Therapeutics Development for Pseudoxanthoma Elasticum and Related Ectopic Mineralization Disorders: Update 2020.

Therapeutics Development for Pseudoxanthoma Elasticum and Related Ectopic Mineralization Disorders: Update 2020.
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DOI:
10.3390/jcm10010114
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发表时间:
2020-12-31
影响因子:
3.9
通讯作者:
Uitto J
Uitto J
中科院分区:
医学2区
文献类型:
--
作者:
Luo H;Li Q;Cao Y;Uitto J

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弹性假黄瘤 (PXE) 是遗传性异位矿化障碍的原型,表现为皮肤、眼睛和动脉血管中羟基磷灰石钙晶体的沉积。这种常染色体隐性遗传病是由 ABCC6 突变引起的,通常在生命的第二个十年左右被诊断出来。在遗传性异位矿化障碍的范围内,还包括婴儿期广泛性动脉钙化(GACI),通过产前超声或围产期诊断出极其严重的动脉钙化,以及由于 CD73 缺乏而导致的动脉钙化(ACDC),在老年人中表现为动脉和关节旁矿化;后一种疾病分别是由 ENPP1 和 NT5E 突变引起的。这三种情况的共同病理机制特征是血浆中无机焦磷酸盐 (PPi) 水平降低,PPi 是异位矿化的强大内源性抑制剂。一些正在进行的针对这些疾病的治疗尝试,无论是为了使 PPi 血浆水平正常化,还是通过防止与 PPi 无关的羟基磷灰石钙沉积,都处于高级临床前水平或处于早期临床试验中。本综述从2020年的角度总结了以PXE、GACI和ACDC为目标疾病的异位矿化障碍的治疗发展前景。
Pseudoxanthoma elasticum (PXE), the prototype of heritable ectopic mineralization disorders, manifests with deposition of calcium hydroxyapatite crystals in the skin, eyes and arterial blood vessels. This autosomal recessive disorder, due to mutations in ABCC6, is usually diagnosed around the second decade of life. In the spectrum of heritable ectopic mineralization disorders are also generalized arterial calcification of infancy (GACI), with extremely severe arterial calcification diagnosed by prenatal ultrasound or perinatally, and arterial calcification due to CD73 deficiency (ACDC) manifesting with arterial and juxta-articular mineralization in the elderly; the latter disorders are caused by mutations in ENPP1 and NT5E, respectively. The unifying pathomechanistic feature in these three conditions is reduced plasma levels of inorganic pyrophosphate (PPi), a powerful endogenous inhibitor of ectopic mineralization. Several on-going attempts to develop treatments for these conditions, either with the goal to normalize PPi plasma levels or by means of preventing calcium hydroxyapatite deposition independent of PPi, are in advanced preclinical levels or in early clinical trials. This overview summarizes the prospects of treatment development for ectopic mineralization disorders, with PXE, GACI and ACDC as the target diseases, from the 2020 vantage point.
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