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Current and potential therapeutic strategies for mucopolysaccharidoses
Author(s) -
Noh H.,
Lee J. I.
Publication year - 2014
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/jcpt.12136
Subject(s) - enzyme replacement therapy , medicine , intensive care medicine , clinical trial , substrate reduction therapy , food and drug administration , medline , transplantation , hematopoietic stem cell transplantation , pediatrics , disease , surgery , pharmacology , political science , law
Summary What is known and objective Mucopolysaccharidoses ( MPS s) are a group of rare inherited metabolic diseases caused by genetic defects in the production of lysosomal enzymes. MPS s are clinically heterogeneous and are characterized by progressive deterioration in visceral, skeletal and neurological functions. This article aims to review the classification and pathophysiology of MPS s and discuss current therapies and new targeted agents under development. Methods A Medline search through P ub M ed was performed for relevant articles and treatment guidelines on MPS s published in E nglish for years 1970 to September of 2013 inclusive. The references listed in the identified articles, prescribing information of the drugs approved for the treatment of MPS s, as well as recent clinical trial information posted on Clinicaltrials.gov website, were reviewed. Results and discussion Until recently, supportive care was the only option available for the management of MPS s. In the early 2000s, enzyme replacement therapy ( ERT ) was approved by the United States Food and Drug Administration ( FDA ) for the treatment of MPS I, II and VI . Clinical trials of ERT showed substantial improvements in patients' somatic symptoms; however, no benefit was found in the neurological symptoms because the enzymes do not readily cross the blood–brain barrier ( BBB ). Haematopoietic stem cell transplantation ( HSCT ), another potentially curative treatment, is not routinely advocated in clinical practice due to its high risk profile and lack of evidence for efficacy, except in preserving cognition and prolonging survival in young patients with severe MPS I. In recent years, substrate reduction therapy ( SRT ) and gene therapy have been rapidly gaining greater recognition as potential therapeutic avenues. What is new and conclusion Enzyme replacement therapy ( ERT ) is effective for the treatment of many somatic symptoms, particularly walking ability and respiratory function, and remains the mainstay of MPS treatment. The usefulness of HSCT has not been established adequately for most MPS s. Although still under investigation, SRT and gene therapy are promising MPS treatments that may prevent the neurodegeneration not affected by ERT .