Adrenoleukodystrophy medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The mainstay of treatment for adrenoleukodystrophy is Hematopoietic stem cell transplantation. Supportive therapy includes Lorenzo's oil and Lovastatin therapy. Antioxidant therapy has also shown some persuasive results demanding a larger study whereas treatment with Gene therapy including Ex vivo lentiviral gene correction and in vivo adeno-associated virus 9 (AAV9) based gene therapy is being pursued. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Revision as of 11:34, 29 June 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
The mainstay of treatment for adrenoleukodystrophy is Hematopoietic stem cell transplantation. Supportive therapy includes Lorenzo's oil and Lovastatin therapy. Antioxidant therapy has also shown some persuasive results demanding a larger study whereas treatment with Gene therapy including Ex vivo lentiviral gene correction and in vivo adeno-associated virus 9 (AAV9) based gene therapy is being pursued.
Medical Therapy
Hematopoietic stem cell transplantation
The only standard therapy currently available is hematopoietic stem cell transplantation in cerebral ALD boys. It is the gold standard for cALD with a Loes score below 8. HSCT prevents demyelination in ALD patients but improvement of microglial peroxisome activity or reduction of VLCFA levels has not been identified as a result of HSCT.[1]
Lorenzo’s oil
While there is currently no cure for the disease, some dietary treatments, for example, Lorenzo's oil in combination with a diet low in VLCFA, have been used with limited success, especially before disease symptoms appear. A recent study by Moser et al (2005) shows positive long-term results with this approach;[2] see also the Myelin Project.
Lorenzo oil is a 4:1 mixture of oleic and erucic acids that, when combined with a fat-restricted diet, normalizes plasma VLCFA levels.
Metabolic modulators
Lovastatin is an anti cholesterol drug that normalized plasma VLCFA in one study but showed no normalization to placebo in randomized double‐blind crossover trial. [3]
Several other studies are being conducted on sobetirome, a thyroid hormone receptor agonist[4], and pioglitazone, a PPARγ agonist.[5]
Antioxidant therapy
High-dose antioxidants have been seen in a limited open-label study with adolescents with AMN. Progress has been seen in a 6-minute walk test, which demands a larger study. [6]
N-Acetyl cysteine (NAC) adjunct therapy for individuals undergoing allogeneic HSCT has been shown to improve survival in patients with more advance neurological deficit.[7]
Gene therapy
Ex vivo lentiviral gene Correction and in vivo adeno-associated virus 9 (AAV9)-based gene therapy is being pursued. The latter has shown to correct the metabolism of VLCFA in mice[8], although the former has also demonstrated positive effects in a study involving 17 ALD boys with early-stage brain disease who underwent Lenti-D ABCD1 gene therapy and confirmed that 15 of the patients survived the therapy. There was no treatment related death or graft versus host disease seen in them.[9]
References
- ↑ Turk, Bela R.; Moser, Ann B.; Fatemi, Ali (2017). "Therapeutic strategies in adrenoleukodystrophy". Wiener Medizinische Wochenschrift. 167 (9–10): 219–226. doi:10.1007/s10354-016-0534-2. ISSN 0043-5341.
- ↑ Moser HW, Raymond GV, Lu S-E, Muenz LR, Moser AB, Xu J, Jones RO, Loes DJ, Melhem ER, Dubey P, Bezman L, Brereton NH, Odone A. Follow-up of 89 asymptomatic patients with adrenoleukodystrophy treated with Lorenzo's Oil. Arch Neurol 2005;62;1073-80. PMID 16009761.
- ↑ Engelen, Marc; Ofman, Rob; Dijkgraaf, Marcel G.W.; Hijzen, Michiel; van der Wardt, Lucinda A.; van Geel, Bjorn M.; de Visser, Marianne; Wanders, Ronald J.A.; Poll-The, Bwee Tien; Kemp, Stephan (2010). "Lovastatin in X-Linked Adrenoleukodystrophy". New England Journal of Medicine. 362 (3): 276–277. doi:10.1056/NEJMc0907735. ISSN 0028-4793.
- ↑ Hartley, Meredith D.; Kirkemo, Lisa L.; Banerji, Tapasree; Scanlan, Thomas S. (2017). "A Thyroid Hormone–Based Strategy for Correcting the Biochemical Abnormality in X-Linked Adrenoleukodystrophy". Endocrinology. 158 (5): 1328–1338. doi:10.1210/en.2016-1842. ISSN 0013-7227.
- ↑ Morató, Laia; Galino, Jorge; Ruiz, Montserrat; Calingasan, Noel Ylagan; Starkov, Anatoly A.; Dumont, Magali; Naudí, Alba; Martínez, Juan José; Aubourg, Patrick; Portero-Otín, Manuel; Pamplona, Reinald; Galea, Elena; Beal, M. Flint; Ferrer, Isidre; Fourcade, Stéphane; Pujol, Aurora (2013). "Pioglitazone halts axonal degeneration in a mouse model of X-linked adrenoleukodystrophy". Brain. 136 (8): 2432–2443. doi:10.1093/brain/awt143. ISSN 1460-2156.
- ↑ Casasnovas C, Ruiz M, Schlüter A, Naudí A, Fourcade S, Veciana M; et al. (2019). "Biomarker Identification, Safety, and Efficacy of High-Dose Antioxidants for Adrenomyeloneuropathy: a Phase II Pilot Study". Neurotherapeutics. 16 (4): 1167–1182. doi:10.1007/s13311-019-00735-2. PMC 6985062 Check
|pmc=value (help). PMID 31077039. - ↑ Miller, Weston P.; Rothman, Steven M.; Nascene, David; Kivisto, Teresa; DeFor, Todd E.; Ziegler, Richard S.; Eisengart, Julie; Leiser, Kara; Raymond, Gerald; Lund, Troy C.; Tolar, Jakub; Orchard, Paul J. (2011). "Outcomes after allogeneic hematopoietic cell transplantation for childhood cerebral adrenoleukodystrophy: the largest single-institution cohort report". Blood. 118 (7): 1971–1978. doi:10.1182/blood-2011-01-329235. ISSN 0006-4971.
- ↑ Gong, Yi; Mu, Dakai; Prabhakar, Shilpa; Moser, Ann; Musolino, Patricia; Ren, JiaQian; Breakefield, Xandra O; Maguire, Casey A; Eichler, Florian S (2015). "Adenoassociated Virus Serotype 9-Mediated Gene Therapy for X-Linked Adrenoleukodystrophy". Molecular Therapy. 23 (5): 824–834. doi:10.1038/mt.2015.6. ISSN 1525-0016.
- ↑ Cartier N, Hacein-Bey-Abina S, Bartholomae CC, Veres G, Schmidt M, Kutschera I; et al. (2009). "Hematopoietic stem cell gene therapy with a lentiviral vector in X-linked adrenoleukodystrophy". Science. 326 (5954): 818–23. doi:10.1126/science.1171242. PMID 19892975.