1
|
Friedman MI, Sørensen TIA, Taubes G, Lund J, Ludwig DS. Trapped fat: Obesity pathogenesis as an intrinsic disorder in metabolic fuel partitioning. Obes Rev 2024; 25:e13795. [PMID: 38961319 DOI: 10.1111/obr.13795] [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: 12/27/2023] [Revised: 05/24/2024] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
Our understanding of the pathophysiology of obesity remains at best incomplete despite a century of research. During this time, two alternative perspectives have helped shape thinking about the etiology of the disorder. The currently prevailing view holds that excessive fat accumulation results because energy intake exceeds energy expenditure, with excessive food consumption being the primary cause of the imbalance. The other perspective attributes the initiating cause of obesity to intrinsic metabolic defects that shift fuel partitioning from pathways for mobilization and oxidation to those for synthesis and storage. The resulting reduction in fuel oxidation and trapping of energy in adipose tissue drives a compensatory increase in energy intake and, under some conditions, a decrease in expenditure. This theory of obesity pathogenesis has historically garnered relatively less attention despite its pedigree. Here, we present an updated comprehensive formulation of the fuel partitioning theory, focused on evidence gathered over the last 80 years from major animal models of obesity showing a redirection of fuel fluxes from oxidation to storage and accumulation of excess body fat with energy intake equal to or even less than that of lean animals. The aim is to inform current discussions about the etiology of obesity and by so doing, help lay new foundations for the design of more efficacious approaches to obesity research, treatment and prevention.
Collapse
Affiliation(s)
| | - Thorkild I A Sørensen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
- Center for Childhood Health, Copenhagen, Denmark
| | | | - Jens Lund
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - David S Ludwig
- New Balance Foundation Obesity Prevention Center, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| |
Collapse
|
2
|
Luccarelli J, Strong TV, Rubin EB, McCoy TH. Inpatient Hospitalizations for COVID-19 Among Patients with Prader-Willi Syndrome: a National Inpatient Sample Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.09.06.24313191. [PMID: 39281756 PMCID: PMC11398596 DOI: 10.1101/2024.09.06.24313191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Background Prader-Willi syndrome (PWS) is a genetic disorder associated with baseline respiratory impairment caused by multiple contributing etiologies. While this may be expected to increase the risk of severe COVID-19 infections in PWS patients, survey studies have suggested paradoxically low disease severity. To better characterize the course of COVID-19 infection in patients with PWS, this study analyzes the outcomes of hospitalizations for COVID-19 among patients with and without PWS. Methods The National Inpatient Sample, an all-payors administrative claims database of hospitalizations in the United States, was queried for patients with a coded diagnosis COVID-19 in 2020 and 2021. Hospitalizations for patients with PWS compared to those for patients without PWS using Augmented Inverse Propensity Weighting (AIPW). Results There were 295 (95% CI: 228 to 362) COVID-19 hospitalizations for individuals with PWS and 4,112,400 (95% CI: 4,051,497 to 4,173,303) for individuals without PWS. PWS patients had a median age of 33 years compared to 63 for those without PWS. Individuals with PWS had higher baseline rates of obesity (47.5% vs. 28.4%). AIPW models show that PWS diagnosis is associated with increased hospital length of stay by 7.43 days, hospital charges by $80,126, and the odds of mechanical ventilation and in-hospital death (odds ratios of 1.79 and 1.67, respectively). Conclusions PWS patients hospitalized with COVID-19 experienced longer hospital stays, higher charges, and increased risk of mechanical ventilation and death. PWS should be considered a risk factor for severe COVID-19, warranting continued protective measures and vaccination efforts. Further research is needed to validate coding for PWS and assess the impact of evolving COVID-19 variants and population immunity on this vulnerable population.
Collapse
Affiliation(s)
- James Luccarelli
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Emily B Rubin
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Thomas H McCoy
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Wang SE, Xiong Y, Jang MA, Park KS, Donahue M, Velez J, Jin J, Jiang YH. Newly developed oral bioavailable EHMT2 inhibitor as a potential epigenetic therapy for Prader-Willi syndrome. Mol Ther 2024; 32:2662-2675. [PMID: 38796700 PMCID: PMC11405540 DOI: 10.1016/j.ymthe.2024.05.034] [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: 12/28/2023] [Revised: 03/29/2024] [Accepted: 05/23/2024] [Indexed: 05/28/2024] Open
Abstract
Prader-Willi syndrome (PWS) is the prototypic genomic disorder resulting from deficiency of paternally expressed genes in the human chromosome 15q11-q13 region. The unique molecular mechanism involving epigenetic modifications renders PWS as the most attractive candidate to explore a proof-of-concept of epigenetic therapy in humans. The premise is that epigenetic modulations could reactivate the repressed PWS candidate genes from the maternal chromosome and offer therapeutic benefit. Our prior study identifies an EHMT2/G9a inhibitor, UNC0642, that reactivates the expression of PWS genes via reduction of H3K9me2. However, low brain permeability and poor oral bioavailability of UNC0642 preclude its advancement into translational studies in humans. In this study, a newly developed inhibitor, MS152, modified from the structure of UNC0642, has better brain penetration and greater potency and selectivity against EHMT2/G9a. MS152 reactivated maternally silenced PWS genes in PWS patient fibroblasts and in brain and liver tissues of PWS mouse models. Importantly, the molecular efficacy of oral administration is comparable with the intraperitoneal route. MS152 treatment in newborns ameliorates the perinatal lethality and poor growth, maintaining reactivation in a PWS mouse model at postnatal 90 days. Our findings provide strong support for MS152 as a first-in-class inhibitor to advance the epigenetic therapy of PWS in humans.
Collapse
Affiliation(s)
- Sung Eun Wang
- Department of Genetics, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA
| | - Yan Xiong
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences, Oncological Sciences and Neuroscience, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mi-Ae Jang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Kwang-Su Park
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences, Oncological Sciences and Neuroscience, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Meaghan Donahue
- Department of Genetics, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA
| | - Julia Velez
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences, Oncological Sciences and Neuroscience, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jian Jin
- Mount Sinai Center for Therapeutics Discovery, Departments of Pharmacological Sciences, Oncological Sciences and Neuroscience, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
| | - Yong-Hui Jiang
- Department of Genetics, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA; Department of Neuroscience, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA; Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06520, USA.
| |
Collapse
|
4
|
Shaikh MG, Barrett TG, Bridges N, Chung R, Gevers EF, Goldstone AP, Holland A, Kanumakala S, Krone R, Kyriakou A, Livesey EA, Lucas-Herald AK, Meade C, Passmore S, Roche E, Smith C, Soni S. Prader-Willi syndrome: guidance for children and transition into adulthood. Endocr Connect 2024; 13:e240091. [PMID: 38838713 PMCID: PMC11301552 DOI: 10.1530/ec-24-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/05/2024] [Indexed: 06/07/2024]
Abstract
Prader-Willi syndrome (PWS) is a rare orphan disease and complex genetic neurodevelopmental disorder, with a birth incidence of approximately 1 in 10,000-30,000. Management of people with PWS requires a multi-disciplinary approach, ideally through a multi-disciplinary team (MDT) clinic with community support. Hypotonia, poor feeding and faltering growth are characteristic features in the neonatal period, followed by hyperphagia and risk of rapid weight gain later in childhood. Children and adolescents (CA) with PWS usually display developmental delay and mild learning disability and can develop endocrinopathies, scoliosis, respiratory difficulties (both central and obstructive sleep apnoea), challenging behaviours, skin picking, and mental health issues, especially into adulthood. This consensus statement is intended to be a reference document for clinicians managing children and adolescents (up to 18 years of age) with PWS. It considers the bio-psycho-social domains of diagnosis, clinical assessment, and management in the paediatric setting as well as during and after transition to adult services. The guidance has been developed from information gathered from peer-reviewed scientific reports and from the expertise of a range of experienced clinicians in the United Kingdom and Ireland involved in the care of patients with PWS.
Collapse
Affiliation(s)
- M Guftar Shaikh
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Timothy G Barrett
- Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Bridges
- Department of Paediatric Endocrinology, Chelsea and Westminster Hospital, London, UK
| | - Robin Chung
- Research Working Group, Prader-Willi Syndrome Association, Northampton, UK
| | - Evelien F Gevers
- Department of Paediatric Endocrinology, Barts Health NHS Trust, Royal London Hospital, London, UK
- Centre for Endocrinology, William Harvey Research Institute, Barts and The London Medical School, Queen Mary University of London, London, UK
| | - Anthony P Goldstone
- PsychoNeuroEndocrinologyResearch Group, Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
- Department of Endocrinology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Anthony Holland
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Ruth Krone
- Department of Endocrinology, Birmingham Womens and Children’s Hospital, Birmingham, UK
| | - Andreas Kyriakou
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus
| | - E Anne Livesey
- Royal Alexandra Children’s Hospital, Brighton, UK
- Sussex Community NHS Trust, Brighton, UK
| | - Angela K Lucas-Herald
- Department of Paediatric Endocrinology, Royal Hospital for Children, Glasgow, UK
- Developmental Endocrinology Research Group, University of Glasgow, Glasgow, UK
| | - Christina Meade
- CHI at Tallaght University Hospital, Dublin, Republic of Ireland
| | | | - Edna Roche
- CHI at Tallaght University Hospital, Dublin, Republic of Ireland
- The University of Dublin, Trinity College Dublin, Dublin, Republic of Ireland
| | - Chris Smith
- Royal Alexandra Children’s Hospital, Brighton, UK
| | - Sarita Soni
- Learning Disability Psychiatry, NHS Greater Glasgow and Clyde, Glasgow, UK
| |
Collapse
|
5
|
Roy SM, Rafferty D, Trejo A, Hamilton L, Bohonowych JE, Strong TV, Ambartsumyan L, Cantu S, Scheimann A, Duis J. Feeding tube use and complications in Prader-Willi syndrome: Data from the Global Prader-Willi Syndrome Registry. Am J Med Genet A 2024; 194:e63546. [PMID: 38303141 DOI: 10.1002/ajmg.a.63546] [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: 09/29/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
Guidance on indications for, and types of, feeding tubes recommended in Prader-Willi syndrome (PWS) is needed. A Global PWS Registry survey was developed to investigate nasogastric (NG) and gastrostomy (G) tube use and associated complications. Of 346 participants, 242 (69.9%) had NG-tubes, 17 (4.9%) had G-tubes, and 87 (25.1%) had both NG- and G-tubes. Primary indication for placement was "feeding difficulties and/or poor weight gain" for both NG- (90.2%) and G-tubes (71.2%), while "aspiration/breathing difficulties" was the procedural indication for 6.4% of NG-tubes and 23.1% of G-tubes. NG-tubes were generally removed by age 6 months (NG Only: 82.9%; NG/G: 98.8%), while G-tubes were often removed by age 2 years (G Only: 85.7%; NG/G: 70.5%). The severe complication rate from G-tubes was 31.7% and from NG-tubes was 1.2%. Overall, caregivers indicated the presence of an NG- or G-tube had a positive effect on quality of life. Feeding difficulties in PWS are largely managed by NG-tube alone. The severe complication rate from G-tubes was about 25 times higher than from NG-tubes; yet, G-tube placement rates have generally increased. G-tube placement puts individuals with PWS at risk for anesthesia and surgery-related complications and should be considered judiciously by a multidisciplinary team.
