Finally, there are also very mild cases that are discovered during adolescence or adulthood following presentation with thoracic kyphosis. [orpha.net]

Both isomers were present in equal amounts. The clinical features were similar to those of the Hurler syndrome or mucopolysaccharidoses type I (McKusick 1966). [onlinelibrary.wiley.com]

Patients commonly present for surgery and anesthesia due to multisystem involvement. [joacp.org]

The data are being presented in poster and oral presentations by Dr. Emil Kakkis, Chief Executive Officer of Ultragenyx, at the 11 th Annual WORLD Symposium in Orlando, Florida. [globenewswire.com]

However, cases of attenuated MPS I show wide variation with respect to age of presentation, symptoms and disease course. [2], [6] The clinical presentation may be limited to growth failure, cloudy corneas, mild coarsening of facial features, hepatomegaly [contempclindent.org]

• Splenomegaly

  Splenomegaly occurs in the hematopoietic system. Inborn mucopolysaccharide metabolic disorders due to β-glucuronidase deficiency with granular inclusions in granulocytes occurs in the biochemical and metabolic systems. [en.wikipedia.org]

  […] signs and symptoms include coarse facial features, vision loss [ 29 ], hearing loss [ 30 ], decreased pulmonary function and obstructive sleep apnoea [ 31 ], frequent and recurrent respiratory infections, cardiac disease [ 32, 33 ], hepatomegaly and splenomegaly [rheumatology.oxfordjournals.org]

• Developmental Delay

  In more severe cases, there may be developmental delay. The severe form of MPS 7 can uniquely present at birth with hydrops fetalis (severe generalized edema). [ultragenyx.com]

  He has short stature, webbing of his hands, pulmonary stenosis, seizures and hydrocephalus along with developmental delay. [ggc.org]

  In addition to developing somatic symptoms, patients having the neuronopathic form of the disease also display developmental delay and cognitive impairment in early childhood that progressively worsens and that is severely life-limiting. [touchneurology.com]

  Affected individuals may have developmental delay and progressive intellectual disability, although intelligence is unaffected in some people with this condition. [ghr.nlm.nih.gov]

• Short Stature

  Patients with MPS 7 may experience joint stiffness, short stature, an enlarged spleen and liver and heart / lung complications. MPS 7 also causes a characteristic facial appearance and can lead to a progressive skeletal dysplasia. [ultragenyx.com]

  He has short stature, webbing of his hands, pulmonary stenosis, seizures and hydrocephalus along with developmental delay. [ggc.org]

  MPS II is found almost exclusively in young males and is clinically characterized by short stature, hepatosplenomegaly, joint contractures, and coarse facies. [centogene.com]

  These disorders are associated with the accumulation of GAGs in tissues with organomegaly, mental retardation and short stature. Otologic and upper respiratory tract pathologies are among the earliest clinical manifestations. [ncbi.nlm.nih.gov]

• Coarse Facial Features

  Features of MPS VII are large head coarse facial features large tongue enlarged liver and spleen heart valve abnormalites umbilical hernia may have narrow airways cloudy cornea may have ear infections and hearing loss may have narrowing of the spinal [ldnz.org.nz]

  Considerations for testing Testing for MPS III is appropriate for any individual with any combination of clinical features consistent with a MPS III including: progressive developmental delay, autistic features, sleep disturbances and mildly coarse facial [invitae.com]

  On physical examination, she appeared short statured (stunted growth) with lumbar kyphosis and presented coarse facial features [Figure 1]. [contempclindent.org]

  The child had coarse facial features, corneal clouding, depressed nasal bridge, large tongue and high arched palate with a 2-cm mouth opening [Figure 1]. Parents did not reveal any history of snoring or apneic episodes while sleeping. [joacp.org]

  The most common clinical manifestations of MPS I include the following: Characteristic coarse facial features Frequent upper-respiratory infections and otitis media Hepatosplenomegaly Inguinal or umbilical hernia Characteristic skeletal and joint findings [centogene.com]

• Inguinal Hernia

  Affected individuals also frequently develop an enlarged liver and spleen (hepatosplenomegaly), heart valve abnormalities, and a soft out-pouching around the belly-button (umbilical hernia ) or lower abdomen (inguinal hernia). [ghr.nlm.nih.gov]

  Umbilical and inguinal hernias frequently occur in MPS due to abdominal protuberance from hepatosplenomegaly and ineffective connective tissue support of the anterior abdominal wall. [joacp.org]

