On Rare

In today’s episode of On Rare, David Rintell, Head of Patient Advocacy at BridgeBio, and Mandy Rohrig, Director of Patient Advocacy at BridgeBio Gene Therapy, speak with Misty about her experience living with limb-girdle muscular dystrophy, type2I/R9 (LGMD2I/R9). Misty details the suffering she experienced in her childhood from bullying for the symptoms she now realizes are connected to LGMD2I/R9 and shares the many frustrations and significant challenges that resulted from her delayed diagnosis. Despite noticing alarming symptoms as early as junior high school, Misty was dismissed by medical professionals for years. Finally, and only after both her younger twin sisters were diagnosed with LGMD2I/R9, Misty received her own genetic confirmation of LGMD2I/R9. She was 32 years old. Receiving her diagnosis was like an emotional tornado, and immediately, Misty feared that she may have passed LGMD2I/R9 on to her children. Throughout her journey, Misty has tried to hold on to the positives. She talks about the creative ways she has adapted to life with a progressive disease and emphasizes the importance of showing oneself grace and finding community.

Ada Lee, M.D., the Medical Director at ML Bio Solutions, a BridgeBio company, the program working on LGMD2I/R9 provides a medical overview. She explains that limb-girdle muscular dystrophy (LGMD) is an umbrella of diseases associated with progressive muscular weakness in the girdle muscles, some of the central muscles that support limbs. LGMD2I/R9 (also called “LGMD R9 FKRP-related”) is a genetic disease caused by a mutation in the FKRP gene. The FKRP gene is involved in helping muscles build a glycoprotein called alpha-dystroglycan. When the gene doesn’t work correctly, it causes damage to muscle tissue, and over time, develops into scar-like, fibrotic tissue. As fibrotic tissue overtakes healthy muscle tissue, muscle strength and function declines, and people living with LGMD2I/R9 lose the ability to perform routine daily activities unassisted—such as walking or standing up. Because it is a rare disease that can have a variety of symptoms early on, many people with LGMD2I/R9 have prolonged pathways to diagnosis.

To learn more about LGMD2I/R9 and the LGMD community, visit the LGMD Awareness Foundation, the CureLGMD2i Foundation, and The Speak Foundation.

In this emotional episode of On Rare, David Rintell, Head of Patient Advocacy at BridgeBio, and Mandy Rohrig, Director of Patient Advocacy at BridgeBio Gene Therapy, speak with Dawn, the single parent of Vayle, a 5-year-old girl living with Canavan Disease. Dawn shares how she came to realize that Vayle was not meeting developmental milestones at 3-4 months old. Despite initial reassurance from her pediatrician, Dawn’s maternal intuition proved correct, leading to a diagnosis of Canavan Disease during Vale’s 6-month checkup. Dawn was told that Vayle might not live beyond the age of ten.

Dawn recounts the emotional challenges of adapting to the diagnosis, while learning how to manage Vayle’s increasingly complex medical and care needs. Even with the expectation of a shortened life, Dawn emphasizes the profound love and quality of life she and Vayle share, underscoring her deep commitment to making Vayle's life as comfortable and joyful as possible. Dawn hopes that telling Vayle’s story can bring awareness to this rare disease and help other families going through similar circumstances. This, she hopes, will be part of Vayle’s legacy.

Dr. Dominic Gessler, a physician and researcher who has extensively studied Canavan Disease explains that Canavan Disease is an autosomal recessive genetic disorder caused by mutations in the ASPA gene, leading to the accumulation of a chemical called N-acetyl-L-aspartic acid, or NAA, throughout the body. The accumulation of NAA is thought to damage the white matter in the brain.  Symptoms of Canavan disease become apparent as children fail to meet developmental milestones. As always, questions about your healthcare and the healthcare of your family should be discussed with your physician.

Sean joins David Rintell, Head of Patient Advocacy at BridgeBio, and Mandy Rohrig, Director of Patient Advocacy at BridgeBio Gene Therapy to share his journey with ATTR. In this episode, Sean describes his initial symptoms, which included carpal tunnel syndrome and numbness in his foot and ankle, the misdiagnosis he experienced, and his eventual diagnosis at the Cleveland Clinic in Abu Dhabi. While the diagnosis was a relief it was also difficult to accept and took an emotional toll on him and those around him. Sean has found this to be a common experience of many diagnosed with ATTR. Since Sean’s form of ATTR is hereditary, various members of his family have also been tested. Sean also highlights the positive changes in his life, including meeting his wife, Robin, discovering a talent for drawing, and becoming a public speaker about ATTR.

