc.LexingtonMassachusettsUSA
| | - Karen S. Yee
- Takeda Development Center Americas, Inc.CambridgeMassachusettsUSA
- Present address:
Alexion Pharmaceuticals, Inc., AstraZeneca Rare DiseaseBostonMassachusettsUSA
| | | | - David Alexanderian
- Takeda Development Center Americas, Inc.LexingtonMassachusettsUSA
- Present address:
MerckBostonMassachusettsUSA
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Nakamura K, Sakai N, Hossain MA, Eisengart JB, Yamamoto T, Tanizawa K, So S, Schmidt M, Sato Y. Analysis of caregiver perspectives on patients with mucopolysaccharidosis II treated with pabinafusp alfa: results of qualitative interviews in Japan. Orphanet J Rare Dis 2024; 19:104. [PMID: 38454486 PMCID: PMC10921713 DOI: 10.1186/s13023-024-03112-1] [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: 08/20/2023] [Accepted: 03/03/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Mucopolysaccharidosis type II (MPS II), or Hunter syndrome, is a rare X-linked metabolic disorder predominantly affecting males. Pabinafusp alfa, an iduronate-2-sulfatase enzyme designed to cross the blood-brain barrier, was approved in Japan in 2021 as the first enzyme replacement therapy targeting both the neuropathic and somatic signs and symptoms of MPS II. This study reports caregivers' experiences of MPS II patients receiving pabinafusp alfa through qualitative interviews. METHODS Semi-structured, qualitative interviews were conducted with caregivers at seven clinical sites in Japan using a semi-structured moderation guide (Voice of the Caregiver guide). Thematic analysis was applied to the interview transcripts to identify symptoms and health-related quality of life impacts at baseline, changes during treatment, and overall treatment experience. RESULTS Seven caregivers from 16 trial sites participated, representing seven children aged 8-18 years who had received pabinafusp alfa for 3.3-3.5 years at the time of the interviews. Data suggest a general trend toward improvement in multiple aspects, although not all caregivers observed discernible changes. Reported cognitive improvements included language skills, concentration, self-control, eye contact, mental clarity, concept understanding, following instructions, and expressing personal needs. Further changes were reported that included musculoskeletal improvements and such somatic changes as motor function, mobility, organ involvement, joint mobility, sleep patterns, and fatigue. Four caregivers reported improvements in family quality of life, five expressed treatment satisfaction, and all seven indicated a strong willingness to continue treatment of their children with pabinafusp alfa. CONCLUSION Caregivers' perspectives in this study demonstrate treatment satisfaction and improvement in various aspects of quality of life following therapy with pabinafusp alfa. These findings enhance understanding of pabinafusp alfa's potential benefits in treating MPS II and contribute to defining MPS II-specific outcome measures for future clinical trials.
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Affiliation(s)
- Kimitoshi Nakamura
- Department of Pediatrics, Faculty of Life Science, Kumamoto University, 860-0862, Kumamoto, Japan
| | - Norio Sakai
- Child Healthcare and Genetic Science Laboratory, Division of Health Sciences, Osaka University Graduate School of Medicine, 565-0871, Osaka, Japan
| | | | - Julie B Eisengart
- Department of Pediatrics, University of Minnesota, 55455, Minneapolis, MN, USA
| | - Tatsuyoshi Yamamoto
- JCR Pharmaceuticals, 11-18 Kusunoki-cho, 659-0015, Ashiya city, Hyogo, Japan
| | - Kazunori Tanizawa
- JCR Pharmaceuticals, 11-18 Kusunoki-cho, 659-0015, Ashiya city, Hyogo, Japan
| | - Sairei So
- JCR Pharmaceuticals, 11-18 Kusunoki-cho, 659-0015, Ashiya city, Hyogo, Japan
| | - Mathias Schmidt
- JCR Pharmaceuticals, 11-18 Kusunoki-cho, 659-0015, Ashiya city, Hyogo, Japan
| | - Yuji Sato
- JCR Pharmaceuticals, 11-18 Kusunoki-cho, 659-0015, Ashiya city, Hyogo, Japan
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De Vuyst R, Jalazo E, Tsujimoto TM, Lin FC, Muenzer J, Muhlebach MS. Airway Findings in Patients with Hunter Syndrome Treated with Intravenous Idursulfase. J Clin Med 2023; 12:480. [PMID: 36675409 PMCID: PMC9863383 DOI: 10.3390/jcm12020480] [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: 12/17/2022] [Revised: 12/30/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
People with Hunter syndrome are known to be affected by a variety of airway pathologies. Treatment of Hunter syndrome with the enzyme replacement therapy (ERT) idursulfase is now the standard of care. However, it is not known how ERT changes the progression of airway involvement. To evaluate this, we performed a retrospective analysis of bronchoscopies performed on children with Hunter syndrome who were part of intrathecal ERT trials. Findings for airway pathology were extracted from bronchoscopy reports and analyses were performed for cross-sectional and longitudinal changes in airway disease. One-hundred and thirty bronchoscopies from 23 subjects were analyzed. Upper airway disease (adenoid hypertrophy and/or pharyngomalacia) was reported in 93% and 87% of bronchoscopies, respectively. Laryngeal abnormalities were recognized in 46% of cases. There were lower airway (tracheal and or bronchial) findings in 64% of all bronchoscopies and prevalence increased with age. Evaluations over time adjusted for repeat evaluations showed that increasing airway involvement was associated with older age (p = 0.0007) despite ongoing ERT. No association was discovered between age of intravenous ERT initiation and progression of airway disease. Individuals with Hunter syndrome who are receiving intravenous enzyme replacement therapy showed the progression of airways disease supporting the need for regular airway monitoring and intervention.
