Results of a pilot study of isoniazid in patients with erythropoietic protoporphyria

Charles J. Parker, Robert J. Desnick, Montgomery D. Bissel, Joseph R. Bloomer, Ashwani Singal, Laurent Gouya, Herve Puy, Karl E. Anderson, Manisha Balwani, John D. Phillips

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)309-313
Number of pages5
JournalMolecular Genetics and Metabolism
Volume128
Issue number3
DOIs
StatePublished - Nov 2019

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Molecular Biology
  • Genetics
  • Endocrinology

Cite this

Parker, C. J., Desnick, R. J., Bissel, M. D., Bloomer, J. R., Singal, A., Gouya, L., Puy, H., Anderson, K. E., Balwani, M., & Phillips, J. D. (2019). Results of a pilot study of isoniazid in patients with erythropoietic protoporphyria. Molecular Genetics and Metabolism, 128(3), 309-313. https://doi.org/10.1016/j.ymgme.2019.07.017