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Shaikh U, Khan A, Kumari P, Ishfaq A, Ekhator C, Yousuf P, Halappa Nagaraj R, Raza H, Ur Rehman U, Zaman MU, Lakshmipriya Vetrivendan G, Nguyen N, Kadel B, Sherpa TN, Ullah A, Bellegarde SB. Novel Therapeutic Targets for Fibrodysplasia Ossificans Progressiva: Emerging Strategies and Future Directions. Cureus 2023; 15:e42614. [PMID: 37521595 PMCID: PMC10378717 DOI: 10.7759/cureus.42614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/01/2023] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP), also known as Stoneman syndrome, is a rare genetic disorder characterized by abnormal bone development caused by activating mutations of the ACVR1 gene. FOP affects both the developmental and postnatal stages, resulting in musculoskeletal abnormalities and heterotopic ossification. Current treatment options for FOP are limited, emphasizing the need for innovative therapeutic approaches. Challenges in the development of management criteria for FOP include difficulties in recruitment due to the rarity of FOP, disease variability, the absence of reliable biomarkers, and ethical considerations regarding placebo-controlled trials. This narrative review provides an overview of the disease and explores emerging strategies for FOP treatment. Gene therapy, particularly the CRISPR-Cas9 (clustered regularly interspaced short palindromic repeats-associated protein 9) system, holds promise in treating FOP by specifically targeting the ACVR1 gene mutation. Another gene therapy approach being investigated is RNA interference, which aims to silence the mutant ACVR1 gene. Small molecule inhibitors targeting glycogen synthase kinase-3β and modulation of the bone morphogenetic protein signaling pathway are also being explored as potential therapies for FOP. Stem cell-based approaches, such as mesenchymal stem cells and induced pluripotent stem cells, show potential in tissue regeneration and inhibiting abnormal bone formation in FOP. Immunotherapy and nanoparticle delivery systems provide alternative avenues for FOP treatment.
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Affiliation(s)
- Usman Shaikh
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Anoosha Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Priya Kumari
- Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology, College of Osteopathic Medicine, Old Westbury, USA
| | - Paras Yousuf
- Emergency Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Hassan Raza
- Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | | | | | | | - Nhan Nguyen
- Medicine, University of Debrecen, Debrecen, HUN
| | - Bijan Kadel
- Internal Medicine, Nepal Medical College and Teaching Hospitals, Kathmandu, NPL
| | - Tenzin N Sherpa
- Internal Medicine, Nepal Medical College and Teaching Hospitals, Kathmandu, NPL
| | | | - Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, Saint John's, ATG
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Korableva NN, Berestnev EV, Kiselyov SM, Chipsanova NF. Fibrodysplasia Ossificans Progressiva: Literature Review and Case Report. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i6s.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background. Fibrodysplasia ossificans progressiva (FOP) is a genetic disease of the heterotopic ossification group associated with the mutation in ACVR1/ALK2 gene. FOP is characterized by progressive heterotopic endochondral ossification of connective tissue that occurs in postnatal period. It leads to formation of qualitatively normal bone in extraskeletal areas. Congenital hallux deformity is typical for this disease. The clinical picture is characterized by aggravations that are usually caused by trauma or viral infections. Formation of Heterotopic ossificate formation can be observed during aggravations. There is no etiological treatment for FOP. Systemic glucocorticosteroids, non-steroidal anti-inflammatory drug (NSAIDs), mast cell stabilisers, antileukotriene drugs and bisphosphonates can be used in these patients. Clinical case description. The child was born with congenital hallux deformity typical for FOP. The disease onset was noted at the age of 2 years 8 months with a tumor-like painful mass on the neck. Oncological (lymphoproliferative) disease was suspected but biopsy from the lesion did not confirm its malignant nature. The child was consulted by pediatric rheumatologist who has diagnosed FOP. Etanercept and zoledronic acid were administrated, though etanercept was later discontinued. For now, the child receives zoledronic acid infusions 2 times per year and daily NSAIDs. Conclusion. The difficulties in FOP diagnosing are associated to its sporadic nature and clinical picture similarity to other diseases. Suspected malignancy leads to biopsy that is highly undesirable in FOP patients due to high risk of iatrogenic complications.
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FIBRODISPLASIA OSSIFICANTE PROGRESSIVA: RELATO DE 2 CASOS NA INFÂNCIA. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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