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Affiliation(s)
- Richard De Vuyst
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Elizabeth Jalazo
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Tamy Moraes Tsujimoto
- Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
| | - Feng-Chang Lin
- Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
| | - Joseph Muenzer
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Marianne S. Muhlebach
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC 27599, USA
- Marsico Lung Institute, University of North Carolina, Chapel Hill, NC 27599, USA
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Zhurkova NV, Vashakmadze ND, Mikhaylova LK, Babaykina MA, Fedorova NV, Voskoboeva EY, Zakharova EY, Namazova-Baranova LS. Results of 14-year-long Enzyme Replacement Therapy in a Patient with Mucopolysaccharidosis Type II: Clinical Case. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i6s.2478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background. Mucopolysaccharidosis type II (MPS II) is a rare hereditary disease from the group of lysosomal storage diseases, with progressive course. There is effective enzyme replacement therapy (ERT) for this disease, it prevents the development of severe complications and improves patients’ quality of life. Long-term follow-up of health changes in individuals on ERT is required for evaluating the treatment impact on disease progression and eventually on the quality of life of the patient and his family. Clinical case description. Results of 14-year-long follow-up of the patient with MPS II who was the first patient on ERT with idursulfase in Russia are presented. Improvement of growth, decrease in ENT-organs infections frequency, liver and spleen sizes decrease, general stabilization, no progression in cardiovascular and respiratory events, normal levels of glycosaminoglycans in urine are shown. Conclusion. Long-term therapy with idursulfase in severe MPS II stabilizes the patient’s somatic condition, prevents the development of severe complications in cardiovascular and respiratory systems, improves the quality of life of the patient and his family. Urinary glycosaminoglycans level decrease is the important indicator of the therapy efficacy along with overall patient's somatic state.
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Affiliation(s)
- Natalia V. Zhurkova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Research Centre for Medical Genetics
| | - Nato D. Vashakmadze
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
| | - Ludmila K. Mikhaylova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | - Marina A. Babaykina
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | - Nina V. Fedorova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery
| | | | | | - Leyla S. Namazova-Baranova
- Research Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical University
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Lin HY, Chang YH, Lee CL, Tu YR, Lo YT, Hung PW, Niu DM, Liu MY, Liu HY, Chen HJ, Kao SM, Wang LY, Ho HJ, Chuang CK, Lin SP. Newborn Screening Program for Mucopolysaccharidosis Type II and Long-Term Follow-Up of the Screen-Positive Subjects in Taiwan. J Pers Med 2022; 12:jpm12071023. [PMID: 35887520 PMCID: PMC9320252 DOI: 10.3390/jpm12071023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Mucopolysaccharidosis II (MPS II) is an X-linked disorder resulting from a deficiency in lysosomal enzyme iduronate-2-sulfatase (IDS), which causes the accumulation of glycosaminoglycans (GAGs) in the lysosomes of many tissues and organs, leading to progressive cellular dysfunction. An MPS II newborn screening program has been available in Taiwan since 2015. The aim of the current study was to collect and analyze the long-term follow-up data of the screen-positive subjects in this program. Methods: From August 2015 to April 2022, 548,624 newborns were screened for MPS II by dried blood spots using tandem mass spectrometry, of which 202 suspected infants were referred to our hospital for confirmation. The diagnosis of MPS II was confirmed by IDS enzyme activity assay in leukocytes, quantitative determination of urinary GAGs by mass spectrometry, and identification of the IDS gene variant. Results: Among the 202 referred infants, 10 (5%) with seven IDS gene variants were diagnosed with confirmed MPS II (Group 1), 151 (75%) with nine IDS gene variants were classified as having suspected MPS II or pseudodeficiency (Group 2), and 41 (20%) with five IDS gene variants were classified as not having MPS II (Group 3). Long-term follow-up every 6 months was arranged for the infants in Group 1 and Group 2. Intravenous enzyme replacement therapy (ERT) was started in four patients at 1, 0.5, 0.4, and 0.5 years of age, respectively. Three patients also received hematopoietic stem cell transplantation (HSCT) at 1.5, 0.9, and 0.6 years of age, respectively. After ERT and/or HSCT, IDS enzyme activity and the quantity of urinary GAGs significantly improved in all of these patients compared with the baseline data. Conclusions: Because of the progressive nature of MPS II, early diagnosis via a newborn screening program and timely initiation of ERT and/or HSCT before the occurrence of irreversible organ damage may lead to better clinical outcomes. The findings of the current study could serve as baseline data for the analysis of the long-term effects of ERT and HSCT in these patients.
