A deficiência de purina nucleosídeo fosforilase (PNP) é um distúrbio do metabolismo das purinas, caracterizado por um enfraquecimento progressivo do sistema imunológico. Isso leva a infecções frequentes e oportunistas, doenças autoimunes, câncer e também a problemas neurológicos.
Introdução
O que você precisa saber de cara
A deficiência de purina nucleosídeo fosforilase (PNP) é um distúrbio do metabolismo das purinas, caracterizado por um enfraquecimento progressivo do sistema imunológico. Isso leva a infecções frequentes e oportunistas, doenças autoimunes, câncer e também a problemas neurológicos.
Escala de raridade
<1/50kMuito rara
1/20kRara
1/10kPouco freq.
1/5kIncomum
1/2k
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Sinais e sintomas
O que aparece no corpo e com que frequência cada sintoma acontece
Partes do corpo afetadas
+ 22 sintomas em outras categorias
Características mais comuns
Os sintomas variam de pessoa para pessoa. Abaixo estão as 61 características clínicas mais associadas, ordenadas por frequência.
Linha do tempo da pesquisa
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Genética e causas
O que está alterado no DNA e como passa nas famílias
Genes associados
1 gene identificado com associação a esta condição. Padrão de herança: Autosomal recessive.
Hormone secreted by pancreatic cells that acts as a regulator of pancreatic and gastrointestinal functions probably by signaling through the G protein-coupled receptor NPY4R2
Secreted
Variantes genéticas (ClinVar)
80 variantes patogênicas registradas no ClinVar.
Classificação de variantes (ClinVar)
Distribuição de 276 variantes classificadas pelo ClinVar.
Vias biológicas (Reactome)
2 vias biológicas associadas aos genes desta condição.
Diagnóstico
Os sinais que médicos procuram e os exames que confirmam
Tratamento e manejo
Remédios, cuidados de apoio e o que precisa acompanhar
Onde tratar no SUS
Hospitais de referência no Brasil e o protocolo oficial do SUS (PCDT)
🇧🇷 Atendimento SUS — Deficiência de nucleosídeos purínicos fosforilase
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Dados de DATASUS/CNES, SBGM, ABNeuro e Ministério da Saúde. Sempre confirme a disponibilidade diretamente com o estabelecimento.
Pesquisa ativa
Ensaios clínicos abertos e novidades científicas recentes
Ensaios em destaque
🟢 Recrutando agora
2 pesquisas recrutando participantes. Converse com seu médico sobre a possibilidade de participar.
Outros ensaios clínicos
3 ensaios clínicos encontrados, 2 ativos.
Publicações mais relevantes
Hematopoietic stem cell transplantation for purine nucleoside phosphorylase deficiency: an EBMT-IEWP retrospective study.
Purine nucleoside phosphorylase (PNP) deficiency causes inadequate purine metabolite detoxification, which leads to combined immunodeficiency and variable neurologic symptoms. Hematopoietic stem cell transplantation (HSCT) cures the immunodeficiency, but large studies on the long-term outcomes are lacking. In a retrospective study of the European Society for Blood and Marrow Transplantation, we investigated 46 patients with PNP deficiency from 21 centers. We analyzed the presenting clinical signs and outcomes after HSCT. Cognition (0-3), hearing (0-3), interaction (0-4), movement (0-4), and occupation (0-3) (CHIMO) were scored at the last follow-up (FU) visit (no impairment, 17; mild, 15-16; moderate, 12-14; and severe impairment, <12). The median age at initial presentation was 7.5 (1-48) months. The patients presented with infections (41%), neurological dysfunction (39%), both (15%), or autoimmune disease (5%). At the time of HSCT (median age, 26 [2-192] months), neurological abnormalities were observed in 88% of patients. After a median FU of 7.9 (1.0-22.3) years, 40 patients were alive with a 3-year overall survival (OS)/event-free survival (EFS) probabilities of 86% (confidence interval [CI], 77%-97%)/75% (CI, 64%-89%), respectively. High-level (>50%-100%)/low-level donor chimerism (11%-50%) was observed in 85%/15% of patients, respectively, leading to resolution of T lymphopenia. The median overall CHIMO score was 14 (6-17), while the median scores for each component were 3 (0-3), 3 (1-3), 4 (1-4), 3 (1-4), and 2 (0-3), respectively. Patients who underwent HSCT before 24 months after the initial presentation demonstrated superior OS (P = .049). Neurological symptoms that occurred before 11 months of age were associated with reduced OS (P = .027). While the overall results were satisfactory, earlier diagnosis could further improve outcomes.
