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Advances in the management of erythropoietic protoporphyria – role of afamelanotide

Erythropoietic protoporphyria (EPP) and the phenotypically similar disease X-linked protoporphyria (XLPP) are inherited cutaneous porphyrias characterized clinically by acute non-blistering photosensitivity, intolerance to sunlight, and significantly reduced quality of life. They are due to marked o...

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Autores principales: Lane, Ashley M, McKay, Jerome T, Bonkovsky, Herbert L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161401/
https://www.ncbi.nlm.nih.gov/pubmed/28003770
http://dx.doi.org/10.2147/TACG.S122030
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author Lane, Ashley M
McKay, Jerome T
Bonkovsky, Herbert L
author_facet Lane, Ashley M
McKay, Jerome T
Bonkovsky, Herbert L
author_sort Lane, Ashley M
collection PubMed
description Erythropoietic protoporphyria (EPP) and the phenotypically similar disease X-linked protoporphyria (XLPP) are inherited cutaneous porphyrias characterized clinically by acute non-blistering photosensitivity, intolerance to sunlight, and significantly reduced quality of life. They are due to marked overproduction of protoporphyrin (PP) chiefly by erythroblasts and reticulocytes. In EPP, the underlying genetic defect is in the ferrochelatase gene, which encodes the final enzyme in the heme synthetic pathway. In XLPP, the genetic defect is a gain-of-function mutation, usually a four-base deletion, in the gene that encodes the enzyme 5-aminolevulinic acid synthase-2, the first and rate-controlling enzyme of heme synthesis in developing red blood cells. The excess PP causes acute and painful photosensitivity, being activated by light in the long ultraviolet to blue spectrum (380–420 nm, the Soret band). Although several treatments have been proposed, presently no very effective treatment exists for EPP or XLPP. Afamelanotide (Scenesse(®)) is a first-in-class synthetic analog of α-melanocyte stimulating hormone. Afamelanotide mimics the naturally occurring hormone to increase skin pigmentation by increasing melanin production in melanocytes, resulting in increased sunlight tolerance in those with EPP/XLPP. Afamelanotide is currently approved for use in the European Union and Switzerland, and it is under review in the United States by the Food and Drug Administration for use in patients with EPP/XLPP. This paper provides a review of the clinical characteristics and current therapies for EPP/XLPP. We discuss the pharmacology, clinical efficacy, safety, and tolerability of afamelanotide and summarize the results of several key Phase II and III clinical trials. These data indicate that afamelanotide is a promising therapy for those with these debilitating diseases.
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spelling pubmed-51614012016-12-21 Advances in the management of erythropoietic protoporphyria – role of afamelanotide Lane, Ashley M McKay, Jerome T Bonkovsky, Herbert L Appl Clin Genet Review Erythropoietic protoporphyria (EPP) and the phenotypically similar disease X-linked protoporphyria (XLPP) are inherited cutaneous porphyrias characterized clinically by acute non-blistering photosensitivity, intolerance to sunlight, and significantly reduced quality of life. They are due to marked overproduction of protoporphyrin (PP) chiefly by erythroblasts and reticulocytes. In EPP, the underlying genetic defect is in the ferrochelatase gene, which encodes the final enzyme in the heme synthetic pathway. In XLPP, the genetic defect is a gain-of-function mutation, usually a four-base deletion, in the gene that encodes the enzyme 5-aminolevulinic acid synthase-2, the first and rate-controlling enzyme of heme synthesis in developing red blood cells. The excess PP causes acute and painful photosensitivity, being activated by light in the long ultraviolet to blue spectrum (380–420 nm, the Soret band). Although several treatments have been proposed, presently no very effective treatment exists for EPP or XLPP. Afamelanotide (Scenesse(®)) is a first-in-class synthetic analog of α-melanocyte stimulating hormone. Afamelanotide mimics the naturally occurring hormone to increase skin pigmentation by increasing melanin production in melanocytes, resulting in increased sunlight tolerance in those with EPP/XLPP. Afamelanotide is currently approved for use in the European Union and Switzerland, and it is under review in the United States by the Food and Drug Administration for use in patients with EPP/XLPP. This paper provides a review of the clinical characteristics and current therapies for EPP/XLPP. We discuss the pharmacology, clinical efficacy, safety, and tolerability of afamelanotide and summarize the results of several key Phase II and III clinical trials. These data indicate that afamelanotide is a promising therapy for those with these debilitating diseases. Dove Medical Press 2016-12-12 /pmc/articles/PMC5161401/ /pubmed/28003770 http://dx.doi.org/10.2147/TACG.S122030 Text en © 2016 Lane et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Review
Lane, Ashley M
McKay, Jerome T
Bonkovsky, Herbert L
Advances in the management of erythropoietic protoporphyria – role of afamelanotide
title Advances in the management of erythropoietic protoporphyria – role of afamelanotide
title_full Advances in the management of erythropoietic protoporphyria – role of afamelanotide
title_fullStr Advances in the management of erythropoietic protoporphyria – role of afamelanotide
title_full_unstemmed Advances in the management of erythropoietic protoporphyria – role of afamelanotide
title_short Advances in the management of erythropoietic protoporphyria – role of afamelanotide
title_sort advances in the management of erythropoietic protoporphyria – role of afamelanotide
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161401/
https://www.ncbi.nlm.nih.gov/pubmed/28003770
http://dx.doi.org/10.2147/TACG.S122030
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