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Sanfilippo syndrome – Wikipedia
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What is Sanfilippo Syndrome?

Sanfilippo syndrome , also known as mucopolysaccharidosis type III MPS III , is a rare autosomal recessive lysosomal storage disease that primarily affects the brain and spinal cord. It is caused by a buildup of large sugar molecules called glycosaminoglycans AKA GAGs, or mucopolysaccharides in the body’s lysosomes. Affected children generally do not show any signs or symptoms at birth. Although some early indicators can be respiratory issues at birth, large head size, and umbilical hernia.

In later stages of the disorder, they may develop seizures and movement disorders. Patients with Sanfilippo syndrome usually live into adolescence or early adulthood. The disease manifests in young children. Symptoms usually begin to appear between 2 and 6 years of age.

Of all of the MPS diseases, Sanfilippo syndrome produces the fewest physical abnormalities. The disease progresses to increasing behavioral disturbance including temper tantrums , hyperactivity, destructiveness, aggressive behavior, pica , difficulties with toilet training, and sleep disturbance. As affected children initially have normal muscle strength and mobility, the behavioral disturbances may be difficult to manage.

The disordered sleep in particular presents a significant problem to care providers. In the final phase of the illness, children become increasingly immobile and unresponsive, often require wheelchairs, and develop swallowing difficulties and seizures. The life-span of an affected child does not usually extend beyond late teens to early twenties. Individuals with MPS Type III tend to have mild skeletal abnormalities; osteonecrosis of the femoral head may be present in patients with the severe form.

Optic nerve atrophy, deafness, and otitis can be seen in moderate to severe individuals. Other characteristics include coarse facial features, thick lips, synophrys, and stiff joints.

It is difficult to clinically distinguish differences among the four types of Sanfilippo syndrome. However, type A is usually the most severe subtype, characterized by earliest onset, rapid clinical progression with severe symptoms, and short survival.

It is important that simple and treatable conditions such as ear infections and toothaches not be overlooked because of behavior problems that make examination difficult. Bumps, bruises, or ear infections that would be painful for other children often go unnoticed in children with MPS type III.

Mutations in four different genes can lead to Sanfilippo Syndrome. This disorder is inherited in an autosomal recessive pattern. People with two working copies of the gene are unaffected. People with one working copy are genetic carriers of Sanfilippo Syndrome. They have no symptoms but may pass down the defective gene to their children. People with two defective copies will suffer from Sanfilippo Syndrome. Glycosaminoglycans GAGs are chains of sugar molecules. They are found in the extracellular matrix and the cell membrane , or stored in the secretory granules.

GAGs are stored in the cell lysosome, and are degraded by enzymes such as glycosidases, sulfatases, and acetyltransferases. Sanfilippo Syndrome Types A, B, C, and D are considered to be clinically indistinguishable, although mutations in different genes are responsible for each disease.

The following discussion is therefore applicable to all four conditions. A urinalysis can show elevated levels of heparan sulfate in the urine. Additionally, urinary GAG levels are higher in infants and toddlers than in older children.

In order to avoid a false negative urine test due to dilution , it is important that a urine sample be taken first thing in the morning. The diagnosis may be confirmed by enzyme assay of skin fibroblasts and white blood cells. The enzyme assay is considered the most-credible diagnostic tool because it detects whether or not the enzymes in the cellular pathway breaking down heparan sulfate is present or not, providing a definitive answer.

This test is also ideal for younger patients in which collecting a viable urine sample is difficult or impossible. Another diagnostic tool can be gene sequencing.

However, if the genetic mutation they carry has never been seen or recorded, the patient would receive a false negative. Prenatal diagnosis is possible by chorionic villus sampling or amniocentesis. Treatment remains largely supportive. If an early diagnosis is made, bone marrow replacement may be beneficial.

Although the missing enzyme can be manufactured and given intravenously, it cannot penetrate the blood—brain barrier and therefore cannot treat the neurological manifestations of the disease. Along with many other lysosomal storage diseases , MPS-III exists as a model of a monogenetic disease involving the central nervous system. Several promising therapies are in development. For any future treatment to be successful, it must be administered as early as possible. Currently MPS-III is mainly diagnosed clinically, by which stage it is probably too late for any treatment to be very effective.

Neonatal screening programs would provide the earliest possible diagnosis. The flavonoid genistein decreases the accumulation of GAGs. Several support and research groups have been established to speed the development of new treatments for Sanfilippo syndrome.

According to a study of patients with Sanfilippo syndrome, the median life expectancy varies depending on the subtype. For Type B, it was The mean life expectancy for Type A has increased since the s. Incidence of Sanfilippo syndrome varies geographically, with approximately 1 case per , live births in Northern Ireland, [23] 1 per 66, in Australia, [24] and 1 per 50, in the Netherlands.

The condition is named after Sylvester Sanfilippo , the pediatrician who first described the disease in Caregivers for children with Sanfilippo Syndrome face a unique set of challenges because of the disease’s complex nature.

There is little understanding among clinicians of the family experience of caring for patients with Sanfilippo and how a caregiver’s experiences change and evolve as patients age.

The burden and impact on caregivers’ quality of life is poorly defined and best-practice guidance for clinicians is lacking. A best-practice guidance to help clinicians understand the challenges caregivers face was published July in the Orphanet Journal of Rare Diseases by a group of international clinical advisors with expertise in the care of pediatric patients with Sanfilippo, lysosomal storage disorders, and life as a caregiver to a child with Sanfilippo.

The group reviewed key aspects of caregiver burden associated with Sanfilippo B by identifying and quantifying the nature and impact of the disease on patients and caregivers. Recommendations were based on findings from qualitative and quantitative research. The article’s authors reported that: “Providing care for patients with Sanfilippo B impinges on all aspects of family life, evolving as the patient ages and the disease progresses.

Important factors contributing toward caregiver burden include sleep disturbances, impulsive and hyperactive behavior, and communication difficulties Caregiver burden remained high throughout the life of the patient and, coupled with the physical burden of daily care, had a cumulative impact that generated significant psychological stress. Additionally, the authors call for changing the narrative associated with Sanfilippo: “The panel agreed that the perceived aggressive behavior of the child may be better described as ‘physical impulsiveness’ and is often misunderstood by the general public.

Parents may seek to protect their child from public scrutiny and avoid situations that many engender criticism of their parenting skills. The community of Sanfilippo families, foundations, scientists and researchers, and industry partners and collaborators around the world have dedicated November 16 as World Sanfilippo Awareness Day.

World Sanfilippo Awareness Day is about spreading awareness and sparking conversations globally about Sanfilippo Syndrome. This special day of Awareness is in honor of the children around the world living with Sanfilippo Syndrome today, and those who have passed away.

It also honors the families of the children with Sanfilippo Syndrome. From Wikipedia, the free encyclopedia. Mucopolysaccharidosis characterized by a deficiency of the lysosomal enzyme resulting in incomplete breakdown of the heparan sulfate sugar chain. Medical condition. National Institute of Neurological Disorders and Stroke. Retrieved 25 May Cure Sanfilippo Foundation. Genetics Home Reference. March Retrieved 22 July Archived from the original PDF on 8 July Retrieved 13 March Valstar; Hennie T.

Bruggenwirth; Renske Olmer; Ron A. Wevers; Frans W. Verheijen; et al. September Inherit Metab Dis. PMC PMID Pediatrics International. Human Gene Therapy. United States National Library of Medicine. Retrieved 20 June Life Science Leader. United States: VertMarkets. Archived from the original on Retrieved Jul