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Zhu J, Sun Y, Zheng W, Wang C. Case report: Multidisciplinary collaboration in diagnosis and treatment of child gaucher disease. Front Pediatr 2023; 11:1057574. [PMID: 37063666 PMCID: PMC10098188 DOI: 10.3389/fped.2023.1057574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Gaucher disease (GD) is an inherited lysosomal storage disease caused by mutations in the glucocerebrosidase gene. The decrease of glucocerebrosidase activity in lysosomes results in the accumulation of its substrate glucocerebroside in the lysosomes of macrophages in organs such as the liver, spleen, bones, lungs, brain and eyes, and the formation of typical storage cells, namely "Gaucher cells", leading to lesions in the affected tissues and organs. Hepatosplenomegaly, bone pain, cytopenia, neurological symptoms, and other systemic manifestations are common in clinical practice. Most pediatric patients have severe symptoms. Early diagnosis and treatment are crucial to improve the curative effect and prognosis. However, due to the low incidence of this disease, multi-system involvement in patients, and diverse clinical manifestations, multidisciplinary teamwork is needed for comprehensive evaluation, diagnosis and treatment. In this study, we reported 2 cases of different types of GD who were diagnosed, treated and followed up by multidisciplinary collaboration in infancy.
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Affiliation(s)
- Jianfang Zhu
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxiao Sun
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiyan Zheng
- Department of Hematology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunlin Wang
- Department of Pediatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Correspondence: Chunlin Wang
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Vece TJ, Popler J, Gower WA. Pediatric pulmonology 2020 year in review: Rare and diffuse lung disease. Pediatr Pulmonol 2022; 57:807-813. [PMID: 34964566 DOI: 10.1002/ppul.25807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/08/2022]
Abstract
Pediatric Pulmonology publishes original research, review articles, and case reports on topics related to a wide range of children's respiratory disorders. Here we review some of the most notable manuscripts published in 2020 in this journal on (1) children's interstitial lung disease (chILD), (2) congenital airway and lung anomalies, and (3) primary ciliary dyskinesia and other non-cystic fibrosis bronchiectasis. The articles reviewed are discussed in context with published works from other journals.
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Affiliation(s)
- Timothy J Vece
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jonathan Popler
- Children's Physician Group - Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - William A Gower
- Division of Pediatric Pulmonology and Program for Rare and Interstitial Lung Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Kishnani PS, Al-Hertani W, Balwani M, Göker-Alpan Ö, Lau HA, Wasserstein M, Weinreb NJ, Grabowski G. Screening, patient identification, evaluation, and treatment in patients with Gaucher disease: Results from a Delphi consensus. Mol Genet Metab 2022; 135:154-162. [PMID: 34972655 DOI: 10.1016/j.ymgme.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 02/06/2023]
Abstract
Several guidelines are available for identification and management of patients with Gaucher disease, but the most recent guideline was published in 2013. Since then, there have been significant advances in newborn screening, phenotypic characterization, identification of biomarkers and their integration into clinical practice, and the development and approval of new treatment options. Accordingly, the goal of this Delphi consensus exercise was to extend prior initiatives of this type by addressing issues related to newborn screening, diagnostic evaluations, and treatment (both disease directed and adjunctive). The iterative Delphi process involved creation of an initial slate of statements, review by a steering committee, and three rounds of consensus development by an independent panel. A preliminary set of statements was developed by the supporting agency based on literature searches covering the period from 1965 to 2020. The Delphi process reduced an initial set of 185 statements to 65 for which there was unanimous support from the panel. The statements supported may ultimately provide a framework for more detailed treatment guidelines. In addition, the statements for which unanimous support could not be achieved help to identify evidence gaps that are targets for future research.
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Affiliation(s)
- Priya S Kishnani
- Duke University Medical Center, Department of Molecular Genetics and Microbiology, 905 Lasalle Street, GSRB1, 4th Floor, Durham, NC 27710, USA.
