Skip to main content
Log in

Mucopolysaccharidoses

  • ORPHAN DISEASES (B MANGER, SECTION EDITOR)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

The mucopolysaccharidoses (MPSs) are a group of rare genetic disorders of glycosaminoglycan catabolism, caused by a deficiency of lysosomal enzymes required for GAG degradation. Incomplete breakdown of glycosaminoglycans leads to progressive accumulation of these substances in many tissues throughout the body. Different residual enzymatic activity can result in different phenotypes of the same MPS disorder, from severe to attenuated. Musculoskeletal manifestations are common across all forms of MPS. Skeletal and joint abnormalities are prominent features of many MPS disorders, particularly attenuated phenotypes. However, diagnostic delays occur frequently for patients with an MPS, especially those with more attenuated forms of disease. In the absence of appropriate treatment, these conditions are chronic, progressive and often debilitating, but treatment for many types of MPS is now available. Therefore, increasing awareness of MPS among rheumatologists is extremely important.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Muenzer J. Overview of the mucopolysaccharidoses. Rheumatology (Oxford). 2011;50 Suppl 5:v4–12. An excellent overview of the MPS disorders emphasising pathophysiology, diagnosis, and treatment options.

    Article  CAS  Google Scholar 

  2. Neufeld EU, Muenzer J. The mucopolysaccharidoses. In: Scriver CR, editor. The metabolic and molecular bases of inherited disease. New York: McGraw–Hill; 2001. p. 3421–52.

    Google Scholar 

  3. Tomatsu S, Okamura K, Maeda H, et al. Keratan sulphate levels in mucopolysaccharidoses and mucolipidoses. J Inherit Metab Dis. 2005;28:187–202.

    Article  CAS  PubMed  Google Scholar 

  4. Tomatsu S, Gutierrez MA, Ishimaru T, et al. Heparan sulfate levels in mucopolysaccharidoses and mucolipidoses. J Inherit Metab Dis. 2005;28:743–57.

    Article  CAS  PubMed  Google Scholar 

  5. Federico A, Capece G, Cecio A, et al. Sanfilippo B syndrome (MPS III B): case report with analysis of CSF mucopolysaccharides and conjunctival biopsy. J Neurol. 1981;225:77–83.

    Article  CAS  PubMed  Google Scholar 

  6. Munoz-Rojas MV, Vieira T, Costa R, et al. Intrathecal enzyme replacement therapy in a patient with mucopolysaccharidosis type I and symptomatic spinal cord compression. Am J Med Genet A. 2008;146A:2538–44.

    Article  PubMed  Google Scholar 

  7. Tuschl K, Gal A, Paschke E, et al. Mucopolysaccharidosis type II in females: case report and review of literature. Pediatr Neurol. 2005;32:270–2.

    Article  PubMed  Google Scholar 

  8. Sukegawa K, Matsuzaki T, Fukuda S, et al. Brother/sister siblings affected with Hunter disease: evidence for skewed X chromosome inactivation. Clin Genet. 1998;53:96–101.

    Article  CAS  PubMed  Google Scholar 

  9. Schulze-Frenking G, Jones SA, Roberts J, et al. Effects of enzyme replacement therapy on growth in patients with mucopolysaccharidosis type II. J Inherit Metab Dis. 2011;34:203–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Cimaz R, Vijay S, Haase C, et al. Attenuated type I mucopolysaccharidosis in the differential diagnosis of juvenile idiopathic arthritis: a series of 13 patients with Scheie syndrome. Clin Exp Rheumatol. 2006;24(2):196–202.

    CAS  PubMed  Google Scholar 

  11. Morishita K, Petty RE. Musculoskeletal manifestations of mucopolysaccharidoses. Rheumatology (Oxford). 2011;50 Suppl 5:v19–25. A comprehensive review of clinical rheumatological aspects of MPS patients.