Jonathan Fox, President and Chief Medical Officer of cardiorenal programs at BridgeBio, joins us again to give a medical introduction to ATTR. On this episode, Jonathan highlights the differences of the ATTR T80 variant. Previously, we learned that ATTR amyloidosis is caused by the dissociation of a protein called transthyretin, or TTR, that changes its shape and forms into fibrous clumps. These clumps of misshapen protein are deposited into various organs and peripheral nerves, including the heart, which can cause them to function abnormally. Jonathan explains the possible origin of the T80 variant and how the T80 variant symptoms can differ from ATTR-CM.

To learn more about living with amyloidosis visit Mackenzie's Mission, www.mm713.org

Alex joins David Rintell, Head of Patient Advocacy at BridgeBio, and Mandy Rohrig, Director of Patient Advocacy at BridgeBio Gene Therapy, to speak about her son, Hudson. Before Hudson’s birth, Alex and her husband learned that Hudson would be born with hypochondroplasia. A genetic counselor helped her to understand the diagnosis. Although Alex is a medical professional, she had never heard of this condition, and the many unknowns of this new diagnosis left Alex feeling scared. However, all these fears were put aside when she held Hudson for the first time. At five days old, Hudson had breathing problems and Alex had to perform CPR on him. Hudson was later diagnosed with severe obstructive sleep apnea and needed to be on oxygen therapy. Alex describes the learning curve that she and her husband experience as they learned to care for Hudson and anticipate some of his early medical needs. Now at 20-months-old, Hudson is a happy little boy who loves to read, walk, and babble, and is adored by his older sister.

Teja Reddi, Ph.D., a Senior Director of Strategy and Operations of Skeletal Dysplasias at BridgeBio, explains that although hypochondroplasia is a milder form of dwarfism than achondroplasia, the condition can cause some medical complications. Hypochondroplasia is a skeletal dysplasia characterized by short stature; stocky build; disproportionately short arms and legs; broad, short hands and feet; mild joint laxity; and macrocephaly. Teja also talks about the challenges of underdiagnosis and the hope for more research to improve the lives of people with hypochondroplasia.

Please note, the views and opinions expressed in this episode of On Rare are those of Alexandra and do not necessarily reflect the official policy or position of BOLDSCIENCE.

In part two, Eric continues talking about his experience living with Transthyretin Amyloidosis (ATTR) with David Rintell, Head of Patient Advocacy at BridgeBio, and Mandy Rohrig, Director of Patient Advocacy at BridgeBio Gene Therapy. Eric recalls the surprise he experienced when a routine doctor’s visit led to him, within hours, to undergoing a heart transplant. Though the surgery was successful, Eric describes his complex recovery from the transplant. Age, old sports injuries, and lingering ATTR symptoms all contributed to a year-long recovery process, which included a two-week stay in the hospital, followed by an acute rehabilitation facility, a few weeks in a hotel, and several more months of recovery at home. Eric ends the conversation by stressing the importance of community – strong connections with other people were not only crucial to his recovery, but also opened doors for mentorship, activism, and his current involvement with the Northern California Amyloidosis Support Group.

Eric joins David Rintell, Head of Patient Advocacy at BridgeBio and Mandy Rohrig, Director of Patient Advocacy at BridgeBio Gene Therapy in a two-part conversation to talk about his experience of living with Transthyretin Amyloidosis (ATTR). Eric was an extremely active person who enjoyed sports, riding horses and working on his 20-acre property when he began to have issues which he now attributes to ATTR. Eric’s diagnostic journey took 14 years and as the disease progressed, he experienced two carpal tunnel surgeries, and several other cardiac procedures. In fact, by the time he was diagnosed, Eric could not walk the length of his home (60 feet) without getting out of breath. Four years after his diagnosis he received a heart transplant. Despite the difficulties, Eric highlights the positives of this diagnosis and how living with ATTR and engaging with the ATTR community has taught him to be intellectually curious, empathetic, grateful for the care he has received and happy to be alive. 

Jonathan Fox, President and Chief Medical Officer of cardiorenal programs at BridgeBio gives a medical introduction to ATTR-CM. Jonathan explains the causes of ATTR and what happens to people living with it. ATTR amyloidosis is caused by the dissociation of a protein called transthyretin, or TTR, that changes its shape and forms into fibrous clumps. These clumps of misshapen protein are deposited into various organs and peripheral nerves, including the heart, which can cause them to function abnormally.

