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Chaiyabutr C, Dawe R, Ibbotson SH, Clarke T, McGuire VA. Porphyria cutanea tarda in Scotland: underlying associations and treatment approaches. Int J Dermatol 2024. [PMID: 38647187 DOI: 10.1111/ijd.17205] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Despite its rarity, porphyria cutanea tarda (PCT) is globally recognized as the most common form of cutaneous porphyria. This study aims to review the underlying associations and treatment of PCT in Scotland. METHODS We retrospectively reviewed data on 27 patients diagnosed with PCT between 1987 and 2022 at the Scottish Cutaneous Porphyria Service. RESULTS Males slightly predominated (66.7%). The mean ± standard deviation (SD) age at diagnosis was 55.6 ± 12.5 years. Common associated factors were heavy alcohol intake (88.5%), genetic hemochromatosis (72%), smoking (45.5%), and hepatitis C virus infection (16%). Most had multiple associated factors (70.4%). Patients with genetic hemochromatosis with the C282Y genotype exhibited higher median transferrin saturation (69.5 vs. 35, P = 0.004) and ferritin levels (observed in males only) (1175 vs. 339; P = 0.014) than those with the H636D genotype. Most (52%) received combination therapy of venesection and antimalarials, followed by venesection monotherapy (32%) and antimalarial monotherapy (16%). Overall, 95.2% achieved biochemical improvement. Median time to improvement was 7, 5, and 9 months with venesection, antimalarial, and combined treatments, respectively (P = 0.173). Biochemical remission was achieved in 50% of patients. Remission occurred in 2/4 of patients with antimalarial monotherapy (median time 19 months) and 9/13 patients with combined treatment (median time 26 months). Biochemical relapse was found in three patients, all of whom received combination therapy. CONCLUSION Excess alcohol intake and genetic hemochromatosis were the most common underlying associations with PCT in our Scottish cohort. Treatment for PCT should be individualized, and long-term follow-up is needed to monitor for disease relapse.
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Affiliation(s)
- Chayada Chaiyabutr
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Scottish Photobiology Service, Photobiology Unit, University of Dundee & NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Robert Dawe
- Scottish Photobiology Service, Photobiology Unit, University of Dundee & NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
- Scottish Cutaneous Porphyria Service, Photobiology Unit, University of Dundee & NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Sally H Ibbotson
- Scottish Photobiology Service, Photobiology Unit, University of Dundee & NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Tara Clarke
- Scottish Photobiology Service, Photobiology Unit, University of Dundee & NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - Victoria A McGuire
- Scottish Photobiology Service, Photobiology Unit, University of Dundee & NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
- Scottish Cutaneous Porphyria Service, Photobiology Unit, University of Dundee & NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
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Harrison S, Mayes V, Brimhall C, King R. IgM-mediated epidermolysis bullosa acquisita. JAAD Case Rep 2024; 46:49-51. [PMID: 38510834 PMCID: PMC10951440 DOI: 10.1016/j.jdcr.2024.01.004] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Affiliation(s)
- Sidney Harrison
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, Tennessee
| | - Vita Mayes
- Lakeway Dermatology Associates, Morristown, Tennessee
| | | | - Roy King
- Dermatopathology Partners, Knoxville, Tennessee
- Department of Pathology, University of Tennessee, Knoxville, Tennessee
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3
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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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4
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Arriaga Escamilla D, Lakhani A, Antony S, Salazar Villegas KN, Gupta M, Ramnath P, Murillo Pineda MI, Bedor A, Banegas D, Calderon Martinez E. Dermatological Manifestations in Patients With Chronic Kidney Disease: A Review. Cureus 2024; 16:e52253. [PMID: 38352109 PMCID: PMC10863542 DOI: 10.7759/cureus.52253] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Chronic kidney disease (CKD) is a progressive disease and has multiple clinical manifestations; when CKD reaches the end stage, at least one cutaneous manifestation appears due to some increased toxin levels or a constant proinflammatory state. Nonspecific manifestations include pruritus, xerosis, pigmentation disorders, acquired ichthyosis, purpuric spots, and nail disorders. Some specific manifestations are bullous dermatoses, acquired perforating dermatoses (APD), eruptive xanthoma, access site infections, calcifying disorders, and nephrogenic systemic fibrosis (NSF). All these cutaneous changes negatively impact patients; early recognition and diagnosis of these dermatoses will make a difference in their quality of treatment. Exploring a patient's skin is fundamental to suspect some diseases and increased toxin levels; pruritus occurs when uremic toxins are raised, and nail disorders are associated with hypoalbuminemia. This review provides the clinician with information on the clinical manifestations that occur in CKD, including epidemiology, pathophysiology, clinical manifestations, diagnosis, histopathology, treatment, and life impact of the dermatoses in CKD.
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Affiliation(s)
| | - Alisha Lakhani
- Medicine, Research MD, Vadodara, IND
- Medicine, Shantabaa Medical College, Amreli, IND
| | - Sneha Antony
- Pharmacology, K S Hegde Medical Academy, Mangalore, IND
| | | | - Manasvi Gupta
- General Practice, Jawaharlal Nehru Medical College, Aligarh, IND
| | | | | | - Alexandra Bedor
- Internal Medicine, Instituto Salvadoreño del Seguro Social, San Salvador, SLV
| | - Douglas Banegas
- General Medicine, Universidad Nacional Autonoma de Honduras, San Pedro Sula, HND
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5
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Varada N, Tun KM, Chang MJ, Bomberger S, Calagari R. A Rare Case of Hereditary Hemochromatosis Presenting With Porphyria Cutanea Tarda. Cureus 2023; 15:e41299. [PMID: 37539416 PMCID: PMC10394580 DOI: 10.7759/cureus.41299] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/05/2023] Open
Abstract
Hereditary hemochromatosis is an autosomal recessive condition with incomplete penetrance that is most commonly caused by a mutation in the HFE gene. Hereditary hemochromatosis can remain asymptomatic in some patients until triggered by certain events. Porphyria cutanea tarda is a condition that can lead to iron overload due to defective synthesis of heme and can cause the onset of adult-onset hereditary hemochromatosis. Herein, we present a case where a 77-year-old man presented with painful blisters on the sun-exposed areas of his hands and was diagnosed with porphyria cutanea tarda. Further testing for mutations in the HFE gene given elevated ferritin was performed and returned positive, which confirmed the diagnosis of adult-onset hereditary hemochromatosis. The patient received serial therapeutic phlebotomy for iron overload and adopted lifestyle modifications such as avoiding sun exposure of upper extremities. The patient's blisters and laboratory iron panel parameters improved with continued phlebotomy. Therapeutic phlebotomy has been demonstrated to be an effective first-line therapy in patients with dual diagnosis. Our case highlights that cutaneous symptoms due to porphyria cutanea tarda may be the first presenting symptom in patients with underlying hemochromatosis.
