The natural history of type B Niemann-Pick disease

Results from a 10-year longitudinal study

Melissa P. Wasserstein, Robert J. Desnick, Edward H. Schuchman, Sabera Hossain, Sylvan Wallenstein, Carin Lamm, Margaret M. McGovern

Research output: Contribution to journalArticle

83 Citations (Scopus)

Abstract

Objectives. Type B Niemann-Pick disease (NPD-B) caused by acid sphingomyelinase deficiency is a rare, autosomal recessive, lysosomal storage disorder with a broad range of disease severity. The objectives of this study were to document the natural history of the disease in a large, clinically heterogeneous patient population that was followed for a period of 10 years and to determine how genotype influences phenotype. Methods. Twenty-nine patients with NPD-B had serial evaluations at least 9 months apart. Organ volumes, hematologic indices, lipid concentrations, pulmonary function, and hepatic activity were studied, and individual phenotypic severity was compared with genotype. Results. All patients with intact spleens had splenomegaly (mean value: 12.7 multiples of normal [MN]; range: 4.5-27.3 MN), and all but 1 had hepatomegaly (mean volume: 1.91 MN; range: 0.93-3.21 MN). At initial visit, 39% had thrombocytopenia and 3% had leukopenia. At final visit, the percentages increased to 54% and 34%, respectively. Mean annual decreases in platelet count and leukocyte count were 7 × 103 and 0.2 × 103 per mm3, respectively. The typical atherogenic lipid profile was worse in older patients. A total of 69% of patients had low diffusion capacity for carbon monoxide, and more than one third had low forced expiratory volume in 1 second, forced vital capacity, and forced expiratory volume in 1 second/forced vital capacity at initial visit. All measurements of pulmonary function showed a gradual deterioration over time. Liver dysfunction was characterized by stable elevation of hepatic transaminases and bilirubin. Homozygotes for ΔR608, P323A, and P330R had milder disease than patients with all other genotypes. Conclusions. The natural history of NPD-B is characterized by hepatosplenomegaly with progressive hypersplenism, worsening atherogenic lipid profile, gradual deterioration in pulmonary function, and stable liver dysfunction.

Original languageEnglish (US)
JournalPediatrics
Volume114
Issue number6
DOIs
StatePublished - Dec 2004
Externally publishedYes

Fingerprint

Type B Niemann-Pick Disease
Longitudinal Studies
Genotype
Vital Capacity
Forced Expiratory Volume
Lipids
Lung
Liver Diseases
Type A Niemann-Pick Disease
Hypersplenism
Hepatomegaly
Organ Size
Liver
Splenomegaly
Leukopenia
Homozygote
Carbon Monoxide
Transaminases
Natural History
Platelet Count

Keywords

  • Acid sphingomyelinase
  • Lysosomal storage disease
  • Natural history
  • Niemann-Pick

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Wasserstein, M. P., Desnick, R. J., Schuchman, E. H., Hossain, S., Wallenstein, S., Lamm, C., & McGovern, M. M. (2004). The natural history of type B Niemann-Pick disease: Results from a 10-year longitudinal study. Pediatrics, 114(6). https://doi.org/10.1542/peds.2004-0887

The natural history of type B Niemann-Pick disease : Results from a 10-year longitudinal study. / Wasserstein, Melissa P.; Desnick, Robert J.; Schuchman, Edward H.; Hossain, Sabera; Wallenstein, Sylvan; Lamm, Carin; McGovern, Margaret M.

In: Pediatrics, Vol. 114, No. 6, 12.2004.

Research output: Contribution to journalArticle

Wasserstein, MP, Desnick, RJ, Schuchman, EH, Hossain, S, Wallenstein, S, Lamm, C & McGovern, MM 2004, 'The natural history of type B Niemann-Pick disease: Results from a 10-year longitudinal study', Pediatrics, vol. 114, no. 6. https://doi.org/10.1542/peds.2004-0887
Wasserstein, Melissa P. ; Desnick, Robert J. ; Schuchman, Edward H. ; Hossain, Sabera ; Wallenstein, Sylvan ; Lamm, Carin ; McGovern, Margaret M. / The natural history of type B Niemann-Pick disease : Results from a 10-year longitudinal study. In: Pediatrics. 2004 ; Vol. 114, No. 6.
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