1
|
Khan J, Hashmi MU, Noor N, Khan AJ, Shrateh ON, Tahir MJ. Congenital erythropoietic porphyria presenting with recurrent epistaxis: a case report. J Med Case Rep 2023; 17:472. [PMID: 37957719 PMCID: PMC10644557 DOI: 10.1186/s13256-023-04204-5] [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] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Congenital erythropoietic porphyria (CEP), also known as pink tooth or Gunther disease, is a rare hereditary disorder caused by an enzyme mutation in the heme biosynthesis pathway, which leads to the accumulation of immature and non-physiological protoporphyrin rings in various tissues. CEP is characterized by sun-exposed bullous skin lesions, hemolytic anemia, red/brown urine, and teeth staining. CASE PRESENTATION We present a unique case of a 10-year-old Asian boy with CEP who presented with recurrent epistaxis, an unusual presentation for this condition. Based on clinical presentation and laboratory findings, including elevated urine uroporphyrin and coproporphyrin I and III levels, microcytic anemia, a higher red cell distribution width (RDW), and a lower platelet count, a thorough assessment and detailed workup resulted in a diagnosis of CEP. The patient underwent a successful splenectomy and recovered without any complications. CONCLUSION This case report aims to raise awareness among healthcare professionals about the uncommon and atypical presentation of CEP and its management options.
Collapse
Affiliation(s)
- Javeriah Khan
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | | | | | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | | |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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: 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] [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.
Collapse
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:
| |
Collapse
|
4
|
Bragazzi Cunha J, Elenbaas JS, Maitra D, Kuo N, Azuero-Dajud R, Ferguson AC, Griffin MS, Lentz SI, Shavit JA, Omary MB. Acitretin mitigates uroporphyrin-induced bone defects in congenital erythropoietic porphyria models. Sci Rep 2021; 11:9601. [PMID: 33953217 PMCID: PMC8100164 DOI: 10.1038/s41598-021-88668-9] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/15/2021] [Indexed: 02/07/2023] Open
Abstract
Congenital erythropoietic porphyria (CEP) is a rare genetic disorder leading to accumulation of uro/coproporphyrin-I in tissues due to inhibition of uroporphyrinogen-III synthase. Clinical manifestations of CEP include bone fragility, severe photosensitivity and photomutilation. Currently there is no specific treatment for CEP, except bone marrow transplantation, and there is an unmet need for treating this orphan disease. Fluorescent porphyrins cause protein aggregation, which led us to hypothesize that uroporphyrin-I accumulation leads to protein aggregation and CEP-related bone phenotype. We developed a zebrafish model that phenocopies features of CEP. As in human patients, uroporphyrin-I accumulated in the bones of zebrafish, leading to impaired bone development. Furthermore, in an osteoblast-like cell line, uroporphyrin-I decreased mineralization, aggregated bone matrix proteins, activated endoplasmic reticulum stress and disrupted autophagy. Using high-throughput drug screening, we identified acitretin, a second-generation retinoid, and showed that it reduced uroporphyrin-I accumulation and its deleterious effects on bones. Our findings provide a new CEP experimental model and a potential repurposed therapeutic.
Collapse
Affiliation(s)
- Juliana Bragazzi Cunha
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, 08854, USA.
| | - Jared S Elenbaas
- Medical Scientist Training Program, Washington University, Saint Louis, 63110, USA
| | - Dhiman Maitra
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, 08854, USA
| | - Ning Kuo
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, 08854, USA
| | - Rodrigo Azuero-Dajud
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, 08854, USA
| | - Allison C Ferguson
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, 48109, USA
| | - Megan S Griffin
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, 48109, USA
| | - Stephen I Lentz
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, 48109, USA
| | - Jordan A Shavit
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Michigan, Ann Arbor, 48109, USA
| | - M Bishr Omary
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, 08854, USA.
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, 48109, USA.
| |
Collapse
|
5
|
Weiss Y, Balwani M, Chen B, Yasuda M, Nazarenko I, Desnick RJ. Congenital erythropoietic porphyria and erythropoietic protoporphyria: Identification of 7 uroporphyrinogen III synthase and 20 ferrochelatase novel mutations. Mol Genet Metab 2019; 128:358-362. [PMID: 30454868 DOI: 10.1016/j.ymgme.2018.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Received: 08/07/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/16/2022]
Abstract
The erythropoietic porphyrias are inborn errors of heme biosynthesis with prominent cutaneous manifestations. They include autosomal recessive Congenital Erythropoietic Porphyria (CEP) due to loss-of-function (LOF) mutations in the Uroporphyrinogen III Synthase (UROS) gene, Erythropoietic Protoporphyria (EPP) due to LOF mutations in the ferrochelatase (FECH) gene, and X-Linked Protoporphyria (XLP) due to gain-of-function mutations in the terminal exon of the Aminolevulinic Acid Synthase 2 (ALAS2) gene. During the 11-year period from 01/01/2007 through 12/31/2017, the Mount Sinai Porphyrias Diagnostic Laboratory provided molecular diagnostic testing for one or more of these disorders in 628 individuals, including 413 unrelated individuals. Of these 628, 120 patients were tested for CEP, 483 for EPP, and 331 for XLP, for a total of 934 tests. For CEP, 24 of 78 (31%) unrelated individuals tested had UROS mutations, including seven novel mutations. For EPP, 239 of 362 (66%) unrelated individuals tested had pathogenic FECH mutations, including twenty novel mutations. The IVS3-48 T > C low-expression allele was present in 231 (97%) of 239 mutation-positive EPP probands with a pathogenic FECH mutation. In the remaining 3%, three patients with two different FECH mutations in trans were identified. For XLP, 24 of 250 (10%) unrelated individuals tested had ALAS2 exon 11 mutations. No novel ALAS2 mutations were identified. Among family members referred for testing, 33 of 42 (79%) CEP, 62 of 121 (51%) EPP, and 31 of 81 (38%) XLP family members had the respective family mutation. Mutation-positive CEP, EPP, and XLP patients who had been biochemically tested had marked elevations of the disease-appropriate porphyrin intermediates. These results expand the molecular heterogeneity of the erythropoietic porphyrias by adding a total of 27 novel mutations. The results document the usefulness of molecular testing to confirm the positive biochemical findings in these patients and to identify heterozygous family members.
Collapse
Affiliation(s)
- Yedidyah Weiss
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Manisha Balwani
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Brenden Chen
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Makiko Yasuda
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Irina Nazarenko
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Robert J Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Cullot G, Boutin J, Toutain J, Prat F, Pennamen P, Rooryck C, Teichmann M, Rousseau E, Lamrissi-Garcia I, Guyonnet-Duperat V, Bibeyran A, Lalanne M, Prouzet-Mauléon V, Turcq B, Ged C, Blouin JM, Richard E, Dabernat S, Moreau-Gaudry F, Bedel A. CRISPR-Cas9 genome editing induces megabase-scale chromosomal truncations. Nat Commun 2019; 10:1136. [PMID: 30850590 PMCID: PMC6408493 DOI: 10.1038/s41467-019-09006-2] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/06/2019] [Indexed: 12/19/2022] Open
Abstract
CRISPR-Cas9 is a promising technology for genome editing. Here we use Cas9 nuclease-induced double-strand break DNA (DSB) at the UROS locus to model and correct congenital erythropoietic porphyria. We demonstrate that homology-directed repair is rare compared with NHEJ pathway leading to on-target indels and causing unwanted dysfunctional protein. Moreover, we describe unexpected chromosomal truncations resulting from only one Cas9 nuclease-induced DSB in cell lines and primary cells by a p53-dependent mechanism. Altogether, these side effects may limit the promising perspectives of the CRISPR-Cas9 nuclease system for disease modeling and gene therapy. We show that the single nickase approach could be safer since it prevents on- and off-target indels and chromosomal truncations. These results demonstrate that the single nickase and not the nuclease approach is preferable, not only for modeling disease but also and more importantly for the safe management of future CRISPR-Cas9-mediated gene therapies.