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Affiliation(s)
- Hsiang-Yu Lin
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (H.-Y.L.); (Y.-H.C.); (C.-L.L.)
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-T.L.); (P.-W.H.)
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Ya-Hui Chang
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (H.-Y.L.); (Y.-H.C.); (C.-L.L.)
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-T.L.); (P.-W.H.)
| | - Chung-Lin Lee
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (H.-Y.L.); (Y.-H.C.); (C.-L.L.)
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-T.L.); (P.-W.H.)
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- MacKay Junior College of Medicine, Nursing and Management, Taipei 11260, Taiwan
| | - Yuan-Rong Tu
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan;
| | - Yun-Ting Lo
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-T.L.); (P.-W.H.)
| | - Pei-Wen Hung
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-T.L.); (P.-W.H.)
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Mei-Ying Liu
- The Chinese Foundation of Health, Neonatal Screening Center, Taipei 10699, Taiwan; (M.-Y.L.); (H.-Y.L.); (H.-J.C.); (S.-M.K.)
| | - Hsin-Yun Liu
- The Chinese Foundation of Health, Neonatal Screening Center, Taipei 10699, Taiwan; (M.-Y.L.); (H.-Y.L.); (H.-J.C.); (S.-M.K.)
| | - Hsiao-Jan Chen
- The Chinese Foundation of Health, Neonatal Screening Center, Taipei 10699, Taiwan; (M.-Y.L.); (H.-Y.L.); (H.-J.C.); (S.-M.K.)
| | - Shu-Min Kao
- The Chinese Foundation of Health, Neonatal Screening Center, Taipei 10699, Taiwan; (M.-Y.L.); (H.-Y.L.); (H.-J.C.); (S.-M.K.)
| | - Li-Yun Wang
- Taipei Institute of Pathology, Neonatal Screening Center, Taipei 10374, Taiwan; (L.-Y.W.); (H.-J.H.)
| | - Huey-Jane Ho
- Taipei Institute of Pathology, Neonatal Screening Center, Taipei 10374, Taiwan; (L.-Y.W.); (H.-J.H.)
| | - Chih-Kuang Chuang
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- College of Medicine, Fu-Jen Catholic University, Taipei 24205, Taiwan
- Correspondence: (C.-K.C.); (S.-P.L.); Tel.: +886-2-2809-4661 (ext. 2348) (C.-K.C.); +886-2-2543-3535 (ext. 3090) (S.-P.L.); Fax: +886-2-2808-5952 (C.-K.C.); +886-2-2543-3642 (S.-P.L.)
| | - Shuan-Pei Lin
- Department of Pediatrics, MacKay Memorial Hospital, Taipei 10449, Taiwan; (H.-Y.L.); (Y.-H.C.); (C.-L.L.)
- Department of Medical Research, MacKay Memorial Hospital, Taipei 10449, Taiwan;
- The Rare Disease Center, MacKay Memorial Hospital, Taipei 10449, Taiwan; (Y.-T.L.); (P.-W.H.)
- Department of Medicine, MacKay Medical College, New Taipei City 25245, Taiwan
- Department of Infant and Child Care, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
- Correspondence: (C.-K.C.); (S.-P.L.); Tel.: +886-2-2809-4661 (ext. 2348) (C.-K.C.); +886-2-2543-3535 (ext. 3090) (S.-P.L.); Fax: +886-2-2808-5952 (C.-K.C.); +886-2-2543-3642 (S.-P.L.)
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Ellinwood NM. Newborn screening and the recommended uniform screening panel: Optimal submissions and suggested improvements based on an advocacy organization's decade-long experience. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2022; 190:156-161. [PMID: 36135708 DOI: 10.1002/ajmg.c.32001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/26/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
The National MPS Society, Inc., founded in 1974, is a rare disease advocacy non-profit with a tripartite mission addressing the needs of the mucopolysaccharidosis and mucolipidosis communities through advocacy, research, and family and patient support. The Recommended Uniform Screening Panel (RUSP) of conditions for newborn screening (NBS), legislatively mandated in 2008, was implemented in 2010 by the Secretary of Health and Human Services (HSS), through the adoption of 29 core conditions. Since its inception the RUSP has grown to 35 core conditions. Each addition followed a defined nomination process that has itself undergone further definition over time. Since the adoption of the RUSP, the Society has nominated two conditions that have been approved by the Advisory Committee on Heritable Disorders in Children and Newborns (ACHDNC) and forwarded to the Secretary of HSS for inclusion on the RUSP. This history places the Society in a position to reflect on the process of successfully nominating conditions. Additionally, the Society is well placed by this experience to provide observations on the RUSP process. We will highlight best practices for pending and future nominations and reflect on potential improvements to the process and infrastructure of NBS, the RUSP, and the ACHDNC.
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Affiliation(s)
- N Matthew Ellinwood
- The National MPS Society, Inc., 1007 Slater Rd. Suite 220, Durham, North Carolina, 27703, USA
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