BACKGROUND Erythropoietic protoporphyria(EPP)is a rare genetic disorder stemming from ferrochelatase gene mutations,which leads to abnormal accumulation of protoporphyrin IX primarily in erythrocytes,skin,bone marrow ...BACKGROUND Erythropoietic protoporphyria(EPP)is a rare genetic disorder stemming from ferrochelatase gene mutations,which leads to abnormal accumulation of protoporphyrin IX primarily in erythrocytes,skin,bone marrow and liver.Although porphyria-related severe liver damage is rare,its consequences can be severe with limited treatment options.CASE SUMMARY This case study highlights a successful intervention for a 35-year-old male with EPP-related liver impairment,employing a combination of red blood cell(RBC)exchange and therapeutic plasma exchange(TPE).The patient experienced significant symptom relief and a decrease in bilirubin levels following multiple PE sessions and an RBC exchange.CONCLUSION The findings suggest that this combined approach holds promise for managing severe hepatic impairment in EPP.展开更多
The porphyries are a group of metabolic disorders characterized by deficiencies in the activity of enzymes involved in the biosynthesis of heme.In erythropoietic protoporphyria(EPP),in the majority of cases an autosom...The porphyries are a group of metabolic disorders characterized by deficiencies in the activity of enzymes involved in the biosynthesis of heme.In erythropoietic protoporphyria(EPP),in the majority of cases an autosomal dominant disease,there is a mutation of the gene that encodes ferrochelatase(FECH).FECH deficiency is associated with increased concentrations of protoporphyrin in erythrocytes,plasma,skin and liver.The prevalence of this inherited disorder oscillates between 1:75 000 and 1:200 000.Clinical manifestations of EPP appear in early infancy upon first exposure to the sun.Nevertheless,approximately 5%-20% of patients with EPP develop liver manifestations.Retention of protoporphyrin in the liver is associated with cholestatic phenomena and oxidative stress that predisposes to hepatobiliary disease of varying degrees of severity,such as cholelithiasis,mild parenchymal liver disease,progressive hepatocellular disease with end-stage liver disease and acute liver failure.Liver damage is the major risk in EPP patients,so surveillance and frequent clinical and biochemical liver follow-up is mandatory.The diagnostic approach consists in detecting increased levels of protoporphyrin,decreased activity of FECH and genetic analysis of the FECH gene.A variety of nonsurgical therapeutic approaches have been adopted for the management of EPP associated with liver disease,but none of these has been shown to be unequivocally efficacious.Nevertheless,some may have a place in preparing patients for liver transplantation.Liver transplantation does not correct the constitutional deficiency of FECH.Consequently,there is a risk of recurrence of liver disease after liver transplantation as a result of continuing overproduction of protoporphyrin.Some authors recommend that bone marrow transplantation should be considered in liver allograft recipients to prevent recurrence of hepatic disease.展开更多
Erythropoietic protoporphyria(EPP)is an extremely rare disease which is often unrecognized as diagnosis.In the recent article Lui et al describe a patient with a new diagnosis of EPP with severe liver injury.Approxima...Erythropoietic protoporphyria(EPP)is an extremely rare disease which is often unrecognized as diagnosis.In the recent article Lui et al describe a patient with a new diagnosis of EPP with severe liver injury.Approximately 5%-20%of patients with EPP develop liver manifestations.The most severe complication of EPP is an hepatic crisis,which is a medical emergency requiring urgent treatment.Intensive treatment should consist of(exchange)transfusions and preferably in a center that performs liver transplantations.展开更多
