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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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2
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Goudet C, Ged C, Petit A, Desage C, Mahe P, Salhi A, Harzallah I, Blouin JM, Mercie P, Schmitt C, Poli A, Gouya L, Barlogis V, Richard E. Severe Perinatal Presentations of Günther's Disease: Series of 20 Cases and Perspectives. Life (Basel) 2024; 14:130. [PMID: 38255745 PMCID: PMC10817338 DOI: 10.3390/life14010130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Congenital erythropoietic porphyria (CEP), named Günther's disease, is a rare recessive type of porphyria, resulting from deficient uroporphyrinogen III synthase (UROS), the fourth enzyme of heme biosynthesis. The phenotype ranges from extremely severe perinatal onset, with life-threatening hemolytic anaemia, to mild or moderate cutaneous involvement in late-onset forms. This work reviewed the perinatal CEP cases recorded in France in order to analyse their various presentations and evolution. (2) Methods: Clinical and biological data were retrospectively collected through medical and published records. (3) Results: Twenty CEP cases, who presented with severe manifestations during perinatal period, were classified according to the main course of the disease: antenatal features, acute neonatal distress and postnatal diagnosis. Antenatal symptoms (seven patients) were mainly hydrops fetalis, hepatosplenomegaly, anemia, and malformations. Six of them died prematurely. Five babies showed acute neonatal distress, associated with severe anemia, thrombocytopenia, hepatosplenomegaly, liver dysfunction, and marked photosensitivity leading to diagnosis. The only two neonates who survived underwent hematopoietic stem cell transplantation (HSCT). Common features in post-natal diagnosis (eight patients) included hemolytic anemia, splenomegaly, skin sensitivity, and discoloured teeth and urine. All patients underwent HSCT, with success for six of them, but with fatal complications in two patients. The frequency of the missense variant named C73R is striking in antenatal and neonatal presentations, with 9/12 and 7/8 independent alleles, respectively. (4) Conclusions: The most recent cases in this series are remarkable, as they had a less fatal outcome than expected. Regular transfusions from the intrauterine period and early access to HSCT are the main objectives.
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Affiliation(s)
- Claire Goudet
- Pediatric Haematology Department, Timone Enfant, Assistance Publique Hôpitaux de Marseille (APHM), F-13005 Marseille, France; (C.G.); (A.P.); (V.B.)
| | - Cécile Ged
- Department of Biochemistry, Groupe Hospitalier Pellegrin, CHU Bordeaux, F-33076 Bordeaux, France; (C.G.)
- BRIC, Bordeaux Institute of Oncology, Inserm UMR1312, University of Bordeaux, 146 Rue Léo Saignat, F-33076 Bordeaux, France
- Laboratory of Excellence Gr-Ex, Institut Imagine, F-75015 Paris, France (A.P.); (L.G.)
| | - Audrey Petit
- Pediatric Haematology Department, Timone Enfant, Assistance Publique Hôpitaux de Marseille (APHM), F-13005 Marseille, France; (C.G.); (A.P.); (V.B.)
| | - Chloe Desage
- Neonatology and Pediatric Haematology, CHU de Montpellier, F-34295 Montpellier, France (P.M.)
| | - Perrine Mahe
- Neonatology and Pediatric Haematology, CHU de Montpellier, F-34295 Montpellier, France (P.M.)
| | - Aicha Salhi
- Faculté de Médecine d’Alger, Department of Dermatology, 16010 Alger, Algeria;
| | - Ines Harzallah
- Genetic Department, CHU de Saint-Etienne, F-42055 Saint-Etienne, France;
| | - Jean-Marc Blouin
- Department of Biochemistry, Groupe Hospitalier Pellegrin, CHU Bordeaux, F-33076 Bordeaux, France; (C.G.)
- BRIC, Bordeaux Institute of Oncology, Inserm UMR1312, University of Bordeaux, 146 Rue Léo Saignat, F-33076 Bordeaux, France
- Laboratory of Excellence Gr-Ex, Institut Imagine, F-75015 Paris, France (A.P.); (L.G.)
- Centre de Compétence Maladies Rares Porphyries, Groupe Hospitalier Saint-André, CHU Bordeaux, F-33000 Bordeaux, France
| | - Patrick Mercie
- BRIC, Bordeaux Institute of Oncology, Inserm UMR1312, University of Bordeaux, 146 Rue Léo Saignat, F-33076 Bordeaux, France
- Laboratory of Excellence Gr-Ex, Institut Imagine, F-75015 Paris, France (A.P.); (L.G.)
