1
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Sanchez-Bretano A, Keeling E, Scott JA, Lynn SA, Soundara-Pandi SP, Macdonald SL, Newall T, Griffiths H, Lotery AJ, Ratnayaka JA, Self JE, Lee H. Human equivalent doses of L-DOPA rescues retinal morphology and visual function in a murine model of albinism. Sci Rep 2023; 13:17173. [PMID: 37821525 PMCID: PMC10567794 DOI: 10.1038/s41598-023-44373-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023] Open
Abstract
L-DOPA is deficient in the developing albino eye, resulting in abnormalities of retinal development and visual impairment. Ongoing retinal development after birth has also been demonstrated in the developing albino eye offering a potential therapeutic window in humans. To study whether human equivalent doses of L-DOPA/Carbidopa administered during the crucial postnatal period of neuroplasticity can rescue visual function, OCA C57BL/6 J-c2J OCA1 mice were treated with a 28-day course of oral L-DOPA/Carbidopa at 3 different doses from 15 to 43 days postnatal age (PNA) and for 3 different lengths of treatment, to identify optimum dosage and treatment length. Visual electrophysiology, acuity, and retinal morphology were measured at 4, 5, 6, 12 and 16 weeks PNA and compared to untreated C57BL/6 J (WT) and OCA1 mice. Quantification of PEDF, βIII-tubulin and syntaxin-3 expression was also performed. Our data showed impaired retinal morphology, decreased retinal function and lower visual acuity in untreated OCA1 mice compared to WT mice. These changes were diminished or eliminated when treated with higher doses of L-DOPA/Carbidopa. Our results demonstrate that oral L-DOPA/Carbidopa supplementation at human equivalent doses during the postnatal critical period of retinal neuroplasticity can rescue visual retinal morphology and retinal function, via PEDF upregulation and modulation of retinal synaptogenesis, providing a further step towards developing an effective treatment for albinism patients.
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Affiliation(s)
- Aida Sanchez-Bretano
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Eloise Keeling
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Jennifer A Scott
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Savannah A Lynn
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Sudha Priya Soundara-Pandi
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Sarah L Macdonald
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Tutte Newall
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Helen Griffiths
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Andrew J Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - J Arjuna Ratnayaka
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
| | - Jay E Self
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Helena Lee
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Sir Henry Wellcome Laboratories, Southampton University Hospital, South Block Mail Point 806, Level D, Southampton, SO16 6YD, UK.
- Eye Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
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2
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Ma EZ, Zhou AE, Hoegler KM, Khachemoune A. Oculocutaneous albinism: epidemiology, genetics, skin manifestation, and psychosocial issues. Arch Dermatol Res 2023; 315:107-116. [PMID: 35217926 DOI: 10.1007/s00403-022-02335-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/06/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
Oculocutaneous albinism (OCA) is a group of rare, inherited disorders associated with reduced melanin biosynthesis. Clinical manifestations of the eight known subtypes of OCA include hypopigmented skin, eyes, and hair and ocular manifestations, such as decreased visual acuity and nystagmus. OCA affects people globally but is most prevalent in African countries. Individuals with oculocutaneous albinism lack UV protection and are prone to skin damage and skin cancers. For many African albino individuals, there are significant challenges in seeking treatment for skin cancer and preventing sun damage due to psychosocial factors and poor education. This review summarizes the current understanding of the epidemiology, genetics, and clinical manifestations of OCA. We also discuss the medical and psychosocial challenges that affect individuals with OCA and the current landscape of albinism treatment modalities. The extent of the psychosocial challenges needs to be better understood and additional educational interventions may improve quality of life for people with albinism.
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Affiliation(s)
- Emily Z Ma
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Albert E Zhou
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Karl M Hoegler
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amor Khachemoune
- Brooklyn Campus of the VA NY Harbor Healthcare System, FACMS, 800 Poly Place, Brooklyn, NY, USA. .,Department of Dermatology, SUNY Downstate, 450 Clarkson Ave, Brooklyn, NY, USA.
