201
|
Quality of life in people with epidermolysis bullosa: a systematic review. Qual Life Res 2020; 29:1731-1745. [DOI: 10.1007/s11136-020-02495-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 12/12/2022]
|
202
|
Sindici E, Basiglio L, Cafaro A, Fazio L, Dragonetti A, Pugliese M, Carossa S, Broccoletti R, Arduino PG. The photobiomodulation therapy together with the use of cord blood platelet gel could be safely suggested as primary treatment for oral lesions in patients with inherited epidermolysis bullosa. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2020; 36:318-321. [PMID: 32176390 DOI: 10.1111/phpp.12548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/14/2020] [Accepted: 03/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ezio Sindici
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - Lucia Basiglio
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - Adriana Cafaro
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - Luigina Fazio
- Torino Cord Blood Bank - Immunohematology and Transfusional Medical Service, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Antonella Dragonetti
- Torino Cord Blood Bank - Immunohematology and Transfusional Medical Service, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Mariateresa Pugliese
- Torino Cord Blood Bank - Immunohematology and Transfusional Medical Service, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Stefano Carossa
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - Roberto Broccoletti
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| | - Paolo G Arduino
- Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy
| |
Collapse
|
203
|
Eng VA, Solis DC, Gorell ES, Choi S, Nazaroff J, Li S, de Souza MP, Murrell DF, Marinkovich MP, Tang JY. Patient-reported outcomes and quality of life in recessive dystrophic epidermolysis bullosa: A global cross-sectional survey. J Am Acad Dermatol 2020; 85:1161-1167. [PMID: 32199895 DOI: 10.1016/j.jaad.2020.03.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 03/06/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A spectrum of skin disease severity exists in patients with recessive dystrophic epidermolysis bullosa (RDEB). OBJECTIVE To characterize the patient-reported outcomes and quality of life (QOL) in patients with RDEB. METHODS A cross-sectional study of patients with RDEB surveyed through the global EBCare Registry. Patient-reported outcomes included skin disease severity, wound characteristics, pain, itch, extracutaneous symptoms, and medications. QOL was measured by using the validated Quality of Life in Epidermolysis Bullosa instrument. RESULTS A total of 85 patients with RDEB reported 1226 wounds (937 recurrent wounds and 289 chronic open wounds). Overall skin disease severity was self-reported as mild (26%; 22/83), moderate (48%; 40/83), or severe (25%; 21/83). Worsening skin disease severity was significantly associated with larger wounds, increased opiate use, anemia, gastrostomy tube use, infections, osteoporosis, and squamous cell carcinoma. Larger wound size was associated with worse quality of life scores. LIMITATIONS All data were self-reported from an online epidermolysis bullosa patient registry. CONCLUSIONS This study shows a significant correlation between larger wound size with worsening skin disease severity and quality of life in participants with RDEB. Worsening skin disease severity significantly correlated with key clinical manifestations. These results show that patients with RDEB are able to self-report their skin disease severity and wounds.
Collapse
Affiliation(s)
- Victor A Eng
- Department of Dermatology, Stanford University School of Medicine, California
| | - Daniel C Solis
- Department of Internal Medicine, University of California Riverside
| | - Emily S Gorell
- Department of Dermatology, Stanford University School of Medicine, California
| | - Sara Choi
- Department of Dermatology, Stanford University School of Medicine, California
| | | | - Shufeng Li
- Department of Dermatology, Stanford University School of Medicine, California
| | | | | | - M Peter Marinkovich
- Department of Dermatology, Stanford University School of Medicine, California; Department of Dermatology, Palo Alto Veterans Affairs Medical Center, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, California.
| |
Collapse
|
204
|
Bchetnia M, Martineau L, Racine V, Powell J, McCuaig C, Puymirat J, Laprise C. Generation of a human induced pluripotent stem cell line (UQACi001-A) from a severe epidermolysis bullosa simplex patient with the heterozygous mutation p.R125S in the KRT14 gene. Stem Cell Res 2020; 44:101748. [PMID: 32179493 DOI: 10.1016/j.scr.2020.101748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 11/18/2022] Open
Abstract
We have generated UQACi001-A, a new induced pluripotent stem cell (iPSC) line derived from skin fibroblasts of a male patient with the generalized severe epidermolysis bullosa simplex phenotype (EBS-gen sev) and carrying the keratin 14 (K14) R125S mutation. Fibroblasts were reprogrammed using non-integrating Sendai virus vectors. The iPSC line displayed normal molecular karyotype, expressed pluripotency markers, is capable of differentiating into three embryonic germ layers and is genetically identical to the originating parental fibroblasts. The established iPSC model provides a valuable resource for studying the rare disease of epidermolysis bullosa simplex and developing new therapies as DNA editing by CRISPR/Cas9 technology.
Collapse
Affiliation(s)
- Mbarka Bchetnia
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, 555 Boulevard de l'Université, Chicoutimi, QC G7H 2B1, Canada
| | - Laurie Martineau
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada
| | - Véronique Racine
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada
| | - Julie Powell
- Hôpital Ste-Justine, Montréal, QC H3T 1C5, Canada
| | | | - Jack Puymirat
- CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada
| | - Catherine Laprise
- Département des Sciences Fondamentales, Université du Québec à Chicoutimi, 555 Boulevard de l'Université, Chicoutimi, QC G7H 2B1, Canada.
| |
Collapse
|
205
|
Camors EM, Purevjav E, Jefferies JL, Saffitz JE, Gong N, Ryan TD, Lucky AW, Taylor MD, Sullivan LM, Mestroni L, Towbin JA. Early Lethality Due to a Novel Desmoplakin Variant Causing Infantile Epidermolysis Bullosa Simplex With Fragile Skin, Aplasia Cutis Congenita, and Arrhythmogenic Cardiomyopathy. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e002800. [PMID: 32164419 DOI: 10.1161/circgen.119.002800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Emmanuel M Camors
- Department of Pediatrics, The Heart Institute (E.M.C., E.P., J.L.J., N.G., T.D.R., M.D.T., J.A.T.), Cincinnati Children's Hospital Medical Center, OH.,The Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center and the Heart Institute, Le Bonheur Children's Hospital Research Center, Memphis, TN (E.M.C., E.P., J.A.T.)
| | - Enkhsaikhan Purevjav
- Department of Pediatrics, The Heart Institute (E.M.C., E.P., J.L.J., N.G., T.D.R., M.D.T., J.A.T.), Cincinnati Children's Hospital Medical Center, OH.,The Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center and the Heart Institute, Le Bonheur Children's Hospital Research Center, Memphis, TN (E.M.C., E.P., J.A.T.)
| | - John L Jefferies
- Department of Pediatrics, The Heart Institute (E.M.C., E.P., J.L.J., N.G., T.D.R., M.D.T., J.A.T.), Cincinnati Children's Hospital Medical Center, OH
| | - Jeffrey E Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA (J.E.S.)
| | - Nan Gong
- Department of Pediatrics, The Heart Institute (E.M.C., E.P., J.L.J., N.G., T.D.R., M.D.T., J.A.T.), Cincinnati Children's Hospital Medical Center, OH
| | - Thomas D Ryan
- Department of Pediatrics, The Heart Institute (E.M.C., E.P., J.L.J., N.G., T.D.R., M.D.T., J.A.T.), Cincinnati Children's Hospital Medical Center, OH
| | - Anne W Lucky
- The Division of Dermatology, Department of Pediatrics (A.W.L.), Cincinnati Children's Hospital Medical Center, OH
| | - Michael D Taylor
- Department of Pediatrics, The Heart Institute (E.M.C., E.P., J.L.J., N.G., T.D.R., M.D.T., J.A.T.), Cincinnati Children's Hospital Medical Center, OH
| | - Lisa M Sullivan
- Department of Pathology, University of Mississippi Medical Center, Jackson (L.M.S.)
| | - Luisa Mestroni
- The Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Denver Anschutz Medical Campus, Aurora (L.M.)
| | - Jeffrey A Towbin
- Department of Pediatrics, The Heart Institute (E.M.C., E.P., J.L.J., N.G., T.D.R., M.D.T., J.A.T.), Cincinnati Children's Hospital Medical Center, OH.,The Division of Cardiology, Department of Pediatrics, University of Tennessee Health Science Center and the Heart Institute, Le Bonheur Children's Hospital Research Center, Memphis, TN (E.M.C., E.P., J.A.T.)
| |
Collapse
|
206
|
Has C, Bauer JW, Bodemer C, Bolling MC, Bruckner-Tuderman L, Diem A, Fine JD, Heagerty A, Hovnanian A, Marinkovich MP, Martinez AE, McGrath JA, Moss C, Murrell DF, Palisson F, Schwieger-Briel A, Sprecher E, Tamai K, Uitto J, Woodley DT, Zambruno G, Mellerio JE. Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility. Br J Dermatol 2020; 183:614-627. [PMID: 32017015 DOI: 10.1111/bjd.18921] [Citation(s) in RCA: 367] [Impact Index Per Article: 91.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several new genes and clinical subtypes have been identified since the publication in 2014 of the report of the last International Consensus Meeting on Epidermolysis Bullosa (EB). OBJECTIVES We sought to reclassify disorders with skin fragility, with a focus on EB, based on new clinical and molecular data. METHODS This was a consensus expert review. RESULTS In this latest consensus report, we introduce the concept of genetic disorders with skin fragility, of which classical EB represents the prototype. Other disorders with skin fragility, where blisters are a minor part of the clinical picture or are not seen because skin cleavage is very superficial, are classified as separate categories. These include peeling skin disorders, erosive disorders, hyperkeratotic disorders, and connective tissue disorders with skin fragility. Because of the common manifestation of skin fragility, these 'EB-related' disorders should be considered under the EB umbrella in terms of medical and socioeconomic provision of care. CONCLUSIONS The proposed classification scheme should be of value both to clinicians and researchers, emphasizing both clinical and genetic features of EB. What is already known about this topic? Epidermolysis bullosa (EB) is a group of genetic disorders with skin blistering. The last updated recommendations on diagnosis and classification were published in 2014. What does this study add? We introduce the concept of genetic disorders with skin fragility, of which classical EB represents the prototype. Clinical and genetic aspects, genotype-phenotype correlations, disease-modifying factors and natural history of EB are reviewed. Other disorders with skin fragility, e.g. peeling skin disorders, erosive disorders, hyperkeratotic disorders, and connective tissue disorders with skin fragility are classified as separate categories; these 'EB-related' disorders should be considered under the EB umbrella in terms of medical and socioeconomic provision of care. Linked Comment: Pope. Br J Dermatol 2020; 183:603.
