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Jericó D, Córdoba KM, Urigo F, Enríquez de Salamanca R, Anderson KE, Deybach JC, Ávila MA, Fontanellas A. Exploring current and emerging therapies for porphyrias. Liver Int 2024; 44:2174-2190. [PMID: 38813953 DOI: 10.1111/liv.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Abstract
Porphyrias are rare, mostly inherited disorders resulting from altered activity of specific enzymes in the haem synthesis pathway that lead to accumulation of pathway intermediates. Photocutaneous symptoms occur when excess amounts of photoreactive porphyrins circulate in the blood to the skin, whereas increases in potentially neurotoxic porphyrin precursors are associated with neurovisceral symptoms. Current therapies are suboptimal and their mechanisms are not well established. As described here, emerging therapies address underlying disease mechanisms by introducing a gene, RNA or other specific molecule with the potential to cure or slow progression of the disease. Recent progress in nanotechnology and nanoscience, particularly regarding particle design and formulation, is expanding disease targets. More secure and efficient drug delivery systems have extended our toolbox for transferring specific molecules, especially into hepatocytes, and led to proof-of-concept studies in animal models. Repurposing existing drugs as molecular chaperones or haem synthesis inhibitors is also promising. This review summarizes key examples of these emerging therapeutic approaches and their application for hepatic and erythropoietic porphyrias.
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Affiliation(s)
- Daniel Jericó
- Solid Tumors Program, Hepatology: Porphyrias & Carcinogenesis Laboratory, CIMA-University of Navarra, Pamplona, Spain
| | - Karol M Córdoba
- Solid Tumors Program, Hepatology: Porphyrias & Carcinogenesis Laboratory, CIMA-University of Navarra, Pamplona, Spain
| | - Francesco Urigo
- Solid Tumors Program, Hepatology: Porphyrias & Carcinogenesis Laboratory, CIMA-University of Navarra, Pamplona, Spain
| | - Rafael Enríquez de Salamanca
- Department of Internal Medicine, Reference Center for Inherited Metabolic Disease-MetabERN, University Hospital 12 de Octubre, UCM, Madrid, Spain
| | - Karl E Anderson
- Porphyria Laboratory and Center, Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jean-Charles Deybach
- French Porphyria Reference Center (CRMR Porphyries France), Université Paris, Paris, France
| | - Matías A Ávila
- Solid Tumors Program, Hepatology: Porphyrias & Carcinogenesis Laboratory, CIMA-University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Fontanellas
- Solid Tumors Program, Hepatology: Porphyrias & Carcinogenesis Laboratory, CIMA-University of Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Poli A, Schmitt C, Puy H, Talbi N, Lefebvre T, Gouya L. Erythropoietic protoporphyrias: updates and advances. Trends Mol Med 2024:S1471-4914(24)00128-X. [PMID: 38890030 DOI: 10.1016/j.molmed.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 06/20/2024]
Abstract
Protoporphyrias are caused by pathogenic variants in genes encoding enzymes involved in heme biosynthesis. They induce the accumulation of a hydrophobic phototoxic compound, protoporphyrin (PPIX), in red blood cells (RBCs). PPIX is responsible for painful cutaneous photosensitivity, which severely impairs quality of life. Hepatic elimination of PPIX increases the risk of cholestatic liver disease, requiring lifelong monitoring. Treatment options are scarce and mainly limited to supportive care such as protection from visible light. Here, we review the pathophysiology of protoporphyrias, their diagnosis, and current recommendations for medical care. We discuss new therapeutic strategies, some of which are currently undergoing clinical trials and are likely to radically alter the severity of the disease in the years to come.