BACKGROUND Porphyria is a rare disease with complex classification. Erythropoietic protoporphyria(EPP) is an autosomal recessively inherited disease, and most are caused by mutations in the FECH gene. EPP combined wit...BACKGROUND Porphyria is a rare disease with complex classification. Erythropoietic protoporphyria(EPP) is an autosomal recessively inherited disease, and most are caused by mutations in the FECH gene. EPP combined with liver injury is even rarer.CASE SUMMARY This paper reports a case of EPP which was admitted to the hospital with abnormal liver function and diagnosed by repeated questioning of medical history, screening of common causes of severe liver injury, and second generation sequencing of the whole exon genome. We also summarize the clinical characteristics of EPP with liver injury, and put forward some suggestions on EPP to provide a reference for the diagnosis of such rare disease.CONCLUSION A new mutation locus(c.32_35 dupCCCT) which may be related to the disease was found by detecting the FECH gene in the pedigree of this case.展开更多
Erythropoietic protoporphyria（EPP）, an autosomal dominant disease, is caused by partial deficiency of ferrochelatase（FECH）, which catalyzes the terminal step of heme biosynthesis because of loss-of-function mutati...Erythropoietic protoporphyria（EPP）, an autosomal dominant disease, is caused by partial deficiency of ferrochelatase（FECH）, which catalyzes the terminal step of heme biosynthesis because of loss-of-function mutations in the FECH gene. To date, only a few cases have been described in Asia. In this study, we describe the clinical features of two Chinese patients with EPP, with diagnosis confirmed by the increase of free protoporphyrin in erythrocytes, detection of plasma fluorescence peak at 630–634 nm, and analysis of FECH gene mutations. Using gene scanning, we identified a small deletion in the FECH gene（c.973 delA） in one proband（patient A） and a pathogenic FECH mutation（c.1232 GT） in the other（patient B） and also observed some nucleotide variations（c.798 CG, c.921 AG, IVS1-23 CT, IVS3＋23 AG, IVS9＋35 CT, and IVS3-48 TC） in these patients. The family pedigree of patient A was then established by characterization of the genotype of the patient＇s relatives. We also analyzed the potential perniciousness of the missense mutation with bioinformatic software, Polyphen and Sift. In summary, Chinese EPP patients have similar manifestations to those of Caucasians, and identification of the Chinese FECH gene mutations expands the FECH genotypic spectrum and may contribute to genetic counseling.展开更多
Objective\ To explore the hepatic pathology of a patient with erythropoietic protoporphyria (EPP). Methods\ Percutaneous liver biopsy was performed with a Chiba needle in a 31 year old man suffering from EPP. The sa...Objective\ To explore the hepatic pathology of a patient with erythropoietic protoporphyria (EPP). Methods\ Percutaneous liver biopsy was performed with a Chiba needle in a 31 year old man suffering from EPP. The sample was fixed in 10% formalin solution, and the paraffin embedded section was stained with H E, PAS, etc. Unstained paraffin embedded and H E stained paraffin embedded sections were examined under polarization microscope. Ultrathin sections were examined in a transmission electron microscope. Results\ In H E stained sections, deposits of dark reddish brown pigment were seen in the hepatocytes, Kupffer cells, portal macrophages and plugs in the lumen of bile canaliculi and ducts. Under light microscope, such deposits, with rare exception, exhibited striking birefringence with the unique shape of 'Maltese cross'. Non membrane limited compact masses of crystals were straight or slightly curved and their dimensions (40 640 nm in length and 6 22 nm in width) were different under the transmission electron microscope. Conclusion\ Microscopy, especially polarization microscopy, provides a highly sensitive and specific technique for the diagnosis of EPP.展开更多
