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[Inheritance in erythropoietic protoporphyria].
[erythropoietic protoporphyria]
Erythropoietic
protoporphyria
(
EPP
)
is
an
inherited
disorder
of
heme
biosynthesis
that
results
from
an
accumulation
of
protoporphyrin
IX
in
erythroid
cells
,
plasma
,
skin
and
liver
.
EPP
leads
to
acute
photosensitivity
and
,
in
about
2
%
of
patients
,
liver
disease
.
EPP
is
a
complex
syndrome
in
which
two
genes
are
independently
involved
:
FECH
and
ALAS
2
.
More
than
96
%
of
unrelated
EPP
patients
have
ferrochelatase
(
FECH
)
deficiency
(
MIM
177000
)
.
Four
percent
of
them
present
with
autosomal
recessive
inheritance
with
two
mutated
FECH
alleles
.
In
dominant
cases
(
95
%
)
the
inheritance
of
a
common
hypomorphic
IVS
3
-
48
C
FECH
allele
trans
to
a
deleterious
FECH
mutation
reduces
FECH
activity
below
a
critical
threshold
.
The
frequency
of
the
IVS
3
-
48
C
allele
differs
widely
from
the
Japanese
(
45
%
)
,
to
Black
West
Africans
(
<
1
%
)
populations
.
These
differences
in
the
frequency
of
this
single
common
SNP
account
for
the
prevalence
of
overt
EPP
in
different
countries
and
for
the
absence
of
EPP
in
Black
Africans
.
The
phylogenic
origin
of
the
IVS
3
-
48
C
haplotypes
strongly
suggests
that
the
IVS
3
-
48
C
allele
arose
from
a
single
recent
mutational
event
that
occurred
60
Kyears
ago
.
Acquired
somatic
mutation
of
FECH
secondary
to
myeloid
disease
may
also
exceptionally
cause
EPP
(
<
1
%
)
.
Finally
,
about
4
%
of
unrelated
EPP
patients
have
X-
linked
dominant
protoporphyria
(
XLDPP
)
(
MIM
300752
)
caused
by
gain-of-function
mutations
in
the
ALAS
2
gene
leading
to
an
increased
erythroid
heme
biosynthesis
and
subsequently
an
accumulation
of
protoporphyrin
without
any
FECH
deficiency
.
Diseases
Validation
Diseases presenting
"inherited disorder of heme biosynthesis that results from an accumulation"
symptom
erythropoietic protoporphyria
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