Marrow Cell Transplantation for Infantile Hypophosphatasia

• Published in: Journal of bone and mineral research 2003-04, Vol.18 (4), p.624-636
• Main Authors: Whyte, Michael P, Kurtzberg, Joanne, McALISTER, William H, Mumm, Steven, Podgornik, Michelle N, Coburn, Stephen P, Ryan, Lawrence M, Miller, Cindy R, Gottesman, Gary S, Smith, Alan K, Douville, Judy, Waters‐Pick, Barbara, Armstrong, R Douglas, Martin, Paul L
• Format: Article
• Language: English
• Subjects: alkaline phosphatase; Alkaline Phosphatase - deficiency; Alkaline Phosphatase - genetics; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Base Sequence; Biological and medical sciences; Bone and Bones - diagnostic imaging; Bone Marrow Transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; cartilage; Child; Child, Preschool; DNA Mutational Analysis; Female; Humans; Hypophosphatasia - diagnostic imaging; Hypophosphatasia - genetics; Hypophosphatasia - metabolism; Hypophosphatasia - therapy; Infant; Medical sciences; Mutation, Missense; osteoblast; Radiography; rickets; stem cells; Stromal Cells - transplantation; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1359/jbmr.2003.18.4.624

An 8‐month‐old girl who seemed certain to die from the infantile form of hypophosphatasia, an inborn error of metabolism characterized by deficient activity of the tissue‐nonspecific isoenzyme of alkaline phosphatase (TNSALP), underwent the first trial of bone marrow cell transplantation for this heritable type of rickets. After cytoreduction, she was given T‐cell‐depleted, haplo‐identical marrow from her healthy sister. Chimerism in peripheral blood and bone marrow became 100% donor. Three months later, she was clinically improved, with considerable healing of rickets and generalized skeletal remineralization. However, 6 months post‐transplantation, worsening skeletal disease recurred, with partial return of host hematopoiesis. At the age of 21 months, without additional chemotherapy or immunosuppressive treatment, she received a boost of donor marrow cells expanded ex vivo to enrich for stromal cells. Significant, prolonged clinical and radiographic improvement followed soon after. Nevertheless, biochemical features of hypophosphatasia have remained unchanged to date. Skeletal biopsy specimens were not performed. Now, at 6 years of age, she is intelligent and ambulatory but remains small. Among several hypotheses for our patient's survival and progress, the most plausible seems to be the transient and long‐term engraftment of sufficient numbers of donor marrow mesenchymal cells, forming functional osteoblasts and perhaps chondrocytes, to ameliorate her skeletal disease.