Collapse
Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J W Bauer
- Department of Dermatology and Allergology and EB Haus Austria University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - C Bodemer
- Department of Dermatology, Necker Hospital des Enfants Malades, University Paris-Centre APHP 5, Paris, France
| | - M C Bolling
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - L Bruckner-Tuderman
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - A Diem
- Department of Dermatology and Allergology and EB Haus Austria University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - J-D Fine
- Vanderbilt University School of Medicine, Nashville, TN, USA; National Epidermolysis Bullosa Registry, Nashville, TN, USA
| | - A Heagerty
- Heart of England Foundation Trust, Birmingham, UK
| | - A Hovnanian
- INSERM UMR1163, Imagine Institute, Department of Genetics, Necker hospital for sick children, Paris University, Paris, France
| | - M P Marinkovich
- Stanford University School of Medicine, Stanford, Palo Alto Veterans Affairs Medical Center CA, USA
| | - A E Martinez
- Dermatology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Moss
- Birmingham Children's Hospital and University of Birmingham, UK
| | - D F Murrell
- St George Hospital and University of New South Wales, Sydney, Australia
| | - F Palisson
- DEBRA Chile, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - A Schwieger-Briel
- Department of Pediatric Dermatology, University Children's Hospital Zürich, Zürich, Switzerland
| | - E Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Tamai
- Dermatology Department, University of Osaka, Osaka, Japan
| | - J Uitto
- Thomas Jefferson University, Philadelphia, PA, USA
| | - D T Woodley
- University of Southern California, Los Angeles, CA, USA
| | - G Zambruno
- Dermatology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
207
|
Gibson M, Rogers CL, Murrell DF. Successful dapsone therapy in inherited epidermolysis bullosa. J Eur Acad Dermatol Venereol 2020; 34:e333-e334. [PMID: 32065464 DOI: 10.1111/jdv.16301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M Gibson
- South Eastern Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C L Rogers
- South Eastern Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - D F Murrell
- South Eastern Sydney Local Health District, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
208
|
Fania L, Provini A, Salemme A, Sinagra JL, Guerra L, Mazzanti C, Didona B, Castiglia D, Di Zenzo G. Development of bullous pemphigoid in junctional epidermolysis bullosa. J Eur Acad Dermatol Venereol 2020; 34:e146-e148. [PMID: 31709656 DOI: 10.1111/jdv.16057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- L Fania
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - A Provini
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - A Salemme
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - J L Sinagra
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - L Guerra
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - C Mazzanti
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - B Didona
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - D Castiglia
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - G Di Zenzo
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| |
Collapse
|
209
|
Diociaiuti A, Giancristoforo S, Pisaneschi E, Condorelli AG, Boldrini R, Zambruno G, El Hachem M. Hoarse cry in a newborn with epidermolysis bullosa simplex, generalized severe. Pediatr Dermatol 2020; 37:393-395. [PMID: 31957133 DOI: 10.1111/pde.14105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hoarse cry and respiratory stridor are the signs of potentially life-threatening laryngeal involvement in selected severe and frequently early lethal subtypes of inherited epidermolysis bullosa (EB). We present a newborn with generalized skin blistering and onychodystrophy who developed a hoarse cry and inspiratory stridor. Ultrastructural skin examination revealed tonofilament clumping in basal keratinocytes and genetic testing identified the de novo missense mutation p.Arg125Cys in the KRT14 gene, consistent with EB simplex generalized severe, which is characterized by major morbidity in infancy but a favorable long-term prognosis. The present case underlines the importance to consider EB simplex generalized severe in the differential diagnosis of EB infants presenting hoarseness and stridor.
Collapse
Affiliation(s)
- Andrea Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Elisa Pisaneschi
- Medical Genetics Laboratory, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Renata Boldrini
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanna Zambruno
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - May El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| |
Collapse
|
210
|
Lalor LE, Chiu YE. Rare Vesiculopustular Eruptions of the Neonatal Period. Clin Perinatol 2020; 47:53-75. [PMID: 32000929 DOI: 10.1016/j.clp.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative to avoid unnecessary testing and treatment for benign eruptions, while allowing for adequate treatment of potentially fatal disorders. In this review, we highlight several rare blistering diseases of the newborn. A diagnostic approach is outlined to provide clinicians with a framework for approaching a neonate with vesicles, pustules, or ulcers.
Collapse
Affiliation(s)
- Leah E Lalor
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Yvonne E Chiu
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| |
Collapse
|
211
|
Valinotto LE, Natale MI, Lusso SB, Cella E, Gutiérrez O, Sebastiani F, Manzur GB. A novel pathogenic FERMT1 variant in four families with Kindler syndrome in Argentina. Pediatr Dermatol 2020; 37:337-341. [PMID: 31957900 DOI: 10.1111/pde.14076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Kindler syndrome is a rare genodermatosis. Major clinical criteria include acral blistering in infancy and childhood, progressive poikiloderma, skin atrophy, abnormal photosensitivity, and gingival fragility. METHODS FERMT1 gene was sequenced in 5 patients with a clinical diagnosis of Kindler syndrome. RESULTS We report a novel pathogenic variant detected in four unrelated families of Paraguayan origin, where one nucleotide deletion in FERMT1 gene (c.450delG) is predicted to cause a frameshift mutation leading to loss of function. Haplotype analysis revealed the propagation of an ancestral allele through this population. CONCLUSIONS The identification of this recurrent pathogenic variant enables optimization of molecular detection strategies in our patients, reducing the cost of diagnosis.
Collapse
Affiliation(s)
- Laura Elena Valinotto
- CEDIGEA, Centro de investigaciones en Genodermatosis y Epidermólisis Ampollar, Hospital de Niños Dr. Ricardo Gutiérrez / Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,CONICET, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Mónica Inés Natale
- CEDIGEA, Centro de investigaciones en Genodermatosis y Epidermólisis Ampollar, Hospital de Niños Dr. Ricardo Gutiérrez / Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Silvina Beatriz Lusso
- CEDIGEA, Centro de investigaciones en Genodermatosis y Epidermólisis Ampollar, Hospital de Niños Dr. Ricardo Gutiérrez / Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eliana Cella
- Servicio de Dermatología, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Olga Gutiérrez
- Servicio de Dermatología, Hospital General Pediátrico Niños de Acosta Ñu, San Lorenzo, Paraguay
| | - Fernando Sebastiani
- Servicio de Dermatología, Hospital de Infecciosas Dr, Francisco Javier Muñiz, Buenos Aires, Argentina
| | - Graciela Beatriz Manzur
- CEDIGEA, Centro de investigaciones en Genodermatosis y Epidermólisis Ampollar, Hospital de Niños Dr. Ricardo Gutiérrez / Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina.,Servicio de Dermatología, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina
| |
Collapse
|
212
|
Peñarrocha-Oltra D, Agustín-Panadero R, Serra-Pastor B, Peñarrocha-Diago M, Peñarrocha-Diago M. Oral rehabilitation with dental implants in patients with recessive dystrophic epidermolysis bullosa: A retrospective study with 2-15 years of follow-up. Med Oral Patol Oral Cir Bucal 2020; 25:e262-e267. [PMID: 31967984 PMCID: PMC7103452 DOI: 10.4317/medoral.23331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/11/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) comprises a group of hereditary disorders characterized by mechanical fragility of the skin and mucous membranes, with the development of blisters and vesicles in response to minimum tissue friction. Recessive dystrophic epidermolysis bullosa (RDEB) with generalized involvement is the most common subtype in the oral cavity. The present study was carried out to investigate dental implant survival, peri-implant tissue condition, patient satisfaction, and the impact of treatment upon the quality of life of patients with RDEB rehabilitated with implants and full-arch implant-supported prostheses. MATERIAL AND METHODS Thirteen patients with RDEB underwent dental implant treatment between September 2005 and December 2016. A retrospective study was made to analyze implant survival, peri-implant tissue health and patient satisfaction. RESULTS A total of 80 implants were placed (42 in the maxilla and 38 in the mandible) in 13 patients between 20-52 years of age and diagnosed with RDEB. All the implants were rehabilitated on a deferred basis with 20 full-arch prostheses. Fifteen fixed prostheses and 5 implant-supported overdentures were placed. The implant survival rate was 97.5% after a mean follow-up of 7.5 years after prosthetic loading. Fifty percent of the implants showed mucositis at the time of evaluation. Probing depth was maintained at 1-3 mm in 96.2% of the implants, and bleeding upon probing was observed in 67.5% of the implants. There was a high prevalence of bacterial plaque (85%). CONCLUSIONS The treatment of edentulous patients with RDEB by means of implants and implant-supported prostheses is predictable as evidenced by the high success rate, and improves patient self-esteem and quality of life.
Collapse
|
213
|
Johnson AL, Peterson SM, Terry MML, Ferguson B, Colgin LM, Lewis AD. Spontaneous KRT5 Gene Mutation in Rhesus Macaques ( Macaca mulatta): A Novel Nonhuman Primate Model of Epidermolysis Bullosa Simplex. Vet Pathol 2020; 57:344-348. [PMID: 32096448 DOI: 10.1177/0300985819900354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Epidermolysis bullosa simplex (EBS) is an inherited skin disorder characterized by increased skin and mucous membrane fragility. Most cases are caused by mutations in keratin 5 (KRT5) and keratin 14 (KRT14). Mutations of these genes result in cytoskeletal disruption of the basal keratinocytes. Gross and histopathologic findings of 2 clinically affected homozygous rhesus macaques with an insertion variant mutation in KRT5 are described and compared with 6 deceased phenotypically normal animals that were heterozygous for the KRT5 insertion variant. Animals that were homozygous for the KRT5 insertion variant were stillborn and had widespread loss of the epidermis. Microscopic examination confirmed severe ulceration and basal cell vacuolation with basilar vesicle formation in the remaining intact epidermis. Immunohistochemistry for cytokeratin 5 demonstrated lack of epidermal immunoreactivity in homozygotes. DNA sequencing identified a 34-base pair insertion variant in exon 5 of the KRT5 gene. To our knowledge, this is the first report of epidermolysis bullosa in rhesus macaques.
