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Bingaman A, Waggoner C, Andrews SM, Pangonis D, Trad M, Giugliani R, Giorgino R, Jarnes J, Vakili R, Ballard V, Peay HL. GM1-gangliosidosis: The caregivers' assessments of symptom impact and most important symptoms to treat. Am J Med Genet A 2023; 191:408-423. [PMID: 36541412 PMCID: PMC10107815 DOI: 10.1002/ajmg.a.63038] [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] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/09/2022] [Accepted: 10/17/2022] [Indexed: 12/24/2022]
Abstract
GM1-gangliosidosis (GM1) is a rare neurodegenerative disorder leading to early mortality and causing progressive decline of physical skills and cerebral functioning. No approved treatment for GM1 exists. In this study-the first to explore priorities of parents of subjects with pediatric onset forms of GM1-we address a crucial gap by characterizing symptoms most critical to caregivers of children with GM1 to treat. Our two-part, mixed-methods approach began with focus groups, followed by interviews with a distinct set of parents. Interviews included a prioritization activity that used best-worst scaling. Quantitative data were analyzed descriptively. Qualitative data were analyzed using thematic analysis and rapid analysis process. Parents prioritized the symptoms they believed would increase their child's lifespan and improve their perceived quality of life (QoL); these symptoms focused on communicating wants/needs, preventing pain/discomfort, getting around and moving one's body, and enhancing eating/feeding. Although lifespan was highly valued, almost all parents would not desire a longer lifespan without acceptable child QoL. Parents indicated high caregiver burden and progressive reduction in QoL for children with GM1. This novel study of caregiver priorities identified important symptoms for endpoints' selection in patient-focused drug development in the context of high disease impact and unmet treatment needs.
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Affiliation(s)
- Amanda Bingaman
- RTI International, Research Triangle, North Carolina, United States
| | | | - Sara M Andrews
- RTI International, Research Triangle, North Carolina, United States
| | - Diana Pangonis
- National Tay-Sachs & Allied Diseases Association (NTSAD), Brighton, Massachusetts, United States
| | | | - Roberto Giugliani
- PPGBM UFRGS, DASA Genomics and Casa dos Raros, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Jeanine Jarnes
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, United States
| | | | | | - Holly L Peay
- RTI International, Research Triangle, North Carolina, United States
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Ou L, Przybilla MJ, Ahlat O, Kim S, Overn P, Jarnes J, O'Sullivan MG, Whitley CB. A Highly Efficacious PS Gene Editing System Corrects Metabolic and Neurological Complications of Mucopolysaccharidosis Type I. Mol Ther 2020; 28:1442-1454. [PMID: 32278382 PMCID: PMC7264433 DOI: 10.1016/j.ymthe.2020.03.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/06/2020] [Accepted: 03/31/2020] [Indexed: 12/19/2022] Open
Abstract
Our previous study delivered zinc finger nucleases to treat mice with mucopolysaccharidosis type I (MPS I), resulting in a phase I/II clinical trial (ClinicalTrials.gov: NCT02702115). However, in the clinical trial, the efficacy needs to be improved due to the low transgene expression level. To this end, we designed a proprietary system (PS) gene editing approach with CRISPR to insert a promoterless α-l-iduronidase (IDUA) cDNA sequence into the albumin locus of hepatocytes. In this study, adeno-associated virus 8 (AAV8) vectors delivering the PS gene editing system were injected into neonatal and adult MPS I mice. IDUA enzyme activity in the brain significantly increased, while storage levels were normalized. Neurobehavioral tests showed that treated mice had better memory and learning ability. Also, histological analysis showed efficacy reflected by the absence of foam cells in the liver and vacuolation in neuronal cells. No vector-associated toxicity or increased tumorigenesis risk was observed. Moreover, no off-target effects were detected through the unbiased genome-wide unbiased identification of double-stranded breaks enabled by sequencing (GUIDE-seq) analysis. In summary, these results showed the safety and efficacy of the PS in treating MPS I and paved the way for clinical studies. Additionally, as a therapeutic platform, the PS has the potential to treat other lysosomal diseases.
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Affiliation(s)
- Li Ou
- Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Michael J Przybilla
- Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ozan Ahlat
- Comparative Pathology Shared Resource, University of Minnesota Masonic Cancer Center, Saint Paul, MN 55108, USA
| | - Sarah Kim
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Paula Overn
- Comparative Pathology Shared Resource, University of Minnesota Masonic Cancer Center, Saint Paul, MN 55108, USA
| | - Jeanine Jarnes
- Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - M Gerard O'Sullivan
- Comparative Pathology Shared Resource, University of Minnesota Masonic Cancer Center, Saint Paul, MN 55108, USA
| | - Chester B Whitley
- Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
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Eisengart JB, Jarnes J, Ahmed A, Nestrasil I, Ziegler R, Delaney K, Shapiro E, Whitley C. Long-term cognitive and somatic outcomes of enzyme replacement therapy in untransplanted Hurler syndrome. Mol Genet Metab Rep 2017; 13:64-68. [PMID: 28983455 PMCID: PMC5622996 DOI: 10.1016/j.ymgmr.2017.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 06/02/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 11/26/2022] Open
Abstract
Mucopolysaccharidosis type I (MPS I) was added to the Recommended Uniform Screening Panel for newborn screening in 2016, highlighting recognition that early treatment of MPS I is critical to stem progressive, irreversible disease manifestations. Enzyme replacement therapy (ERT) is an approved treatment for all MPS I phenotypes, but because the severe form (MPS IH, Hurler syndrome) involves rapid neurocognitive decline, the impermeable blood-brain-barrier is considered an obstacle for ERT. Instead, hematopoietic cell transplantation (HCT) has long been recommended, as it is believed to be the only therapy that arrests neurocognitive decline. Yet ERT monotherapy has never been compared to HCT, because it is unethically unacceptable to evaluate a therapeutic alternative to one shown to treat Central Nervous System (CNS) disease. An unusual opportunity to address this question is presented with this clinical report of a 16-year-old female with MPS IH treated only with ERT since her diagnosis at age 2. Neurological functioning was stable until cervical spinal cord compression at age 8, hydrocephalus at age 11, and neurocognitive declines beginning at age 10. Somatic disease burden is significant for first degree AV block, restrictive lung disease, bilateral hearing loss, severe corneal clouding, joint pain/limitations requiring mobility assistance, and short stature. This patient's extended survival and prolonged intact neurocognitive functioning depart from the untreated natural history of MPS IH. Disease burden typically controlled by HCT emerged. Although not anticipated to provide benefit for CNS disease, ERT may have provided some amelioration or slowing of neurocognitive deterioration.
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Affiliation(s)
- Julie B Eisengart
- Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Jeanine Jarnes
- College of Pharmacy, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Alia Ahmed
- Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Igor Nestrasil
- Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Richard Ziegler
- Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | | | - Elsa Shapiro
- Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.,Shapiro Neuropsychology Consulting, LLC, 820 NW 12th Avenue #304, Portland, OR 97209, USA
| | - Chester Whitley
- Department of Pediatrics, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.,College of Pharmacy, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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