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To-Figueras J, Erwin AL, Aguilera P, Millet O, Desnick RJ. Congenital erythropoietic porphyria. Liver Int 2024; 44:1842-1855. [PMID: 38717058 DOI: 10.1111/liv.15958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 07/17/2024]
Abstract
Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disease due to the deficient, but not absent, activity of uroporphyrinogen III synthase (UROS), the fourth enzyme in the heme biosynthesis pathway. Biallelic variants in the UROS gene result in decreased UROS enzymatic activity and the accumulation of non-physiologic Type I porphyrins in cells and fluids. Overproduced uroporphyrins in haematopoietic cells are released into the circulation and distributed to tissues, inducing primarily hematologic and dermatologic symptoms. The clinical manifestations vary in severity ranging from non-immune hydrops fetalis in utero to mild dermatologic manifestations in adults. Here, the biochemical, molecular and clinical features of CEP as well as current and new treatment options, including the rescue of UROS enzyme activity by chaperones, are presented.
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Affiliation(s)
- Jordi To-Figueras
- Biochemistry and Molecular Genetics Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Angelika L Erwin
- Center for Personalized Genetic Healthcare, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paula Aguilera
- Dermatology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Oscar Millet
- Precision Medicine and Metabolism Laboratory, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), Bilbao, Spain
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Desjardins MP, Naccache L, Hébert A, Auger I, Teira P, Pelland-Marcotte MC. Very Early Diagnosis and Management of Congenital Erythropoietic Porphyria. Clin Pediatr (Phila) 2023; 62:399-403. [PMID: 36217751 PMCID: PMC10170564 DOI: 10.1177/00099228221128661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital erythropoietic porphyria (CEP), a rare form of porphyria, is caused by a defect in the heme biosynthesis pathway of the enzyme uroporphyrinogen III synthase (UROS). Uroporphyrinogen III synthase deficiency leads to an accumulation of nonphysiological porphyrins in bone marrow, red blood cells, skin, bones, teeth, and spleen. Consequently, the exposure to sunlight causes severe photosensitivity, long-term intravascular hemolysis, and eventually, irreversible mutilating deformities. Several supportive therapies such as strict sun avoidance, physical sunblocks, red blood cells transfusions, hydroxyurea, and splenectomy are commonly used in the management of CEP. Currently, the only available curative treatment of CEP is hematopoietic stem cell transplantation (HSCT). In this article, we present a young girl in which precocious genetic testing enabled early diagnosis and allowed curative treatment with HSCT for CEP at the age of 3 months of age, that is, the youngest reported case thus far.
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Affiliation(s)
- Marie-Pier Desjardins
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
- Marie-Pier Desjardins, CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, 2705 Boulevard Laurier, Quebec City, QC G1V 4G2, Canada.
| | - Lamia Naccache
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
| | - Audrey Hébert
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
| | - Isabelle Auger
- CHU de Québec, Centre Hospitalier de l’Université Laval, Division of Dermatology, Department of Medicine, Université Laval, Québec City, QC, Canada
| | - Pierre Teira
- CHU Sainte-Justine, Division of Hematology/Oncology, Department of Pediatrics, University of Montréal, Montréal, QC, Canada
| | - Marie-Claude Pelland-Marcotte
- CHU de Québec, Centre Hospitalier de l’Université Laval, Department of Pediatrics, Université Laval, Québec City, QC, Canada
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Mohamed ZA, Pelletier S, Vintze-Geoffrion A, Lagacé-Nadon S, Olney HJ, Adam JP. Autologous Stem Cell Transplant for Treatment of Multiple Myeloma in a Patient with Concomitant Porphyria Cutanea Tarda. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:e264-e266. [PMID: 33390349 DOI: 10.1016/j.clml.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/27/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | - Sarah Pelletier
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | | | | | - Harold J Olney
- Division of Hematology-Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada; Research Center of Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.