Collapse
Affiliation(s)
- Amanda L Johnson
- Pathology Services Unit, Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Samuel M Peterson
- Division of Genetics, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Margaret M L Terry
- Pathology Services Unit, Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Betsy Ferguson
- Division of Genetics, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Lois M Colgin
- Pathology Services Unit, Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| | - Anne D Lewis
- Pathology Services Unit, Division of Comparative Medicine, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR, USA
| |
Collapse
|
214
|
Hartenstein-Pinter A, Hübner-Möhler B, Zernikow B, Wager J. [Living with bandages: a mixed-methods-study on the view of families of children with epidermolysis bullosa]. Pflege 2020; 33:75-84. [PMID: 32048916 DOI: 10.1024/1012-5302/a000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Living with bandages: a mixed-methods-study on the view of families of children with epidermolysis bullosa Abstract. Background: Children with epidermolysis bullosa (EB) often need new bandages regularly due to sore skin and blistering. Aim: The question about the experiences of parents and children affected by EB with dressing materials is intended to identify starting points for effective support of families. Methods: In the first part of the sequential mixed-methods study, guideline-based interviews were conducted and evaluated with qualitative content analysis. Based on the results, a questionnaire was developed and implemented as an online survey. After analysis with descriptive statistics, these results were combined with the qualitative results. Results: In the "Find out what works" process, the cutting of the materials and the importance of flexibility come to the fore. The parents' confidence in their actions is particularly evident in the application of the bandages and in their knowledge of the materials. The removal of glued dressings is often associated with pain. Dirty bandages are the most common problem in everyday life. Both aspects relate to the wearability of the bandages. When bandages are integrated into everyday family life, the most important role is played by cost absorption and expertise in the organisation. Conclusions: Parents develop specific competences on EB, on their child and dressings. With counselling and education, nursing takes a central function within the multi-professional accompanying interventions to support and relieve families.
Collapse
Affiliation(s)
| | | | - Boris Zernikow
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik, Datteln.,Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten / Herdecke
| | - Julia Wager
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik, Datteln
| |
Collapse
|
215
|
Wu YH, Sun FK, Lee PY. Family caregivers' lived experiences of caring for epidermolysis bullosa patients: A phenomenological study. J Clin Nurs 2020; 29:1552-1560. [PMID: 32043289 DOI: 10.1111/jocn.15209] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/31/2019] [Accepted: 02/03/2020] [Indexed: 12/31/2022]
Abstract
AIMS AND OBJECTIVES To explore the lived experiences of family caregivers of epidermolysis bullosa (EB) patients. BACKGROUND Patients with EB need long-term care. Their family experiences physical and mental stress while proving that care. However, very little research has explored the family caregivers' actual lived experiences when caring for EB patients. DESIGN This is a qualitative research using the phenomenological approach. METHODS Data were collected with the assistance of the Taiwan Foundation for Rare Disorders (TFRD). Interviews were conducted between 2015 and 2017 with primary family caregivers (n = 10) who had cared for EB patients for at least five years. Data were analysed using Colaizzi's (1978) seven-step phenomenological method. COREQ reporting guidelines were utilised. RESULTS Four themes and eleven subthemes emerged after data analysis: (a) transformation and helplessness: changing expectations and helplessness associated with the rare, unknown disease; (b) mother's responsibility: mothers loving and protecting their children, surviving through adversity and challenges and self-experiencing a child's pain; (c) physical and mental fatigue experienced by the whole family: physical and mental exhaustion, and unbalanced lives; and (d) adjustment and social support: providing mutual assistance to mitigate adversity, hopeful search for treatments, the importance of patient associations and rare disease foundations, and social assistance requirements. CONCLUSION Family caregivers experience many challenges when caring for EB patients and experience substantial stress and overwhelming burdens. Consequently, they would benefit greatly from various support systems to reduce the burden of caring for EB patients. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals can use the findings from this study to understand the circumstances faced by family caregivers and tailor care and education specifically to support each family's financial, social and household needs, thereby helping them reduce the stress of caring for EB patients.
Collapse
Affiliation(s)
- Yeh-Hsun Wu
- Department of Nursing, Yuan's General Hospital, Kaohsiung City, Taiwan ROC
| | - Fan-Ko Sun
- Department of Nursing, I-Shou University, Kaohsiung City, Taiwan ROC
| | - Pei-Yu Lee
- Department of Nursing, Fooyin University, Kaohsiung City, Taiwan ROC
| |
Collapse
|
216
|
Wang W, Zuidema A, te Molder L, Nahidiazar L, Hoekman L, Schmidt T, Coppola S, Sonnenberg A. Hemidesmosomes modulate force generation via focal adhesions. J Cell Biol 2020; 219:e201904137. [PMID: 31914171 PMCID: PMC7041674 DOI: 10.1083/jcb.201904137] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 09/30/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023] Open
Abstract
Hemidesmosomes are specialized cell-matrix adhesion structures that are associated with the keratin cytoskeleton. Although the adhesion function of hemidesmosomes has been extensively studied, their role in mechanosignaling and transduction remains largely unexplored. Here, we show that keratinocytes lacking hemidesmosomal integrin α6β4 exhibit increased focal adhesion formation, cell spreading, and traction-force generation. Moreover, disruption of the interaction between α6β4 and intermediate filaments or laminin-332 results in similar phenotypical changes. We further demonstrate that integrin α6β4 regulates the activity of the mechanosensitive transcriptional regulator YAP through inhibition of Rho-ROCK-MLC- and FAK-PI3K-dependent signaling pathways. Additionally, increased tension caused by impaired hemidesmosome assembly leads to a redistribution of integrin αVβ5 from clathrin lattices to focal adhesions. Our results reveal a novel role for hemidesmosomes as regulators of cellular mechanical forces and establish the existence of a mechanical coupling between adhesion complexes.
Collapse
Affiliation(s)
- Wei Wang
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Alba Zuidema
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Lisa te Molder
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Leila Nahidiazar
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Liesbeth Hoekman
- Mass Spectrometry/Proteomics Facility, The Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Thomas Schmidt
- Physics of Life Processes, Huygens-Kamerlingh Onnes Laboratory, Leiden University, Leiden, Netherlands
| | - Stefano Coppola
- Physics of Life Processes, Huygens-Kamerlingh Onnes Laboratory, Leiden University, Leiden, Netherlands
| | - Arnoud Sonnenberg
- Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, Netherlands
| |
Collapse
|
217
|
Parodi E, Tirtei E, Bianchi M, Frigerio M, Morra I, Coppo P. Association of dystrophic epidermolysis bullosa and neuroblastoma in a newborn. Pediatr Neonatol 2020; 61:117-118. [PMID: 31806449 DOI: 10.1016/j.pedneo.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 09/30/2019] [Accepted: 11/06/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Emilia Parodi
- Pediatric and Neonatology Unit, AO Ordine Mauriziano Hospital, Turin, Italy.
| | - Elisa Tirtei
- Oncology Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
| | - Maurizio Bianchi
- Oncology Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
| | - Mario Frigerio
- Pediatric and Neonatology Unit, AO Ordine Mauriziano Hospital, Turin, Italy
| | - Isabella Morra
- Pathology Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Paola Coppo
- Pediatric Department, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza, Turin, Italy
| |
Collapse
|
218
|
McGowan DS, Gao DX, Kentosh JB. Absent Skin and Butterfly Children: A Sporadic Case of Bart Syndrome. J Pediatr 2020; 217:214-214.e1. [PMID: 31604626 DOI: 10.1016/j.jpeds.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | - David X Gao
- University of Illinois College of Medicine, Peoria, Illinois
| | - Joshua B Kentosh
- Department of Dermatology, University of Illinois College of Medicine, Peoria, Illinois
| |
Collapse
|
219
|
Vahidnezhad H, Youssefian L, Sotoudeh S, Liu L, Guy A, Lovell PA, Kariminejad A, Zeinali S, McGrath JA, Uitto J. Genomics-based treatment in a patient with two overlapping heritable skin disorders: Epidermolysis bullosa and acrodermatitis enteropathica. Hum Mutat 2020; 41:906-912. [PMID: 31930626 DOI: 10.1002/humu.23980] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/12/2019] [Accepted: 01/07/2020] [Indexed: 11/08/2022]
Abstract
Next-generation sequencing (NGS) is helpful in diagnosing complex genetic disorders and phenotypes, particularly when more than one overlapping condition is present. From a large cohort of 362 families with clinical manifestations of skin and mucosal fragility, referred by several major medical centers, one patient was found by NGS to have two overlapping heritable skin diseases, recessive dystrophic epidermolysis bullosa (RDEB; COL7A1 mutations) and acrodermatitis enteropathica (AE; SLC39A4 mutations). The pathogenicity of the variants was studied at gene expression as well as ultrastructural and tissue levels. Although there is no specific treatment for RDEB except avoiding trauma, supplementation with oral zinc (3 mg·kg-1 ·day-1 ) for the AE resulted in rapid amelioration of the skin findings. This case demonstrates the power of NGS in identifying two genetically unlinked diseases that led to effective treatment with major clinical benefits as an example of genomics-guided treatment.
Collapse
Affiliation(s)
- Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.,Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Leila Youssefian
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Soheila Sotoudeh
- Department of Dermatology, Children's Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Lu Liu
- Viapath, St. Thomas' Hospital, London, UK
| | - Alyson Guy
- Viapath, St. Thomas' Hospital, London, UK
| | | | - Ariana Kariminejad
- Clinical Genetics Deaprtment, Kariminejad-Najmabadi Pathology and Genetics Center, Tehran, Iran
| | - Sirous Zeinali
- Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London, UK
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College and Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
220
|
Koller U. [Ex vivo stem cell gene therapy of the skin : Ready for clinical use?]. Hautarzt 2020; 71:85-90. [PMID: 31965203 DOI: 10.1007/s00105-019-04529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Use of ex vivo stem cell gene therapy enables the correction of the genetic cause of a monogenetic skin disease. OBJECTIVES The procedure and choice of gene therapy method in the course of ex vivo gene therapy of the skin are presented. MATERIALS AND METHODS Current gene therapeutic applications focus on the addition or targeted correction of the respective gene within the genome. RESULTS So far, gene replacement therapy has been successfully used in patients suffering from the blistering skin disease epidermolysis bullosa. Designer nuclease-based gene therapy approaches are at the preclinical stage. CONCLUSIONS The selection of the gene therapy method depends on its safety profile, the target genodermatoses and the genetic mutation to correct.