Collapse
MESH Headings
- CRISPR-Associated Protein 9/genetics
- CRISPR-Associated Protein 9/metabolism
- CRISPR-Cas Systems
- Chromosome Deletion
- Chromosomes, Human, Pair 10
- Clustered Regularly Interspaced Short Palindromic Repeats
- DNA/genetics
- DNA/metabolism
- DNA Breaks, Double-Stranded
- Deoxyribonuclease I/genetics
- Deoxyribonuclease I/metabolism
- Fibroblasts/cytology
- Fibroblasts/metabolism
- Gene Editing/methods
- Genetic Therapy/methods
- Genome, Human
- HEK293 Cells
- High-Throughput Nucleotide Sequencing
- Humans
- K562 Cells
- Models, Biological
- Porphyria, Erythropoietic/genetics
- Porphyria, Erythropoietic/metabolism
- Porphyria, Erythropoietic/pathology
- Porphyria, Erythropoietic/therapy
- Primary Cell Culture
- RNA, Guide, CRISPR-Cas Systems/genetics
- RNA, Guide, CRISPR-Cas Systems/metabolism
- Recombinational DNA Repair
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
- Uroporphyrinogen III Synthetase/genetics
- Uroporphyrinogen III Synthetase/metabolism
Collapse
Affiliation(s)
- Grégoire Cullot
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
| | - Julian Boutin
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Biochemistry Laboratory, CHU Bordeaux, 33000, Bordeaux, France
| | - Jérôme Toutain
- Medical genetic laboratory, CHU Bordeaux, 33000, Bordeaux, France
| | - Florence Prat
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
| | - Perrine Pennamen
- Medical genetic laboratory, CHU Bordeaux, 33000, Bordeaux, France
| | - Caroline Rooryck
- Medical genetic laboratory, CHU Bordeaux, 33000, Bordeaux, France
| | - Martin Teichmann
- Univ. Bordeaux, 33000, Bordeaux, France
- UMR 5320, INSERM U1212, ARNA Laboratory, 33000, Bordeaux, France
| | - Emilie Rousseau
- Univ. Bordeaux, 33000, Bordeaux, France
- UMR 5320, INSERM U1212, ARNA Laboratory, 33000, Bordeaux, France
| | - Isabelle Lamrissi-Garcia
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
| | - Véronique Guyonnet-Duperat
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Vectorology Platform, 33000, Bordeaux, France
| | - Alice Bibeyran
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Vectorology Platform, 33000, Bordeaux, France
| | - Magalie Lalanne
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
| | | | - Béatrice Turcq
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1218, ACTION, 33000, Bordeaux, France
| | - Cécile Ged
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Biochemistry Laboratory, CHU Bordeaux, 33000, Bordeaux, France
- Laboratory of excellence, GR-Ex, Imagine institute, 75015, Paris, France
| | - Jean-Marc Blouin
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Biochemistry Laboratory, CHU Bordeaux, 33000, Bordeaux, France
- Laboratory of excellence, GR-Ex, Imagine institute, 75015, Paris, France
| | - Emmanuel Richard
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Biochemistry Laboratory, CHU Bordeaux, 33000, Bordeaux, France
- Laboratory of excellence, GR-Ex, Imagine institute, 75015, Paris, France
| | - Sandrine Dabernat
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Biochemistry Laboratory, CHU Bordeaux, 33000, Bordeaux, France
| | - François Moreau-Gaudry
- Univ. Bordeaux, 33000, Bordeaux, France.
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France.
- Biochemistry Laboratory, CHU Bordeaux, 33000, Bordeaux, France.
- Vectorology Platform, 33000, Bordeaux, France.
- Laboratory of excellence, GR-Ex, Imagine institute, 75015, Paris, France.
| | - Aurélie Bedel
- Univ. Bordeaux, 33000, Bordeaux, France
- INSERM U1035, Biotherapy of genetic diseases, inflammatory disorders and cancers, 33000, Bordeaux, France
- Biochemistry Laboratory, CHU Bordeaux, 33000, Bordeaux, France
- Laboratory of excellence, GR-Ex, Imagine institute, 75015, Paris, France
| |
Collapse
|
8
|
Gonzalez-Estrada A, Garcia-Morillo JS. Brothers with congenital erythropoietic porphyria. Mayo Clin Proc 2014; 89:e11. [PMID: 24485140 DOI: 10.1016/j.mayocp.2013.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 10/25/2022]
Affiliation(s)
| | - Jose S Garcia-Morillo
- Internal Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Andalucia, Spain
| |
Collapse
|
9
|
Huxley JN, Lloyd EL, Parker CS, Woolf JR, Strugnell BW. Congenital erythropoietic porphyria in a longhorn calf. Vet Rec 2009; 165:694-695. [PMID: 19966335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- J N Huxley
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, Leicestershire LE12 5RD.
| | | | | | | | | |
Collapse
|
10
|
Ged C, Moreau-Gaudry F, Richard E, Robert-Richard E, de Verneuil H. Congenital erythropoietic porphyria: mutation update and correlations between genotype and phenotype. Cell Mol Biol (Noisy-le-grand) 2009; 55:53-60. [PMID: 19268002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Accepted: 01/17/2009] [Indexed: 05/27/2023]
Abstract
High quality genotype/phenotype analysis is a difficult issue in rare genetic diseases such as congenital erythropoietic porphyria (CEP) or Günther's disease, a heme biosynthesis defect due to uroporphyrinogen III synthase deficiency. The historical background and the main phenotypic features of the disease are depicted together with an update of published mutants and genotype/phenotype correlations. General rules concerning the prediction of disease severity are drawn as a guide for patient management and therapeutic choices. The phenotypic heterogeneity of the disease is presented in relation with a likely influence of modifying factors, either genetic or acquired.
Collapse
Affiliation(s)
- C Ged
- INSERM, U876 Bordeaux, France.
| | | | | | | | | |
Collapse
|
11
|
Schneider-Yin X, Mamet R, Minder EI, Schoenfeld N. Biochemical and molecular diagnosis of erythropoietic protoporphyria in an Ashkenazi Jewish family. J Inherit Metab Dis 2008; 31 Suppl 2:S363-7. [PMID: 18758989 DOI: 10.1007/s10545-008-0924-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 05/28/2008] [Accepted: 06/04/2008] [Indexed: 10/21/2022]
Abstract
Erythropoietic protoporphyria (EPP) is a rare hereditary disorder due to a partial deficiency of ferrochelatase (FECH). The genotype of EPP patients features a mutation on one allele of the FECH gene and a common hypomorphic FECH IVS3-48c on the other allele (M/c). The resulting enzyme activity in patients is ∼35% of that in normal individuals. Ferrochelatase deficiency results in the accumulation of protoporphyrin in the skin, which is responsible for the clinical symptom of cutaneous photosensitivity in patients. In this study, we report the identification of a novel FECH mutation delT23 in an 11-member EPP family of Jewish origin. Two EPP siblings shared an identical genotype of delT23/IVS3-48c (M/c). They were both photosensitive and showed highly increased erythrocyte protoporphyrin. The genotype of the patients' mother, who did not present with any EPP clinical symptoms, was delT23/IVS3-48t (M/t). The patients' father, an offspring of consanguineous parents, was homozygous IVS3-48 c/c. He exhibited a mild photosensitivity, and an increase of 4-fold in erythrocyte protoporphyrin. His FECH mRNA amount was 71% of that of genotype t/t. It is the first reported case of an individual with c/c genotype who exhibits both biochemical and clinical indications of EPP. These results suggest that IVS3-48c is a functional variant of ferrochelatase. The clinical symptoms and biochemical abnormalities in the patients' father could be the result of an interaction between genetic and environmental factors. In addition, the frequency of IVS3-48c in the Ashkenazi Jewish population was estimated at 8%, which is similar to that in the European populations.
