1
|
Bernardini G, Braconi D, Zatkova A, Sireau N, Kujawa MJ, Introne WJ, Spiga O, Geminiani M, Gallagher JA, Ranganath LR, Santucci A. Alkaptonuria. Nat Rev Dis Primers 2024; 10:16. [PMID: 38453957 DOI: 10.1038/s41572-024-00498-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/09/2024]
Abstract
Alkaptonuria is a rare inborn error of metabolism caused by the deficiency of homogentisate 1,2-dioxygenase activity. The consequent homogentisic acid (HGA) accumulation in body fluids and tissues leads to a multisystemic and highly debilitating disease whose main features are dark urine, ochronosis (HGA-derived pigment in collagen-rich connective tissues), and a painful and severe form of osteoarthropathy. Other clinical manifestations are extremely variable and include kidney and prostate stones, aortic stenosis, bone fractures, and tendon, ligament and/or muscle ruptures. As an autosomal recessive disorder, alkaptonuria affects men and women equally. Debilitating symptoms appear around the third decade of life, but a proper and timely diagnosis is often delayed due to their non-specific nature and a lack of knowledge among physicians. In later stages, patients' quality of life might be seriously compromised and further complicated by comorbidities. Thus, appropriate management of alkaptonuria requires a multidisciplinary approach, and periodic clinical evaluation is advised to monitor disease progression, complications and/or comorbidities, and to enable prompt intervention. Treatment options are patient-tailored and include a combination of medications, physical therapy and surgery. Current basic and clinical research focuses on improving patient management and developing innovative therapies and implementing precision medicine strategies.
Collapse
Affiliation(s)
- Giulia Bernardini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.
| | - Daniela Braconi
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Andrea Zatkova
- Institute of Clinical and Translational Research, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
- Geneton Ltd, Bratislava, Slovakia
| | | | - Mariusz J Kujawa
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Wendy J Introne
- Human Biochemical Genetics Section, Medical Genetics Branch, Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ottavia Spiga
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Michela Geminiani
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - James A Gallagher
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences University of Liverpool, Liverpool, UK
| | - Lakshminarayan R Ranganath
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences University of Liverpool, Liverpool, UK
- Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | - Annalisa Santucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| |
Collapse
|
2
|
Zaib S, Rana N, Hussain N, Ogaly HA, Dera AA, Khan I. Identification of Potential Inhibitors for the Treatment of Alkaptonuria Using an Integrated In Silico Computational Strategy. Molecules 2023; 28:molecules28062623. [PMID: 36985595 PMCID: PMC10058836 DOI: 10.3390/molecules28062623] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Alkaptonuria (AKU) is a rare genetic autosomal recessive disorder characterized by elevated serum levels of homogentisic acid (HGA). In this disease, tyrosine metabolism is interrupted because of the alterations in homogentisate dioxygenase (HGD) gene. The patient suffers from ochronosis, fractures, and tendon ruptures. To date, no medicine has been approved for the treatment of AKU. However, physiotherapy and strong painkillers are administered to help mitigate the condition. Recently, nitisinone, an FDA-approved drug for type 1 tyrosinemia, has been given to AKU patients in some countries and has shown encouraging results in reducing the disease progression. However, this drug is not the targeted treatment for AKU, and causes keratopathy. Therefore, the foremost aim of this study is the identification of potent and druggable inhibitors of AKU with no or minimal side effects by targeting 4-hydroxyphenylpyruvate dioxygenase. To achieve our goal, we have performed computational modelling using BioSolveIT suit. The library of ligands for molecular docking was acquired by fragment replacement of reference molecules by ReCore. Subsequently, the hits were screened on the basis of estimated affinities, and their pharmacokinetic properties were evaluated using SwissADME. Afterward, the interactions between target and ligands were investigated using Discovery Studio. Ultimately, compounds c and f were identified as potent inhibitors of 4-hydroxyphenylpyruvate dioxygenase.