- Centre de Compétence Maladies Rares Porphyries, Groupe Hospitalier Saint-André, CHU Bordeaux, F-33000 Bordeaux, France
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Saint-André, CHU Bordeaux, F-33000 Bordeaux, France
| | - Caroline Schmitt
- Laboratory of Excellence Gr-Ex, Institut Imagine, F-75015 Paris, France (A.P.); (L.G.)
- Centre de Recherche sur l’Inflammation, Université de Paris Cité, Inserm U1149, F-45018 Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares Porphyries, Hôpital Louis Mourier, F-92400 Colombes, France
| | - Antoine Poli
- Laboratory of Excellence Gr-Ex, Institut Imagine, F-75015 Paris, France (A.P.); (L.G.)
- Centre de Recherche sur l’Inflammation, Université de Paris Cité, Inserm U1149, F-45018 Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares Porphyries, Hôpital Louis Mourier, F-92400 Colombes, France
| | - Laurent Gouya
- Laboratory of Excellence Gr-Ex, Institut Imagine, F-75015 Paris, France (A.P.); (L.G.)
- Centre de Recherche sur l’Inflammation, Université de Paris Cité, Inserm U1149, F-45018 Paris, France
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares Porphyries, Hôpital Louis Mourier, F-92400 Colombes, France
| | - Vincent Barlogis
- Pediatric Haematology Department, Timone Enfant, Assistance Publique Hôpitaux de Marseille (APHM), F-13005 Marseille, France; (C.G.); (A.P.); (V.B.)
| | - Emmanuel Richard
- Department of Biochemistry, Groupe Hospitalier Pellegrin, CHU Bordeaux, F-33076 Bordeaux, France; (C.G.)
- BRIC, Bordeaux Institute of Oncology, Inserm UMR1312, University of Bordeaux, 146 Rue Léo Saignat, F-33076 Bordeaux, France
- Laboratory of Excellence Gr-Ex, Institut Imagine, F-75015 Paris, France (A.P.); (L.G.)
- Centre de Compétence Maladies Rares Porphyries, Groupe Hospitalier Saint-André, CHU Bordeaux, F-33000 Bordeaux, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mickevicius T, Holtmann C, Draganov J, Prues-Hoelscher J, Geerling G, Borrelli M. Lagophthalmos-induced corneal perforation in a patient with congenital erythropoietic porphyria. Orbit 2023:1-7. [PMID: 36734461 DOI: 10.1080/01676830.2023.2169718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disorder in which the activity of uroporphyrinogen III synthase (UROS) is decreased. This results in the accumulation of photoreactive porphyrinogens, primarily in the skin and bone marrow. We describe a case of a patient with CEP who initially presented with scarring and shortening of the anterior and posterior lid lamella, which led to the development of lagophthalmos. Vascularized hyperkeratotic plaques in both corneas were also present. Despite treatment with topical ocular surface lubricants, corneal perforation with iris and uvea prolapse developed and evisceration of the right eye under local anesthesia was performed. The presented case suggests that despite topical therapy, ocular complications may exacerbate requiring surgical intervention, especially in the presence of lagophthalmos.
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Affiliation(s)
- Tomas Mickevicius
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Christoph Holtmann
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jutta Draganov
- Department of Anesthesiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | | | - Gerd Geerling
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Maria Borrelli
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
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Swanson LA, Johannsson F, Tortorelli S, Yi CA, Shah S. Acquired erythropoietic uroporphyria associated with clonal cytopenia of undetermined significance. JAAD Case Rep 2022; 32:44-47. [PMID: 36687304 PMCID: PMC9849863 DOI: 10.1016/j.jdcr.2022.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Leah A. Swanson
- Department of Dermatology, Mayo Clinic, Scottsdale, Arizona
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona
| | - Freyr Johannsson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Biochemical Genetics Laboratory, Rochester, Minnesota
| | - Silvia Tortorelli
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Biochemical Genetics Laboratory, Rochester, Minnesota
| | - Cecilia Arana Yi
- Department of Medicine, Mayo Clinic, Hematology and Medical Oncology, Phoenix, Arizona
| | - Surbhi Shah
- Department of Medicine, Mayo Clinic, Hematology and Medical Oncology, Phoenix, Arizona
- Correspondence to: Surbhi Shah, MBBS, MD, Department of Medicine, Mayo Clinic, Hematology and Medical Oncology, 5881 E. Mayo Blvd, Phoenix, AZ 85054.