Collapse
Affiliation(s)
- Sani M Roy
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | | | - Amy Trejo
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Luke Hamilton
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | | | | | | | - Samson Cantu
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Ann Scheimann
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Texas Children's Hospital, Houston, Texas, USA
| | - Jessica Duis
- Children's Hospital Colorado, Aurora, Colorado, USA
- SequenceMD, Denver, Colorado, USA
| |
Collapse
|
6
|
González-Domenech PJ, Gurpegui M, González-Domenech CM, Gómez-González S, Rustarazo A, Ruiz-Nieto V, Carretero MD, Gutiérrez-Rojas L. Prader-Willi syndrome in a large sample from Spain: general features, obesity and regular use of psychotropic medication. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:446-463. [PMID: 38246690 DOI: 10.1111/jir.13123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Prader-Willi syndrome (PWS), a genetically determined disorder, the most frequent cause of early onset obesity, is associated with physical and cognitive dysfunctions and behavioural disturbances; these disturbances are frequently treated with psychotropic medication. The aim of this cross-sectional study was to describe the characteristics of the first large national sample of persons with PWS in Spain and analyse the relationships of those characteristics with key demographic and clinical factors, particularly with obesity and the regular use of psychotropic medication. METHODS Participants were recruited among all members of the Spanish Prader-Willi Association who agreed to take part in the study and fulfilled its inclusion criteria. Family and patient demographic features, family size and birth order, intelligence quotient (IQ), anthropometric measures, lifestyle habits, behavioural disturbances (with the Aberrant Behavior Checklist) and clinical data, as well as use of psychotropic drugs and their side effects (with the UKU scale), were collected in genetically confirmed cases of PWS. Bivariate and logistic regression analyses were used for determining the associations of demographic and clinical factors with both obesity and the regular use of psychotropic medication. RESULTS The cohort included 177 participants (aged 6-48 years), that is, 90 (50.8%) males and 87 (49.2%) females. Behavioural disturbances were present in a range of 75% to 93% of participants; psychotropic medication was prescribed to 81 (45.8%) of them. Number of siblings showed a direct correlation with IQ, especially among males, and inappropriate speech was more intense in only-child females. Obesity was, in parallel, strongly associated with ascending age and with not being currently under growth hormone (GH) treatment. Participants taking any psychotropic medication were characterised by more frequent age ≥30 years, high level of hyperactivity and a psychiatric diagnosis. CONCLUSIONS Characterisation of persons with PWS in Spain confirms their physical and behavioural phenotype and supports the long-term application of GH therapy and the rational use of psychotropic medication.
Collapse
Affiliation(s)
- P J González-Domenech
- Multicentre CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Granada, Spain
- Department of Psychiatry, Universidad de Granada, Granada, Spain
| | - M Gurpegui
- Multicentre CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Granada, Spain
- Granada Centre for Psychiatric Studies, Granada, Spain
| | | | | | - A Rustarazo
- Asociación Española para el Síndrome de Prader-Willi, Madrid, Spain
| | - V Ruiz-Nieto
- Asociación Española para el Síndrome de Prader-Willi, Madrid, Spain
| | - M D Carretero
- Multicentre CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Granada, Spain
- Department of Psychiatry, Universidad de Granada, Granada, Spain
| | - L Gutiérrez-Rojas
- Multicentre CTS-549 Research Group (Psychiatry and Neurosciences), Junta de Andalucía, Granada, Spain
- Department of Psychiatry, Universidad de Granada, Granada, Spain
- Psychiatry Service, Hospital Clínico San Cecilio, Granada, Spain
| |
Collapse
|
7
|
Madeo SF, Zagaroli L, Vandelli S, Calcaterra V, Crinò A, De Sanctis L, Faienza MF, Fintini D, Guazzarotti L, Licenziati MR, Mozzillo E, Pajno R, Scarano E, Street ME, Wasniewska M, Bocchini S, Bucolo C, Buganza R, Chiarito M, Corica D, Di Candia F, Francavilla R, Fratangeli N, Improda N, Morabito LA, Mozzato C, Rossi V, Schiavariello C, Farello G, Iughetti L, Salpietro V, Salvatoni A, Giordano M, Grugni G, Delvecchio M. Endocrine features of Prader-Willi syndrome: a narrative review focusing on genotype-phenotype correlation. Front Endocrinol (Lausanne) 2024; 15:1382583. [PMID: 38737552 PMCID: PMC11082343 DOI: 10.3389/fendo.2024.1382583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder caused by three different types of molecular genetic abnormalities. The most common defect is a deletion on the paternal 15q11-q13 chromosome, which is seen in about 60% of individuals. The next most common abnormality is maternal disomy 15, found in around 35% of cases, and a defect in the imprinting center that controls the activity of certain genes on chromosome 15, seen in 1-3% of cases. Individuals with PWS typically experience issues with the hypothalamic-pituitary axis, leading to excessive hunger (hyperphagia), severe obesity, various endocrine disorders, and intellectual disability. Differences in physical and behavioral characteristics between patients with PWS due to deletion versus those with maternal disomy are discussed in literature. Patients with maternal disomy tend to have more frequent neurodevelopmental problems, such as autistic traits and behavioral issues, and generally have higher IQ levels compared to those with deletion of the critical PWS region. This has led us to review the pertinent literature to investigate the possibility of establishing connections between the genetic abnormalities and the endocrine disorders experienced by PWS patients, in order to develop more targeted diagnostic and treatment protocols. In this review, we will review the current state of clinical studies focusing on endocrine disorders in individuals with PWS patients, with a specific focus on the various genetic causes. We will look at topics such as neonatal anthropometry, thyroid issues, adrenal problems, hypogonadism, bone metabolism abnormalities, metabolic syndrome resulting from severe obesity caused by hyperphagia, deficiencies in the GH/IGF-1 axis, and the corresponding responses to treatment.
Collapse
Affiliation(s)
- Simona F. Madeo
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Zagaroli
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Sara Vandelli
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Post-Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | - Antonino Crinò
- Center for Rare Diseases and Congenital Defects, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luisa De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Maria Felicia Faienza
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Danilo Fintini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Guazzarotti
- Pediatric Endocrinology Unit, University Hospital of Padova, Padova, Italy
| | - Maria Rosaria Licenziati
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Enza Mozzillo
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Roberta Pajno
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Emanuela Scarano
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria E. Street
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Sarah Bocchini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Carmen Bucolo
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Raffaele Buganza
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Mariangela Chiarito
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Francesca Di Candia
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Nadia Fratangeli
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Nicola Improda
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | | | - Chiara Mozzato
- Child and Women Health Department, University of Padova, Padova, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | | | - Giovanni Farello
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Mara Giordano
- Laboratory of Genetics, Struttura Complessa a Direzione Universitaria (SCDU) Biochimica Clinica, Ospedale Maggiore della Carità, Novara, Italy
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| |
Collapse
|
8
|
Bar-Peled Y, Denton JJ, Richards JL, Brown D, Worthey E, Strong TV. Pharmacogenomics for Prader-Willi syndrome: caregiver interest and planned utilization. Pharmacogenomics 2024; 25:207-216. [PMID: 38506331 DOI: 10.2217/pgs-2023-0189] [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: 03/21/2024] Open
Abstract
Aim: The study aim was to determine caregiver interest and planned utilization of pharmacogenomic (PGx) results for their child with Prader-Willi syndrome. Methods: Caregivers consented to PGx testing for their child and completed a survey before receiving results. Results: Of all caregivers (n = 48), 93.8% were highly interested in their child's upcoming PGx results. Most (97.9%) planned to share results with their child's medical providers. However, only 47.9% of caregivers were confident providers would utilize the PGx results. Conclusion: Caregivers are interested in utilizing PGx but are uncertain providers will use these results in their child's care. More information about provider comfort with PGx utilization is needed to understand how PGx education would benefit providers and ultimately patients with PGx results.
Collapse
Affiliation(s)
- Yael Bar-Peled
- Department of Clinical & Diagnostic Sciences, University of Alabama at Birmingham, AL 35294, USA
| | - Jessica J Denton
- Department of Clinical & Diagnostic Sciences, University of Alabama at Birmingham, AL 35294, USA
| | - Jaimie L Richards
- Department of Preventive Medicine, University of Alabama at Birmingham, AL 35294, USA
- Department of Genetics & Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, AL 35294, USA
| | - Donna Brown
- Department of Genetics & Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, AL 35294, USA
| | - Elizabeth Worthey
- Department of Genetics & Pediatrics, University of Alabama at Birmingham Heersink School of Medicine, AL 35294, USA
| | - Theresa V Strong
- Department of Genetics, University of Alabama at Birmingham Heersink School of Medicine, AL 35294, USA
- Foundation for Prader-Willi Research, Covina, CA 91723, USA
| |
Collapse
|
9
|
Dykens EM, Roof E, Hunt-Hawkins H. The Prader-Willi syndrome Profile: validation of a new measure of behavioral and emotional problems in Prader-Willi syndrome. Orphanet J Rare Dis 2024; 19:83. [PMID: 38395848 PMCID: PMC10885615 DOI: 10.1186/s13023-024-03045-9] [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: 08/16/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare, neurodevelopmental disorder caused by the lack of expression of paternally imprinted genes on chromosome 15q11-13. PWS features a complex behavioral phenotype, including hyperphagia, anxiety, compulsivity, rigidity, repetitive speech, temper outbursts, aggressivity, and skin-picking. Questionnaires exist for measuring hyperphagia, but not for the aggregation of other problems that are distinctive to PWS. A PWS-specific tool is needed for phenotypic research, and to help evaluate treatment efficacy in future clinical trials aimed at attenuating PWS's hyperphagia and related problems. In this 4-phase study, we leveraged our expertise in PWS with feedback from families and specialists to validate the PWS Profile, a novel, informant-based measure of behavioral and emotional problems in this syndrome. RESULTS The authors developed a bank of 73 items that tapped both common and less frequent but clinically significant problems in PWS (Phase 1). An iterative feedback process with families and stakeholders was used to ensure content and construct validity (Phase 2). After adding, omitting, or revising items, in Phase 3, we pilot tested the measure in 112 participants. Results were reviewed by an international team of PWS specialists and revised again (Phase 3). The final, 57-item Profile was then administered to 761 participants (Phase 4). Principal component factor analyses (n = 873) revealed eight conceptually meaningful factors, accounting for 60.52% of test variance, and were readily interpretated as: Rigidity, Insistence; Aggressive Behaviors; Repetitive Questioning, Speech; Compulsive Behaviors; Depression, Anxiety; Hoarding; Negative Distorted Thinking; and Magical Distorted Thinking. Factors were internally consistent and showed good test-retest reliability and convergent validity with existent measures of behavioral problems. Profile factors were not related to IQ, BMI, or parental SES. Three Profile factors differed across PWS genetic subtypes. Age and gender differences were found in only one Profile factor, Hoarding. CONCLUSIONS The PWS Profile is a valid, psychometrically-sound questionnaire that already has shown responsivity to treatment in a previous clinical trial. The Profile can extend the reach of future clinical trials by evaluating the impact of novel agents not only on hyperphagia, but also on the emotional and behavioral problems that characterize PWS.
