Abstract | BACKGROUND:
Molybdenum cofactor deficiency (MoCD) is characterised by early, rapidly progressive postnatal encephalopathy and intractable seizures, leading to severe disability and early death. Previous treatment attempts have been unsuccessful. After a pioneering single treatment we now report the outcome of the complete first cohort of patients receiving substitution treatment with cyclic pyranopterin monophosphate (cPMP), a biosynthetic precursor of the cofactor. METHODS: In this observational prospective cohort study, newborn babies with clinical and biochemical evidence of MoCD were admitted to a compassionate-use programme at the request of their treating physicians. Intravenous cPMP (80-320 μg/kg per day) was started in neonates diagnosed with MoCD (type A and type B) following a standardised protocol. We prospectively monitored safety and efficacy in all patients exposed to cPMP. FINDINGS: Between June 6, 2008, and Jan 9, 2013, intravenous cPMP was started in 16 neonates diagnosed with MoCD (11 type A and five type B) and continued in eight type A patients for up to 5 years. We observed no drug-related serious adverse events after more than 6000 doses. The disease biomarkers urinary S-sulphocysteine, xanthine, and urate returned to almost normal concentrations in all type A patients within 2 days, and remained normal for up to 5 years on continued cPMP substitution. Eight patients with type A disease rapidly improved under treatment and convulsions were either completely suppressed or substantially reduced. Three patients treated early remain seizure free and show near-normal long-term development. We detected no biochemical or clinical response in patients with type B disease. INTERPRETATION: cPMP substitution is the first effective therapy for patients with MoCD type A and has a favourable safety profile. Restoration of molybdenum cofactor-dependent enzyme activities results in a greatly improved neurodevelopmental outcome when started sufficiently early. The possibility of MoCD type A needs to be urgently explored in every encephalopathic neonate to avoid any delay in appropriate cPMP substitution, and to maximise treatment benefit. FUNDING: German Ministry of Education and Research; Orphatec/Colbourne Pharmaceuticals.
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Authors | Bernd C Schwahn, Francjan J Van Spronsen, Abdel A Belaidi, Stephen Bowhay, John Christodoulou, Terry G Derks, Julia B Hennermann, Elisabeth Jameson, Kai König, Tracy L McGregor, Esperanza Font-Montgomery, José A Santamaria-Araujo, Saikat Santra, Mamta Vaidya, Anne Vierzig, Evangeline Wassmer, Ilona Weis, Flora Y Wong, Alex Veldman, Günter Schwarz |
Journal | Lancet (London, England)
(Lancet)
Vol. 386
Issue 10007
Pg. 1955-1963
(Nov 14 2015)
ISSN: 1474-547X [Electronic] England |
PMID | 26343839
(Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2015 Elsevier Ltd. All rights reserved. |
Chemical References |
- Organophosphorus Compounds
- Pterins
- nulibry
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Topics |
- Cohort Studies
- Compassionate Use Trials
- Drug Administration Schedule
- Female
- Humans
- Infant, Newborn
- Male
- Metal Metabolism, Inborn Errors
(diagnosis, drug therapy)
- Organophosphorus Compounds
(therapeutic use)
- Pterins
(therapeutic use)
- Treatment Outcome
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