The pathophysiology and treatment of hereditary tyrosinemia type 1
Abstract
The topic of this review is hepatorenal tyrosinemia (hereditary tyrosinemia type 1 [HT1], or fumarylacetoacetate hydrolase deficiency; OMIM# 276700). HT1 is the most serious and common of the genetic defects in tyrosine degradation. In addition, this disorder has importance as a model of spontaneous self-correction of liver disease, as a model of liver repopulation by transplanted cells and gene therapy, and as a genetic cause of hepatocarcinoma. However, other forms of hypertyrosinemia exist; hence, the differential diagnosis also will be described briefly. Recent years have seen much progress in our understanding of the molecular basis, the pathophysiology, and especially the treatment of HT1. The current intervention with 2-(2-nitro-4-trifluoro-methylbenzyol)-1,3 cyclohexanedione (NTBC) therapy has improved the outcome of this once devastating disorder. The successful repopulation of the HT1 liver with transplanted cells and positive results in the use of gene therapy in animal models may someday lead to therapy in humans that will obviate the need for life-long dietary and pharmacological therapy.
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When a FAH deficiency exists, toxic metabolites such as fumarylacetoacetate accumulate in hepatocytes and renal proximal tubules causing death in a cell-autonomous manner.
“When a FAH deficiency exists, toxic metabolites such as fumarylacetoacetate accumulate in hepatocytes and renal proximal tubules causing death in a cell-autonomous manner.22”
From Adeno‐associated virus gene repair corrects a mouse model of hereditary tyrosinemia in vivo†‡ (2010) · cites this paper as [22]
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BackgroundChronic liver disease in murine hereditary tyrosinemia type 1 induces resistance to cell death
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“Affected patients develop both liver injury and renal Fanconi syndrome.(25) The mouse model is neonatal lethal, but animals can survive if treated with cyclohexanedione.”
BackgroundOxidative damage to ferritin by 5-aminolevulinic acid
Rocha, M. E. M., Dutra, F., Bandy, B., Baldini, R. L., Gomes, S. L., Faljoni‐Alário, A., Liria, C. W., Teresa, M., Miranda, M., & Bechara, E. J. H. (2002) · Archives of Biochemistry and Biophysics · doi:10.1016/s0003-9861(02)00633-1 · Cited by 64 · see citing works
Insights into the Pathogenesis and Treatment of Cancer from Inborn Errors of Metabolism
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“Hereditary tyrosinemia type I (HT1; OMIM #276700) is an autosomal-recessive inborn error of metabolism caused by deficiency in fumarylacetoacetate hydrolase (FAH), an enzyme that catalyzes the last step of tyrosine metabolism.[1-4] Absence of FAH causes accumulation of the toxic metabolite fumarylacetoacetate (FAA) in…”
Self-citationHuman Glutathione Transferase Zeta
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“The clinical phenotype of HT is variable (1, 12 , 13) .I t is characterized by progressive liver failure and a high risk of hepatocellular carcinoma, renal tubular disease, and porphyria-like neurologic crises.”
BackgroundAcute liver failure in neonates, infants and children
Devictor, D. J., Tissières, P., Durand, P., Chevret, L., & Debray, D. (2011) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/egh.11.57 · Cited by 56 · see citing works
Disorders of Tyrosine Metabolism
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A genetic screen reveals Foxa3 and TNFR1 as key regulators of liver repopulationPreprint
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Neuropsychological outcome of NTBC-treated patients with tyrosinaemia type 1: Clinical Letter
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Cas9-mediated allelic exchange repairs compound heterozygous recessive mutations in mice
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Reprogramming homing endonuclease specificity through computational design and directed evolution
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“Potential target sites for I-AniI engineering were found in the genes involved in the diseases pyruvate kinase (PK) defi-ciency (44) and tyrosinemia (45), as well as several genes putatively associated with Anopheles reproduction (Table 1) (28).”
BackgroundCurative Ex Vivo Hepatocyte-Directed Gene Editing in a Mouse Model of Hereditary Tyrosinemia Type 1
VanLith, C. J., Guthman, R. M., Nicolas, C. T., Allen, K. L., Du, Z., Joo, D. J., Nyberg, S. L., Lillegard, J. B., & Hickey, R. (2018) · Human Gene Therapy · doi:10.1089/hum.2017.252 · Cited by 39 · see citing works
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Kidney repair and stem cells: a complex and controversial process
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“Affected human patients develop both chronic liver injury and renal Fanconi syndrome [ 56 ].”