Collapse
Affiliation(s)
- Elisabeth M Dykens
- Department of Psychology and Human Development, Vanderbilt University, Vanderbilt Kennedy Center, 1 Magnolia Circle, 37203, Nashville, TN, USA.
| | - Elizabeth Roof
- Department of Psychology and Human Development, Vanderbilt University, Vanderbilt Kennedy Center, 1 Magnolia Circle, 37203, Nashville, TN, USA
| | - Hailee Hunt-Hawkins
- Department of Psychology and Human Development, Vanderbilt University, Vanderbilt Kennedy Center, 1 Magnolia Circle, 37203, Nashville, TN, USA
| |
Collapse
|
10
|
Matesevac L, Vrana-Diaz CJ, Bohonowych JE, Schwartz L, Strong TV. Analysis of Hyperphagia Questionnaire for Clinical Trials (HQ-CT) scores in typically developing individuals and those with Prader-Willi syndrome. Sci Rep 2023; 13:20573. [PMID: 37996659 PMCID: PMC10667498 DOI: 10.1038/s41598-023-48024-5] [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: 09/30/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023] Open
Abstract
The Hyperphagia Questionnaire for Clinical Trials (HQ-CT) is an observer-reported outcome measure that has been widely used in interventional studies to assess changes in hyperphagic behaviors in individuals with Prader-Willi syndrome (PWS). However, HQ-CT scores in the wider PWS population and the general population have not been reported. Here we report HQ-CT scores from more than 400 individuals with PWS and 600 typical individuals, aged 5-26. Overall, HQ-CT scores were significantly higher in those with PWS compared to typically developing individuals at all ages evaluated. In addition, while HQ-CT scores in the typically developing population decreased with age, scores increased with age in PWS. To further understand the variability of HQ-CT scores in the PWS population, semi-structured interviews were conducted with caregivers of a small subset of adults with PWS who had unexpectedly low HQ-CT scores. These caregivers reported that strict adherence to a food routine, food security measures and supervised food preparation reduced the frequency and intensity of hyperphagic behaviors measured by HQ-CT. Thus, hyperphagic behaviors are captured by the HQ-CT for most individuals with PWS, but for some individuals residing in settings with highly structured food routines, HQ-CT scores may not fully reflect the extent of PWS-associated hyperphagia.
Collapse
Affiliation(s)
| | | | | | - Lauren Schwartz
- Foundation for Prader-Willi Research, Covina, CA, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
11
|
Tones M, Zeps N, Wyborn Y, Smith A, Barrero RA, Heussler H, Cross M, McGree J, Bellgard M. Does the registry speak your language? A case study of the Global Angelman Syndrome Registry. Orphanet J Rare Dis 2023; 18:330. [PMID: 37858180 PMCID: PMC10588126 DOI: 10.1186/s13023-023-02904-1] [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: 04/01/2023] [Accepted: 08/31/2023] [Indexed: 10/21/2023] Open
Abstract
Global disease registries are critical to capturing common patient related information on rare illnesses, allowing patients and their families to provide information about their condition in a safe, accessible, and engaging manner that enables researchers to undertake critical research aimed at improving outcomes. Typically, English is the default language of choice for these global digital health platforms. Unfortunately, language barriers can significantly inhibit participation from non-English speaking participants. In addition, there is potential for compromises in data quality and completeness. In contrast, multinational commercial entities provide access to their websites in the local language of the country they are operating in, and often provide multiple options reflecting ethnic diversity. This paper presents a case study of how the Global Angelman Syndrome Registry (GASR) has used a novel approach to enable multiple language translations for its website. Using a "semi-automated language translation" approach, the GASR, which was originally launched in English in September 2016, is now available in several other languages. In 2020, the GASR adopted a novel approach using crowd-sourcing and machine translation tools leading to the availability of the GASR in Spanish, Traditional Chinese, Italian, and Hindi. As a result, enrolments increased by 124% percent for Spain, 67% percent for Latin America, 46% percent for Asia, 24% for Italy, and 43% for India. We describe our approach here, which we believe presents an opportunity for cost-effective and timely translations responsive to changes to the registry and helps build and maintain engagement with global disease communities.
Collapse
Affiliation(s)
- Megan Tones
- Office of eResearch, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
| | - Nikolajs Zeps
- Office of eResearch, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Yvette Wyborn
- Office of eResearch, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Adam Smith
- Office of eResearch, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Roberto A Barrero
- Office of eResearch, Queensland University of Technology, Brisbane, QLD, 4000, Australia
| | - Helen Heussler
- Centre for Clinical Trials in Rare Neurodevelopmental Disorders, Child Development Program, Children's Health Queensland, Child Health Research Centre University of Queensland, Brisbane, QLD, 4101, Australia
| | - Meagan Cross
- Foundation for Angelman Syndrome Therapeutics Australia, Salisbury, QLD, 4107, Australia
| | - James McGree
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Matthew Bellgard
- Office of eResearch, Queensland University of Technology, Brisbane, QLD, 4000, Australia.
- University of East London, London, UK.
| |
Collapse
|
12
|
Wolfe G, Salehi V, Browne A, Riddle R, Hall E, Fam J, Tichansky D, Myers S. Metabolic and bariatric surgery for obesity in Prader Willi syndrome: systematic review and meta-analysis. Surg Obes Relat Dis 2023; 19:907-915. [PMID: 36872159 DOI: 10.1016/j.soard.2023.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 01/12/2023] [Accepted: 01/21/2023] [Indexed: 02/04/2023]
Abstract
Obesity is the leading cause of morbidity and mortality in patients with Prader-Willi Syndrome (PWS). Our objective was to compare changes in body mass index (BMI) after metabolic and bariatric surgery (MBS) for the treatment of obesity (BMI ≥35 kg/m2) in PWS. A systematic review of MBS in PWS was performed using PubMed, Embase, and Cochrane Central, identifying 254 citations. Sixty-seven patients from 22 articles met criteria for inclusion in the meta-analysis. Patients were organized into 3 groups: laparoscopic sleeve gastrectomy (LSG), gastric bypass (GB), and biliopancreatic diversion (BPD). No mortality within 1 year was reported in any of the 3 groups after a primary MBS operation. All groups experienced a significant decrease in BMI at 1 year with a mean reduction in BMI of 14.7 kg/m2 (P < .001). The LSG groups (n = 26) showed significant change from baseline in years 1, 2, and 3 (P value at year 3 = .002) but did not show significance in years 5, 7, and 10. The GB group (n = 10) showed a significant reduction in BMI of 12.1 kg/m2 in the first 2 years (P = .001). The BPD group (n = 28) had a significant reduction in BMI through 7 years with an average reduction of 10.7 kg/m2 (P = .02) at year 7. Individuals with PWS who underwent MBS had significant BMI reduction sustained in the LSG, GB, and BPD groups for 3, 2, and 7 years, respectively. No deaths within 1 year of these primary MBS operations were reported in this study or any other publication.
Collapse
Affiliation(s)
- Gunnar Wolfe
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Vesta Salehi
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania; St. Christopher's Hospital for Children, Tower Health, Philadelphia, Pennsylvania
| | | | - Renee Riddle
- Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - Erin Hall
- Temple University College of Medicine, Philadelphia, Pennsylvania
| | - John Fam
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - David Tichansky
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania
| | - Stephan Myers
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania; Tower Health Weight Loss Surgery and Wellness Center, Reading Hospital, Wyomissing, Pennsylvania; St. Christopher's Hospital for Children, Tower Health, Philadelphia, Pennsylvania.
| |
Collapse
|
13
|
Abstract
Genetic forms of obesity contribute to ∼7% of severe obesity in children and adolescents. The exact global prevalence of monogenic and syndromic forms of obesity is not well established, most likely due to missed or delayed diagnosis. The challenge in determining the prevalence can be attributed to the lack of consensus on identifying and evaluating symptoms of genetic defects in a timely manner and hence a vastly undertested patient population. Further large-scale and long-term studies are needed to advance the understanding of this unique phenotype of obesity and effective treatment options."
Collapse
Affiliation(s)
| | - Sonali Malhotra
- MGH Weight Center, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 430, Boston, MA 02114, USA; Rhythm Pharmaceuticals, 222 Berkeley Street, 12th Floor, Boston, MA 02116, USA.
| |
Collapse
|
14
|
Salvatore M, Torreri P, Grugni G, Rocchetti A, Maghnie M, Patti G, Crinò A, Elia M, Greco D, Romano C, Franzese A, Mozzillo E, Colao A, Pugliese G, Pagotto U, Lo Preiato V, Scarano E, Schiavariello C, Tornese G, Fintini D, Bocchini S, Osimani S, De Sanctis L, Sacco M, Rutigliano I, Delvecchio M, Faienza MF, Wasniewska M, Corica D, Stagi S, Guazzarotti L, Maffei P, Dassie F, Taruscio D. The Italian registry for patients with Prader-Willi syndrome. Orphanet J Rare Dis 2023; 18:28. [PMID: 36793093 PMCID: PMC9930253 DOI: 10.1186/s13023-023-02633-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare and complex genetic disease, with numerous implications on metabolic, endocrine, neuropsychomotor systems, and with behavioural and intellectual disorders. Rare disease patient registries are important scientific tools (1) to collect clinical and epidemiologic data, (2) to assess the clinical management including the diagnostic delay, (3) to improve patients' care and (4) to foster research to identify new therapeutic solutions. The European Union has recommended the implementation and use of registries and databases. The main aims of this paper are to describe the process of setting up the Italian PWS register, and to illustrate our preliminary results. MATERIALS AND METHODS The Italian PWS registry was established in 2019 with the aims (1) to describe the natural history of the disease, (2) to determine clinical effectiveness of health care services, (3) to measure and monitor quality of care of patients. Information from six different variables are included and collected into this registry: demographics, diagnosis and genetics, patient status, therapy, quality of life and mortality. RESULTS A total of 165 patients (50.3% female vs 49.7% male) were included into Italian PWS registry in 2019-2020 period. Average age at genetic diagnosis was 4.6 years; 45.4% of patients was less than 17 years old aged, while the 54.6% was in adult age (> 18 years old). Sixty-one percent of subjects had interstitial deletion of the proximal long arm of paternal chromosome 15, while 36.4% had uniparental maternal disomy for chromosome 15. Three patients presented an imprinting centre defect and one had a de novo translocation involving chromosome 15. A positive methylation test was demonstrated in the remaining 11 individuals but the underlying genetic defect was not identified. Compulsive food-seeking and hyperphagia was present in 63.6% of patients (prevalently in adults); 54.5% of patients developed morbid obesity. Altered glucose metabolism was present in 33.3% of patients. Central hypothyroidism was reported in 20% of patients; 94.7% of children and adolescents and 13.3% of adult patients is undergoing GH treatment. CONCLUSIONS The analyses of these six variables allowed to highlight important clinical aspects and natural history of PWS useful to inform future actions to be taken by national health care services and health professionals.