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3
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Aamir A, Kuht HJ, Grønskov K, Brooks BP, Thomas MG. Clinical utility gene card for oculocutaneous (OCA) and ocular albinism (OA)-an update. Eur J Hum Genet 2021; 29:1577-1583. [PMID: 33504991 PMCID: PMC8484472 DOI: 10.1038/s41431-021-00809-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/12/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023] Open
Affiliation(s)
- Abdullah Aamir
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - Helen J Kuht
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK
| | - Karen Grønskov
- Rigshospitalet, Department of Clinical Genetics, Kennedy Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Brian P Brooks
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, Bethesda, MD, USA
| | - Mervyn G Thomas
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKCSB, PO Box 65, Leicester, LE2 7LX, UK.
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4
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Moreno-Artero E, Morice-Picard F, Bremond-Gignac D, Drumare-Bouvet I, Duncombe-Poulet C, Leclerc-Mercier S, Dufresne H, Kaplan J, Jouanne B, Arveiler B, Taieb A, Hadj-Rabia S. Management of albinism: French guidelines for diagnosis and care. J Eur Acad Dermatol Venereol 2021; 35:1449-1459. [PMID: 34042219 DOI: 10.1111/jdv.17275] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
Albinism is a worldwide genetic disorder caused by mutations in at least 20 genes, identified to date, that affect melanin production or transport in the skin, hair and eyes. Patients present with variable degrees of diffuse muco-cutaneous and adnexal hypopigmentation, as well as ocular features including nystagmus, misrouting of optic nerves and foveal hypoplasia. Less often, albinism is associated with blood, immunological, pulmonary, digestive and/or neurological anomalies. Clinical and molecular characterizations are essential in preventing potential complications. Disease-causing mutations remain unknown for about 25% of patients with albinism. These guidelines have been developed for the diagnosis and management of syndromic and non-syndromic forms of albinism, based on a systematic review of the scientific literature. These guidelines comprise clinical and molecular characterization, diagnosis, therapeutic approach and management.
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Affiliation(s)
- E Moreno-Artero
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Universitaire Necker- Enfants Malades, Assistance Publique - Hôpitaux de Paris-Centre (AP-HP5), Paris, France
| | - F Morice-Picard
- Pediatric Dermatology Unit, National Centre for Rare Skin Disorders, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
| | - D Bremond-Gignac
- Department of Ophthalmology, Reference Centre for Rare Ocular Diseases (OPHTARA), Hôpital Necker-Enfants Malades, APHP5, Paris, France.,Université de Paris-Centre, Paris, France
| | - I Drumare-Bouvet
- Service d'exploration de la vision et neuro-ophtalmologie, CHRU de Lille, Lille, France
| | | | - S Leclerc-Mercier
- Department of Pathology, Hôpital Necker-Enfants Malades, APHP5, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Université de Paris-Centre, Paris, France
| | - H Dufresne
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Universitaire Necker- Enfants Malades, Assistance Publique - Hôpitaux de Paris-Centre (AP-HP5), Paris, France.,Service Social Pédiatrique, Hôpital Necker-Enfants Malades, APHP5, Université de Paris-Centre, Paris, France
| | - J Kaplan
- Laboratory of Genetics in Ophthalmology, Imagine Institute, Paris, France
| | - B Jouanne
- French Association for Albinism (Genespoir), Rennes, France
| | - B Arveiler
- Molecular Genetics Laboratory, CHU de Bordeaux, Bordeaux, France.,INSERM U1211, Maladies Rares, Génétique et Métabolisme, Bordeaux, France
| | - A Taieb
- Pediatric Dermatology Unit, National Centre for Rare Skin Disorders, Hôpital Pellegrin-Enfants, CHU de Bordeaux, Bordeaux, France
| | - S Hadj-Rabia
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), Hôpital Universitaire Necker- Enfants Malades, Assistance Publique - Hôpitaux de Paris-Centre (AP-HP5), Paris, France.,Université de Paris-Centre, Paris, France