MTAP Loss Correlates With Favorable Prognosis in HPV-independent, p16-negative Oropharyngeal Squamous Cell Carcinoma.
Human papillomavirus (HPV)-independent oropharyngeal squamous cell carcinoma (OPSCC) is an aggressive cancer without established molecular prognosis. CDKN2A (encoding p16) deletion is a common genetic event in HPV-independent OPSCC. CDKN2A homozygous deletion is recognized as a poor prognostic factor in various tumors, such as gliomas, and methylthioadenosine phosphorylase (MTAP) immunostaining serves as a surrogate marker for it. Because MTAP is related to the methionine salvage pathway, various cancer cell lines with MTAP deletion have been reported to exhibit increased sensitivity to the pyrimidine analog 5-fluorouracil (5-FU). This study aimed to clarify the prognostic effect of the expressions and homozygous deletions of CDKN2A ( p16 ) and MTAP in 177 patients with OPSCC (106 HPV-positive and 71 HPV-negative) by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). MTAP loss by IHC was observed in 25.3% (16/63) of HPV-negative/p16-negative OPSCCs, and FISH confirmed homozygous deletions of both CDKN2A and MTAP . All HPV-negative/p16-positive (n=8) and HPV-positive (n=106) OPSCCs did not exhibit MTAP deficiency. The prognosis of the HPV-negative/MTAP - loss group (n=16) was significantly better than that of the HPV-negative/MTAP-retained group (n=47) and was as favorable as that of the HPV-positive group (n=106). A similar trend was confirmed in patients with HPV-negative OPSCC who received pyrimidine-based chemotherapy (n=46). MTAP deficiency is closely associated with homozygous CDKN2A and MTAP deletions in HPV-negative/p16-negative OPSCCs. Furthermore, MTAP loss may be a favorable prognostic factor in HPV-negative OPSCC, and this paradoxical phenomenon might be explained by the enhanced efficacy of chemotherapy with pyrimidine analogs.
Partial Purine Nucleoside Phosphorylase Deficiency: an Unexpected Diagnosis in an Adult Patient.
MTAP-Null Tumors: A Comprehensive Review on Synthetic Vulnerabilities and Therapeutic Strategies.
Homozygous deletion of the 9p21.3 genomic locus spanning the CDKN2A/B and MTAP genes is an event affecting 15% of cancers. While CDKN2A is a well-established tumor suppressor gene, the role of MTAP in tumorigenesis varies across cancer types. MTAP codes for methylthioadenosine phosphorylase, a key enzyme in the methionine salvage pathway, and its loss has been associated with several downstream synthetic vulnerabilities. Despite multiple efforts to exploit MTAP loss for targeted therapies, none of these efforts have yielded substantial results in clinical trials. In this review, we consolidate the existing literature along with our systematic analysis to provide an updated perspective on the incidence of MTAP loss in different cancers and elucidate its impact on metabolism, immune microenvironment, and tumor progression. In addition, we summarize the therapeutic strategies that have been investigated preclinically on MTAP-null tumors before and after the advent of functional genomic screening tools. We further assess the current landscape of clinical trials investigating MTAP-targeted inhibitors, evaluating their limitations and potential avenues for improvement. The insights gained from this review will inform future research directions beyond the promising PRMT5/MAT2A axis for rational combination therapies that would work synergistically to eradicate this devastating disease.
MTAP deficiency confers resistance to cytosolic nucleic acid sensing and STING agonists.