Collapse
Affiliation(s)
- X Schneider-Yin
- Zentrallabor, Stadtspital Triemli, Birmensdorferstrasse 497, CH-8063, Zürich, Switzerland
| | | | | | | |
Collapse
|
12
|
Brancaleoni V, Di Pierro E, Besana V, Ausenda S, Cappellini MD. Gene symbol: FECH. Disease: Porphyria, erythropoietic. Hum Genet 2008; 124:296. [PMID: 18846613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Valentina Brancaleoni
- Dipartamento di Medicina Interna-Università degli studi di Milano-Ospedale Maggiore Policlinico, F. Sforza, 35, 20122 Milano, Italy
| | | | | | | | | |
Collapse
|
13
|
Brancaleoni V, Di Pierro E, Besana V, Ausenda S, Cappellini MD. Gene symbol: FECH. Disease: Porphyria, erythropoietic. Hum Genet 2008; 124:296. [PMID: 18846614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Valentina Brancaleoni
- Dipartamento di Medicina Interna-Università degli studi di Milano-Ospedale Maggiore Policlinico, F. Sforza, 35, 20122 Milano, Italy
| | | | | | | | | |
Collapse
|
14
|
Kang TW, Oh SW, Kim MR, Lee JS, Kim SC. Compound heterozygosity for a premature termination codon and missense mutation in the exon 10 of the uroporphyrinogen III cosynthase gene causes a severe phenotype of congenital erythropoietic porphyria. J Eur Acad Dermatol Venereol 2008; 23:470-1. [PMID: 18647208 DOI: 10.1111/j.1468-3083.2008.02905.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Brancaleoni V, Di Pierro E, Besana V, Ausenda S, Cappellini MD. Gene symbol: FECH. Disease: Porphyria, Erythropoietic. Hum Genet 2008; 123:546-547. [PMID: 20960631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
16
|
Dam C, Bathum L, Sommerlund M, Bygum A. [Erythropoietic protoporphyria. A rare inherited metabolic disorder with skin symptoms]. Ugeskr Laeger 2008; 170:352. [PMID: 18252165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Erythropoietic protoporphyria (EPP) is a rare inherited metabolic disorder, resulting from a deficiency of a specific enzyme, ferrochelatase, in the haem biosynthesis pathway. Early and late skin symptoms in EPP are demonstrated by three case stories. Diagnosis depends on characteristic skin symptoms and raised level of protoporphyrin in erythrocytes. The cases illustrate the aspect of inheritance, prophylaxis and recommended follow-up in EPP.
Collapse
Affiliation(s)
- Claus Dam
- Baagøes Allé 8A, 3. th., DK-5700 Svendborg.
| | | | | | | |
Collapse
|
17
|
Brancaleoni V, Di Pierro E, Besana V, Ausenda S, Drury S, Cappellini MD. Novel human pathological mutations. Gene symbol: FECH. Disease: porphyria, erythropoietic. Hum Genet 2007; 121:646. [PMID: 17879435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- V Brancaleoni
- Department of Internal Medicine, University of Milan, and Centro Anemie Congenite, Ospedale Maggiore Policlinico, Italy.
| | | | | | | | | | | |
Collapse
|
18
|
To-Figueras J, Badenas C, Mascaró JMA, Madrigal I, Merino A, Bastida P, Lecha M, Herrero C. Study of the genotype–phenotype relationship in four cases of congenital erythropoietic porphyria. Blood Cells Mol Dis 2007; 38:242-6. [PMID: 17270473 DOI: 10.1016/j.bcmd.2006.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 12/07/2006] [Indexed: 10/23/2022]
Abstract
Congenital erythropoietic porphyria (CEP) is a rare inborn error of metabolism that results from a deficient activity of uroporphyrinogen III synthase (URO-synthase). We report four Spanish CEP cases studied at a clinical, biochemical and molecular level. The patients harbored missense mutations in the URO-synthase gene showing the following genotypes: C73R/T228M; C73R/P248Q; and P248Q/P248Q (two patients). The last allelic combination had never been reported in a CEP patient. The compound heterozygote patients presented both a moderate-to-severe disease with hematological and dermatological involvement. The two homozygote P248Q/P248Q cases showed, however, a very different phenotype. One patient presented signs of hemolysis, cutaneous scarring and severe deformities, while the other showed only mild hyperpigmentation and no signs of hemolysis. Biochemical study showed that the former patient presented a higher erythrocytic concentration and a higher urinary excretion of porphyrins with the residual activity of URO-synthase in red blood cells being similar in both cases. Differences in stimulation of erythropoiesis; long-term divergences in life-style and inadequate protection from sunlight may explain, in part, the drastic clinical divergence and the lack of genotype-phenotype correlation among these CEP patients.
Collapse
Affiliation(s)
- Jordi To-Figueras
- Biochemistry and Molecular Genetics Unit, Dermatology Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Villarroel 170, Barcelona 08036, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Phillips JD, Steensma DP, Pulsipher MA, Spangrude GJ, Kushner JP. Congenital erythropoietic porphyria due to a mutation in GATA1: the first trans-acting mutation causative for a human porphyria. Blood 2007; 109:2618-21. [PMID: 17148589 PMCID: PMC1852202 DOI: 10.1182/blood-2006-06-022848] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 10/31/2006] [Indexed: 11/20/2022] Open
Abstract
Congenital erythropoietic porphyria (CEP), an autosomal recessive disorder, is due to mutations of uroporphyrinogen III synthase (UROS). Deficiency of UROS results in excess uroporphyrin I, which causes photosensitization. We evaluated a 3-year-old boy with CEP. A hypochromic, microcytic anemia was present from birth, and platelet counts averaged 70 x 10(9)/L (70,000/microL). Erythrocyte UROS activity was 21% of controls. Red cell morphology and globin chain labeling studies were compatible with beta-thalassemia. Hb electrophoresis revealed 36.3% A, 2.4% A(2), 59.5% F, and 1.8% of an unidentified peak. No UROS or alpha- and beta-globin mutations were found in the child or the parents. The molecular basis of the phenotype proved to be a mutation of GATA1, an X-linked transcription factor common to globin genes and heme biosynthetic enzymes in erythrocytes. A mutation at codon 216 in the child and on one allele of his mother changed arginine to tryptophan (R216W). This is the first report of a human porphyria due to a mutation in a trans-acting factor and the first association of CEP with thalassemia and thrombocytopenia. The Hb F level of 59.5% suggests a role for GATA-1 in globin switching. A bone marrow allograft corrected both the porphyria and the thalassemia.