Porphyria refers to a group of rare inherited metabolic disorders caused by enzymatic deficiencies in the heme biosynthesis pathway.These deficiencies lead to the pathological accumulation of neurotoxic porphyrin prec...Porphyria refers to a group of rare inherited metabolic disorders caused by enzymatic deficiencies in the heme biosynthesis pathway.These deficiencies lead to the pathological accumulation of neurotoxic porphyrin precursors,resulting in multisystem damage.Currently,there are no curative therapeutic interventions,and patients frequently experience severe morbidity or life-threatening complic-ations.Among the most critical manifestations is protoporphyric liver disease,in which hepatotoxic porphyrins and their precursors drive progressive hepatic injury and cholestasis.Persistent elevation of these metabolites can lead to irreversible parenchymal damage,significantly affecting both quality of life and long-term prognosis.The clinical presentation of porphyria-associated liver injury is highly variable and often has an insidious onset.However,a subset of patients may experience rapid progression to acute liver failure or fulminant hepatic dysfunction.Diagnosis is based on clinical evaluation and is confirmed by genetic testing.Current treatment strategies are focused on symptom management while underlying disease mechanisms remain unaddressed,posing significant the-rapeutic challenges.This review summarizes the pathophysiology,clinical mani-festations,and diagnostic approaches for porphyria-associated liver injury,highlighting emerging therapies with the potential to improve patient outcomes.展开更多
Erythropoietic protoporphyria(EPP)is a rare inherited disease caused by partial deficiency activity of the enzyme ferrochelatase(FECH),resulting in excessive accumulation of protoporphyrin IX in erythrocyte and tissue...Erythropoietic protoporphyria(EPP)is a rare inherited disease caused by partial deficiency activity of the enzyme ferrochelatase(FECH),resulting in excessive accumulation of protoporphyrin IX in erythrocyte and tissues.Here,we report a patient with photosensitive dermatitis and acute icteric hepatitis caused by EPP,whose clinical and biochemical results successfully improved following 2-month treatment with glucose load,ursodeoxycholic acid capsules,and cholestyramine powder.This case provides a reference for a combination therapy strategy for patients with liver and skin injury caused by EPP.展开更多
Introduction:Erythropoietic protoporphyria(EPP)is a rare photodermatosis mainly caused by deficiency of the enzyme ferrochelatase(FECH).We herein report a case of EPP associated with 2 novel mutations in FECH.Case pre...Introduction:Erythropoietic protoporphyria(EPP)is a rare photodermatosis mainly caused by deficiency of the enzyme ferrochelatase(FECH).We herein report a case of EPP associated with 2 novel mutations in FECH.Case presentation:A 15-year-old boy experienced pain and pruritus after sunlight exposure.He had occasional claret-red urine,hepatomegaly with increased alanine aminotransferase and aspartate aminotransferase levels,and an elevated free erythrocyte protoporphyrin level.He was treated with oralβ-carotene and cholestyramine and avoidance of sunlight as much as possible.Discussion:Genome sequencing revealed 2 novel FECH mutations that had been inherited from his healthy parents.Pathogenicity analysis involving prediction using PolyPhen-2,SIFT,and Mutation Taster revealed that the 2 novel mutations were likely pathogenic.Although the patient’s parents were healthy,they each had one of these 2 mutations.This finding is consistent with previous reports stating that individuals carrying low-expression alleles can be asymptomatic.The pathogenesis of the disease caused by these 2 mutations requires verification by larger and more detailed studies.Conclusion:Although the precise role of these mutations in EPP is not clear,the findings in the present case expand the genotypic spectrum of the disease.展开更多
文摘BACKGROUND Erythropoietic protoporphyria(EPP)is a rare genetic disorder stemming from ferrochelatase gene mutations,which leads to abnormal accumulation of protoporphyrin IX primarily in erythrocytes,skin,bone marrow and liver.Although porphyria-related severe liver damage is rare,its consequences can be severe with limited treatment options.CASE SUMMARY This case study highlights a successful intervention for a 35-year-old male with EPP-related liver impairment,employing a combination of red blood cell(RBC)exchange and therapeutic plasma exchange(TPE).The patient experienced significant symptom relief and a decrease in bilirubin levels following multiple PE sessions and an RBC exchange.CONCLUSION The findings suggest that this combined approach holds promise for managing severe hepatic impairment in EPP.