| | - Walla Al-Hertani
- Harvard Medical School, Boston Children's Hospital, Department of Pediatrics, Division of Genetics and Genomics, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Manisha Balwani
- Icahn School of Medicine at Mount Sinai, Division of Medical Genetics and Genomics, Department of Genetics and Genomic Sciences, 1428 Madison Avenue, 1st Floor, New York, NY 10029, USA
| | - Özlem Göker-Alpan
- Lysosomal & Rare Disorders Research & Treatment Center, 3702 Pender Drive, Suite 170, Fairfax, VA 22030, USA
| | - Heather A Lau
- Ultragenyx Pharmaceutical Inc., Global Clinical Development, 840 Memorial Drive, Cambridge, MA 02139, USA
| | - Melissa Wasserstein
- The Children's Hospital at Montefiore and the Albert Einstein College of Medicine, Division of Pediatric Genetic Medicine, Departments of Pediatrics and Genetics, 3411 Wayne Ave, 9th Floor, Bronx, NY 10467, USA
| | - Neal J Weinreb
- University of Miami Miller School of Medicine, Departments of Human Genetics and Medicine, Hematology Division, 7367 Wexford Terrace, Boca Raton, FL 33433, USA
| | - Gregory Grabowski
- University of Cincinnati College of Medicine, Department of Pediatrics, and Department of Molecular Genetics, Biochemistry and Microbiology, Division of Human Genetics, Cincinnati Children's Hospital Research Foundation, Cincinnati, OH, USA
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Gumus E, Karhan AN, Hizarcioglu-Gulsen H, Demir H, Ozen H, Saltik Temizel IN, Dokmeci Emre S, Yuce A. Clinical-genetic characteristics and treatment outcomes of Turkish children with Gaucher disease type 1 and type 3: A sixteen year single-center experience. Eur J Med Genet 2021; 64:104339. [PMID: 34500086 DOI: 10.1016/j.ejmg.2021.104339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/31/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022]
Abstract
Data from 38 children were retrospectively analyzed to determine the patient characteristics of Turkish children with Gaucher disease (GD) and evaluate the impact of enzyme replacement therapy (ERT) in a pediatric cohort consisting of two different sub-types of the disease, Gaucher disease type 1 (GD1) and type 3 (GD3). Both types were represented equally (GD1/GD3 = 20/18). L444P (35.5%) was the most common mutant allele while L444P/L444P (34.2%) was the most common genotype overall. Compound heterozygosity of N370S and L444P homozygosity were the dominant genotypes in Turkish children with GD1 and GD3, respectively. None of the patients had moderate to severe thrombocytopenia at last follow-up while the percent of patients with anemia decreased from 60% to 5.7% (p < 0.001). Significant improvements in mean liver (from 2.2 to 1.6 MN, p < 0.001) and spleen (from 15.5 to 7.6 MN, p < 0.001) volumes were observed in the first year of ERT. Linear growth was ameliorated as shown by the decrease in the percent of patients having short stature from 34.3% to 13.3% (p < 0.01) at year 5. Erlenmeyer flask deformity, osteopenia and scoliosis were common skeletal findings. Although none of the patients had lung disease at diagnosis, 20% developed radiological findings suggestive of pulmonary involvement. This single center experience is the first comprehensive study from Turkey not only reporting clinical and genetic characteristics of GD patients but also providing information on the outcomes of ERT in two different sub-types of GD. Genotypic background of Turkish children with GD is similar to western populations. Although visceral and hematological therapeutic goals are reached as early as one year of ERT in both sub-types, achieving normal growth takes several more years than suggested in significant number of children with GD.
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Affiliation(s)
- Ersin Gumus
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey.
| | - Asuman Nur Karhan
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | | | - Hulya Demir
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Hasan Ozen
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Inci Nur Saltik Temizel
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
| | - Serap Dokmeci Emre
- Department of Medical Biology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysel Yuce
- Department of Pediatric Gastroenterology, Hacettepe University Children's Hospital, Ankara, Turkey
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Ramaswami U, Mengel E, Berrah A, AlSayed M, Broomfield A, Donald A, Seif El Dein HM, Freisens S, Hwu WL, Peterschmitt MJ, Yoo HW, Abdelwahab M. Throwing a spotlight on under-recognized manifestations of Gaucher disease: Pulmonary involvement, lymphadenopathy and Gaucheroma. Mol Genet Metab 2021; 133:335-344. [PMID: 34229967 DOI: 10.1016/j.ymgme.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gaucher disease (GD) is a rare lysosomal storage disorder classically subdivided into type 1 (non-neuronopathic) GD, and types 2 and 3 (neuronopathic) GD. It is typically characterized by clinical manifestations including anemia, thrombocytopenia, hepatosplenomegaly, bone lesions, and (in more severe forms) neurological impairment. However, less-commonly reported and often under-recognized manifestations exist, which potentially have a significant impact on patient outcomes. Greater efforts are needed to understand, recognize, and manage these manifestations. OBJECTIVES This review provides a synthesis of published information about three under-recognized GD manifestations (pulmonary involvement, lymphadenopathy, and Gaucheroma) and recommends diagnostic, management, and treatment strategies based on the available literature and author experience. The authors aim to raise awareness about these serious, progressive, and sometimes life-threatening conditions, which are often diagnosed late in life. CONCLUSIONS Little is known about the incidence, pathophysiology, prognostic factors, and optimal management of pulmonary involvement, lymphadenopathy, and Gaucheroma in patients with GD. Enzyme replacement therapy (ERT) has shown limited efficacy for the prevention and treatment of these manifestations. More research is needed to evaluate the potential effect of substrate reduction therapy (SRT) with glucosylceramide synthase (GCS) inhibitors, and to develop additional approaches to treat these GD manifestations. Improvements in data collection registries and international data-sharing are required to better understand the impact of these manifestations on GD patients, help develop effective management strategies, and, ultimately, improve patient outcomes.
