Is early detection of late-onset Pompe disease a pneumologist's affair? A lesson from an Italian screening study

AIPO Pneumoloped Group

Research output: Contribution to journalArticle

Abstract

Background: Late-onset Pompe disease (LOPD) is a recessive disease caused by α-glucosidase (GAA) deficiency, leading to progressive muscle weakness and/or respiratory failure in children and adults. Respiratory derangement can be the first indication of LOPD, but the diagnosis may be difficult for pneumologists. We hypothesize that assessing the GAA activity in suspected patients by a dried blood spot (DBS) may help the diagnosis of LOPD in the pneumological setting. Population and methods: We performed a multicenter DBS survey of patients with suspected LOPD according to a predefined clinical algorithm. From February 2015 to December 2017, 140 patients (57 ± 16 yrs., 80 males) were recruited in 19 Italian pneumological units. The DBS test was performed by a drop of blood collected on absorbent paper. Patients with GAA activity < 2.6 μmol/L/h were considered positive. A second DBS test was performed in the patients positive to the first assay. Patients testing positive at the re-test underwent a skeletal muscle biopsy to determine the GAA enzymatic activity. Results: 75 recruited subjects had outpatient access, 65 subjects were admitted for an acute respiratory failure episode. Two patients tested positive in both the first and second DBS test (1.4% prevalence), and the LOPD diagnosis was confirmed through histology, with patients demonstrating a deficient GAA muscle activity (3.6 and 9.1 pmol/min/mg). A further five subjects were positive in the first DBS test but were not confirmed at re-test. The two positive cases were both diagnosed after hospitalization for acute respiratory failure and need of noninvasive ventilation. Most of the recruited patients had reduced maximal respiratory pressures (MIP 50 ± 27% and MEP 55 ± 27% predicted), restrictive pattern (FEV1/FVC 81.3 ± 13.6) and hypoxaemia (PaO2 70.9 ± 14.5 mmHg). Respiratory symptoms were present in all the patients, but only 48.6% of them showed muscle weakness in the pelvic girdle and/or in the scapular girdle (35.7%). Conclusions: DBS GAA activity test may be a powerful screening tool among pneumologists, particularly in the acute setting. A simple clinical algorithm may aid in the selection of patients on which to administer the DBS test.

Original languageEnglish
Article number62
JournalOrphanet Journal of Rare Diseases
Volume14
Issue number1
DOIs
Publication statusPublished - Mar 4 2019

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Glycogen Storage Disease Type II
Hematologic Tests
Respiratory Insufficiency
Muscle Weakness
Late Onset Disorders
Glucosidases
Noninvasive Ventilation
Patient Selection
Histology
Skeletal Muscle
Hospitalization
Outpatients

Keywords

  • Acute respiratory failure
  • Diagnosis
  • Late-onset Pompe disease
  • Noninvasive ventilation
  • Respiratory high dependency care unit

ASJC Scopus subject areas

  • Genetics(clinical)
  • Pharmacology (medical)

Cite this

Is early detection of late-onset Pompe disease a pneumologist's affair? A lesson from an Italian screening study. / AIPO Pneumoloped Group.

In: Orphanet Journal of Rare Diseases, Vol. 14, No. 1, 62, 04.03.2019.