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Affiliation(s)
- Antoine Poli
- Institut National de la Santé et de la Recherche Médicale U1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares Porphyries, Hôpital Louis Mourier, Colombes, France; Laboratory of excellence Gr-Ex, Paris, France.
| | - Caroline Schmitt
- Institut National de la Santé et de la Recherche Médicale U1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares Porphyries, Hôpital Louis Mourier, Colombes, France; Laboratory of excellence Gr-Ex, Paris, France
| | - Hervé Puy
- Institut National de la Santé et de la Recherche Médicale U1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares Porphyries, Hôpital Louis Mourier, Colombes, France; Laboratory of excellence Gr-Ex, Paris, France
| | - Neila Talbi
- Institut National de la Santé et de la Recherche Médicale U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Thibaud Lefebvre
- Institut National de la Santé et de la Recherche Médicale U1149, Centre de Recherche sur l'Inflammation, Paris, France
| | - Laurent Gouya
- Institut National de la Santé et de la Recherche Médicale U1149, Centre de Recherche sur l'Inflammation, Paris, France; Université Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares Porphyries, Hôpital Louis Mourier, Colombes, France; Laboratory of excellence Gr-Ex, Paris, France
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Abstract
The porphyrias are a group of rare diseases, each resulting from a defect in a different enzymatic step of the heme biosynthetic pathway. They can be broadly divided into two categories, hepatic and erythropoietic porphyrias, depending on the primary site of accumulation of heme intermediates. These disorders are multisystemic with variable symptoms that can be encountered by physicians in any specialty. Here, we review the porphyrias and describe their clinical presentation, diagnosis, and management. We discuss novel therapies that are approved or in development. Early diagnosis is key for the appropriate management and prevention of long-term complications in these rare disorders.
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Affiliation(s)
- Amy K Dickey
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Karp Leaf
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA;
| | - Manisha Balwani
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA;
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Madigan KE, Rudnick SR, Agnew MA, Urooj N, Bonkovsky HL. Illuminating Dersimelagon: A Novel Agent in the Treatment of Erythropoietic Protoporphyria and X-Linked Protoporphyria. Pharmaceuticals (Basel) 2023; 17:31. [PMID: 38256864 PMCID: PMC10819203 DOI: 10.3390/ph17010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/05/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Erythropoietic protoporphyria (EPP) is a genetic disorder stemming from reduced ferrochelatase expression, the final enzyme in the pathway of heme biosynthesis. A closely related condition, X-linked protoporphyria (XLP), bears similar clinical features although it arises from the heightened activity of δ-aminolevulinic acid synthase 2 (ALAS2), the first and normally rate-controlling enzyme in heme biosynthesis in developing red blood cells. Both of these abnormalities result in the buildup of protoporphyrin IX, leading to excruciating light sensitivity and, in a minority of cases, potentially fatal liver complications. Traditionally, managing EPP and XLP involved sun avoidance. However, the emergence of innovative therapies, such as dersimelagon, is reshaping the therapeutic landscape for these conditions. In this review, we summarize salient features of the properties of dersimelagon, shedding light on its potential role in advancing our understanding of treatment options for EPP and XLP.
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Affiliation(s)
- Katelyn E. Madigan
- Section on Gastroenterology & Hepatology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (S.R.R.); (H.L.B.)
| | - Sean R. Rudnick
- Section on Gastroenterology & Hepatology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (S.R.R.); (H.L.B.)
| | - Matthew A. Agnew
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA;
| | - Numra Urooj
- Department of Medicine, Parkview Health, Fort Wayne, IN 46845, USA;
| | - Herbert L. Bonkovsky
- Section on Gastroenterology & Hepatology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA; (S.R.R.); (H.L.B.)