Collapse
Affiliation(s)
- Marco Salvatore
- National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Paola Torreri
- grid.416651.10000 0000 9120 6856National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Graziano Grugni
- grid.418224.90000 0004 1757 9530Division of Auxology, Istituto Auxologico Italiano IRCCS, Piancavallo di Oggebbio, VB Italy
| | - Adele Rocchetti
- grid.416651.10000 0000 9120 6856National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| | - Mohamad Maghnie
- grid.419504.d0000 0004 1760 0109Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Giuseppa Patti
- grid.419504.d0000 0004 1760 0109Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Antonino Crinò
- grid.411075.60000 0004 1760 4193Center for Rare Diseases and Congenital Defects, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy
| | - Maurizio Elia
- grid.419843.30000 0001 1250 7659Oasi Research Institute – IRCCS, Troina, EN Italy
| | - Donatella Greco
- grid.419843.30000 0001 1250 7659Oasi Research Institute – IRCCS, Troina, EN Italy
| | - Corrado Romano
- grid.419843.30000 0001 1250 7659Oasi Research Institute – IRCCS, Troina, EN Italy ,grid.8158.40000 0004 1757 1969Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Enza Mozzillo
- grid.4691.a0000 0001 0790 385XAOU Federico II, Naples, Italy
| | - Annamaria Colao
- grid.4691.a0000 0001 0790 385XAOU Federico II, Naples, Italy
| | | | - Uberto Pagotto
- grid.6292.f0000 0004 1757 1758Unità di Endocrinologia e Prevenzione e Cura del Diabete, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Valentina Lo Preiato
- grid.6292.f0000 0004 1757 1758Unità di Endocrinologia e Prevenzione e Cura del Diabete, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Emanuela Scarano
- Rare Diseases Unit, Department of Pediatrics, IRCCS AOU Sant’Orsola, Bologna, Italy
| | | | - Gianluca Tornese
- grid.418712.90000 0004 1760 7415IRCCS Materno Infantile Burlo Garofolo, Trieste, Italy
| | - Danilo Fintini
- grid.414603.4IRCCS Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Sarah Bocchini
- grid.414603.4IRCCS Bambino Gesù Paediatric Hospital, Rome, Italy
| | - Sara Osimani
- grid.18887.3e0000000417581884IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luisa De Sanctis
- grid.7605.40000 0001 2336 6580AOU Città della Salute e della Scienza/Ospedale Infantile Regina Margherita and Dipartimento di Scienze di Sanità Pubblica e Pediatriche, Università di Torino, Turin, Italy
| | - Michele Sacco
- grid.413503.00000 0004 1757 9135IRCCS Casa Sollievo della Sofferenza - San Giovanni Rotondo, Foggia, Italy
| | - Irene Rutigliano
- grid.413503.00000 0004 1757 9135IRCCS Casa Sollievo della Sofferenza - San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | - Stefano Stagi
- grid.413181.e0000 0004 1757 8562Azienda Ospedaliera Universitaria Meyer, Florence, Italy
| | - Laura Guazzarotti
- grid.411474.30000 0004 1760 2630Azienda Ospedale Università Padova (LG), Padua, Italy ,grid.5608.b0000 0004 1757 3470Dipartimento di Medicina (DIMED), University of Padua (PM, FD), Padua, Italy
| | - Pietro Maffei
- grid.411474.30000 0004 1760 2630Azienda Ospedale Università Padova (LG), Padua, Italy ,grid.5608.b0000 0004 1757 3470Dipartimento di Medicina (DIMED), University of Padua (PM, FD), Padua, Italy
| | - Francesca Dassie
- grid.411474.30000 0004 1760 2630Azienda Ospedale Università Padova (LG), Padua, Italy ,grid.5608.b0000 0004 1757 3470Dipartimento di Medicina (DIMED), University of Padua (PM, FD), Padua, Italy
| | - Domenica Taruscio
- grid.416651.10000 0000 9120 6856National Centre for Rare Diseases, Undiagnosed Rare Diseases Interdepartmental Unit, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy
| |
Collapse
|
15
|
Ahmed S, Naz A, K M. Weight Loss of Over 100 lbs in a Patient of Prader-Willi Syndrome Treated With Glucagon-Like Peptide-1 (GLP-1) Agonists. Cureus 2023; 15:e35102. [PMID: 36945294 PMCID: PMC10024922 DOI: 10.7759/cureus.35102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/19/2023] Open
Abstract
Prader-Willi syndrome (PWS) is the most common genetic obesity syndrome. The clinical features of this condition include childhood obesity, hyperphagia, infantile hypotonia, hypogonadism, short stature, and characteristic facial features. The leading cause of morbidity and mortality in PWS is hyperphagia and resultant obesity. Here, we highlight the effectiveness of glucagon-like peptide-1 (GLP-1) agonists by reporting an interesting case of successful rapid weight loss in an adult with PWS using GLP-1 agonists - exenatide and liraglutide. To the best of our knowledge, this report presents the first clinical evidence supporting the use of GLP-1 receptor agonists in the treatment of genetic obesity syndromes; our patient lost a total of 125 lbs on GLP-1 analog and continues to lose weight.
Collapse
Affiliation(s)
- Sana Ahmed
- Internal Medicine, Smt. Kashibai Navale Medical College, Mumbai, IND
| | - Arooj Naz
- Medicine, Frontier Medical and Dental College, Abbottabad, PAK
| | - Mahnoor K
- Internal Medicine, Fauji Foundation University, Islamabad, PAK
- Internal Medicine, Foundation University Medical College, Islamabad, PAK
| |
Collapse
|
16
|
Cotter SP, Schwartz L, Strong TV, Bender RH, Fehnel SE. The Prader-Willi Syndrome Anxiousness and Distress Behaviors Questionnaire: Development and Psychometric Validation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:243-250. [PMID: 36202701 DOI: 10.1016/j.jval.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To facilitate the development of new therapies for Prader-Willi syndrome (PWS), we sought to develop a reliable and valid assessment of anxiousness and distress, common characteristics that have a significant negative impact on individuals with PWS and their families. METHODS The PWS Anxiousness and Distress Behaviors Questionnaire (PADQ) was developed with extensive input from clinical experts, as well as caregivers of individuals with PWS, who participated in iterative sets of qualitative interviews. The psychometric properties of the PADQ were subsequently demonstrated in a cross-sectional evaluation using data from the Global PWS Registry provided by > 400 caregivers and confirmed using data from a phase 3 clinical trial of an oxytocin analogue (intranasal carbetocin, LV-101). RESULTS Qualitative interview participants consistently endorsed the content of the PADQ and were confident they could accurately respond to each item based on their observations of their child's behavior. Analysis of cross-sectional data supported the computation of a total PADQ score, as well as the reliability and validity of the measure. The results of analyses using longitudinal clinical trial data confirmed these properties and provided evidence for the responsiveness of the PADQ, further supporting its appropriateness for the evaluation of new treatments targeting anxiousness and distress in PWS. CONCLUSIONS The current body of evidence supports the conclusion that the PADQ measures observable behaviors that are meaningful to patients and their families and provides a valid and reliable method to assess beneficial treatment effects for some of the most challenging behaviors associated with PWS.
Collapse
Affiliation(s)
| | - Lauren Schwartz
- Foundation for Prader-Willi Research (FPWR), Walnut, CA, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Theresa V Strong
- Foundation for Prader-Willi Research (FPWR), Walnut, CA, USA; Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Randall H Bender
- Department of Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Sheri E Fehnel
- Department of Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA.
| |
Collapse
|
17
|
Cuda S, Censani M, Kharofa R, Williams DR, O'Hara V, Karjoo S, Paisley J, Browne NT. Social consequences and genetics for the child with overweight and obesity: An obesity medicine association (OMA) clinical practice statement 2022. OBESITY PILLARS (ONLINE) 2022; 3:100032. [PMID: 37990726 PMCID: PMC10662046 DOI: 10.1016/j.obpill.2022.100032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2023]
Abstract
Background This Obesity Medicine Association (OMA) clinical practice statement (CPS) covers two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. This CPS is intended to provide clinicians with an overview of clinical practices applicable to children and adolescents with body mass indices greater than or equal to the 85th percentile for their ages, particularly those with adverse consequences resulting from increased body mass. The information in this CPS is based on scientific evidence, supported by the medical literature, and derived from the clinical experiences of members of the OMA. Methods The scientific information and clinical guidance in this CPS is based upon referenced evidence and derived from the clinical perspectives of the authors. Results This OMA clinical practice statement details two topics: 1) genetics and 2) social consequences for the child with overweight and obesity. Conclusions This OMA clinical practice statement on genetics and social consequences for the child with overweight and obesity is an overview of current literature. The literature provides a roadmap to the improvement of the health of children and adolescents with obesity, especially those with metabolic, physiological, and psychological complications.