BackgroundBlackburn, P. R., Hickey, R., Nace, R. A., Giama, N. H., Kraft, D. L., Bordner, A. J., Chaiteerakij, R., McCormick, J. B., Radulovic, M., Graham, R. P., et al. (2016) · Human Mutation · doi:10.1002/humu.23047 · Cited by 35 · see citing works
Self-citationPregnancy During Nitisinone Treatment for Tyrosinaemia Type I: First Human Experience
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“Nitisinone prevents the accumulation of fumarylacetoacetate and, therefore, its conversion to succinylacetone (Grompe 2001).”
BackgroundNew Management Options for End-Stage Chronic Liver Disease and Acute Liver Failure
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“The oxidative degradation of tyrosine is significant not only for human and animals (Grompe, 2001), but also for the normal growth and development of some bacteria (Milcamps and Bruijn, 1999).”
Background“Silent” Tyrosinemia Presenting as Hepatocellular Carcinoma in a 10‐year‐old Girl
Castilloux, J., Laberge, A., Martin, S. R., Lallier, M., & Marchand, V. (2007) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e31802f640c · Cited by 32 · see citing works
Current knowledge for pyridoxine-dependent epilepsy: a 2016 update
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“However, such spontaneous selection does not reverse hereditary tyrosinemia type 1 in most patients because the number of reverted hepatocytes is too low.(41) Although a similarly high repopulation efficiency was observed in our rat model of WD (in which”
BackgroundDevelopment of Humanized Mice for the Study of Hepatitis C Virus Infection
Turrini, P., Sasso, R. N., Germoni, S., Marcucci, I., Celluci, A., Marco, A. D., Marra, E., Paonessa, G., Eutropi, A., Laufer, R., et al. (2006) · Transplantation Proceedings · doi:10.1016/j.transproceed.2006.02.149 · Cited by 31 · see citing works
Disorders of phenylalanine and tyrosine metabolism
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“However, an active TYR pathway causing nephropathy in hereditary tyrosinaemia type 1 (HT 1) is previously described, although the magnitude of the activity in the renal TYR pathway remains unknown.(24)”
BackgroundDifferential roles for diploid and polyploid hepatocytes in acute and chronic liver injury
Wilkinson, P. D., & Duncan, A. (2020) · Seminars in liver disease (Print) · doi:10.1055/s-0040-1719175 · Cited by 25 · see citing works
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“Comparisons were performed between the following groups: (1) wild-type (n = 2), (2) FAH pigs adequately maintained on NTBC (n = 3), (3) FAH sick pig No.”
BackgroundMethodShroads, A. L. (2004) · Journal of Chromatography B · doi:10.1016/j.jchromb.2004.05.005 · Cited by 27 · see citing works
In vivo models of hepatitis B and C virus infection
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The use of glutathione transferase-knockout mice as pharmacological and toxicological models
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“The absence of human subjects with GSTZ1-1 deficiency and the severity of fumarylacetoacetate hydrolase deficiency [90], the next step in the tyrosine catabolic pathway, suggested that GSTZ1-1 deficiency might be lethal.”
BackgroundLectin‐reactive α‐Fetoprotein in Patients with Tyrosinemia Type I and Hepatocellular Carcinoma
Baumann, U., Duhme, V., Auth, M. K. H., McKiernan, P. J., & Holme, E. (2006) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/01.mpg.0000228112.29359.f8 · Cited by 25 · see citing works
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“Fumarylacetoacetate is toxic to liver, leading to raised a-fetoprotein (AFP) early in disease, and to kidney (Grompe 2001; Lindblad et al 1974).”
BackgroundNuclease-Mediated Gene Therapies for Inherited Metabolic Diseases of the Liver.
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Hepatocarcinogenesis in multidrug‐resistant P‐glycoprotein 3 deficiency
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“( B ) Four steps are involved in this process: (1) partial hepatectomy, (2)”
Liver Cancer Gene Discovery Using Gene Targeting, Sleeping Beauty, and CRISPR/Cas9
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Cost–Consequence Analysis of Nitisinone for Treatment of Tyrosinemia Type I
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BackgroundGene therapy for inborn errors of liver metabolism
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Gene Therapy in Liver Diseases: State-of-the-Art and Future Perspectives
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“Toxic metabolites such as fumarylacetoacetate accumulate in hepatocytes and renal proximal tubules, causing death in a cellautonomous manner [102].”
BackgroundFumarylacetoacetate Hydrolase Knock-out Rabbit Model for Hereditary Tyrosinemia Type 1
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“As SA can be used as a surrogate marker of toxicity in the liver, we should aim at the lowest NTBC dose associated with the lowest possible SA concentration in blood and urine (Grompe et al Grompe 2001, de Laet et al 2013, Mayorandan et al 2014).”
