Safety and Efficacy of Genistein in Sanfilippo Syndrome - A Systematic Review

Sanfilippo syndrome, commonly known as mucopolysaccharidosis type III (MPS III), is a rare autosomal recessive lysosomal storage disease that primarily affects the brain and spinal cord. It is caused by a deficiency of enzymes involved in the catabolism of glycosaminoglycan (GAG) and heparin sulfate (HS). Although Genistein has been presented as a potential therapeutic, its safety and efficacy for the treatment of Sanfilippo syndrome are not well established. This systematic review aims to evaluate the safety and efficacy of Genistein with a primary endpoint of providing an inference whether the medication is producing any improvements when administered in patients suffering from Sanfilippo syndrome. An intensive computerized literature search was performed according to PRISMA guidelines in major databases such as PubMed, ScienceDirect, Embase, Science Citation Index Expanded, The Cochrane Library, and Web of Science until 30 April 2022. Studies evaluating the efficacy and safety of genistein in patients with Sanfilippo Syndrome were included. The quality of the included studies was assessed using the New Castle Ottawa Scale. A total of 558 studies were identified in the initial search. After removing duplicates, 25 studies were screened based on title and abstract, of which 06 studies were included in this systematic review. Among them, 02 studies were of high quality and 04 studies were of moderate quality. After administration of genistein, a decrease in urinary GAG levels and HS levels was observed. Based on the limited evidence present in the literature, this systematic review suggests that genistein can be safely used to treat Sanfilippo syndrome as it lowers GAG levels. However, data on the long-term benefit profile of genistein and high-quality evidence are still needed as a conclusive result could not be withdrawn.