Heart damage in mucopolysaccharidosis
Abstract
The paper gives the data available in the literature on the current classification, genealogy, clinical manifestations, diagnosis, treatment, and prevention of mucopolysaccharidosis, one of the most common nosological entities of lysosomal storage diseases. Particular emphasis is laid on cardiovascular pathology in this group of diseases. Heart damage is ascertained to be one of the cardinal signs of mucopolysaccharides frequently leading to rather early fatal outcomes. Cardiac pathology is notified in all types of muco-polysaccharidoses; however, it is most important for patients with three clinical variants of Hurler syndrome, Hunter syndrome, and Maroteaux-Lamy syndrome. According to the data available in the literature, the characteristic signs of cardiovascular system damage in mucopolysaccharides should be considered to be: thickening of the valves with the development of their dysfunction (the severity of left-sided valve lesion being more pronounced), myocardial hypertrophy, conduction disturbance, coronary artery lesion, and arterial hypertension. Many investigators emphasize difficulties in clinically and functionally examining the cardiovascular system in patients with mucopolysaccharides, which is due to physical and intellectual limitations in the patients and to a gradual progression of symptoms. Medical and surgical methods were used to treat cardiovascular disease in mucopolysaccharides. Enzyme replacement therapy and hematopoietic stem cell transplantation have become much more topical in the past years. These methods may stop disease progression and favor regression of ventricular hypertrophy and stabilization of left ventricular function.
About the Authors
M. I. DovganRussian Federation
Yu. M. Belozerov
Russian Federation
A. N. Semyachkina
Russian Federation
References
1. Семячкина АН, Новиков П.В., Воскобоева Е.Ю. и др. Мукополисахаридоз I типа: новая технология лечения — ферментозамещающая терапия. Рос вестн перинатол и педиат 2012; 4: 1: 94—102. (Semyachkina A.N., Novikov P.V., Voskoboeva E.Yu. et al. Type I mucopolysaccaridosis: enzyme replacement therapy is a new treatment technology. Ros vestn perinatal i pediat 2012; 4: 1: 94—102.)
2. Am P., Wraith J.E., Underhill L. Characterization of surgical procedures in patients with mucopolysaccharidosis type I: findings from the MPSI Registry. J Pediatr 2009; 154: 859—864.
3. Azevedo AC, Schwartz I.V., Kalakun L. et al. Clinical and biochemical study of 28 patients with mucopolysaccharidosis type VI. Clin Genet. 2004; 66:208-213.
4. Natowicz M.R., Short M.P., Wang Y. et al. Clinical and biochemical manifestations of hyaluronidase deficiency. N Engl J Med 1996; 335: 1029-1033.
5. Barry M.O., Beardslee M.A., Braverman AC. Morquio's syndrome: severe aortic regurgitation and late pulmonary autograft failure. J Heart Valve Dis 2006; 15: 839—842.
6. Krovetz L.J., Lorincz A.E., Schiebler G.L. Cardiovascular manifestations of the Hurler syndrome. Hemodynamic and angiocardiographic observations in 15 patients. Circulation 1965; 31: 132-141.
7. Renteria V.G., Ferraris V.J., Roberts W.C. The heart in the Hurler syndrome. Gross, histologic and ultrastructural observations in five necropsy cases. Am J Cardiol 1976; 38: 487-501.
8. Chen M.R., Lin S.P., Hwang H.K., Yu C.H. Cardiovascular changes in mucopolysaccharidoses in Taiwan. Acta Cardiol 2005; 60: 51-53.
9. Fesslova V., Corti P., Sersale G. et al. The natural course and the impact of therapies of cardiac involvement in the mucopolysaccharidoses. Cardiol Young 2009; 19: 170—178.
10. Leal G.N., Paula AC, Leone C, Kim С A. Echocardiographic study of paediatric patients with mucopolysaccharidosis. Cardiol Young 2010; 20: 254-261.
11. Jones S.A., Almassy Z., Beck M. et al. Mortality and cause of death in mucopolysaccharidosis type II — a historical review based on data from the Hunter Outcome Survey (HOS). J Inherit Metab Dis 2009; 32: 534-543.
12. Martins A.M., DualibiAP, Norato D. et al. Guidelines for the management of mucopolysaccharidosis type I. J Pediatr 2009; 155: S32-S46.
13. Lin H.Y., Lin S.P, Chuang CK. et al. Mucopolysaccharidosis I under enzyme replacement therapy with laronidase — a mortality case with autopsy report. J Inherit Metab Dis 2005; 28: 1146—1148.
14. Braunlin E.A, Harmatz, PR., Scarpa M. et al. Cardiac disease in patients with mucopolysaccharidosis: presentation, diagnosis and management J Inherit Metab Dis 2011; 34: 6: 1183-1197.
15. Pastores G.M., Arn P., Beck M. et al. The MPS I registry: design, methodology, and early findings of a global disease registry for monitoring patients with mucopolysaccharidosis type I. Mol Genet Metab 2007; 91: 37—47.
16. HirthA, Berg A, Greve G. Successful treatment of severe heart failure in an infant with Hurler syndrome. J Inherit Metab Dis 2007; 30: 820.
17. Soliman O.LL, Timmermans RGM, Nemes A. et al. Cardiac abnormalities in adults with the attenuated form of mucopolysaccharidosis type I. J Inherit Metab Dis 2007; 30: 750-757.
18. Scarpa M., Barone R., FiumaraA. et al. Mucopolysaccharidosis VI: the Italian experience. EurJ Pediatr 2009; 168:1203—1206.
19. Thomas J.A., Beck M., Clarke J.TR., Cox G.F. Childhood onset of Scheie syndrome, the attenuated form of mucopolysaccharidosis I. J Inherit Metab Dis 2010; 33:421-427.