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5
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Taylor J, Bradbury-Jones C, Ogik P, Kawuma F, Betts J, Lund P. Reactions to and explanations for the birth of a baby with albinism: a qualitative study in Busoga, Uganda. BMJ Open 2021; 11:e040992. [PMID: 33622943 PMCID: PMC7907870 DOI: 10.1136/bmjopen-2020-040992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 01/05/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Babies born with the genetic condition albinism lack pigment in their hair, skin and eyes due to compromised melanin production. This leads to poor vision and the risk of early death due to skin cancer. In Uganda, one of the least developed countries in the world, their lack of pigmentation makes them very different in appearance within their communities. Local explanations of albinism include links to witchcraft and the supernatural. We aimed to explore reactions to the birth of a baby with albinism in Uganda. DESIGN Secondary analysis of birth stories derived from qualitative interviews and focus group discussions in sharing circles. SETTING Interviews took place in the Busoga subregion (kingdom) in the eastern part of Uganda. PARTICIPANTS Seventy-three (73) participants took part in eight sharing circles (n=56) and 17 individual interviews. Participants included people with albinism, parents of people with albinism and a range of other interested parties, including local leaders and teachers. RESULTS Reactions were generally those of shock and rejection, although cases of acceptance were also recorded. The varied explanations given to account for this unexpected event included accounts involving witchcraft, ghosts, animal familiars and religion, as well as genetics. In a framework surmising that someone must possess a dark skin to be intrinsically valued in African societies a baby with albinism does not fulfil this requirement of 'personhood'. The mother was often blamed for having produced some 'thing' that is not a proper person. CONCLUSIONS We argue that a biomedical explanation, although unlikely to displace other understandings, helps to establish a baby with albinism as a real person with a genetic difference, and hence fosters greater acceptance.
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Affiliation(s)
- Julie Taylor
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - C Bradbury-Jones
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter Ogik
- Source of the Nile Union for Persons with Albinism, Jinja, Uganda
| | - Fazira Kawuma
- Source of the Nile Union for Persons with Albinism, Jinja, Uganda
| | | | - Patricia Lund
- School of Life Sciences, Coventry University, Coventry, UK
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6
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Current and emerging treatments for albinism. Surv Ophthalmol 2020; 66:362-377. [PMID: 33129801 DOI: 10.1016/j.survophthal.2020.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
Albinism is a group of rare inherited disorders arising from impairment of melanin biosynthesis. The reduction of melanin synthesis leads to hypopigmentation of the skin and eyes. A wide range of ophthalmic manifestations arise from albinism, including reduction of visual acuity, nystagmus, strabismus, iris translucency, foveal hypoplasia, fundus hypopigmentation, and abnormal decussation of retinal ganglion cell axons at the optic chiasm. Currently, albinism is incurable, and treatment aims either surgically or pharmacologically to optimize vision and protect the skin; however, novel therapies that aim to directly address the molecular errors of albinism, such as l-dihydroxyphenylalanine and nitisinone, are being developed and have entered human trials though with limited success. Experimental gene-based strategies for editing the genetic errors in albinism have also met early success in animal models. The emergence of these new therapeutic modalities represents a new era in the management of albinism. We focus on the known genetic subtypes, clinical assessment, and existing and emerging therapeutic options for the nonsyndromic forms of albinism.