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Yasuda M, Lee S, Gan L, Bergonia HA, Desnick RJ, Phillips JD. Cimetidine Does Not Inhibit 5-Aminolevulinic Acid Synthase or Heme Oxygenase Activity: Implications for Treatment of Acute Intermittent Porphyria and Erythropoietic Protoporphyria. Biomolecules 2023; 14:27. [PMID: 38254627 PMCID: PMC10813085 DOI: 10.3390/biom14010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Acute intermittent porphyria (AIP) is characterized by acute neurovisceral attacks that are precipitated by the induction of hepatic 5-aminolevulinic acid synthase 1 (ALAS1). In erythropoietic protoporphyria (EPP), sun exposure leads to skin photosensitivity due to the overproduction of photoreactive porphyrins in bone marrow erythroid cells, where heme synthesis is primarily driven by the ALAS2 isozyme. Cimetidine has been suggested to be effective for the treatment of both AIP and EPP based on limited case reports. It has been proposed that cimetidine acts by inhibiting ALAS activity in liver and bone marrow for AIP and EPP, respectively, while it may also inhibit the hepatic activity of the heme catabolism enzyme, heme oxygenase (HO). Here, we show that cimetidine did not significantly modulate the activity or expression of endogenous ALAS or HO in wildtype mouse livers or bone marrow. Further, cimetidine did not effectively decrease hepatic ALAS activity or expression or plasma concentrations of the putative neurotoxic porphyrin precursors 5-aminolevulinic acid (ALA) and porphobilinogen (PBG), which were all markedly elevated during an induced acute attack in an AIP mouse model. These results show that cimetidine is not an efficacious treatment for acute attacks and suggest that its potential clinical benefit for EPP is not via ALAS inhibition.
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Affiliation(s)
- Makiko Yasuda
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave Box 1498, New York, NY 10029, USA; (S.L.); (L.G.); (R.J.D.)
| | - Sangmi Lee
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave Box 1498, New York, NY 10029, USA; (S.L.); (L.G.); (R.J.D.)
| | - Lin Gan
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave Box 1498, New York, NY 10029, USA; (S.L.); (L.G.); (R.J.D.)
| | - Hector A. Bergonia
- Department of Medicine, Hematology Division, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (H.A.B.); (J.D.P.)
| | - Robert J. Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, 1425 Madison Ave Box 1498, New York, NY 10029, USA; (S.L.); (L.G.); (R.J.D.)
| | - John D. Phillips
- Department of Medicine, Hematology Division, University of Utah School of Medicine, Salt Lake City, UT 84132, USA; (H.A.B.); (J.D.P.)
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Tumminelli C, Burlo F, Pastore S, Severini GM, Berti I, Marchini S, Zanon D, De Martino E, Tommasini A. Erythropoietic protoporphyria: case reports for clinical and therapeutic hints. Ital J Pediatr 2023; 49:156. [PMID: 37996925 PMCID: PMC10668413 DOI: 10.1186/s13052-023-01544-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/03/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Erythropoietic protoporphyria is a rare disorder which represents an important health problem in children, causing painful photosensitivity. Little is known on the correlation between genetic profile and clinical manifestations. The standard of care for Erythropoietic protoporphyria is based on avoiding sun and using sun protections, but recent literature has suggested that cimetidine may have a role in improving sun sensitivity. Herein we report our case series describing the successful use of cimetidine and analyzing potential phenotype-genotype correlations. CASE PRESENTATION This case series describes five patients presented to our Rheumatology Service complaining sun sensitivity. Blood exams and genetic analysis were consistent with the diagnosis of erythropoietic protoporphyria. Four of 5 patients received cimetidine in addition to standard therapies and the effect of treatment was evaluated by Erythropoietic Protoporphyria - Quality of Life questionnaire. CONCLUSIONS Erythropoietic protoporphyria usually manifests in early childhood after a short sun exposure. Skin manifestations are the main reason for investigations, although sometimes they can be more subtle, leading to a significant diagnostic delay. Skin diseases in children can have profound effects on their family and social relationships. A treatment with cimetidine appears to be an excellent therapeutic option in children with Erythropoietic protoporphyria.