| | - Jean-Philippe Adam
- Research Center of Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada; Department of Pharmacy, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Besnard C, Schmitt C, Galmiche-Rolland L, Debray D, Fabre M, Molina T, Gouya L, Ged C, Castelle M, Cavazzana M, Magrin E, Neven B, Moshous D, Blanche S, Frémond ML. Bone Marrow Transplantation in Congenital Erythropoietic Porphyria: Sustained Efficacy but Unexpected Liver Dysfunction. Biol Blood Marrow Transplant 2019; 26:704-711. [PMID: 31843562 DOI: 10.1016/j.bbmt.2019.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022]
Abstract
Congenital erythropoietic porphyria (CEP) is a rare disease characterized by erosive photosensitivity and chronic hemolysis due to a defect of the enzyme uroporphyrinogen-III-synthase (UROS). To date, hematopoietic stem cell transplantation (HSCT) is the only curative therapy for the devastating early and severe form of the disease. We describe 6 patients with CEP treated with HSCT (3 of them twice after failure of a first graft) between 1994 and 2016 in our center, including 2 of the very first living patients treated more than 20 years ago. Four patients are doing well at 6 to 25 years post-HSCT, with near-normal biochemical parameters of porphyrin metabolism without the cutaneous or hematologic features of CEP. One patient died within the first year after HSCT from severe graft-versus-host disease (GVHD), and 1 child died of unexplained acute hepatic failure at 1 year after HSCT, despite full donor chimerism. Retrospectively, it appears that all but 1 child had increased transaminase activity with onset from the early postnatal period, which was significantly more marked in the child who died of liver failure. In contrast, liver function values progressively normalized after engraftment in all other children. Liver pathology before HSCT for 3 patients revealed varying degrees of portal, centrilobular, and perisinusoidal fibrosis; clarification of hepatocytes; and cytosolic porphyrin deposits. The liver porphyrin content in biopsy specimens was >60 times the normal values. Despite difficult engraftment, the long-term efficacy of HSCT in CEP appears to be favorable and reinforces its benefits for the severe form of CEP. Hepatic involvement requires careful evaluation before and after HSCT and further investigation into its pathophysiology and care.
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Affiliation(s)
- Caroline Besnard
- Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France
| | - Caroline Schmitt
- French Center of Porphyrias, Louis Mourier Hospital, AP-HP, Colombes and Research Center of Inflammation, UMR1149 INSERM, Université de Paris, Paris, France
| | | | - Dominique Debray
- Pediatric Hepatology Unit, Necker Enfants Malades Hospital, AP-HP, Paris, France
| | - Monique Fabre
- Pathology Department, Necker Enfants Malades Hospital, AP-HP, Paris, France
| | - Thierry Molina
- Pathology Department, Necker Enfants Malades Hospital, AP-HP, Paris, France
| | - Laurent Gouya
- French Center of Porphyrias, Louis Mourier Hospital, AP-HP, Colombes and Research Center of Inflammation, UMR1149 INSERM, Université de Paris, Paris, France
| | - Cécile Ged
- Biotherapy of Genetic Diseases, Inflammatory Disorders, and Cancers, U1035 INSERM, Bordeaux University, Bordeaux, France
| | - Martin Castelle
- Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France
| | - Marina Cavazzana
- Biotherapy Unit, Necker Enfants Malades Hospital, AP-HP, Paris, France
| | - Elisa Magrin
- Biotherapy Unit, Necker Enfants Malades Hospital, AP-HP, Paris, France
| | - Bénédicte Neven
- Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France
| | - Despina Moshous
- Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France
| | - Stéphane Blanche
- Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France.
