Published online July 14, 2008
PEDIATRICS (doi:10.1542/peds.2007-3016)
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ARTICLE

A Prospective, Cross-sectional Survey Study of the Natural History of Niemann-Pick Disease Type B

Margaret M. McGovern, MD, PhDa, Melissa P. Wasserstein, MDb, Roberto Giugliani, MD, PhDc, Bruno Bembi, MDd, Marie T. Vanier, MD, PhDe, Eugen Mengel, MDf, Scott E. Brodie, MDg, David Mendelson, MDh, Gwen Skloot, MDi, Robert J. Desnick, PhD, MDb, Noriko Kuriyama, MAj and Gerald F. Cox, MD, PhDj,k,l

a Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, New York
b Departments of Genetics and Genomic Sciences
g Ophthalmology
h Radiology
i Medicine, Mount Sinai School of Medicine, New York, New York
c Medical Genetics Service, Hospital de Clinicas, Porto Alegre, Brazil
d Clinica Pediatrica, Instituto per I'Infanzia Burlo Garofolo, Trieste, Italy
e Laboratoire Gillet-Merieux, Centre Hospitalier Lyon-Sud, Pierre Benite, France
f Center of Pediatrics, Villa Metabolica, Hospital of the Gutenberg-University, Mainz, Germany
j Clinical Research, Genzyme Corporation, Cambridge, Massachusetts
k Division of Genetics, Children's Hospital Boston, Boston, Massachusetts
l Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

OBJECTIVE. The objective of this study was to characterize the clinical features of patients with Niemann-Pick disease type B and to identify efficacy end points for future clinical trials of enzyme-replacement therapy.

METHODS. Fifty-nine patients who had Niemann-Pick disease type B, were at least 6 years of age, and manifested at least 2 disease symptoms participated in this multicenter, multinational, cross-sectional survey study. Medical histories; physical examinations; assessments of cardiorespiratory function, clinical laboratory data, and liver and spleen volumes; radiographic evaluation of the lungs and bone age; and quality-of-life assessments were obtained during a 2- to 3-day period.

RESULTS. Fifty-three percent of the patients were male, 92% were white, and the median age was 17.6 years. The R608del mutation accounted for 25% of all disease alleles. Most patients initially presented with splenomegaly (78%) or hepatomegaly (73%). Frequent symptoms included bleeding (49%), pulmonary infections and shortness of breath (42% each), and joint/limb pain (39%). Growth was markedly delayed during adolescence. Patients commonly had low levels of platelets and high-density lipoprotein, elevated levels of low-density lipoprotein, very-low-density lipoprotein, triglycerides, leukocyte sphingomyelin, and serum chitotriosidase, and abnormal liver function test results. Nearly all patients had documented splenomegaly and hepatomegaly and interstitial lung disease. Patients commonly showed restrictive lung disease physiology with impaired pulmonary gas exchange and decreased maximal exercise tolerance. Quality of life was only mildly decreased by standardized questionnaires. The degree of splenomegaly correlated with most aspects of disease, including hepatomegaly, growth, lipid profile, hematologic parameters, and pulmonary function.

CONCLUSIONS. This study documents the multisystem involvement and clinical variability of Niemann-Pick B disease. Several efficacy end points were identified for future clinical treatment studies. Because of its correlation with disease severity, spleen volume may be a useful surrogate end point in treatment trials, whereas biomarkers such as chitotriosidase also may play a role in monitoring patient treatment responses.

Key Words: Niemann Pick disease • acid sphingomyelinase deficiency • lysosomal storage disorder • cross-sectional study • natural history

Abbreviations: ASM—acid sphingomyelinase • NPD— Niemann-Pick disease • IGF-1—insulin-like growth factor 1 • ECG—electrocardiography • FVC—forced vital capacity • FEV1—forced expiratory volume in 1 second • DLCO—diffusing capacity of the lung • 6MWT—6-minute walk test • HRCT—high-resolution computed tomography • MN—multiples of normal • CHQ—Child Health Questionnaire • SF-36—Short Form-36 • HDL—high-density lipoprotein

Accepted Apr 3, 2008.