Collapse
Affiliation(s)
- Sumera Zaib
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
- Correspondence: (S.Z.); (I.K.)
| | - Nehal Rana
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore 54590, Pakistan
| | - Nadia Hussain
- Department of Pharmaceutical Sciences, College of Pharmacy, Al Ain University, Al Ain P.O. Box 64141, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - Hanan A. Ogaly
- Chemistry Department, College of Science, King Khalid University, Abha 61421, Saudi Arabia
- Biochemistry and Molecular Biology Department, Faculty of Veterinary Medicine, Cairo University, Giza 12211, Egypt
| | - Ayed A. Dera
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 62529, Saudi Arabia
| | - Imtiaz Khan
- Manchester Institute of Biotechnology, The University of Manchester, 131 Princess Street, Manchester M1 7DN, UK
- Correspondence: (S.Z.); (I.K.)
| |
Collapse
|
3
|
Ebrahim IC, Hoang TD, Vietor NO, Schacht JP, Shakir MKM. Dilemmas in the diagnosis and management of osteoporosis in a patient with alkaptonuria: Successful treatment with teriparatide. Clin Case Rep 2022; 10:e6729. [PMID: 36583204 PMCID: PMC9794677 DOI: 10.1002/ccr3.6729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022] Open
Abstract
Management of osteoporosis in patients with alkaptonuria can be challenging. This is the first case report confirming the effectiveness of teriparatide following zoledronic acid therapy in treating osteoporosis and preventing fragility fractures in a patient with alkaptonuria.
Collapse
Affiliation(s)
- Ismail C. Ebrahim
- Division of Endocrinology, Department of MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Thanh D. Hoang
- Division of Endocrinology, Department of MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
- Division of Endocrinology, Department of MedicineUniformed Service University of the Health SciencesBethesdaMarylandUSA
| | - Nicole O. Vietor
- Division of Endocrinology, Department of MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
- Division of Endocrinology, Department of MedicineUniformed Service University of the Health SciencesBethesdaMarylandUSA
| | - John P. Schacht
- Department of GeneticsWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Mohamed K. M. Shakir
- Division of Endocrinology, Department of MedicineWalter Reed National Military Medical CenterBethesdaMarylandUSA
- Division of Endocrinology, Department of MedicineUniformed Service University of the Health SciencesBethesdaMarylandUSA
| |
Collapse
|
4
|
Abbas K, Basit J, Rehman MEU. Adequacy of nitisinone for the management of alkaptonuria. Ann Med Surg (Lond) 2022; 80:104340. [PMID: 36045846 PMCID: PMC9422360 DOI: 10.1016/j.amsu.2022.104340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/24/2022] Open
Abstract
Alkaptonuria is a rare hereditary disease with a defective enzyme that results in increased homogentisic acid levels in the body. Homogentisic acid accumulates in multiple body parts and initializes tissue damage. Clinical manifestations such as pigmentation of the skin areas and joint destruction result in ochronosis. Nitisinone decreases serum and urinary homogentisic acid levels, improving morbidity by preventing and slowing the progression of alkaptonuria. Nitisinone-induced hypertyrosinemia causes keratopathy and mental ill effects, which can be managed by diet restriction and regular check-ups. A personalized approach is required for treatment by nitisinone. Low-dose oral nitisinone is associated with overall good results and a better safety profile.
Collapse
|
5
|
Mahdkhah A, Salehpour F, Lotfinia I, Riazi A, Mirzaee F, Kaleibar SA. Asymptomatic alkaptonuria and degenerative disc herniation report of two rare cases. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
6
|
Ying Z, Lu J, Wang X, Zeng Q, Jin H, He B. Case Report: First Documented Hip Arthroplasty on Chinese Patient with Ochronotic Arthropathy. Front Surg 2022; 9:875777. [PMID: 35615647 PMCID: PMC9124898 DOI: 10.3389/fsurg.2022.875777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
Alkaptonuria (AKU) is a rare autosomal recessive disorder caused by homogentisc acid (HGA) accumulation, the deposition of which in the joints usually causes ochronotic arthropathy. With no specific therapy for AKU currently, total joint arthroplasty in ochronotic arthropathy is applied to relieve the symptoms. A 63-year-old female patient came to our Orthopedic Surgery Department in 2019, complaining of severe limitation of movement and pain in the right hip for more than one year. A right total hip arthroplasy (THA) was performed due to the ineffective conservative therapy. At a follow-up of more than 15 months, the woman had full mobility with no complaining of pains. Since there is no relevant case reported about THA therapy for Chinese AKU patients, this report provides a feasible scheme, which makes clinical data more comprehensive.
