title: Is there an effect of intranasal insulin on development and behaviour in Phelan-McDermid syndrome? A randomized, double-blind, placebo-controlled trial.
abstract: Phelan-McDermid syndrome (PMS) or 22q13.3 deletion syndrome is a rare neurodevelopmental disorder with at least 60 children and 35 adults diagnosed in the Netherlands. Clinical features are moderate to severe intellectual disability and behavioural problems in the autism spectrum. Other researchers had observed a beneficial effect of intranasal insulin on development and behaviour in a pilot study in six children with PMS. To validate this effect, we conducted a randomized, double-blind, placebo-controlled clinical trial using a stepped-wedge design. From March 2013 to June 2015, 25 children aged 1-16 years with a molecularly confirmed 22q13.3 deletion including the SHANK3 gene participated in the clinical trial for a period of 18 months. Starting 6 months before the trial, children were systematically assessed for cognitive, language and motor development and for adaptive, social and emotional behaviour every 6 months. The second, third and fourth assessments were followed by daily nose sprays containing either intranasal insulin or intranasal placebo for a 6-month period. A fifth assessment was done directly after the end of the trial. Intranasal insulin did not cause serious adverse events. It increased the level of developmental functioning by 0.4-1.4 months per 6-month period, but the effect was not statistically significant in this small group. We found a stronger effect of intranasal insulin, being significant for cognition and social skills, for children older than 3 years, who usually show a decrease of developmental growth. However, clinical trials in larger study populations are required to prove the therapeutic effect of intranasal insulin in PMS.
authors: University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, The Netherlands.
authors: Renée J
authors: RJ
authors: Zwanenburg
authors: University of Groningen, University Medical Centre Groningen, Beatrix Children's Hospital, Department of Paediatrics, Groningen, The Netherlands.
authors: Gianni
authors: G
authors: Bocca
authors: De Kinderacademie Groningen, Centre of Expertise for Child Development Care and Research, Groningen, The Netherlands.
authors: Selma A J
authors: SA
authors: Ruiter
authors: University of Groningen, University Medical Centre Groningen, Department of Clinical Pharmacy and Pharmacology, Groningen, The Netherlands.
authors: Jan H
authors: JH
authors: Dillingh
authors: University of Groningen, University Medical Centre Groningen, Beatrix Children's Hospital, Department of Paediatrics, Groningen, The Netherlands.
authors: Boudien C T
authors: BC
authors: Flapper
authors: Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors: Edwin R
authors: ER
authors: van den Heuvel
authors: University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, The Netherlands.
authors: Conny M A
authors: CM
authors: van Ravenswaaij-Arts
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D002872:Chromosome Deletion; D025063:Chromosome Disorders / Q000188:drug therapy / Q000235:genetics / Q000534:rehabilitation*; D002892:Chromosomes, Human, Pair 22 / Q000235:genetics; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D009419:Nerve Tissue Proteins / Q000235:genetics; D066107:Social Skills
chemical_list: D007328:Insulin; D009419:Nerve Tissue Proteins; C492357:SHANK3 protein, human