Collapse
Affiliation(s)
- John D Phillips
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.
| | | | | | | | | |
Collapse
|
20
|
Prasad AN. Congenital erythropoeitic porphyria. Indian Pediatr 2006; 43:740. [PMID: 16951441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- A N Prasad
- Military Hospital, Mhow, 453 441 (M.P.). India.
| |
Collapse
|
21
|
Bishop DF, Johansson A, Phelps R, Shady AA, Ramirez MCM, Yasuda M, Caro A, Desnick RJ. Uroporphyrinogen III synthase knock-in mice have the human congenital erythropoietic porphyria phenotype, including the characteristic light-induced cutaneous lesions. Am J Hum Genet 2006; 78:645-58. [PMID: 16532394 PMCID: PMC1424695 DOI: 10.1086/502667] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 01/25/2006] [Indexed: 11/03/2022] Open
Abstract
Congenital erythropoietic porphyria (CEP), an autosomal recessive inborn error, results from the deficient but not absent activity of uroporphyrinogen III synthase (URO-synthase), the fourth enzyme in the heme biosynthetic pathway. The major clinical manifestations include severe anemia, erythrodontia, and disfiguring cutaneous involvement due to the accumulation of phototoxic porphyrin I isomers. Murine models of CEP could facilitate studies of disease pathogenesis and the evaluation of therapeutic endeavors. However, URO-synthase null mice were early embryonic lethals. Therefore, knock-in mice were generated with three missense mutations, C73R, V99A, and V99L, which had in vitro-expressed activities of 0.24%, 5.9%, and 14.8% of expressed wild-type activity, respectively. Homozygous mice for all three mutations were fetal lethals, except for mice homozygous for a spontaneous recombinant allele, V99A(T)/V99A(T), a head-to-tail concatemer of three V99A targeting constructs. Although V99A(T)/V99A(T) and C73R/V99A(T) mice had approximately 2% hepatic URO-synthase activity and normal hepatic microsomal heme and hemoprotein levels, they had 20% and 13% of wild-type activity in erythrocytes, respectively, which indicates that sufficient erythroid URO-synthase was present for fetal development and survival. Both murine genotypes showed marked porphyrin I isomer accumulation in erythrocytes, bone, tissues, and excreta and had fluorescent erythrodontia, hemolytic anemia with reticulocytosis and extramedullary erythropoiesis, and, notably, the characteristic light-induced cutaneous involvement. These mice provide insight into why CEP is an erythroid porphyria, and they should facilitate studies of the disease pathogenesis and therapeutic endeavors for CEP.
Collapse
Affiliation(s)
- David F Bishop
- Department of Human Genetics, Mount Sinai School of Medicine, New York, NY 10029, USA
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Berry AA, Desnick RJ, Astrin KH, Shabbeer J, Lucky AW, Lim HW. Two brothers with mild congenital erythropoietic porphyria due to a novel genotype. ACTA ACUST UNITED AC 2006; 141:1575-9. [PMID: 16365260 DOI: 10.1001/archderm.141.12.1575] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disease caused by the deficient activity of the heme biosynthetic enzyme, uroporphyrinogen III synthase (URO-synthase), and the accumulation of the nonphysiologic and phototoxic porphyrin I isomers. Clinical manifestations range from severe mutilation to mild erosions and blisters on sun-exposed areas. Evaluation of the URO-synthase mutation and residual enzyme activity has been correlated with the phenotypic expression of the disease. OBSERVATIONS We describe 16- and 4-year-old brothers with CEP with a mild phenotype due to a novel genotype, one allele having a promoter mutation (-76G-->A) and the other having an exonic missense mutation (G225S). The father and a 4-year-old fraternal twin brother were carriers of the -76G-->A mutation, whereas the mother and a 15-year-old brother were carriers of the G225S mutation. Previous in vitro expression studies demonstrated that the G225S mutation severely decreased URO-synthase activity to 1.2% of normal, whereas the promoter mutation decreased the activity to approximately 50% of wild type, accounting for the mild clinical phenotype. CONCLUSION The mild disease phenotype in these patients is a further example of the clinical heterogeneity seen in CEP and is additional proof that in vitro enzyme expression studies provide dependable genotype-phenotype correlations.
Collapse
Affiliation(s)
- Ali A Berry
- Department of Dermatology, Ford Medical Center, Henry Ford Hospital, New Center One, 3031 W. Grand Boulevard, Ste, 800, Detroit, MI 48202, USA
| | | | | | | | | | | |
Collapse
|
23
|
Di Pierro E, Brancaleoni V, Moriondo V, Besana V, Cappellini MD. Gene symbol: FECH. Disease: Porphyria, erythropoietic. Accession #Hg0501. Hum Genet 2006; 118:776. [PMID: 17297688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- E Di Pierro
- Department of Internal Medicine, University of Milan, Centro Anemie Congenite-Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena IRCCS, Italy.
| | | | | | | | | |
Collapse
|
24
|
Wiederholt T, Poblete-Gutiérrez P, Gardlo K, Goerz G, Bolsen K, Merk HF, Frank J. Identification of mutations in the uroporphyrinogen iii cosynthase gene in German patients with congenital erythropoietic porphyria. Physiol Res 2006; 55 Suppl 2:S85-92. [PMID: 17298225 DOI: 10.33549/physiolres.930000.55.s2.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The porphyrias are heterogeneous disorders arising from predominantly inherited catalytic deficiencies of specific enzymes along the heme biosynthetic pathway. Congenital erythropoietic porphyria is a very rare disease that is inherited as an autosomal recessive trait and results from a profound deficiency of uroporphyrinogen III cosynthase, the fourth enzyme in heme biosynthesis. The degree of severity of clinical symptoms mainly depends on the amount of residual uroporphyrinogen III cosynthase activity. In this study, we sought to characterize the molecular basis of congenital erythropoietic porphyria in Germany by studying four patients with congenital erythropoietic porphyria and their families. Using PCR-based techniques, we identified four different mutations: C73R, a well-known hotspot mutation, the promoter mutation -86A that was also described previously, and two novel missense mutations, designated G236V and L237P, the latter one encountered in the homozygous state in one of the patients. Our data from the German population further emphasize the molecular heterogeneity of congenital erythropoietic porphyria as well as the advantages of molecular genetic techniques as a diagnostic tool and for the detection of clinically asymptomatic heterozygous mutation carriers within families.
Collapse
Affiliation(s)
- T Wiederholt
- Department of Dermatology, University Hospital Maastricht, The Netherlands
| | | | | | | | | | | | | |
Collapse
|
25
|
Jacobo A, Almeida HLD, Jorge VM. Congenital erythropoietic porphyria in two siblings. Dermatol Online J 2005; 11:15. [PMID: 16409911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Congenital erythropoietic porphyria is a very rare autosomal recessive disease, with mutation in the gene that codifies uroporphyrinogen-III synthetase, leading to porphyrin accumulation in many tissues, with marked skin photosensitivity. Two male siblings, aged 43 and 29, are described. The oldest shows severe sclerodermiform mutilation and the youngest exhibits initial involvement with hypertrichosis. Laboratory investigation shows polycythemia, increased urine uroporphyrins and coproporphyrins and increased erythrocyte porphyrins.