Collapse
Affiliation(s)
- Ulrich Koller
- Universitätsklinik für Dermatologie und Allergologie, EB-Haus Austria, Universitätsklinikum der Paracelsus Medizinischen Privatuniversität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| |
Collapse
|
221
|
Wang JY, Marinkovich MP, Rieger KE. Epidermolysis bullosa with pyloric atresia consistently demonstrates concurrent low intra-basal epidermal and lamina lucida cleavage planes: a survey of six cases. J Eur Acad Dermatol Venereol 2020; 34:e200-e203. [PMID: 31851393 DOI: 10.1111/jdv.16153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Y Wang
- Department of Dermatology, Stanford University Medical Center, Stanford, CA, USA.,Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - M P Marinkovich
- Department of Dermatology, Stanford University Medical Center, Stanford, CA, USA.,Dermatology Division, Palo Alto Veteran's Affairs Medical Center, Palo Alto, CA, USA
| | - K E Rieger
- Department of Dermatology, Stanford University Medical Center, Stanford, CA, USA.,Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| |
Collapse
|
222
|
Paganelli A, Reggiani C, Fiorentini C, Lando M, Cesinaro AM, Magnoni C. Surgical management of squamous cell carcinoma arising in patients affected by epidermolysis bullosa: a comparative study. Int Wound J 2020; 17:519-521. [PMID: 31944565 DOI: 10.1111/iwj.13306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/10/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alessia Paganelli
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy
| | - Camilla Reggiani
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Italy
| | - Chiara Fiorentini
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| | - Mario Lando
- Department of Muscle-Skeletal Surgery, Hand and Microsurgery Division, Modena University Hospital, Italy
| | - Anna M Cesinaro
- Department of Pathological Anatomy, Modena University Hospital, Italy
| | - Cristina Magnoni
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Italy
| |
Collapse
|
223
|
Yu Y, Mi Z, Fu X, Wang Z, Sun L, Liu H, Zhang F. Digenic inheritance of KRT5 and KRT14 mutations in a family with epidermolysis bullosa simplex. Australas J Dermatol 2020; 61:e267-e269. [PMID: 31919841 DOI: 10.1111/ajd.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yueqian Yu
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zihao Mi
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xi'an Fu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhenzhen Wang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Lele Sun
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Hong Liu
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and Venereology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| |
Collapse
|
224
|
Bruckner AL, Losow M, Wisk J, Patel N, Reha A, Lagast H, Gault J, Gershkowitz J, Kopelan B, Hund M, Murrell DF. The challenges of living with and managing epidermolysis bullosa: insights from patients and caregivers. Orphanet J Rare Dis 2020; 15:1. [PMID: 31900176 PMCID: PMC6942340 DOI: 10.1186/s13023-019-1279-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/16/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Little information is available regarding the burden of living with and managing epidermolysis bullosa, including the distinct challenges faced by patients with different disease types/subtypes. METHODS A 90-question/item survey was developed to collect demographics, diagnostic data, management practices, and burden of illness information for patients with epidermolysis bullosa living in the United States. Recruitment was conducted via email and social media in partnership with epidermolysis bullosa patient advocacy organizations in the United States, and the survey was conducted via telephone interview by a third-party health research firm. Respondents aged ≥ 18 years with a confirmed diagnosis of epidermolysis bullosa or caring for a patient with a confirmed diagnosis of epidermolysis bullosa were eligible to participate in the survey. RESULTS In total, 156 responses were received from patients (n = 63) and caregivers (n = 93) representing the epidermolysis bullosa types of simplex, junctional, and dystrophic (subtypes: dominant and recessive). A large proportion of patients (21%) and caregivers (32%) reported that the condition was severe or very severe, and 19% of patients and 26% of caregivers reported a visit to an emergency department in the 12 months prior to the survey. Among the types/subtypes represented, recessive dystrophic epidermolysis bullosa results in the greatest wound burden, with approximately 60% of patients and caregivers reporting wounds covering > 30% of total body area. Wound care is time consuming and commonly requires significant caregiver assistance. Therapeutic options are urgently needed and reducing the number and severity of wounds was generally ranked as the most important treatment factor. CONCLUSIONS Survey responses demonstrate that epidermolysis bullosa places a considerable burden on patients, their caregivers, and their families. The limitations caused by epidermolysis bullosa mean that both patients and caregivers must make difficult choices and compromises regarding education, career, and home life. Finally, survey results indicate that epidermolysis bullosa negatively impacts quality of life and causes financial burden to patients and their families.
Collapse
Affiliation(s)
- Anna L Bruckner
- Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, B570, Aurora, CO, 80045, USA.
| | - Michael Losow
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Jayson Wisk
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Nita Patel
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Allen Reha
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Hjalmar Lagast
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Jamie Gault
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Jayne Gershkowitz
- Amicus Therapeutics, Inc, 1 Cedar Brook Drive, Cranbury, NJ, 08512, USA
| | - Brett Kopelan
- Debra of America, 75 Broad St #300, New York, NY, 10004, USA
| | - Michael Hund
- EB Research Partnership, 132 East 43rd St, Suite 432, New York, NY, 10017, USA
| | - Dedee F Murrell
- St. George-Hospital, University of Sydney, NSW, 2052, Australia
| |
Collapse
|
225
|
March OP, Kocher T, Koller U. Context-Dependent Strategies for Enhanced Genome Editing of Genodermatoses. Cells 2020; 9:E112. [PMID: 31906492 PMCID: PMC7016731 DOI: 10.3390/cells9010112] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 12/17/2022] Open
Abstract
The skin provides direct protection to the human body from assault by the harsh external environment. The crucial function of this organ is significantly disrupted in genodermatoses patients. Genodermatoses comprise a heterogeneous group of largely monogenetic skin disorders, typically involving mutations in genes encoding structural proteins. Therapeutic options for this debilitating group of diseases, including epidermolysis bullosa, primarily consist of wound management. Genome editing approaches co-opt double-strand break repair pathways to introduce desired sequence alterations at specific loci. Rapid advances in genome editing technologies have the potential to propel novel genetic therapies into the clinic. However, the associated phenotypes of many mutations may be treated via several genome editing strategies. Therefore, for potential clinical applications, implementation of efficient approaches based upon mutation, gene and disease context is necessary. Here, we describe current genome editing approaches for the treatment of genodermatoses, along with a discussion of the optimal strategy for each genetic context, in order to achieve enhanced genome editing approaches.
Collapse
Affiliation(s)
| | | | - Ulrich Koller
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (O.P.M.); (T.K.)
| |
Collapse
|
226
|
Petrova A, Georgiadis C, Fleck RA, Allison L, McGrath JA, Dazzi F, Di WL, Qasim W. Human Mesenchymal Stromal Cells Engineered to Express Collagen VII Can Restore Anchoring Fibrils in Recessive Dystrophic Epidermolysis Bullosa Skin Graft Chimeras. J Invest Dermatol 2020; 140:121-131.e6. [DOI: 10.1016/j.jid.2019.05.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 04/22/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
|
227
|
Oral and perioral soft tissue lesions and oral functions in patients with dystrophic epidermolysis bullosa. VOJNOSANIT PREGL 2020. [DOI: 10.2298/vsp201010128c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Numerous oral manifestations may occur within dystrophic
epidermolysis bullosa (DEB). Aim of the study was to examine oral and
perioral soft tissues and oral functions in DEB patients over a period of
one year. Methods. Twenty-four patients (1 month to 36 years old), were
clinically examined initially (T0), after 6 months (T6) and after 12 months
(T12). Appearance and localization of perioral and oral bullae and scars,
maximum mouth opening, reduced vestibule depth, absence of lingual papillae
and palatal rugae and restricted tongue movement due to scarring were
monitored. The values of maximum mouth opening at the initial examination
were compared to those measured in healthy control group of the same age.
The age of patients and differences between dominant and recessive subtype
of DEB were analyzed. Results. Average maximum mouth opening was
significantly lower in DEB patients compared to healthy individuals. Oral
and perioral bullae and scars, microstomia, and reduced vestibule depth were
very common, with no statistically significant difference among T0, T6, and
T12. The prevalence of restricted tongue movement due to scarring and the
absence of lingual papillae and palatal rugae increased significantly over
one year. Patients with microstomia, vestibule depth, and restricted tongue
movement due to scarring were significantly older than patients without
these characteristics. Lingual papillae and palatal rugae were more
frequently absent in recessive than in dominant DEB. Conclusion. DEB causes
significant changes in oral and perioral soft tissues and oral functions
impairment.
Collapse
|
228
|
Kearney S, Donohoe A, McAuliffe E. Living with epidermolysis bullosa: Daily challenges and health-care needs. Health Expect 2019; 23:368-376. [PMID: 31868299 PMCID: PMC7104643 DOI: 10.1111/hex.13006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & OBJECTIVE Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health-care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. SETTING AND PARTICIPANTS Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. RESULTS Participants' needs were grouped into five themes: support managing physical health-care issues; access to community/home-based services; EB-specific information and psychosocial support; effective interaction with health-care professionals; and advice regarding benefits and entitlements. DISCUSSION AND CONCLUSIONS This article represents the health-care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition.
Collapse
Affiliation(s)
- Sandra Kearney
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Ann Donohoe
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eilish McAuliffe
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
229
|
Eichstadt S, Tang JY, Solis DC, Siprashvili Z, Marinkovich MP, Whitehead N, Schu M, Fang F, Erickson SW, Ritchey ME, Colao M, Spratt K, Shaygan A, Ahn MJ, Sarin KY. From Clinical Phenotype to Genotypic Modelling: Incidence and Prevalence of Recessive Dystrophic Epidermolysis Bullosa (RDEB). Clin Cosmet Investig Dermatol 2019; 12:933-942. [PMID: 31920360 PMCID: PMC6935313 DOI: 10.2147/ccid.s232547] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
Background Recessive dystrophic epidermolysis bullosa (RDEB) is an inherited genetic disorder characterized by recurrent and chronic open wounds with significant morbidity, impaired quality of life, and early mortality. RDEB patients demonstrate reduction or structural alteration type VII collagen (C7) owing to mutations in the gene COL7A1, the main component of anchoring fibrils (AF) necessary to maintain epidermal-dermal cohesion. While over 700 alterations in COL7A1 have been reported to cause dystrophic epidermolysis bullosa (DEB), which may be inherited in an autosomal dominant (DDEB) or autosomal recessive pattern (RDEB), the incidence and prevalence of RDEB is not well defined. To date, the widely estimated incidence (0.2–6.65 per million births) and prevalence (3.5–20.4 per million people) of RDEB has been primarily characterized by limited analyses of clinical databases or registries. Methods Using a genetic modelling approach, we use whole exome and genome sequencing data to estimate the allele frequency of pathogenic variants. Through the ClinVar and NCBI database of human genome variants and phenotypes, DEB Register, and analyzing premature COL7A1 termination variants we built a model to predict the pathogenicity of previously unclassified variants. We applied the model to publicly available sequences from the Exome Aggregation Consortium (ExAC) and Genome Aggregation Database (gnomAD) and identified variants which were classified as pathogenic for RDEB from which we estimate disease incidence and prevalence. Results Genetic modelling applied to the whole exome and genome sequencing data resulted in the identification of predicted RDEB pathogenic alleles, from which our estimate of the incidence of RDEB is 95 per million live births, 30 times the 3.05 per million live birth incidence estimated by the National Epidermolysis Bullosa Registry (NEBR). Using a simulation approach, we estimate a mean of approximately 3,850 patients in the US who may benefit from COL7A1-mediated treatments in the US. Conclusion We conclude that genetic allele frequency estimation may enhance the underdiagnosis of rare genetic diseases generally, and RDEB specifically, which may improve incidence and prevalence estimates of patients who may benefit from treatment.