文摘The porphyries are a group of metabolic disorders characterized by deficiencies in the activity of enzymes involved in the biosynthesis of heme.In erythropoietic protoporphyria(EPP),in the majority of cases an autosomal dominant disease,there is a mutation of the gene that encodes ferrochelatase(FECH).FECH deficiency is associated with increased concentrations of protoporphyrin in erythrocytes,plasma,skin and liver.The prevalence of this inherited disorder oscillates between 1:75 000 and 1:200 000.Clinical manifestations of EPP appear in early infancy upon first exposure to the sun.Nevertheless,approximately 5%-20% of patients with EPP develop liver manifestations.Retention of protoporphyrin in the liver is associated with cholestatic phenomena and oxidative stress that predisposes to hepatobiliary disease of varying degrees of severity,such as cholelithiasis,mild parenchymal liver disease,progressive hepatocellular disease with end-stage liver disease and acute liver failure.Liver damage is the major risk in EPP patients,so surveillance and frequent clinical and biochemical liver follow-up is mandatory.The diagnostic approach consists in detecting increased levels of protoporphyrin,decreased activity of FECH and genetic analysis of the FECH gene.A variety of nonsurgical therapeutic approaches have been adopted for the management of EPP associated with liver disease,but none of these has been shown to be unequivocally efficacious.Nevertheless,some may have a place in preparing patients for liver transplantation.Liver transplantation does not correct the constitutional deficiency of FECH.Consequently,there is a risk of recurrence of liver disease after liver transplantation as a result of continuing overproduction of protoporphyrin.Some authors recommend that bone marrow transplantation should be considered in liver allograft recipients to prevent recurrence of hepatic disease.
文摘Erythropoietic protoporphyria(EPP)is an extremely rare disease which is often unrecognized as diagnosis.In the recent article Lui et al describe a patient with a new diagnosis of EPP with severe liver injury.Approximately 5%-20%of patients with EPP develop liver manifestations.The most severe complication of EPP is an hepatic crisis,which is a medical emergency requiring urgent treatment.Intensive treatment should consist of(exchange)transfusions and preferably in a center that performs liver transplantations.
基金Supported by the Clinical Innovation Project from the Southwest Hospital,No.SWH2016ZDCX1007
文摘BACKGROUND Porphyria is a rare disease with complex classification. Erythropoietic protoporphyria(EPP) is an autosomal recessively inherited disease, and most are caused by mutations in the FECH gene. EPP combined with liver injury is even rarer.CASE SUMMARY This paper reports a case of EPP which was admitted to the hospital with abnormal liver function and diagnosed by repeated questioning of medical history, screening of common causes of severe liver injury, and second generation sequencing of the whole exon genome. We also summarize the clinical characteristics of EPP with liver injury, and put forward some suggestions on EPP to provide a reference for the diagnosis of such rare disease.CONCLUSION A new mutation locus(c.32_35 dupCCCT) which may be related to the disease was found by detecting the FECH gene in the pedigree of this case.
基金supported by the National Basic Research Project(973)of China(No.2012CB934000)the National Distinguished Youth Scholar Grant of China(No.31325010)
文摘Erythropoietic protoporphyria（EPP）, an autosomal dominant disease, is caused by partial deficiency of ferrochelatase（FECH）, which catalyzes the terminal step of heme biosynthesis because of loss-of-function mutations in the FECH gene. To date, only a few cases have been described in Asia. In this study, we describe the clinical features of two Chinese patients with EPP, with diagnosis confirmed by the increase of free protoporphyrin in erythrocytes, detection of plasma fluorescence peak at 630–634 nm, and analysis of FECH gene mutations. Using gene scanning, we identified a small deletion in the FECH gene（c.973 delA） in one proband（patient A） and a pathogenic FECH mutation（c.1232 GT） in the other（patient B） and also observed some nucleotide variations（c.798 CG, c.921 AG, IVS1-23 CT, IVS3＋23 AG, IVS9＋35 CT, and IVS3-48 TC） in these patients. The family pedigree of patient A was then established by characterization of the genotype of the patient＇s relatives. We also analyzed the potential perniciousness of the missense mutation with bioinformatic software, Polyphen and Sift. In summary, Chinese EPP patients have similar manifestations to those of Caucasians, and identification of the Chinese FECH gene mutations expands the FECH genotypic spectrum and may contribute to genetic counseling.