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7
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Albinism: epidemiology, genetics, cutaneous characterization, psychosocial factors. An Bras Dermatol 2019; 94:503-520. [PMID: 31777350 PMCID: PMC6857599 DOI: 10.1016/j.abd.2019.09.023] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/09/2019] [Indexed: 11/20/2022] Open
Abstract
Oculocutaneous albinism is an autosomal recessive disease caused by the complete absence or decrease of melanin biosynthesis in melanocytes. Due to the reduction or absence of melanin, albinos are highly susceptible to the harmful effects of ultraviolet radiation and are at increased risk of actinic damage and skin cancer. In Brazil, as in other parts of the world, albinism remains a little known disorder, both in relation to epidemiological data and to phenotypic and genotypic variation. In several regions of the country, individuals with albinism have no access to resources or specialized medical care, and are often neglected and deprived of social inclusion. Brazil is a tropical country, with a high incidence of solar radiation during the year nationwide. Consequently, actinic damage and skin cancer occur early and have a high incidence in this population, often leading to premature death. Skin monitoring of these patients and immediate therapeutic interventions have a positive impact in reducing the morbidity and mortality associated with this condition. Health education is important to inform albinos and their families, the general population, educators, medical professionals, and public agencies about the particularities of this genetic condition. The aim of this article is to present a review of the epidemiological, clinical, genetic, and psychosocial characteristics of albinism, with a focus in skin changes caused by this rare pigmentation disorder.
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8
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Zungu Z, Mashige KP. Utilisation of eye and skin care, and social services among persons with albinism in Ulundi, KwaZulu-Natal, South Africa. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Knowledge of the utilisation of eye and skin care, and social services among persons with albinism is essential for planning intervention strategies for this group.Aim: The aim of this study was to determine the utilisation of eye and skin care, and social services among persons with albinism in the Ulundi Municipality of KwaZulu-Natal Province, South Africa.Setting: The Ulundi Municipality of KwaZulu-Natal, South Africa.Methods: The cross-sectional survey used a questionnaire to collect data from 21 participants living with albinism. Semi-structured face-to-face interviews were conducted in small peer groups.Results: The participants (n = 21; males 8 and females 13) were aged 4 to 60 years (mean = 24.5 ± 17.9 years). All participants reported that they had their eyes tested within the last two years by an optometrist and none by an ophthalmologist. Almost half (42.9%) had never used a low vision device, this being because of their non-availability (44.4%), financial constraints (33.3%) and lack of or poor awareness (22.2%). Participants reported wearing a wide-brimmed hat (47.6%), a combination of wide-brimmed-hats and sunglasses (33.3%) for eye protection and 19% reported using neither. All the participants reported that they used sunscreen with sun protection factor and 90.5% reported using long-sleeved shirts for skin protection. The majority (81%) of participants reported receiving the South African Social Security Agency (SASSA) social (visual disability) grant, with 85.7% knowing where the SASSA offices were located.Conclusion: Despite the poor use of low vision aids, the level of utilisation of eye and skin care, and other social services among participants was good.
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Abstract
Albinism can be divided into oculocutaneous albinism (OCA) and ocular albinism (OA). In the differential diagnostics these can be distinguished from rarer syndromes with partial albinism, which are frequently associated with susceptibility to infections and neurological symptoms. The OCA is an autosomal recessive inherited disease of melanin biosynthesis, which leads to complete or partial loss of melanin in the skin, hair follicles and eyes. Of the seven currently known subtypes (OCA 1-7), four are well-characterized (OCA 1-4). These are based on gene mutations, which code for tyrosinase, a key enzyme in melanin synthesis and for further proteins. These play an important role in the catalytic activity of tyrosinase and the structure and function of melanosomes. In the presence of these subtypes, the clinical symptoms and the course of the disease show a pronounced variability, especially in the type and extent of pigmentation of the skin and hair as well as the severity of eye involvement, which makes the phenotypic classification difficult. Treatment priorities are a consistent protection from UV light for prophylaxis against skin cancer and regular preventive investigations. The ocular alterations typical for albinism necessitate timely diagnostics and care by institutions specialized in ophthalmology. Novel strategies for systemic treatment of subtypes of albinism are in preclinical testing. The OA without skin involvement shows X‑linked inheritance, is much rarer and is characterized by reduced pigmentation of the retina and iris, nystagmus and macular hypoplasia, sometimes with substantial loss of visual acuity. The typical ocular symptoms of OA can be manifested to a varying extent in all forms of OCA.
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Affiliation(s)
- A S Kubasch
- UniversitätsCentrum für Seltene Erkrankungen, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M Meurer
- Stiftung Hochschulmedizin Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland.
