Skip to main content
Top
Published in: Orphanet Journal of Rare Diseases 1/2017

Open Access 01-12-2017 | Letter to the Editor

Extreme caution on the use of sirolimus for the congenital hyperinsulinism in infancy patient

Authors: Indraneel Banerjee, Diva De Leon, Mark J. Dunne

Published in: Orphanet Journal of Rare Diseases | Issue 1/2017

Login to get access

Abstract

We have recently published on the limited effectiveness of sirolimus as a treatment option for hypoglycaemia as a consequence of hyperinsulinism. Our data oppose the view that mTOR inhibitors provide new opportunities for the treatment of patients with hyperinsulinism. We are not convinced by the argument that any benefit for some patients outweighs the potential and later long-term problems that accompany mTOR inhibition in the neonate. We also express the opinion that caution must be taken when repurposing/repositioning therapies in the field of rare disease.
Literature
2.
go back to reference Senniappan S, Alexandrescu S, Tatevian N, Shah P, Arya V, Flanagan S, Ellard S, Rampling D, Ashworth M, Brown RE, Hussain K. Sirolimus therapy in infants with severe hyperinsulinemic hypoglycemia. Sirolimus therapy in infants with severe hyperinsulinemic hypoglycemia. N Engl J Med. 2014;370(12):1131–37.CrossRefPubMed Senniappan S, Alexandrescu S, Tatevian N, Shah P, Arya V, Flanagan S, Ellard S, Rampling D, Ashworth M, Brown RE, Hussain K. Sirolimus therapy in infants with severe hyperinsulinemic hypoglycemia. Sirolimus therapy in infants with severe hyperinsulinemic hypoglycemia. N Engl J Med. 2014;370(12):1131–37.CrossRefPubMed
3.
go back to reference Mao S, Zhang A, Huang S. Sirolimus in severe hyperinsulinemic hypoglycemia. N Engl J Med. 2014;370(25):2448.CrossRefPubMed Mao S, Zhang A, Huang S. Sirolimus in severe hyperinsulinemic hypoglycemia. N Engl J Med. 2014;370(25):2448.CrossRefPubMed
4.
go back to reference Ünal S, Gönülal D, Uçaktürk A, Siyah Bilgin B, Flanagan SE, Gürbüz F, Tayfun M, Elmaoğulları S, Araslı A, Demirel F, Ellard S, Hussain K. A novel homozygous mutation in the KCNJ11 gene pF3151 of a neonate with Congenital Hyperinsulism and successful management by sirolimus. J Clin Res Pediatr Endocrinol. 2016;8(4):478–81.CrossRefPubMedPubMedCentral Ünal S, Gönülal D, Uçaktürk A, Siyah Bilgin B, Flanagan SE, Gürbüz F, Tayfun M, Elmaoğulları S, Araslı A, Demirel F, Ellard S, Hussain K. A novel homozygous mutation in the KCNJ11 gene pF3151 of a neonate with Congenital Hyperinsulism and successful management by sirolimus. J Clin Res Pediatr Endocrinol. 2016;8(4):478–81.CrossRefPubMedPubMedCentral
5.
go back to reference Méder Ü, Bokodi G, Balogh L, Körner A, Szabó M, Pruhova S, Szabó AJ. Severe hyperinsulinemic hypoglycemia in a neonate: response to sirolimus therapy. Pediatrics. 2015;136(5):e1369–72.CrossRefPubMed Méder Ü, Bokodi G, Balogh L, Körner A, Szabó M, Pruhova S, Szabó AJ. Severe hyperinsulinemic hypoglycemia in a neonate: response to sirolimus therapy. Pediatrics. 2015;136(5):e1369–72.CrossRefPubMed
6.
go back to reference Shah P, Arya VB, Flanagan SE, Morgan K, Ellard S, Senniappan S, Hussain K. Sirolimus therapy in a patient with severe hyperinsulinaemic hypoglycaemia due to a compound heterozygous ABCC8 gene mutation. J Pediatr Endocrinol Metab. 2015;28(5–6):695–99.PubMed Shah P, Arya VB, Flanagan SE, Morgan K, Ellard S, Senniappan S, Hussain K. Sirolimus therapy in a patient with severe hyperinsulinaemic hypoglycaemia due to a compound heterozygous ABCC8 gene mutation. J Pediatr Endocrinol Metab. 2015;28(5–6):695–99.PubMed
