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Mevalonate kinase deficiency: current perspectives

Authors Favier L, Schulert G

Received 19 April 2016

Accepted for publication 10 May 2016

Published 20 July 2016 Volume 2016:9 Pages 101—110

DOI https://doi.org/10.2147/TACG.S93933

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Martin H. Maurer


Leslie A Favier, Grant S Schulert

Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

Abstract: Mevalonate kinase deficiency (MKD) is a recessively inherited autoinflammatory disorder with a spectrum of manifestations, including the well-defined clinical phenotypes of hyperimmunoglobulinemia D and periodic fever syndrome and mevalonic aciduria. Patients with MKD have recurrent attacks of hyperinflammation associated with fever, abdominal pain, arthralgias, and mucocutaneous lesions, and more severely affected patients also have dysmorphisms and central nervous system anomalies. MKD is caused by mutations in the gene encoding mevalonate kinase, with the degree of residual enzyme activity largely determining disease severity. Mevalonate kinase is essential for the biosynthesis of nonsterol isoprenoids, which mediate protein prenylation. Although the precise pathogenesis of MKD remains unclear, increasing evidence suggests that deficiency in protein prenylation leads to innate immune activation and systemic hyperinflammation. Given the emerging understanding of MKD as an autoinflammatory disorder, recent treatment approaches have largely focused on cytokine-directed biologic therapy. Herein, we review the current genetic and pathologic understanding of MKD, its various clinical phenotypes, and the evolving treatment approach for this multifaceted disorder.

Keywords: mevalonic aciduria, hyperimmunoglobulinemia D and periodic fever syndrome, autoinflammatory, periodic fever syndrome

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