Research output: Contribution to journalArticle

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title = "Is early detection of late-onset Pompe disease a pneumologist's affair? A lesson from an Italian screening study",
abstract = "Background: Late-onset Pompe disease (LOPD) is a recessive disease caused by α-glucosidase (GAA) deficiency, leading to progressive muscle weakness and/or respiratory failure in children and adults. Respiratory derangement can be the first indication of LOPD, but the diagnosis may be difficult for pneumologists. We hypothesize that assessing the GAA activity in suspected patients by a dried blood spot (DBS) may help the diagnosis of LOPD in the pneumological setting. Population and methods: We performed a multicenter DBS survey of patients with suspected LOPD according to a predefined clinical algorithm. From February 2015 to December 2017, 140 patients (57 ± 16 yrs., 80 males) were recruited in 19 Italian pneumological units. The DBS test was performed by a drop of blood collected on absorbent paper. Patients with GAA activity < 2.6 μmol/L/h were considered positive. A second DBS test was performed in the patients positive to the first assay. Patients testing positive at the re-test underwent a skeletal muscle biopsy to determine the GAA enzymatic activity. Results: 75 recruited subjects had outpatient access, 65 subjects were admitted for an acute respiratory failure episode. Two patients tested positive in both the first and second DBS test (1.4{\%} prevalence), and the LOPD diagnosis was confirmed through histology, with patients demonstrating a deficient GAA muscle activity (3.6 and 9.1 pmol/min/mg). A further five subjects were positive in the first DBS test but were not confirmed at re-test. The two positive cases were both diagnosed after hospitalization for acute respiratory failure and need of noninvasive ventilation. Most of the recruited patients had reduced maximal respiratory pressures (MIP 50 ± 27{\%} and MEP 55 ± 27{\%} predicted), restrictive pattern (FEV1/FVC 81.3 ± 13.6) and hypoxaemia (PaO2 70.9 ± 14.5 mmHg). Respiratory symptoms were present in all the patients, but only 48.6{\%} of them showed muscle weakness in the pelvic girdle and/or in the scapular girdle (35.7{\%}). Conclusions: DBS GAA activity test may be a powerful screening tool among pneumologists, particularly in the acute setting. A simple clinical algorithm may aid in the selection of patients on which to administer the DBS test.",
keywords = "Acute respiratory failure, Diagnosis, Late-onset Pompe disease, Noninvasive ventilation, Respiratory high dependency care unit",
author = "{AIPO Pneumoloped Group} and Marco Confalonieri and Michele Vitacca and Raffaele Scala and Mario Polverino and Eugenio Sabato and Grazia Crescimanno and Piero Ceriana and Caterina Antonaglia and Gabriele Siciliano and Nadja Ring and Serena Zacchigna and Francesco Salton and Andrea Vianello and Alessio Mattei and {De Michele}, Fausto and Luca Triolo and Giuseppe Culla and Pieraldo Canessa and Giuseppe Girbino and Mirco Lusuardi and Enrico Perretta and {De Michelis}, Claudio and Teresa Renda",
year = "2019",
month = "3",
day = "4",
doi = "10.1186/s13023-019-1037-1",
language = "English",
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journal = "Orphanet Journal of Rare Diseases",
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T1 - Is early detection of late-onset Pompe disease a pneumologist's affair? A lesson from an Italian screening study

