Clinical outcomes of children with abnormal newborn screening results for Krabbe disease in New York State.

Abstract

Background

Early infantile Krabbe disease is rapidly fatal, but hematopoietic stem cell transplantation (HSCT) may improve outcomes if performed soon after birth. New York State began screening all newborns for Krabbe disease in 2006.

Methods

Infants with abnormal newborn screen results for Krabbe disease were referred to specialty-care centers. Newborns found to be at high risk for Krabbe disease underwent a neurodiagnostic battery to determine the need for emergent HSCT.

Results

Almost 2 million infants were screened. Five infants were diagnosed with early infantile Krabbe disease. Three died, two from HSCT-related complications and one from untreated disease. Two children who received HSCT have moderate to severe developmental delays. Forty-six currently asymptomatic children are considered to be at moderate or high risk for development of later-onset Krabbe disease.

Conclusions

These results show significant HSCT-associated morbidity and mortality in early infantile Krabbe disease and raise questions about its efficacy when performed in newborns diagnosed through newborn screening. The unanticipated identification of "at risk" children introduces unique ethical and medicolegal issues. New York's experience raises questions about the risks, benefits, and practicality of screening newborns for Krabbe disease. It is imperative that objective assessments be made on an ongoing basis as additional states begin screening for this disorder.Genet Med 18 12, 1235-1243.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1038/gim.2016.35

Publication Info

Wasserstein, Melissa P, Mary Andriola, Georgianne Arnold, Alan Aron, Patricia Duffner, Richard W Erbe, Maria L Escolar, Lissette Estrella, et al. (2016). Clinical outcomes of children with abnormal newborn screening results for Krabbe disease in New York State. Genetics in medicine : official journal of the American College of Medical Genetics, 18(12). pp. 1235–1243. 10.1038/gim.2016.35 Retrieved from https://hdl.handle.net/10161/24621.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Kurtzberg

Joanne Kurtzberg

Jerome S. Harris Distinguished Professor of Pediatrics

Dr. Kurtzberg is an internationally renowned expert in pediatric hematology/oncology, pediatric blood and marrow transplantation, umbilical cord blood banking and transplantation, and novel applications of cord blood and birthing tissues in the emerging fields of cellular therapies and regenerative medicine.   Dr. Kurtzberg serves as the Director of the Marcus Center for Cellular Cures (MC3), Director of the Pediatric Transplant and Cellular Therapy Program, Director of the Carolinas Cord Blood Bank, and Co-Director of the Stem Cell Transplant Laboratory at Duke University.  The Carolinas Cord Blood Bank is an FDA licensed public cord blood bank distributing unrelated cord blood units for donors for hematopoietic stem cell transplantation (HSCT) through the CW Bill Young Cell Transplantation Program.  The Robertson GMP Cell Manufacturing Laboratory supports manufacturing of RETHYMIC (BLA, Enzyvant, 2021), allogeneic cord tissue derived and bone marrow derived mesenchymal stromal cells (MSCs), and DUOC, a microglial/macrophage cell derived from cord blood.

Dr. Kurtzberg’s research in MC3 focuses on translational studies from bench to bedside, seeking to develop transformative clinical therapies using cells, tissues, molecules, genes, and biomaterials to treat diseases and injuries that currently lack effective treatments. Recent areas of investigation in MC3 include clinical trials investigating the safety and efficacy of autologous and allogeneic cord blood in children with neonatal brain injury – hypoxic ischemic encephalopathy (HIE), cerebral palsy (CP), and autism. Clinical trials testing allogeneic cord blood are also being conducted in adults with acute ischemic stroke. Clinical trials optimizing manufacturing and testing the safety and efficacy of cord tissue MSCs in children with autism, CP and HIE and adults with COVID-lung disease are underway. DUOC, given intrathecally, is under study in children with leukodystrophies and adults with primary progressive multiple sclerosis.

In the past, Dr. Kurtzberg has developed novel chemotherapeutic drugs for acute leukemias, assays enumerating ALDH bright cells to predict cord blood unit potency, methods of cord blood expansion, potency assays for targeted cell and tissue based therapies. Dr. Kurtzberg currently holds several INDs for investigational clinical trials from the FDA.  She has also trained numerous medical students, residents, clinical and post-doctoral fellows over the course of her career.

Provenzale

James Michael Provenzale

Professor of Radiology

I have the following major research areas:
I. Diffusion tensor imaging (an MR technique that measures rate and direction of microscopic water motion) to examine white matter pathways in the brain. This technique is used by many investigators in an attempt to understand white matter microstructure. My recent work has centered on the histological correlation of DTI metrics. In addition, because DTI metrics can vary substantially within a single scanner at multiple time points as well as between scanners, my work is focused on understanding causes of such variability and designing methods to decrease it. 
Since 1998, I have mentored third-year students at Duke University School of Medicine (typically one medical student per year) in both DTI research and perfusion imaging research. Although the research techniques are highly advanced, our implementation of various "user-friendly" software programs allows students with little or no prior experience to analyze data in a productive manner. Our research is also well-suited to individuals with advanced computer skills or an interest in biomedical or electrical engineering. Students work closely with research personnel on a daily basis. They also meet with collaborators from various basic science and clinical departments and me in a laboratory meeting once a week. The focus of these meetings is to plan experiments, refine research methods, discuss experimental results and prepare manuscripts. Students serve as first authors or co-authors on manuscripts based on their specific research project. The results of a number of such projects have been published.

II. Applications of nanotechnology to treatment of cancer (both CNS and non-CNS) and brain disorders. My research involves design and implementation of nanoparticles and fluorescent molecules for cancer diagnosis and therapy. Although I am trained as a neurologist and neuroradiologist, most of my nanotechnology-based research is oriented towards non-CNS tumors such as breast cancer and sarcomas. In the past few years, my Emory and Georgia Tech colleagues and I have conducted research using animals with naturally-occurring tumors at the University of Georgia College of Veterinary Medicine. This work has focused on the use of a handheld device to detect fluorophores that are administered intravenously prior to surgery. We are presently validating the use of this combination of imaging device and contrast agent to guide surgical resection of tumors. I am also interested in development of nanotechnology-based non-invasive and minimally invasive devices that can continuously monitor tumor physiological characteristics and response to therapy. This work is done in conjunction with a number of colleagues in Biomedical Engineering at both Duke and Emory and supported by a number of NIH grants. Finally, I have a strong interest in use of nanotechnology for tissue engineering and regenerative medicine. 


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