  The most common clinical manifestations of MPS I include the following: Characteristic coarse facial features Frequent upper-respiratory infections and otitis media Hepatosplenomegaly Inguinal or umbilical hernia Characteristic skeletal and joint findings [centogene.com]

  hernias, chronic diarrhoea, CTS [ 34 ], communicating hydrocephalus and spinal cord compression. [rheumatology.oxfordjournals.org]

• Recurrent Otitis Media

  We found ear, nose and throat manifestations in all types of MPS; in particular, recurrent otitis media was present in 30% of cases, hearing loss in 75% (mixed in 43.33%, conductive in 43.33%, sensorineural in 13.33%), adenotonsillar hypertrophy in 75% [ncbi.nlm.nih.gov]

  Recurrent otitis media (middle ear infections) significantly contribute to hearing loss in individuals with MPS. Prescription medications are used to treat otitis media. [encyclopedia.com]

• Failure to Thrive

  […] to thrive, intellectual disability, and developmental delay.[ 5 12 ] The extensive storage of these glycosaminoglycans is also known to cause meningeal thickening.[ 4 ] Intraoperatively, our patient was noted to have thickened arachnoid membrane, which [surgicalneurologyint.com]

• Hepatosplenomegaly

  Clinical description Clinical signs are extremely variable: there are prenatal forms with non-immune hydrops fetalis, and severe neonatal forms with dysmorphism, hernias, hepatosplenomegaly, club feet, dysostosis, severe hypotonia and neurological disorders [orpha.net]

  Affected individuals also frequently develop an enlarged liver and spleen (hepatosplenomegaly), heart valve abnormalities, and a soft out-pouching around the belly-button (umbilical hernia ) or lower abdomen (inguinal hernia). [ghr.nlm.nih.gov]

  The Phase 3 study will also evaluate the safety and tolerability of rhGUS, pulmonary function, walking, stair climb, shoulder flexion, fine and gross motor function, hepatosplenomegaly, cardiac size and function, visual acuity, patient and caregiver assessment [biospace.com]

  Coarse facies, mild dysostosis multiplex, hepatosplenomegaly and joint contractures may also be present. There is considerable variation in onset and severity of the clinical phenotype even within a sibship. [genedx.com]

  MPS II is found almost exclusively in young males and is clinically characterized by short stature, hepatosplenomegaly, joint contractures, and coarse facies. [centogene.com]

• Hepatomegaly

  Hepatomegaly occurs in the gastrointestinal system. Splenomegaly occurs in the hematopoietic system. [en.wikipedia.org]

  Medical history revealed that she suffered frequent respiratory infections (chronic sinus infections), stiffness of joints and hepatomegaly. Gradual hearing loss and vision impairment has been reported with evidence of corneal clouding [Figure 2]. [contempclindent.org]

  Most patients with the intermediate phenotype show hepatomegaly, skeletal anomalies, coarse facies, and variable degrees of mental impairment. [genecards.org]

  Somatic manifestations such as hepatomegaly, dysostosis multiplex, coarse facies and hypertrichosis are relatively mild compared to the other mucopolysaccharidoses. [invitae.com]

  Ultrasound abdomen showed moderate hepatomegaly. The echocardiogram showed mitral valve prolapse with moderate mitral regurgitation and tricuspid valve collapse with mild tricuspid regurgitation. [neurologyindia.com]

• Hearing Impairment

  Neurological signs and symptoms that may be evident in patients having either the neuronopathic or non-neuronopathic phenotypes include seizures, optic nerve compression, hearing impairment, sleep apnoea, hydrocephalus, carpal tunnel syndrome, spinal [touchneurology.com]

• Hirsutism

  Patient had virilization of the external genitalia with hirsutism and masculine voice. Patient had ambiguous genitalia. There was history of unexplained sibling death in the family at 1 year of age. [joacp.org]

• Hypertrichosis

  Somatic manifestations such as hepatomegaly, dysostosis multiplex, coarse facies and hypertrichosis are relatively mild compared to the other mucopolysaccharidoses. [invitae.com]

• Corneal Opacity

  The symptoms include: in the head, neck, and face: coarse (Hurler-like) facies and macrocephaly, frontal prominence, premature closure of sagittal lambdoid sutures, and J-shaped sella turcica in the eyes: corneal opacity and iris coloboma in the nose: [en.wikipedia.org]

• Hydrops Fetalis

  More than half of infants with hydrops fetalis do not survive beyond early infancy. Some adults with MPS 7 can have a less severe physical or skeletal disease. [ultragenyx.com]

  The most severe cases of MPS VII are characterized by hydrops fetalis, a condition in which excess fluid builds up in the body before birth. Most babies with hydrops fetalis are stillborn or die soon after birth. [ghr.nlm.nih.gov]