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Affiliation(s)
- Neilmegh Varada
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Kyaw Min Tun
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Mark J Chang
- Internal Medicine, Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, Las Vegas, USA
| | - Shana Bomberger
- Primary Care, VA Southern Nevada Healthcare System, Las Vegas, USA
| | - Randy Calagari
- Hematology and Oncology, VA Southern Nevada Healthcare System, Las Vegas, USA
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Takata K, Fukunaga A, Nishizawa S, Uchida Y, Fukuyama M, Nagata T, Higashi T, Fukuda H, Yamauchi R, Tanaka T, Yokoyama K, Morihara D, Takeyama Y, Shakado S, Sakisaka S, Hirai F. Multiple focal fatty changes in the liver in patients with porphyria cutanea tarda: A case series and review of the literature. J Clin Ultrasound 2022; 50:832-842. [PMID: 34882818 DOI: 10.1002/jcu.23108] [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] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
Porphyria cutanea tarda (PCT) is commonly diagnosed in cases where multiple hyperechoic nodules are observed in the liver. Pathologically, these nodules associated with PCT are focal fatty deposits. We report here, seven cases of PCT with fatty changes over multiple foci in the liver. Furthermore, the characteristics of ultrasonography (US) findings of 32 previously reported cases are summarized. The US features of these nodules showed a homogenous hyperechoic or hyperechoic rim pattern, partial confluence, and no mass effect in the vascular structures. Because multiple hyperechoic liver nodules occasionally mimic malignancies, and because their diagnosis can be challenging, clinicians should consider checking urine porphyrin levels to rule out PCT when such nodules are observed on US.
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Affiliation(s)
- Kazuhide Takata
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | | | - Shinya Nishizawa
- Department of Hepatology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Yotaro Uchida
- Department of Hepatology, Hakujyuji Hospital, Fukuoka, Japan
| | - Makoto Fukuyama
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Takahiro Nagata
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Tomotaka Higashi
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Daisuke Morihara
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Yasuaki Takeyama
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology and Medicine, Fukuoka University, Faculty of Medicine, Fukuoka, Japan
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Ramai D, Deliwala SS, Chandan S, Lester J, Singh J, Samanta J, di Nunzio S, Perversi F, Cappellini F, Shah A, Ghidini M, Sacco R, Facciorusso A, Giacomelli L. Risk of Hepatocellular Carcinoma in Patients with Porphyria: A Systematic Review. Cancers (Basel) 2022; 14:cancers14122947. [PMID: 35740611 PMCID: PMC9221430 DOI: 10.3390/cancers14122947] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 04/25/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Porphyria is a metabolic condition which leads to reduced heme production. While it involves multiple organs systems, porphyria affecting the liver can lead to elevations in hepatic enzymes, progressive fibrosis, cirrhosis and eventually malignancy. Our study looked at the prevalence of liver cancer in patients with porphyria. Overall, we found that patients with porphyria are at increased risk of developing hepatic malignancy. As a result, patients with porphyria should undergo routine surveillance for detecting primary liver malignancy. Abstract Acute porphyrias are a group of metabolic disorders resulting in defective porphyrin synthesis and reduced heme production, which carries a risk of malignancy. Porphyrias are inborn defects in the heme biosynthesis pathway resulting in neurovisceral manifestations and cutaneous photosensitivity attacks with multi-systemic involvement. Its estimated prevalence nears 5 per 100,000 patients worldwide. Subclinical liver disease is common, which can progress into transaminitis, fibrosis, cirrhosis, and malignancy. However, data on the incidence of primary liver cancer are lacking. We aim to determine the risk of hepatocellular carcinoma (HCC) in patients with porphyria. A systematic review and pooled analysis were conducted through 2021 on studies assessing blood tests, imaging, cancer development, liver transplant, surgical resection, and outcomes in porphyria. In total, 19 studies, which included 7381 patients with porphyria (3476 females), were considered for the final review. In eight studies, alpha-fetoprotein levels were elevated between 200 and 1000 IU/mL. Of the total cohort of patients with porphyria, primary liver cancer was diagnosed in 351 patients (4.8%), of whom 243 (3.3% of the total) were found to have HCC. A subset of patients was found to have cholangiocarcinoma (n = 18; 0.3% of the total). Interestingly, advanced liver disease or cirrhosis was not a prerequisite for the formation of HCC in a small group of patients. Of the total cohort, 30 patients underwent liver resection, 48 patients underwent liver transplantation, and 327 patients died. Patients with porphyria are at risk of developing primary liver malignancy. Further studies should aim to develop diagnostic and prognostic models aimed at the early detection of HCC in porphyria.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT 84112, USA;
| | - Smit S. Deliwala
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA;
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE 68131, USA;
| | - Janice Lester
- Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY 11040, USA;
| | - Jameel Singh
- Department of Internal Medicine, Mather Hospital, Northwell Health, Port Jefferson, NY 11777, USA;
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, Sector 12, Chandigarh 160012, India;
| | - Sara di Nunzio
- Polistudium SRL, 20135 Milan, Italy; (S.d.N.); (F.P.); (F.C.); (A.S.)
| | - Fabio Perversi
- Polistudium SRL, 20135 Milan, Italy; (S.d.N.); (F.P.); (F.C.); (A.S.)
| | | | - Aashni Shah
- Polistudium SRL, 20135 Milan, Italy; (S.d.N.); (F.P.); (F.C.); (A.S.)
| | - Michele Ghidini
- Division of Medical Oncology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Rodolfo Sacco
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy; (R.S.); (A.F.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, 71122 Foggia, Italy; (R.S.); (A.F.)
| | - Luca Giacomelli
- Polistudium SRL, 20135 Milan, Italy; (S.d.N.); (F.P.); (F.C.); (A.S.)
