РОССИЙСКИЙ ПЕДИАТРИЧЕСКИЙ ОПЫТ ПО ОЦЕНКЕ ЭФФЕКТИВНОСТИ ПРИМЕНЕНИЯ ИМИГЛЮЦЕРАЗЫ ДЛЯ ДОЛГОСРОЧНОЙ ФЕРМЕНТНОЙ ЗАМЕСТИТЕЛЬНОЙ ТЕРАПИИ БОЛЕЗНИ ГОШЕ 1-ГО ТИПА У ДЕТЕЙ

Background: Today the gold standard for the treatment of Gaucher’s disease (GD) is an enzyme replacement therapy (ERT) which allows to stop the main clinical manifestations of the disease and to improve the quality of life in patients. In Russian pediatric practice, there are no publications which assess the effects of long-term ERT in children with GD type 1.Aim: To evaluate the effectiveness of imiglucerase for the treatment of Gaucher’s disease of type 1 in child population of the Russian Federation.Materials and methods: An evaluation of the effectiveness of enzyme replacement therapy was carried out by analyzing the monitoring data of 60 patients who were entered in the Russian pediatric registry of Gaucher disease at the National Scientific and Practical Center for Children’s Health for the period 2013−2016. Patients received continuous infusions of imiglucerase at a dose of 30−60 U/kg/2 weeks. Among of 60 children with Gaucher’s disease type 1, in 35 (group I) were recorded the dynamics of clinical and laboratory-instrumental indices during three years of therapy and in 25 (group II) ― an assessment of changes in quality of life parameters according to the PedsQL questionnaire within one year of treatment.Results: In group I, statistically significant changes for all key parameters (p0.001) were detected: median hemoglobin level and platelet count increased from 106 to 128 g/l and from 85 to 165×109/l, respectively; median chitotriosidase level decreased from 8303 to 1680 nmol/h/mL; median linear size of length and width of the spleen decreased by 54.5% and 40.0%, respectively, and the right lobe of the liver by 15%; parameters of physical development (height and weight) improved and median bone mineral density Z-score for the lumbar spine increased from -1.3 to -0.3. In group II: basing on the answers of children and parents, a statistically significant improvement (p0,05) of physical, emotional, and social functioning and the total score of quality of life was observed in 17 children aged 5−18 years; according to the parents’ answers, the increase of physical functioning was detected in 8 children aged 2−4 years.Conclusions: The timely appointment of ERT with imiglucerase in adequate dose and the regular infusion regime allows achievement of the key points of the treatment within 3 years and significant improvement of the quality of life parameters in children with GD type 1 in a year.Обоснование. На современном этапе «золотым стандартом» лечения болезни Гоше является ферментная заместительная терапия (ФЗТ),  позволяющая купировать основные клинические проявления заболевания и улучшить качество жизни пациентов. В отечественной педиатрии не обнаружено исследований по оценке эффективности и безопасности длительной патогенетической терапии болезни Гоше 1-го типа у детей.Цель исследования ― оценить эффективность имиглюцеразы для лечения болезни Гоше 1-го типа у детей в Российской Федерации.Методы. Оценку эффективности ферментной заместительной терапии проводили путем анализа данных мониторинга 60 пациентов, занесенных в российский педиатрический регистр болезни Гоше на базе Национального медицинского исследовательского центра здоровья детей в период 2013−2016 гг. Пациенты в течение 2 нед получали непрерывные инфузии имиглюцеразы в дозе 30−60 ЕД/кг. У 35/60 (I группа) детей с болезнью Гоше 1-го типа проведен учет динамики клинических и лабораторно-инструментальных показателей в течение 3 лет терапии, у 25/60 (II группа) ― оценка изменения параметров качества жизни по данным вопросника PedsQL в течение одного года лечения.Результаты. У пациентов I группы отмечены статистически достоверные для всех показателей изменения (p0,001) в виде повышения концентрации гемоглобина (со 106 до 128 г/л) и количества тромбоцитов (с 85 до 165×109/л), снижения активности хитотриозидазы (с 8303 до 1680 нМ/мл в час), сокращения линейных размеров длины и ширины селезенки (на 54 и 40% соответственно), уменьшения правой доли печени (на 15%), улучшения параметров физического развития (линейный рост, масса тела) и повышения медианы Z-score минеральной плотности костной ткани (c -1,3 до -0,3). У 17/25 пациентов II группы (возраст 5−18 лет), по ответам детей и родителей, наблюдалось статистически достоверное повышение (p0,05) значений физического, эмоционального, социального функционирования и общего балла качества жизни, у 8/25 детей в возрасте 2−4 лет, по ответам родителей, ― повышение показателя физического функционирования.Заключение. Своевременно назначенная регулярная ФЗТ  имиглюцеразой при адекватном режиме дозирования позволяет в течение 3 лет достичь ключевых целей лечения и уже через 1 год значимо улучшить параметры качества жизни у детей c болезнью Гоше 1-го типа