Collapse
Affiliation(s)
- Suzanne Cuda
- Alamo City Healthy Kids and Families, 1919 Oakwell Farms Parkway, Ste 145 San Antonio, TX, 78218, USA
| | - Marisa Censani
- Associate Professor of Clinical Pediatrics, Division of Pediatric Endocrinology, Department of Pediatrics, New York Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Box 103, New York, NY, 10021, USA
| | - Roohi Kharofa
- Center for Better Health & Nutrition, The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA
| | - Dominique R. Williams
- The Ohio State University College of MedicineCenter for Healthy Weight and Nutrition, Nationwide Children's Hospital 700 Children's Drive LA, Suite 5F Columbus, OH, 43215, USA
| | - Valerie O'Hara
- Medical Director, WOW 4 Wellness Clinic/ PCHC, 6 Telcom Drive, Bangor, ME, 04401, USA
| | - Sara Karjoo
- Johns Hopkins All Children's Hospital Pediatric Gastroenterology, 501 6th Ave S, St. Petersburg, FL, 33701, USA
| | - Jennifer Paisley
- St Elizabeth Physician's Group Primary Care 98 Elm Street Lawrenceburg, IN, 47025-2048, USA
| | | |
Collapse
|
18
|
Ta D, Downs J, Baynam G, Wilson A, Richmond P, Schmidt A, Decker A, Leonard H. Development of an International Database for a Rare Genetic Disorder: The MECP2 Duplication Database (MDBase). CHILDREN 2022; 9:children9081111. [PMID: 35892614 PMCID: PMC9332564 DOI: 10.3390/children9081111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022]
Abstract
The natural history of MECP2 duplication syndrome (MDS), a rare X-linked neurodevelopmental disorder with an estimated birth prevalence of 1/150,000 live births, is poorly understood due to a lack of clinical data collected for research. Such information is critical to the understanding of disease progression, therapeutic endpoints and outcome measures for clinical trials, as well as the development of therapies and orphan products. This clinical information can be systematically collected from caregivers through data collation efforts—yet, no such database has existed for MDS before now. Here, in this methodological study, we document the development, launch and management of the international MECP2 Duplication Database (MDBase). The MDBase consists of an extensive family questionnaire that collects information on general medical history, system-specific health problems, medication and hospitalisation records, developmental milestones and function, and quality of life (for individuals with MDS, and their caregivers). Launched in 2020, in its first two years of operation the MDBase has collected clinical data from 154 individuals from 26 countries—the largest sample size to date. The success of this methodology for the establishment and operation of the MDBase may provide insight and aid in the development of databases for other rare neurodevelopmental disorders.
Collapse
Affiliation(s)
- Daniel Ta
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; (D.T.); (J.D.); (G.B.); (A.W.); (P.R.)
| | - Jenny Downs
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; (D.T.); (J.D.); (G.B.); (A.W.); (P.R.)
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
| | - Gareth Baynam
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; (D.T.); (J.D.); (G.B.); (A.W.); (P.R.)
- Rare Care Centre, Perth Children’s Hospital, Nedlands, WA 6009, Australia
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Subiaco, WA 6904, Australia
| | - Andrew Wilson
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; (D.T.); (J.D.); (G.B.); (A.W.); (P.R.)
- Curtin School of Allied Health, Curtin University, Bentley, WA 6102, Australia
- North Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA 6009, Australia
- Discipline of Paediatrics, School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Peter Richmond
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; (D.T.); (J.D.); (G.B.); (A.W.); (P.R.)
- North Entrance, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA 6009, Australia
- Discipline of Paediatrics, School of Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Aron Schmidt
- MECP2 Duplication Foundation, Tuscon, AZ 85724, USA; (A.S.); (A.D.)
| | - Amelia Decker
- MECP2 Duplication Foundation, Tuscon, AZ 85724, USA; (A.S.); (A.D.)
- Department of Paediatrics, University of Arizona College of Medicine, Tuscon, AZ 85724, USA
| | - Helen Leonard
- Telethon Kids Institute, University of Western Australia, Perth, WA 6009, Australia; (D.T.); (J.D.); (G.B.); (A.W.); (P.R.)
- Correspondence:
| |
Collapse
|
19
|
Proteins and Proteases of Prader-Willi Syndrome: A Comprehensive Review and Perspectives. Biosci Rep 2022; 42:231361. [PMID: 35621394 PMCID: PMC9208313 DOI: 10.1042/bsr20220610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Prader–Willi Syndrome (PWS) is a rare complex genetic disease that is associated with pathological disorders that include endocrine disruption, developmental, neurological, and physical problems as well as intellectual, and behavioral dysfunction. In early stage, PWS is characterized by respiratory distress, hypotonia, and poor sucking ability, causing feeding concern and poor weight gain. Additional features of the disease evolve over time. These include hyperphagia, obesity, developmental, cognitive delay, skin picking, high pain threshold, short stature, growth hormone deficiency, hypogonadism, strabismus, scoliosis, joint laxity, or hip dysplasia. The disease is associated with a shortened life expectancy. There is no cure for PWS, although interventions are available for symptoms management. PWS is caused by genetic defects in chromosome 15q11.2-q13, and categorized into three groups, namely Paternal deletion, Maternal uniparental disomy, and Imprinting defect. PWS is confirmed through genetic testing and DNA-methylation analysis. Studies revealed that at least two key proteins namely MAGEL-2 and NECDIN along with two proteases PCSK1 and PCSK2 are linked to PWS. Herein, we summarize our current understanding and knowledge about the role of these proteins and enzymes in various biological processes associated with PWS. The review also describes how loss and/or impairment of functional activity of these macromolecules can lead to hormonal disbalance by promoting degradation of secretory granules and via inhibition of proteolytic maturation of precursor-proteins. The present review will draw attention of researchers, scientists, and academicians engaged in PWS study and will help to identify potential targets and molecular pathways for PWS intervention and treatment.
Collapse
|
20
|
Matesevac L, Miller JL, McCandless SE, Malloy JL, Bohonowych JE, Vrana-Diaz C, Strong TV. Thrombosis Risk History and D-dimer Levels in Asymptomatic Individuals with Prader-Willi Syndrome. J Clin Med 2022; 11:jcm11072040. [PMID: 35407648 PMCID: PMC9000191 DOI: 10.3390/jcm11072040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 12/12/2022] Open
Abstract
Individuals with Prader–Willi syndrome (PWS) may be at higher risk of developing blood clots as compared to the typical population, but this risk is poorly understood. It is also unclear if laboratory testing of D-dimer concentration might be useful to screen for thrombosis in PWS. Here, we surveyed the thrombosis history of 883 individuals with PWS and evaluated the D-dimer concentration in a subset of 214 asymptomatic individuals, ages 5–55. A history of at least one blood clot was reported by 3.6% of respondents. Thrombosis increased with age, but no significant difference was found on the basis of sex or family history. Genetic subtype was a significant factor when considering only those with a known subtype, and individuals with a history of edema had significantly more blood clots. In the D-dimer sub-study, ≈15% of participants had high D-dimer concentrations, and 3.7% had D-dimer values more than twice the normal upper limit. One participant with a high D-dimer result was found to have a blood clot. No significant differences in D-dimer results were found on the basis of age, sex, genetic subtype, family history of blood clots, edema history, or BMI. The D-dimer test does not appear to be a sensitive and specific screening tool for blood clots in asymptomatic individuals with PWS.
Collapse
Affiliation(s)
- Lisa Matesevac
- Foundation for Prader–Willi Research, Walnut, CA 91789, USA; (L.M.); (J.E.B.); (C.V.-D.)
| | - Jennifer L. Miller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Shawn E. McCandless
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | | | - Jessica E. Bohonowych
- Foundation for Prader–Willi Research, Walnut, CA 91789, USA; (L.M.); (J.E.B.); (C.V.-D.)
| | - Caroline Vrana-Diaz
- Foundation for Prader–Willi Research, Walnut, CA 91789, USA; (L.M.); (J.E.B.); (C.V.-D.)
| | - Theresa V. Strong
- Foundation for Prader–Willi Research, Walnut, CA 91789, USA; (L.M.); (J.E.B.); (C.V.-D.)
- Correspondence: ; Tel.: +1-888-322-5487 (ext. 702)
| |
Collapse
|
21
|
Raj R, Owen D, Kannan L, Syeda U. Polypharmacy in a Patient With Intellectual and Developmental Disabilities. Cureus 2022; 14:e22019. [PMID: 35282537 PMCID: PMC8908801 DOI: 10.7759/cureus.22019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Prader-Willi syndrome (PWS) is an uncommon condition and its clinical manifestation in adulthood includes central obesity, hypogonadism, osteoporosis, cardiovascular disease, diabetes mellitus, and sleep apnea. These patients often have mild to moderate intellectual disability and are dependent upon their caregiver for healthcare needs. Hence, they may be at increased risk of polypharmacy-related complications, if there is poor communication between healthcare providers and caregivers. We present a case of a 26-year-old adult with PWS and mild to moderate intellectual disability, who was found to have acute kidney injury resulting from drug interaction between multiple nephrotoxic medications. Our case report highlights the importance of continuity of care with primary care providers, especially in patients with intellectual and developmental disabilities (IDD).
Collapse
|
22
|
Patel VP, Patroneva A, Glaze DG, Davis MS K, Merikle E, Revana A. Establishing the content validity of the Epworth Sleepiness Scale for Children and Adolescents in Prader-Willi syndrome. J Clin Sleep Med 2022; 18:485-496. [PMID: 34437052 PMCID: PMC8804999 DOI: 10.5664/jcsm.9632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness is common in Prader-Willi syndrome (PWS), with prevalence ranging from 52% to 100%. The goal of this study was to establish the content validity (ie, evidence that an instrument measures an intended concept of interest) of the parent/caregiver version of the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), a measure of daytime sleepiness, in PWS. METHODS Qualitative, dyadic semistructured video interviews were conducted with 18 caregivers and their children with PWS from April to June 2020. Concept elicitation and cognitive interview techniques were implemented. Thematic analyses allowed for examination of themes and data patterns. RESULTS All caregivers (mean age 49 years) were mothers of individuals with PWS who experienced troublesome daytime sleepiness (mean age 14 years). The most prevalent observable signs/symptoms of daytime sleepiness were sleepy/sleepiness (n = 17; 94.4%), tired/tiredness (n = 16; 88.9%), exhaustion/exhausted (n = 5; 27.8%), anxious/stressed (n = 5; 27.8%), irritable/frustrated (n = 5; 27.8%), having tantrums/outbursts (n = 5; 27.8%), and lethargy (n = 4; 22.2%). Daytime sleepiness impacted various aspects of health including mental, emotional, physical, and social well-being. When caregivers were asked about the activities associated with daytime sleepiness, all salient concepts elicited mapped to the ESS-CHAD; saturation was met after the first 4 interviews. Only 2 concepts, after physical exertion and while inactive/bored, did not map. Caregiver statements indicated that these concepts, although related to daytime activities, were atypical of daily routines. The ESS-CHAD was well understood and relevant to caregivers. CONCLUSIONS This study supports the content validity of the ESS-CHAD and its appropriateness for evaluating treatment efficacy of daytime sleepiness in PWS. CITATION Patel VP, Patroneva A, Glaze DG, Davis K, Merikle E, Revana A. Establishing the content validity of the Epworth Sleepiness Scale for Children and Adolescents in Prader-Willi syndrome. J Clin Sleep Med. 2022;18(2):485-496.
