Published online October 1, 2007
PEDIATRICS Vol. 120 No. 4 October 2007, pp. 824-833 (doi:10.1542/peds.2007-1357)
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ARTICLE

Disease Progression in Hutchinson-Gilford Progeria Syndrome: Impact on Growth and Development

Leslie B. Gordon, MD, PhDa,b, Kathleen M. McCarten, MDc,d, Anita Giobbie-Hurder, MSe, Jason T. Machan, PhDf, Susan E. Campbell, MAg, Scott D. Berns, MD, MPHa,b and Mark W. Kieran, MD, PhDh,i

a Departments of Pediatrics
c Diagnostic Imaging
f Biostatistics, Rhode Island Hospital, Providence, Rhode Island
b Departments of Pediatrics
d Radiology, Warren J. Alpert Medical School at Brown University, Providence, Rhode Island
e Biostatistics and Computational Biology
h Pediatric Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
g Department of Gerontology, Brown University, Providence, Rhode Island
i Department of Pediatric Hematology and Oncology, Children's Hospital Boston, Boston, Massachusetts

OBJECTIVES. Hutchinson-Gilford progeria syndrome is a rare and uniformly fatal segmental "premature aging" disease that affects a variety of organ systems. We sought to more clearly define the bone and weight abnormalities in patients with progeria as potential outcome parameters for prospective clinical trials.

PATIENTS AND METHODS. We collected and analyzed longitudinal medical information, both retrospectively and prospectively, from a total of 41 children with Hutchinson-Gilford progeria syndrome spanning 14 countries, from the Progeria Research Foundation Medical and Research Database at the Brown University Center for Gerontology.

RESULTS. In addition to a number of previously well-defined phenotypic findings in children with progeria, this study identified abnormalities in the eruption of secondary incisors lingually and palatally in the mandible and maxilla, respectively. Although bony structures appeared normal in early infancy, clavicular resorption, coxa valga, avascular necrosis of the femoral head, modeling abnormalities of long bones with slender diaphyses, flared metaphyses, and overgrown epiphyses developed. Long bones showed normal cortical thickness centrally and progressive focal demineralization peripherally. The most striking finding identified in the retrospective data set of 35 children was an average weight increase of only 0.44 kg/year, beginning at ~24 months of age and persisting through life, with remarkable intrapatient linearity. This rate is >2 SD below normal weight gain for any corresponding age and sharply contrasts with the parabolic growth pattern for normal age- and gender-matched children. This finding was also confirmed prospectively.

CONCLUSIONS. Our analysis shows evidence of a newly identified abnormal growth pattern for children with Hutchinson-Gilford progeria syndrome. The skeletal and dental findings are suggestive of a developmental dysplasia rather than a classical aging process. The presence of decreased and linear weight gain, maintained in all of the patients after the age of 2 years, provides the ideal parameter on which altered disease status can be assessed in clinical trials.

Key Words: progeria • Hutchinson-Gilford progeria syndrome • developmental dysplasia • osteoporosis • clinical trial

Abbreviations: HGPS—Hutchinson-Gilford progeria syndrome • CI—confidence interval

Accepted Jun 26, 2007.




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M. A. Merideth, L. B. Gordon, S. Clauss, V. Sachdev, A. C.M. Smith, M. B. Perry, C. C. Brewer, C. Zalewski, H. J. Kim, B. Solomon, et al.
Phenotype and Course of Hutchinson-Gilford Progeria Syndrome
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