Cytosolic nucleic acid-sensing pathways are potential targets for cancer immunotherapy. Although stimulator of interferon genes (STING) agonists have shown substantial antitumor effects in animal models, their clinical efficacy in human tumors remains unclear. Deletion of methylthioadenosine phosphorylase (MTAP) is a common genomic alteration in human tumors but is rare in preclinical syngeneic mouse models. We found that homozygous MTAP deletion in human tumors creates a tumor microenvironment that obstructs cytosolic nucleic acid-sensing pathways by down-regulating interferon regulatory factor 3 (IRF3), leading to resistance to STING agonists. Targeting polyamine biosynthesis reverses IRF3 down-regulation, restoring sensitivity to STING agonists in MTAP-deficient tumors. Our findings suggest that MTAP genetic status may inform patient responses to STING agonist therapy and offer an alternative strategy for boosting antitumor immune responses using STING agonists in MTAP-deleted tumors.
Publicações recentes
Partial Purine Nucleoside Phosphorylase Deficiency: an Unexpected Diagnosis in an Adult Patient.
Hematopoietic stem cell transplantation for purine nucleoside phosphorylase deficiency: an EBMT-IEWP retrospective study.
The Success of Newborn Screening Beyond War: An International Collaborative Case of Purine Nucleoside Phosphorylase (PNP) Deficiency.
Purine Nucleoside Phosphorylase Deficiency: A Case Report of an Extremely Rare Disorder.
Hematopoietic stem cell transplantation for purine nucleoside phosphorylase deficiency with two novel mutations: a case report and review of literature.
📚 EuropePMC105 artigos no totalmostrando 58
Partial Purine Nucleoside Phosphorylase Deficiency: an Unexpected Diagnosis in an Adult Patient.
Journal of clinical immunologyMTAP-Null Tumors: A Comprehensive Review on Synthetic Vulnerabilities and Therapeutic Strategies.
CellsFuro[2,3-f]quinazolin-7(6H)-one Derivatives as Potent, Selective, and Orally Bioavailable MAT2A Inhibitors for MTAP-Deficient Cancer Therapy.
Journal of medicinal chemistryImmune suppression in MTAP-deficient cancers via glutamate metabolism and CXCL10 downregulation.
Frontiers in immunologyMTAP Loss Correlates With Favorable Prognosis in HPV-independent, p16-negative Oropharyngeal Squamous Cell Carcinoma.
The American journal of surgical pathologyMTAP deficiency confers resistance to cytosolic nucleic acid sensing and STING agonists.
Science (New York, N.Y.)Hematopoietic stem cell transplantation for purine nucleoside phosphorylase deficiency: an EBMT-IEWP retrospective study.
BloodThe Success of Newborn Screening Beyond War: An International Collaborative Case of Purine Nucleoside Phosphorylase (PNP) Deficiency.
International journal of neonatal screeningA systematic literature review of MTAP deletions in solid and hematologic Cancers.
Cancer treatment and research communicationsMTAP deficiency is highly homogeneous in advanced, muscle-invasive urothelial carcinoma of the urinary bladder.
Scientific reportsPrognostic Role of MTAP Loss in Cholangiocarcinoma.
JCO precision oncologyMTA-Cooperative PRMT5 Inhibitors Are Efficacious in MTAP-Deleted Malignant Peripheral Nerve Sheath Tumor Models.
Clinical cancer research : an official journal of the American Association for Cancer ResearchDiscovery and Mechanism of 16-19F, a Novel Synthetic Lethal Inhibitor of the PRMT5•MTA Complex in MTAP-Deleted Cancer Cells.
ACS chemical biologyDiscovery of AMG 193, an MTA-Cooperative PRMT5 Inhibitor for the Treatment of MTAP-Deleted Cancers.
Journal of medicinal chemistryPan-cancer clinical and molecular landscape of MTAP deletion in nationwide and international comprehensive genomic data.
ESMO open5'-S-(3-Aminophenyl)-5'-thioadenosine, a Novel Chemoprotective Agent for Reducing Toxic Side Effects of Fluorouracil in Treatment of MTAP-Deficient Cancers.
Molecular cancer therapeuticsMethionine intervention induces PD-L1 expression to enhance the immune checkpoint therapy response in MTAP-deleted osteosarcoma.
Cell reports. MedicinePurine Nucleoside Phosphorylase Deficiency: A Case Report of an Extremely Rare Disorder.
CureusDiscovery of Novel Spirocyclic MAT2A Inhibitors Demonstrating High In Vivo Efficacy in MTAP-Null Xenograft Models.
