Клинические проявления и современные подходы к диагностике и терапии недостаточности кислой сфингомиелиназы (болезни Ниманна–Пика тип АВ)

Болезнь Ниманна-Пика (БНП) тип AB – лизосомная болезнь накопления, вызываемая дефицитом фермента кислой сфингомиелиназы (ASM, acid sphingomyelinase). Накопление субстрата блокированной реакции сфингомиелина вызывает повреждение различных систем и органов, таких, как печень и центральная нервная система. Выделяют три основных формы болезни: тип A, тип B и промежуточный тип A/B. Тип A характеризуется быстропрогрессирующим течением и вовлечением нервной системы, тогда как тип B имеет более мягкое течение с преимущественным поражением висцеральных органов – печени, селезенки и легких. Промежуточный тип А/В характеризуется минимальными неврологическими нарушениям в сочетании с висцеральными проявлениями. Золотой стандарт лабораторной диагностики БНП типа AB – определение активности фермента кислой сфингомиелиниазы. Дополнительным тестом является измерение концентрации лизосфинголипидов в крови, а завершающим этапом – ДНК-диагностика. Эффективным методом лечения висцеральных проявлений БНП типа АВ является ферментная заместительная терапия. Также применяют трансплантацию гемопоэтических стволовых клеток, симптоматическую терапию, и разрабатываются подходы к генной терапии и лечению с применением молекулярных шаперонов. В обзоре приведены данные последних лет по патогенезу и диагностике, а также приводится обзор терапевтических подходов к БНП типа AB, в особенности с использованием генетических технологий.

1. Geberhiwot T., Wasserstein M., Wanninayake S. et al. Consensus clinical management guidelines for acid sphingomyelinase deficiency (Niemann–Pick disease types A, B and A/B). Orphanet J Rare Dis. 2023;18(1):85.

2. Zampieri S., Filocamo M., Pianta A. et al. SMPD1 Mutation Update: Database and Comprehensive Analysis of Published and Novel Variants: HUMAN MUTATION. Human Mutation. 2016;37(2):139–47.

3. Hollak C.E.M., De Sonnaville E.S.V., Cassiman D. et al. Acid sphingomyelinase (Asm) deficiency patients in The Netherlands and Belgium: Disease spectrum and natural course in attenuated patients. Molecular Genetics and Metabolism. 2012;107(3):526–33.

4. Wasserstein M.P., Desnick R.J., Schuchman E.H. et al. The Natural History of Type B Niemann-Pick Disease: Results From a 10-Year Longitudinal Study. Pediatrics. 2004;114(6):e672–7.

5. McGovern M.M., Aron A., Brodie S.E. et al. Natural history of Type A Niemann-Pick disease: Possible endpoints for therapeutic trials. Neurology. 2006;66(2):228–32.

6. Wasserstein M.P., Aron A., Brodie S.E. et al. Acid sphingomyelinase deficiency: prevalence and characterization of an intermediate phenotype of Niemann-Pick disease. J Pediatr. 2006;149(4):554–9.

7. McGovern M.M., Dionisi-Vici C., Giugliani R. et al. Consensus recommendation for a diagnostic guideline for acid sphingomyelinase deficiency. Genetics in Medicine. 2017;19(9):967–74.

8. Cassiman D., Packman S., Bembi B. et al. Cause of death in patients with chronic visceral and chronic neurovisceral acid sphingomyelinase deficiency (Niemann-Pick disease type B and B variant): Literature review and report of new cases. Mol Genet Metab. 2016;118(3):206–13.

9. Wasserstein M., Godbold J., McGovern M.M. Skeletal manifestations in pediatric and adult patients with Niemann Pick disease type B. J Inherit Metab Dis. 2013;36(1):123–7.

10. McGovern M.M., Wasserstein M.P., Giugliani R. et al. A prospective, cross-sectional survey study of the natural history of Niemann-Pick disease type B. Pediatrics. 2008;122(2):e341-349.

11. Thurberg B.L., Wasserstein M.P., Schiano T. et al. Liver and skin histopathology in adults with acid sphingomyelinase deficiency (Niemann-Pick disease type B). Am J Surg Pathol. 2012;36(8):1234–46.

12. Mendelson D.S., Wasserstein M.P., Desnick R.J. et al. Type B Niemann-Pick disease: findings at chest radiography, thin-section CT, and pulmonary function testing. Radiology. 2006;238(1):339–45.

13. Pavlů‐Pereira H., Asfaw B., Poupčtova H. et al. Acid sphingomyelinase deficiency. Phenotype variability with prevalence of intermediate phenotype in a series of twenty‐five Czech and Slovak patients. A multi‐approach study. J of Inher Metab Disea. 2005;28(2):203–27.

14. Quinn P.J. Sphingolipid symmetry governs membrane lipid raft structure. Biochimica et Biophysica Acta (BBA) – Biomembranes. 2014;1838(7):1922–30.

15. Podbielska M., Ariga T., Pokryszko-Dragan A. Sphingolipid Players in Multiple Sclerosis: Their Influence on the Initiation and Course of the Disease. IJMS. 2022;23(10):5330.