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Affiliation(s)
- Cristina Tumminelli
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesca Burlo
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Serena Pastore
- Department of Pediatrics, Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Via dell'Istria, 65, Trieste, 34137, Italy.
| | - Giovanni Maria Severini
- Department of Medical Genetics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Irene Berti
- Department of Pediatrics, Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Via dell'Istria, 65, Trieste, 34137, Italy
| | - Stefano Marchini
- Department of Surgical and Medical Sciences for Children and Adults, Internal Medicine Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41124, Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Department, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Eleonora De Martino
- Department of Pediatrics, Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Via dell'Istria, 65, Trieste, 34137, Italy
| | - Alberto Tommasini
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Department of Pediatrics, Institute for Maternal and Child Health "IRCCS Burlo Garofolo", Via dell'Istria, 65, Trieste, 34137, Italy
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Balwani M, Bonkovsky HL, Levy C, Anderson KE, Bissell DM, Parker C, Takahashi F, Desnick RJ, Belongie K. Dersimelagon in Erythropoietic Protoporphyrias. N Engl J Med 2023; 388:1376-1385. [PMID: 37043653 DOI: 10.1056/nejmoa2208754] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Erythropoietic protoporphyria and X-linked protoporphyria are inborn errors of heme biosynthesis that cause elevated circulating levels of metal-free protoporphyrin and phototoxicity. Both disorders are characterized by excruciating phototoxic attacks after exposure to visible light. Dersimelagon is a new, orally administered, selective melanocortin 1 receptor agonist that increases levels of skin eumelanin. METHODS We conducted a randomized, placebo-controlled, phase 2 trial to investigate the efficacy and safety of dersimelagon with respect to the time to onset and the severity of symptoms associated with sunlight exposure in patients with erythropoietic protoporphyria or X-linked protoporphyria. Patients 18 to 75 years of age were randomly assigned in a 1:1:1 ratio to receive placebo or dersimelagon at a dose of 100 or 300 mg once daily for 16 weeks. The primary end point was the change from baseline to week 16 in the time to the first prodromal symptom associated with sunlight exposure. Patients recorded daily sunlight exposure and symptom data in an electronic diary. Quality of life and safety were also assessed. RESULTS Of the 102 patients (93 with erythropoietic protoporphyria and 9 with X-linked protoporphyria) who underwent randomization, 90% completed the treatment period. The mean daily time to the first prodromal symptom associated with sunlight exposure increased significantly with dersimelagon: the least-squares mean difference from placebo in the change from baseline to week 16 was 53.8 minutes in the 100-mg dersimelagon group (P = 0.008) and 62.5 minutes in the 300-mg dersimelagon group (P = 0.003). The results also suggest that quality of life improved in patients receiving dersimelagon as compared with placebo. The most common adverse events that occurred or worsened during treatment were nausea, freckles, headache, and skin hyperpigmentation. CONCLUSIONS At both doses evaluated, dersimelagon significantly increased the duration of symptom-free sunlight exposure in patients with erythropoietic protoporphyria or X-linked protoporphyria. (Funded by Mitsubishi Tanabe Pharma; Endeavor ClinicalTrials.gov number, NCT03520036.).
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Affiliation(s)
- Manisha Balwani
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - Herbert L Bonkovsky
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - Cynthia Levy
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - Karl E Anderson
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - D Montgomery Bissell
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - Charles Parker
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - Fumihiro Takahashi
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - Robert J Desnick
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
| | - Kirstine Belongie
- From the Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York (M.B., R.J.D.); the Section on Gastroenterology and Hepatology, Wake Forest University-North Carolina Baptist Medical Center, Winston-Salem (H.L.B.); Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami (C.L.); the Division of Gastroenterology and Hepatology and the Porphyria Center, University of Texas Medical Branch, Galveston (K.E.A.); Liver Center and Porphyria Center, University of California, San Francisco, San Francisco (D.M.B.); the Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake City (C.P.); Mitsubishi Tanabe Pharma Corporation, Tokyo (F.T.); and Mitsubishi Tanabe Pharma Development America, Jersey City, NJ (K.B.)
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