20. Wraith J.E., Beck M., Giugliani R. et al. Initial report from the Hunter Outcome Survey. Genet Med 2008; 10: 508—516.
21. YanoS., MoseleyK., PavlovaZ. Postmortem studies on a patient with mucopolysaccharidosis type I: histopathological findings after one year of enzyme replacement therapy. J Inherit Metab Dis 2009; doi:10.1007/sl0545-009-1057-4.
22. Johnson G.L., Vine D.L., Cottrill СМ., Noonan J.A. Echocardiographic mitral valve deformity in the mucopolysaccharidoses. Pediatrics 1981; 67: 401—406.
23. Maganti K, Rigolin V.H., Sarano M.E., Bonow R.O. Valvular heart disease: diagnosis and management. Mayo Clin Proc 2010; 85: 483-500.
24. Kettles D.J., Sheppard M., Liebmann R.D., Davidson С Left ventricular aneurysm, aortic valve disease and coronary narrowing in a patient with Hunter's syndrome. Cardiovasc Pathol2002; 11:94-96.
25. Brosius F.C, Roberts W.C. Coronary artery disease in the Hurler syndrome. Qualitative and quantitative analysis of the extent of coronary narrowing at necropsy in six children. Am J Cardiol 1981; 47: 649-653.
26. Hinek A, Wilson S.E. Impaired elastogenesis in Hurler disease. Dermatan sulfate accumulation linked to deficiency in elastin-binding protein and elastic fiber assembly. Am J Pathol2000; 156:925-938.
27. Braunlin E.A, Krivit W., Burke B.A. et al. Radiological case of the month. Coarctation of the aorta in Hurler syndrome. Arch Pediatr Adolesc Med 2000; 154: 841—842.
28. Giugliani R., Harmatz P., Wraith J.E. Management guidelines for mucopolysaccharidosis VI. Pediatrics 2007; 120:405—418.
29. Nemes A, Timmermans R.G., Wilson J.H. et al. The mild form of mucopolysaccharidosis type I (Scheie syndrome) is associated with increased ascending aortic stiffness. Heart Vessels 2008; 23: 108-111.
30. MaX., Tittiger M., Knutsen R.H. et al. Upregulation of elastase proteins results in aortic dilatation in mucopolysaccharidosis I mice. Mol Genet Metab 2008; 94: 298—304.
31. MisumiL, Chikaz,awaS., Ishitsu T. et al. Atrioventricuiar block and diastolic dysfunction in a patient with Sanfilippo C. Intern Med 2010; 49: 2313-2316.
32. Keller C, BrinerJ., Schneider J. et al. Mucopolysaccharidosis 6-A (Maroteaux-Lamy disease): comparison of clinical and pathologico-anatomic findings in a 27-year-old patient. Helv Paediatr Acta 1987; 42: 317-333.
33. Hishitani T, Wakita S., Isoda T. et al. Sudden death in Hunter syndrome caused by complete atrioventricuiar block. J Pediatr 2000; 136: 268-269.
34. Gupta V., Barzilla J.E., Mendez, J.S. et al. Abundance and location of proteoglycans and hyaluronan within normal and myxomatous mitral valves. Cardiovasc Pathol 2009; 18:191—197.
35. Latif N., Sarathchandra P., Taylor P.M. et al. Localization and pattern of expression of extracellular matrix components in human heart valves. J Heart Valve Dis 2005; 14: 218—227.
36. Grande-Allen K.J., Griffin B.P, Ratliff N.B. et al. Glycosaminoglycan profiles of myxomatous mitral leaflets and chordae parallel the severity of mechanical alterations. J Am Coll Cardiol 2003; 42: 271-277.
37. Theocharis AT)., Tsolakis Т., Hjerpe A, Karamanos N.K Versican undergoes specific alterations in the fine molecular structure and organization in human aneurysmal abdominal aortas. Biomed Chromatogr 2003; 17: 411—416.
38. Nakashima Y, Wight T.N., Sueishi K. Early atherosclerosis in humans: role of diffuse intimal thickening and extracellular matrix proteoglycans. Cardiovasc Res 2008; 79: 14—23.
39. Braunlin E., Tolar J., Mackey-Bojack S. et al. Clear cells in the atrioventricuiar valves of infants with severe human mucopolysaccharidosis (Hurler syndrome) are activated valvular interstitial cells. Cardiovasc Pathol 2010; doi:10.1016/j.carpath.2010.06.004.
40. Simonaro СМ. Cartilage and chondrocyte pathology in the mucopolysaccharidoses: the role of glycosaminoglycan-mediatedinflammation. JPediatr Rehabil Med2010; 3: 85—88.
41. Aguilar E, Nesser H.J., Faletra F. et al. Imaging modalities in valvular heart disease. Curr Cardiol Rep 2008; 10: 98—103.
42. Taylor AL, CerqueiraM., HodgsonJ.M. etal.ACCF/SCCT/ACR/ AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography,
43. the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2010; 56:1864-1894.
44. Gabrielli O., Clarke L.A., Bruni S., Coppa G.V. Enzyme-replacement therapy in a 5-month-old boy with attenuated presymptomatic MPS I: 5-year follow-up. Pediatrics 2010; 125:el83-el87.
45. McGill J.J., Inwood AC, Coman D.J. et al. Enzyme replacement therapy for mucopolysaccharidosis VI from 8 weeks of age — a sibling control study. Clin Genet 2010; 77: 492-498.
Review
For citations:
Dovgan M.I., Belozerov Yu.M., Semyachkina A.N. Heart damage in mucopolysaccharidosis. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2014;59(3):22-31. (In Russ.)