Collapse
|
26
|
Affiliation(s)
- F Gundling
- Medizinische Klinik und Poliklinik II, Universität Leipzig
| | | |
Collapse
|
27
|
Dupuis-Girod S, Akkari V, Ged C, Galambrun C, Kebaïli K, Deybach JC, Claudy A, Geburher L, Philippe N, de Verneuil H, Bertrand Y. Successful match-unrelated donor bone marrow transplantation for congenital erythropoietic porphyria (Günther disease). Eur J Pediatr 2005; 164:104-7. [PMID: 15703981 DOI: 10.1007/s00431-004-1575-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2004] [Revised: 10/11/2004] [Accepted: 10/13/2004] [Indexed: 11/29/2022]
Abstract
UNLABELLED Congenital erythropoietic porphyria (CEP; Gunther disease; OMIM 263700) is a rare autosomal recessive disorder caused by a deficiency of uroporphyrinogen III synthase (UROS). The deficiency of this enzyme is associated with lifelong overproduction of series I porphyrins which circulate and are deposited in many tissues, causing light-sensitisation and severe damage to skin beginning in childhood. Blistering and scarring of exposed areas may lead to mutilating deformities. We describe two cases: a 4-year-old boy and his first cousin who were cured of CEP by matched unrelated donor bone marrow transplants. Both are alive and disease-free 3 and 2 years post-transplant, respectively. Cutaneous lesions improved dramatically. The correction of the enzyme deficiency was confirmed by measuring erythrocyte UROS activity and urinary porphyrin excretion. Chimerism was complete for both children. Both patients were homoallelic for a novel mutation of the UROS gene, the missense mutation A69T. CONCLUSION Considering the severity of the disease, if HLA-matched sibling donor is not available, haematopoietic stem cell transplantation using a matched unrelated donor should be strongly considered for treating congenital erythropoietic porphyria since this is currently the only known curative therapy.
Collapse
Affiliation(s)
- Sophie Dupuis-Girod
- Immuno-hématologie Pédiatrique et transplantation de moelle osseuse, Hôpital Debrousse, 29 rue Soeur Bouvier, 6932 Lyon Cedex 05, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Partial deficiency of enzymes in the haem synthetic pathway gives rise to a group of seven inherited metabolic disorders, the porphyrias. Each deficiency is associated with a characteristic increase in haem precursors that correlates with the symptoms associated with individual porphyrias and allows accurate diagnosis. Two types of clinical presentation occur separately or in combination; acute life-threatening neurovisceral attacks and/or cutaneous symptoms. Five of the porphyrias are low-penetrance autosomal dominant conditions in which clinical expression results from additional factors that act by increasing demand for haem or by causing an additional decrease in enzyme activity or by a combination of these effects. These include both genetic and environmental factors. In familial porphyria cutanea tarda (PCTF), environmental factors that include alcohol, exogenous oestrogens and hepatotropic viruses result in inhibition of hepatic enzyme activity via a mechanism that involves excess iron accumulation. In erythropoietic protoporphyria (EPP), co-inheritance of a functional polymorphism in trans to a null ferrochelatase allele accounts for most clinically overt cases. In the autosomal dominant acute hepatic porphyrias (acute intermittent porphyria, variegate porphyria, hereditary coproporphyria), acute neurovisceral attacks occur in a minority of those who inherit one of these disorders. Although various exogenous (e.g. drugs, alcohol) and endogenous factors (e.g. hormones) have been identified as provoking acute attacks, these do not provide a full explanation for the low penetrance of these disorders. It seems probable that genetic background influences susceptibility to acute attacks, but the genes that are involved have not yet been identified.
Collapse
Affiliation(s)
- M N Badminton
- Cardiff Porphyria Service, Department of Medical Biochemistry and Immunology, School of Medicine, Cardiff University, UK.
| | | |
Collapse
|
29
|
Ged C, Mégarbané H, Chouery E, Lalanne M, Mégarbané A, de Verneuil H. Congenital erythropoietic porphyria: report of a novel mutation with absence of clinical manifestations in a homozygous mutant sibling. J Invest Dermatol 2004; 123:589-91. [PMID: 15304101 DOI: 10.1111/j.0022-202x.2004.23401.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In a Palestinian family, four siblings were shown to express typical and severe congenital erythropoietic porphyria (CEP). A new mutation of the uroporphyrinogen III synthase (UROS) gene was evidenced by systematic sequencing of the UROS gene: the substitution of serine by proline at the amino acid residue 47 (S47P) was present at the homozygous state in the four patients. The mother was heterozygous, the father was not examined. Surprisingly, in one unaffected sister, UROS activity was markedly deficient and UROS gene analysis showed a homozygous mutant profile. The deleterious role of the mutant S47P protein on UROS activity was demonstrated by prokaryotic expression. This observation is the first report of a healthy status associated with homozygosity for a mutation of UROS gene in a severely affected family. We then draw hypotheses to explain the protective phenotype in the homozygous healthy subject.
Collapse
Affiliation(s)
- Cécile Ged
- INSERM E 217, Université Bordeaux2, 146 rue Léo Saignat, 33076 Bordeaux, France.
| | | | | | | | | | | |
Collapse
|
30
|
Lazebnik N, Lazebnik RS. The prenatal presentation of congenital erythropoietic porphyria: report of two siblings with elevated maternal serum alpha-fetoprotein. Prenat Diagn 2004; 24:282-6. [PMID: 15065102 DOI: 10.1002/pd.852] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Congenital erythropoietic porphyria (CEP), also termed Günther's disease, is extremely rare and is inherited as an autosomal recessive trait. The mutation that causes the most severe deficiency of the enzyme uroporphyrinogen III synthase (URO-synthase) is C73R. Inheritance of two abnormal alleles results in the accumulation of porphyrins of isomer type I that are biologically useless but cause a wide spectrum of abnormalities in multiple organs. The intrauterine diagnosis of the first affected conceptus within a family is extremely challenging despite abnormal ultrasound findings suggesting severe fetal anemia. We report the abnormal findings in a pair of successive pregnancies in a single Caucasian family that yielded two C73R homozygous affected offspring. The course of the pregnancies, sonographic and laboratory abnormalities, method used for intrauterine diagnosis, therapeutic interventions, and variability of outcome between cases within a single family and the difficulty in managing even prenatally diagnosed cases are reported and discussed.
Collapse
Affiliation(s)
- Noam Lazebnik
- Department of OB-GYN, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106, USA.
| | | |
Collapse
|
31
|
Di Pierro E, Moriondo V, Cappellini MD. Gene Symbol: FECH. Disease: Porphyria, erythropoietic. Hum Genet 2004; 114:609. [PMID: 15176393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- E Di Pierro
- Department of Internal Medicine, University of Milan, Centro Anemie Congenite, Milan, Italy.
| | | | | |
Collapse
|
32
|
Di Pierro E, Moriondo V, Cappellini MD. Gene Symbol: FECH. Disease: Porphyria, erythropoietic. Hum Genet 2004; 114:608. [PMID: 15176387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- E Di Pierro
- Department of Internal Medicine, University of Milan, Centro Anemie Congenite, Milan, Italy.
| | | | | |
Collapse
|
33
|
Abstract
We report two sisters, ages 12 and 8 years, with the characteristic clinical and biochemical profile of congenital erythropoietic porphyria (CEP). The disease is inherited as an autosomal recessive. The elder sibling had squamous cell carcinoma arising from the stump of the amputated left arm with metastases to lymph nodes, adrenals, and bone. To our knowledge, this feature has not been described in the English language literature, making our patient the first documented report of CEP with squamous cell carcinoma.
