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Sponsored by: |
Shire Human Genetic Therapies, Inc. |
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Information provided by: | Shire Human Genetic Therapies, Inc. |
ClinicalTrials.gov Identifier: | NCT00639132 |
There have not been longitudinal studies which track patients' neurologically or developmentally in a systematic manner. By simultaneously tracking patients' neurodevelopment along with neuroimaging and neurophysiologic studies it becomes much easier to draw conclusions on the differential effects of the disease process and any available treatments that patients might receive. In addition, many of the gene mutations, which cause MLD have not been linked to the age of onset or the expected disease course.
Condition |
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Metachromatic Leukodystrophy |
Study Type: | Observational |
Study Design: | Case-Only, Prospective |
Official Title: | The Natural History of Metachromatic Leukodystrophy |
Genetic and/or biochemical testing for diagnosis of MLD Spinal tap
Estimated Enrollment: | 10 |
Study Start Date: | March 2008 |
Estimated Study Completion Date: | March 2009 |
Estimated Primary Completion Date: | January 2009 (Final data collection date for primary outcome measure) |
Metachromatic leukodystrophy (MLD), an autosomal recessively inherited lysosomal storage disorder, causes a deficiency of arylsulfatase A. This results in accumulation of sulfated glycolipids (sulphatide) within lysosomes of myelin forming cells in the central and peripheral nervous system and to a lesser extent in lysosomes of cells comprising the liver, kidneys, and gallbladder. The disease is characterized by progressive demyelination with wide variability in clinical onset and severity. Depending upon the age at onset and disease progression, MLD may be classified as late infantile (6 months to 4 years), early juvenile (4 to 6 years), late juvenile (6 to 16 years), and adult (>16 years). In the late infantile and early juvenile forms, blindness, gait disturbances, loss of speech, loss of hearing, and quadriparesis are common signs. In older children and adults the disease may present with gait disturbances, mental regression, and behavioral abnormalities. Disease progression, also variable, results in death within a few years to several decades; however, disease progression among affected siblings seems to follow a similar course, unlike many other leukodystrophies.
Bone marrow transplantation (BMT) has been the only partially effective treatment reported for MLD. BMT has been shown to halt disease progression when asymptomatic patients achieve engraftment prior to the age at which symptoms occurred in an affected, symptomatic sibling. Despite stabilization of the clinical course when receiving BMT before symptoms, patients' neurophysiologic test abnormalities persist. The clinical implication of this finding has not been further researched. Patients who show mild to moderate progression of their disease prior to transplantation continue to exhibit disease progression to severe impairment. However, specific degrees of clinical impairment in neurodevelopmental function have not been monitored to determine what level of cognitive and motor impairment can be present and still allow the patient to confer benefits from treatment.
Patients with late infantile MLD appear to benefit the least from the transplantation process based on preliminary unpublished data. Several case report studies for patients with late infantile MLD indicate delayed, but continued progression of the disease despite BMT, while others suggest initial deterioration followed by stabilization.
Transplantation with allogenic hematopoietic stem cells has been shown to positively influence the disease progression of other lysosomal storage diseases such as Hurler Syndrome and Krabbe Disease and testing for enzyme replacement for MLD is already underway. For future researchers to be able compare the benefits of children with MLD who receive treatment to those who remained untreated, a better understanding of the natural progression of late infantile MLD is necessary. The current literature contains only case studies of individual or small groups of MLD patients that tracked intelligence quotients and neurophysiologic function, but did not correlate this with patients' neurodevelopment. A longitudinal study of a larger population of patients with late infantile MLD has yet to be performed. This protocol is a 6 month longitudinal observational study to capture natural history data in patients with late infantile MLD. This data will provide baseline neurobehavioral, neuroimaging, and neurophysiological information that can in the future be used to evaluate treatment effects.
Ages Eligible for Study: | up to 5 Years |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Sampling Method: | Non-Probability Sample |
Patients with biochemical evidence of MLD including low levels of arylsulphatase A white cell activity and increased amounts of urinary sulphatide excretion are eligible for the study. A total of 10 patients representing various ranges of disease severity are expected to enroll.
Inclusion Criteria:
The patient must have a confirmed diagnosis of MLD as defined by:
ASA activity < 10 nmol/h/mg in leukocytes
Presence of elevated sulfatide in urine
Exclusion Criteria:
Contact: Maria L Escolar, MD | +1 919 477 0479 | Maria.Escolar@CDL.UNC.EDU |
United States, North Carolina | |
University of North Carolina at Chapel Hill | Recruiting |
CHAPEL HILL, North Carolina, United States, 27599-7255 | |
Contact: Maria L Escolar, MD 919-477-0479 Maria.Escolar@CDL.UNC.EDU |
Principal Investigator: | Maria L Escolar, MD | The University of North Carolina, Chapel Hill |
Responsible Party: | Zymenex ( Jens Fogh ) |
Study ID Numbers: | rhASA-NH-US |
Study First Received: | March 11, 2008 |
Last Updated: | January 8, 2009 |
ClinicalTrials.gov Identifier: | NCT00639132 History of Changes |
Health Authority: | United States: Institutional Review Board |
Natural history Metachromatic Leukodystrophy Disease progression |
Lipid Metabolism, Inborn Errors Metachromatic Leukodystrophy Sphingolipidoses Metabolic Diseases Leukodystrophy, Metachromatic Demyelinating Diseases Lysosomal Storage Diseases Disease Progression Sphingolipidosis Central Nervous System Diseases |
Brain Diseases Leukodystrophy Metabolism, Inborn Errors Genetic Diseases, Inborn Brain Diseases, Metabolic, Inborn Lipidoses Metabolic Disorder Lipid Metabolism Disorders Brain Diseases, Metabolic |
Lipid Metabolism, Inborn Errors Sphingolipidoses Metabolic Diseases Leukodystrophy, Metachromatic Demyelinating Diseases Lysosomal Storage Diseases, Nervous System Lysosomal Storage Diseases Nervous System Diseases Sulfatidosis |
Central Nervous System Diseases Brain Diseases Hereditary Central Nervous System Demyelinating Diseases Metabolism, Inborn Errors Genetic Diseases, Inborn Lipidoses Brain Diseases, Metabolic, Inborn Lipid Metabolism Disorders Brain Diseases, Metabolic |