  The most severe cases of MPS VII are characterized by hydrops fetalis, a condition in which excess fluid builds up in the body before birth. Most babies with this condition are stillborn or die soon after birth. [ldnz.org.nz]

  Clinical description Clinical signs are extremely variable: there are prenatal forms with non-immune hydrops fetalis, and severe neonatal forms with dysmorphism, hernias, hepatosplenomegaly, club feet, dysostosis, severe hypotonia and neurological disorders [orpha.net]

• Macrocephaly

  The symptoms include: in the head, neck, and face: coarse (Hurler-like) facies and macrocephaly, frontal prominence, premature closure of sagittal lambdoid sutures, and J-shaped sella turcica in the eyes: corneal opacity and iris coloboma in the nose: [en.wikipedia.org]

  The features of MPS VII include a large head ( macrocephaly ), a buildup of fluid in the brain (hydrocephalus), distinctive-looking facial features that are described as " coarse ," and a large tongue ( macroglossia ). [ghr.nlm.nih.gov]

  The typical features appear at about the age of 12 years, including macrocephaly and coarse facies, and restriction of joint mobility with deformities becomes apparent at the age of 12-15 years. [7] The combination of metaphyseal deformities and thickened [contempclindent.org]

  Other forms of MPS VII are less severe and present during early childhood and are characterized by the following signs and symptoms: Macrocephaly and hydrocephalus Distinctive facial features and macroglossia Hepatosplenomegaly Cardiac valve abnormalities [centogene.com]

• Joint Stiffness

  Patients with MPS 7 may experience joint stiffness, short stature, an enlarged spleen and liver and heart / lung complications. MPS 7 also causes a characteristic facial appearance and can lead to a progressive skeletal dysplasia. [ultragenyx.com]

  For example, physical therapy may help preserve joint function for individuals with joint stiffness. Joint stiffness is present in all of the MPS disorders except MPS IV and MPS IX. [encyclopedia.com]

• Genu Valgum

  valgum, hypermobile joints Waddling gait with frequent falls Qualitative urine glycosaminoglycan (GAG) analysis demonstrates keratan sulfate and chondroitin 6-sulfate. [centogene.com]

  A 7-year-old girl with Morquio syndrome and typical severe genu valgum. Courtesy of Dennis P. Grogan, MD. [emedicine.medscape.com]

  Skeletal abnormalities can be extreme and include dwarfism, kyphosis (outward-curved spine), prominent breastbone, flat feet, and genu-valgum (knock-knees). [encyclopedia.com]

• Short Neck

  Airway evaluation: abnormal neck anatomy, short neck with limited mobility, hyromental and thyromentonian distance less than 6 cm, severely limited jaw protrusion, mouth opening inferior to 6 cm, mallampati IV and snoring. [omicsonline.org]

  She had dysmorphic facial features, macroglossia, a short neck, a low hair line, a high arched palate, corneal haziness, Mongolian spots over back, exaggerated thoracic kyphosis, and short stout fingers. [neurologyindia.com]

• Frontal Bossing

  Figure 1: (a - c) Magnetic resonance image showing scaphocephaly with frontal bossing and bilateral frontotemporal atrophy; (d - f) computed tomography surface shaded display showing craniosynostosis involving metopic, sagittal and bilateral lambdoid [neurologyindia.com]

• Seizure

  Tonic–clonic seizures are the most common type of seizure in Hunter syndrome, but absent and myoclonic seizures have also been reported. 15 It is possible that absence seizures (petit mal) are under-reported; neurologists should be aware of this and seek [touchneurology.com]

  In March, the drug failed a mid-stage study testing it as a seizure medication for Glut1 DS patients. [biopharmadive.com]

  He has short stature, webbing of his hands, pulmonary stenosis, seizures and hydrocephalus along with developmental delay. [ggc.org]

  Additional clinical symptoms include intellectual disability, progressive neurologic symptoms including aggressive behavior, poor coordination, seizures and hearing loss. [genedx.com]

  SEIZURES Seizures are a problem found in severe forms of MPS and especially in MPS III (Sanfilippo syndrome). Patients with seizures are given a type of prescription medication known as an anticonvulsant. [encyclopedia.com]

CASE REPORT The patient is a 6-year-old male who was referred to a pediatric clinic for an incidentally found CM-I and cervicothoracic syrinx [ Figure 1 ] identified during a preoperative workup prior to the surgical management of a progressive thoracolumbar [surgicalneurologyint.com]

This would require addition to the CSF before workup, and the lack of stable isotope–labeled precursor molecules (GAGs) precludes this possibility. [clinchem.aaccjnls.org]