- Correspondence:
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8
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Nyckowski T, Grammenos A, Vinokurov A, Nathoo R. Between a Rock and a Hard Place: Management of Systemic Lupus Erythematosus and Porphyria Cutanea Tarda. J DERMATOL TREAT 2022; 33:2689-2691. [PMID: 35362354 DOI: 10.1080/09546634.2022.2060925] [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] [Indexed: 10/18/2022]
Abstract
Porphyria cutanea tarda (PCT), the most common porphyria, is a rare photodermatosis characterized by fragile, hemorrhagic bullae and erosions with associated milia, hyperpigmentation, and hypertrichosis. SLE is a systemic connective tissue disease with approximately 80% of those affected manifesting cutaneous findings. These include malar and discoid rashes, photosensitivity, bullae, oral ulcerations, as well as a variety of other non-specific findings. In this case we illustrate a rare but established association between these two pathologic entities, and the resulting therapeutic challenge in treating a patient with both conditions. The concurrence of these two diseases poses therapeutic challenges with a paucity of evidence-based recommendations. Management with low dose weekly antimalarial therapy may be the appropriate middle ground in effectively treating the two co-morbid conditions especially in a patient with other underlying systemic conditions.
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Affiliation(s)
- Timothy Nyckowski
- Kansas City University Graduate Medical Education Consortium- Orlando Dermatology, Orlando, FL, USA
| | - Alexandra Grammenos
- Kansas City University Graduate Medical Education Consortium- Orlando Dermatology, Orlando, FL, USA
| | | | - Rajiv Nathoo
- Kansas City University Graduate Medical Education Consortium- Orlando Dermatology, Orlando, FL, USA
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Tabata K, Kaminaka C, Yasutake M, Matsumiya R, Inaba Y, Yamamoto Y, Jinnin M, Fujii T. Forearm porphyrin levels evaluated by digital imaging system are increased in patients with systemic sclerosis compared with patients in pre-clinical stage. Intractable Rare Dis Res 2022; 11:1-6. [PMID: 35261844 PMCID: PMC8898390 DOI: 10.5582/irdr.2021.01157] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 11/05/2022] Open
Abstract
We hypothesized that changes in skin characteristics on the forearm could be useful for early diagnosis of systemic sclerosis (SSc). We used VISIA digital imaging system to investigate this possibility for the first time. Twenty-eight Japanese patients who were diagnosed with typical or very early diagnosis of SSc (VEDOSS) were enrolled in this study, and ten age- and gender-matched patients with other disorders were included as a control group. Eight skin characteristics were analyzed. Our method of evaluating forearm skin characteristics was shown to be reproducible. The scores of WRINKLES, TEXTURE, PORES, and PORPHYRINS were higher in SSc subjects with sclerotic forearm skin (SSc forearm+; 11.004, 5.116, 3.230, and 0.084, respectively) and those without (SSc forearm-: 11.915, 4.898, 2.624, 0.0616, respectively) than in the non-SSc control subjects (10.075, 4.496, 2.459, 0.0223, respectively). Also, the scores of SPOTS, TEXTURE, PORES, UV SPOTS, BROWN SPOTS, and PORPHYRINS were elevated in SSc forearm+ (3.182, 5.116, 3.230, 5.761, 6.704, 0.084, respectively) and SSc forearm- patients (2.391, 4.898, 2.624, 9.835, 5.798, 0.0616, respectively) compared with those with VEDOSS (2.362, 4.738, 2.234, 5.999, 4.898, 0.0169, respectively). We found statistical significance in the difference in score of PORPHYRINS between SSc forearm- and VEDOSS groups (p = 0.044), and between SSc forearm+ and VEDOSS groups (p = 0.012). Therefore, they can be used to differentiate VEDOSS from early or mild SSc cases, which is sometimes clinically problematic. Our study also suggests that the porphyrin research will lead to a better understanding of SSc pathogenesis.
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Affiliation(s)
- Kayoko Tabata
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Chikako Kaminaka
- Department of Dermatology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
- Address correspondence to:Chikako Kaminaka, Department of Dermatology, Wakayama Medical University Graduate School of Medicine, 811-1 Kimiidera, Wakayama 641-0012, Japan. E-mail:
| | - Misaki Yasutake
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryo Matsumiya
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yutaka Inaba
- Department of Dermatology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuki Yamamoto
- Department of Dermatology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takao Fujii
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Wakayama Medical University, Wakayama, Japan
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Leasure AC, Turner N, Lim I. Facial hyperpigmentation and crusted papules on the hands. JAAD Case Rep 2022; 20:23-25. [PMID: 35036499 PMCID: PMC8753054 DOI: 10.1016/j.jdcr.2021.09.043] [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: 11/20/2022] Open
Affiliation(s)
| | - Noel Turner
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Ilya Lim
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
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Serra-García L, Morgado-Carrasco D, Pérez-Valencia AI, Castaño-Díez S, Alamon-Reig F, Badenas C, To-Figueras J, Aguilera P. Acquired erythropoietic uroporphyria secondary to myeloid malignancy: A case report and literature review. Photodermatol Photoimmunol Photomed 2022; 38:86-91. [PMID: 34319628 DOI: 10.1111/phpp.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/25/2021] [Accepted: 07/17/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Laura Serra-García
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Daniel Morgado-Carrasco
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - Sandra Castaño-Díez
- Department of Haematology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Alamon-Reig
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Cèlia Badenas
- Department of Biochemistry and Molecular Genetics, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Jordi To-Figueras
- Department of Biochemistry and Molecular Genetics, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Paula Aguilera
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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12
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Yamada M, Nakano H, Ogita A, Saeki H, Ansai SI. The second Japanese case of porphyria cutanea tarda with a novel genetic mutation in UROD. J Dermatol 2021; 48:1802-1803. [PMID: 34528261 DOI: 10.1111/1346-8138.16156] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mai Yamada
- Division of Dermatology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Hajime Nakano
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Azusa Ogita
- Division of Dermatology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | - Shin-Ichi Ansai
- Division of Dermatology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
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13
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Anderson HB, Storandt MH, Kallamadi R, Bande D, Matta A. Iatrogenic Iron Overload Causing Porphyria Cutanea Tarda in a Patient With a Rare Nonsense Heterozygous UROD Gene Mutation. Cureus 2021; 13:e16215. [PMID: 34367815 PMCID: PMC8341219 DOI: 10.7759/cureus.16215] [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] [Accepted: 07/06/2021] [Indexed: 01/07/2023] Open
Abstract
Porphyria cutanea tarda (PCT) is a rare dermatologic condition characterized by blistering of sun-exposed surfaces and elevated hepatic enzymes. It may infrequently occur as the primary presentation of underlying hemochromatosis. A 61-year-old female with anemia caused by chronic kidney disease and end-stage renal disease on hemodialysis presented with a bullous rash on her hands with associated pruritus. The rash worsened despite conservative treatment. An initial biopsy demonstrated a pauci-inflammatory cell-poor subepidermal cleft. Subsequent workup revealed elevated serum and urine porphyrins, confirming a diagnosis of PCT. Additionally, her skin was darkened and ferritin was elevated. MRI of the liver demonstrated iron overload with genetic testing negative for C282Y or H63D mutations, supporting a diagnosis of secondary hemochromatosis. Further genetic testing revealed that the patient had a rare heterozygous nonsense mutation of the uroporphyrinogen decarboxylase (UROD) gene, for a sequence variant designated c.616C>T, which is predicted to result in premature protein termination (p.Gln206*). PCT occurs due to decreased function of UROD, leading to accumulation of porphyrins causing dermatologic manifestations and liver injury. UROD is inactivated in an iron-dependent process, explaining the mechanistic link between hemochromatosis and PCT.
