Abstract
Alkaptonuria (AKU), a rare genetic disorder, is characterized by the accumulation of homogentisic
acid (HGA) in organs, which occurs because the homogentisate 1,2-dioxygenase (HGD) enzyme
is not functional due to gene variants. Over time, HGA oxidation and accumulation cause the
formation of the ochronotic pigment, a deposit that provokes tissue degeneration and organ malfunction.
Here, we report a comprehensive review of the variants so far reported, the structural studies on
the molecular consequences of protein stability and interaction, and molecular simulations for pharmacological
chaperones as protein rescuers. Moreover, evidence accumulated so far in alkaptonuria research
will be re-proposed as the bases for a precision medicine approach in a rare disease.
Graphical Abstract
[10]
Craide, F.H.; Mariano, P.C.; de Castro, C.G.C.; da Fonseca, J.S.B.M.; Fernandez, N.M.; de Mene, Y.S.L. Alkaptonuria - Case report. An. Bras. Dermatol., 2014, 89(5), 799-801.
[21]
Hanika, C.; Hornphutkul, P.; Ntrone, E.J.I.; Onique, M.; Erry, B.P.; Sa, I. Natural History of Alkaptonuria. N. Engl. J. Med., 2002, 347(26), 2111-21.
[33]
Ranganath, L.R.; Psarelli, E.E.; Arnoux, J.B.; Braconi, D.; Briggs, M.; Bröijersén, A.; Loftus, N.; Bygott, H.; Cox, T.F.; Davison, A.S.; Dillon, J.P.; Fisher, M.; FitzGerald, R.; Genovese, F.; Glasova, H.; Hall, A.K.; Hughes, A.T.; Hughes, J.H.; Imrich, R.; Jarvis, J.C.; Khedr, M.; Laan, D.; Le Quan Sang, K.H.; Luangrath, E. Lukáčová, O.; Milan, A.M.; Mistry, A.; Mlynáriková, V.; Norman,
B.P.; Olsson, B.; Rhodes, N.P.; Rovenský, J.; Rudebeck, M.;
Santucci, A.; Shweihdi, E.; Scott, C.; Sedláková, J.; Sireau, N.;
Stančík, R.; Szamosi, J.; Taylor, S.; van Kan, C.; Vinjamuri, S.;
Vrtíková, E.; Webb, C.; West, E.; Záňová, E.; Zatkova, A.; Gallagher,
J.A. Efficacy and safety of once-daily nitisinone for patients with alkaptonuria (SONIA 2): An international, multicentre, open-label, randomised controlled trial.
Lancet Diabetes Endocrinol., 2020,
8(9), 762-772.
[
http://dx.doi.org/10.1016/S2213-8587(20)30228-X] [PMID:
32822600]