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25-year-old man with fibrodysplasia ossificans progressiva, right, and a
view of his skeleton post mortem, left.
(Dr. Fred Kaplan)
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This is the fate of those with fibrodysplasia ossificans progressiva
(FOP), one of the rarest,
most disabling genetic conditions, in which inflammation causes the
body's soft tissues to turn to bone, slowly trapping victims in a second
skeleton.
Ashley Kurpiel, 28, from Peachtree City, Ga., has battled FOP since she
was diagnosed at age 3 -- just five months after doctors mistakenly
amputated her right arm, on the assumption that the growths caused by FOP
were cancerous
tumors.
"Ninety percent of [FOPers] get misdiagnosed with some form of
cancer," Kurpiel says.
Some undergo needless chemotherapy, biopsies, or surgeries, all of
which worsen the condition -- causing more inflammation and consequently,
more bone.
There are believed to be 700 patients with FOP around the globe. For
them, something as simple as a visit to the dentist, a fall, or an
immunization shot can lead the joints to lock up -- sometimes overnight --
never to move again.
"I can't move my left arm from my side at all, I have very little
neck movement, no lower back movement at all, my right hip is affected,
and my upper back is really stiff," Kurpiel says.
The condition slowly freezes up the victim's body, but trauma,
infection, or any cause for inflammation can speed the progression,
precipitating a painful flare-up and leading to further bone growth and
disability.
"The worst flare-up I had was my upper thigh at age 25. The whole
leg was red and swollen, I couldn't move, it was insanely painful,"
Kurpiel says.
Currently there is "no real treatment to cure or significantly
change the course of the disease," says Dr. Eileen Shore, a research
associate professor of orthopedic surgery at the University of
Pennsylvania, who has studied the disease since 1991.
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Ashley Kurpiel seen before the amputation,
right, and today, left.
(Courtesy Ashley Kurpiel) |
Steroids can be administered at the first signs of a flare-up to reduce
the inflammation, but the success of this treatment is limited and varies
greatly from patient to patient, Shore says.
While the fate of FOPers may seem bleak, there
is much reason to hope, says Dr. Fred Kaplan, an orthopedist who has
devoted his life to solving the mysterious genetic disorder.
Since the identification of the gene, which causes FOP, in 2006
"we are in a whole different universe" in the research, Kaplan
says. "It opened up new horizons of therapy and unlocked the doors of
hope."
Science Behind the Mystery
Muscles spontaneously turning into bone may sound like science fiction,
but researchers now understand that it is the work of a single genetic
mutation that causes the body's inflammation response to run amok.
At birth, FOP may show up as a deformity of the big toes and sometimes
extra bones in the neck, but extra bone formation elsewhere usually begins
in the first decade of life, Kaplan says.
FOPers feel a flare-up coming on when a particular body part becomes
stiff, red, swollen, and painful -- indicating that an inflammation
response is occurring. During this response, signals get crossed: instead
of producing new healthy soft tissue to heal the injury, the body begins
making hard tissue -- pushing out healthy muscles and ligaments in the
process.
Avoiding trauma that can cause inflammation is one way to slow the
progression of FOP, but for many parents, it's a tradeoff. They can
protect their child temporarily but rob him of a (more) normal childhood.
Or the child can jump and play like other kids, but pay the price later.
"You listen to some kids, what they remember is being a kid and
being able to ride a bike and run and play and it's good for them,"
says Shore. "They all say they were glad they had the chance to do
these things."
The average lifespan of those with FOP is the early 40s. Death is often
caused by heart or lung failure after the heart has been weakened by years
pumping against a hardened chest wall, Kaplan says.
Shore says future generations may benefit from increased awareness and
caution -- but the real solution may be genetic-based treatments from
research by Kaplan and Shore.
"Basically the mutation created a trap door in evolution that
allowed something to occur that we've never seen before: the
transformation of one organ into another, muscle into bone. The
identification of this mutation gives us the possibility of sealing this
trap door back up with appropriate therapies," Kaplan says.
"We've been developing animal models of FOP in chickens and flies
and fish and mice to screen and test drugs that can seal this door back
up."
FOP Community Breeds Research Advances
A large factor in making this new research possible is money raised by
the International Fibrodysplasia Ossificans Progressiva Association
(IFOPA), a nonprofit started in 1988 by Jeannie Peeper to "instill
hope through research, education and support while searching for a
cure."
Peeper was diagnosed with FOP when she was 4.
"They showed my mom and dad a couple of graphic pictures, and said
'go home and enjoy her, she's not going to live very long,'" she
says.
Now 51, Peeper has exceeded expectations -- both of her own projected
lifespan and of what could be done for this rare condition.
Before starting IFOPA, Peeper had not known anyone else with FOP. She
started the organization as a way to bring together other sufferers, and
raise funding for research.
IFOPA "lets us know that we're not alone," Kurpiel says. When
she struggled emotionally with the loss of mobility in her leg at age 25,
she says that the "support was tremendous."
When Peeper started IFOPA in her late twenties, she had mobility in one
wrist -- virtually all her other joints were locked, including her jaw, so
she says she wasn't looking for a "miracle cure" for herself.
"My desire was to make a difference for the children of future
generations," Peeper says.
"Without Jeannie, we wouldn't be where we are today," Kaplan
says. "Many adults with FOP say, 'What can you do for me?' Jeannie
says, 'What can we do for the next generation so they can have medicine to
treat this instead of a wheelchair?'"
The organization supports research by Kaplan and Shore, offers support
for those with FOP who need special equipment, and hosts seminars,
webinars, and international symposiums to raise awareness.
FOP research has unlocked "many of the secrets of how to create a
skeleton," Kaplan says -- knowledge which might also aid treatment
research for more common conditions like osteoporosis, arthritis, and
ossified heart valves.
An effective treatment may still be years away, "but I think we
see some lights on the distant horizon where before, there was only
darkness," Kaplan says.