Mucopolysaccharidosis type II (Hunter syndrome): a clinical review and recommendations for treatment in the era of enzyme replacement therapy.
Mucopolysaccharidosis type II (MPS II; Hunter syndrome) is a rare X-linked recessive disease caused by deficiency of the lysosomal enzyme iduronate-2-sulphatase, leading to progressive accumulation of glycosaminoglycans in nearly all cell types, tissues and organs. Clinical manifestations include severe airway obstruction, skeletal deformities, cardiomyopathy and, in most patients, neurological decline. Death usually occurs in the second decade of life, although some patients with less severe disease have survived into their fifth or sixth decade. Until recently, there has been no effective therapy for MPS II, and care has been palliative. Enzyme replacement therapy (ERT) with recombinant human iduronate-2-sulphatase (idursulfase), however, has now been introduced. Weekly intravenous infusions of idursulfase have been shown to improve many of the signs and symptoms and overall wellbeing in patients with MPS II. This paper provides an overview of the clinical manifestations, diagnosis and symptomatic management of patients with MPS II and provides recommendations for the use of ERT. The issue of treating very young patients and those with CNS involvement is also discussed. ERT with idursulfase has the potential to benefit many patients with MPS II, especially if started early in the course of the disease.
Willink Biochemical Genetics Unit, Royal Manchester Children's Hospital, Hospital Road, Manchester M27 4HA, UK. ed.wraith@cmmc.nhs.uk
J Edmond
JE
Wraith
Maurizio
M
Scarpa
Michael
M
Beck
Olaf A
OA
Bodamer
Linda
L
De Meirleir
Nathalie
N
Guffon
Allan
A
Meldgaard Lund
Gunilla
G
Malm
Ans T
AT
Van der Ploeg
Jiri
J
Zeman
D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D006801:Humans; D007066:Iduronate Sulfatase / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D007262:Infusions, Intravenous; D016532:Mucopolysaccharidosis II / Q000175:diagnosis / Q000201:enzymology / Q000235:genetics / Q000628:therapy*; D010641:Phenotype
D007066:Iduronate Sulfatase