Collapse
Affiliation(s)
- Zhibo Ying
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Jufeng Lu
- Zhuji Sixth People’s Hospital, Shaoxing City, China
- Correspondence: Bangjian He Hongting Jin Jufeng Lu
| | - Xucheng Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Qinghe Zeng
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Hongting Jin
- First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
- Correspondence: Bangjian He Hongting Jin Jufeng Lu
| | - Bangjian He
- First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
- Correspondence: Bangjian He Hongting Jin Jufeng Lu
| |
Collapse
|
7
|
Lorquin F, Piccerelle P, Orneto C, Robin M, Lorquin J. New insights and advances on pyomelanin production: from microbial synthesis to applications. J Ind Microbiol Biotechnol 2022; 49:6575554. [PMID: 35482661 PMCID: PMC9338888 DOI: 10.1093/jimb/kuac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/21/2022] [Indexed: 11/14/2022]
Abstract
Pyomelanin is a brown-black phenolic polymer and results from the oxidation of homogentisic acid (HGA) in the L-tyrosine pathway. As part of the research for natural and active ingredients issued from realistic bioprocesses, this work re-evaluates the HGA pigment and makes an updated inventory of its syntheses, microbial pathways, and properties, with tracks and recent advances for its large-scale production. The mechanism of the HGA polymerization is also well documented. In alkaptonuria, pyomelanin formation leads to connective tissue damages and arthritis, most probably due to the ROS issued from HGA oxidation. While UV radiation on human melanin may generate degradation products, pyomelanin is not photodegradable, is hyperthermostable, and has other properties better than the L-Dopa melanin. This review aims to raise awareness about the potential of this pigment for various applications, not only for skin coloring and protection but also for other cells, materials, and as a promising (semi)conductor for bioelectronics and energy.
Collapse
Affiliation(s)
- Faustine Lorquin
- Aix-Marseille Université, Mediterranean Institute of Oceanology (MIO), 163 avenue de Luminy, 13288 Marseille Cedex 9, France.,Aix-Marseille Université, Mediterranean Institute of Marine and Terrestrial Biodiversity and Ecology (IMBE), 27 boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Philippe Piccerelle
- Aix-Marseille Université, Mediterranean Institute of Marine and Terrestrial Biodiversity and Ecology (IMBE), 27 boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Caroline Orneto
- Aix-Marseille Université, Mediterranean Institute of Marine and Terrestrial Biodiversity and Ecology (IMBE), 27 boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Maxime Robin
- Aix-Marseille Université, Mediterranean Institute of Marine and Terrestrial Biodiversity and Ecology (IMBE), 27 boulevard Jean Moulin, 13385 Marseille Cedex 5, France
| | - Jean Lorquin
- Aix-Marseille Université, Mediterranean Institute of Oceanology (MIO), 163 avenue de Luminy, 13288 Marseille Cedex 9, France
| |
Collapse
|
8
|
Khan AH, Afroze B, Majid H, Zaidi Y, Jamil A, Jafri L. Musculoskeletal manifestations in Alkaptonuria: A cross-sectional study. Medicine (Baltimore) 2021; 100:e28241. [PMID: 34941093 PMCID: PMC8702201 DOI: 10.1097/md.0000000000028241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to determine the patient characteristics and clinical presentation of Alkaptonuria cases reported by the Biochemical Genetics Lab.An observational study was conducted at the Biochemical Genetics Lab. Alkaptonuria patients were diagnosed based on the homogentisic acid peak in urine and their demographics and clinical data collected from to 2013 to 2019. Clinical history related to joint diseases, ochronotic presentation, and urine darkening on standing was collected.During 7 years, 21 Alkaptonuria cases were reported from BGL; mean age 19.4 ± 24.5 years (range 0.2-66 years) and male to female ratio of 2:1. Of the total, only 9 were adults (mean age, 44 ± 12 years). Most adult patients had musculoskeletal involvement, with joint pain (n = 9) and ochronotic pigmentation (n = 6), whereas all patients presented with a history of urine darkening on standing (21/21 cases).The high prevalence of musculoskeletal involvement observed in patients with albuminuria is likely to be missed by physicians unless specifically tested for in such cases.