    Article  CAS  Google Scholar 

  12. Vijay S, Wraith JE. Clinical presentation and follow-up of patients with the attenuated phenotype of mucopolysaccharidosis type I. Acta Paediatr. 2005;94:872–7.

    Article  PubMed  Google Scholar 

  13. Cudry S, Tigaud I, Froissart R, et al. MPS II in females: molecular basis of two different cases. J Med Genet. 2000;37:E29.

    Article  CAS  PubMed  Google Scholar 

  14. Peters C. Hematopoietic cell transplantation for storage diseases. In: Blume KG, Forman SJ, Appelbaum FR, editors. Hematopoietic stem cell transplantation. Malden: Blackwell Science; 2004. p. 1455–70.

    Google Scholar 

  15. McGill JJ, Inwood AC, Coman DJ, et al. Enzyme replacement therapy for mucopolysaccharidosis VI from 8 weeks of age—a sibling control study. Clin Genet. 2010;77:492–8.

    Article  CAS  PubMed  Google Scholar 

  16. Manger B. Rheumatological manifestations are key in the early diagnosis of mucopolysaccharidosis type I. Eur Musculoskelet Rev. 2008;1–6.

  17. Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.

    PubMed  Google Scholar 

  18. Cimaz R, Coppa GV, Kone-Paut I, et al. Joint contractures in the absence of inflammation may indicate mucopolysaccharidosis. Pediatr Rheumatol Online J. 2009;7:18.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Aldenhoven M, Sakkers RJ, Boelens J, et al. Musculoskeletal manifestations of lysosomal storage disorders. Ann Rheum Dis. 2009;68:1659–65.

    Article  CAS  PubMed  Google Scholar 

  20. Pastores GM, Meere PA. Musculoskeletal complications associated with lysosomal storage disorders: Gaucher disease and Hurler–Scheie syndrome (mucopolysaccharidosis type 1). Curr Opin Rheumatol. 2005;17:70–8.

    Article  PubMed  Google Scholar 

  21. Del Rosso A, Matucci-Cerinic M, De Giorgio F, et al. Rheumatological manifestations in diabetes mellitus. Curr Diabetes Rev. 2006;2:455–66.

    Google Scholar 

  22. Thomas JA, Beck M, Clarke JT, et al. Childhood onset of Scheie syndrome, the attenuated form of mucopolysaccharidosis I. J Inherit Metab Dis. 2010;33:421–7. This paper reveals the characteristics of the most frequent attenuated form of MPS disorders: Scheie syndrome.

    Article  PubMed Central  PubMed  Google Scholar 

  23. White KK, Karol LA, White DR, et al. Musculoskeletal manifestations of Sanfilippo syndrome (mucopolysaccharidosis type III). J Pediatr Orthop. 2011;31:594–8.

    Article  PubMed  Google Scholar 

  24. Link B, de Camargo Pinto LL, Giugliani R, et al. Orthopedic manifestations in patients with mucopolysaccharidosis type II (Hunter syndrome) enrolled in the Hunter Outcome Survey. Orthop Rev. 2010;2:e16.

    Article  Google Scholar 

  25. Al-Qatan MM, Thomson HG, Clarke HM. Carpal tunnel syndrome in children and adolescents with no history of trauma. J Hand Surg. 1996;21B:108–11.

    Article  Google Scholar 

  26. Yuen A, Dowling G, Johnstone B, et al. Carpal tunnel syndrome in children with mucopolysaccaridoses. J Child Neurol. 2007;22:260–3.

    Article  PubMed  Google Scholar 

  27. Van Heest AE, House J, Krivit W, Walker K. Surgical treatment of carpal tunnel syndrome and trigger digits in children with mucopolysaccharide storage disorders. J Hand Surg. 1998;23A:236–43.

    Article  Google Scholar 

  28. MacDougal B, Weeks PM, Wray RC. Median nerve compression and trigger finger in the mucopolysaccharidoses and related diseases. Plast Reconstr Surg. 1977;59:260–3.