Collapse
|
23
|
Campbell N, Van Zant S, Lammers J. Multifactorial influences on successful health outcomes for an adolescent with Prader-Willi syndrome: a qualitative case study. Physiother Theory Pract 2022; 39:1215-1223. [PMID: 35100943 DOI: 10.1080/09593985.2022.2036277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Prader-Willi syndrome (PWS) is the most common syndromic cause of childhood obesity. This qualitative case study aimed to identify and describe lifestyle themes of an adolescent with PWS that resulted in maintenance of a healthy body mass index (BMI). CASE DESCRIPTION The 16-year-old female demonstrated failure to thrive upon birth and underwent 9 months supplemented tube feeding, achieving 50th percentile weight for height. Throughout childhood she received treatment of physical, occupational, and speech therapies, and has maintained a healthy BMI ranging from 25-50th percentile weight for height. METHODS AND RESULTS Two video interviews were completed separately. Qualitative analysis of the transcribed data identified two overarching themes for maintaining a healthy BMI in this adolescent: 1) adolescent and parent individual characteristics; and 2) family dynamics and lifestyle. Adolescent and parental characteristics included: high level of cognitive function for diagnosis, mild hyperphagia, desire for a regimented schedule, parental type A personalities, intentionality in parental decisions/actions. Family lifestyle characteristics included strong parental involvement and well-defined expectations for their daughter, purposeful integration of physical activity into lifestyle, and presence of a strong family support system. CONCLUSION The convergence of multiple optimal influences provided an ideal health outcome in the adolescent.
Collapse
Affiliation(s)
- Nicole Campbell
- Physical Therapy Program, University of Findlay, Findlay, OH, USA
| | - Scott Van Zant
- Doctor of Physical Therapy Program, Hanover College, Hanover, IN, USA
| | - Joyce Lammers
- Physical Therapy Program, University of Findlay, Findlay, OH, USA
| |
Collapse
|
24
|
Shelkowitz E, Gantz MG, Ridenour TA, Scheimann AO, Strong T, Bohonowych J, Duis J. Neuropsychiatric features of Prader-Willi syndrome. Am J Med Genet A 2022; 188:1457-1463. [PMID: 35098642 DOI: 10.1002/ajmg.a.62662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/10/2021] [Accepted: 12/26/2021] [Indexed: 01/21/2023]
Abstract
Prader-Willi syndrome (PWS) is a genetic disorder characterized by hypotonia and poor feeding in infancy which progresses to hyperphagia in early-mid childhood, as well as developmental delays, a spectrum of behavioral and psychiatric concerns, endocrinopathies, orthopedic issues, and less commonly, seizures, sleep apnea, and narcolepsy with or without cataplexy. This study used data in the Global PWS Registry (N = 893) to explore the onset and severity over time of the neuropsychiatric features reported in individuals with PWS and explored its associations with sleep disorders, seizures, and psychiatric symptoms. Results demonstrate that seizures are more common in the deletion subtype and that narcolepsy and cataplexy are more common in individuals who have sleep-related seizures. Finally, this work shows that anxiety and compulsive behaviors are persistent features of PWS that may arise early in childhood, and that anxiety is associated with higher frequency of other comorbid psychiatric diagnoses. In conclusion, this study is one of the largest to date characterizing sleep disorders and neuropsychiatric characteristics of individuals with PWS and reports on the novel association between sleep disorders and seizures. This study is also one of the first to offer details on the nature of the progression of these features in individuals with PWS.
Collapse
Affiliation(s)
- Emily Shelkowitz
- Section of Genetics and Inherited Metabolic Disease, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| | | | | | - Ann O Scheimann
- Division of Gastroenterology, Department of Pediatrics, John Hopkins University, Baltimore, Maryland, USA
| | - Theresa Strong
- Foundation for Prader-Willi Research, Pasadena, California, USA
| | | | - Jessica Duis
- Section of Genetics and Inherited Metabolic Disease, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Campus, Aurora, Colorado, USA
| |
Collapse
|
25
|
Godler DE, Ling L, Gamage D, Baker EK, Bui M, Field MJ, Rogers C, Butler MG, Murgia A, Leonardi E, Polli R, Schwartz CE, Skinner CD, Alliende AM, Santa Maria L, Pitt J, Greaves R, Francis D, Oertel R, Wang M, Simons C, Amor DJ. Feasibility of Screening for Chromosome 15 Imprinting Disorders in 16 579 Newborns by Using a Novel Genomic Workflow. JAMA Netw Open 2022; 5:e2141911. [PMID: 34982160 PMCID: PMC8728620 DOI: 10.1001/jamanetworkopen.2021.41911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Newborn screening for Angelman syndrome (AS), Prader-Willi syndrome (PWS), and chromosome 15 duplication syndrome (Dup15q) may lead to benefit from early diagnosis and treatment. OBJECTIVE To examine the feasibility of newborn screening for these chromosome 15 imprinting disorders at population scale. DESIGN, SETTING, AND PARTICIPANTS In this diagnostic study, the validation data set for the first-tier SNRPN test, called methylation-specific quantitative melt analysis (MS-QMA), included 109 PWS, 48 AS, 9 Dup15q, and 1190 population control newborn blood spots (NBS) and peripheral tissue samples from participants recruited from January 2000 to December 2016. The test data set included NBS samples from 16 579 infants born in 2011. Infants with an NBS identified as positive for PWS, AS, or Dup15q by the first-tier test were referred for droplet digital polymerase chain reaction, real-time polymerase chain reaction, and low-coverage whole-genome sequencing for confirmatory testing. Data analyses were conducted between February 12, 2015, and August 15, 2020. RESULTS In the validation data set, the median age for the 77 patients with PWS was 3.00 years (IQR, 0.01-44.50 years); for the 46 patients with AS, 2.76 years (IQR, 0.028 to 49.00 years); and for the 9 patients with Dup15q, 4.00 years (IQR, 1.00 to 28.00 years). Thirty-eight patients (51.4%) in the PWS group, 20 patients (45.5%) in the AS group, and 6 patients (66.7%) in the Dup15q group who had sex reported were male. The validation data set showed MS-QMA sensitivity of 99.0% for PWS, 93.8% for AS, and 77.8% for Dup15q; specificity of 100% for PWS, AS, and Dup15q; positive predictive and negative predictive values of 100% for PWS and AS; and a positive predictive value of 87.5% and negative predictive value of 100% for Dup15q. In the test data set of NBS samples from 16 579 infants, 92 had a positive test result using a methylation ratio cut-off of 3 standard deviations from the mean. Of these patients, 2 were confirmed to have PWS; 2, AS; and 1, maternal Dup15q. With the use of more conservative PWS- and AS-specific thresholds for positive calls from the validation data set, 9 positive NBS results were identified by MS-QMA in this cohort. The 2 PWS and 2 AS calls were confirmed by second-tier testing, but the 1 Dup15q case was not confirmed. Together, these results provided prevalence estimates of 1 in 8290 for both AS and PWS and 1 in 16 579 for maternal Dup15q, with positive predictive values for first-tier testing at 67.0% for AS, 33.0% for PWS, and 44.0% for combined detection of chromosome 15 imprinting disorders for the validation data set. CONCLUSIONS AND RELEVANCE The findings of this diagnostic study suggest that it is feasible to screen for all chromosome 15 imprinting disorders using SNRPN methylation analysis, with 5 individuals identified with these disorders out of 16 579 infants screened.
Collapse
Affiliation(s)
- David E. Godler
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- E.D.G. Innovations and Consulting, St Kilda, Victoria, Australia
| | - Ling Ling
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
| | - Dinusha Gamage
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
| | - Emma K. Baker
- Diagnosis and Development, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Parkville, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Michael J. Field
- Genetics of Learning Disability Service, Hunter Genetics, Waratah, New South Wales, Australia
| | - Carolyn Rogers
- Genetics of Learning Disability Service, Hunter Genetics, Waratah, New South Wales, Australia
| | - Merlin G. Butler
- Departments of Psychiatry, Behavioral Sciences and Pediatrics, University of Kansas Medical Centre, Kansas City, Kansas
| | - Alessandra Murgia
- Molecular Genetics of Neurodevelopment, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Istituto di Ricerca Pediatrica (IRP), Città della Speranza, Padua, Italy
| | - Emanuela Leonardi
- Molecular Genetics of Neurodevelopment, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Istituto di Ricerca Pediatrica (IRP), Città della Speranza, Padua, Italy
| | - Roberta Polli
- Molecular Genetics of Neurodevelopment, Department of Women's and Children's Health, University of Padua, Padua, Italy
- Istituto di Ricerca Pediatrica (IRP), Città della Speranza, Padua, Italy
| | - Charles E. Schwartz
- Center for Molecular Studies, J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, South Carolina
| | - Cindy D. Skinner
- Center for Molecular Studies, J.C. Self Research Institute of Human Genetics, Greenwood Genetic Center, Greenwood, South Carolina
| | - Angelica M. Alliende
- Cytogenetics and Molecular Laboratory, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
- Centre for Diagnosis and Treatment of Fragile X Syndrome (CDTSXF), INTA University of Chile, Santiago, Chile
| | - Lorena Santa Maria
- Cytogenetics and Molecular Laboratory, Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
- Centre for Diagnosis and Treatment of Fragile X Syndrome (CDTSXF), INTA University of Chile, Santiago, Chile
| | - James Pitt
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Ronda Greaves
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - David Francis
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Ralph Oertel
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Min Wang
- Translational Bioinformatics, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Cas Simons
- Translational Bioinformatics, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - David J. Amor
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
26
|
Gonzalez M, Saxena S, Chowdhury F, Dyck Holzinger S, Martens R, Oskoui M, Shikako-Thomas K. Informing the development of the Canadian Neurodiversity Platform: What is important to parents of children with neurodevelopmental disabilities? Child Care Health Dev 2022; 48:88-98. [PMID: 34374115 DOI: 10.1111/cch.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 06/04/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A crowd-sourced Canadian platform that collects information across neurodevelopmental disabilities (NDDs) can (1) facilitate knowledge mobilization; (2) provide epidemiological data that can benefit knowledge, treatment, and advocacy; and (3) inform policy and resource allocation decisions. We obtained input from parents of children with NDDs about relevance and feasibility of questionnaire items as a first step to inform questionnaire development of a stakeholder-driven, national platform for data collection on children with NDDs. METHODS A parent of a teenager with NDDs was a research partner on the project. Through four focus groups and using a guided discussion consensus process, 16 participants provided feedback on whether questionnaire items from existing instruments related to function and disability were feasible for parents to complete and important to include in the platform. Data were analysed using content analysis. RESULTS Participants (1) indicated that questions about medical history, general health, body functioning, self-care, access to resources, and outcomes (e.g., quality of life) are important to include in the platform and are feasible for self-completion; (2) provided various suggestions for the questionnaire ranging from additional items to include, using non-medical language, and keeping completion time from 20 to 30 min; (3) identified incentives and knowing the purpose of the platform as strong motivators to platform participation; (4) spoke about the challenges of their caregiver experience including impact of caregiving on themselves and barriers to accessing services; and (5) highlighted the isolation experienced by their children. CONCLUSION Through the focus groups, parent stakeholders contributed to questionnaire development and shared their caregiver experiences. Obtaining feedback from youths with NDDs and healthcare providers on the questionnaire is a next step to validating findings. Stakeholder engagement is fundamental to developing a platform that will inform research that is relevant to the needs of children with NDDs and their families.