Changes from before treatment (baseline) to 24 weeks after treatment in each domain variable were scored against pre-specified MIDs. [clinicaltrials.gov]

The study provides evidence of clinical improvement with rhGUS treatment. [checkorphan.org]

Management and treatment Multidisciplinary management allows adapted symptomatic treatment, which is essential for improving the quality of life of the patients. In late-onset forms, treatment is mainly orthopaedic. [orpha.net]

The use of enzyme replacement therapy as a potential treatment is based on 20 years of research work in murine models of the disease. [biospace.com]

treatment to replace the missing enzyme in MPS 7 patients. [io.nihr.ac.uk]

Prognosis Prognosis is poor for antenatal forms, most often leading to death in utero. Neonatal and childhood forms have a very limited life expectancy, whereas milder forms have a prolonged survival. [orpha.net]

The decision for surgery should be taking into account, the characterization of the metabolic disorder, its course, prognosis, and life expectancy. [neurologyindia.com]

Prognosis Fetal deaths have been reported in severe cases. In patients with milder cases, survival to age 19-20 years has been reported. [emedicine.medscape.com]

Prognosis Life expectancy for individuals with an MPS is extremely varied. [encyclopedia.com]

With such an approach, current management options may alleviate some of the neurological symptoms of Hunter syndrome, but treatments that target accumulation of GAGs in the central nervous system are required if we hope to further improve the prognosis [touchneurology.com]

Etiology The disease is caused by beta-D-glucuronidase deficiency, which leads to accumulation of several glycosaminoglycans (dermatan sulfate (DS), heparan sulfate (HS), and chondroitin sulfate (CS)) in lysosomes. [orpha.net]

Summary Epidemiology Less than 40 patients with neonatal to moderate presentation have been reported since the initial description of the disease by Sly in 1973. [orpha.net]

Relevant External Links for GUSB Genetic Association Database (GAD) GUSB Human Genome Epidemiology (HuGE) Navigator GUSB Atlas of Genetics and Cytogenetics in Oncology and Haematology: GUSB No data available for Genatlas for GUSB Gene Identification and [genecards.org]

Epidemiology Frequency Sly syndrome is a rare form of mucopolysaccharidosis with an estimated worldwide frequency of 1 per 250,000 births. United States Sly syndrome is extremely rare in the United States, and few cases have been described. [emedicine.medscape.com]

The overall frequency of either p.R59H or 1622-1627insG was 57.7% of the disease-causing alleles, and this epidemiological study suggested a carrier frequency of 1:58 for this population 31. [centogene.com]

[Frontiers in Bioscience, Landmark, 22, 385-406, January 1, 2016] Mucopolysaccharidosis VI: Pathophysiology, diagnosis and treatment 1 UCSF Benioff Children’s Hospital Oakland, Department of Gastroenterology, Oakland, CA, USA, 2 BioMarin Pharmaceutical [bioscience.org]

A clear understanding of the pathophysiology is important for the management of such patients. [joacp.org]

Pathophysiology Mutations in the beta-glucuronidase ( GUSB ) gene cause Sly syndrome. This gene instructs the production of the beta-glucuronidase enzyme, which is involved in the breakdown of glycosaminoglycans (GAGs). [emedicine.medscape.com]

Pathophysiology of the MPS disorders The MPSs are chronic and progressive syndromes that produce a spectrum of signs and symptoms in multiple organ systems. A good example of this is seen in individuals with MPS I. [rheumatology.oxfordjournals.org]

Prevention No specific measures can prevent the gene mutations that cause MPS. [encyclopedia.com]

Maintenance steroid therapy intraoperatively prevents adrenal crisis. Daily cortisol production ranges from 9 to 11 mg/ m 2 /day. [18] Stress causes ACTH mediated increase in the cortisol production. [joacp.org]

Currently, HSCT with bone marrow or umbilical cord blood stem cells has been shown to prevent many of the clinical features of the severe phenotypes of MPS I, VI and VII [ 55–57 ]. [rheumatology.oxfordjournals.org]

[…] ganglion cells and loss of hair cells. 9,24 Carpal tunnel syndrome caused by entrapment of the median or ulnar nerves has been reported to affect 96 % of children who have Hunter syndrome but may be underdiagnosed, for patients’ cognitive impairment often prevents [touchneurology.com]

Preventing mucopolysaccharidosis type II (Hunter syndrome): PGD and establishing a Hunter (46, XX) stem cell line. Prenat Diagn. 2011 Jun 27. [Medline]. [emedicine.medscape.com]