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Poli A, Schmitt C, Moulouel B, Mirmiran A, Puy H, Lefèbvre T, Gouya L. Iron, Heme Synthesis and Erythropoietic Porphyrias: A Complex Interplay. Metabolites 2021; 11:798. [PMID: 34940556 DOI: 10.3390/metabo11120798] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/13/2022] Open
Abstract
Erythropoietic porphyrias are caused by enzymatic dysfunctions in the heme biosynthetic pathway, resulting in porphyrins accumulation in red blood cells. The porphyrins deposition in tissues, including the skin, leads to photosensitivity that is present in all erythropoietic porphyrias. In the bone marrow, heme synthesis is mainly controlled by intracellular labile iron by post-transcriptional regulation: translation of ALAS2 mRNA, the first and rate-limiting enzyme of the pathway, is inhibited when iron availability is low. Moreover, it has been shown that the expression of ferrochelatase (FECH, an iron-sulfur cluster enzyme that inserts iron into protoporphyrin IX to form heme), is regulated by intracellular iron level. Accordingly, there is accumulating evidence that iron status can mitigate disease expression in patients with erythropoietic porphyrias. This article will review the available clinical data on how iron status can modify the symptoms of erythropoietic porphyrias. We will then review the modulation of heme biosynthesis pathway by iron availability in the erythron and its role in erythropoietic porphyrias physiopathology. Finally, we will summarize what is known of FECH interactions with other proteins involved in iron metabolism in the mitochondria.
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Sudrié-Arnaud B, Legendre M, Snanoudj S, Pelluard F, Bekri S, Tebani A. An Atypical Case of Congenital Erythropoietic Porphyria. Genes (Basel) 2021; 12:genes12111828. [PMID: 34828434 PMCID: PMC8620571 DOI: 10.3390/genes12111828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Congenital erythropoietic porphyria (CEP, OMIM #606938) is a severe autosomal recessive inborn error of heme biosynthesis. This rare panethnic disease is due to a deficiency of uroporphyrinogen III synthase (or cosynthase). Subsequently, its substrate, the hydroxymethylbilane is subsequently converted into uroporphyrinogen I in a non-enzymatic manner. Of note, uroporphyrinogen I cannot be metabolized into heme and its accumulation in red blood cells results in intramedullary and intravascular hemolysis. The related clinical symptoms occur most frequently during antenatal or neonatal periods but may also appear in late adulthood. The main antenatal clinical presentation is a non-immune hydrops fetalis. We report here two cases of antenatal CEP deficiency and a review of the reported cases in the literature.
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Affiliation(s)
- Bénédicte Sudrié-Arnaud
- Department of Metabolic Biochemistry, Normandie University, UNIROUEN, INSERM U1245, CHU Rouen, 76000 Rouen, France; (B.S.-A.); (S.S.); (S.B.)
| | - Marine Legendre
- Service de Génétique Médicale, CHU de Bordeaux, 33400 Bordeaux, France;
| | - Sarah Snanoudj
- Department of Metabolic Biochemistry, Normandie University, UNIROUEN, INSERM U1245, CHU Rouen, 76000 Rouen, France; (B.S.-A.); (S.S.); (S.B.)
| | - Fanny Pelluard
- Service d’Anatomopathologie, CHU de Bordeaux, 33400 Bordeaux, France;
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Normandie University, UNIROUEN, INSERM U1245, CHU Rouen, 76000 Rouen, France; (B.S.-A.); (S.S.); (S.B.)
| | - Abdellah Tebani
- Department of Metabolic Biochemistry, Normandie University, UNIROUEN, INSERM U1245, CHU Rouen, 76000 Rouen, France; (B.S.-A.); (S.S.); (S.B.)
- Correspondence:
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Wang YM, Gloude NJ, Davies SM, Lucky AW, Nelson AS. Hematopoietic stem cell transplant for erythropoietic porphyrias in pediatric patients. Pediatr Blood Cancer 2021; 68:e29231. [PMID: 34245225 DOI: 10.1002/pbc.29231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 06/06/2021] [Accepted: 06/25/2021] [Indexed: 11/08/2022]
Abstract
Cutaneous, hematopoietic, and hepatic manifestations of congenital erythropoietic porphyria (CEP) and erythropoietic protoporphyria (EPP) can be debilitating. We present our institution's experience with five patients with porphyria who underwent hematopoietic stem cell transplant (HSCT). Four patients with CEP, including three under age 2, received myeloablation. One patient with EPP, with prior liver transplant, received reduced intensity conditioning (RIC). Four patients are alive without porphyria symptomology and with full donor chimerism. HSCT corrects the defective heme pathway and should be considered early in patients with severe erythropoietic porphyrias to minimize end-organ damage. RIC regimens can minimize toxicity in patients with comorbidities.