    CAS  PubMed  Google Scholar 

  29. Maurer K, Fenske A, Samii M. Carpal tunnel syndrome combined with trigger finger in early childhood. J Neurol Neurosurg Psychiatry. 1980;3:1148.

    Article  Google Scholar 

  30. Haddad FS, Hill RA, Jones DH. Triggering in the mucopolysaccharidoses. J Pediatr Orthop B. 1998;7:138–40.

    Article  CAS  PubMed  Google Scholar 

  31. Kim HR, Lee SH. Ultrasonographic assessment of clinically diagnosed trigger fingers. Rheumatol Int. 2010;30:1455–8.

    Article  PubMed  Google Scholar 

  32. Serafini G, Derchi LE, Quadri P, et al. High resolution sonography of the flexor tendons in trigger fingers. J Ultrasound Med. 1996;15:213–9.

    CAS  PubMed  Google Scholar 

  33. Ryzewicz M, Wolf JM. Trigger digits: principles, management, and complications. J Hand Surg [Am]. 2006;31:135–46.

    Article  Google Scholar 

  34. Pastores GM. Musculoskeletal complications encountered in the lysosomal storage disorders. Best Pract Res Clin Rheumatol. 2008;22:937–47.

    Article  CAS  PubMed  Google Scholar 

  35. Simonaro CM, Haskins ME, Schuchman EH. Articular chondrocytes from animals with a dermatan sulfate storage disease undergo a high rate of apoptosis and release nitric oxide and inflammatory cytokines: a possible mechanism underlying degenerative joint disease in the mucopolysaccharidoses. Lab Invest. 2001;81:1319–28.

    Article  CAS  PubMed  Google Scholar 

  36. Simonaro CM, D’Angelo M, Haskins ME, Schuchman EH. Joint and bone disease in mucopolysaccharidoses VI and VII: identification of new therapeutic targets and biomarkers using animal models. Pediatr Res. 2005;57:701–7.

    Article  CAS  PubMed  Google Scholar 

  37. Simonaro CM, D’Angelo M, He X, et al. Mechanism of glycosaminoglycan-mediated bone and joint disease:implications for the mucopolysaccharidoses and other connective tissue diseases. Am J Pathol. 2008;172:112–22.

    Article  CAS  PubMed  Google Scholar 

  38. Wraith JE. The first 5 years of clinical experience with laronidase enzyme replacement therapy for mucopolysaccharidosis I. Expert Opin Pharmacother. 2005;6:489–506.

    Article  CAS  PubMed  Google Scholar 

  39. Schmidt H, Ullrich K, von Lengerke HJ, et al. Radiological findings in patients with mucopolysaccharidosis I H/S (Hurler–Scheie syndrome). Pediatr Radiol. 1987;17:409–14.

    Article  CAS  PubMed  Google Scholar 

  40. Chen SJ, Li YW, Wang TR, Hsu JC. Bony changes in common mucopolysaccharidoses. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1996;37:178–84.

    CAS  PubMed  Google Scholar 

  41. Tandon V, Williamson JB, Cowie RA, et al. Spinal problems in mucopolysaccharidosis I (Hurler syndrome). J Bone Joint Surg Br. 1996;78:938–44.

    Article  CAS  PubMed  Google Scholar 

  42. Weisstein JS, Delgado E, Steinbach LS, et al. Musculoskeletal manifestations of Hurler syndrome:long-term follow-up after bone marrow transplantation. J Pediatr Orthop. 2004;24:97–101.

    Article  PubMed  Google Scholar 

  43. White KK. Orthopaedic aspects of mucopolysaccharidoses. Rheumatology (Oxford). 2011;50 Suppl 5:v26–33. A comprehensive review of orthopedic aspects of MPS disorders.

    Article  Google Scholar 

  44. Field RE, Buchanan JA, Copplemans MG, et al. Bone-marrow transplantation in Hurler’s syndrome. Effect on skeletal development. J Bone Joint Surg Br. 1994;76:975–81.