16. Kirkegaard T., Roth A.G., Petersen N.H.T. et al. Hsp70 stabilizes lysosomes and reverts Niemann–Pick disease-associated lysosomal pathology. Nature. 2010;463(7280):549–53.

17. Schuchman E.H., Desnick R.J. Types A and B Niemann-Pick disease. Molecular Genetics and Metabolism. 2017;120(1–2):27–33.

18. Buccinna B., Piccinini M., Prinetti A. et al. Alterations of myelinspecific proteins and sphingolipids characterize the brains of acid sphingomyelinase‐deficient mice, an animal model of Niemann–Pick disease type A. Journal of Neurochemistry. 2009;109(1):105–15.

19. Kinnunen P. Sphingomyelinase Activity of LDL A Link between Atherosclerosis, Ceramide, and Apoptosis? Trends in Cardiovascular Medicine. 2002;12(1):37–42.

20. Charruyer A., Grazide S., Bezombes C. et al. UV-C Light Induces Raft-associated Acid Sphingomyelinase and JNK Activation and Translocation Independently on a Nuclear Signal. Journal of Biological Chemistry. 2005;280(19):19196–204.

21. Kornhuber J., Muller C.P., Becker K.A. et al. The ceramide system as a novel antidepressant target. Trends in Pharmacological Sciences. 2014;35(6):293–304.

22. Da Veiga Pereira L., Desnick R.J., Adler D.A. et al.Regional assignment of the human acid sphingomyelinase gene (SMPD1) by PCR analysis of somatic cell hybrids and in situ hybridization to 11p15.1→p15.4. Genomics. 1991;9(2):229–34.

23. Mihaylova V., Hantke J., Sinigerska I. et al. Highly variable neural involvement in sphingomyelinase-deficient Niemann-Pick disease caused by an ancestral Gypsy mutation. Brain. 2006;130(4):1050–61.

24. Simonaro C.M., Desnick R.J., McGovern M.M. et al. The Demographics and Distribution of Type B Niemann-Pick Disease: Novel Mutations Lead to New Genotype/Phenotype Correlations. The American Journal of Human Genetics. 2002;71(6):1413–9.

25. Ferlinz K., Hurwitz R., Vielhaber G. et al. Occurrence of two molecular forms of human acid sphingomyelinase. Biochemical Journal. 1994;301(3):855–62.

26. McGovern M.M., Pohl-Worgall T., Deckelbaum R.J. et al. Lipid abnormalities in children with types A and B Niemann Pick disease. J Pediatr. 2004;145(1):77–81.

27. Wang R., Qin Z., Huang L. et al. SMPD1 expression profile and mutation landscape help decipher genotype–phenotype association and precision diagnosis for acid sphingomyelinase deficiency. Hereditas. 2023;160(1):11.

28. Dardis A., Zampieri S., Filocamo M. et al. Functionalin vitro characterization of 14SMPD1 mutations identified in Italian patients affected by Niemann Pick Type B disease. Hum Mutat. 2005;26(2):164–164.

29. Pittis M.G., Ricci V., Guerci V.I. et al. Acid sphingomyelinase: Identification of nine novel mutations among Italian Niemann Pick type B patients and characterization of in vivo functional in-frame start codon: MUTATIONS IN BRIEF. Hum Mutat. 2004;24(2):186–7.

30. Jones I., He X., Katouzian F., Darroch P.I., Schuchman E.H. Characterization of common SMPD1 mutations causing types A and B Niemann-Pick disease and generation of mutation-specific mouse models. Mol Genet Metab. 2008;95(3):152–62.

31. Simonaro C.M., Park J.H., Eliyahu E. et al. Imprinting at the SMPD1 Locus: Implications for Acid Sphingomyelinase–Deficient Niemann-Pick Disease. The American Journal of Human Genetics. 2006;78(5):865–70.

32. Oliva P., Schwarz M., Mechtler T.P. et al. Importance to include differential diagnostics for acid sphingomyelinase deficiency (ASMD) in patients suspected to have to Gaucher disease. Molecular Genetics and Metabolism. 2023;139(1):107563.

33. Piraud M., Pettazzoni M., Lavoie P. et al. Contribution of tandem mass spectrometry to the diagnosis of lysosomal storage disorders. J of Inher Metab Disea. 2018;41(3):457–77.

34. Kuchar L., Sikora J., Gulinello M.E. et al. Quantitation of plasmatic lysosphingomyelin and lysosphingomyelin-509 for differential screening of Niemann-Pick A/B and C diseases. Anal Biochem. 2017; 525: 73-77.

35. Voorink-Moret M., Goorden S.M.I., Van Kuilenburg A.B.P. et al. Rapid screening for lipid storage disorders using biochemical markers. Expert center data and review of the literature. Molecular Genetics and Metabolism. 2018;123(2):76–84.

36. Breilyn M.S., Zhang W., Yu C., Wasserstein M.P. Plasma lyso-sphingomyelin levels are positively associated with clinical severity in acid sphingomyelinase deficiency. Mol Genet Metab Rep. 2021;28:100780.