| | - Marie-Louise Frémond
- Pediatric Immuno-Hematology and Rheumatology Unit, Necker Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, AP-HP, Paris, France
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Erwin AL, Desnick RJ. Congenital erythropoietic porphyria: Recent advances. Mol Genet Metab 2019; 128:288-297. [PMID: 30685241 PMCID: PMC6597325 DOI: 10.1016/j.ymgme.2018.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disorder characterized by photosensitivity and by hematologic abnormalities in affected individuals. CEP is caused by mutations in the uroporphyrinogen synthase (UROS) gene. In three reported cases, CEP has been associated with a specific X-linked GATA1 mutation. Disease-causing mutations in either gene result in absent or markedly reduced UROS enzymatic activity. This in turn leads to the accumulation of the non-physiologic and photoreactive porphyrinogens, uroporphyrinogen I and coproporphyrinogen I, which damage erythrocytes and elicit a phototoxic reaction upon light exposure. The clinical spectrum of CEP depends on the level of residual UROS activity, which is determined by the underlying pathogenic loss-of-function UROS mutations. Disease severity ranges from non-immune hydrops fetalis in utero to late-onset disease with only mild cutaneous involvement. The clinical characteristics of CEP include exquisite photosensitivity to visible light resulting in bullous vesicular lesions which, when infected lead to progressive photomutilation of sun-exposed areas such as the face and hands. In addition, patients have erythrodontia (brownish discoloration of teeth) and can develop corneal scarring. Chronic transfusion-dependent hemolytic anemia is common and leads to bone marrow hyperplasia, which further increases porphyrin production. Management of CEP consists of strict avoidance of exposure to visible light with sun-protective clothing, sunglasses, and car and home window filters. Adequate care of ruptured vesicles and use of topical antibiotics is indicated to prevent superinfections and osteolysis. In patients with symptomatic hemolytic anemia, frequent erythrocyte cell transfusions may be necessary to suppress hematopoiesis and decrease marrow production of the phototoxic porphyrins. In severe transfection-dependent cases, bone marrow or hematopoietic stem cell transplantation has been performed, which is curative. Therapeutic approaches including gene therapy, proteasome inhibition, and pharmacologic chaperones are under investigation.
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Affiliation(s)
| | - Robert J. Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
- Address all Correspondence to: R. J. Desnick, PhD, MD, Dean for Genetic and Genomic Medicine Professor and Chairman Emeritus, Department of Genetic and Genomic Sciences Icahn School of Medicine at Mount Sinai New York, NY 10029, Phone: (212) 659-6700 Fax: (212) 360-1809
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Ciftci V, Kılavuz S, Bulut FD, Mungan HN, Bisgin A, Dogan MC. Congenital erythropoietic porphyria with erythrodontia: A case report. Int J Paediatr Dent 2019; 29:542-548. [PMID: 30706587 DOI: 10.1111/ipd.12473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/02/2019] [Accepted: 01/24/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The causes for intrinsic tooth discoloration can be separated into two categories as systemic and local. Systemic causes are either genetic or drug-induced effects. The development of dentition can also be affected by a number of systemic factors and metabolic diseases such as porphyria. Congenital erythropoietic porphyria (CEP), also known as Gunther's disease, is a metabolic disease caused by a transformation in the gene that codifies uroporphyrinogen-3 synthesis, leading to porphyrin aggregation in urine, skin, bone, and dentin. CASE REPORT A 21-month-old girl with erythrodontia was referred to Paediatric Dentistry Department in September 2017. A physical examination revealed blisters on her face, nose, hands, and feet. Laboratory findings showed highly elevated urine total uroporphyrin and total coproporphyrin I and III levels. Next-generation sequencing multigene panel testing for porphyria demonstrated a homozygous c.10C>T (p.L4F) mutation in the UROS gene. For curative therapy, the patient was admitted to the allogeneic bone marrow transplantation program. CONCLUSION Congenital erythropoietic porphyria most commonly presents in the first few years of life. Manifestations can include reddish-colored urine, skin blistering, scarring, and erythrodontia. A timely diagnosis can prevent undesirable skin findings of the disease and death due to hematological involvement before a curative allogeneic bone marrow transplantation is performed.
