Results of a pilot study of isoniazid in patients with erythropoietic protoporphyria
| Autor: | Laurent Gouya, Robert J. Desnick, Montgomery D. Bissel, Manisha Balwani, Charles J. Parker, Karl E. Anderson, John D. Phillips, Joseph R. Bloomer, Hervé Puy, Ashwani K. Singal |
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| Rok vydání: | 2019 |
| Předmět: |
Male
0301 basic medicine Protoporphyria Erythropoietic Endocrinology Diabetes and Metabolism Protoporphyrins Pilot Projects 030105 genetics & heredity Pharmacology Proof of Concept Study Biochemistry Article Mice 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Endocrinology Sideroblastic anemia Isoniazid Genetics Animals Humans Medicine Molecular Biology Heme biology Protoporphyrin IX business.industry medicine.disease ALAS2 Anemia Sideroblastic Disease Models Animal Porphyria Liver chemistry Aminolevulinic acid synthase biology.protein Female Erythropoietic protoporphyria business 030217 neurology & neurosurgery 5-Aminolevulinate Synthetase medicine.drug |
| Zdroj: | Mol Genet Metab |
| ISSN: | 1096-7192 |
| Popis: | Erythropoietic protoporphyria (EPP), the most common porphyria of childhood and the third most common porphyria of adulthood, is characterized clinically by painful, non-blistering cutaneous photosensitivity. Two distinct inheritance patterns involving mutations affecting genes that encode enzymes of the heme biosynthetic pathway underlie the clinical phenotype. Aminolevulinic acid synthase 2 (ALAS2), the rate limiting enzyme of the heme pathway in the erythron, is a therapeutic target in EPP because inhibiting enzyme function would reduce downstream production of protoporphyrin IX (PPIX), preventing accumulation of the toxic molecule and thereby ameliorating symptoms. Isoniazid (INH) is widely used for treatment of latent and active M. tuberculosis (TB). Sideroblastic anemia is observed in some patients taking INH, and studies have shown that this process is a consequence of inhibition of ALAS2 by INH. Based on these observations, we postulated that INH might have therapeutic activity in patients with EPP. We challenged this hypothesis in a murine model of EPP and showed that, after 4 weeks of treatment with INH, both plasma PPIX and hepatic PPIX were significantly reduced. Next, we tested the effect of INH on patients with EPP. After eight weeks, no significant difference in plasma or red cell PPIX was observed among the 15 patients enrolled in the study. These results demonstrate that while INH can lower PPIX in an animal model of EPP, the standard dose used to treat TB is insufficient to affect levels in humans. |
| Databáze: | OpenAIRE |
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