The translational observations made in a cohort of patients in the EPP revealed elevated miR-137 and decreased COX6A2 and mitophagy marker levels in plasma exosomes (Fig. 2A), changes similar to those measured in the ACC of Gclm-KO mice exposed to persisting oxidative stress (Fig. 1). This evidence concerns the gene COX6A2 and autosomal erythropoietic protoporphyria.