    CAS  PubMed  Google Scholar 

  45. White KK, Steinman S, Mubarak SJ. Cervical stenosis and spastic quadriparesis in morquio disease (MPS IV). A case report with twenty-six-year follow-up. J Bone Joint Surg Am. 2009;91:438–42.

    Article  PubMed  Google Scholar 

  46. Kanazawa T, Yasunaga Y, Ikuta Y, et al. Femoral head dysplasia in Morquio disease type A: bilateral varus osteotomy of the femur. Acta Orthop Scand. 2001;72:18–21.

    Article  CAS  PubMed  Google Scholar 

  47. Taylor C, Brady P, O’Meara A, et al. Mobility in Hurler syndrome. J Pediatr Orthop. 2008;28:163–8.

    Article  PubMed  Google Scholar 

  48. Montano AM, Tomatsu S, Gottesman GS, et al. International Morquio A Registry: clinical manifestation and natural course of Morquio A disease. J Inherit Metab Dis. 2007;30:165–74.

    Article  CAS  PubMed  Google Scholar 

  49. Odunusi E, Peters C, Krivit W, et al. Genu valgum deformity in Hurler syndrome after hematopoietic stem cell transplantation: correction by surgical intervention. J Pediatr Orthop. 1999;19:270–4.

    CAS  PubMed  Google Scholar 

  50. De Waal Malefijt MC, van Kampen A, van Gemund JJ. Total knee arthroplasty in patients with inherited dwarfism _a report of five knee replacements in two patients with Morquio’s disease type A and one with spondylo-epiphyseal dysplasia. Arch Orthop Trauma Surg. 2000;120:179–82.

    Article  PubMed  Google Scholar 

  51. Pizzutillo PD, Osterkamp JA, Scott Jr CI, Lee MS. Atlantoaxial instability in mucopolysaccharidosis type VII. J Pediatr Orthop. 1989;9:76–8.

    Article  CAS  PubMed  Google Scholar 

  52. Thomas SL, Childress MH, Quinton B. Hypoplasia of the odontoid with atlanto-axial subluxation in Hurler’s syndrome. Pediatr Radiol. 1985;15:353–4.

    Article  CAS  PubMed  Google Scholar 

  53. Brill CB, Rose JS, Godmilow L, et al. Spastic quadriparesis due to C1–C2 subluxation in Hurler syndrome. J Pediatr. 1978;92:441–3.

    Article  CAS  PubMed  Google Scholar 

  54. Kacher E, Maestro RD. Mucopolysaccharidoses and spinal cord compression: case report and review of the literature with implications of bone marrow transplantation. Neurosurgery. 2000;47:223–8.

    Google Scholar 

  55. Paulson GW, Meagher JN, Burkhart J. Spinal pachymeningitis secondary to mucopolysaccharidosis. J Neurosurg. 1974;41:618–21.

    Article  CAS  PubMed  Google Scholar 

  56. Balani KG, Krivit W, Carpenter BL, et al. Children with mucopolysaccharidosis: perioperative care, morbidity, mortality and new findings. J Pediatr Surg. 1993;28:403–8.

    Article  Google Scholar 

  57. Nelson J, Thomas PS. Clinical findings in 12 patients with MPS IV A (Morquio’s disease). Further evidence for heterogeneity. Part III: odontoid dysplasia. Clin Genet. 1988;33:126–30.

    Article  CAS  PubMed  Google Scholar 

  58. Mikles M, Stanton RP. A review of Morquio syndrome. Am J Orthop. 1997;26:533–40.

    CAS  PubMed  Google Scholar 

  59. Northover H, Cowie RA, Wraith JE. Mucopolysaccharidosis type IVA (Morquio syndrome): a clinical review. J Inherit Metab Dis. 1996;19:357–65.

    Article  CAS  PubMed  Google Scholar 

  60. Silveri CP, Kaplan FS, Fallon MD, et al. Hurler syndrome with special reference to histologic abnormalities of the growth plate. Clin Orthop. 1991;269:305–11.