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Affiliation(s)
| | | | | | - Moeenaldeen AlSayed
- Alfaisal University and King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Alex Broomfield
- Willink Biochemical Genetics Unit, Manchester Center for Genomic Medicine, Manchester Foundation NHS Trust, UK
| | - Aimee Donald
- Willink Unit, Saint Mary's Hospital, Manchester, UK
| | | | | | | | | | - Han-Wook Yoo
- Asan Medical Center Children's Hospital, Seoul, South Korea; University of Ulsan College of Medicine, Seoul, South Korea
| | - Magy Abdelwahab
- Cairo University Pediatric Hospital, Cairo, Egypt; Social and Preventive Medicine Center, Kasr Elainy Hospital, Cairo, Egypt.
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Lee FS, Yen HJ, Niu DM, Hung GY, Lee CY, Yeh YC, Chen PCH, Chang SK, Yang CF. Allogeneic hematopoietic stem cell transplantation for treating severe lung involvement in Gaucher disease. Mol Genet Metab Rep 2020; 25:100652. [PMID: 33101978 PMCID: PMC7576510 DOI: 10.1016/j.ymgmr.2020.100652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/18/2020] [Accepted: 09/19/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To provide strategies for monitoring and treating severe lung involvement in Gaucher disease. Study design We reviewed the chart of a 5-year-old boy who developed rapidly progressive, severe infiltrative lung involvement of Gaucher disease (GD) and improved after allogeneic hematopoietic stem cell transplant (HSCT), along with other case studies reported before December 2019. He was diagnosed with GD (homozygous mutation at c.1448 T > C, p.L483P), and started receiving enzyme replacement therapy (ERT) at 17 months old. He developed respiratory distress symptoms after 45 months of ERT; chest imaging reported diffuse interstitial infiltration of the bilateral lungs and consolidations at the right lungs. Allogeneic HSCT using cells from a matched unrelated donor was performed four months upon progressive respiratory symptoms. Results His respiratory symptoms subsided in one month; chest imaging improvement, pulmonary function test improvement, and normalized activity of β-glucocerebrosidase were reported in three months. Conclusion This is the first report of a patient who received early and regular ERT but developed severe infiltrative lung involvement and recovered after allogeneic HSCT. Based on study results, we suggest regular chest imaging, even for asymptomatic patients. For patients with severe lung involvement, rapid deterioration, and unresponsive to higher ERT dosages, allogeneic HSCT should be considered.
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Affiliation(s)
- Fu-Shiuan Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsiu-Ju Yen
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Giun-Yi Hung
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Ying Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Paul Chih-Hsueh Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Sheng-Kai Chang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Tantawy AAG, Adly AAM, Hashem NH, Ebeid WM, Abdeen MS, Salah NY. Ganglion Cell Complex Thinning in Young Gaucher Patients: Relation to Prodromal Parkinsonian Markers. Mov Disord 2020; 35:2211-2219. [PMID: 32918500 DOI: 10.1002/mds.28256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/09/2020] [Accepted: 07/28/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with Gaucher disease (GD) have an increased risk for parkinsonism. Retinal thinning has been described in parkinsonism as an early nonmotor feature. Scarce reports have addressed retinal thickness changes in GD. OBJECTIVES The objectives of this study were to compare ganglion cell complex (GCC) thickness in adolescents and young adults (AYAs) with GD with healthy control subjects, and to correlate it with the presence of parkinsonian features (PFs), clinical prodromal markers of parkinsonism, severity score index (SSI), and glucosylsphingosine (Lyso-GL-1). METHODS This study included 48 AYAs with GD (11-29 years), 11 with manifest PFs (Group 1) and 37 with no PFs (Group 2), and 48 matched healthy control subjects (Group 3). Age of GD onset, disease duration, medication history, history of constipation, SSI, and hematological assessment were done. Neurocognitive evaluation included Parts I, II, and III of the Unified Parkinson's Disease Rating Scale (UPDRS), Wechsler Adult and Intelligence Scale and Wechsler Intelligence Scale for Children, Beck Depression Inventory (BDI), rapid eye movement sleep behavior disorder (RBD) scale, Munich Parasomnia Screening scale, and the olfactory dysfunction scale. Molecular analyses of the acid GBA gene and Lyso-GL-1 were done. Participants underwent full ophthalmological examination and optical coherence tomography with GCC thickness measurement. RESULTS GCC was significantly thinner in Group 1 than in Groups 2 and 3 (P < 0.001), whereas no significant difference was found between Groups 2 and 3 (P = 0.977). In addition, a significant interocular GCC thickness difference was found among the studied AYAs with GD (P = 0.007). GCC correlated positively with total intelligence quotient (P < 0.001) and negatively with Lyso-GL-1 (P = 0.019), UPDRS (P = 0.004), and BDI (P = 0.029), but not with SSI (P = 0.874), GD type (P = 0.85), or genotype (P = 0.842). A significant negative relationship was found between GCC thickness and PFs (P = 0.001), parasomnia (P = 0.003), constipation (P = 0.031), RBD (P = 0.044), and hyposmia (P = 0.033). CONCLUSIONS GCC thinning may be a promising biomarker for central nervous system neurodegeneration that has the potential to monitor early PFs among people with GD. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | | | | | - Weam Mohamed Ebeid
- Opthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mai Seifeldin Abdeen
- Opthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Psychiatry department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nouran Yousef Salah
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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