Perspectives of current understanding and therapeutics of Diamond-Blackfan anemia

Abstract

Diamond-Blackfan anemia (DBA) is a rare congenital bone marrow failure disorder characterized by erythroid hypoplasia. It primarily affects infants and is often caused by heterozygous allelic variations in ribosomal protein (RP) genes. Recent studies also indicated that non-RP genes like GATA1, TSR2, are associated with DBA. P53 activation, translational dysfunction, inflammation, imbalanced globin/heme synthesis, and autophagy dysregulation were shown to contribute to disrupted erythropoiesis and impaired red blood cell production. The main therapeutic option for DBA patients is corticosteroids. However, half of these patients become non-responsive to corticosteroid therapy over prolonged treatment and have to be given blood transfusions. Hematopoietic stem cell transplantation is currently the sole curative option, however, the treatment is limited by the availability of suitable donors and the potential for serious immunological complications. Recent advances in gene therapy using lentiviral vectors have shown promise in treating RPS19-deficient DBA by promoting normal hematopoiesis. With deepening insights into the molecular framework of DBA, emerging therapies like gene therapy hold promise for providing curative solutions and advancing comprehension of the underlying disease mechanisms.

Fig. 1

Timeline of understanding the history of DBA.

Fig. 2. Summary of current understanding of molecular mechanisms for DBA.

A p53 activation and cell cycle arrest leading to ribosomal stress. B Translational dysfunction caused by GATA1 and RP mutations. C Abnormal inflammatory signaling pathways due to RP mutations. D Unbalanced globin/heme synthesis caused by RP mutations.

Fig. 3

Summary of therapeutic alternatives for DBA.