37. Diaz G.A., Jones S.A., Scarpa M. et al. One-year results of a clinical trial of olipudase alfa enzyme replacement therapy in pediatric patients with acid sphingomyelinase deficiency. Genet Med. 2021;23(8):1543–50.

38. Wasserstein M., Lachmann R., Hollak C. et al. A randomized, placebo-controlled clinical trial evaluating olipudase alfa enzyme replacement therapy for chronic acid sphingomyelinase deficiency (ASMD) in adults: One-year results. Genetics in Medicine. 2022;24(7):1425–36.

39. Hollak C.E., van Weely S., van Oers M.H., Aerts J.M. Marked elevation of plasma chitotriosidase activity. A novel hallmark of Gaucher disease. J Clin Invest. 1994;93(3):1288–92.

40. Boot R.G., Renkema G.H., Verhoek M. et al. The human chitotriosidase gene. Nature of inherited enzyme deficiency. J Biol Chem. 1998;273(40):25680–5.

41. Porter F.D., Scherrer D.E., Lanier M.H. et al. Cholesterol oxidation products are sensitive and specific blood-based biomarkers for Niemann-Pick C1 disease. Sci Transl Med. 2010;2(56):56ra81.

42. Romanello M., Zampieri S., Bortolotti N. et al. Comprehensive Evaluation of Plasma 7-Ketocholesterol and Cholestan-3β,5α,6β-Triol in an Italian Cohort of Patients Affected by Niemann-Pick Disease due to NPC1 and SMPD1 Mutations. Clin Chim Acta. 2016;455:39–45.

43. Di Rocco M., Vici C.D., Burlina A. et al. Screening for lysosomal diseases in a selected pediatric population: the case of Gaucher disease and acid sphingomyelinase deficiency. Orphanet J Rare Dis. 2023;18(1):197.

44. Hickey R.E, Baker J. Newborn screening for acid sphingomyelinase deficiency in Illinois: A single center’s experience. J of Inher Metab Disea. J Inherit Metab Dis. 2024;47(6):1363-1370.

45. McGovern M.M., Wasserstein M.P., Kirmse B. et al. Novel first-dose adverse drug reactions during a phase I trial of olipudase alfa (recombinant human acid sphingomyelinase) in adults with Niemann–Pick disease type B (acid sphingomyelinase deficiency). Genetics in Medicine. 2016;18(1):34–40.

46. Wasserstein M.P., Jones S.A., Soran H. et al. Successful within-patient dose escalation of olipudase alfa in acid sphingomyelinase deficiency. Mol Genet Metab. 2015;116(1–2):88–97.

47. Cassiman D., Packman S., Bembi B. et al. Cause of death in patients with chronic visceral and chronic neurovisceral acid sphingomyelinase deficiency (Niemann-Pick disease type B and B variant): Literature review and report of new cases. Mol Genet Metab. 2016;118(3):206–13.

48. O’Neill R.S., Belousova N., Malouf M.A.. Pulmonary Type B Niemann-Pick Disease Successfully Treated with Lung Transplantation. Case Reports in Transplantation. 2019;2019:1–5.

49. Mannem H., Kilbourne S., Weder M. Lung transplantation in a patient with Niemann–Pick disease. The Journal of Heart and Lung Transplantation. 2019;38(1):100–1.

50. Uyan Z.S., Karadağ B., Ersu R. et al. Early pulmonary involvement in Niemann‐Pick type B disease: Lung lavage is not useful. Pediatric Pulmonology. 2005;40(2):169–72.

51. Nicholson A.G., Wells A.U., Hooper J. et al. Successful Treatment of Endogenous Lipoid Pneumonia due to Niemann–Pick Type B Disease with Whole-Lung Lavage. Am J Respir Crit Care Med. 2002;165(1):128–31.

52. Jin H.K., Carter J.E., Huntley G.W., Schuchman E.H. Intracerebral transplantation of mesenchymal stem cells into acid sphingomyelinase-deficient mice delays the onset of neurological abnormalities and extends their life span. J Clin Invest. 2002;109(9):1183–91.

53. Barbon C.M., Ziegler R.J., Li C. et al. AAV8-mediated hepatic expression of acid sphingomyelinase corrects the metabolic defect in the visceral organs of a mouse model of Niemann-Pick disease. Mol Ther. 2005;12(3):431–40.

54. Miranda S.R., Erlich S., Friedrich V.L. et al.. Hematopoietic stem cell gene therapy leads to marked visceral organ improvements and a delayed onset of neurological abnormalities in the acid sphingomyelinase deficient mouse model of Niemann-Pick disease. Gene Ther. 2000;7(20):1768–76.

55. Samaranch L., Perez-Canamas A., Soto-Huelin B. et al. Adeno-associated viral vector serotype 9–based gene therapy for Niemann-Pick disease type A. Sci Transl Med. 2019;11(506):eaat3738.

56. Beretta G., Shala A.L. Impact of Heat Shock Proteins in Neurodegeneration: Possible Therapeutical Targets. Annals of Neurosciences. 2022;29(1):71–82.