文摘Objective\ To explore the hepatic pathology of a patient with erythropoietic protoporphyria (EPP). Methods\ Percutaneous liver biopsy was performed with a Chiba needle in a 31 year old man suffering from EPP. The sample was fixed in 10% formalin solution, and the paraffin embedded section was stained with H E, PAS, etc. Unstained paraffin embedded and H E stained paraffin embedded sections were examined under polarization microscope. Ultrathin sections were examined in a transmission electron microscope. Results\ In H E stained sections, deposits of dark reddish brown pigment were seen in the hepatocytes, Kupffer cells, portal macrophages and plugs in the lumen of bile canaliculi and ducts. Under light microscope, such deposits, with rare exception, exhibited striking birefringence with the unique shape of 'Maltese cross'. Non membrane limited compact masses of crystals were straight or slightly curved and their dimensions (40 640 nm in length and 6 22 nm in width) were different under the transmission electron microscope. Conclusion\ Microscopy, especially polarization microscopy, provides a highly sensitive and specific technique for the diagnosis of EPP.
文摘Porphyria refers to a group of rare inherited metabolic disorders caused by enzymatic deficiencies in the heme biosynthesis pathway.These deficiencies lead to the pathological accumulation of neurotoxic porphyrin precursors,resulting in multisystem damage.Currently,there are no curative therapeutic interventions,and patients frequently experience severe morbidity or life-threatening complic-ations.Among the most critical manifestations is protoporphyric liver disease,in which hepatotoxic porphyrins and their precursors drive progressive hepatic injury and cholestasis.Persistent elevation of these metabolites can lead to irreversible parenchymal damage,significantly affecting both quality of life and long-term prognosis.The clinical presentation of porphyria-associated liver injury is highly variable and often has an insidious onset.However,a subset of patients may experience rapid progression to acute liver failure or fulminant hepatic dysfunction.Diagnosis is based on clinical evaluation and is confirmed by genetic testing.Current treatment strategies are focused on symptom management while underlying disease mechanisms remain unaddressed,posing significant the-rapeutic challenges.This review summarizes the pathophysiology,clinical mani-festations,and diagnostic approaches for porphyria-associated liver injury,highlighting emerging therapies with the potential to improve patient outcomes.
基金the Guangdong Key Field R&D Plan of China(2019B020228001)the 5010 Project of Clinical Research in Sun Yat-sen University,China(No.2018024).
文摘Erythropoietic protoporphyria(EPP)is a rare inherited disease caused by partial deficiency activity of the enzyme ferrochelatase(FECH),resulting in excessive accumulation of protoporphyrin IX in erythrocyte and tissues.Here,we report a patient with photosensitive dermatitis and acute icteric hepatitis caused by EPP,whose clinical and biochemical results successfully improved following 2-month treatment with glucose load,ursodeoxycholic acid capsules,and cholestyramine powder.This case provides a reference for a combination therapy strategy for patients with liver and skin injury caused by EPP.
文摘Introduction:Erythropoietic protoporphyria(EPP)is a rare photodermatosis mainly caused by deficiency of the enzyme ferrochelatase(FECH).We herein report a case of EPP associated with 2 novel mutations in FECH.Case presentation:A 15-year-old boy experienced pain and pruritus after sunlight exposure.He had occasional claret-red urine,hepatomegaly with increased alanine aminotransferase and aspartate aminotransferase levels,and an elevated free erythrocyte protoporphyrin level.He was treated with oralβ-carotene and cholestyramine and avoidance of sunlight as much as possible.Discussion:Genome sequencing revealed 2 novel FECH mutations that had been inherited from his healthy parents.Pathogenicity analysis involving prediction using PolyPhen-2,SIFT,and Mutation Taster revealed that the 2 novel mutations were likely pathogenic.Although the patient’s parents were healthy,they each had one of these 2 mutations.This finding is consistent with previous reports stating that individuals carrying low-expression alleles can be asymptomatic.The pathogenesis of the disease caused by these 2 mutations requires verification by larger and more detailed studies.Conclusion:Although the precise role of these mutations in EPP is not clear,the findings in the present case expand the genotypic spectrum of the disease.
