Journal of Inherited Metabolic Disease

, Volume 41, Issue 6, pp 965–976 | Cite as

Long-term complications of glycogen storage disease type Ia in the canine model treated with gene replacement therapy

  • Elizabeth D. Brooks
  • Dustin J. Landau
  • Jeffrey I. Everitt
  • Talmage T. Brown
  • Kylie M. Grady
  • Lauren Waskowicz
  • Cameron R. Bass
  • John D’Angelo
  • Yohannes G. Asfaw
  • Kyha Williams
  • Priya S. Kishnani
  • Dwight D. KoeberlEmail author
Glycogen Storage Disease



Glycogen storage disease type Ia (GSD Ia) in dogs closely resembles human GSD Ia. Untreated patients with GSD Ia develop complications associated with glucose-6-phosphatase (G6Pase) deficiency. Survival of human patients on intensive nutritional management has improved; however, long-term complications persist including renal failure, nephrolithiasis, hepatocellular adenomas (HCA), and a high risk for hepatocellular carcinoma (HCC). Affected dogs fail to thrive with dietary therapy alone. Treatment with gene replacement therapy using adeno-associated viral vectors (AAV) expressing G6Pase has greatly prolonged life and prevented hypoglycemia in affected dogs. However, long-term complications have not been described to date.


Five GSD Ia-affected dogs treated with AAV-G6Pase were evaluated. Dogs were euthanized due to reaching humane endpoints related to liver and/or kidney involvement, at 4 to 8 years of life. Necropsies were performed and tissues were analyzed.


Four dogs had liver tumors consistent with HCA and HCC. Three dogs developed renal failure, but all dogs exhibited progressive kidney disease histologically. Urolithiasis was detected in two dogs; uroliths were composed of calcium oxalate and calcium phosphate. One affected and one carrier dog had polycystic ovarian disease. Bone mineral density was not significantly affected.


Here, we show that the canine GSD Ia model demonstrates similar long-term complications as GSD Ia patients in spite of gene replacement therapy. Further development of gene therapy is needed to develop a more effective treatment to prevent long-term complications of GSD Ia.



We would like to acknowledge inspiration and support from Dr. Emory and Mrs. Mary Chapman and their son Christopher, and from Dr. John and Mrs. Michelle Kelly. We appreciate the care that these dogs received from the Duke Division of Laboratory Animal Resources staff, namely Ms. Laura Jordan and the veterinary support from Drs. Francis Sun, Amanda DeMaster, Sarah Faircloth, Shannon Smith, Feli Smith, Angela Garner, and Jai Tubbs, and veterinary technicians, namely Christian Marsini, Kelly Franke, Diego Zapata, and Jeff Lee. The collective support from the multiple students and staff in the dog feeding team over these years ensured a long, comfortable life for the GSD Ia dogs.

Funding information

This work received funding provided by the Children’s Fund for GSD Research, Children’s Miracle Network, Association for Glycogen Storage Disease, For the Love of Christopher, and the Alice and YT Chen Center for Pediatric Genetics and Genomics, and grant R01DK105434-01A1 from the National Institute of Diabetes and Digestive and Kidney Diseases.

Compliance with ethical standards

Conflict of interest

E. D. Brooks, D. J. Landau, J. I. Everitt, T. T. Brown, K. M. Grady, L. Waskowicz, C. R. Bass, J. D’Angelo, Y. G. Asfaw, K. Williams, P. Kishnani, and D. D. Koeberl declare that they have no conflict of interest.

Animal rights

All institutional and national guidelines for the care and use of laboratory animals were followed.

Supplementary material

10545_2018_223_MOESM1_ESM.docx (12 kb)
ESM 1 (DOCX 12 kb)
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Supplementary Figure 1

Area under the curve (AUC) of 8-hour fasted glucose curves over the lifetime of GSD Ia AAV-G6Pase treated dogs. *indicates glucose curve 2-4 weeks after last vector treatment. See Table 1 for vector therapy summary, excluding dog T, which had poor response to all vector therapies given and data is not included in main document. (JPG 957 kb)

10545_2018_223_Fig4_ESM.png (329 kb)
Supplementary Figure 2

a. Hepatic G6Pase from individual dogs at necropsy. b. Vector DNA copies/cell in dog liver at necropsy; mean ± SD for untreated dogs. (JPG 167 kb)

10545_2018_223_Fig5_ESM.png (1 mb)
Supplementary Figure 3

Serum enzyme concentrations of GSD Ia dogs throughout lifetime; Open symbols denote female dogs. Dotted lines denote enzyme concentrations for normal dogs. ^ denote that some values were higher than lab was able to detect. Dog De was >993 for ALP at 3 years of age, dogs De and H were >993 for ALP at 4 years of age, and dogs R and L were >993 for ALP at 6 years of age. Dog De was >450 for cholesterol at 3 years of age and dog L was >450 for cholesterol at 6 years of age. (JPG 432 kb)

10545_2018_223_Fig6_ESM.png (2.2 mb)
Supplementary Figure 4

a. Urolithiasis detected in Dog L on Radiographs at 8 years of age, urinary bladder denoted by circle. b. Urolith surgically removed from Dog De at 4 years of age. c. Renal cysts from Dog R at 5.7 years of age. d. Polycystic Ovaries in GSD Ia carrier, Dog A at 5 years of age. (JPG 343 kb)

10545_2018_223_Fig7_ESM.png (44 kb)
Supplementary Figure 5

Bone mineral densities of the femurs of GSD Ia dogs compared to a GSD Ia carrier. Mean ± SD of 5 different measurements through QCT. Dotted lines represent BMD range obtained from Schneider et al. 2006 in normal dog femurs. (PNG 43 kb)

10545_2018_223_MOESM2_ESM.tif (143 kb)
High resolution image (TIF 142 kb)


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Copyright information

© SSIEM 2018

Authors and Affiliations

  • Elizabeth D. Brooks
    • 1
    • 2
  • Dustin J. Landau
    • 1
  • Jeffrey I. Everitt
    • 3
  • Talmage T. Brown
    • 4
  • Kylie M. Grady
    • 1
  • Lauren Waskowicz
    • 1
  • Cameron R. Bass
    • 5
  • John D’Angelo
    • 5
  • Yohannes G. Asfaw
    • 2
  • Kyha Williams
    • 2
  • Priya S. Kishnani
    • 1
  • Dwight D. Koeberl
    • 1
    Email author
  1. 1.Division of Medical GeneticsDuke University Medical Center (DUMC)DurhamUSA
  2. 2.Division of Laboratory Animal ResourcesDuke University Medical CenterDurhamUSA
  3. 3.Department of PathologyDuke University Medical CenterDurhamUSA
  4. 4.College of Veterinary MedicineNorth Carolina State UniversityRaleighUSA
  5. 5.Department of Biomedical EngineeringDuke University Medical CenterDurhamUSA

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