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Affiliation(s)
- Hallie B Anderson
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
| | - Michael H Storandt
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
| | | | - Dinesh Bande
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
| | - Abhishek Matta
- Hospital Medicine, Sanford Health, Fargo, USA.,Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
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Pagnotta PA, Melito VA, Lavandera JV, Parera VE, Rossetti MV, Zuccoli JR, Buzaleh AM. Role of ABCB1 and glutathione S-transferase gene variants in the association of porphyria cutanea tarda and human immunodeficiency virus infection. Biomed Rep 2020; 14:22. [PMID: 33335728 PMCID: PMC7739863 DOI: 10.3892/br.2020.1398] [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: 06/24/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022] Open
Abstract
In Argentina, porphyria cutanea tarda (PCT) is strongly associated with infection with human immunodeficiency virus (HIV); however, whether the onset of this disease is associated with HIV infection and/or the antiretroviral therapy has not been determined. The ABCB1 gene variants c.1236C>T, c.2677G>T/A and c.3435C>T affect drug efflux. The GSTT1 null, GSTM1 null and GSTP1 (c.313A>G) gene variants alter Glutathione S-transferase (GST) activity, modifying the levels of xenobiotics. The aim of the present study was to evaluate the role of genetic variants in initiation of PCT and to analyze the genetic basis of the PCT-HIV association. Control individuals, and HIV, PCT and PCT-HIV patients were recruited, PCR-restriction fragment length polymorphism was used to genotype the ABCB1 and GSTP1 variants, and multiplex PCR was used to study the GSTM1 and GSTT1 variants. The high frequency of c.3435C>T (PCT and PCT-HIV) and c.1236C>T (PCT) suggested that the onset of PCT were not specifically related to HIV infection or antiretroviral therapy for these variants. c.2677G>T/A frequencies in the PCT-HIV patients were higher compared with the other groups, suggesting that a mechanism involving antiretroviral therapy served a role in this association. PCT-HIV patients also had a high frequency of GSTT1 null and low frequency for GSTM1 null variants; thus, the genetic basis for PCT onset may involve a combination between the absence of GSTT1 and the presence of GSTM1. In conclusion, genes encoding for proteins involved in the flow and metabolism of xenobiotics may influence the PCT-HIV association. The present study is the first to investigate the possible role of GST and ABCB1 gene variants in the triggering of PCT in HIV-infected individuals, to the best of our knowledge, and may provide novel insights into the molecular basis of the association between PCT and HIV.
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Affiliation(s)
- Priscila Ayelén Pagnotta
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina.,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires 1428, Argentina
| | - Viviana Alicia Melito
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina.,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires 1428, Argentina
| | - Jimena Verónica Lavandera
- Cátedra de Bromatología y Nutrición, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe 3000, Argentina
| | - Victoria Estela Parera
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina
| | - María Victoria Rossetti
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina
| | - Johanna Romina Zuccoli
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina
| | - Ana Maria Buzaleh
- Centro de Investigaciones sobre Porfirinas y Porfirias, Universidad de Buenos Aires, Argentina-National Scientific and Technical Research Council, Hospital de Clínicas José de San Martín, Buenos Aires 1120, Argentina.,Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires 1428, Argentina
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15
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Adams PC, Horgan-Bell C, Walsh S, Sadikovic B. Porphyria cutanea tarda associated with elevated serum ferritin, iron overload, and a bone morphogenetic protein 6 genetic variant. Can Liver J 2020; 3:232-234. [PMID: 35991856 PMCID: PMC9202784 DOI: 10.3138/canlivj-2019-0018] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/04/2019] [Indexed: 08/27/2023]
Abstract
A man aged 51 years was referred to dermatology for hand dermatitis. The dorsal hands and fingers had superficial erosions with pale pink shallow scars and milia suggestive of porphyria cutanea tarda (PCT). Urine and fecal studies were typical of PCT. The patient had daily alcohol use and was found to have elevated serum ferritin, aspartate aminotransferase, and alanine transaminase. Genetic testing for common hemochromatosis genetic variants (HFE C282Y and H63D) was normal. He underwent next-generation sequencing analysis using the 16-gene hyperferritinemia gene panel for genes known to be associated with hereditary hyperferritinemia, iron overload, or both and was discovered to have a genetic variant in bone morphogenetic 6 (BMP6, c.287T> C, p.Leu96Pro). The skin lesions improved with phlebotomy therapy.
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Affiliation(s)
- Paul C Adams
- Department of Medicine, University Hospital, Western University, London, Ontario, Canada
| | | | - Scott Walsh
- Division of Dermatology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, and Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, Ontario, Canada
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16
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Affiliation(s)
| | - Jaroslaw J Jedrych
- Department of Dermatology, The Johns Hopkins University, Baltimore, Maryland
| | - Alaina J James
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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17
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Calado JDOA, Bastos LMH, Miot HA. Case for diagnosis. Sclerodermiform manifestations of porphyria cutanea tarda secondary to hepatitis C. An Bras Dermatol 2019; 94:479-481. [PMID: 31644627 PMCID: PMC7007016 DOI: 10.1590/abd1806-4841.20198681] [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: 08/06/2018] [Accepted: 11/06/2018] [Indexed: 11/21/2022] Open
Abstract
A 63-year-old black female patient with blisters and exulcerations on the face, neck, upper limbs, and subsequent evolution with hypochromic sclerotic areas and alopecia, is reported. Chronic hepatitis C and presence of high levels of porphyrins in urine were demonstrated. There was complete remission with the use of hydroxychloroquine, photoprotection, and treatment of hepatitis. Significant sclerodermoid involvement of the skin as a manifestation of porphyria cutanea tarda secondary to hepatitis C emphasizes the importance of diagnostic suspicion regarding skin manifestation in order to indicate the appropriate therapy, and to minimize the hepatic morbidity.