Collapse
Affiliation(s)
- Shaundra Eichstadt
- Stanford University School of Medicine, Department of Dermatology, Redwood City, CA 94063, USA
| | - Jean Y Tang
- Stanford University School of Medicine, Department of Dermatology, Redwood City, CA 94063, USA
| | - Daniel C Solis
- Stanford University School of Medicine, Department of Dermatology, Redwood City, CA 94063, USA
| | - Zurab Siprashvili
- Stanford University School of Medicine, Department of Dermatology, Redwood City, CA 94063, USA
| | - M Peter Marinkovich
- Stanford University School of Medicine, Department of Dermatology, Redwood City, CA 94063, USA.,Veterans Affairs Medical Center, Palo Alto, CA, USA
| | | | - Matthew Schu
- RTI International, Research Triangle Park, NC, USA
| | - Fang Fang
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Max Colao
- Abeona Therapeutics, New York, NY, USA
| | | | - Amir Shaygan
- Department of Engineering and Technology Management, Portland State University, Portland, OR, USA
| | - Mark J Ahn
- Department of Engineering and Technology Management, Portland State University, Portland, OR, USA
| | - Kavita Y Sarin
- Stanford University School of Medicine, Department of Dermatology, Redwood City, CA 94063, USA
| |
Collapse
|
230
|
|
231
|
Abstract
Integrin adhesion receptors are critical for cell adhesion to the extracellular matrix. In this issue of Structure, Manso et al. (2019) provide new insights into formation of specialized integrin adhesion structures, termed hemidesmosomes, that anchor epithelial cells to the basement membrane.
Collapse
Affiliation(s)
- Titus J Boggon
- Department of Pharmacology, Yale University, New Haven, CT 06510, USA; Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT 06510, USA; Yale Cancer Center, Yale University, New Haven, CT 06510, USA.
| |
Collapse
|
232
|
Zhang J, Ding Y, Li M, Yao Z, Zhuang Y. Known and novel mutations responsible for epidermolysis bullosa simplex cases in a Chinese population. Exp Ther Med 2019; 18:4661-4664. [PMID: 31772641 PMCID: PMC6862070 DOI: 10.3892/etm.2019.8130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022] Open
Abstract
Epidermolysis bullosa simplex, generalized severe (EBS-gen sev) is one of the major forms of EBS, caused by mutations of the keratin 5 (KRT5) or keratin 14 (KRT14). However, it is rarely reported in the Chinese population. The current study was performed on three unrelated Chinese families with five patients clinically suspicious for distinct stages of EBS. Mutation screening was performed by direct sequencing of the entire coding regions of KRT5 and KRT14 genes. A diagnosis of EBS-gen sev for patients in these three families was confirmed by revealing missense mutations c.373C>T (p.Arg125Cys), c.374G>T (p.Arg125Leu), and a novel frameshift mutation c.1231delG (p.Glu411Argfs*31) in KRT14. Considering two previously reported cases and the results of the current report, amino acid residue 125 is likely the most frequent hotspot of EBS-gen sev in the Chinese population. The current study further indicated that the symptoms of EBS-gen sev patients decline with age.
Collapse
Affiliation(s)
- Jia Zhang
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Yu Ding
- Dermatology Department, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
| | - Ming Li
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Yin Zhuang
- Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| |
Collapse
|
233
|
Rashidghamat E, Kadiyirire T, Ayis S, Petrof G, Liu L, Pullabhatla V, Ainali C, Guy A, Aristodemou S, McMillan JR, Ozoemena L, Mee J, Pramanik R, Saxena A, Nuamah R, de Rinaldis E, Serrano S, Maurin C, Martinez-Queipo M, Lwin SM, Ilic D, Martinez A, Dazzi F, Slaper-Cortenbach I, Westinga K, Zeddies S, van den Broek M, Onoufriadis A, Mellerio JE, McGrath JA. Phase I/II open-label trial of intravenous allogeneic mesenchymal stromal cell therapy in adults with recessive dystrophic epidermolysis bullosa. J Am Acad Dermatol 2019; 83:447-454. [PMID: 31786163 DOI: 10.1016/j.jaad.2019.11.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/30/2019] [Accepted: 11/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recessive dystrophic epidermolysis bullosa (RDEB) is a hereditary blistering disorder due to a lack of type VII collagen. At present, treatment is mainly supportive. OBJECTIVES To determine whether intravenous allogeneic bone marrow-derived mesenchymal stromal/stem cells (BM-MSCs) are safe in RDEB adults and if the cells improve wound healing and quality of life. METHODS We conducted a prospective, phase I/II, open-label study recruiting 10 RDEB adults to receive 2 intravenous infusions of BM-MSCs (on day 0 and day 14; each dose 2-4 × 106 cells/kg). RESULTS BM-MSCs were well tolerated with no serious adverse events to 12 months. Regarding efficacy, there was a transient reduction in disease activity scores (8/10 subjects) and a significant reduction in itch. One individual showed a transient increase in type VII collagen. LIMITATIONS Open-label trial with no placebo. CONCLUSIONS MSC infusion is safe in RDEB adults and can have clinical benefits for at least 2 months.
Collapse
Affiliation(s)
- Ellie Rashidghamat
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Tendai Kadiyirire
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Gabriela Petrof
- Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lu Liu
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, Guy's Hospital, London, UK
| | - Venu Pullabhatla
- UK NIHR GSTFT/KCL Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Chrysanthi Ainali
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK; Dignosis Ltd, London, UK
| | - Alyson Guy
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, Guy's Hospital, London, UK
| | - Sophia Aristodemou
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, Guy's Hospital, London, UK
| | - James R McMillan
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, Guy's Hospital, London, UK
| | - Linda Ozoemena
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, Guy's Hospital, London, UK
| | - John Mee
- Immunodermatology Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - Rashida Pramanik
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Alka Saxena
- UK NIHR GSTFT/KCL Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Rosamund Nuamah
- UK NIHR GSTFT/KCL Comprehensive Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Sonia Serrano
- Clinical Trial Management Research Platform, NIHR Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Clarisse Maurin
- Clinical Trial Management Research Platform, NIHR Biomedical Research Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Magdalena Martinez-Queipo
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Su M Lwin
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Dusko Ilic
- Stem Cell Laboratories, Guy's Assisted Conception Unit, Department of Women & Children's Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Anna Martinez
- Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Francesco Dazzi
- Department of Haematological Medicine, The Rayne Institute, King's College London, London, UK
| | - Ineke Slaper-Cortenbach
- Cell Therapy Facility, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kasper Westinga
- Cell Therapy Facility, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sabrina Zeddies
- Cell Therapy Facility, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel van den Broek
- Cell Therapy Facility, Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexandros Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Jemima E Mellerio
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - John A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK.
| |
Collapse
|
234
|
Reimer A, Hess M, Schwieger-Briel A, Kiritsi D, Schauer F, Schumann H, Bruckner-Tuderman L, Has C. Natural history of growth and anaemia in children with epidermolysis bullosa: a retrospective cohort study. Br J Dermatol 2019; 182:1437-1448. [PMID: 31487386 DOI: 10.1111/bjd.18475] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Impaired growth and anaemia are major extracutaneous complications of epidermolysis bullosa (EB), but data on their development are lacking. OBJECTIVES To determine the clinical course of growth and anaemia in children with EB and clarify the impact of nutritional compromise, inflammation and genetic factors. METHODS A retrospective study was conducted of 200 children, 157 with recessive dystrophic EB (RDEB) and 43 with junctional EB (JEB)-generalized intermediate, followed at the main referral centre in Germany. Growth charts were calculated using the modified LMS method and were correlated with parameters of anaemia, nutrition, inflammation and the molecular defect in a linear model. RESULTS In our cohort of patients with RDEB, weight impairment started at 12-18 months old; by the age of 10 years, 50% showed wasting. The predicted median weight at age 20 years was 35·2 kg for men and 40·1 kg for women. In JEB, growth resembled that of healthy children. Anaemia was present from the second year of life onwards in RDEB and JEB. Low levels of haemoglobin, iron, vitamin D, zinc and albumin, high levels of C-reactive protein, and absence of collagen VII correlated significantly with low weight in RDEB. No correlation was observed in JEB. CONCLUSIONS The results highlight that nutritional compromise occurs early in children with RDEB and therefore may require interventions as of the first year or two of life. What's already known about this topic? Children with epidermolysis bullosa (EB) suffer from failure to thrive and anaemia as major extracutaneous complications. The course of growth and the development of anaemia in EB are poorly characterized. What does this study add? A molecularly well characterized cohort of 200 children with EB was followed with regard to anthropometrics, anaemia and inflammation. We demonstrate early onset of growth failure and anaemia, most pronounced in the subset of recessive dystrophic EB. Awareness of early growth delay and nutritional deficiencies will improve EB care in daily practice.
Collapse
Affiliation(s)
- A Reimer
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - M Hess
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Schwieger-Briel
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany.,University Children's Hospital Zurich, Zurich, Switzerland
| | - D Kiritsi
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - F Schauer
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - H Schumann
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - L Bruckner-Tuderman
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - C Has
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| |
Collapse
|
235
|
Gaucher S, Lwin SM, Titeux M, Abdul-Wahab A, Pironon N, Izmiryan A, Miskinyte S, Ganier C, Duchatelet S, Mellerio JE, Bourrat E, McGrath JA, Hovnanian A. EBGene trial: patient preselection outcomes for the European GENEGRAFT ex vivo phase I/II gene therapy trial for recessive dystrophic epidermolysis bullosa. Br J Dermatol 2019; 182:794-797. [PMID: 31557321 DOI: 10.1111/bjd.18559] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Gaucher
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France.,Service de Chirurgie Générale, Plastique et Ambulatoire, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - S M Lwin
- St John's Institute of Dermatology, King's College London, London, U.K
| | - M Titeux
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - A Abdul-Wahab
- St John's Institute of Dermatology, King's College London, London, U.K
| | - N Pironon
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - A Izmiryan
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - S Miskinyte
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - C Ganier
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - S Duchatelet
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London, London, U.K
| | - E Bourrat
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, London, U.K
| | - A Hovnanian
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France.,Department of Genetics, Assistance Publique-Hôpitaux de Paris, Necker Hospital for Sick Children, Paris, France
| |
Collapse
|
236
|
Has C, Fischer J. Epidermolysis bullosa hereditaria. MED GENET-BERLIN 2019. [DOI: 10.1007/s11825-019-00266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Zusammenfassung
Epidermolysis bullosa hereditaria (EB) umfasst eine Gruppe von Erkrankungen, die mit Hautfragilität und mechanisch verursachter Blasenbildung einhergehen. Die klinischen Manifestationen zeigen unterschiedliche Schweregrade, von lebensbedrohlich bis leicht. Im Kindesalter und bei Erwachsenen kann das klinische Bild typisch sein; allerdings kann bei Neugeborenen der EB-Subtyp klinisch häufig nicht bestimmt werden. Pathogene Varianten in 20 Genen sind bereits als krankheitsursächlich für die verschiedenen Formen der EB beschrieben. Die allelische Heterogenität ist sehr groß. Die Diagnostik basiert auf der genauen klinischen Untersuchung, der Familienanamnese und der molekulargenetischen Analyse. Aufgrund der genetischen Heterogenität und der Größe der Gene eignet sich die „Next-generation-sequencing“-basierte Multi-Gen-Panel-Diagnostik am besten. Teilweise sind Genotyp-Phänotyp-Korrelationen bekannt, sodass die genetische Diagnostik auch prognostisch eine Rolle spielt.
