engleski

Effects of immune modulation therapy in the first Croatian infant diagnosed with Pompe disease: a 3- year follow up study

Pompe disease is autosomal recessive storage disorder characterized by deficient or absent activity of the enzyme acid alpha-glucosidase. Due to ineffective metabolism, glycogen accumulates in muscle tissues. Patients with classic infantile- onset form usually present by the first months of life with hypertrophic cardiomyopathy and muscle weakness. If left untreated, these patients rapidly die of cardiorespiratory failure. A cross- reactive immunological material (CRIM)-negative status is predictive of high anti-alglucosidase alfa antibody titers. CRIM-positive patients also sometimes develop robust antibody titers. High antibody titers complicate therapeutic management, and those patients have worse clinical outcome of enzyme replacement therapy (ERT). Fours years ago, we successfully used an immune modulation therapy (IMT) protocol in a CRIM- positive infantile-onset patient with Pompe disease in whom infusions had to be temporarily discontinued because of severe infusion-associated reactions. She was found to be positive for anti- alglucosidase alfa antibodies (1:6, 400). IMT (rituximab, methotrexate and intravenous gammaglobulin) was started, and ERT was safely reintroduced during the IMT induction phase without complications. Antibodies disappeared, IMT was tapered and discontinued, and cadiomyopathy steadily improved. During more than three years of follow up, she remained ventilator- dependent and no gains in motor skills were noticed. Antibodies are still undetectable and no adverse reactions associated with IMT had occurred. The cardiomyopathy is gradually increasing, but there is still ~50% reduction as compared to the highest value measured. Although the reversal of clinical decline in our CRIM- positive and antibody-positive infant with Pompe disease can not be solely attributed to IMT, this protocol proved itself efficient and safe.

Pompe disease; gene mutation; acid alpha-glucosidase; enzyme replacement therapy; immunomodulation

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