7.
go back to reference Abraham MB, Shetty VB, Price G, Smith N. Bock Md, Siafarikas A, Resnick S, Whan E, Ellard S, Flanagan SE, Davis EA, Jones TW, Hussain K, Choong CS: Efficacy and safety of sirolimus in a neonate with persistent hypoglycaemia following near-total pancreatectomy for hyperinsulinaemic hypoglycaemia. J Pediatr Endocrinol Metab. 2015;28(11–12):1391–8.PubMed Abraham MB, Shetty VB, Price G, Smith N. Bock Md, Siafarikas A, Resnick S, Whan E, Ellard S, Flanagan SE, Davis EA, Jones TW, Hussain K, Choong CS: Efficacy and safety of sirolimus in a neonate with persistent hypoglycaemia following near-total pancreatectomy for hyperinsulinaemic hypoglycaemia. J Pediatr Endocrinol Metab. 2015;28(11–12):1391–8.PubMed
8.
go back to reference Alexandrescu S, Tatevian N, Olutoye O, Brown RE. Persistent hyperinsulinemic hypoglycemia of infancy: constitutive activation of the mTOR pathway with associated exocrine-islet transdifferentiation and therapeutic implications. Int J Clin Exp Pathol. 2010;3(7):691–705.PubMedPubMedCentral Alexandrescu S, Tatevian N, Olutoye O, Brown RE. Persistent hyperinsulinemic hypoglycemia of infancy: constitutive activation of the mTOR pathway with associated exocrine-islet transdifferentiation and therapeutic implications. Int J Clin Exp Pathol. 2010;3(7):691–705.PubMedPubMedCentral
9.
go back to reference Senniappan S, Brown RE, Hussain K. Genomic and morphoproteomic correlates implicate the IGF-1/mTOR/Akt pathway in the pathogenesis of diffuse congenital hyperinsulinism. Int J Clin Exp Pathol. 2016;9:548–62. Senniappan S, Brown RE, Hussain K. Genomic and morphoproteomic correlates implicate the IGF-1/mTOR/Akt pathway in the pathogenesis of diffuse congenital hyperinsulinism. Int J Clin Exp Pathol. 2016;9:548–62.
10.
go back to reference Szymanowski M, Salomon-Estebanez M, Padidela R, Han B, Mosinska K, Stevens A, Damaj L, Ferreira C, Pihan-Le Bars F, Lascouts E, Bansept C, de Lonlay P, Raynaud R, Dunne MJ, Banerjee I, Arnoux J-B. Mammalian target of rapamycin (mTOR) inhibitors for the treatment of severe Congenital Hyperinsulinism in Infancy: perspectives on limited therapeutic success. J Clinc Endo Metab. 2016;101(12):4719–29.CrossRef Szymanowski M, Salomon-Estebanez M, Padidela R, Han B, Mosinska K, Stevens A, Damaj L, Ferreira C, Pihan-Le Bars F, Lascouts E, Bansept C, de Lonlay P, Raynaud R, Dunne MJ, Banerjee I, Arnoux J-B. Mammalian target of rapamycin (mTOR) inhibitors for the treatment of severe Congenital Hyperinsulinism in Infancy: perspectives on limited therapeutic success. J Clinc Endo Metab. 2016;101(12):4719–29.CrossRef
11.
go back to reference Pallet N, Legendre C. Adverse events associated with mTOR inhibitors. Expert Opin Drug Saf. 2013;12:177–86.CrossRefPubMed Pallet N, Legendre C. Adverse events associated with mTOR inhibitors. Expert Opin Drug Saf. 2013;12:177–86.CrossRefPubMed
Metadata
Title
Extreme caution on the use of sirolimus for the congenital hyperinsulinism in infancy patient
Authors
Indraneel Banerjee
Diva De Leon
Mark J. Dunne
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2017
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/s13023-017-0621-5

Other articles of this Issue 1/2017

Orphanet Journal of Rare Diseases 1/2017 Go to the issue