Journal of medicinal chemistryHematopoietic stem cell transplantation for purine nucleoside phosphorylase deficiency with two novel mutations: a case report and review of literature.
Hematology (Amsterdam, Netherlands)Discovery of 2(1H)-Quinoxalinone Derivatives as Potent and Selective MAT2A Inhibitors for the Treatment of MTAP-Deficient Cancers.
Journal of medicinal chemistryInhibitory Effect of PRMT5/MTA Inhibitor on MTAP-Deficient Glioma May Be Influenced by Surrounding Normal Cells.
Cancer medicineMTAP as an emerging biomarker in thoracic malignancies.
Lung cancer (Amsterdam, Netherlands)Prevalence of S-methyl-5'-thioadenosine Phosphorylase (MTAP) Deficiency in Human Cancer: A Tissue Microarray Study on 13,067 Tumors From 149 Different Tumor Types.
The American journal of surgical pathologyExpanded Newborn Screening for Inborn Errors of Immunity: The Experience of Tuscany.
The journal of allergy and clinical immunology. In practicePurine Nucleoside Phosphorylase Deficiency in Two Unrelated Patients with Autoimmune Hemolytic Anemia and Eosinophilia: Two Novel Mutations.
Archives of Iranian medicineNeurologic Status of Patients with Purine Nucleoside Phosphorylase Deficiency Before and After Hematopoetic Stem Cell Transplantation.
Journal of clinical immunologyQuantitation of Purine in Urine by Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry.
Methods in molecular biology (Clifton, N.J.)Purine nucleoside phosphorylase deficiency induces p53-mediated intrinsic apoptosis in human induced pluripotent stem cell-derived neurons.
Scientific reportsDeletion of MTAP Highly Sensitizes Osteosarcoma Cells to Methionine Restriction With Recombinant Methioninase.
Cancer genomics & proteomicsCombined immunodeficiency due to purine nucleoside phosphorylase deficiency: Outcome of three patients.
European journal of medical geneticsFragment-Based Discovery of MRTX1719, a Synthetic Lethal Inhibitor of the PRMT5•MTA Complex for the Treatment of MTAP-Deleted Cancers.
Journal of medicinal chemistryEarly Diagnosis and Treatment of Purine Nucleoside Phosphorylase (PNP) Deficiency through TREC-Based Newborn Screening.
International journal of neonatal screeningMTAP Deficiency-Induced Metabolic Reprogramming Creates a Vulnerability to Cotargeting De Novo Purine Synthesis and Glycolysis in Pancreatic Cancer.
Cancer researchHomozygous MTAP deletion in primary human glioblastoma is not associated with elevation of methylthioadenosine.
Nature communicationsThe purine nucleoside phosphorylase pnp-1 regulates epithelial cell resistance to infection in C. elegans.
PLoS pathogensUpfront Enzyme Replacement via Erythrocyte Transfusions for PNP Deficiency.
Journal of clinical immunologyInborn errors of immunity associated with characteristic phenotypes.
Jornal de pediatriaRecurrent infections, neurologic signs, low serum uric acid levels, and lymphopenia in childhood: Purine nucleoside phosphorylase deficiency, an emergency for infants.
Turk pediatri arsiviPartial Purine Nucleoside Phosphorylase Deficiency Helps Determine Minimal Activity Required for Immune and Neurological Development.
Frontiers in immunologyA Case with Purine Nucleoside Phosphorylase Deficiency Suffering from Late-Onset Systemic Lupus Erythematosus and Lymphoma.
Journal of clinical immunologyMTAP-deficiency could predict better treatment response in advanced lung adenocarcinoma patients initially treated with pemetrexed-platinum chemotherapy and bevacizumab.
Scientific reportsThe Broad Clinical Spectrum and Transplant Results of PNP Deficiency.
Journal of clinical immunologyAnti-tumor Activity of the Type I PRMT Inhibitor, GSK3368715, Synergizes with PRMT5 Inhibition through MTAP Loss.
Cancer cellAn unusual presentation of purine nucleoside phosphorylase deficiency mimicking systemic juvenile idiopathic arthritis complicated by macrophage activation syndrome.