    PubMed  Google Scholar 

  61. Polgreen LE, Miller BS. Growth patterns and the use of growth hormone in the mucopolysaccharidoses. J Pediatr Rehabil Med. 2010;3:25–38.

    CAS  PubMed Central  PubMed  Google Scholar 

  62. Scheie HG, Hambrick Jr GW, Barness LA. A newly recognized forme fruste of Hurler’s disease (gargoylism). Am J Ophthalmol. 1962;53:753–69.

    CAS  PubMed  Google Scholar 

  63. Vieira T, Schwartz I, Munoz V et al. Mucopolysaccharidoses in Brazil: what happens from birth to biochemical diagnosis? Am J Med Genet A. 2008;146A(13):1741–47.

    Google Scholar 

  64. Arn P, Wraith JE, Underhill L. Characterization of surgical procedures in patients with mucopolysaccharidosis type I: findings from the MPS I Registry. J Pediatr. 2009;154(6):859–864.

    Google Scholar 

  65. Mahalingam K, Janani S, Priya S, et al. Diagnosis of mucopolysaccharidoses: how to avoid false positives and false negatives. Indian J Pediatr. 2004;71:29–32.

    Article  CAS  PubMed  Google Scholar 

  66. Hall CW, Liebaers I, Di Natale P, Neufeld EF. Enzymatic diagnosis of the genetic mucopolysaccharide storage disorders. Methods Enzymol. 1978;50:439–56.

    CAS  PubMed  Google Scholar 

  67. Young EP. Prenatal diagnosis of Hurler disease by analysis of alpha–iduronidase in chorionic villi. J Inherit Metab Dis. 1992;15:224–30.

    Article  CAS  PubMed  Google Scholar 

  68. Filocamo M, Morrone A. Lysosomal storage disorders: molecular basis and laboratory testing. Hum Genomics. 2011;5:156–69.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  69. Gelb MH, Turecek F, Scott CR, Chamoles NA. Direct multiplex assay of enzymes in dried blood spots by tandem mass spectrometry for the newborn screening of lysosomal storage disorders. J Inherit Metab Dis. 2006;29:397–404.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  70. Meikle PJ, Grasby DJ, Dean CJ, et al. Newborn screening for lysosomal storage disorders. Mol Genet Metab. 2006;88:307–14.

    Article  CAS  PubMed  Google Scholar 

  71. De Ruijter J, de Ru MH, Wagemans T, et al. Heparan sulfate and dermatan sulfate derived disaccharides are sensitive markers for newborn screening for mucopolysaccharidoses types I, II and III. Mol Genet Metab. 2012;107(4):705–10.

    Article  PubMed  Google Scholar 

  72. Tomatsu S, Fujii T, Fukushi M, et al. Newborn screening and diagnosis of mucopolysaccharidoses. Mol Genet Metab. 2013. doi:10.1016/j.ymgme.2013.06.007.

    Google Scholar 

  73. Souillet G, Guffon N, Maire I, et al. Outcome of 27 patients with Hurler’s syndrome transplanted from either related or unrelated haematopoietic stem cell sources. Bone Marrow Transplant. 2003;31:1105–17.

    Article  CAS  PubMed  Google Scholar 

  74. Herskhovitz E, Young E, Rainer J, et al. Bone marrow transplantation for Maroteaux–Lamy syndrome (MPS VI):long-term follow-up. J Inherit Metab Dis. 1999;22:50–62.

    Article  CAS  PubMed  Google Scholar 

  75. Yamada Y, Kato K, Sukegawa K. Treatment of MPS VII (Sly disease) by allogeneic BMT in a female with homozygous A619V mutation. Bone Marrow Transplant. 1998;21:629–34.

    Article  CAS  PubMed  Google Scholar 

  76. Braunlin EA, Stauffer NR, Peters CH, et al. Usefulness of bone marrow transplantation in the Hurler syndrome. Am J Cardiol. 2003;92:882–6.