Collapse
Affiliation(s)
- Miriam Gonzalez
- Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada.,Research Institute of the McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Shikha Saxena
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Farhin Chowdhury
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montréal, Canada
| | - Sasha Dyck Holzinger
- Research Institute of the McGill University Health Centre, McGill University, Montréal, Quebec, Canada
| | - Rachel Martens
- CHILD BRIGHT Network, Montreal, Quebec, Canada.,Kids Brain Health Network, Surrey, British Columbia, Canada
| | - Maryam Oskoui
- Department of Neurology and Neurosurgery, McGill University, Montréal, Quebec, Canada.,Research Institute of the McGill University Health Centre, McGill University, Montréal, Quebec, Canada.,Department of Pediatrics, McGill University, Montréal, Quebec, Canada
| | - Keiko Shikako-Thomas
- Research Institute of the McGill University Health Centre, McGill University, Montréal, Quebec, Canada.,School of Physical and Occupational Therapy, McGill University, Montréal, Quebec, Canada.,Canada Research Chair in Childhood Disabilities: Participation and Knowledge Translation, McGill University, Montréal, Quebec, Canada
| |
Collapse
|
27
|
Amaro AS, Rubin DA, Teixeira MCTV, Ferreira AJ, Rodrigues GM, Carreiro LRR. Health Problems in Individuals With PWS Are Associated With Lower Quality of Life for Their Parents: A Snapshot in the Brazilian Population. Front Pediatr 2022; 10:746311. [PMID: 35242723 PMCID: PMC8885721 DOI: 10.3389/fped.2022.746311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder requiring interdisciplinary team monitoring and intensive care by parents. So far there is little information on people with PWS in Brazil. Our aim was to describe health problems and treatments used by people with PWS in Brazil and their relationship to their parents' quality of life. Parents answered questionnaires about their child's medical and exercise history, behavior problems, sociodemographic characteristics, and their own quality of life. Results: The responses of the participants showed similar health problems as in other countries. Anxiety and tantrums were the behavioral problems most commonly cited by parents. Parents of people with PWS had lower scores in respect of quality of life than the Brazilian population. Behavioral problems in individuals with PWS were negatively associated with their parents' quality of life. Behavioral and medical conditions in the children were associated with reduced quality of life in the parents. We conclude that heath care should not only be directed toward those with PWS, but also their parents.
Collapse
Affiliation(s)
- Alexandre Slowetzky Amaro
- Development Disorders Graduate Program, Center for Health and Biological Science, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
| | - Daniela Andrea Rubin
- Department of Kinesiology, California State University, Fullerton, CA, United States
| | | | - Arcenio José Ferreira
- Development Disorders Graduate Program, Center for Health and Biological Science, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
| | - Graciele Massoli Rodrigues
- Physical Education Program, Universidade São Judas Tadeu, São Paulo, Brazil.,Physical Education Program, Escola Superior de Educação Física de Jundiaí, Jundiaí, Brazil
| | - Luiz Renato Rodrigues Carreiro
- Development Disorders Graduate Program, Center for Health and Biological Science, Universidade Presbiteriana Mackenzie, São Paulo, Brazil
| |
Collapse
|
28
|
Kehinde TA, Bhatia A, Olarewaju B, Shoaib MZ, Mousa J, Osundiji MA. Syndromic obesity with neurodevelopmental delay: Opportunities for targeted interventions. Eur J Med Genet 2022; 65:104443. [DOI: 10.1016/j.ejmg.2022.104443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 01/01/2023]
|
29
|
Suicidality and Self-Harming Behaviors in Patients with Prader-Willi Syndrome (PWS): Case Report and Literature Review. Case Rep Psychiatry 2021; 2021:2527261. [PMID: 34671495 PMCID: PMC8523272 DOI: 10.1155/2021/2527261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder which is often associated with significant behavioral challenges and poor intellectual functioning. Research has shown that individuals with PWS are more likely to experience mental health problems, have higher relapse rates, and are at risk of self-harming behavior. Although PWS is associated with mild intellectual disability, which in itself confers a higher mortality rate, suicidality in this population is so far unreported in the literature. We present the case of an 18-year-old male patient who was admitted to our facility following exogenous insulin administration with suicidal intent. The main clinical characteristics, self-harming behaviors, and suicide risk factors of patients with PWS are discussed in this report. The article's objective is to redirect clinicians' attention to carefully screen and treat the underlying behavioral problems in PWS patients.
Collapse
|
30
|
Veatch OJ, Malow BA, Lee HS, Knight A, Barrish JO, Neul JL, Lane JB, Skinner SA, Kaufmann WE, Miller JL, Driscoll DJ, Bird LM, Butler MG, Dykens EM, Gold JA, Kimonis V, Bacino CA, Tan WH, Kothare SV, Peters SU, Percy AK, Glaze DG. Evaluating Sleep Disturbances in Children With Rare Genetic Neurodevelopmental Syndromes. Pediatr Neurol 2021; 123:30-37. [PMID: 34388423 PMCID: PMC8429141 DOI: 10.1016/j.pediatrneurol.2021.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Adequate sleep is important for proper neurodevelopment and positive health outcomes. Sleep disturbances are more prevalent in children with genetically determined neurodevelopmental syndromes compared with typically developing counterparts. We characterize sleep behavior in Rett (RTT), Angelman (AS), and Prader-Willi (PWS) syndromes to identify effective approaches for treating sleep problems in these populations. We compared sleep-related symptoms across individuals with these different syndromes with each other, and with typically developing controls. METHODS Children were recruited from the Rare Diseases Clinical Research Network consortium registries; unaffected siblings were enrolled as related controls. For each participant, a parent completed multiple sleep questionnaires including Pediatric Sleep Questionnaire (Sleep-Disordered Breathing), Children's Sleep Habits Questionnaire (CSHQ), and Pediatric Daytime Sleepiness Scale. RESULTS Sleep data were analyzed from 714 participants, aged two to 18 years. Young children with AS had more reported sleep problems than children with RTT or PWS. Older children with RTT had more reported daytime sleepiness than those with AS or PWS. Finally, all individuals with RTT had more evidence of sleep-disordered breathing when compared with individuals with PWS. Notably, typically developing siblings were also reported to have sleep problems, except for sleep-related breathing disturbances, which were associated with each of the genetic syndromes. CONCLUSIONS Individuals with RTT, AS, and PWS frequently experience sleep problems, including sleep-disordered breathing. Screening for sleep problems in individuals with these and other neurogenetic disorders should be included in clinical assessment and managements. These data may also be useful in developing treatment strategies and in clinical trials.
Collapse
Affiliation(s)
- Olivia J Veatch
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas.
| | - Beth A Malow
- Departments of Pediatrics and Neurology, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hye-Seung Lee
- Department of Pediatrics, University of South Florida, Tampa, Florida
| | - Aryn Knight
- Center for Clinical Research, Texas Heart Institute, Houston, Texas
| | - Judy O Barrish
- Departments of Pediatrics and Neurology, Baylor College of Medicine, Houston, Texas
| | - Jeffrey L Neul
- Vanderbilt Kennedy Center, Departments of Pediatrics, Pharmacology, and Special Education, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jane B Lane
- University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; University of Alabama at Birmingham, Civitan International Research Center, Birmingham, Alabama
| | | | - Walter E Kaufmann
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer L Miller
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Daniel J Driscoll
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Lynne M Bird
- Division of Genetics and Dysmorphology, Department of Pediatrics, University of California San Diego/Rady Children's Hospital, San Diego, California
| | - Merlin G Butler
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, Kansas
| | - Elisabeth M Dykens
- Departments of Pediatrics and Special Education, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - June-Anne Gold
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
| | - Virginia Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
| | - Carlos A Bacino
- Departments of Pediatrics and Neurology, Baylor College of Medicine, Houston, Texas
| | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts
| | - Sanjeev V Kothare
- Pediatric Sleep Program, Cohen Children's Medical Center, New Hyde Park, New York
| | - Sarika U Peters
- Departments of Pediatrics and Psychiatry & Behavioral Sciences, Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan K Percy
- University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; University of Alabama at Birmingham, Civitan International Research Center, Birmingham, Alabama
| | - Daniel G Glaze
- Departments of Pediatrics and Neurology, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
31
|
Godler DE, Butler MG. Special Issue: Genetics of Prader-Willi Syndrome. Genes (Basel) 2021; 12:genes12091429. [PMID: 34573411 PMCID: PMC8471269 DOI: 10.3390/genes12091429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/10/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- David E. Godler
- Royal Children’s Hospital, Murdoch Children’s Research Institute, Parkville 3052, Australia;
- Department of Paediatrics, University of Melbourne, Parkville 3052, Australia
| | - Merlin G. Butler
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Correspondence: ; Tel.: +1-913-588-1800; Fax: +1-913-588-1305
| |
Collapse
|
32
|
Malhotra S, Sivasubramanian R, Srivastava G. Evaluation and Management of Early Onset Genetic Obesity in Childhood. J Pediatr Genet 2021; 10:194-204. [PMID: 34504723 DOI: 10.1055/s-0041-1731035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/16/2021] [Indexed: 01/10/2023]
Abstract
One in five children and adolescents in the United States are diagnosed with obesity and nearly 6% of them are being classified under the severe obesity category. With over 7% of severe obesity being attributed to genetic disorders, in this review we aim to focus on monogenic and syndromic obesity: its etiology, wide spectrum of clinical presentation, criticalness of early identification, and limited management options. Advanced genetic testing methods including microarray and whole genome sequencing are imperative to identify the spectrum of mutations and develop targeted treatment strategies including personalized multidisciplinary care, use of investigational drugs, and explore surgical options in this unique subset of severe pediatric obesity.
Collapse
Affiliation(s)
- Sonali Malhotra
- Department of Pediatric Endocrinology, Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts, United States
| | - Ramya Sivasubramanian
- Division of Pediatric Nephrology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Gitanjali Srivastava
- Department of Medicine; Department of Pediatrics; Department of Surgery; Division of Endocrinology, Diabetes & Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| |
Collapse
|
33
|
Peleggi A, Bohonowych J, Strong TV, Schwartz L, Kim SJ. Suicidality in individuals with Prader-Willi syndrome: a review of registry survey data. BMC Psychiatry 2021; 21:438. [PMID: 34488710 PMCID: PMC8422732 DOI: 10.1186/s12888-021-03436-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/23/2021] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Prader-Willi syndrome (PWS) is a rare, genetic, neurodevelopmental syndrome associated with hyperphagia and early onset obesity, growth and sex hormone insufficiencies, mild-to-moderate intellectual disability, and behavioral challenges such as compulsivity, anxiety, skin picking, social skills deficits and temper outbursts. Given high rates of psychiatric comorbidity and potential risk factors for suicide in PWS, this study sought a first estimate of the prevalence of suicidal ideation (SI) and attempts (SA) in the PWS population and any characteristics associated with suicidality in this population. METHODS Using the Global Prader-Willi Syndrome Registry, we included all participants who had answered a question about SI. We examined the most recent data from the surveys about social, economic, and demographic factors, genetic subtype, and psychiatric symptoms and treatments. A chi-square analysis was used to compare registry participants who reported SI to those without reported SI. RESULTS From 750 included survey respondents, 94 (12.5%) endorsed some history of SI. Of these, 25 (26.6%) also reported a history of SA, with an average age of 16.25 years at their first attempt. Those with a history of SI were predominantly male and adult age, and had higher rates of aggression and psychiatric comorbidities, therapies, and medications. CONCLUSIONS This study indicates that the rate of SI and SA in PWS is comparable to the general population, and that suicide attempts in PWS typically begin in middle-teenage years. Despite unique challenges, individuals with PWS and their caregivers should be included in screens and psychoeducation for suicide and mental health concerns.
