Small interfering ribonucleic acids [siRNAs] are short ribonucleic acid (RNA) fragments cleaved from double-stranded RNA molecules that target and bind to specific sequences on messenger RNA (mRNA), leading to their destruction. Therefore, the siRNA down-regulates the formation of selected mRNAs and their protein products. Givosiran is one such siRNA that uses this mechanism to treat acute hepatic porphyrias. Acute hepatic porphyrias are a group of rare, inherited metabolic disorders, characterized by acute potentially life-threatening attacks as well as chronic symptoms with a negative impact on quality of life. It has four types, each associated with distinct enzyme defects in the heme biosynthesis pathway in the liver. By targeting the expression of hepatic 5-aminolevulinic acid [ALA] synthase-1 [ALAS1], givosiran can down-regulate levels of toxic metabolites, leading to biochemical and clinical improvement. Givosiran selectively targets hepatocytes due to its linkage to -acetylgalactosamine (GalNac) leading to its selective uptake via asialoglycoprotein receptors (ASGPR). We provide an up-to-date literature review regarding givosiran in the context of a clinical overview of the porphyrias, an overview of siRNAs for therapy of human disorders, the design and development of givosiran, key clinical trial results of givosiran for prevention of acute porphyric attacks, emerging concerns regarding chronic use of givosiran, and the overall management of acute hepatic porphyrias. These insights are important not only for the management of acute hepatic porphyrias but also for the emerging field of siRNAs and their role in novel therapies for various diseases.
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http://dx.doi.org/10.2147/DDDT.S281631 | DOI Listing |
Best Pract Res Clin Gastroenterol
December 2024
Department of Critical Care Medicine, University of Alberta, Edmonton, Canada; Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Canada. Electronic address:
Best Pract Res Clin Gastroenterol
December 2024
Institute of Digestive & Liver Diseases, BLK Superspeciality Hospital, Delhi, India. Electronic address:
Neurological complications in acute liver failure are the most common cause of mortality in this group of patients. Almost all neurologic complications arise from underlying increase in intracranial pressure in ALF. In addition to symptomatic management, the treatment relies on measures to bring down ICP.
View Article and Find Full Text PDFBest Pract Res Clin Gastroenterol
December 2024
Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
Acute liver failure (ALF) is defined as the loss of hepatic function in conjunction with hepatic encephalopathy and coagulopathy. There is histological evidence of profound hepatocyte damage. If it is not aggressively managed, ALF can be fatal within a few days.
View Article and Find Full Text PDFBest Pract Res Clin Gastroenterol
December 2024
Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India. Electronic address:
Acute liver failure (ALF) is a rare but preventable cause of acute hepatic dysfunction which is associated with significant mortality, unless treated appropriately. There are significant regional variations in the etiologies of ALF globally and this determines the outcomes of the disease as well as the long-term survival in patients receiving liver transplantation for management. Improvements in understanding of disease pathophysiology and critical care medicine have led to better outcomes over the last few decades.
View Article and Find Full Text PDFBest Pract Res Clin Gastroenterol
December 2024
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address:
Acute liver failure (ALF) is a rare but rapidly progressing syndrome, marked by severe liver dysfunction and altered mental status. While definitions of ALF vary across different guidelines, with timelines ranging from 4 to 26 weeks between jaundice onset and encephalopathy, the key defining features remain encephalopathy and coagulopathy. Elevated coagulation markers, particularly prothrombin time and international normalized ratio, have traditionally been associated with bleeding risks.
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