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10
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Affram AA, Teye‐Kwadjo E, Gyasi‐Gyamerah AA. Influence of social stigma on subjective well‐being of persons with albinism in Ghana. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2019. [DOI: 10.1002/casp.2403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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11
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Li Y, Geng X, Bao L, Elaswad A, Huggins KW, Dunham R, Liu Z. A deletion in the Hermansky–Pudlak syndrome 4 (Hps4) gene appears to be responsible for albinism in channel catfish. Mol Genet Genomics 2017; 292:663-670. [DOI: 10.1007/s00438-017-1302-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
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12
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Brocco G. Albinism, stigma, subjectivity and global-local discourses in Tanzania. Anthropol Med 2016; 23:229-243. [PMID: 27354179 PMCID: PMC5351792 DOI: 10.1080/13648470.2016.1184009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 04/26/2016] [Indexed: 12/02/2022]
Abstract
Societal ideas and explanations of albinism at the local level in Tanzania are conceived in terms of family history, social relations, economic status, moral-religious positions, global-local flows of information and humanitarian actions on behalf of people with the congenital condition. This paper aims to show how the subjectivities of people with albinism in Tanzania are shaped and re-shaped through local moral conceptions as well as globalizing (bio)medical explanations of albinism. An exemplary case study of a 28-year-old woman, plus episodes from the lives of seven other informants with the condition, are analyzed in order to understand, on the one hand, local social relationships between people with albinism and other individuals in family and community settings, and on the other hand, the interconnections between persons with albinism and global humanitarian actors and the broadcast media. When stigma and marginalizing behaviors are perceived by individuals with albinism in Tanzania as impeding their social lives, they employ different coping strategies and discourses to enhance social acceptance.
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Affiliation(s)
- Giorgio Brocco
- Freie Universität Berlin, Institut für Sozial- und Kulturanthropologie, Landoltweg 9-11, Berlin, 14195Germany
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13
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Elias PM, Williams ML. Basis for the gain and subsequent dilution of epidermal pigmentation during human evolution: The barrier and metabolic conservation hypotheses revisited. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 161:189-207. [PMID: 27324932 DOI: 10.1002/ajpa.23030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 05/27/2016] [Accepted: 05/29/2016] [Indexed: 12/25/2022]
Abstract
The evolution of human skin pigmentation must address both the initial evolution of intense epidermal pigmentation in hominins, and its subsequent dilution in modern humans. While many authorities believe that epidermal pigmentation evolved to protect against either ultraviolet B (UV-B) irradiation-induced mutagenesis or folic acid photolysis, we hypothesize that pigmentation augmented the epidermal barriers by shifting the UV-B dose-response curve from toxic to beneficial. Whereas erythemogenic UV-B doses produce apoptosis and cell death, suberythemogenic doses benefit permeability and antimicrobial function. Heavily melanized melanocytes acidify the outer epidermis and emit paracrine signals that augment barrier competence. Modern humans, residing in the cooler, wetter climes of south-central Europe and Asia, initially retained substantial pigmentation. While their outdoor lifestyles still permitted sufficient cutaneous vitamin D3 (VD3) synthesis, their marginal nutritional status, coupled with cold-induced caloric needs, selected for moderate pigment reductions that diverted limited nutritional resources towards more urgent priorities (=metabolic conservation). The further pigment-dilution that evolved as humans reached north-central Europe (i.e., northern France, Germany), likely facilitated cutaneous VD3 synthesis, while also supporting ongoing, nutritional requirements. But at still higher European latitudes where little UV-B breaches the atmosphere (i.e., present-day UK, Scandinavia, Baltic States), pigment dilution alone could not suffice. There, other nonpigment-related mutations evolved to facilitate VD3 production; for example, in the epidermal protein, filaggrin, resulting in reduced levels of its distal metabolite, trans-urocanic acid, a potent UV-B chromophore. Thus, changes in human pigmentation reflect a complex interplay between latitude, climate, diet, lifestyle, and shifting metabolic priorities.
