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Tsujimoto M, Kakei Y, Yamano N, Fujita T, Ueda T, Ono R, Murakami S, Moriwaki S, Nishigori C. Clinical trial on the efficacy and safety of NPC-15 for patients with xeroderma pigmentosum exaggerated sunburn reaction type: XP-1 study protocol for a multicentre, double-blinded, placebo-controlled, two-group crossover study followed by a long-term open study in Japan. BMJ Open 2023; 13:e068112. [PMID: 36948554 PMCID: PMC10040004 DOI: 10.1136/bmjopen-2022-068112] [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] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Xeroderma pigmentosum (XP) is a rare intractable disease without a fundamental treatment, presenting with severe photosensitivity, freckle-like pigmented and depigmented maculae and numerous skin cancers before the age of 10 years without strict sun protection. About 70% of the patients exhibit extremely severe sunburn reactions and most of them develop neurological symptoms, including sensorineural hearing impairment and progressive peripheral and central nervous disorders beginning from childhood ages. In the preclinical study, we found that N-acetyl-5-methoxytryptamine was effective in suppressing skin tumour development in addition to improvement of auditory brainstem response in chronically ultraviolet-irradiated XP-A model mice. METHODS AND ANALYSIS On the bases of the preclinical study, we conduct a clinical trial on the efficacy of NPC-15 for patients with XP with exaggerated sunburn reaction type by a multicentre, double-blinded placebo-controlled, two-group crossover study followed by a 52 weeks open study. ETHICS AND DISSEMINATION Ethics approval is overseen by the Kobe University Institutional Review Board and Osaka Medical and Pharmaceutical University Institutional Review Board, and the study is conducted in accordance with the approved protocol. All participants will be required to provide written informed consent. Findings will be disseminated through scientific and professional conferences and peer-reviewed journal publications. The data sets generated during the study will be available from the corresponding author on reasonable request. TRIAL REGISTRATION NUMBER jRCTs051210181.
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Affiliation(s)
- Mariko Tsujimoto
- Dermatology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Yasumasa Kakei
- Clinical & Translational Research Center, Kobe University Hospital, Kobe, Japan
- Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Nozomi Yamano
- Dermatology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Takeshi Fujita
- Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Takehiro Ueda
- Neurology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Ryusuke Ono
- Dermatology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Sae Murakami
- Clinical & Translational Research Center, Kobe University Hospital, Kobe, Japan
| | - Shinichi Moriwaki
- Dermatology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Chikako Nishigori
- Dermatology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
- Hyogo Red Cross Blood Center, Kobe, Japan
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Heyne HO, Karjalainen J, Karczewski KJ, Lemmelä SM, Zhou W, Havulinna AS, Kurki M, Rehm HL, Palotie A, Daly MJ. Mono- and biallelic variant effects on disease at biobank scale. Nature 2023; 613:519-525. [PMID: 36653560 PMCID: PMC9849130 DOI: 10.1038/s41586-022-05420-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/06/2022] [Indexed: 01/20/2023]
Abstract
Identifying causal factors for Mendelian and common diseases is an ongoing challenge in medical genetics1. Population bottleneck events, such as those that occurred in the history of the Finnish population, enrich some homozygous variants to higher frequencies, which facilitates the identification of variants that cause diseases with recessive inheritance2,3. Here we examine the homozygous and heterozygous effects of 44,370 coding variants on 2,444 disease phenotypes using data from the nationwide electronic health records of 176,899 Finnish individuals. We find associations for homozygous genotypes across a broad spectrum of phenotypes, including known associations with retinal dystrophy and novel associations with adult-onset cataract and female infertility. Of the recessive disease associations that we identify, 13 out of 20 would have been missed by the additive model that is typically used in genome-wide association studies. We use these results to find many known Mendelian variants whose inheritance cannot be adequately described by a conventional definition of dominant or recessive. In particular, we find variants that are known to cause diseases with recessive inheritance with significant heterozygous phenotypic effects. Similarly, we find presumed benign variants with disease effects. Our results show how biobanks, particularly in founder populations, can broaden our understanding of complex dosage effects of Mendelian variants on disease.
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Affiliation(s)
- H O Heyne
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
- Digital Health Center, Hasso Plattner Institute for Digital Engineering, University of Potsdam, Potsdam, Germany.
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - J Karjalainen
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - K J Karczewski
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - S M Lemmelä
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - W Zhou
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - A S Havulinna
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - M Kurki
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - H L Rehm
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - A Palotie
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - M J Daly
- Finnish Institute for Molecular Medicine (FIMM), University of Helsinki, Helsinki, Finland.
- Program for Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
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