NIMANN-PICK TYPE C DISEASE. CLINICAL CASE STUDIES

Nimann-Pick Type C Disease is a hereditary progressive disease of the nervous system from the group of lysosomal accumulation diseases resulting from abnormal subcellular lipid distribution, which leads to the accumulation of cholesterol and glycosphingolipid in the brain and other body tissues. Clinical presentation of the disease is varied and manifested as progressive cerebellar, cognitive disorders, vertical ophthalmoparesis, frequently combined with disorders of the liver, spleen and lungs. This article outlines the key mechanisms of Nimann-Pick type C disease pathogenesis, leading clinical presentations depending on the time the disease manifested it self and key therapy approaches. We described two cases of this disease registered in Russia. It provides a comparative clinical analysis with already published data. To date, a pathogenetic treatment course has been developed for this disease, a timely detection of this pathology is, therefore, important to the burdened family. This representative article on modern data on diagnostics and treatment of NPC is intended for neurologists, pediatricians, psychiatrists and geneticists. Key words: neurodegenerative disease, Nimann-Pick type C disease, convulsions, ataxia, vertical ophthalmoparesis, loss of acquired skills. (Pediatric Pharmacology. – 2010; 7(5):48-53

NIMANN-PICK TYPE C DISEASE. CLINICAL CASE STUDIES

Nimann-Pick Type C Disease is a hereditary progressive disease of the nervous system from the group of lysosomal accumulation diseases resulting from abnormal subcellular lipid distribution, which leads to the accumulation of cholesterol and glycosphingolipid in the brain and other body tissues. Clinical presentation of the disease is varied and manifested as progressive cerebellar, cognitive disorders, vertical ophthalmoparesis, frequently combined with disorders of the liver, spleen and lungs. This article outlines the key mechanisms of Nimann-Pick type C disease pathogenesis, leading clinical presentations depending on the time the disease manifested it self and key therapy approaches. We described two cases of this disease registered in Russia. It provides a comparative clinical analysis with already published data. To date, a pathogenetic treatment course has been developed for this disease, a timely detection of this pathology is, therefore, important to the burdened family. This representative article on modern data on diagnostics and treatment of NPC is intended for neurologists, pediatricians, psychiatrists and geneticists. Key words: neurodegenerative disease, Nimann-Pick type C disease, convulsions, ataxia, vertical ophthalmoparesis, loss of acquired skills. (Pediatric Pharmacology. – 2010; 7(5):48-53

Serum cytokine profile, beta-hexosaminidase a enzymatic activity and gm<inf>2</inf> ganglioside levels in the plasma of a tay-sachs disease patient after cord blood cell transplantation and curcumin administration: A case report

Tay-Sachs disease (TSD) is a progressive neurodegenerative disorder that occurs due to a deficiency of a β hexosaminidase A (HexA) enzyme, resulting in the accumulation of GM2 gangliosides. In this work, we analyzed the effect of umbilical cord blood cell transplantation (UCBCT) and curcumin administration on the course of the disease in a patient with adult TSD. The patient’s serum cytokine profile was determined using multiplex analysis. The level of GM2 gangliosides in plasma was determined using mass spectrometry. The enzymatic activity of HexA in the plasma of the patient was assessed using a fluorescent substrate assay. The HexA α-subunit (HexA) concentration was determined using ELISA. It was shown that both UCBCT and curcumin administration led to a change in the patient’s cytokine profile. The UCBCT resulted in an increase in the concentration of HexA in the patient’s serum and in an improvement in the patient’s neurological status. However, neither UCBCT nor curcumin were able to alter HexA activity and the level of GM2 in patient’s plasma. The data obtained indicate that UCBCT and curcumin administration can alter the immunity of a patient with TSD, reduce the level of inflammatory cytokines and thereby improve the patient’s condition