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Affiliation(s)
- Volkan Ciftci
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fatma Derya Bulut
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Halise Neslihan Mungan
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Atil Bisgin
- Medical Genetics Department of Balcali Hospital and Clinics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Muharrem Cem Dogan
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, Adana, Turkey
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Schulenburg-Brand D, Katugampola R, Anstey AV, Badminton MN. The Cutaneous Porphyrias. Dermatol Clin 2014; 32:369-84, ix. [DOI: 10.1016/j.det.2014.03.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Tintle S, Alikhan A, Horner ME, Hand JL, Davis DMR. Cutaneous porphyrias part II: treatment strategies. Int J Dermatol 2013; 53:3-24. [PMID: 24134210 DOI: 10.1111/ijd.12016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The porphyrias are diverse in pathophysiology, clinical presentation, severity, and prognosis, presenting a diagnostic and therapeutic challenge. Although not easily curable, the dermatological manifestations of these diseases, photosensitivity and associated cutaneous pathology, can be effectively prevented and managed. Sun avoidance is essential, and patient education regarding the irreversibility of photocutaneous damage is a necessary corollary. Beyond preventative measures, the care of fragile, vulnerable skin, and pain management, each of the porphyrias has a limited number of unique additional therapeutic options. Many of the treatments have been published only in small case series or anecdotal reports and do not have well-understood nor proven mechanisms of action. This article presents a comprehensive review of available therapeutic options and long-term management recommendations for the cutaneous porphyrias.
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Affiliation(s)
- Suzanne Tintle
- Department of Dermatology, Tufts Medical Center, Boston, MA, USA
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Martinez Peinado C, Díaz de Heredia C, To-Figueras J, Arias-Santiago S, Nogueras P, Elorza I, Olivé T, Bádenas C, Moreno MJ, Tercedor J, Herrero C. Successful treatment of congenital erythropoietic porphyria using matched unrelated hematopoietic stem cell transplantation. Pediatr Dermatol 2013; 30:484-9. [PMID: 23557135 DOI: 10.1111/pde.12117] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital erythropoietic porphyria (CEP), or Günther's disease, is an inborn error of metabolism produced by a deficiency of uroporphyrinogen III synthase (UROS), the fourth enzyme of the heme biosynthesis pathway. This enzymatic defect induces the accumulation of isomer I porphyrins in erythrocytes, skin, and tissues, producing various clinical manifestations. Severe cases are characterized by extreme photosensitivity, causing scarring and mutilations, and by hemolytic anemia, reducing life expectancy. CEP is caused by mutations in the UROS gene, and one of the most severe forms of the disease is associated with a cysteine to arginine substitution at residue 73 of the protein (C73R). CEP has been successfully treated only by the transplantation of hematopoietic precursors. We report the case of a male infant with severe postdelivery symptoms diagnosed with CEP and found to be homozygous for the C73R mutation. He underwent successful allogeneic bone marrow transplantation from a matched unrelated donor at 7 months of age. The hemolytic anemia was corrected and the porphyrin overproduction was significantly reduced. The patient remained asymptomatic after 1 year. This new case confirms that patients with severe CEP can benefit from early postnatal hematopoietic stem cell transplantation.
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Katugampola RP, Anstey AV, Finlay AY, Whatley S, Woolf J, Mason N, Deybach JC, Puy H, Ged C, de Verneuil H, Hanneken S, Minder E, Schneider-Yin X, Badminton MN. A management algorithm for congenital erythropoietic porphyria derived from a study of 29 cases. Br J Dermatol 2012; 167:888-900. [PMID: 22804244 DOI: 10.1111/j.1365-2133.2012.11154.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Congenital erythropoietic porphyria (CEP) is an autosomal recessive photomutilating porphyria with onset usually in childhood, where haematological complications determine prognosis. Due to its extreme rarity and clinical heterogeneity, management decisions in CEP are often difficult. OBJECTIVES To develop a management algorithm for patients with CEP based on data from carefully characterized historical cases. METHODS A single investigator collated data related to treatments and their outcomes in 29 patients with CEP from the U.K., France, Germany and Switzerland. RESULTS Six children were treated with bone marrow transplantation (BMT); five have remained symptomatically cured up to 11.5 years post-transplantation. Treatments such as oral charcoal, splenectomy and chronic hypertransfusion were either of no benefit or were associated with complications and negative impact on health-related quality of life. Lack of consistent genotype-phenotype correlation meant that this could not be used to predict disease prognosis. The main poor prognostic factors were early age of disease onset and severity of haematological manifestations. CONCLUSIONS A management algorithm is proposed where every patient, irrespective of disease severity at presentation, should receive a comprehensive, multidisciplinary clinical assessment and should then be reviewed at intervals based on their predicted prognosis, and the rate of onset of complications. A BMT should be considered in those with progressive, symptomatic haemolytic anaemia and/or thrombocytopenia. Uroporphyrinogen III synthase genotypes associated with poor prognosis would additionally justify consideration for a BMT. Rigorous photoprotection of the skin and eyes from visible light is essential in all patients.
