Intrathecal enzyme replacement therapy reverses cognitive decline in mucopolysaccharidosis type I

Igor Nestrasil, Elsa Shapiro, Alena Svatkova, Patricia Dickson, Agnes Chen, Amy Wakumoto, Alia Ahmed, Edward Stehel, Sarah McNeil, Curtis Gravance, Elizabeth Maher

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Mucopolysaccharidosis type I (MPS I) is an inherited lysosomal storage disease that seriously affects the brain. Severity of neurocognitive symptoms in attenuated MPS subtype (MPS IA) broadly varies partially, due to restricted permeability of blood-brain barrier (BBB) which limits treatment effects of intravenously applied α-L-iduronidase (rhIDU) enzyme. Intrathecal (IT) rhIDU application as a possible solution to circumvent BBB improved brain outcomes in canine models; therefore, our study quantifies effects of IT rhIDU on brain structure and function in an MPS IA patient with previous progressive cognitive decline. Neuropsychological testing and MRIs were performed twice prior (baseline, at 1 year) and twice after initiating IT rhIDU (at 2nd and 3rd years). The difference between pre- and post-treatment means was evaluated as a percentage of the change. Neurocognitive performance improved particularly in memory tests and resulted in improved school performance after IT rhIDU treatment. White matter (WM) integrity improved together with an increase of WM and corpus callosum volumes. Hippocampal and gray matter volume decreased which may either parallel reduction of glycosaminoglycan storage or reflect typical longitudinal brain changes in early adulthood. In conclusion, our outcomes suggest neurological benefits of IT rhIDU compared to the intravenous administration on brain structure and function in a single MPS IA patient.

Original languageEnglish (US)
Pages (from-to)780-783
Number of pages4
JournalAmerican Journal of Medical Genetics, Part A
Volume173
Issue number3
DOIs
StatePublished - Mar 1 2017

Bibliographical note

Funding Information:
Funding for this study was provided by The Ryan Foundation (a private MPS I family charitable organization), BioMarin Pharmaceutical, Inc., and the Lysosomal Disease Network. The Lysosomal Disease Network (U54NS065768) is a part of the National Institutes of Health (NIH) Rare Diseases Clinical Research Network (RDCRN), supported through collaboration between the NIH Office of Rare Diseases Research (ORDR) at the National Center for Advancing Translational Science (NCATS), the National Institute of Neurological Disorders and Stroke (NINDS), and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Additional support was received from National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114 and by the project ?CEITEC 2020 (LQ1601)? from the Ministry of Education, Youth and Sports of the Czech Republic (to AS).

Publisher Copyright:
© 2017 Wiley Periodicals, Inc.

Keywords

  • blood-brain barrier
  • brain
  • diffusion tensor imaging
  • enzyme replacement therapy
  • intrathecal administration
  • magnetic resonance imaging
  • mucopolysaccharidosis
  • neuropsychology

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