Collapse
Affiliation(s)
- Analise Peleggi
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington USA
| | - Jessica Bohonowych
- grid.453561.0Foundation for Prader-Willi Research, Walnut, California USA
| | - Theresa V. Strong
- grid.453561.0Foundation for Prader-Willi Research, Walnut, California USA
| | - Lauren Schwartz
- grid.453561.0Foundation for Prader-Willi Research, Walnut, California USA ,grid.34477.330000000122986657Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington USA
| | - Soo-Jeong Kim
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA. .,Seattle Children's Autism Center, Seattle, Washington, USA.
| |
Collapse
|
34
|
Bohonowych JE, Vrana-Diaz CJ, Miller JL, McCandless SE, Strong TV. Incidence of strabismus, strabismus surgeries, and other vision conditions in Prader-Willi syndrome: data from the Global Prader-Willi Syndrome Registry. BMC Ophthalmol 2021; 21:296. [PMID: 34380467 PMCID: PMC8359621 DOI: 10.1186/s12886-021-02057-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is a relative lack of information on the incidence and treatment of vision problems in Prader-Willi syndrome (PWS). Using data from the Global PWS Registry, we performed a cross-sectional study of vision problems in PWS. METHODS Data, reported by caregivers who completed the Vision Survey in the Global PWS Registry between May of 2015 and March of 2020, were analyzed using descriptive statistics. RESULTS There were 908 participants in this survey, with a mean age of 14.5 years (range 0-62 years). The prevalence of strabismus in this population was 40 %, with no statistically significant difference in prevalence by genetic subtype. Ninety-one percent of participants with strabismus were diagnosed before 5 years of age. Of those with strabismus, 42 % went on to have strabismus surgery, with 86 % of those having their first strabismus surgery before 5 years of age and 10.1 % having more than one strabismus surgery. Additional vision issues reported included myopia (41 %), hyperopia (25 %), astigmatism (25 %), and amblyopia (16 %). CONCLUSIONS The prevalence of strabismus, amblyopia, and hyperopia are considerably higher in the PWS population represented in the Global PWS Registry as compared to the general population. People with PWS should be screened early and regularly for vision problems.
Collapse
|
35
|
|
36
|
Kayadjanian N, Vrana-Diaz C, Bohonowych J, Strong TV, Morin J, Potvin D, Schwartz L. Characteristics and relationship between hyperphagia, anxiety, behavioral challenges and caregiver burden in Prader-Willi syndrome. PLoS One 2021; 16:e0248739. [PMID: 33765021 PMCID: PMC7993772 DOI: 10.1371/journal.pone.0248739] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by maladaptive behaviors, amongst which hyperphagia is a life-long concern for individuals with PWS and their caregivers. The current study examined the contribution of hyperphagia and other factors to caregiver burden across lifespan, in 204 caregivers of individuals with PWS living in the US, using the Zarit Burden Interview (ZBI) and the hyperphagia questionnaire (HQ-CT). Results We found a strong relationship between ZBI and HQ-CT especially in individuals with PWS older than 4 y and showed that HQ-CT scores of individuals with PWS is positively correlated with ZBI scores of their caregivers. The weight status of individuals with PWS was not associated with HQ-CT and ZBI scores, except for obese individuals who had significantly higher HQ-CT scores when compared to normal weight PWS individuals. We looked at PWS symptoms and care-related issues that impacted individuals and caregivers the most. We found that care-related tasks had the biggest negative impact on caregivers of children aged 0–4 y, whereas anxiety, temper tantrums, and oppositional behaviors of older individuals with PWS had the biggest impact on their caregivers concomitant with their high caregiver burden. Finally, we assessed the variability of HQ-CT and ZBI over 6 months in a subgroup of 83 participants. Overall, neither measure differed between 6 months and baseline. Most individual’s absolute HQ-CT score changes were between 0–2 units, whereas absolute ZBI score changes were between 0–6 points. Changes in the caregiver’s or individual’s life had little or no effect on HQ-CT and ZBI scores. Conclusions This study demonstrates a relationship between hyperphagia and caregiver burden and sheds light on predominant symptoms in children and adolescents that likely underly PWS caregiver burden. The stability and relationship between HQ-CT and ZBI support ZBI as an additional outcome measure in PWS clinical trials.
Collapse
Affiliation(s)
- Nathalie Kayadjanian
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- * E-mail:
| | - Caroline Vrana-Diaz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
| | - Jessica Bohonowych
- Foundation for Prader-Willi Research, Walnut, California, United States of America
| | - Theresa V. Strong
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Genetics, University of Alabama, Birmingham, Alabama, United States of America
| | - Josée Morin
- Excelsus Statistics, Montreal, Quebec, Canada
| | | | - Lauren Schwartz
- Foundation for Prader-Willi Research, Walnut, California, United States of America
- PWS-Clinical Trial Consortium, Walnut, California, United States of America
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
37
|
Gao C, Yao X, Liu J. Secondary diabetes mellitus in Prader-Willi syndrome. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00936-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
38
|
Angulo M, Abuzzahab MJ, Pietropoli A, Ostrow V, Kelepouris N, Tauber M. Outcomes in children treated with growth hormone for Prader-Willi syndrome: data from the ANSWER Program® and NordiNet® International Outcome Study. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:20. [PMID: 33292530 PMCID: PMC7653711 DOI: 10.1186/s13633-020-00090-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Background Growth hormone (GH) deficiency is common in patients with Prader-Willi syndrome (PWS) and leads to short adult stature. The current study assessed clinical outcomes based on real-world observational data in pediatric patients with PWS who were treated with GH. Methods Data from patients previously naïve to treatment with GH who began therapy with somatropin were collected from 2006 to 2016 in the observational American Norditropin® Studies: Web-Enabled Research (ANSWER) Program® and NordiNet® International Outcome Study. Variables affecting change from baseline in height standard deviation scores (HSDS; n = 129) and body mass index standard deviation scores (BMI SDS; n = 98) were determined. Results Patients included in both HSDS and BMI SDS analyses were treated with a mean GH dose of 0.03 mg/kg/d (SD, 0.01 mg/kg/d). Results from the HSDS analysis revealed that baseline age and years on treatment had a significant impact on the change in HSDS. In the BMI SDS analysis, longer GH treatment time led to a greater change in BMI SDS from baseline, and patients with a higher BMI at the start of treatment had a greater decrease in BMI over time. Conclusions GH is effective in the management of children with PWS. Earlier treatment resulted in a greater gain in height, and a longer treatment period resulted in better outcomes for both height and BMI. Trial registration This study was registered with ClinicalTrials.gov (NCT01009905) on November 9, 2009.
Collapse
Affiliation(s)
| | | | | | - Vlady Ostrow
- Novo Nordisk Inc., 800 Scudders Mills Rd, Plainsboro, NJ, 08536, USA
| | - Nicky Kelepouris
- Novo Nordisk Inc., 800 Scudders Mills Rd, Plainsboro, NJ, 08536, USA.
| | - Maithe Tauber
- Center for Physiopathology of Toulouse-Purpan, and the Reference Centre for PWS, Department of Endocrinology, Children's Hospital, CHU Toulouse, Toulouse, France
| |
Collapse
|
39
|
Vrana-Diaz CJ, Balasubramanian P, Kayadjanian N, Bohonowych J, Strong TV. Variability and change over time of weight and BMI among adolescents and adults with Prader-Willi syndrome: a 6-month text-based observational study. Orphanet J Rare Dis 2020; 15:233. [PMID: 32883323 PMCID: PMC7469274 DOI: 10.1186/s13023-020-01504-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare neurodevelopmental disorder in which hyperphagia (excessive appetite) is a hallmark feature. Understanding how weight changes over time in this population is important for capturing the contemporary natural history of the disorder as well as assessing the impact of new treatments for hyperphagia. Therefore, we aimed to determine the feasibility of a remote assessment of weight change over time in PWS. METHODS We developed a text message-based, prospective cohort study of adolescents and adults with PWS to assess changes in weight and body mass index (BMI) over a six-month period. Weight was collected weekly, while changes in height, living situation, access to food, activity level, and medication were collected at three-month intervals. RESULTS One hundred and sixty-five participants enrolled in the study, with a mean age of 19.7 years (range 12-48). There was considerable variability in weight across participants (range: 76.8-207.7 kg). Thirty-three percent of the participants were normal weight, while 15% were overweight and 52% were obese. Overall, the weight of the study participants increased over the study period (mean weight change + 2.35%), while BMI was relatively stable, albeit high (mean BMI of 31.4 at baseline, mean BMI percent change + 1.42%). Changes in living situation, activity, food access, and medication had limited impact on weight and BMI changes. Multivariable analysis found that time, sex, age, and percentage of life on growth hormone (GH) therapy were statistically significant fixed effects. Participants submitted more than 95% of possible weight data points across the 26 weeks of the study. CONCLUSIONS This remote, observational study of weight change in PWS showed small increases in weight and BMI over a six-month period. Participants were highly compliant with this text message-based study, suggesting that mobile technology-based data collection was manageable for the participants. We anticipate that the results of this study will inform clinical trials for hyperphagia/obesity related therapies in PWS and provide a basis for understanding the efficacy of new therapies for hyperphagia in the real-world setting.
Collapse
Affiliation(s)
- Caroline J Vrana-Diaz
- Foundation for Prader-Willi Research, 340 S. Lemon Ave, #3620, Walnut, CA, 91789, USA
| | - Priya Balasubramanian
- Foundation for Prader-Willi Research, 340 S. Lemon Ave, #3620, Walnut, CA, 91789, USA.,Present Address: Citizens United for Research in Epilepsy, Chicago, USA
| | - Nathalie Kayadjanian
- Foundation for Prader-Willi Research, 340 S. Lemon Ave, #3620, Walnut, CA, 91789, USA
| | - Jessica Bohonowych
- Foundation for Prader-Willi Research, 340 S. Lemon Ave, #3620, Walnut, CA, 91789, USA
| | - Theresa V Strong
- Foundation for Prader-Willi Research, 340 S. Lemon Ave, #3620, Walnut, CA, 91789, USA.
| |
Collapse
|