Collapse
Affiliation(s)
- Deepika Pandhi
- Department of Dermatology and STD, Lok Nayak Hospital, New Delhi, India
| | | | | | | |
Collapse
|
34
|
Abstract
The erythropoietic porphyrias are erythropoietic protoporphyria, and congenital erythropietic porphyria. Diagnosis is made based on clinical manifestations, and their characteristic porphyrin profiles. There are multiple treatment options for these two porphyrias, however, aside from bone marrow transplant for CEP, none is curative.
Collapse
|
35
|
Affiliation(s)
- M Lecha
- Department of Dermatology. Hospital Clínic, University of Barcelona, Spain.
| |
Collapse
|
36
|
Géronimi F, Richard E, Lamrissi-Garcia I, Lalanne M, Ged C, Redonnet-Vernhet I, Moreau-Gaudry F, de Verneuil H. Lentivirus-mediated gene transfer of uroporphyrinogen III synthase fully corrects the porphyric phenotype in human cells. J Mol Med (Berl) 2003; 81:310-20. [PMID: 12721665 DOI: 10.1007/s00109-003-0438-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2003] [Accepted: 03/14/2003] [Indexed: 11/25/2022]
Abstract
Congenital erythropoietic porphyria (CEP) is an inherited disease due to a deficiency in the uroporphyrinogen III synthase, the fourth enzyme of the heme biosynthesis pathway. It is characterized by accumulation of uroporphyrin I in the bone marrow, peripheral blood and other organs. The prognosis of CEP is poor, with death often occurring early in adult life. For severe transfusion-dependent cases, when allogeneic cell transplantation cannot be performed, the autografting of genetically modified primitive/stem cells may be the only alternative. In vitro gene transfer experiments have documented the feasibility of gene therapy via hematopoietic cells to treat this disease. In the present study lentiviral transduction of porphyric cell lines and primary CD34(+) cells with the therapeutic human uroporphyrinogen III synthase (UROS) cDNA resulted in both enzymatic and metabolic correction, as demonstrated by the increase in UROS activity and the suppression of porphyrin accumulation in transduced cells. Very high gene transfer efficiency (up to 90%) was achieved in both cell lines and CD34(+) cells without any selection. Expression of the transgene remained stable over long-term liquid culture. Furthermore, gene expression was maintained during in vitro erythroid differentiation of CD34(+) cells. Therefore the use of lentiviral vectors is promising for the future treatment of CEP patients by gene therapy.
Collapse
Affiliation(s)
- F Géronimi
- INSERM E 0217, Université Victor Segalen, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Arné JL, Depeyre C, Lesueur L. [Corneoscleral involvement in congenital erythropoietic porphyria. Günther disease]. J Fr Ophtalmol 2003; 26:498-502. [PMID: 12819610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Congenital erythropoietic porphyria (CEP) is an extremely rare autosomal recessively inherited disorder characterized by mutilating cutaneous photosensitivity and abnormal porphyrin heme synthesis in bone marrow. The present report describes a typical case of CEP with cornea involvement and scleromalacia in areas exposed to sunlight. The results obtained by conjunctival impression cytology are reported.
Collapse
Affiliation(s)
- J-L Arné
- Service d'Ophtalmologie, Hôpital Purpan, Place du Docteur Baylac, 31059 Toulouse Cedex 9
| | | | | |
Collapse
|
38
|
Pannier E, Viot G, Aubry MC, Grange G, Tantau J, Fallet-Bianco C, Muller F, Cabrol D. Congenital erythropoietic porphyria (Günther's disease): two cases with very early prenatal manifestation and cystic hygroma. Prenat Diagn 2003; 23:25-30. [PMID: 12533808 DOI: 10.1002/pd.491] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Congenital erythropoietic porphyria (CEP) or Günther's disease is the rarest form of the porphyrias. The disease is usually diagnosed at birth or during early infancy, but rarely in utero. We describe here the first two cases of very early prenatal expression of CEP with cystic hygroma diagnosed at 14 weeks in the first fetus and at 19 weeks in the second. Both fetuses presented with severe nonimmune hydrops fetalis as early as 19 and 22 weeks, associated with intrauterine growth retardation, hyperechogenic kidneys and bones. Amniotic fluid was dark brown and uro- and coproporphyrin I was dramatically increased. Molecular screening of the CEP gene detected heterozygous C73R mutation in both fetuses, the other parental mutation being as yet unknown.
Collapse
Affiliation(s)
- E Pannier
- Centre multidisciplinaire de Diagnostic Prénatal et d'Echographie, Maternité Port-Royal, Paris, France.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Eriksson M, Hänni A. [Vampirism seen from medical and historical point of view--amusing and alarming]. Lakartidningen 2002; 99:3522-4, 3527. [PMID: 12362752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Mats Eriksson
- Institutionen för kirurgiska vetenskaper, enheten för anestesi och intensivvård, Uppsala universitet
| | | |
Collapse
|
40
|
Ged C, Ozalla D, Herrero C, Lecha M, Mendez M, de Verneuil H, Mascaro JM. Description of a new mutation in hepatoerythropoietic porphyria and prenatal exclusion of a homozygous fetus. Arch Dermatol 2002; 138:957-60. [PMID: 12071824 DOI: 10.1001/archderm.138.7.957] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Hepatoerythropoietic porphyria (HEP) is usually a severe form of cutaneous porphyria, characterized biochemically by an increased urinary excretion of polycarboxylated porphyrins. The disease is the result of a profound deficiency (<10% of normal activity) of uroporphyrinogen decarboxylase (UROD) activity. Hepatoerythropoietic porphyria is inherited as an autosomal recessive trait, whereas familial porphyria cutanea tarda is dominant. At least 30 different mutations of the UROD gene have been identified in patients with HEP and familial porphyria cutanea tarda, with 1 predominant missense mutation (glycine-to-glutamic acid substitution at codon 281) in Spanish patients with HEP. OBSERVATION A 5-year-old patient with first-degree-related parents presented with HEP and mild symptomatology. We found low levels of UROD enzymatic activity and a new homozygous mutation of the UROD gene, a phenylanine-to-leucine substitution at codon 46 (F46L). Both parents were healthy carriers of the mutation. The mother had reduced UROD activity (50% of normal), whereas the father had normal UROD activity. Prokaryotic expression of the F46L mutation using a pGEX vector has been used to confirm the deleterious effect of the mutation. When the mother started a new pregnancy, a prenatal study showed the absence of F46L mutation in the fetus and no accumulation of porphyrins in the amniotic fluid. CONCLUSIONS A new mutation in the UROD gene causes a mild HEP phenotype. A normal UROD enzymatic activity was observed in the father, despite the presence of the heterozygous mutation. To our knowledge, this observation is the first description of a prenatal exclusion of HEP.
Collapse
Affiliation(s)
- Cécile Ged
- Laboratoire de Pathologie Moléculaire et Thérapie Génique, Université Victor Segalen-Bordeaux 2, 146, rue Léo Saignat, 33076 Bordeaux CEDEX, France.
| | | | | | | | | | | | | |
Collapse
|
41
|
Shady AA, Colby BR, Cunha LF, Astrin KH, Bishop DF, Desnick RJ. Congenital erythropoietic porphyria: identification and expression of eight novel mutations in the uroporphyrinogen III synthase gene. Br J Haematol 2002; 117:980-7. [PMID: 12060141 DOI: 10.1046/j.1365-2141.2002.03558.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mutations in the uroporphyrinogen III synthase (URO-synthase) gene cause congenital erythropoietic porphyria (CEP), an autosomal recessive inborn error of haem biosynthesis. Molecular analysis of the URO-synthase gene in seven unrelated CEP patients revealed eight novel mutations. These included four missense mutations (A69T, E81D, G188W and I219S), a deletion (21delG), two insertions (398insG and 672ins28) and one complex mutation (627del6ins39), as well as three previously reported mutations, C73R, T228M, and -86C-->A. When the four novel missense mutations were expressed in Escherichia coli, only E81D expressed significant enzymatic activity (30% of expressed wild-type activity), which was thermolabile. In addition, reverse transcription polymerase chain reaction studies demonstrated that E81D, which altered the penultimate nucleotide in exon 4, impaired splicing and caused about 85% exon 4 skipping. The identification and expression of these mutations provided genotype-phenotype correlations and further evidence of the molecular heterogeneity underlying this erythropoietic porphyria.