Collapse
Affiliation(s)
- Cristina Has
- 1 Klinik für Dermatologie und Venerologie Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Hauptstr. 7 79104 Freiburg Deutschland
| | - Judith Fischer
- 2 Institut für Humangenetik, Zentrum für Diagnostik und Forschung Genodermatosen ZDFG Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Breisacher Str. 33 79106 Freiburg Deutschland
| |
Collapse
|
237
|
Venti V, Scalia B, Sauna A, Nasca MR, Smilari P, Praticò AD, Fiumara A, Pappalardo XG, Pavone P. Previously Unreported COL7A1 Mutation in a Somali Patient with Dystrophic Epidermolysis Bullosa. Mol Syndromol 2019; 10:332-338. [PMID: 32021608 DOI: 10.1159/000504210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Epidermolysis bullosa (EB) encompasses a group of inheritable skin disorders characterized by various degrees of epithelial fragility that lead to cutaneous and mucosal blistering following negligible mechanical traumas. These disorders are clinically and genetically heterogeneous, ranging from mild skin involvement to severe disabling conditions with associated manifestations affecting the gastrointestinal and vesico-urinary tracts. EB may be classified into 4 main categories: simplex, junctional, dystrophic, and Kindler syndrome. Clinically, EB may present as syndromic or nonsyndromic forms. EB subtypes have mainly reported a number of mutations in the candidate COL7A1 gene encoding type VII collagen, a major stabilizing molecule of the dermoepidermal junction. Herein, we report a Somali girl with dystrophic EB who showed a previously unreported missense variant c.6797G>T in exon 86 in COL7A1.
Collapse
Affiliation(s)
- Valeria Venti
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Bruna Scalia
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alessandra Sauna
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Pierluigi Smilari
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea D Praticò
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Agata Fiumara
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Xena G Pappalardo
- National Council of Research, CNR, Institute for Research and Innovation in Biomedicine (IRIB) Unit of Catania, Catania, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
238
|
Epidermolysis Bullosa-Associated Squamous Cell Carcinoma: From Pathogenesis to Therapeutic Perspectives. Int J Mol Sci 2019; 20:ijms20225707. [PMID: 31739489 PMCID: PMC6888002 DOI: 10.3390/ijms20225707] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022] Open
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of inherited skin disorders determined by mutations in genes encoding for structural components of the cutaneous basement membrane zone. Disease hallmarks are skin fragility and unremitting blistering. The most disabling EB (sub)types show defective wound healing, fibrosis and inflammation at lesional skin. These features expose patients to serious disease complications, including the development of cutaneous squamous cell carcinomas (SCCs). Almost all subjects affected with the severe recessive dystrophic EB (RDEB) subtype suffer from early and extremely aggressive SCCs (RDEB-SCC), which represent the first cause of death in these patients. The genetic determinants of RDEB-SCC do not exhaustively explain its unique behavior as compared to low-risk, ultraviolet-induced SCCs in the general population. On the other hand, a growing body of evidence points to the key role of tumor microenvironment in initiation, progression and spreading of RDEB-SCC, as well as of other, less-investigated, EB-related SCCs (EB-SCCs). Here, we discuss the recent advances in understanding the complex series of molecular events (i.e., fibrotic, inflammatory, and immune processes) contributing to SCC development in EB patients, cross-compare tumor features in the different EB subtypes and report the most promising therapeutic approaches to counteract or delay EB-SCCs.
Collapse
|
239
|
Delebarre H, Chiaverini C, Vandersteen C, Savoldelli C. Orofacial management for epidermolysis bullosa during wisdom tooth removal surgery: A technical note. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:467-470. [DOI: 10.1016/j.jormas.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/28/2019] [Accepted: 03/14/2019] [Indexed: 12/01/2022]
|
240
|
Khan MT, O'Sullivan M, Faitli B, Mellerio JE, Fawkes R, Wood M, Hubbard LD, Harris AG, Iacobaccio L, Vlahovic T, James L, Brains L, Fitzpatrick M, Mayre-Chilton K. Foot care in epidermolysis bullosa: evidence-based guideline. Br J Dermatol 2019; 182:593-604. [PMID: 31397882 PMCID: PMC7065089 DOI: 10.1111/bjd.18381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/28/2022]
Abstract
This guideline was designed to provide service providers and users with an evidence-based set of current best practice guidelines for people and their families and carers, living with epidermolysis bullosa (EB). A systematic literature review relating to the podiatric care of patients with EB was undertaken. Search terms were used, for which the most recent articles relating to podiatric treatment were identified from as early as 1979 to the present day, across seven electronic search engines: MEDLINE, Wiley Online Library, Google Scholar, Athens, ResearchGate, Net and PubFacts.com. The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used. The first guideline draft was analysed and discussed by clinical experts, methodologists and patients and their representatives at four panel meetings. The resulting document went through an external review process by a panel of experts, other healthcare professionals, patient representatives and lay reviewers. The final document will be piloted in three different centres in the U.K. and Australia. Following an EB community international survey the outcomes indicated six main areas that the community indicated as a priority to foot management. These include blistering and wound management, exploring the most suitable footwear and hosiery for EB, management of dystrophic nails, hyperkeratosis (callus), maintaining mobility and fusion of toes (pseudosyndactyly). The evidence here is limited but several interventions currently practised by podiatrists show positive outcomes.
Collapse
Affiliation(s)
- M T Khan
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K.,Royal London Hospital for Integrated Medicine, UCLH, London, U.K.,St George Hospital, Sydney, NSW, Australia.,Barts and The London NHS Foundation Trust, London, U.K
| | - M O'Sullivan
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, U.K.,Birmingham Women's and Children's NHS Foundation Trust, Podiatry Birmingham, Birmingham, U.K
| | - B Faitli
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K
| | - J E Mellerio
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K.,St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K.,St John's Institute of Dermatology, Rare Diseases Centre, London, U.K
| | - R Fawkes
- St John's Institute of Dermatology, Rare Diseases Centre, London, U.K
| | - M Wood
- EB Department, Great Ormond Street Hospital for Sick Children, London, U.K
| | - L D Hubbard
- St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A G Harris
- St George Hospital, Sydney, NSW, Australia.,Department of Dermatology, Concord Hospital, Sydney, NSW, Australia
| | - L Iacobaccio
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - T Vlahovic
- Temple University, Philadelphia, PA, U.S.A
| | - L James
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, U.K.,Birmingham Women's and Children's NHS Foundation Trust, Podiatry Birmingham, Birmingham, U.K
| | - L Brains
- DEBRA Australia Member and Volunteer, Pittsworth, QLD, Australia
| | - M Fitzpatrick
- DEBRA Australia Member and Volunteer, Pittsworth, QLD, Australia.,DEBRA International, Vienna, Austria
| | - K Mayre-Chilton
- St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, U.K.,DEBRA International, Vienna, Austria
| |
Collapse
|
241
|
Condorelli AG, Logli E, Cianfarani F, Teson M, Diociaiuti A, El Hachem M, Zambruno G, Castiglia D, Odorisio T. MicroRNA-145-5p regulates fibrotic features of recessive dystrophic epidermolysis bullosa skin fibroblasts. Br J Dermatol 2019; 181:1017-1027. [PMID: 30816994 DOI: 10.1111/bjd.17840] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recessive dystrophic epidermolysis bullosa (RDEB) is a skin fragility disorder caused by mutations in the COL7A1 gene encoding type VII collagen, a cutaneous basement membrane component essential for epidermal-dermal adhesion. Hallmarks of the disease are unremitting blistering and chronic wounds with severe inflammation and fibrosis. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression also implicated in fibrotic processes. However, the role of miRNAs in RDEB fibrosis is almost unexplored. OBJECTIVES Our study aimed to identify miRNAs deregulated in primary RDEB skin fibroblasts (RDEBFs) and to characterize their function in RDEB fibrosis. METHODS Real-time quantitative polymerase chain reaction (qRT-PCR) was used to screen RDEBFs for expression levels of a group of miRNAs deregulated in hypertrophic scars and keloids, pathological conditions with abnormal wound healing and fibrosis. Contractility, proliferation and migration rate were evaluated by different in vitro assays in RDEBFs transfected with a miR-145-5p inhibitor. Expression levels of fibrotic markers and miR-145-5p targets were measured using qRT-PCR and western blot. RESULTS The miR-143/145 cluster was upregulated in RDEBFs compared with fibroblasts from healthy subjects. RDEBFs transfected with a miR-145-5p inhibitor showed attenuated fibrotic traits of contraction, proliferation and migration, accompanied by reduced expression of the contractile proteins α-smooth muscle actin and transgelin. These effects were associated with upregulation of Krüppel-like factor 4 transcriptional repressor and downregulation of Jagged1, a known inducer of fibrosis. CONCLUSIONS Our results highlight the profibrotic role of miR-145-5p and its regulatory networks in RDEB, shedding light on novel disease pathomechanisms and targets for future therapeutic approaches. What's already known about this topic? Recessive dystrophic epidermolysis bullosa (RDEB) is a highly disabling genetic skin disease caused by mutations in the collagen VII gene and characterized by unremitting blistering and defective wound healing, leading to inflammation and fibrosis. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression in health and disease, and their deregulation has been implicated in fibrotic skin conditions. To date, only miR-29 has been associated with injury-driven fibrosis in RDEB. What does this study add? In patients with RDEB, miR-145-5p is overexpressed in RDEB skin fibroblasts (RDEBFs), where it plays a profibrotic role, as its inhibition reduces RDEBF fibrotic traits (contraction, proliferation and migration). miR-145-5p inhibition in RDEBFs determines the reduction of contractile markers α-smooth muscle actin and transgelin through upregulation of Krüppel-like factor 4, a transcriptional repressor of contractile proteins, and downregulation of Jagged1 (JAG1), an inducer of fibrosis. What is the translational message? Our findings expand the knowledge on miRNA-driven pathomechanisms implicated in RDEB fibrosis. miR-145-5p and its targets (e.g. JAG1) could represent relevant molecules for the development of novel therapeutic strategies to counteract fibrosis progression in patients with RDEB.
