WEDNESDAY, Oct. 26 (HealthDay News) -- A sibling pair with a
puzzling condition that made even walking a short distance an
agony; a 20-year-old man with a rare respiratory ailment forcing
him to live on a ventilator; a woman with a potentially fatal
buildup of a protein in her muscles -- all rare cases that were
difficult to diagnose, let alone treat.
And yet all of these patients, and dozens more, have had their
"mystery" illnesses properly diagnosed and, in some cases, treated,
through work done at a "clinic of last resort" run by the U.S.
National Institutes of Health (NIH).
Researchers at the NIH's Undiagnosed Diseases Program (UDP) in
Bethesda, Md., say that since the program's inception two years
back, they've made considerable headway in unraveling complex
medical riddles like these that have puzzled patients and
"We're talking about patients who have gone a long, long time without any diagnosis," noted UDP director Dr. William A. Gahl, who is also clinical director of the National Human Genome Research Institute (NHGRI). "These are patients who have already been seen at one of the country's major health facilities -- sometimes all of them -- but have had no success."
Established in 2008, the UDP has taken on the cases of 326
patients out of a pool of nearly 1,200 applicants.
Of these, 39 have gone on to see their cases "solved." This,
Gahl and his colleagues explain, means that after an exhaustive
investigation, doctors have reached a definitive diagnosis.
The program's access to cutting-edge genetics technologies has
been key to its success, Gahl said. "[We] offer something others
can't: greater in-depth in-patient access to first-generation
genetics on a wide scale," he said.
Writing in a recent issue of
Genetics in Medicine, Gahl and his colleagues detailed the UDP's objectives and achievements to date, describing the experiences of 160 patients who have already participated in the program.
Gahl and his colleagues point out that a center like the UDP is
crucial for patients like these, because the typical physician will
only be knowledgeable about roughly 500 common diseases.
On the other hand, about 6,500 rare (and unfamiliar) illnesses
are known to exist. "Rare diseases" are defined are those that
strike fewer than 200,000 Americans. They often occur in the
absence of reliable diagnostic tests or clear clinical
Trickier still are the so-called "extremely rare" diseases,
those affecting fewer than 10,000 patients. And then there are the
wholly unknown illnesses: new diseases that have yet to yet to be
identified and named.
Patients admitted to the UDP first undergo a battery of
evaluations and genetic tests, often along with family members.
"We see two to four patients every week, and every one is really a mystery," noted Gahl. "But with the UDP we are able to do the kind of testing in one week that would ordinarily take one or two years."
More than half of the 160 patients (65 men, 95 women)
highlighted in the current UDP report entered the program with an
undiagnosed neurological issue. Other symptoms appeared to stem
from a variety of causes, such as heart disease, skin disease,
mental illness, pain, gastrointestinal disease, fibromyalgia and
chronic fatigue syndrome, autoimmune disorders and rheumatic
In many cases, researchers work with DNA, blood, urine and other
variables long after a patient departs the center. According to
Gahl, it can take a year or two of "devoted effort" to decode a
single illness. And there's never any guarantee of success.
That's why, "we try to select individuals and families that we
feel we can help," according to UDP senior staff clinician Dr.
David Adams. "By that I mean that if someone has a condition with
the hallmarks of a genetic condition as opposed to something caused
by an individual's environment, then it's more likely that the
genetic tools we have to use are going to be useful."
But he stressed that, "even with a diagnosis, it's unlikely you
will be able to come up with a treatment that will help that
particular patient. These are patients that have already undergone
a huge medical odyssey even before they come to us, and by this
point it's not likely that they will be fixed by some 'miracle
cure' based on our work."
"Our diagnosis rate is about 20 percent," Adams said, "and we have had a few cases where we've been able to help an individual. But we know that in many cases that's not going to happen. And so a lot of what we're trying to accomplish with this program is longer term. To contribute to medicine, so that an ultra-rare disease or syndrome becomes better diagnosed and more easily treatable."
Of the program's 39 "solved" cases to date, 15 involved men and
24 involved women. Eight of the cases have been deemed "rare", and
15 "extremely rare". Two turned out to be new, never-before
"That's the part that's intellectually satisfying," Adams said. "Where we're thrilled to have the opportunity to figure out what's really going on. But then on the other hand, as a practicing physician, some of the cases are just heartbreaking. We're working with devastated families, who know they're being helpful, but who we know we probably can't treat, much less cure."
"It's a balancing act we try and strike every day."
Find out more at the
U.S. National Institutes of Health, Office of Rar...iseases Research.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.