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Affiliation(s)
| | - Luan Moura Hortencio Bastos
- Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, Faculdade de Medicina, Universidade Estadual Paulista, Botucatu, SP, Brazil
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18
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Singh M, Duckett A, Heincelman M. Porphyria Cutanea Tarda Associated With Acute Hemorrhagic Pancreatitis. J Investig Med High Impact Case Rep 2019; 7:2324709619852769. [PMID: 31155958 PMCID: PMC6547174 DOI: 10.1177/2324709619852769] [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: 11/16/2022] Open
Abstract
Porphyria cutanea tarda (PCT) is a condition of dysregulated heme synthesis that
leads to accumulation of photosensitizing precursors with resultant fragility
and blistering of the skin. It can be hereditary or acquired and has been known
to be associated with hepatic C virus, alcohol, HIV, and estrogen. In this
article, we report an unusual presentation of PCT associated with acute
hemorrhagic pancreatitis in a 57-year-old man. He presented initially to a
community hospital with acute onset of epigastric abdominal pain and new-onset
ascites. Lipase was elevated. Diagnostic paracentesis was grossly bloody. He was
then transferred to our institution for concern for acute hemorrhagic
pancreatitis. On arrival, physical examination demonstrated vesicles and bullae
with erythematous bases, in different stages of healing seen over the dorsal
aspects of both hands with scaling, scarring, and hypopigmentation and
hyperpigmentation of the skin. Laboratory evaluation and skin biopsy confirmed
the diagnosis of PCT. Search for an underlying etiology failed to reveal typical
predisposing factors. This report illustrates that acute hemorrhagic
pancreatitis may be an underlying etiology for PCT.
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Affiliation(s)
- Manasi Singh
- 1 Medical University of South Carolina, Charleston, SC, USA
| | - Ashley Duckett
- 1 Medical University of South Carolina, Charleston, SC, USA
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19
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Guliani A, Jha K, Aggarwal D, Radotra BD, Rana A, Kumaran MS. Blisters on the sun-exposed area: as a clue for underlying hepatitis C virus infection. Postgrad Med J 2018; 95:108-109. [PMID: 30446515 DOI: 10.1136/postgradmedj-2018-136181] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Ankur Guliani
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Jha
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Divya Aggarwal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bishan Dass Radotra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muthu Sendhil Kumaran
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Abstract
Vitamin C (ascorbic acid) plays an important role in maintaining skin health and can promote the differentiation of keratinocytes and decrease melanin synthesis, leading to antioxidant protection against UV-induced photodamage. Normal skin needs high concentrations of vitamin C, which plays many roles in the skin, including the formation of the skin barrier and collagen in the dermis, the ability to counteract skin oxidation, and the modulation of cell signal pathways of cell growth and differentiation. However, vitamin C deficiency can cause or aggravate the occurrence and development of some skin diseases, such as atopic dermatitis (AD) and porphyria cutanea tarda (PCT). Levels of vitamin C in plasma are decreased in AD, and vitamin C deficiency may be one of the factors that contributes to the pathogenesis of PCT. On the other hand, high doses of vitamin C have significantly reduced cancer cell viability, as well as invasiveness, and induced apoptosis in human malignant melanoma. In this review, we will summarize the effects of vitamin C on four skin diseases (porphyria cutanea tarda, atopic dermatitis, malignant melanoma, and herpes zoster and postherpetic neuralgia) and highlight the potential of vitamin C as a therapeutic strategy to treat these diseases, emphasizing the clinical application of vitamin C as an adjuvant for drugs or physical therapy in other skin diseases.
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Affiliation(s)
- Kaiqin Wang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hui Jiang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wenshuang Li
- Bio-ID Center, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Mingyue Qiang
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tianxiang Dong
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongbin Li
- Department of Dermatology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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21
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Sunkara B, Roofeh D, Silver S, Pearson TL, Ettel M, McCune WJ. The devil's in the dosing: severe drug-induced liver injury in a hydroxychloroquine-naive patient with subacute cutaneous lupus erythematosus and porphyria cutanea tarda. Lupus 2018; 27:1383-1386. [PMID: 29631513 DOI: 10.1177/0961203318768884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 29-year-old woman with a 1.5 year history of photosensitive skin lesions on her hands presented with a malar rash, bullous lesions on her hands, and was diagnosed with subacute lupus erythematosus after serologies revealed a positive antinuclear antibody test (1:2560), and antibodies to Ro/SSA and dsDNA. Hydroxychloroquine (400 mg/day) was prescribed and the patient developed severe drug-induced liver injury. Biopsy of her bullous skin lesions was consistent with porphyria cutanea tarda, as were her serological and urinary exams. She was successfully treated with therapeutic phlebotomy. This case identifies porphyria cutanea tarda as an important differential diagnosis for the rheumatologist to consider when evaluating patients with bullous skin lesions. Hydroxychloroquine in lower doses is an effective treatment for porphyria cutanea tarda; at doses used to treat systemic lupus erythematosus and subacute cutaneous lupus, there is a potentially life-threatening complication of hepatotoxicity.
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Affiliation(s)
- B Sunkara
- 1 Division of Rheumatology, University of Michigan Medical School, USA
| | - D Roofeh
- 1 Division of Rheumatology, University of Michigan Medical School, USA
| | - S Silver
- 2 Division of Hematology/Oncology, University of Michigan Medical School, USA
| | - T LeBleu Pearson
- 3 Department of Dermatology, University of Michigan Medical School, USA
| | - M Ettel
- 4 Department of Pathology, University of Michigan Medical School, USA
| | - W J McCune
- 1 Division of Rheumatology, University of Michigan Medical School, USA
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22
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Abstract
The kidneys, after the bone marrow and liver, are third in terms of the amounts of haem synthesized daily. Haem is incorporated into haemoproteins that are critical to renal physiology. In turn, disturbances in haem metabolism interfere with renal physiology and are tightly interrelated with kidney diseases. Acute intermittent porphyria causes kidney injury, whereas medical situations associated with end-stage renal disease, such as porphyrin accumulation, iron overload and hepatitis C, participate in the inhibition of uroporphyrinogen decarboxylase and predispose the individual to porphyria cutanea tarda. Even if some of these interactions have been known for a long time, the clinical situations associated with these interrelations have strikingly evolved over time with the advent of new therapeutic strategies for dialysis therapy and a better understanding of the pathophysiological mechanisms of porphyria-associated kidney disease. Physicians should be aware of these interactions. The aim of this review is to summarize the complex interactions between kidney physiology and pathology in the settings of porphyria and to emphasize their often-underestimated importance.