Collapse
Affiliation(s)
- A G Condorelli
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - E Logli
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - F Cianfarani
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - M Teson
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - A Diociaiuti
- Dermatology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - M El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - G Zambruno
- Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - D Castiglia
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - T Odorisio
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| |
Collapse
|
242
|
Karamova AE, Albanova VI, Monchakovskaya ES. Management of patients with congenital epidermolysis bullosa. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-4-24-30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Congenital epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of hereditary skin diseases characterized by the formation of blisters and/or erosions in response to minimal trauma. Etiopathogenetic methods for treating the disease are undergoing various stages of clinical research; therefore, external therapy implying caring for affected and non-affected skin remains to be the main treatment method. Such a therapy aims to reduce the healing period of erosive and ulcerative skin defects, thus improving the overall quality of patients’ life. This review sets out to provide clinical recommendations for the management of EB patients developed by different groups of experts, which generalize methods for treating EB patients, main principles of external therapy and relieving subjective sensations, as well as to describe specific situations entailing this pathology.
Collapse
Affiliation(s)
- A. E. Karamova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. I. Albanova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - E. S. Monchakovskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| |
Collapse
|
243
|
Feinstein JA, Jambal P, Peoples K, Lucky AW, Khuu P, Tang JY, Lara-Corrales I, Pope E, Wiss K, Hook KP, Levin LE, Morel KD, Paller AS, McCuaig CC, Powell J, Eichenfield LF, Price H, Levy ML, Schachner LA, Browning JC, Bayliss S, Jahnke M, Shwayder T, Glick SA, Bruckner AL. Assessment of the Timing of Milestone Clinical Events in Patients With Epidermolysis Bullosa From North America. JAMA Dermatol 2019; 155:196-203. [PMID: 30586139 DOI: 10.1001/jamadermatol.2018.4673] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Children with epidermolysis bullosa (EB) comprise a rare population with high morbidity and mortality. An improved understanding of the clinical trajectory of patients with EB, including age at time of clinical diagnosis and major clinical events, is needed to refine best practices and improve quality of life and clinical outcomes for patients with EB. Objectives To describe demographics, clinical characteristics, milestone diagnostic and clinical events (such as initial esophageal dilation), and outcomes in patients with EB using the Epidermolysis Bullosa Clinical Characterization and Outcomes Database and to determine what characteristics may be associated with overall EB severity and/or disease progression. Design, Setting, and Participants This cohort study included data on patients with EB who were enrolled in the Epidermolysis Bullosa Clinical Characterization and Outcomes Database from January 1, 2011, to June 30, 2017; 17 participating EB centers in the United States and Canada contributed data to this study. Exposures Type of EB, including recessive dystrophic epidermolysis bullosa (RDEB), junctional epidermolysis bullosa (JEB), dominant dystrophic epidermolysis bullosa (DDEB), and epidermolysis bullosa simplex (EBS). Main Outcomes and Measures Demographic information, clinical characteristics (including age at onset of signs of EB and subsequent clinical diagnosis), types of diagnostic testing performed, and milestone clinical events for patients with RDEB. Results Of 644 enrolled patients from 17 sites included in this study, 323 were male (50.2%), with a mean (SD) age of 14.4 (11.7) years; 283 (43.9%) had RDEB, 194 (30.1%) had EBS, 104 (16.2%) had DDEB, and 63 (9.8%) had JEB. Signs of disease were present at birth in 202 patients with RDEB (71.4%), 39 with JEB (61.9%), 60 with DDEB (57.7%), and 74 with EBS (38.1%). For those with signs of disease at birth, a clinical diagnosis was made at the time of birth in 135 patients with RDEB (67.0%), 31 with DDEB (52.6%), 35 with EBS, (47.3%) and 18 with JEB (46.2%). Patients with JEB had the highest rate of any confirmatory testing (51 of 63 [81.0%]), followed by RDEB (218 of 283 [77.0%]), DDEB (71 of 104 [68.3%]), and EBS (100 of 194 [51.5%]). For all types of EB, both electron microscopy and immunofluorescence microscopy were performed at younger ages than genetic analysis. Among 283 patients with RDEB, 157 (55.5%) had esophageal dilation, 104 (36.7%) had gastrostomy tube placement, 62 (21.9%) had hand surgery, 18 (6.4%) developed squamous cell carcinoma, and 19 (6.7%) died. Conclusions and Relevance The findings suggest that diagnostic testing for EB is more common for patients with severe phenotypes. Earlier diagnostic testing may enable improved characterizations of patients so that appropriate counseling and clinical care may be offered, especially pertaining to milestone events for those with RDEB.
Collapse
Affiliation(s)
- James A Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora.,Children's Hospital Colorado, Aurora
| | - Purevsuren Jambal
- Department of Dermatology, University of Colorado School of Medicine, Aurora
| | | | - Anne W Lucky
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Phuong Khuu
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elena Pope
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Kristen P Hook
- Department of Dermatology, University of Minnesota Medical School, Minneapolis
| | - Laura E Levin
- Department of Dermatology, Columbia Irving Medical Center, New York, New York
| | - Kimberly D Morel
- Department of Dermatology, Columbia Irving Medical Center, New York, New York.,Department of Pediatrics, Columbia Irving Medical Center, New York, New York
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Julie Powell
- CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California San Diego, San Diego.,Department of Pediatrics, University of California San Diego, San Diego.,Department of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Harper Price
- Department of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Moise L Levy
- Departments of Internal Medicine, Dell Medical School, University of Texas, Austin.,Departments of Pediatrics, Dell Medical School, University of Texas, Austin.,Department of Pediatric Dermatology, Dell Children's Medical Center, Austin, Texas
| | - Lawrence A Schachner
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - John C Browning
- Department of Pediatric Dermatology, Children's Hospital San Antonio, San Antonio, Texas
| | - Susan Bayliss
- Division of Dermatology, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Marla Jahnke
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Tor Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn
| | - Anna L Bruckner
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.,Children's Hospital Colorado, Aurora.,Department of Dermatology, University of Colorado School of Medicine, Aurora.,Associate Editor
| |
Collapse
|
244
|
Cho RJ, Alexandrov LB, den Breems NY, Atanasova VS, Farshchian M, Purdom E, Nguyen TN, Coarfa C, Rajapakshe K, Prisco M, Sahu J, Tassone P, Greenawalt EJ, Collisson EA, Wu W, Yao H, Su X, Guttmann-Gruber C, Hofbauer JP, Hashmi R, Fuentes I, Benz SC, Golovato J, Ehli EA, Davis CM, Davies GE, Covington KR, Murrell DF, Salas-Alanis JC, Palisson F, Bruckner AL, Robinson W, Has C, Bruckner-Tuderman L, Titeux M, Jonkman MF, Rashidghamat E, Lwin SM, Mellerio JE, McGrath JA, Bauer JW, Hovnanian A, Tsai KY, South AP. APOBEC mutation drives early-onset squamous cell carcinomas in recessive dystrophic epidermolysis bullosa. Sci Transl Med 2019; 10:10/455/eaas9668. [PMID: 30135250 DOI: 10.1126/scitranslmed.aas9668] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/09/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023]
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is a rare inherited skin and mucous membrane fragility disorder complicated by early-onset, highly malignant cutaneous squamous cell carcinomas (SCCs). The molecular etiology of RDEB SCC, which arises at sites of sustained tissue damage, is unknown. We performed detailed molecular analysis using whole-exome, whole-genome, and RNA sequencing of 27 RDEB SCC tumors, including multiple tumors from the same patient and multiple regions from five individual tumors. We report that driver mutations were shared with spontaneous, ultraviolet (UV) light-induced cutaneous SCC (UV SCC) and head and neck SCC (HNSCC) and did not explain the early presentation or aggressive nature of RDEB SCC. Instead, endogenous mutation processes associated with apolipoprotein B mRNA-editing enzyme catalytic polypeptide-like (APOBEC) deaminases dominated RDEB SCC. APOBEC mutation signatures were enhanced throughout RDEB SCC tumor evolution, relative to spontaneous UV SCC and HNSCC mutation profiles. Sixty-seven percent of RDEB SCC driver mutations was found to emerge as a result of APOBEC and other endogenous mutational processes previously associated with age, potentially explaining a >1000-fold increased incidence and the early onset of these SCCs. Human papillomavirus-negative basal and mesenchymal subtypes of HNSCC harbored enhanced APOBEC mutational signatures and transcriptomes similar to those of RDEB SCC, suggesting that APOBEC deaminases drive other subtypes of SCC. Collectively, these data establish specific mutagenic mechanisms associated with chronic tissue damage. Our findings reveal a cause for cancers arising at sites of persistent inflammation and identify potential therapeutic avenues to treat RDEB SCC.