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Affiliation(s)
- R P Katugampola
- Department of Dermatology and Wound Healing, Cardiff University, UK.
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Hogeling M, Nakano T, Dvorak CC, Maguiness S, Frieden IJ. Severe neonatal congenital erythropoietic porphyria. Pediatr Dermatol 2011; 28:416-20. [PMID: 21362030 DOI: 10.1111/j.1525-1470.2010.01376.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital erythropoietic porphyria is a rare form of porphyria, presenting during the neonatal period or during infancy. Clinical features include photosensitive blistering and severe anemia. Wood's lamp fluorescence of the diaper is a useful screening test. We describe a severely affected neonate with systemic involvement due to a homozygous mutation. Because of ongoing severe hemolytic anemia and severe photosensitivity, bone-marrow transplantation was performed, but the patient ultimately succumbed to chemotherapy-induced lung damage, as well as severe pulmonary hypertension, likely due to his chronic hemolytic anemia.
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Affiliation(s)
- Marcia Hogeling
- Department of Dermatology, University of California, San Francisco, California, USA.
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Lebreuilly-Sohyer I, Morice A, Acher A, Dompmartin A, Clement C, de Verneuil H, Ged C, Leroy D, Verneuil L. Porphyrie érythropoïétique congénitale traitée par allogreffe de cellules souches hématopoïétiques. Ann Dermatol Venereol 2010; 137:635-9. [DOI: 10.1016/j.annder.2010.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 04/25/2010] [Accepted: 06/22/2010] [Indexed: 11/25/2022]
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de Verneuil H, Robert-Richard E, Ged C, Mazurier F, Richard E, Moreau-Gaudry F. [Successful gene therapy of mice with congenital erythropoietic porphyria]. Med Sci (Paris) 2008; 24:615-20. [PMID: 18601879 DOI: 10.1051/medsci/20082467615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Porphyrias are a group of disorders due to a genetic deficiency in one of the heme biosynthetic pathway enzymes. Congenital erythropoietic porphyria (CEP) is the most severe type characterized by a deficiency in uroporphyrinogen III synthase (UROS) activity. Bone marrow transplantation represents a curative treatment for patients, as long as human leucocyte antigen-compatible donor is available. We used a recently obtained murine model to check the feasibility of gene therapy in this disease. Lentivirus-mediated transfer of the human UROS cDNA into hematopoietic stem cells (HSCs) from Uros(mut 248) mice resulted in a complete and long-term enzymatic, metabolic and phenotypic correction of the disease, favored by a survival advantage of corrected red blood cells. These results demonstrate for the first time that the cure of this mouse model of CEP at moderate transduction level supports the proof of concept of a gene therapy in this disease by transplantation of genetically modified HSCs.
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Faraci M, Morreale G, Boeri E, Lanino E, Dallorso S, Dini G, Scuderi F, Cohen A, Cappelli B. Unrelated HSCT in an adolescent affected by congenital erythropoietic porphyria. Pediatr Transplant 2008; 12:117-20. [PMID: 18186900 DOI: 10.1111/j.1399-3046.2007.00842.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CEP is a rare inborn error of porphyrin-heme synthesis. Clinical manifestations can range from mild to severe and include erythrodontia, reddish-colored urine, and hemolytic anemia that can be mild or severe and may result in splenomegaly. Completely avoiding exposure to the sun is crucial. Attempts to reduce erythropoiesis and to lower circulating porphyrin levels by means of erythrocyte transfusions have been successful in reducing the expression of the disease. However, the complications of a chronic transfusion regimen are potentially severe. Successful bone marrow transplantation has been reported in CEP. We report a case of successful bone marrow transplantation and prolonged follow-up in an adolescent CEP patient.
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Affiliation(s)
- Maura Faraci
- Department of Hematology and Oncology, G. Gaslini Institute, Genoa, Italy
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