Gazda HT, Preti M, Sheen MR, et al
Gazda HT, Preti M, Sheen MR, et al. Visual Abstract Open in a separate window Introduction Diamond-Blackfan anemia (DBA)1-3 is a rare congenital intrinsic erythroid hypoplasia, identified in 20054 as the first human ribosomopathy.5,6 Mutations in 20 ribosomal protein (RP) genes associated with DBA have been identified to date.7 In all instances, the RP gene mutations lead to defective ribosomal RNA (rRNA) maturation, the signature Silymarin (Silybin B) feature of classical DBA.4,8 Indeed, the definition of DBA has become somewhat problematic. Rather than classical DBA with RP gene mutations, some patients exhibit erythroblastopenia resulting from non-RP mutated genes (gene, which has been successful in a mouse model,32 but currently, there are no active human trials. Under best circumstances, gene therapy will cure the erythropoietic defect Rabbit Polyclonal to CCRL1 at a lower cost compared with HSCT, if it can be performed without a myeloablative conditioning regimen, with no transplantation-related mortality, and no risk of graft-versus-host disease or oncogenic risk. However, this approach needs to be critically validated before implementation. Other approaches, such as use of induced pluripotent stem cells or genome editing, are also being considered.30 The availability of cell models, including fetal liver erythroid progenitors from mice models or reprogrammed hematopoietic progenitors, are making it possible to perform systematic drug screening using large-scale chemical libraries. Such approaches have identified different agents that are of potential clinical interest, such as SMER28 (a small-molecule inducer of autophagy),33 kinase inhibitors,34 and trifluoperazine, which is currently in a clinical trial (registered at www.clinicaltrials.gov as #”type”:”clinical-trial”,”attrs”:”text”:”NCT03966053″,”term_id”:”NCT03966053″NCT03966053). Complication management DBA patients need comprehensive multispecialty clinical care. In children, growth is the main concern. Therapeutic approaches include steroid use limitations; leucine, reported to be associated with growth acceleration; and GH. Silymarin (Silybin B) Treatment of 19 DBA children with GH was reported to be effective.35 GH administration should be considered for DBA children with major growth retardation. However, caution is warranted, because 3 cases of osteosarcoma were reported Silymarin (Silybin B) in DBA patients treated with GH.35 Adult DBA patients are at increased risk for severe complications. In the most recent analysis of data on 702 patients from the DBA Registry of North America, the cumulative incidence of death resulting from nonmalignant and malignant complications was noted to be 25% by the age of 50 years.36 DBA individuals are now formally recognized to have increased susceptibility for malignancies.36-38 The observed/expected (O/E) ratio for all cancers is 4.8 and the cumulative incidence of solid tumors and hematological malignancies is 13.7 by the age of 45 years.36 As expected for an IBMFS, the risk is very high for myelodysplastic syndromes (O/E ratio, 352.1) and myeloid leukemias (O/E ratio, 28.8). Among a spectrum of reported solid tumors, the most significant risks are for colon carcinoma (O/E ratio, 44.7) and osteogenic sarcoma (O/E ratio, 42.6).36,37 Solid tumors and myeloid malignancies rates increase at ages 30 and 40 years, respectively. These results support targeted cancer surveillance, such as colonoscopy for colon cancer.36 As in the other IBMFSs, immune deficiency is reported in DBA patients, mainly in adult patients. Immunoglobulin levels must be checked annually. In a cohort of 107 DBA patients, intrinsic quantitative defects were demonstrated in the lymphocyte count (mostly B and natural killer) and serum immunoglobulins.39 Finally, other concerns for adult.