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Affiliation(s)
- Nicolas Pallet
- INSERM U1147, Centre Universitaire des Saints Pères, Paris, France.,Université Paris Descartes, Paris, France.,Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Biochimie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alexandre Karras
- INSERM U1147, Centre Universitaire des Saints Pères, Paris, France.,Université Paris Descartes, Paris, France.,Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Thervet
- INSERM U1147, Centre Universitaire des Saints Pères, Paris, France.,Université Paris Descartes, Paris, France.,Service de Néphrologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Gouya
- Centre Francais des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,INSERM U1149, CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence, GR-Ex, Paris, France
| | - Zoubida Karim
- INSERM U1149, CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence, GR-Ex, Paris, France
| | - Hervé Puy
- Centre Francais des Porphyries, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.,INSERM U1149, CNRS ERL 8252, Centre de Recherche sur l'inflammation, Université Paris Diderot, Site Bichat, Sorbonne Paris Cité, Paris, France.,Laboratory of Excellence, GR-Ex, Paris, France
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23
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Succi IB, Pôrto LC, Domingues PMGDRP, Fonseca JCM. Genetic ancestry of patients with porphyria cutanea tarda in a country with mixed races: a cross-sectional study (Rio de Janeiro - Brazil). An Bras Dermatol 2018; 93:148-150. [PMID: 29641722 PMCID: PMC5871387 DOI: 10.1590/abd1806-4841.20186666] [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: 11/08/2016] [Accepted: 03/16/2017] [Indexed: 11/30/2022] Open
Abstract
Porphyria cutanea tarda has a complex etiology with genetic factors not completely elucidated. The miscegenation of the Brazilian population has important implications in the predisposition to diseases. There are no studies concerning the genetic ancestry of patients with porphyria cutanea tarda from a mixed population. Thirty patients living in Rio de Janeiro with sporadic porphyria cutanea tarda were studied for the genetic ancestry through informative markers - INDELS. There was a significant predominance of European ancestry across the sample of patients with porphyria cutanea tarda (70.2%), and a small contribution of African and Amerindian ancestry, 20.1% and 10.9%, respectively.
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Affiliation(s)
- Isabella Brasil Succi
- Department of Dermatology, Hospital
Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro (UERJ) -
Rio de Janeiro (RJ), Brazil
| | - Luís Cristóvão Pôrto
- Laboratory of Histocompatibility and
Cryopreservation - Policlínica Piquet Carneiro - Universidade do Estado do Rio
de Janeiro (UERJ) - Rio de Janeiro (RJ), Brazil
| | | | - João Carlos Macedo Fonseca
- Department of Dermatology, Hospital
Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro (UERJ) -
Rio de Janeiro (RJ), Brazil
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24
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Abstract
Phlebotomy is the removal of blood from the body, and therapeutic phlebotomy is the preferred treatment for blood disorders in which the removal of red blood cells or serum iron is the most efficient method for managing the symptoms and complications. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and nonalcoholic fatty liver disease with hyperferritinemia. This review discusses therapeutic phlebotomy and the related disorders and also offers guidelines for establishing a therapeutic phlebotomy program.
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Affiliation(s)
- Kyung Hee Kim
- Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon
| | - Ki Young Oh
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University, Cheonan Hospital, Cheonan, South Korea
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25
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Lacarrubba F, Verzì AE, Pippione M, Micali G. Reflectance confocal microscopy in the diagnosis of vesicobullous disorders: case series with pathologic and cytologic correlation and literature review. Skin Res Technol 2016; 22:479-486. [PMID: 27259839 DOI: 10.1111/srt.12289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vesicobullous disorders are characterized by intraepidermal or subepidermal blistering resulting from different pathogenetic mechanisms. The diagnosis is generally based on clinical examination and semi-invasive/invasive procedures such as cytology and histopathology. In vivo reflectance confocal microscopy (RCM) is a non-invasive technique for real-time, en face imaging of the epidermis and upper dermis with high resolution close to conventional histopathology. PURPOSE To evaluate RCM features of different vesicobullous diseases and correlate with cytologic and histopathologic examination. METHODS Ten patients (6M/4F, age range: 9-81 years) affected by blistering diseases, such as herpes simplex, herpes zoster, Kaposi's varicelliform eruption, pemphigus vulgaris, Hailey-Hailey disease, bullous pemphigoid, and porphyria cutanea tarda were evaluated using a handheld RCM device. RESULTS In our study, a clear correlation between RCM and Tzanck's test and/or histopathology was observed. RCM allowed in all cases an easy identification of the blister spaces and of the split levels, and in some cases specific features were detected, such as giant keratinocytes in herpes infections and acantholytic cells in pemphigus vulgaris and Hailey-Hailey disease. CONCLUSION Reflectance confocal microscopy may support the clinical diagnosis of vesicobullous disorders and indicate to the physician the appropriate patient management and/or the need for further investigation.
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Affiliation(s)
- F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - A E Verzì
- Dermatology Clinic, University of Catania, Catania, Italy
| | - M Pippione
- Dermopathology Unit, Gradenigo Hospital, Turin, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy.
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26
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Szlendak U, Bykowska K, Lipniacka A. Clinical, Biochemical and Molecular Characteristics of the Main Types of Porphyria. ADV CLIN EXP MED 2016; 25:361-8. [PMID: 27627571 DOI: 10.17219/acem/58955] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 02/18/2015] [Revised: 06/26/2015] [Accepted: 07/28/2015] [Indexed: 01/03/2023]
Abstract
Porphyrias are diverse disorders that arise from various inherited enzyme defects in the heme biosynthesis pathway, except for porphyria cutanea tarda (PCT), in which the enzyme deficiency in most cases is acquired. The biosynthetic blocks resulting from the defective enzymes are largely expressed either in the liver or bone marrow, the sites where the majority of heme is produced. Although the pathophysiologic mechanisms of the clinical manifestations of the porphyrias are not fully understood, two cardinal features prevail: skin photosensitivity and neurologic symptoms of intermittent autonomic neuropathy, acute neurovisceral attacks, and disorders of the nervous system. The primary diagnosis of the proband is based on biochemical testing, which is not always able to identify acute porphyrias, especially in asymptomatic family carriers when heme precursors and porphyrins excretion is normal, low-normal and high-reduced values of enzyme activity overlap, and hematological diseases responsible for abnormal blood cells distribution coexist. Molecular analysis of gene mutations responsible for each type of porphyria is the best diagnostic approach for symptomatic as well as presymptomatic gene carriers.