BackgroundLiu, Y., Gao, S., Ye, T., Li, J., Ye, F., & Fu, Y. (2020) · Future Medicinal Chemistry · doi:10.4155/fmc-2019-0349 · Cited by 19 · see citing works
Schiff, M., Broue, P., Chabrol, B., De Laet, C., Habes, D., Mention, K., Sarles, J., Spraul, A., Valayannopoulos, V., Ogier de Baulny, H., et al. (2012) · Journal of Inherited Metabolic Disease · doi:10.1007/s10545-011-9429-y · Cited by 28 · see citing works
“These guidelines are based on our personal experience as well as extensive (albeit scarce) literature review (Couce et al. 2010, Grompe 2001, Sniderman King et al. 1993) and are detailed in Table 1 to 4.”
BackgroundMethodNicolas, C. T., Kaiser, R. A., Hickey, R., Allen, K. L., Du, Z., VanLith, C. J., Guthman, R. M., Amiot, B. P., Suksanpaisan, L., Han, B., et al. (2020) · Molecular Therapy — Methods & Clinical Development · doi:10.1016/j.omtm.2020.07.009 · Cited by 18 · see citing works
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Self-citationKidneys of Mice With Hereditary Tyrosinemia Type I Are Extremely Sensitive to Cytotoxicity
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Female Protection Against Diabetic Kidney Disease Is Regulated by Kidney-Specific AMPK Activity
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“FAH deficiency impairs tyrosine catabolism, induces accumulation of toxic metabolic intermediates in the liver, and has a cytotoxic effect on hepatocytes (Grompe, 2001).”
BackgroundTyrosinemia type I: A clinico-laboratory case report
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“2), which has appeared to be specific and extremely efficient, has found application as a life-saving medicine against a rare but fatal hereditary disease , tyrosinemia type I (Lock, 1998; Grompe, 2001; Russo, 2001).”
NTBC and Correction of Renal Dysfunction
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Living‐donor liver transplantation for children with tyrosinemia type I
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“By combining it with the screening of newborns, more patients have been diagnosed and treated at an early age with nitisinone, which makes it possible to prevent the evolution of severe liver disease and greatly improve the clinical outcomes of these patients.(20) However, 5%-10% of patients with tyrosinemia have a po…”
BackgroundER Stress Signaling in Hepatic Injury
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“Hereditary tyrosinemia type 1 (HT1; or hepatorenal tyrosinemia, OMIM 276700) is an inherited, life-threatening disease caused by deficiency of fumarylacetoacetate hydroxylase, the last enzyme of the tyrosine degradation pathway [ 4 ] (Fig. 1). Patients with HT1 are usually asymptomatic at birth, but if left untreated,…”
BackgroundIn vivo selection of hepatocytes
Vonada, A., & Grompe, M. (2024) · Hepatology · doi:10.1097/hep.0000000000001143 · Cited by 7 · see citing works
Self-citationMolecular therapy and prevention of liver diseases
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“efficiency of >90% of hepatocytes and the restoration of a normal liver function ( 33 , 82).”
BackgroundMetabolic Disorders in Childhood
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Treatment strategies for acute metabolic disorders in neonates.
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“An elevated SA level in blood or urine is diagnostic of HT1 (1, 5).”
BackgroundLarson, E. L., Joo, D. J., Nelson, E., Amiot, B. P., Aravalli, R. N., & Nyberg, S. L. (2021) · Stem Cell Reports · doi:10.1016/j.stemcr.2021.09.018 · Cited by 6 · see citing works
“MAA and FAA have short half-lives and do not leave the cells where they are produced (Grompe, 2017).”
Background
- Authors
- Grompe, M.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- Grompe, Markus
- ORCID
- Grompe, Markus
- Venue
- Seminars in Liver Disease
- Publisher
- Georg Thieme Verlag KG
- Published
- 2001
- Volume
- 21
- Issue
- 04
- Pages
- 563-572
- ISSN
- 0272-8087 (ISSN-L)
- 1098-8971
- OpenAlex
- W2022449977
- Semantic Scholar
- b052e17377cc56df7ac16c995702a40e45e433db
- Cited by
- 167
- References
- 78
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 3 · 2022: 6 · 2021: 7 · 2020: 10 · 2019: 5 · 2018: 6 · 2017: 9 · 2016: 6 · 2015: 7 · 2014: 3 · 2013: 3 · 2012: 9
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Seminars in Liver Disease (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Amino Acid Enzymes and Metabolism
- Health Sciences › Medicine › Rheumatology › Glycogen Storage Diseases and Myoclonus
- Keywords
- tyrosinemia type I, fumarylacetoacetate hydrolase deficiency, tyrosine degradation, liver transplantation, gene therapy, hepatocellular carcinoma, hypertyrosinemia, differential diagnosis, pathophysiology, dietary therapy
- MeSH terms
- Animals, Humans, Infant, Newborn, Tyrosinemias, Mice
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