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Affiliation(s)
- YunZu M Wang
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Nicholas J Gloude
- Division of Hematology Oncology, Rady Children's Hospital and Department of Pediatrics, University of California, San Diego, California, USA
| | - Stella M Davies
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Anne W Lucky
- Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Adam S Nelson
- Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Bhusal M, Bhattarai S, Shah M, Khadka A. Congenital erythropoietic porphyria: A case series of a rare uroporphyrinogen III synthase gene mutation in Nepalese patients. JAAD Case Rep 2021; 10:102-106. [PMID: 33850991 PMCID: PMC8022107 DOI: 10.1016/j.jdcr.2021.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Mohan Bhusal
- Nepal Plastic Cosmetic and Laser Center, Lalitpur, Nepal
| | - Sabina Bhattarai
- Department of Dermatology and Venereology, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | | | - Anupa Khadka
- Department of Dermatology and Venereology, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
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Prat F, Toutain J, Boutin J, Amintas S, Cullot G, Lalanne M, Lamrissi-Garcia I, Moranvillier I, Richard E, Blouin JM, Dabernat S, Moreau-Gaudry F, Bedel A. Mutation-Specific Guide RNA for Compound Heterozygous Porphyria On-target Scarless Correction by CRISPR/Cas9 in Stem Cells. Stem Cell Reports 2020; 15:677-693. [PMID: 32795423 PMCID: PMC7486222 DOI: 10.1016/j.stemcr.2020.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/31/2023] Open
Abstract
CRISPR/Cas9 is a promising technology for gene correction. However, the edition is often biallelic, and uncontrolled small insertions and deletions (indels) concomitant to precise correction are created. Mutation-specific guide RNAs were recently tested to correct dominant inherited diseases, sparing the wild-type allele. We tested an original approach to correct compound heterozygous recessive mutations. We compared editing efficiency and genotoxicity by biallelic guide RNA versus mutant allele-specific guide RNA in iPSCs derived from a congenital erythropoietic porphyria patient carrying compound heterozygous mutations resulting in UROS gene invalidation. We obtained UROS function rescue and metabolic correction with both guides with the potential of use for porphyria clinical intervention. However, unlike the biallelic one, the mutant allele-specific guide was free of on-target collateral damage. We recommend this design to avoid genotoxicity and to obtain on-target scarless gene correction for recessive disease with frequent cases of compound heterozygous mutations.
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Affiliation(s)
- Florence Prat
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France
| | - Jérôme Toutain
- Medical Genetic Laboratory, CHU Bordeaux, Bordeaux 33000, France
| | - Julian Boutin
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France
| | - Samuel Amintas
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France; Laboratory of Tumor Biology, CHU Bordeaux, Pessac 33604, France
| | - Grégoire Cullot
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France
| | - Magalie Lalanne
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France
| | - Isabelle Lamrissi-Garcia
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France
| | | | - Emmanuel Richard
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France; Biochemistry Laboratory, CHU Bordeaux, Bordeaux 33000, France; Laboratory of Excellence, GR-Ex, Imagine Institute, Paris 75015, France
| | - Jean-Marc Blouin
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France; Biochemistry Laboratory, CHU Bordeaux, Bordeaux 33000, France; Laboratory of Excellence, GR-Ex, Imagine Institute, Paris 75015, France
| | - Sandrine Dabernat
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France; Biochemistry Laboratory, CHU Bordeaux, Bordeaux 33000, France; Laboratory of Excellence, GR-Ex, Imagine Institute, Paris 75015, France
| | - François Moreau-Gaudry
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France; Biochemistry Laboratory, CHU Bordeaux, Bordeaux 33000, France; Laboratory of Excellence, GR-Ex, Imagine Institute, Paris 75015, France
| | - Aurélie Bedel
- Univ Bordeaux, Bordeaux 33000, France; INSERM U1035, Biotherapy of Genetic Diseases, Inflammatory Disorders and Cancers, Bordeaux 33000, France; Biochemistry Laboratory, CHU Bordeaux, Bordeaux 33000, France; Laboratory of Excellence, GR-Ex, Imagine Institute, Paris 75015, France.
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Kahila A, Zamlout A, Mazloum A, Laila O, Badran A. Congenital erythropoietic porphyria (Gunther disease): a case report. Oxf Med Case Reports 2020; 2020:omaa051. [PMID: 32728454 PMCID: PMC7376977 DOI: 10.1093/omcr/omaa051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/02/2020] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
Congenital erythropoietic porphyria (CEP or Gunther disease) is a very rare subtype of porphyria with a prevalence of <0.9 per 1 000 000. A 13-year-old female patient came to our hospital complaining of a severe cutaneous ulceration and scarring. The symptoms began in her first year of life as urine discoloration and skin blistering in sun-exposed areas. The family had been trapped in a high-risk conflict zone in Syria for many years, which precipitated the aggravation of symptoms. Based on clinical examination and laboratory tests, we diagnosed the patient with CEP and treated her with vitamin D supplementation alongside chronic blood transfusions, strict photoprotection and psychotherapy. After 7 months, there were no longer active ulcers or novel complications. Psychotherapy and patient education were important for her psychological development at this age. This treatment limited the deterioration of the symptoms and made the patient more committed to the periodic examinations.
