Pathogenesis and treatment of spine disease in the mucopolysaccharidoses.
The mucopolysaccharidoses (MPS) are a family of lysosomal storage disorders characterized by deficient activity of enzymes that degrade glycosaminoglycans (GAGs). Skeletal disease is common in MPS patients, with the severity varying both within and between subtypes. Within the spectrum of skeletal disease, spinal manifestations are particularly prevalent. Developmental and degenerative abnormalities affecting the substructures of the spine can result in compression of the spinal cord and associated neural elements. Resulting neurological complications, including pain and paralysis, significantly reduce patient quality of life and life expectancy. Systemic therapies for MPS, such as hematopoietic stem cell transplantation and enzyme replacement therapy, have shown limited efficacy for improving spinal manifestations in patients and animal models. Therefore, there is a pressing need for new therapeutic approaches that specifically target this debilitating aspect of the disease. In this review, we examine how pathological abnormalities affecting the key substructures of the spine - the discs, vertebrae, odontoid process and dura - contribute to the progression of spinal deformity and symptomatic compression of neural elements. Specifically, we review current understanding of the underlying pathophysiology of spine disease in MPS, how the tissues of the spine respond to current clinical and experimental treatments, and discuss future strategies for improving the efficacy of these treatments.
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, United States; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, United States.
Sun H
SH
Peck
Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, United States.
Margret L
ML
Casal
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, United States; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, United States.
Neil R
NR
Malhotra
Division of Human Genetics and Metabolism, The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, United States.
Can
C
Ficicioglu
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, United States; Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, United States. Electronic address: lachlans@mail.med.upenn.edu.
Lachlan J
LJ
Smith
D056947:Enzyme Replacement Therapy; D006025:Glycosaminoglycans / Q000378:metabolism*; D006801:Humans; D009083:Mucopolysaccharidoses / Q000503:physiopathology* / Q000628:therapy; D011788:Quality of Life; D013122:Spinal Diseases / Q000503:physiopathology* / Q000628:therapy; D013131:Spine / Q000503:physiopathology
D006025:Glycosaminoglycans
Animal models; Bone; Intervertebral disc; Lysosomal storage disorder; Mucopolysaccharidosis; Spine; Therapy; Vertebra