J Inherit Metab Dis. 2023 Jun 21.
Bibiche den Hollander,
Marion M Brands,
Lonneke de Boer,
Charlotte Haaxma,
Anna Lengyel,
Peter van Essen,
Gera Peters,
Hanneke J T Kwast,
Willemijn M Klein,
Karlien L M Coene,
Dirk J Lefeber,
Clara D M van Karnebeek.
BACKGROUND: NANS-CDG is a congenital disorder of glycosylation (CDG) caused by biallelic variants in NANS, encoding an essential enzyme in de novo sialic acid synthesis. It presents with intellectual developmental disorder (IDD), skeletal dysplasia, neurologic impairment, and gastrointestinal dysfunction. Some patients suffer progressive intellectual neurologic deterioration (PIND), emphasizing the need for a therapy. In a previous study, sialic acid supplementation in knockout nansa zebrafish partially rescued skeletal abnormalities. Here, we performed the first in-human pre- and postnatal sialic-acid study in NANS-CDG.METHODS: In this open-label observational study, 5 patients with NANS-CDG (range 0 - 28 years) were treated with oral sialic acid for 15 months. Primary outcome was safety. Secondary outcomes were psychomotor / cognitive testing, height and weight, seizure control, bone health, gastrointestinal symptoms and biochemical and hematological parameters.
RESULTS: Sialic acid was well tolerated. In postnatally treated patients, there was no significant improvement. For the prenatally treated patient, psychomotor and neurologic development was better than two other genotypically identical patients (one treated postnatally, one untreated).
CONCLUSIONS: The effect of sialic acid treatment may depend on the timing, with prenatal treatment potentially benefiting neurodevelopmental outcomes. Evidence is limited however, and longer-term follow-up in a larger number of prenatally treated patients is required. This article is protected by copyright. All rights reserved.
Keywords: Congenital Disorder of Glycosylation; N-acetyl-D-neuraminic acid; glycosylation; inherited metabolic disorder; intellectual developmental disorder; personalized medicine; sialic acid biosynthesis