Collapse
Affiliation(s)
- Amr A Shady
- Department of Human Genetics, Mount Sinai School of Medicine, New York University, Fifth Avenue at 100th Street, New York, NY 10029, USA
| | | | | | | | | | | |
Collapse
|
42
|
Affiliation(s)
- Robert J Desnick
- Department of Human Genetics, Mount Sinai School of Medicine, Box 1498, New York University, Fifth Avenue and 100th Street, New York, NY 10029, USA.
| | | |
Collapse
|
43
|
Minder EI, Gouya L, Schneider-Yin X, Deybach JC. A genotype-phenotype correlation between null-allele mutations in the ferrochelatase gene and liver complication in patients with erythropoietic protoporphyria. Cell Mol Biol (Noisy-le-grand) 2002; 48:91-6. [PMID: 11929053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Erythropoietic protoporphyria (EPP), an inborn error of heme metabolism, causes in the majority of the patients only a symptom of photosensitivity. However, around 2% of the EPP sufferers develop liver complication in the form of liver cirrhosis and progressive liver failure. Mutations in the human ferrochelatase (FECH) gene causing EPP are highly heterogeneous and mostly family-specific. Actually, 62 FECH mutations have been published, 48 of them are "null allele" mutations inducing the formation of a truncated protein. The remaining 14 are missense mutations. In contrast to the null allele mutations, the latter lead to substitution of a single amino acid residue in the protein molecule and generate an enzyme that, although functionally impaired, is in its full length. In order to study the association between "null allele" mutation and liver complication, we combined our data with those in the literature. A total of 112 EPP patients were counted among 93 EPP families with a known FECH mutation. All 18 EPP patients who had severe liver complication carried a "null allele" mutation. In contrast, none of the 20 patients who carried a missense mutation had developed liver complication till the time of study (Fisher's exact test, p<0.05). High protoporphyrin blood concentration are considered to be a sign of an increased risk of liver disease. No correlation of protoporphyrin blood level with the type of mutation, was found, if patients with overt liver disease were excluded from the sample. Furthermore, no significant association of the liver complication with the location of the mutation within the FECH gene was found (Fisher exact test p = 0.46). These available data indicate a significant genotype-phenotype correlation between "null allele" mutation and protoporphyrin related liver disease in EPP. Although the risk for a EPP patient with a missense mutation to develop liver disease cannot be totally eliminated based on these data, it is comparably low.
Collapse
Affiliation(s)
- E I Minder
- Zentrallabor Stadtspital Triemli, Zürich, Switzerland.
| | | | | | | |
Collapse
|
44
|
Gouya L, Puy H, Robreau AM, Bourgeois M, Lamoril J, Da Silva V, Grandchamp B, Deybach JC. The penetrance of dominant erythropoietic protoporphyria is modulated by expression of wildtype FECH. Nat Genet 2002; 30:27-8. [PMID: 11753383 DOI: 10.1038/ng809] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Erythropoietic protoporphyria (EPP) is an inherited disorder of heme biosynthesis caused by a partial deficiency of ferrochelatase (FECH, EC 4.99.1.1). EPP is transmitted as an autosomal dominant disorder with an incomplete penetrance. Using haplotype segregation analysis, we have identified an intronic single nucleotide polymorphism (SNP), IVS3-48T/C, that modulates the use of a constitutive aberrant acceptor splice site. The aberrantly spliced mRNA is degraded by a nonsense-mediated decay mechanism (NMD), producing a decreased steady-state level of mRNA and the additional FECH enzyme deficiency necessary for EPP phenotypic expression.
Collapse
Affiliation(s)
- Laurent Gouya
- Centre Francais des Porphyries, INSERM U 409, Faculté X. Bichat, Hôpital Louis Mourier, 92701 Colombes Cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Aplin C, Whatley SD, Thompson P, Hoy T, Fisher P, Singer C, Lovell CR, Elder GH. Late-onset erythropoietic porphyria caused by a chromosome 18q deletion in erythroid cells. J Invest Dermatol 2001; 117:1647-9. [PMID: 11886534 DOI: 10.1046/j.0022-202x.2001.01560.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The erythropoietic porphyrias, erythropoietic protoporphyria and congenital erythropoietic porphyria, result from germline mutations in the ferrochelatase gene and uroporphyrinogen III synthase gene, respectively. Both conditions normally present in childhood but rare cases with onset past the age of 40 y have been reported. Here we show that late-onset erythropoietic protoporphyria can be caused by deletion of the ferrochelatase gene in hematopoietic cells with clonal expansion as part of the myelodysplastic process. This is the first direct demonstration of porphyria produced by an acquired molecular defect restricted to one tissue. Some other cases of late-onset erythropoietic porphyria may be explained by a similar mechanism.
Collapse
Affiliation(s)
- C Aplin
- Department of Dermatology, Royal United Hospital, Bath, UK
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Mathews MA, Schubert HL, Whitby FG, Alexander KJ, Schadick K, Bergonia HA, Phillips JD, Hill CP. Crystal structure of human uroporphyrinogen III synthase. EMBO J 2001; 20:5832-9. [PMID: 11689424 PMCID: PMC125291 DOI: 10.1093/emboj/20.21.5832] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2001] [Revised: 09/10/2001] [Accepted: 09/10/2001] [Indexed: 11/15/2022] Open
Abstract
Uroporphyrinogen III synthase, U3S, the fourth enzyme in the porphyrin biosynthetic pathway, catalyzes cyclization of the linear tetrapyrrole, hydroxymethylbilane, to the macrocyclic uroporphyrino gen III, which is used in several different pathways to form heme, siroheme, chlorophyll, F(430) and vitamin B(12). U3S activity is essential in all organisms, and decreased activity in humans leads to the autosomal recessive disorder congenital erythropoetic porphyria. We have determined the crystal structure of recombinant human U3S at 1.85 A resolution. The protein folds into two alpha/beta domains connected by a beta-ladder. The active site appears to be located between the domains, and variations in relative domain positions observed between crystallographically independent molecules indicates the presence of flexibility that may be important in the catalytic cycle. Possible mechanisms of catalysis were probed by mutating each of the four invariant residues in the protein that have titratable side chains. Additionally, six other highly conserved and titratable side chains were also mutated. In no case, however, did one of these mutations abolish enzyme activity, suggesting that the mechanism does not require acid/base catalysis.
