Phytol is a branched chain fatty alcohol, which is abundantly present in nature as part of the chlorophyll molecule. In its free form, phytol is metabolized to phytanic acid, which accumulates in patients suffering from a variety of peroxisomal disorders, including Refsum disease. The breakdown of phytol to phytanic acid takes place in three steps, in which first, the alcohol is converted to the aldehyde, second the aldehyde is converted to phytenic acid, and finally the double bond is reduced to yield phytanic acid. By culturing fibroblasts in the presence of phytol, increases in the levels of phytenic and phytanic acid were detected. Interestingly, fibroblasts derived from patients affected by Sjögren Larsson syndrome (SLS), known to be deficient in microsomal fatty aldehyde dehydrogenase (FALDH) were found to be deficient in this. In addition, fibroblast homogenates of these patients, incubated with phytol in the presence of NAD+ did not produce any phytenic acid. This indicates that FALDH is involved in the breakdown of phytol.

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http://dx.doi.org/10.1016/j.ymgme.2004.01.019DOI Listing

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  • Refsum disease is a rare genetic disorder affecting lipid metabolism, leading to the buildup of phytanic acid and resulting in symptoms like ataxia, neuropathy, and hearing loss, with potential cardiac issues developing later in life.
  • A case study presented a 38-year-old man who experienced acute heart failure due to dilated cardiomyopathy, confirmed by high levels of phytanic acid, illustrating that cardiac problems are common in advanced Refsum disease.
  • Management options for Refsum disease include dietary restrictions on phytanic acid and lipid apheresis to alleviate symptoms and improve patients' quality of life.
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  • The study aims to investigate the molecular effects of the PHYH:c.678+5G>T variant, which has conflicting reports in the ClinVar database and appears with a low frequency in the South Asian population.
  • Researchers recruited patients with retinitis pigmentosa from Moorfields Eye Hospital and Buenos Aires, who had biallelic PHYH variants, and analyzed their blood samples for RNA sequencing.
  • Results showed that the variant significantly affects splicing in the PHYH gene, indicating a pathogenic classification, suggesting that patients with this genotype should be tested for phytanic acid levels due to varying presentations of the disease.
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