Collapse
Affiliation(s)
- Aysha Habib Khan
- Department of Pathology& Laboratory Medicine, Faculty of Pathology, Aga Khan University, Karachi, Pakistan
| | - Bushra Afroze
- Department of Pediatrics and Child Health, Faculty of Pediatrics, Aga Khan University, Karachi, Pakistan
| | - Hafsa Majid
- Department of Pathology& Laboratory Medicine, Faculty of Pathology, Aga Khan University, Karachi, Pakistan
| | - Yusra Zaidi
- Department of Pathology& Laboratory Medicine, Faculty of Pathology, Aga Khan University, Karachi, Pakistan
| | - Azeema Jamil
- Department of Pathology& Laboratory Medicine, Faculty of Pathology, Aga Khan University, Karachi, Pakistan
| | - Lena Jafri
- Department of Pathology& Laboratory Medicine, Faculty of Pathology, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
9
|
Roopnarinesingh RC, Donlon NE, Reynolds JV. Alkaptonuria: clinical manifestations and an updated approach to treatment of a rare disease. BMJ Case Rep 2021; 14:e244240. [PMID: 34876442 PMCID: PMC8655580 DOI: 10.1136/bcr-2021-244240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
Abstract
Alkaptonuria (AKU) is a rare autosomal recessive disorder with a global incidence of 1 in 250 000 to 1 million people worldwide. It results from a deficiency of the enzyme homogentisic acid (HGA) oxidase which when absent, leads to an accumulation of HGA. Without this enzymatic degradation, HGA deposits in connective tissues resulting in pigmentation (ochronosis), plaque formation and accelerated cartilage destruction. With this, many patients who suffer from AKU develop ochronotic arthropathies, tendon ruptures, fractures, and chronic joint pain. Similarly, patients can develop cardiac valvular dysfunction and interstitial renal disease. Our two cases highlight the array of pathologies seen in AKU and, in light of newly published research, give us a platform from which we can discuss the developments in management of this rare disease.
Collapse
Affiliation(s)
| | | | - John V Reynolds
- Department of Upper GI Surgery, St.James Hospital, Dublin, Ireland
| |
Collapse
|
10
|
Wolffenbuttel BHR, Heiner-Fokkema MR, van Spronsen FJ. Preventive use of nitisinone in alkaptonuria. Orphanet J Rare Dis 2021; 16:343. [PMID: 34344451 PMCID: PMC8336241 DOI: 10.1186/s13023-021-01977-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Abstract
Alkaptonuria (AKU, OMIM 203500) is a rare congenital disorder caused by a deficiency of the enzyme homogentisate-1,2,-dioxygenase. The long-term consequences of AKU are joint problems, cardiac valve abnormalities and renal problems. Landmark intervention studies with nitisinone 10 mg daily, suppressing an upstream enzyme activity, demonstrated its beneficial effects in AKU patients with established complications, which usually start to develop in the fourth decade. Lower dose of nitisinone in the range of 0.2–2 mg daily will already reduce urinary homogentisic acid (uHGA) excretion by > 90%, which may prevent AKU-related complications earlier in the course of the disease while limiting the possibility of side-effects related to the increase of plasma tyrosine levels caused by nitisinone. Future preventive studies should establish the lowest possible dose for an individual patient, the best age to start treatment and also collect evidence to which level uHGA excretion should be reduced to prevent complications.
Collapse
Affiliation(s)
- Bruce H R Wolffenbuttel
- Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
| | - M Rebecca Heiner-Fokkema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Francjan J van Spronsen
- Beatrix Children's Hospital, Division of Metabolic Disorders, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
11
|
Chu P, Cuellar MC, Bracken SJ, Tarrant TK. A Mimic of Ankylosing Spondylitis, Ochronosis: Case Report and Review of the Literature. Curr Allergy Asthma Rep 2021; 21:19. [PMID: 33666743 PMCID: PMC8285993 DOI: 10.1007/s11882-021-01002-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE OF REVIEW Ochronosis and alkaptonuria are manifestations of the same condition-a rare autosomal recessive disorder resulting from a constitutional lack of homogentisate 1,2-dioxygenase (HGD) with the consequent accumulation of homogentisic acid (HGA). In ochronosis, HGA undergoes autoxidation as well as enzymatic oxidation to form an ochronotic pigment that accumulates in cartilage and connective tissues. In the beginning, there is homogentisic aciduria and pigmentation of cartilages and other connective tissues. In later years, generalized osteoarthritis of the spine and large joints, termed ochronotic arthropathy, develops. RECENT FINDINGS The diagnosis is confirmed by quantitative measurement of HGA in urine and mutation analysis of the HGD gene. One of the differential diagnoses for the skin findings is exogenous ochronosis, a limited hyperpigmentation of skin caused by some chemicals. As for the lumbar spine findings, there can be radiographic similarities with ankylosing spondylitis (AS) including reduced intervertebral disc spaces and loss of lumbar lordosis; however, ochronosis will spare the sacroiliac joint, and the lumbar spine will show dense, wafer-like disk calcification with a vacuum disc phenomenon and broad syndesmophytes. Here, we present a case of a patient with probable ochronosis that was treated many years as ankylosing spondylitis without response, and we provide a review of the current literature on ochronosis pathogenesis, diagnosis, and treatment.