    Article  PubMed  Google Scholar 

  77. Prasad VK, Kurtzberg J. Transplant outcomes in mucopolysaccharidoses. Semin Hematol. 2010;47:59–69.

    Article  CAS  PubMed  Google Scholar 

  78. Boelens JJ, Wynn RF, O’Meara A, et al. Outcomes of hematopoietic stem cell transplantation for Hurler’s syndrome in Europe: a risk factor analysis for graft failure. Bone Marrow Transplant. 2007;40:225–33.

    Article  CAS  PubMed  Google Scholar 

  79. Valayannopoulos V, Nicely H, Harmatz P, Turbeville S. Mucopolysaccharidosis VI. Orphanet J Rare Dis. 2010;5:5.

    Article  PubMed Central  PubMed  Google Scholar 

  80. Wraith JE, Beck M, Lane R, et al. Enzyme replacement therapy in patients who have mucopolysaccharidosis I and are younger than 5 years: results of a multinational study of recombinant human alpha-L-iduronidase (laronidase). Pediatrics. 2007;120:e37–46.

    Article  PubMed  Google Scholar 

  81. Clarke LA, Wraith JE, Beck M, et al. Long-term efficacy and safety of laronidase in the treatment of mucopolysaccharidosis I. Pediatrics. 2009;123:229–40.

    Article  PubMed  Google Scholar 

  82. Muenzer J, Wraith JE, Beck M, et al. A phase II/III clinical study of enzyme replacement therapy with idursulfase in mucopolysaccharidosis II (Hunter syndrome). Genet Med. 2006;8:465–73.

    Article  CAS  PubMed  Google Scholar 

  83. Harmatz P, Giugliani R, Schwartz I, MPS VI Study Group, et al. Enzyme replacement therapy for mucopolysaccharidosis VI: a phase 3, randomized, double-blind, placebo-controlled, multinational study of recombinant human N-acetylgalactosamine 4-sulfatase (recombinant human arylsulfatase B or rhASB) and follow-on, open-label extension study. J Pediatr. 2006;148:533–9.

    Article  CAS  PubMed  Google Scholar 

  84. Muenzer J, Beck M, Eng CM, et al. Long-term, open labeled extension study of idursulfase in the treatment of Hunter syndrome. Genet Med. 2011;13:95–101.

    Article  CAS  PubMed  Google Scholar 

  85. Muenzer J, Beck M, Giugliani R, et al. Idursulfase treatment of Hunter syndrome in children younger than 6 years: results from the Hunter Outcome Survey. Genet Med. 2011;13:102–9.

    Article  CAS  PubMed  Google Scholar 

  86. Mendelsohn NJ, Harmatz P, Bodamer O, Hunter Outcome Survey Investigators, et al. Importance of surgical history in diagnosing mucopolysaccharidosis type II (Hunter syndrome): data from the Hunter Outcome Survey. Genet Med. 2010;12:816–22.

    Article  PubMed  Google Scholar 

  87. Valayannopoulos V, Wijburg FA. Therapy for the mucopolysaccharidoses. Rheumatology (Oxford). 2011;50 Suppl 5:v49–59. An excellent review of treatment options for MPS disorders.

    Article  CAS  Google Scholar 

Download references

Acknowledgment

The authors wish to thank Dr Alberto Gaeta from the Radiology Unit, Pope Giovanni XXIII Pediatric Hospital, Bari, Italy, for contributing the radiographic image of MPS.

Compliance with Ethics Guidelines

Conflict of Interest

Francesco La Torre has served as a consultant for Genzyme and Biomarin. Rolando Cimaz has received speaking fees from Genzyme and Biomarin.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rolando Cimaz.

Additional information

This article is part of the Topical Collection on Orphan Diseases

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cimaz, R., La Torre, F. Mucopolysaccharidoses. Curr Rheumatol Rep 16, 389 (2014). https://doi.org/10.1007/s11926-013-0389-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-013-0389-0

Keywords

Navigation