Therapeutic advances for blocking heterotopic ossification in fibrodysplasia ossificans progressiva

Br J Clin Pharmacol. 2019 Jun;85(6):1180-1187. doi: 10.1111/bcp.13823. Epub 2019 Jan 6.

Abstract

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disease in which heterotopic bone forms in muscle and soft tissue, leading to joint dysfunction and significant disability. FOP is progressive and many patients are wheelchair-bound by the 3rd decade of life. FOP is caused by an activating mutation in the ACVR1 gene, which encodes the activin A Type 1 receptor. Aberrant signalling through this receptor leads to abnormal activation of the pSMAD 1/5/8 pathway and triggers the formation of bone outside of the skeleton. There is no curative therapy for FOP; however, exciting advances in novel therapies have developed recently. Here, we review the clinical and translational pharmacology of three drugs that are currently in clinical trials (palovarotene, REGN 2477 and rapamycin) as well as other emerging treatment strategies for FOP.

Keywords: children; drug development; immunology; immunosuppression; paediatrics.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Bone Remodeling / drug effects*
  • Bone and Bones / drug effects*
  • Bone and Bones / metabolism
  • Bone and Bones / physiopathology
  • Humans
  • Myositis Ossificans / drug therapy*
  • Myositis Ossificans / metabolism
  • Myositis Ossificans / physiopathology
  • Ossification, Heterotopic / drug therapy*
  • Ossification, Heterotopic / metabolism
  • Ossification, Heterotopic / physiopathology
  • Pyrazoles / adverse effects
  • Pyrazoles / therapeutic use*
  • Signal Transduction
  • Sirolimus / adverse effects
  • Sirolimus / therapeutic use*
  • Stilbenes / adverse effects
  • Stilbenes / therapeutic use*
  • Treatment Outcome

Substances

  • Pyrazoles
  • Stilbenes
  • Palovarotene
  • Sirolimus