Collapse
Affiliation(s)
- Philip Chu
- Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC, 27710, USA
| | - Maria C Cuellar
- Division of Rheumatology, Department of Medicine, Hospital del Salvador, Santiago, Chile
| | - Sonali J Bracken
- Department of Internal Medicine, Duke University, Durham, NC, 27710, USA
| | - Teresa K Tarrant
- Division of Rheumatology and Immunology, Department of Medicine, Duke University, Durham, NC, 27710, USA.
| |
Collapse
|
12
|
Sangeetha G, Chandran S, Ganesan S, Jayaraj J. Alkaptonuria in an adolescent boy. BMJ Case Rep 2021; 14:14/2/e240147. [PMID: 33541951 PMCID: PMC7868218 DOI: 10.1136/bcr-2020-240147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Alkaptonuria is a rare genetic disorder resulting in abnormality of tyrosine metabolism. It is one of the Garrod's tetrad of 'inborn errors of metabolism' proposed to have Mendelian recessive inheritance. The disorder is characterised by deposition of homogentisic acid leading to ochronosis and ochronotic osteoarthropathy; however, blackish discoloration of urine is the only childhood manifestation. Other manifestations present only after third decade. A 13-year-old boy presented to paediatric nephrology clinic with blackish discolouration of urine since infancy. Examination revealed bluish black discolouration of bilateral sclera and ear cartilage; however, he had no symptoms of ochronotic osteoarthropathy. Genetic test pointed towards alkaptonuria. Currently, he is on regular follow-up and is being treated with vitamin C to delay the progression of the disease. Early diagnosis with appropriate intervention delays the onset of complications and preserves the quality of life of the patient.
Collapse
Affiliation(s)
| | - Senthil Chandran
- General Medicine, ACS Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Swathi Ganesan
- MBBS, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Jaippreetha Jayaraj
- MBBS, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| |
Collapse
|
13
|
Wu K, Bauer E, Myung G, Fang MA. Musculoskeletal manifestations of alkaptonuria: A case report and literature review. Eur J Rheumatol 2018; 6:98-101. [PMID: 30451653 PMCID: PMC6467321 DOI: 10.5152/eurjrheum.2018.18116] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022] Open
Abstract
Alkaptonuria (AKU) is a rare autosomal recessive disorder that results from the deficient activity of homogentisate 1,2-dioxygenase and leads to increased levels of homogentisic acid (HGA) and its oxidized product benzoquinone acetic acid (BQA). Both HGA and BQA form polymerized deposits that lead to a bluish-black discoloration of the cartilage as well as degeneration, inflammation, and calcification of the tendons, ligaments, intervertebral discs, and large joints and increased bone resorption. A brittle and fragmented cartilage forms and leads to aberrant loading of the subchondral bone. These fragments then adhere to the synovial membrane and cause fibrosis or chondromatosis, leading to ochronotic arthropathy. Ochronotic tendinopathy most commonly affects the patellar or Achilles tendon and can lead to enthesopathy or spontaneous tendon ruptures. Ochronotic pigments deposited in the bone impair the bone mineralization process and lead to osteopenia or osteoporosis. Here, we report a case of a patient with several musculoskeletal manifestations of AKU and reviewed the literature to summarize the pathophysiology, clinical characteristics, and radiologic findings of the rheumatic features of AKU. Though medical treatment options are limited, early identification of AKU can facilitate prompt surgical intervention.