Collapse
Affiliation(s)
- Raymond J Cho
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
| | - Ludmil B Alexandrov
- Department of Cellular and Molecular Medicine and Department of Bioengineering and Moores Cancer Center, University of California, San Diego, La Jolla, CA 92093, USA
| | | | - Velina S Atanasova
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Mehdi Farshchian
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Elizabeth Purdom
- Department of Statistics, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Tran N Nguyen
- Departments of Anatomic Pathology and Tumor Biology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Cristian Coarfa
- Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Kimal Rajapakshe
- Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Marco Prisco
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Joya Sahu
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Evan J Greenawalt
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Eric A Collisson
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Wei Wu
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94115, USA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94158, USA.,Translational Medical Center, Central Hospital, Zhengzhou University, Zhengzhou, China
| | - Hui Yao
- Bioinformatics and Computational Biology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xiaoping Su
- Bioinformatics and Computational Biology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Christina Guttmann-Gruber
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Josefina Piñón Hofbauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Raabia Hashmi
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ignacia Fuentes
- Fundación DEBRA Chile, Santiago 7760099, Chile.,Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | | | | | - Erik A Ehli
- Avera Institute for Human Genetics, Sioux Falls, SD 57108, USA
| | | | - Gareth E Davies
- Avera Institute for Human Genetics, Sioux Falls, SD 57108, USA
| | | | - Dedee F Murrell
- St. George Hospital, University of New South Wales, Sydney, New South Wales 2217, Australia
| | - Julio C Salas-Alanis
- Escuela de Medicina y Ciencias de la Salud TecSalud del Tecnologico de Monterrey, Morones Prieto 3000, Los doctores, Monterrey, Nuevo León 64710, Mexico
| | - Francis Palisson
- Fundación DEBRA Chile, Santiago 7760099, Chile.,Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
| | - Anna L Bruckner
- Departments of Dermatology and Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - William Robinson
- Cutaneous Oncology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Cristina Has
- Department of Dermatology, Medical Center-University of Freiburg, 79104 Freiburg, Germany
| | | | - Matthias Titeux
- INSERM UMR 1163, Paris, France.,Imagine Institute, 75015 Paris, France
| | - Marcel F Jonkman
- Center for Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, Netherlands
| | - Elham Rashidghamat
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - Su M Lwin
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - Jemima E Mellerio
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London SE1 9RT, UK
| | - Johann W Bauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Alain Hovnanian
- INSERM UMR 1163, Paris, France.,Imagine Institute, 75015 Paris, France
| | - Kenneth Y Tsai
- Departments of Anatomic Pathology and Tumor Biology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Andrew P South
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| |
Collapse
|
245
|
Grilletta EA. Cardiac transplant for epidermolysis bullosa simplex with KLHL24 mutation-associated cardiomyopathy. JAAD Case Rep 2019; 5:912-914. [PMID: 31649980 PMCID: PMC6804561 DOI: 10.1016/j.jdcr.2019.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Erica Ann Grilletta
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
246
|
Eichstadt S, Barriga M, Ponakala A, Teng C, Nguyen NT, Siprashvili Z, Nazaroff J, Gorell ES, Chiou AS, Taylor L, Khuu P, Keene DR, Rieger K, Khosla RK, Furukawa LK, Lorenz HP, Marinkovich MP, Tang JY. Phase 1/2a clinical trial of gene-corrected autologous cell therapy for recessive dystrophic epidermolysis bullosa. JCI Insight 2019; 4:130554. [PMID: 31578311 DOI: 10.1172/jci.insight.130554] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/31/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUNDRecessive dystrophic epidermolysis bullosa (RDEB) patients have mutations in the COL7A1 gene and thus lack functional type VII collagen (C7) protein; they have marked skin fragility and blistering. This single-center phase 1/2a open-label study evaluated the long-term efficacy, safety, and patient-reported outcomes in RDEB patients treated with gene-corrected autologous cell therapy.METHODSAutologous keratinocytes were isolated from participant skin biopsies. Epidermal sheets were prepared from cells transduced with a retrovirus carrying the full-length human COL7A1 gene. These gene-corrected autologous epidermal sheets measured 5 × 7 cm (35 cm2) and were transplanted onto 6 wound sites in each of 7 adult participants (n = 42 sites total) from 2013 to 2017. Participants were followed for 2 to 5 years.RESULTSNo participants experienced any serious related adverse events. Wound healing of 50% or greater by Investigator Global Assessment was present in 95% (36 of 38) of treated wounds versus 0% (0 of 6) of untreated control wounds at 6 months (P < 0.0001). At year 1, 68% (26 of 38) of treated wounds had 50% or greater healing compared with 17% (1 of 6) of control wounds (P = 0.025). At year 2, 71% (27 of 38) of treated wounds had 50% or greater healing compared with 17% (1 of 6) of control wounds (P = 0.019).CONCLUSIONC7 expression persisted up to 2 years after treatment in 2 participants. Treated wounds with 50% or greater healing demonstrated improvement in patient-reported pain, itch, and wound durability. This study provides additional data to support the clinically meaningful benefit of treating chronic RDEB wounds with ex vivo, C7 gene-corrected autologous cell therapy. This approach was safe and promoted wound healing that was associated with improved patient-reported outcomes.TRIAL REGISTRATIONClinicaltrials.gov identifier: NCT01263379.FUNDINGEpidermolysis Bullosa Research Partnership, Epidermolysis Bullosa Medical Research Foundation, NIH R01 AR055914, Office of Research and Development at the Palo Alto Veteran's Affairs Medical Center, and the Dermatology Foundation.
Collapse
Affiliation(s)
- Shaundra Eichstadt
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Melissa Barriga
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Anusha Ponakala
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Claudia Teng
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | | | - Zurab Siprashvili
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Jaron Nazaroff
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Emily S Gorell
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Albert S Chiou
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Lisa Taylor
- Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, California, USA
| | - Phuong Khuu
- Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, California, USA
| | | | - Kerri Rieger
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Rohit K Khosla
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| | - Louise K Furukawa
- Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, California, USA
| | - H Peter Lorenz
- Lucile Packard Children's Hospital, Stanford Children's Health, Stanford, California, USA
| | - M Peter Marinkovich
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA.,Veterans Affairs Medical Center, Palo Alto, California, USA
| | - Jean Y Tang
- Stanford University School of Medicine, Department of Dermatology, Redwood City, California, USA
| |
Collapse
|
247
|
Ansai O, Shinkuma S, Kabata Y, Katsumi T, Hagiwara R, Tomii K, Fujikawa H, Matsubara M, Abe R. Amino acid charge and epidermolysis bullosa simplex severity: genotype-phenotype correlations. J Eur Acad Dermatol Venereol 2019; 34:e87-e90. [PMID: 31573706 DOI: 10.1111/jdv.15990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- O Ansai
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - S Shinkuma
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Y Kabata
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - T Katsumi
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - R Hagiwara
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - K Tomii
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - H Fujikawa
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - M Matsubara
- Division of Dermatology, Shirone General Hospital, Niigata, Japan
| | - R Abe
- Division of Dermatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| |
Collapse
|
248
|
Abstract
Bullous diseases are uncommon in children; however, as they have the potential to affect quality of life, occasionally have long-term side effects in the setting of scarring processes, and carry a rare risk of underlying malignancy [e.g., with paraneoplastic pemphigus (PNP)], knowledge of their clinical presentation and treatment options is essential. Given the rarity of these conditions, our current state of knowledge is largely derived from case reports and case series, with a paucity of evidence-based recommendations. In this review, we discuss the clinical presentation of and treatment options for linear immunoglobulin A disease, dermatitis herpetiformis, pemphigus vulgaris, pemphigus foliaceus, PNP, bullous pemphigoid, mucus membrane pemphigoid, epidermolysis bullosa acquisita, and inherited epidermolysis bullosa. In general, when these conditions, except for PNP, occur in childhood, they have a better prognosis than when they occur in adults. Clinical, histopathological, and immunologic features frequently overlap, but distinct differences have also been reported, most commonly in clinical presentation. Treatment is often similar to that in adults, although specific considerations are necessary for a pediatric population.
Collapse
Affiliation(s)
- Brittney Schultz
- Department of Dermatology, University of Minnesota, 240 Phillips-Wangensteen Building, 516 Delaware Street Southeast, Minneapolis, MN, 55455, USA.,Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Kristen Hook
- Department of Dermatology, University of Minnesota, 240 Phillips-Wangensteen Building, 516 Delaware Street Southeast, Minneapolis, MN, 55455, USA. .,Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| |
Collapse
|
249
|
Schauer F, Monasterio C, Technau-Hafsi K, Kern JS, Lazaro A, Deibert P, Hasselblatt P, Schwacha H, Heeg S, Brass V, Küllmer A, Schmidt AR, Schmitt-Graeff A, Kreisel W. Esophageal lichen planus: towards diagnosis of an underdiagnosed disease. Scand J Gastroenterol 2019; 54:1189-1198. [PMID: 31608788 DOI: 10.1080/00365521.2019.1674375] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Although lichen planus (LP) is a common skin disorder, the prevalence of esophageal involvement (ELP) and its clinical manifestations are poorly defined. We aimed to establish diagnostic criteria and characterize disease outcomes of ELP.Methods: Clinical, endoscopic, histological, and immunofluorescence data from consecutive patients with known LP between 2013 and 2018 were analyzed. We established endoscopic (denudation and tearing of the mucosa, hyperkeratosis and trachealization) and histological criteria (mucosal detachment, T-lymphocytic infiltrate, intraepithelial apoptosis, dyskeratosis, and fibrinogen deposits along the basement membrane) to grade disease severity. Endoscopic findings were correlated with clinical symptoms. Response to medical therapy was monitored.Results: Fifty-two consecutive patients (median age 59.5 years) were analyzed. According to our grading system, 16 patients were considered as severe and 18 as mild ELP. Dysphagia was the only symptom which differentiated patients with severe (14/16) or mild ELP (8/18) from patients without ELP (1/18). Concomitant oral and genital involvement of LP was associated with the presence of ELP, while oral involvement alone was not. Follow-up of 14/16 patients with severe EPL for at least one year revealed that most of these patients responded to topical corticosteroids (budesonide: n = 9/10 or fluticasone n = 2/2). Three budesonide patients experienced a resolution of symptomatic esophageal stenosis.Conclusions: Esophageal involvement of LP is frequent, but may be asymptomatic. ELP can be diagnosed using the diagnostic criteria proposed here. Dysphagia and combined oral and genital manifestation are associated with ELP. Therapy with topical corticosteroids appears to be a prudent therapeutic approach for ELP.
Collapse
Affiliation(s)
- Franziska Schauer
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Carmen Monasterio
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kristin Technau-Hafsi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Steffen Kern
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Dermatology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Adhara Lazaro
- Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Deibert
- Department of Medicine, Institute of Exercise and Occupational Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Hasselblatt
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Henning Schwacha
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen Heeg
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker Brass
- Kliniken des Landkreises Lörrach GmbH, Gastroenterology, Germany
| | - Armin Küllmer
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arthur Robert Schmidt
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Annette Schmitt-Graeff
- Institute of Clinical Pathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wolfgang Kreisel
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
250
|
Natsuga K, Watanabe M, Nishie W, Shimizu H. Life before and beyond blistering: The role of collagen XVII in epidermal physiology. Exp Dermatol 2019; 28:1135-1141. [PMID: 29604146 DOI: 10.1111/exd.13550] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2018] [Indexed: 12/15/2022]
Abstract
Type XVII collagen (COL17) is a transmembranous protein that is mainly expressed in the epidermal basal keratinocytes. Epidermal-dermal attachment requires COL17 expression at the hemidesmosomes of the epidermal basement membrane zone because congenital COL17 deficiency leads to junctional epidermolysis bullosa and acquired autoimmunity to COL17 induces bullous pemphigoid. Recently, in addition to facilitating epidermal-dermal attachment, COL17 has been reported to serve as a niche for hair follicle stem cells, to regulate proliferation in the interfollicular epidermis and to be present along the non-hemidesmosomal plasma membrane of epidermal basal keratinocytes. This review focuses on the physiological properties of COL17 in the epidermis, its role in maintaining stem cells and its association with signalling pathways. We propose possible solutions to unanswered questions in this field.
Collapse
Affiliation(s)
- Ken Natsuga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mika Watanabe
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|