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Affiliation(s)
- Peter M Elias
- Department of Veterans Affairs Medical Center, Dermatology Service, University of California San Francisco, California. .,Department of Dermatology, Dermatology Service, University of California San Francisco, California.
| | - Mary L Williams
- Department of Dermatology, University of California, San Francisco, California.,Department of Pediatrics, University of California, San Francisco, California
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14
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Brilliant MH. Albinism in Africa: a medical and social emergency. Int Health 2015; 7:223-5. [DOI: 10.1093/inthealth/ihv039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/04/2015] [Indexed: 11/13/2022] Open
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15
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Wright CY, Norval M, Hertle RW. Oculocutaneous albinism in sub-Saharan Africa: adverse sun-associated health effects and photoprotection. Photochem Photobiol 2014; 91:27-32. [PMID: 25298350 DOI: 10.1111/php.12359] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 10/01/2014] [Indexed: 01/15/2023]
Abstract
Oculocutaneous albinism (OCA) is a genetically inherited autosomal recessive condition. Individuals with OCA lack melanin and therefore are susceptible to the harmful effects of solar ultraviolet radiation, including extreme sun sensitivity, photophobia and skin cancer. OCA is a grave public health issue in sub-Saharan Africa with a prevalence as high as 1 in 1000 in some tribes. This article considers the characteristics and prevalence of OCA in sub-Saharan African countries. Sun-induced adverse health effects in the skin and eyes of OCA individuals are reviewed. Sun exposure behavior and the use of photoprotection for the skin and eyes are discussed to highlight the major challenges experienced by these at-risk individuals and how these might be best resolved.
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Affiliation(s)
- Caradee Y Wright
- Climate Studies, Modelling and Environmental Health Research Group, Council for Scientific and Industrial Research, Pretoria, South Africa; Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria, South Africa
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Rooryck C, Morice F, Lacombe D, Taieb A, Arveiler B. Genetic basis of oculocutaneous albinism. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.09.53] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cruz-Inigo AE, Ladizinski B, Sethi A. Albinism in Africa: Stigma, Slaughter and Awareness Campaigns. Dermatol Clin 2011; 29:79-87. [DOI: 10.1016/j.det.2010.08.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lund PM, Taylor JS. Lack of adequate sun protection for children with oculocutaneous albinism in South Africa. BMC Public Health 2008; 8:225. [PMID: 18590551 PMCID: PMC2447834 DOI: 10.1186/1471-2458-8-225] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Accepted: 06/30/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood is a high risk time for ultraviolet induced skin damage as this age group has more time and opportunity to be outdoors in the sun. Children in Africa with the inherited condition oculocutaneous albinism (OCA) are especially vulnerable due to their lack of protective melanin. They are highly susceptible to developing skin lesions that have both cosmetic and health complications, with a high risk of developing skin cancers. The study aimed to explore the adequacy of sun protection strategies of children with albinism in order to inform future provision. METHODS Community based participatory research methods were employed to investigate sun protection strategies in 90 pupils with OCA (40 female and 50 male) boarding at a special school educating pupils with visual impairment in a rural area of northern South Africa. Hats worn and sunscreen preparations used were examined during semi-structured face to face interviews conducted in small peer groups. The resident nurse interpreted if necessary and provided additional information on monitoring and treatment of skin lesions. RESULTS Participants with albinism in this study were exposed to high levels of ultraviolet radiation throughout the year and showed skin damage despite wearing protective head gear. All except one pupil possessed at least one hat, with a mean brim width of 5.4 cm. Gender differences in sun avoidance behaviour were documented, with females seeking shade during recreational periods and males playing soccer outside. Although 38% of pupils were using a sunscreen with a sun protection factor (SPF) rating, only 12% had government sponsored tubes of SPF15 cream. Government sponsored sunscreen preparations were only provided if actively sought, involving time consuming trips to regional hospitals, with inadequate availability and insufficient supply. CONCLUSION Children with albinism living away from home in rural areas appear to have inadequate sun protection strategies. Changes in health policy could address these deficiencies. We recommend providing more detailed health care information, giving advice on appropriate styles of hat to wear and how to assess commercial SPF products. Health promotional material should also be evaluated to determine its effectiveness among user groups.