Join David Rintell, Head of Patient Advocacy at BridgeBio and Mandy Rohrig, Director of Patient Advocacy at BridgeBio Gene Therapy as they recognize Rare Disease Day, February 29, 2024, by speaking with siblings of people living with rare conditions. It is often said that a rare condition or disease impacts the entire family, and this is particularly true for rare siblings. Due to the extra care needed by a child living with a rare condition, rare siblings may sometimes miss out on time or attention from their parents. Rare siblings often contribute to caregiving in their families. Though being a rare sibling can be challenging, rare siblings are often more mature, empathic, and aware of what others around them are going through than typical children their age.

Marina, a nineteen-year-old, is a sister to Sammy, who is living with Limb-girdle Muscular Dystrophy Type 2I/R9 (LGMD2I/R9), a rare condition caused by changes in the FKRP gene and is associated with weakness and wasting of arm and leg muscles. In her conversation with David and Mandy, Marina describes what it was like to first learn about LGMD2I/R9 and what it was like to watch Sammy live with a progressive muscle wasting disease. Marina speaks with love as she describes their bond as sisters and how she’s looked out for Sammy. When Sammy started going to the same high school, Marina took calls from Sammy or her teachers anytime Sammy fell or needed other assistance. Even though Marina is now miles away at college, she’s always thinking about Sammy and hoping that she’s getting help at school, if she needs it.

Michael, a thirteen-year-old, is the eldest of six siblings. Two of his brothers are living with Canavan disease, a genetic neurodegenerative disorder. Michael is wise beyond his years. He has a special ability enabling him to understand his brothers, who are non-verbal but always trying to communicate. Michael acknowledges that it is sometimes hard and there have been times when he has wanted more attention from his parents, but he also recognizes that he wouldn’t be who he is today without the challenges he’s experienced. Michael shares his personal experience that that sometimes a rare sibling might seem fine but not truly doing well.

Sydney, a nineteen-year-old, is a triplet and also the younger sister of Sean who is living with achondroplasia, the most common cause of dwarfism. Sometimes when she was younger, Sydney would get upset by the attention Sean received and she would miss her parents as they would be away supporting Sean through surgery. As she has grown up, Sydney has realized that it was necessary for her family to put extra attention and resources into supporting Sean and she is proud of who he has become. She’s inspired by his mantra, “Heart over height, 24/7.”

These rare siblings are incredibly resilient. They demonstrate that living with challenges or adversity is not only not harmful, but it is the cause for a lot of personal growth.

For additional information or resources for rare siblings visit The Courage Parents Network  https://courageousparentsnetwork.org/topics/siblings   or the Rare Siblings Project, http://raresiblingsproject.org/

To learn more about LGMD2I/R9 and the LGMD community visit the CureLGMD2i Foundation, https://curelgmd2i.com/about/   LGMD Awareness Foundation, https://www.lgmd-info.org/    and The Speak Foundation  https://thespeakfoundation.com/

Becoming a parent to a child with a rare disease was extremely isolating for Effie. In the second episode of our two-part series with Effie, she shares that finding the world of podcasts, documenting similar experiences to her own, was magical. Effie explains how important it is to find others who "get it" and how this feeling of belonging changed everything for her. As Effie explains, “In this community of rare disease families, every story matters, every effort counts, and every heart is connected. We are stronger together and are empowered by the love that guides us.” She describes her secret to conducting a compelling interview and reminds us to remember who we are here to serve – patients and caregivers.

To learn more about Effie,  her son Ford, his amazing laugh and CTNNB1 go back and listen to the first episode of the two-part series.

Effie Parks, a rare mom, a patient advocate, a podcaster, and host of “Once Upon a Gene” joins David Rintell, Head of Patient Advocacy at BridgeBio to share her story. Recorded during the 2023 Global Genes Conference in San Diego, Effie talks about her journey into motherhood and into the rare community. Effie’s son, Ford, was born with CTNNB1 syndrome, an extremely rare genetic condition. Isolated and trying to navigate her new life as a rare mom, Effie stumbled across Two Disabled Dudes and on first listen, realized she now had a community who understood her experiences. With this new understanding, Effie dove into the world of advocacy.

CTNNB1 Syndrome is the result of a change to the CTNNB1 gene, which contributes to production of a protein called beta-catenin that has a role in cellular growth and development. While symptoms experienced by individuals with CTNNB1 Syndrome vary and are unique to each person, many individuals experience cognitive challenges, speech, swallowing or feeding difficulties, behavioral issues, motor developmental delays, or impaired vision.

In the first episode of this two-part series, Effie shares the story of Ford’s birth and diagnosis, the founding of her rare community, and her personal journey to becoming a patient advocate and podcaster. Her mission is to learn, lift the voices of the rare community, connect people to resources and to leave the world better than she found it.

*Reference: https://www.curectnnb1.org/ctnnb1-syndrome/