TY - JOUR
T1 - The cholic acid extension study in Zellweger spectrum disorders: Results and implications for therapy
AU - Klouwer, Femke C. C.
AU - Koot, Bart G. P.
AU - Berendse, Kevin
AU - Kemper, Elles M.
AU - Ferdinandusse, Sacha
AU - Koelfat, Kiran V. K.
AU - Lenicek, Martin
AU - Vaz, Frédéric M.
AU - Engelen, Marc
AU - Jansen, Peter L. M.
AU - Wanders, Ronald J. A.
AU - Waterham, Hans R.
AU - Schaap, Frank G.
AU - Poll-The, Bwee Tien
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Introduction: Currently, no therapies are available for Zellweger spectrum disorders (ZSDs), a group of genetic metabolic disorders characterised by a deficiency of functional peroxisomes. In a previous study, we showed that oral cholic acid (CA) treatment can suppress bile acid synthesis in ZSD patients and, thereby, decrease plasma levels of toxic C 27 -bile acid intermediates, one of the biochemical abnormalities in these patients. However, no effect on clinically relevant outcome measures could be observed after 9 months of CA treatment. It was noted that, in patients with advanced liver disease, caution is needed because of possible hepatotoxicity. Methods: An extension study of the previously conducted pretest-posttest design study was conducted including 17 patients with a ZSD. All patients received oral CA for an additional period of 12 months, encompassing a total of 21 months of treatment. Multiple clinically relevant parameters and markers for bile acid synthesis were assessed after 15 and 21 months of treatment. Results: Bile acid synthesis was still suppressed after 21 months of CA treatment, accompanied with reduced levels of C 27 -bile acid intermediates in plasma. These levels significantly increased again after discontinuation of CA. No significant changes were found in liver tests, liver elasticity, coagulation parameters, fat-soluble vitamin levels or body weight. Conclusions: Although CA treatment did lead to reduced levels of toxic C 27 -bile acid intermediates in ZSD patients without severe liver fibrosis or cirrhosis, no improvement of clinically relevant parameters was observed after 21 months of treatment. We discuss the implications for CA therapy in ZSD based on these results.
AB - Introduction: Currently, no therapies are available for Zellweger spectrum disorders (ZSDs), a group of genetic metabolic disorders characterised by a deficiency of functional peroxisomes. In a previous study, we showed that oral cholic acid (CA) treatment can suppress bile acid synthesis in ZSD patients and, thereby, decrease plasma levels of toxic C 27 -bile acid intermediates, one of the biochemical abnormalities in these patients. However, no effect on clinically relevant outcome measures could be observed after 9 months of CA treatment. It was noted that, in patients with advanced liver disease, caution is needed because of possible hepatotoxicity. Methods: An extension study of the previously conducted pretest-posttest design study was conducted including 17 patients with a ZSD. All patients received oral CA for an additional period of 12 months, encompassing a total of 21 months of treatment. Multiple clinically relevant parameters and markers for bile acid synthesis were assessed after 15 and 21 months of treatment. Results: Bile acid synthesis was still suppressed after 21 months of CA treatment, accompanied with reduced levels of C 27 -bile acid intermediates in plasma. These levels significantly increased again after discontinuation of CA. No significant changes were found in liver tests, liver elasticity, coagulation parameters, fat-soluble vitamin levels or body weight. Conclusions: Although CA treatment did lead to reduced levels of toxic C 27 -bile acid intermediates in ZSD patients without severe liver fibrosis or cirrhosis, no improvement of clinically relevant parameters was observed after 21 months of treatment. We discuss the implications for CA therapy in ZSD based on these results.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85062766558&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30793331
U2 - https://doi.org/10.1007/s10545-018-0194-z
DO - https://doi.org/10.1007/s10545-018-0194-z
M3 - Article
C2 - 29766340
SN - 0141-8955
VL - 42
SP - 303
EP - 312
JO - Journal of Inherited Metabolic Disease
JF - Journal of Inherited Metabolic Disease
IS - 2
ER -