AU - AIPO Pneumoloped Group

AU - Confalonieri, Marco

AU - Vitacca, Michele

AU - Scala, Raffaele

AU - Polverino, Mario

AU - Sabato, Eugenio

AU - Crescimanno, Grazia

AU - Ceriana, Piero

AU - Antonaglia, Caterina

AU - Siciliano, Gabriele

AU - Ring, Nadja

AU - Zacchigna, Serena

AU - Salton, Francesco

AU - Vianello, Andrea

AU - Mattei, Alessio

AU - De Michele, Fausto

AU - Triolo, Luca

AU - Culla, Giuseppe

AU - Canessa, Pieraldo

AU - Girbino, Giuseppe

AU - Lusuardi, Mirco

AU - Perretta, Enrico

AU - De Michelis, Claudio

AU - Renda, Teresa

PY - 2019/3/4

Y1 - 2019/3/4

N2 - Background: Late-onset Pompe disease (LOPD) is a recessive disease caused by α-glucosidase (GAA) deficiency, leading to progressive muscle weakness and/or respiratory failure in children and adults. Respiratory derangement can be the first indication of LOPD, but the diagnosis may be difficult for pneumologists. We hypothesize that assessing the GAA activity in suspected patients by a dried blood spot (DBS) may help the diagnosis of LOPD in the pneumological setting. Population and methods: We performed a multicenter DBS survey of patients with suspected LOPD according to a predefined clinical algorithm. From February 2015 to December 2017, 140 patients (57 ± 16 yrs., 80 males) were recruited in 19 Italian pneumological units. The DBS test was performed by a drop of blood collected on absorbent paper. Patients with GAA activity < 2.6 μmol/L/h were considered positive. A second DBS test was performed in the patients positive to the first assay. Patients testing positive at the re-test underwent a skeletal muscle biopsy to determine the GAA enzymatic activity. Results: 75 recruited subjects had outpatient access, 65 subjects were admitted for an acute respiratory failure episode. Two patients tested positive in both the first and second DBS test (1.4% prevalence), and the LOPD diagnosis was confirmed through histology, with patients demonstrating a deficient GAA muscle activity (3.6 and 9.1 pmol/min/mg). A further five subjects were positive in the first DBS test but were not confirmed at re-test. The two positive cases were both diagnosed after hospitalization for acute respiratory failure and need of noninvasive ventilation. Most of the recruited patients had reduced maximal respiratory pressures (MIP 50 ± 27% and MEP 55 ± 27% predicted), restrictive pattern (FEV1/FVC 81.3 ± 13.6) and hypoxaemia (PaO2 70.9 ± 14.5 mmHg). Respiratory symptoms were present in all the patients, but only 48.6% of them showed muscle weakness in the pelvic girdle and/or in the scapular girdle (35.7%). Conclusions: DBS GAA activity test may be a powerful screening tool among pneumologists, particularly in the acute setting. A simple clinical algorithm may aid in the selection of patients on which to administer the DBS test.

AB - Background: Late-onset Pompe disease (LOPD) is a recessive disease caused by α-glucosidase (GAA) deficiency, leading to progressive muscle weakness and/or respiratory failure in children and adults. Respiratory derangement can be the first indication of LOPD, but the diagnosis may be difficult for pneumologists. We hypothesize that assessing the GAA activity in suspected patients by a dried blood spot (DBS) may help the diagnosis of LOPD in the pneumological setting. Population and methods: We performed a multicenter DBS survey of patients with suspected LOPD according to a predefined clinical algorithm. From February 2015 to December 2017, 140 patients (57 ± 16 yrs., 80 males) were recruited in 19 Italian pneumological units. The DBS test was performed by a drop of blood collected on absorbent paper. Patients with GAA activity < 2.6 μmol/L/h were considered positive. A second DBS test was performed in the patients positive to the first assay. Patients testing positive at the re-test underwent a skeletal muscle biopsy to determine the GAA enzymatic activity. Results: 75 recruited subjects had outpatient access, 65 subjects were admitted for an acute respiratory failure episode. Two patients tested positive in both the first and second DBS test (1.4% prevalence), and the LOPD diagnosis was confirmed through histology, with patients demonstrating a deficient GAA muscle activity (3.6 and 9.1 pmol/min/mg). A further five subjects were positive in the first DBS test but were not confirmed at re-test. The two positive cases were both diagnosed after hospitalization for acute respiratory failure and need of noninvasive ventilation. Most of the recruited patients had reduced maximal respiratory pressures (MIP 50 ± 27% and MEP 55 ± 27% predicted), restrictive pattern (FEV1/FVC 81.3 ± 13.6) and hypoxaemia (PaO2 70.9 ± 14.5 mmHg). Respiratory symptoms were present in all the patients, but only 48.6% of them showed muscle weakness in the pelvic girdle and/or in the scapular girdle (35.7%). Conclusions: DBS GAA activity test may be a powerful screening tool among pneumologists, particularly in the acute setting. A simple clinical algorithm may aid in the selection of patients on which to administer the DBS test.

KW - Acute respiratory failure

KW - Diagnosis

KW - Late-onset Pompe disease

KW - Noninvasive ventilation

KW - Respiratory high dependency care unit

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U2 - 10.1186/s13023-019-1037-1

DO - 10.1186/s13023-019-1037-1

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JO - Orphanet Journal of Rare Diseases

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