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Mol Genet Metab. 2018 Sep;125(1-2):127-134. doi: 10.1016/j.ymgme.2018.07.011. Epub 2018 Jul 24.

Nitisinone arrests ochronosis and decreases rate of progression of Alkaptonuria: Evaluation of the effect of nitisinone in the United Kingdom National Alkaptonuria Centre.

Author information

1
Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. Electronic address: lrang@liv.ac.uk.
2
Departments of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
3
Physiotherapy, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
4
Rheumatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK; Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK.
5
Dermatology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
6
Anaesthesia, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
7
Ophthalmology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
8
Cardiology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
9
ENT, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
10
Dietetics, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
11
Nuclear Medicine, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK.
12
Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, Liverpool L69 3GL, UK.
13
AKU Society, 66 Devonshire Road, Cambridge, UK.
14
Department of Musculoskeletal Biology, University of Liverpool, L69 7ZX, UK.
15
Department of Psychological Sciences, University of Liverpool, L69 7ZX, UK.
16
Liverpool John Moores University, Liverpool, UK.

Abstract

QUESTION:

Does Nitisinone prevent the clinical progression of the Alkaptonuria?

FINDINGS:

In this observational study on 39 patients, 2 mg of daily nitisinone inhibited ochronosis and significantly slowed the progression of AKU over a three-year period.

MEANING:

Nitisinone is a beneficial therapy in Alkaptonuria.

BACKGROUND:

Nitisinone decreases homogentisic acid (HGA), but has not been shown to modify progression of Alkaptonuria (AKU).

METHODS:

Thirty-nine AKU patients attended the National AKU Centre (NAC) in Liverpool for assessments and treatment. Nitisinone was commenced at V1 or baseline. Thirty nine, 34 and 22 AKU patients completed 1, 2 and 3 years of monitoring respectively (V2, V3 and V4) in the VAR group. Seventeen patients also attended a pre-baseline visit (V0) in the VAR group. Within the 39 patients, a subgroup of the same ten patients attended V0, V1, V2, V3 and V4 visits constituting the SAME Group. Severity of AKU was assessed by calculation of the AKU Severity Score Index (AKUSSI) allowing comparison between the pre-nitisinone and the nitisinone treatment phases.

RESULTS:

The ALL (sum of clinical, joint and spine AKUSSI features) AKUSSI rate of change of scores/patient/month, in the SAME group, was significantly lower at two (0.32 ± 0.19) and three (0.15 ± 0.13) years post-nitisinone when compared to pre-nitisinone (0.65 ± 0.15) (p < .01 for both comparisons). Similarly, the ALL AKUSSI rate of change of scores/patient/month, in the VAR group, was significantly lower at one (0.16 ± 0.08) and three (0.19 ± 0.06) years post-nitisinone when compared to pre-nitisinone (0.59 ± 0.13) (p < .01 for both comparisons). Combined ear and ocular ochronosis rate of change of scores/patient/month was significantly lower at one, two and three year's post-nitisinone in both VAR and SAME groups compared with pre-nitisinone (p < .05).

CONCLUSION:

This is the first indication that a 2 mg dose of nitisinone slows down the clinical progression of AKU. Combined ocular and ear ochronosis progression was arrested by nitisinone.

KEYWORDS:

AKUSSI; Alkaptonuria; Homogentisic acid; Natural history; Nitisinone; Severity

PMID:
30055994
DOI:
10.1016/j.ymgme.2018.07.011
[Indexed for MEDLINE]

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