Oculocutaneous albinism (OCA) is a group of genetic disorders characterized by hypopigmentation of the skin, hair, and eyes. Affected individuals experience reduced visual acuity and substantially increased skin cancer risk. There are four major types of OCA (OCA1-OCA4) that result from disruption in production of melanin from tyrosine. Current treatment options for individuals with OCA are limited to attempts to correct visual problems and counseling to promote use of sun protective measures. However, Onojafe et al., reporting in this issue of the JCI, provide hope for a new treatment approach for OCA, as they demonstrate that treating mice that model OCA-1b with nitisinone, which is FDA approved for treating hereditary tyrosinemia type 1, elevates plasma tyrosine levels, and increases eye and hair pigmentation.
Oculocutaneous albinismMelanin is a biopolymer synthesized from tyrosine. Upon synthesis, it is deposited in specialized organelles (melanosomes) in neural crest-derived melanocytes found in the skin, hair follicles, iris, uveal tract, and inner ear as well as in retinal pigmented epithelium (RPE) derived from the optic cup. Oculocutaneous albinism (OCA) denotes a group of common autosomal-recessive disorders that result from disruption of melanin synthesis. There are four major forms: OCA1, which is caused by mutations in the tyrosinase gene (TYR) (1); OCA2, caused by mutations in OCA2 (2); OCA3, caused by mutations in the tyrosinase-related protein 1 gene (TYRP1) (3); and OCA4, caused by mutations in the solute carrier family 45, member 2 gene (SLC45A2) (4). OCA1 affects approximately 1 in 40,000 people worldwide and is the most prevalent form of OCA among individuals of mixed European descent. OCA2 affects 1 in 39,000 such individuals, with substantially higher prevalence in AfricanAmerican and Amerindian populations. The carrier rate of a pathogenic deletion of OCA2 in African-American newborns is estimated to be 1 in 235 (5); rates in some Amerindian populations reach 1 in 200 (6). OCA3 is rare, with notable frequency only in African populations (3). The incidence of OCA4 is not known; however, it appears to be more prevalent in Japanese populations (7).OCAs are characterized by decreased or absent melanin in skin, hair, and eyes. In skin, melanin plays a central role in protection from UV-induced carcinogenesis. Thus, individuals with OCA are highly susceptible to skin cancers, particularly squamous cell carcinoma. During embryogenesis, melanin synthesis in the RPE affects development of the fovea and of adjacent retinal ganglion cells, which in turn regulate decussation of the nerve connecting the retina to brain at the optic chiasm. Numerous structural abnormalities ensue if melanogenesis is deficient. In the adult eye, melanin appears important for reducing light scatter and aiding acuity. Individuals with OCA consequently suffer from nystagmus, strabismus, photophobia, and loss of visual acuity that can be severe enough to render them legally blind (8).The highly visible OCA phenotypemost dram...