Collapse
Affiliation(s)
- Katherine Wu
- Division of Rheumatology, University of California David Geffen School of Medicine, Los Angeles, USA.,Rheumatology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Erin Bauer
- Division of Rheumatology, University of California David Geffen School of Medicine, Los Angeles, USA.,Rheumatology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gihyun Myung
- Division of Rheumatology, University of California David Geffen School of Medicine, Los Angeles, USA.,Rheumatology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Meika A Fang
- Division of Rheumatology, University of California David Geffen School of Medicine, Los Angeles, USA.,Rheumatology Section, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| |
Collapse
|
14
|
Alkaptonuria Severity Score Index Revisited: Analysing the AKUSSI and Its Subcomponent Features. JIMD Rep 2018; 41:53-62. [PMID: 29654544 DOI: 10.1007/8904_2018_98] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/08/2018] [Accepted: 02/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Alkaptonuria (AKU) is a rare disorder with no licensed treatment; nitisinone may reduce symptoms and progression. The All Alkaptonuria Severity Score Index (AKUSSI) measures disease severity in clinical, joint and spine domains, with 57 subcomponent feature scores. Our primary aim was to assess tools for validating scores such as the AKUSSI by detecting relationships between features both before and during nitisinone treatment. METHODS AKUSSI measurements from nitisinone-treated patients visiting the National AKU Centre between 01-Jun-2012 and 31-May-2016 were analysed pre-treatment, at first treatment and annually to Year 3 post-treatment. Principal component analysis (PCA) and redundancy analysis assessed whether any AKUSSI features contributed little information to the overall score. RESULTS 65 AKU patients were included: 17 with a pre-treatment AKUSSI measurement (10 later received nitisinone) and 48 with a first measurement at their first treatment visit. In PCA, the first four principal components (PC1-PC4) explained ≥50% of AKUSSI variance at all visits (54.1-87.3%). Some features regularly dominated their domain's PC1: ears, aortic sclerosis, and nasal/temporal eye scores (clinical), pain-related scores (joint) and cervical, lumbar and thoracic spine scores (spine). Only the right-hand/wrist score was consistently redundant. Right eye (nasal) and left ear scores were redundant pre-treatment, potentially correlating with other dominant clinical PC1 features. CONCLUSIONS PCA and redundancy analysis supported the AKUSSI as a robust AKU disease severity measure, although some AKUSSI features could be removed for simplicity. For small patient populations and rare diseases, PCA and redundancy analysis together can aid validation of disease severity metrics.
Collapse
|
15
|
Abstract
Inborn errors of metabolism encompass a wide spectrum of disorders, frequently affecting bone. The most important metabolic disorders that primarily influence calcium or phosphate balance, resulting in skeletal pathology, are hypophosphatemic rickets and hypophosphatasia. Conditions involving bone marrow or affecting skeletal growth and development are mainly the lysosomal storage disorders, in particular the mucopolysaccharidoses. In these disorders skeletal abnormalities are often the presenting symptom and early recognition and intervention improves outcome in many of these diseases. Many disorders of intermediary metabolism may impact bone health as well, resulting in higher frequencies of osteopenia and osteoporosis. In these conditions factors contributing to the reduced bone mineralization can be the disorder itself, the strict dietary treatment, reduced physical activity or sunlight exposure and/or early ovarian failure. Awareness of these primary or secondary bone problems amongst physicians treating patients with inborn errors of metabolism is of importance for optimization bone health and recognition of skeletal complications.
Collapse
Affiliation(s)
- M Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - C E M Hollak
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| |
Collapse
|
16
|
Peake RWA, Bodamer OA. Dark Colored Urine in a 2-Year-Old Child. Clin Chem 2017; 63:786-788. [DOI: 10.1373/clinchem.2016.269910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/29/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Roy W A Peake
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA
| | - Olaf A Bodamer
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Boston, MA
| |
Collapse
|
17
|
Laschi M, Bernardini G, Dreassi E, Millucci L, Geminiani M, Braconi D, Marzocchi B, Botta M, Manetti F, Santucci A. Inhibition ofpara-Hydroxyphenylpyruvate Dioxygenase by Analogues of the Herbicide Nitisinone As a Strategy to Decrease Homogentisic Acid Levels, the Causative Agent of Alkaptonuria. ChemMedChem 2016; 11:674-8. [DOI: 10.1002/cmdc.201500578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Marcella Laschi
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Giulia Bernardini
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Elena Dreassi
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Lia Millucci
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Michela Geminiani
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Daniela Braconi
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Barbara Marzocchi
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Maurizio Botta
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Fabrizio Manetti
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| | - Annalisa Santucci
- Department of Biotechnology, Chemistry and Pharmacy; Università degli Studi di Siena; Via Aldo Moro 2 53100 Siena Italy
| |
Collapse
|
18
|
Mistry JB, Jackson DJ, Bukhari M, Taylor AM. A role for interleukins in ochronosis in a chondrocyte in vitro model of alkaptonuria. Clin Rheumatol 2015; 35:1849-56. [DOI: 10.1007/s10067-015-3091-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 01/26/2023]
|
19
|
Affiliation(s)
- L R Ranganath
- Department of Clinical Biochemistry and Metabolism, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | | | | |
Collapse
|