Pediatric rheumatology online journalImmunodeficiency, Motor Delay, and Hypouricemia Caused by a Novel Mutation of Purine Nucleoside Phosphorylase Gene in an Indian Infant.
Annals of Indian Academy of NeurologyDirect-infusion based metabolomics unveils biochemical profiles of inborn errors of metabolism in cerebrospinal fluid.
Molecular genetics and metabolismThe First Purine Nucleoside Phosphorylase Deficiency Patient Resembling IgA Deficiency and a Review of the Literature.
Immunological investigationsIntracellular Delivery of Human Purine Nucleoside Phosphorylase by Engineered Diphtheria Toxin Rescues Function in Target Cells.
Molecular pharmaceuticsInfusion of Sibling Marrow in a Patient with Purine Nucleoside Phosphorylase Deficiency Leads to Split Mixed Donor Chimerism and Normal Immunity.
Frontiers in pediatricsMTAP Deletions in Cancer Create Vulnerability to Targeting of the MAT2A/PRMT5/RIOK1 Axis.
Cell reportsThe First Report of a Pregnancy in a Patient with Purine Nucleoside Phosphorylase Deficiency.
Fetal and pediatric pathologyMethylthioadenosine (MTA) Regulates Liver Cells Proteome and Methylproteome: Implications in Liver Biology and Disease.
Molecular & cellular proteomics : MCPCharacterization and Prognostic Significance of Methylthioadenosine Phosphorylase Deficiency in Nasopharyngeal Carcinoma.
MedicineUrine Purine Metabolite Determination by UPLC-Tandem Mass Spectrometry.
Methods in molecular biology (Clifton, N.J.)Development and validation of a 2nd tier test for identification of purine nucleoside phosphorylase deficiency patients during expanded newborn screening by liquid chromatography-tandem mass spectrometry.
Clinical chemistry and laboratory medicineNovel Genetic Mutations in the First Swedish Patient with Purine Nucleoside Phosphorylase Deficiency and Clinical Outcome After Hematopoietic Stem Cell Transplantation with HLA-Matched Unrelated Donor.
JIMD reportsMethylthioadenosine phosphorylase (MTAP)-deficient T-cell ALL xenografts are sensitive to pralatrexate and 6-thioguanine alone and in combination.
Cancer chemotherapy and pharmacologyAssociações
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Referências e fontes
Bases de dados externas citadas neste artigo
Publicações científicas
Artigos indexados no PubMed ligados a esta doença no grafo RarasNet — título, periódico e PMID direto da fonte, sem intermediação de IA.
- Hematopoietic stem cell transplantation for purine nucleoside phosphorylase deficiency: an EBMT-IEWP retrospective study.
- MTAP Loss Correlates With Favorable Prognosis in HPV-independent, p16-negative Oropharyngeal Squamous Cell Carcinoma.
- Partial Purine Nucleoside Phosphorylase Deficiency: an Unexpected Diagnosis in an Adult Patient.
- MTAP-Null Tumors: A Comprehensive Review on Synthetic Vulnerabilities and Therapeutic Strategies.
- MTAP deficiency confers resistance to cytosolic nucleic acid sensing and STING agonists.
- The Success of Newborn Screening Beyond War: An International Collaborative Case of Purine Nucleoside Phosphorylase (PNP) Deficiency.
- Purine Nucleoside Phosphorylase Deficiency: A Case Report of an Extremely Rare Disorder.
- Hematopoietic stem cell transplantation for purine nucleoside phosphorylase deficiency with two novel mutations: a case report and review of literature.
Bases de dados e fontes oficiais
Identificadores e referências canônicas usadas para montar este verbete.
- ORPHA:760(Orphanet)
- OMIM OMIM:613179(OMIM)
- MONDO:0013171(MONDO)
- GARD:4606(GARD (NIH))
- Variantes catalogadas(ClinVar)
- Busca completa no PubMed(PubMed)
- Q3043155(Wikidata)
Dados compilados pelo RarasNet a partir de fontes abertas (Orphanet, OMIM, MONDO, PubMed/EuropePMC, ClinicalTrials.gov, DATASUS, PCDT/MS). Este conteúdo é informativo e não substitui avaliação médica.
Conteúdo mantido por Agente Raras · Médicos e pesquisadores podem colaborar
