ABSTRACT
OBJECTIVE@#To explore the long-term efficacy of allogeneic hematopoietic stem cell transplantation (alloHSCT) in patients with Mucopolysaccharidosis (MPS), which has rarely been reported in China.@*METHODS@#A 18-month-old boy and a 23-month-old girl undergoing alloHSCT for MPS VI and MPS IH Shanghai Children's Medical Center on March 30, 2006 and September 6, 2006 were selected as the study subjects. A busulfan-based myeloablative regimen was used as the conditioning regimen. Peripheral stem cells were respectively collected from a human leucocyte antigen (HLA) matched sibling carrier donor and a HLA 9/10 matched unrelated donor. Both patients were followed up for more than 15 years. The functions of internal organs before and after the transplantation were compared, and child 1 was also compared with his untreated brother and healthy brother.@*RESULTS@#Both children have achieved full donor chimerism after the transplantation, and their enzymatic activities have remained stable. The enzymatic activity of the child 1 was slightly lower than normal but similar to that of his carrier donor, whilst that of the child 2 was normal. Both children have attended schools with good academic performance. Compared with his untreated brother, the respiratory function and hearing of child 1 have significantly improved. However, his orthopedic and cardiac disorders have still remained and required medical intervention. For child 2, her obstructive pulmonary disease was resolved and cognitive development was well preserved after the HSCT. Her heart disease has become stabilized and even improved with time, though her corneal clouding and skeletal malformation still required surgery.@*CONCLUSION@#MPS patients can sustain long-term and stable enzymatic activities after successful alloHSCT. Compared with untreated patients, their health can be significantly improved, along with considerably prolonged survival, though the long-term efficacy of HSCT for different organs may vary to a certain extent.
Subject(s)
Humans , Child , Male , Female , Infant , Child, Preschool , Graft vs Host Disease/etiology , China , Hematopoietic Stem Cell Transplantation/adverse effects , Mucopolysaccharidoses/etiology , Busulfan , Treatment OutcomeABSTRACT
INTRODUÇÃO: Mucopolissacaridose (MPS) é um conjunto de doenças raras causadas pela deficiência de enzimas lisossômicas levando ao acúmulo de glicosaminoglanos (GAG) em órgãos e tecidos, responsáveis pelo quadro clínico multissistêmico, crônico e progressivo. OBJETIVO: Descrever o perfil do exame clínico otorrinolaringológico de pacientes acompanhados no submetidos à Terapia de Reposição Enzimática (TRE) e propor um algoritmo de acompanhamento otorrinolaringológico para estes pacientes. MÉTODO: Realizado estudo de série de casos incluindo 21 pacientes com MPS I, II e VI. RESULTADOS: As queixas otorrinolaringológicas mais frequentes foram obstrução nasal, roncos, respiração bucal. A presença de apneia foi relatada em 31 por cento dos casos. No exame físico a macroglossia foi a principal alteração (41 por cento) da orofaringoscopia. Na otoscopia, a retração da membrana timpânica esteve presente em 33 por cento e a queixa de hipoacusia esteve presente em 45 por cento. CONCLUSÃO: É importante avaliar as queixas, exame físico e o impacto das alterações associadas à respiração e audição produzidas pela MPS visando um melhor acompanhamento destes pacientes e a prevenção das alterações crônicas resultantes como a perda auditiva, distúrbios do sono e respiração bucal, promovendo assim uma melhor qualidade de vida destes pacientes.
INTRODUCTION: Mucopolysaccharidosis (MPS) is a group of rare diseases caused by the deficit of lysosomal enzymes, causing an accumulation of glycosaminoglycans (GAG) in organs and tissues responsible for the multi-systemic clinical, chronic and progressive status. OBJECTIVE: Describe the profile of the otorhinolaryngologic clinical evaluation in patients submitted to Enzyme Replacement Therapy (ERT) and suggest an algorithm to otorhinolaryngolgically follow up with these patients. METHOD: A study with a number of cases was performed, including 21 patients having MPS I, II and VI. RESULTS: The most common otorhinolaryngological complaints were nasal obstruction, snore, and mouth-breathing. Apnea was reported in 31 percent of the cases. In the physical examination, macroglossia was the main alteration (41 percent) of oral pharyngoscopy. At otoscopy, the retraction of the tympanic membrane was found in 33 percent and hearing loss was found in 45 percent. CONCLUSION: It is important to evaluate the complaints, physical examination and the impact of alterations associated with MPS-produced breathing and hearing, for purposes of better following up with these patients and preventing consequential chronic alterations such as hearing loss, sleep disorder, and mouth breathing, thus, enhancing these patients' quality of life.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Glycosaminoglycans , Mucopolysaccharidoses/etiology , Otorhinolaryngologic Diseases/pathologyABSTRACT
Las mucopolisacaridosis (MPS) son errores innatos del metabolismo de los glicosaminoglicanos (GAG), que ocurren por déficit de alguna de las enzimas que degradan estas moléculas en los lisosomas. Esto conduce al depósito intralisosomal progresivo de GAG en diferentes tejidos, lo que explica el carácter multistémico de estas patologías. Las MPS, se presentan con una frecuencia aproximada de 1 caso en 10.000 a 25.000 recién nacidos vivos y son de herencia autosómica recesiva, salvo la MPS II o enfermedad de Hunter, que se hereda ligada al cromosoma X. Las características clínicas más frecuentes de las MPS son la presencia de rasgos faciales toscos, macrocefalia, opacidades corneales, disostosis múltiple, talla baja, valvulopatía mitroaórtica, hepatoesplenomegalia, hernias umbilical e inguinales, con o sin retraso del desarrollo sicomotor y con un deterioro neurológico progresivo. Salvo para las formas menos severas de MPS I, hasta ahora no hay un tratamiento efectivo para estas patologías, por lo que el daño sistémico progresivo produce la muerte entre los fines de la primera y de la cuarta década de la vida. En esta revisión se discuten las características clínicas de las MPS con las particularidades de cada fenotipo, el modo de confirmar el diagnóstico y los avances recientes en su tratamiento.
Subject(s)
Humans , Infant, Newborn , Glycosaminoglycans/analysis , Glycosaminoglycans/metabolism , Glycosaminoglycans/urine , Metabolism, Inborn Errors , Mucopolysaccharidoses/diagnosis , Mucopolysaccharidoses/etiology , Mucopolysaccharidoses/physiopathology , Mucopolysaccharidoses/therapy , Enzymes/deficiency , LysosomesABSTRACT
Se estudiaron a 31 varones prepuberales del Servicio de Endocrinología Infantil del Hospital de Niños no descendidos de los cuales 7 tenían criptorquidia unilateral, 14 eran bilaterales y 10 testículos retráctiles que no permanecen la mayor parte del tiempo en el escroto. El motivo fué evaluar la respuesta tanto clínica como hormonal a la administración de Gonadotrofina Corionica Humana a 15.000 Uds. por m2 sc por dosis siendo el total 9 dosis y determinar la posibilidad de su uso terapéutico de rutina en testículos no descendidos. La respuesta hormonal fué evidenciada por el aumento de los niveles de testosterona por estimulación con G lo cual demostró integridad funcional de las células de Leydig en el 100% de los casos estudiados. En cuanto el éxito de descenso testicular no fué muy significativo sin embargo se recomienda utilizarse en niños de edad preescolar y que la dosis total supere a las 10.000 Uds. para lograr un mejor efecto terapéutico