期刊
EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY
卷 16, 期 9, 页码 879-894出版社
TAYLOR & FRANCIS LTD
DOI: 10.1080/17474124.2022.2110469
关键词
Acute hepatic porphyria (AHP); acute intermittent porphyria (AIP); givosiran; homocysteine; hyperhomocysteinemia; small interfering RNA
资金
- Alnylam Pharmaceuticals
This article summarizes the exacerbation of dysregulated homocysteine metabolism in patients with acute hepatic porphyria (AHP) treated with givosiran and suggests monitoring homocysteine levels and supplementing with vitamin B6 based on the homocysteine levels.
Introduction Homocysteine is a sulfur-containing amino acid formed in the intermediary metabolism of methionine. Amino acid metabolism and heme biosynthesis pathways are complexly intertwined. Plasma homocysteine elevation, hyperhomocysteinemia (HHcy), has been reported in patients with acute hepatic porphyria (AHP), a family of rare genetic disorders caused by defects in hepatic heme biosynthesis. Areas covered This article summarizes published case series in which givosiran, a subcutaneously administered small interfering RNA approved for AHP treatment, appeared to exacerbate dysregulated homocysteine metabolism in patients with AHP. A comprehensive exploratory analysis of ENVISION trial data demonstrated that on a population level, givosiran increased homocysteine but with wide interpatient variations, and there is no proof of correlations between HHcy and changes in efficacy or safety of givosiran. Expert opinion The strong correlation and co-increase of homocysteine and methionine suggest that HHcy associated with givosiran is likely attributable to the impaired trans-sulfuration pathway catalyzed by cystathionine beta-synthase, which uses vitamin B6 as a cofactor. Data-based consensus supports monitoring total plasma homocysteine and vitamin B6, B12, and folate levels before and during givosiran treatment; supplementing with pyridoxine/vitamin B6 in patients with homocysteine levels >100 mu mol/L; and involving patients with homocysteine levels >30 mu mol/L in decisions to supplement.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据