Collapse
Affiliation(s)
| | | | | | | | | | - Hector A. Bergonia
- Department of Biochemistry and
Department of Medicine, University of Utah School of Medicine, 50 N. Medical Drive, Salt Lake City, UT 84132, USA Corresponding authors e-mail: or
M.A.A.Mathews and H.L.Schubert contributed equally to this work
| | - John D. Phillips
- Department of Biochemistry and
Department of Medicine, University of Utah School of Medicine, 50 N. Medical Drive, Salt Lake City, UT 84132, USA Corresponding authors e-mail: or
M.A.A.Mathews and H.L.Schubert contributed equally to this work
| | - Christopher P. Hill
- Department of Biochemistry and
Department of Medicine, University of Utah School of Medicine, 50 N. Medical Drive, Salt Lake City, UT 84132, USA Corresponding authors e-mail: or
M.A.A.Mathews and H.L.Schubert contributed equally to this work
| |
Collapse
|
47
|
Solis C, Aizencang GI, Astrin KH, Bishop DF, Desnick RJ. Uroporphyrinogen III synthase erythroid promoter mutations in adjacent GATA1 and CP2 elements cause congenital erythropoietic porphyria. J Clin Invest 2001; 107:753-62. [PMID: 11254675 PMCID: PMC208941 DOI: 10.1172/jci10642] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Congenital erythropoietic porphyria, an autosomal recessive inborn error of heme biosynthesis, results from the markedly deficient activity of uroporphyrinogen III synthase. Extensive mutation analyses of 40 unrelated patients only identified approximately 90% of mutant alleles. Sequencing the recently discovered erythroid-specific promoter in six patients with a single undefined allele identified four novel mutations clustered in a 20-bp region: (a) a -70T to C transition in a putative GATA-1 consensus binding element, (b) a -76G to A transition, (c) a -86C to A transversion in three unrelated patients, and (d) a -90C to A transversion in a putative CP2 binding motif. Also, a -224T to C polymorphism was present in approximately 4% of 200 unrelated Caucasian alleles. We inserted these mutant sequences into luciferase reporter constructs. When transfected into K562 erythroid cells, these constructs yielded 3 +/- 1, 54 +/- 3, 43 +/- 6, and 8 +/- 1%, respectively, of the reporter activity conferred by the wild-type promoter. Electrophoretic mobility shift assays indicated that the -70C mutation altered GATA1 binding, whereas the adjacent -76A mutation did not. Similarly, the -90C mutation altered CP2 binding, whereas the -86A mutation did not. Thus, these four pathogenic erythroid promoter mutations impaired erythroid-specific transcription, caused CEP, and identified functionally important GATA1 and CP2 transcriptional binding elements for erythroid-specific heme biosynthesis.
Collapse
Affiliation(s)
- C Solis
- Department of Human Genetics, Mount Sinai School of Medicine, Fifth Avenue at 100th Street, New York, NY 10029, USA
| | | | | | | | | |
Collapse
|
48
|
Daïkha-Dahmane F, Dommergues M, Narcy F, Gubler MC, Dumez Y, Gauthier E, Nordmann Y, Nessmann C, Terrasse G, Muller F. Congenital erythropoietic porphyria: prenatal diagnosis and autopsy findings in two sibling fetuses. Pediatr Dev Pathol 2001; 4:180-4. [PMID: 11178635 DOI: 10.1007/s100240010143] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Congenital erythropoietic porphyria is an autosomal recessive disease characterized by a deficiency of uroporphyrinogen III cosynthetase activity, with diffuse tissue accumulation of specific type I porphyrins. The diagnosis of this disease was made in two fetuses, who were siblings, and from a Caucasian nonconsanguinous family. The first fetus died in utero with hydrops fetalis and anemia, but without an etiopathogenic diagnosis. In the second case, the diagnosis was based on pink fluorescence of the amniotic fluid examined fortuitously in sunlight. DNA analysis showed that the fetus was heteroallelic for the mutation C73R. The autopsy showed brown skin, and at histological examination, porphyrin pigment was deposited in many tissues. Retrospectively, similar deposits were found in the tissues of the first fetus.
Collapse
Affiliation(s)
- F Daïkha-Dahmane
- Service de Biologie du Développement, H pital Robert Debré, Faculté de Médecine Xavier Bichat, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Rogounovitch T, Takamura N, Hombrados I, Morel C, Tanaka T, Kameyoshi Y, Shimizu-Yoshida Y, de Verneuil H, Yamashita S. Congenital erythropoietic porphyria: a novel homozygous mutation in a Japanese patient. J Invest Dermatol 2000; 115:1156. [PMID: 11121156 DOI: 10.1046/j.1523-1747.2000.0202a.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
50
|
Abstract
Porphyrias are divided into erythropoietic and hepatic manifestations. Erythropoietic porphyrias are characterized by cutaneous symptoms and appear in early childhood. Erythropoietic protoporphyria is complicated by cholestatic liver cirrhosis and progressive hepatic failure in 10%, of patients. Acute hepatic porphyrias (delta-aminolaevulinic acid dehydratase deficiency porphyria, acute intermittent porphyria, hereditary coproporphyria and variegate porphyria) are characterized by variable extrahepatic gastrointestinal, neurological-psychiatric and cardiovascular manifestations requiring early diagnosis to avoid life-threatening complications. Acute hepatic porphyrias are pharmacogenetic and molecular regulatory diseases (without porphyrin accumulation) mainly induced by drugs, sex hormones, fasting or alcohol. The disease process depends on the derepression of hepatic delta-aminolaevulinic acid synthase following haem depletion. In contrast to the acute porphyrias, nonacute, chronic hepatic porphyrias such as porphyria cutanea tarda are porphyrin accumulation disorders leading to cutaneous symptoms associated with liver disease, especially caused by alcohol or viral hepatitis. Alcohol, oestrogens, haemodialysis, hepatitis C and AIDS are triggering factors. Porphyria cutanea tarda is the most common porphyria, followed by acute intermittent porphyria and erythropoietic protoporphyria. The molecular genetics of the porphyrias is very heterogenous. Nearly every family has its own mutation. The mutations identified account for the corresponding enzymatic deficiencies, which may remain clinically silent throughout life. Thus, the recognition of the overt disorder with extrahepatic manifestations depends on the demonstration of biochemical abnormalities due to these primary defects and compensatory hepatic overexpression of hepatic delta-aminolaevulinic acid synthase in the acute porphyrias. Consequently, haem precursors are synthesized in excess. The increased metabolites upstream of the enzymatic defect are excreted into urine and faeces. The diagnosis is based on their evaluation. Primary enzymatic or molecular analyses are noncontributary and may be misleading. Acute polysymptomatic exacerbations accompany a high excretory constellation of porphyrin precursors delta-aminolaevulinic acid and porphobilinogen. Homozygous or compound heterozygous variants of acute hepatic porphyrias may already manifest in childhood.
Collapse
MESH Headings
- Animals
- Humans
- Porphyria Cutanea Tarda/diagnosis
- Porphyria Cutanea Tarda/genetics
- Porphyria Cutanea Tarda/physiopathology
- Porphyria Cutanea Tarda/therapy
- Porphyria, Acute Intermittent/diagnosis
- Porphyria, Acute Intermittent/genetics
- Porphyria, Acute Intermittent/physiopathology
- Porphyria, Acute Intermittent/therapy
- Porphyria, Erythropoietic/diagnosis
- Porphyria, Erythropoietic/genetics
- Porphyria, Erythropoietic/physiopathology
- Porphyria, Erythropoietic/therapy
- Porphyrias, Hepatic/diagnosis
- Porphyrias, Hepatic/genetics
- Porphyrias, Hepatic/physiopathology
- Porphyrias, Hepatic/therapy
Collapse
Affiliation(s)
- U Gross
- Division of Clinical Biochemistry, Faculty of Medicine, Philipps University, Marburg, Germany.
| | | | | |
Collapse
|