Charcot-Marie-Tooth disease (CMT), or inherited motor-sensory neuropathy, afflicts 1 in 2500 children, often resulting in pain, depression, disabling weakness and significantly reduced health-related quality of life (QOL) by adulthood. Reducing this large disease burden by treating children who are in the early stages of the disease is crucial;however, to date, no therapy has proven effective in clinical trials. The lack of treatment effect in recent trials may have been due to the selection of unsuitable outcome measures. The current lack of valid, sensitive and reliable primary outcome measures to utilize as endpoints in pediatric inherited neuropathy trials represents a critical barrier to progression in this field. The research objective of this application is to identify an outcome measure that accurately reflects CMT disease progression in children. The central hypothesis is that a disease-specific pediatric CMT QOL instrument will serve as a valid, reliable, and more sensitive measure of disease progression, than previously utilized neuropathy trial endpoints. The rationale for the proposed research is that identifying validated outcome measures for a clinical trial increases the likelihood that potentially efficacious therapies are not discarded injudiciously. The educational objective is to achieve expertise in early phase trial methodology and regulatory training, to translate promising drugs to clinical trials and thereby develop into an independent investigator and leader in this field.
The specific aims of the project are to (a) identify the QOL instrument of greater clinical validity between generic and disease-specific options in pediatric CMT, and (b) identify the outcome measure that is most relevant to the pediatric patient with CMT, among composite neuropathy scores, electrophysiology, and QOL data, via a multicenter, longitudinal study of 300 children with CMT. This proposal is significant because it would identify valid, sensitive and reliable outcome measures that could (a) serve as endpoints in planned clinical trials of interventions designed to improve the quality of life of this population, and (b) assist in monitoring the perspective of a highly vulnerable population: children with disability due to a chronic, progressive neuromuscular disease. The study is innovative because it may lead to the selection of patient-reported outcomes as primary endpoints in neuropathy trials, thus shifting the current paradigm of utilizing electrophysiologic outcome measures, which have rarely shown meaningful improvement in clinical trials. The proposed research is relevant to the NIH's mission to help reduce the burdens of human disability, as achieving study aims will positively impact future efforts to identify therapeutic interventions that improve the QOL of patients with neuromuscular diseases. The PI's career development will be facilitated by an expert multidisciplinary Mentoring Committee, and direct access to the resources of an Inherited Neuropathy Consortium directed by the PI's mentor. Success in achieving the proposed aims would lead to the identification of validated outcome measures for future clinical trials as well as the expertise needed by the PI to lead early phase clinical trials in pediatric CMT.

Public Health Relevance

Identification of validated outcome measures for pediatric inherited neuropathy trials offers the opportunity to develop targeted therapies that may eventually be broadly applicable to all neuropathies. Thus, study outcomes will positively impact future efforts to improve the quality of life of patients with neuromuscular diseases. The proposed research has relevance to public health, because enabling researchers to measure treatment responses in children with inherited neuropathy via reliable, valid and sensitive outcome measures can lead to interventions that help reduce the disease burden in this vulnerable population.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Mentored Patient-Oriented Research Career Development Award (K23)
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Neurological Sciences Training Initial Review Group (NST)
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Gwinn, Katrina
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Ramchandren, Sindhu (2017) Charcot-Marie-Tooth Disease and Other Genetic Polyneuropathies. Continuum (Minneap Minn) 23:1360-1377
Bogue, Lauren; Ramchandren, Sindhu (2016) Outdated risk assessment in a family with Duchenne dystrophy: Implications for duty to reassess. Neurol Genet 2:e103
Bogue, Lauren; Peay, Holly; Martin, Ann et al. (2016) Knowledge of carrier status and barriers to testing among mothers of sons with Duchenne or Becker muscular dystrophy. Neuromuscul Disord 26:860-864
Fridman, V; Bundy, B; Reilly, M M et al. (2015) CMT subtypes and disease burden in patients enrolled in the Inherited Neuropathies Consortium natural history study: a cross-sectional analysis. J Neurol Neurosurg Psychiatry 86:873-8
Ramchandren, Sindhu; Shy, Michael; Feldman, Eva et al. (2015) Defining disability: development and validation of a mobility-Disability Severity Index (mDSI) in Charcot-Marie-tooth disease. J Neurol Neurosurg Psychiatry 86:635-9
Sanmaneechai, Oranee; Feely, Shawna; Scherer, Steven S et al. (2015) Genotype-phenotype characteristics and baseline natural history of heritable neuropathies caused by mutations in the MPZ gene. Brain 138:3180-92
Ramchandren, Sindhu; Jaiswal, Mamta; Feldman, Eva et al. (2014) Effect of pain in pediatric inherited neuropathies. Neurology 82:793-7
Lai, Saien; Ahmed, Umair; Bollineni, Aruna et al. (2014) Diagnostic accuracy of qualitative versus quantitative tuning forks: outcome measure for neuropathy. J Clin Neuromuscul Dis 15:96-101
Komyathy, Kelsey; Neal, Stephanie; Feely, Shawna et al. (2013) Anterior tibialis CMAP amplitude correlations with impairment in CMT1A. Muscle Nerve 47:493-6
Ramchandren, Sindhu; Gruis, Kirsten L; Chervin, Ronald D et al. (2010) Hypoglossal nerve conduction findings in obstructive sleep apnea. Muscle Nerve 42:257-61

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