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Affiliation(s)
- Urszula Szlendak
- Department of Immunogenetics of the Institute of Haematology and Transfusion Medicine, Warszawa, Poland
- Department of Haemostasis and Metabolic Disorders of the Institute of Haematology and Transfusion Medicine, Warszawa, Poland
| | - Ksenia Bykowska
- Department of Haemostasis and Metabolic Disorders of the Institute of Haematology and Transfusion Medicine, Warszawa, Poland
| | - Agnieszka Lipniacka
- Department of Haemostasis and Metabolic Disorders of the Institute of Haematology and Transfusion Medicine, Warszawa, Poland
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27
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Aguilera P, Laguno M, To-Figueras J. Human immunodeficiency virus and risk of porphyria cutanea tarda: a possible association examined in a large hospital. Photodermatol Photoimmunol Photomed 2015; 32:93-7. [PMID: 26576928 DOI: 10.1111/phpp.12222] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection has been reported to be a risk factor for porphyria cutanea tarda (PCT). PURPOSE To assess the strength of the association between HIV infection and PCT in a large hospital setting. METHODS All patients (N = 210) diagnosed of PCT between 1990 and 2014 were retrospectively investigated for HIV infection and co-precipitating factors. High-performance liquid chromatography was used to assess the appearance of pre-PCT urinary porphyrin abnormalities among a group (N = 22) of HIV-infected patients without PCT using the urine of patients co-infected with hepatitis C virus (HCV) without PCT for comparison. RESULTS Twenty-six HIV-infected patients (19 males and seven females) were diagnosed of PCT. During the same interval of time, ~8000 different patients infected with HIV were attended in the hospital of infectious diseases department. Examination of risk factors showed that 25 out of 26 of the PCT patients with HIV were co-infected with HCV. No chromatographic abnormalities were found in the urine of non-PCT-HIV-infected patients, whereas 39% co-infected patients showed urinary porphyrin abnormalities. CONCLUSIONS In our large hospital series, the appearance of PCT among HIV-infected patients is low (<1%) and most present co-infection with HCV. Therefore, in most HIV-infected patients with PCT, hepatitis C and not HIV may induce uroporphyrinogen decarboxylase deficiency.
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Affiliation(s)
- Paula Aguilera
- Dermatology Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Montserrat Laguno
- Infectious Disease Department, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi To-Figueras
- Biochemistry and Molecular Genetics Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Bhat RM, Pinto M, Dandakeri S, Kambil SM. Porphyria cutanea tarda in a human immunodeficiency virus-infected patient: A rare scenario in India. Indian J Sex Transm Dis AIDS 2014. [PMID: 24958988 PMCID: PMC4066599 DOI: 10.4103/2589-0557.132430] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 30-year-old unmarried, heterosexual male presented with an 8-month history of tense blistering skin lesions over the hands. Physical examination revealed facial hypertrichosis and multiple erosions with crusts and scars over the dorsum of both hands. Woods lamp examination of the urine, histopathology and urinary porphyrin levels were suggestive of porphyria cutanea tarda (PCT). The patient responded well to hydroxychloroquine and antiretroviral drugs. This case report calls for a detailed evaluation and HIV testing in every patient with PCT.
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Affiliation(s)
- Ramesh M. Bhat
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India,Address for correspondence: Dr. Ramesh M. Bhat, Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Kankanady, Mangalore - 575 002,, India. E-mail:
| | - Malcolm Pinto
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - S. Dandakeri
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
| | - Srinath M. Kambil
- Department of Dermatology, Venereology and Leprosy, Father Muller Medical College, Mangalore, Karnataka, India
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Vasconcelos P, Luz-Rodrigues H, Santos C, Filipe P. Desferrioxamine treatment of porphyria cutanea tarda in a patient with HIV and chronic renal failure. Dermatol Ther 2013; 27:16-8. [PMID: 24502304 DOI: 10.1111/dth.12024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Porphyria cutanea tarda (PCT) can occur in HIV patients. Current evidence suggests that HIV infection may interfere with the hepatic cytochrome oxidase system, leading to porphyrin metabolism impairment. Moreover, chronic hemodialysis in renal failure may be a risk factor for PCT. In addition to the contributory factors for PCT associated to HIV infection, it is possible that porphyrin accumulation secondary to renal failure may play a role in the expression of this disease. We report a case of PCT in an HIV-1 infected patient under blood dialysis, refractory to antimalarials and controlled with desferrioxamine.
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Affiliation(s)
- Pedro Vasconcelos
- Dermatology University Clinic, Hospital de Santa Maria, Serviço de Dermatologia, Lisboa, Portugal
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Abstract
Porphyria cutanea tarda (PCT) is the most common form of porphyria across the world. Unlike other forms of porphyria, which are inborn errors of metabolism, PCT is usually an acquired liver disease caused by exogenous factors, chief among which are excess alcohol intake, iron overload, chronic hepatitis C, oestrogen therapy and cigarette smoking. The pathogenesis of PCT is complex and varied, but hereditary or acquired factors that lead to hepatic iron loading and increased oxidative stress are of central importance. Iron loading is usually only mild or moderate in degree [less than that associated with full-blown haemochromatosis (HFE)] and is usually acquired and/or mutations in HFE. Among acquired factors are excessive alcohol intake and chronic hepatitis C infection, which, like mutations in HFE, decrease hepcidin production by hepatocytes. The decrease in hepcidin leads to increased iron absorption from the gut. In the liver, iron loading and increased oxidative stress leads to the formation of non-porphyrin inhibitor(s) of uroporphyrinogen decarboxylase and to oxidation of porphyrinogens to porphyrins. The treatment of choice of active PCT is iron reduction by phlebotomy and maintenance of a mildly iron-reduced state without anaemia. Low-dose antimalarials (cinchona alkaloids) are also useful as additional therapy or as alternative therapy for active PCT in those without haemochromatosis or chronic hepatitis C. In this review, we provide an update of PCT with special emphasis upon the important role often played by the hepatitis C virus.