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Affiliation(s)
- Patricia M Lund
- Department of Biomolecular and Sport Science, Faculty of Health and Life Sciences, Priory Street, Coventry, UK.
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Lund PM, Maluleke TG, Gaigher I, Gaigher MJ. Oculocutaneous albinism in a rural community of South Africa: a population genetic study. Ann Hum Biol 2007; 34:493-7. [PMID: 17620156 DOI: 10.1080/03014460701401261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Oculocutaneous albinism type II (OCA2), the most common form of albinism worldwide, is prevalent throughout sub-Saharan Africa. The hypopigmentory phenotype distinguishes affected individuals as 'different' in a black population, resulting in problems of social acceptance and integration. Health issues include constant, lifelong sun-induced skin damage and poor vision. This study determined the frequency and distribution of albinism among the Vhavenda ethnic group living in the relatively low-income north of South Africa in a clan-oriented society. A retrospective study of birth records from regional hospitals gave an incidence of OCA of 1 in 1970, whereas a survey of mainstream schools gave a frequency of only one pupil with albinism in 13,319 as most affected children attended the regional special school. A community-based field study of 35 rural villages gave a prevalence of 1 in 2239 for OCA. One clan, the Vhatavhatsindi, had a significantly higher frequency of 1 in 832. This epidemiological study provides the necessary data for developing health care and welfare system for families affected by albinism in this region.
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Affiliation(s)
- P M Lund
- Faculty of Health and Life Sciences, Department of Bimolecular and Sports Sciences, Coventry University, Coventry, UK.
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Rooryck C, Morice F, Mortemousque B, Lacombe D, Taïeb A, Arveiler B. Albinisme oculo-cutané. Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89250-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Hong ES, Zeeb H, Repacholi MH. Albinism in Africa as a public health issue. BMC Public Health 2006; 6:212. [PMID: 16916463 PMCID: PMC1584235 DOI: 10.1186/1471-2458-6-212] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 08/17/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oculocutaneous albinism (OCA) is a genetically inherited autosomal recessive condition and OCA2, tyrosine-positive albinism, is the most prevalent type found throughout Africa. Due to the lack of melanin, people with albinism are more susceptible to the harmful effects of ultraviolet radiation exposure. This population must deal with issues such as photophobia, decreased visual acuity, extreme sun sensitivity and skin cancer. People with albinism also face social discrimination as a result of their difference in appearance. The World Health Organization is currently investigating the issues concerning this vulnerable population. METHODS Systematic electronic search of articles in PubMed concerning albinism in Africa. Furthermore, a World Health Organization (WHO) pilot survey of albinism was drafted in English, French and Portuguese, and distributed to African countries through WHO African Regional Offices (AFRO) in an attempt to gather further information on albinism. RESULTS Epidemiologic data on albinism, such as prevalence, were available for South Africa, Zimbabwe, Tanzania and Nigeria. Prevalences as high as 1 in 1,000 were reported for selected populations in Zimbabwe and other specific ethnic groups in Southern Africa. An overall estimate of albinism prevalences ranges from 1/5,000-1/15,000. In addition, both the literature review and the survey underscored the medical and social issues facing people with albinism. CONCLUSION The estimated prevalence of albinism suggests the existence of tens of thousands of people living with albinism in Africa. This finding reiterates the need for increased awareness of and public health interventions for albinism in order to better address the medical, psychological and social needs of this vulnerable population.
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Affiliation(s)
- Esther S Hong
- World Health Organization, Department of Protection of the Human Environment, Geneva, Switzerland and University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Hajo Zeeb
- World Health Organization, Department of Protection of the Human Environment, Geneva, Switzerland
| | - Michael H Repacholi
- World Health Organization, Department of Protection of the Human Environment, Geneva, Switzerland
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