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Consiglieri G, Tucci F, De Pellegrin M, Guerrini B, Cattoni A, Risca G, Scarparo S, Sarzana M, Pontesilli S, Mellone R, Gasperini S, Galimberti S, Silvani P, Filisetti C, Darin S, Forni G, Miglietta S, Santi L, Facchini M, Corti A, Fumagalli F, Cicalese MP, Calbi V, Migliavacca M, Barzaghi F, Ferrua F, Gallo V, Recupero S, Canarutto D, Doglio M, Tedesco L, Volpi N, Rovelli A, la Marca G, Valsecchi MG, Zancan S, Ciceri F, Naldini L, Baldoli C, Parini R, Gentner B, Aiuti A, Bernardo ME. Early skeletal outcomes after hematopoietic stem and progenitor cell gene therapy for Hurler syndrome. Sci Transl Med 2024; 16:eadi8214. [PMID: 38691622 DOI: 10.1126/scitranslmed.adi8214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/19/2023] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
Mucopolysaccharidosis type I Hurler (MPSIH) is characterized by severe and progressive skeletal dysplasia that is not fully addressed by allogeneic hematopoietic stem cell transplantation (HSCT). Autologous hematopoietic stem progenitor cell-gene therapy (HSPC-GT) provides superior metabolic correction in patients with MPSIH compared with HSCT; however, its ability to affect skeletal manifestations is unknown. Eight patients with MPSIH (mean age at treatment: 1.9 years) received lentiviral-based HSPC-GT in a phase 1/2 clinical trial (NCT03488394). Clinical (growth, measures of kyphosis and genu velgum), functional (motor function, joint range of motion), and radiological [acetabular index (AI), migration percentage (MP) in hip x-rays and MRIs and spine MRI score] parameters of skeletal dysplasia were evaluated at baseline and multiple time points up to 4 years after treatment. Specific skeletal measures were retrospectively compared with an external cohort of HSCT-treated patients. At a median follow-up of 3.78 years after HSPC-GT, all patients treated with HSPC-GT exhibited longitudinal growth within WHO reference ranges and a median height gain greater than that observed in patients treated with HSCT after 3-year follow-up. Patients receiving HSPC-GT experienced complete and earlier normalization of joint mobility compared with patients treated with HSCT. Mean AI and MP showed progressive decreases after HSPC-GT, suggesting a reduction in acetabular dysplasia. Typical spine alterations measured through a spine MRI score stabilized after HSPC-GT. Clinical, functional, and radiological measures suggested an early beneficial effect of HSPC-GT on MPSIH-typical skeletal features. Longer follow-up is needed to draw definitive conclusions on HSPC-GT's impact on MPSIH skeletal dysplasia.
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Affiliation(s)
- Giulia Consiglieri
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Francesca Tucci
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | | | | | - Alessandro Cattoni
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Giulia Risca
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20854 Vedano al Lambro, Italy
| | - Stefano Scarparo
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Marina Sarzana
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Silvia Pontesilli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Renata Mellone
- Radiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Serena Gasperini
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
| | - Stefania Galimberti
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20854 Vedano al Lambro, Italy
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Paolo Silvani
- Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Chiara Filisetti
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Silvia Darin
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giulia Forni
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
| | - Simona Miglietta
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Ludovica Santi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Marcella Facchini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Ambra Corti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Francesca Fumagalli
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Valeria Calbi
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Maddalena Migliavacca
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Federica Barzaghi
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Francesca Ferrua
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Vera Gallo
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Daniele Canarutto
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Matteo Doglio
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Lucia Tedesco
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Laboratory of Biochemistry and Glycobiology, 41125 Modena, Italy
| | - Attilio Rovelli
- Paediatrics, IRCCS San Gerardo dei Tintori Foundation, 20900 Monza, Italy
| | - Giancarlo la Marca
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy
- Newborn Screening, Clinical Chemistry and Pharmacology Laboratory, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Maria Grazia Valsecchi
- Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, School of Medicine and Surgery, University of Milano-Bicocca, 20854 Vedano al Lambro, Italy
- Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Stefano Zancan
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Fabio Ciceri
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
- Department of Haematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rossella Parini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- Ludwig Institute for Cancer Research and Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), 1015 Lausanne, Switzerland
| | - Alessandro Aiuti
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
| | - Maria Ester Bernardo
- Pediatric Immunohematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), 20132 Milan, Italy
- "Vita-Salute" San Raffaele University, 20132 Milan, Italy
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Faccioli S, Sassi S, Pandarese D, Borghi C, Montemaggiori V, Sarzana M, Scarparo S, Butera C, Calbi V, Aiuti A, Fumagalli F. Preserving Ambulation in a Gene Therapy-Treated Girl Affected by Metachromatic Leukodystrophy: A Case Report. J Pers Med 2023; 13:jpm13040637. [PMID: 37109023 PMCID: PMC10144348 DOI: 10.3390/jpm13040637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
(1) Background: Atidarsagene autotemcel is a hematopoietic stem and progenitor cell gene therapy (HSPC-GT) approved to treat early-onset metachromatic leukodystrophy (MLD). The purpose of this case report is to describe the long-term management of residual gait impairment of a child with late infantile MLD treated with HSPC-GT. (2) Methods: Assessment included Gross Motor Function Measure-88, nerve conduction study, body mass index (BMI), Modified Tardieu Scale, passive range of motion, modified Medical Research Council scale, and gait analysis. Interventions included orthoses, a walker, orthopedic surgery, physiotherapy, and botulinum. (3) Results: Orthoses and a walker were fundamental to maintaining ambulation. Orthopedic surgery positively influenced gait by reducing equinovarus. Nonetheless, unilateral recurrence of varo-supination was observed, attributable to spasticity and muscle imbalance. Botulinum improved foot alignment but induced transient overall weakness. A significant increase in BMI occurred. Finally, a shift to bilateral valgopronation was observed, more easily managed with orthoses. (4) Conclusions: HSPC-GT preserved survival and locomotor abilities. Rehabilitation was then considered fundamental as a complementary treatment. Muscle imbalance and increased BMI contributed to gait deterioration in the growing phase. Caution is recommended when considering botulinum in similar subjects, as the risk of inducing overall weakness can outweigh the benefits of spasticity reduction.
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Affiliation(s)
- Silvia Faccioli
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy
- PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Silvia Sassi
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Daniela Pandarese
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Corrado Borghi
- Children Rehabilitation Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Valentina Montemaggiori
- Orthopaedic Unit of S. M. Nuova Hospital, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Marina Sarzana
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
| | - Stefano Scarparo
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
| | - Carla Butera
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
| | - Valeria Calbi
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
| | - Alessandro Aiuti
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
- Vita-Salute San Raffaele University, 20019 Milan, Italy
| | - Francesca Fumagalli
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, 20019 Milan, Italy
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