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Affiliation(s)
- Ali Kahila
- Department of Dermatology and Venereology, Damascus University, Damascus, Syria
| | - Ali Zamlout
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | | | - Omar Laila
- Department of Dermatology and Venereology, Damascus University, Damascus, Syria
| | - Ayham Badran
- Department of Dermatology and Venereology, Damascus University, Damascus, Syria
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Isanta-Otal C, López-Valverde G, Orobia AJM, Pablo LE. Ocular manifestations in patient with congenital erythropoietic porphyria. Indian J Ophthalmol 2019; 67:1765-1768. [PMID: 31546559 PMCID: PMC6786212 DOI: 10.4103/ijo.ijo_1776_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present the case of a 52-year-old woman referred to our service because of extreme ocular surface dryness. The patient showed corneal, conjunctival, and eyelid manifestations of ocular congenital erythropoietic porphyria (CEP). We started treatment with autologous serum, topical steroids, and cyclosporine twice a day, topical retinoids, and intense corneal lubrication. The patient referred significant improvement of ocular bothering and less discomfort since treatment was initiated. We describe the management of the herewith presented case of ocular CEP.
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Affiliation(s)
- C Isanta-Otal
- Department of Ophthalmology, Miguel Servet University Hospital; GIMSO Research and Innovative Group, Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - G López-Valverde
- Department of Ophthalmology, Miguel Servet University Hospital; GIMSO Research and Innovative Group, Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - A J Mateo Orobia
- Department of Ophthalmology, Miguel Servet University Hospital; GIMSO Research and Innovative Group, Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - L E Pablo
- Department of Ophthalmology, Miguel Servet University Hospital; GIMSO Research and Innovative Group, Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
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Abstract
Congenital erythropoietic porphyria (CEP) is a rare genetic disease resulting from the remarkable deficient activity of uroporphyrinogen III synthase, the fourth enzyme of the haem biosynthetic pathway. This enzyme defect results in overproduction of the non-physiological and pathogenic porphyrin isomers, uroporphyrin I and coproporphyrin I. The predominant clinical characteristics of CEP include bullous cutaneous photosensitivity to visible light from early infancy, progressive photomutilation and chronic haemolytic anaemia. The severity of clinical manifestations is markedly heterogeneous among patients; and interdependence between disease severity and porphyrin amount in the tissues has been pointed out. A more pronounced endogenous production of porphyrins concomitant to activation of ALAS2, the first and rate-limiting of the haem synthesis enzymes in erythroid cells, has also been reported. CEP is inherited as autosomal recessive or X-linked trait due to mutations in UROS or GATA1 genes; however an involvement of other causative or modifier genes cannot be ruled out.
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Affiliation(s)
- Elena Di Pierro
- U.O. di Medicina Interna, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Valentina Brancaleoni
- U.O. di Medicina Interna, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesca Granata
- U.O. di Medicina Interna, Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milano, Italy
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Abstract
Porphyrias are group of disorders caused by deficiency of the enzymes in heme synthetic pathway. Congenital erythropoietic porphyria (CEP) is an extremely rare disease with mutation in the gene that codes for uroporphyrinogen III synthase leading to accumulation of porphyrin in different tissues and marked cutaneous photosensitivity. Here, we describe a case of CEP with infancy onset blistering, photosensitivity, red colored urine and teeth along with scarring but without any feature of hemolysis.
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Affiliation(s)
- Arun K De
- Department of Pediatric Medicine, Medical College, Kolkata, India
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Abstract
Porphyrias form a group of disorders caused due to defects in the haem synthetic pathway. Congenital erythropoietic porphyia (CEP) is the rarest of the bullous porphyrias (less than 200 cases have been reported till recent times) and a clinician may not see a case during his professional life. We present two cases of CEP. One child with CEP presented with typical infancy-onset blistering, photosensitivity, red urine, and erythrodontia, with hypertrichosis of the upper arms and back. The other child of CEP presented with childhood-onset blistering, mutilation, and hypertrichosis on the face.
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Affiliation(s)
- Sankha Koley
- Department of Dermatology, Bankura Sammilani Medical College, West Bengal, India
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