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Affiliation(s)
- F Ryan Caballes
- The Liver-Biliary-Pancreatic Center of Carolinas Medical Center, Charlotte, NC,Department of Medicine, CMC
| | - Hossein Sendi
- The Liver-Biliary-Pancreatic Center of Carolinas Medical Center, Charlotte, NC
| | - Herbert L. Bonkovsky
- The Liver-Biliary-Pancreatic Center of Carolinas Medical Center, Charlotte, NC,Department of Medicine, CMC,Department of Medicine, Universities of CT and NC,Address for Correspondence: Suite 201, Cannon Research Center, 1542 Garden Terrace, Charlotte, NC 28203, Phone: 704-355-3959, Fax: 704-355-7648,
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31
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Abstract
Cytochrome P4501A2 (Cyp1a2) is important in the development of uroporphyria in mice, a model of porphyria cutanea tarda in humans. Heretofore, mice homozygous for the Cyp1a2-/- mutation do not develop uroporphyria with treatment regimens that result in uroporphyria in wild-type mice. Here we report uroporphyria development in Cyp1a2-/- mice additionally null for both alleles of the hemochromatosis (Hfe) gene and heterozygous for deletion of the uroporphyrinogen decarboxylase (Urod) gene (genotype: Cyp1a2-/-;Hfe-/-;Urod+/-), demonstrating that upon adding porphyria-predisposing genetic manipulations, Cyp1a2 is not essential. Cyp1a2-/-;Hfe-/-;Urod+/- mice were treated with various combinations of an iron-enriched diet, parenteral iron-dextran, drinking water containing δ-aminolevulinic acid and intraperitoneal Aroclor 1254 (a polychlorinated biphenyl mixture) and analyzed for uroporphyrin accumulation. Animals fed an iron-enriched diet alone did not develop uroporphyria but uroporphyria developed with all treatments that included iron supplementation and δ-aminolevulinic acid, even with a regimen without Aroclor 1254. Hepatic porphyrin levels correlated with low UROD activity and high levels of an inhibitor of UROD but marked variability in the magnitude of the porphyric response was present in all treatment groups. Gene expression profiling revealed no major differences between genetically identical triple cross mice exhibiting high and low magnitude porphyric responses from iron-enriched diet and iron-dextran supplementation, and δ-aminolevulinic acid. Even though the variation in porphyric response did not parallel the hepatic iron concentration, the results are compatible with the presence of a Cyp1a2-independent, iron-dependent pathway for the generation of uroporphomethene, the UROD inhibitor required for the expression of uroporphyria in mice and PCT in humans.
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Affiliation(s)
- John D Phillips
- University of Utah School of Medicine, Department of Internal Medicine, Division of Hematology, Salt Lake City, UT 84132, USA.
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WARBY CA, PHILLIPS JD, BERGONIA HA, WHITBY FG, HILL CP, KUSHNER JP. Structural and kinetic characterization of mutant human uroporphyrinogen decarboxylases. Cell Mol Biol (Noisy-le-grand) 2009; 55:40-5. [PMID: 19656450 PMCID: PMC2863003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 05/15/2009] [Indexed: 01/07/2023]
Abstract
Porphyria cutanea tarda (PCT) is caused by inhibition of uroporphyrinogen decarboxylase (URO-D) activity in hepatocytes. Subnormal URO-D activity results in accumulation and urinary excretion of uroporphyrin and heptacarboxyl porphyrin. Heterozygosity for mutations in the URO-D gene is found in the familial form of PCT (F-PCT). Over 70 mutations of URO-D have been described but very few have been characterized structurally. Here we characterize 3 mutations in the URO-D gene found in patients with F-PCT, G318R, K297N, and D306Y. Expression of the D306Y mutation results in an insoluble recombinant protein. G318R and K297N have little effect on the structure or activity of recombinant URO-D, but the proteins display reduced stability in vitro.
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Affiliation(s)
- C. A. WARBY
- Department of Medicine, University of Utah School of Medicine, 30 N, 1900 E., Salt Lake City, Utah, 84132
| | - J. D. PHILLIPS
- Department of Medicine, University of Utah School of Medicine, 30 N, 1900 E., Salt Lake City, Utah, 84132,Corresponding Author phone: (801) 581-6650, fax: (801) 585-3432,
| | - H. A. BERGONIA
- Department of Medicine, University of Utah School of Medicine, 30 N, 1900 E., Salt Lake City, Utah, 84132
| | - F. G. WHITBY
- Department of Biochemistry, University of Utah School of Medicine, 15 N. Medical Dr. E. Salt Lake City, UT 84112
| | - C. P. HILL
- Department of Biochemistry, University of Utah School of Medicine, 15 N. Medical Dr. E. Salt Lake City, UT 84112
| | - J. P. KUSHNER
- Department of Medicine, University of Utah School of Medicine, 30 N, 1900 E., Salt Lake City, Utah, 84132
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Ma Y, Fracanzani AL, Sampietro M, Mattioli M, Cheeseman P, Williams R, Mieli-Vergani G, Vergani D, Fargion S. Autoantibodies to human cytosol: a marker of sporadic porphyria cutanea tarda. Clin Exp Immunol 2001; 126:47-53. [PMID: 11678898 PMCID: PMC1906169 DOI: 10.1046/j.1365-2249.2001.01645.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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] [Indexed: 12/25/2022] Open
Abstract
The enzymes potentially involved in the pathogenesis of sporadic porphyria cutanea tarda (PCT) reside in liver cytosoles and microsomes. PCT is frequently associated with hepatitis C virus (HCV) infection, which is in turn associated with autoimmune manifestations. To investigate whether autoimmune reactions, possibly triggered by HCV, are involved in the pathogenesis of PCT, we measured by immunoblot autoantibodies to human cytosolic and microsomal liver fractions in 82 patients with PCT (77% with HCV infection), 105 with other liver disorders and 40 healthy subjects. Anti-liver cytosolic antibodies were more frequent in PCT patients (38/82, 46%) than in pathological controls (P < 0.05-P < 0.001) or in healthy subjects (3/40, 8%, P < 0.001). Among PCT patients, anticytosolic antibodies were more frequent in HCV positive (36/63, 57%) than in HCV negative (2/19, 11%, P < 0.05) cases. Reactivity to a 40-kDa cytosolic polypeptide was present in 20 PCT patients (19 HCV positive), being more frequent than in all pathological controls (P < 0.01-P < 0.0001). Histological activity index (P = 0.04) and antibodies to HCV (P = 0.027) - but not HCV RNA - were associated independently with anticytosolic antibodies as assessed by multivariate analysis. In contrast, frequency of antiliver microsomal antibodies was similar in PCT patients (24/82, 29%) and pathological controls (8-26%), being higher in the autoimmune hepatitis control group (23/23, 100%, P < 0.0001). In conclusion, anticytosolic antibodies, particularly to a 40-kDa polypeptide, are frequent in PCT and associated with HCV infection and severity of liver damage.
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Affiliation(s)
- Y Ma
- Institute of Hepatology, University College London, London, UK
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