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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.
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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
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252
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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.
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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
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253
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Improved Double-Nicking Strategies for COL7A1-Editing by Homologous Recombination. MOLECULAR THERAPY-NUCLEIC ACIDS 2019; 18:496-507. [PMID: 31670199 PMCID: PMC6838546 DOI: 10.1016/j.omtn.2019.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 11/21/2022]
Abstract
Current gene-editing approaches for treatment of recessive dystrophic epidermolysis bullosa (RDEB), an inherited, severe form of blistering skin disease, suffer from low efficiencies and safety concerns that complicate implementation in clinical settings. We present a strategy for efficient and precise repair of RDEB-associated mutations in the COL7A1 gene. We compared the efficacy of double-strand breaks (induced by CRISPR/Cas9), single nicks, or double nicks (induced by Cas9n) in mediating repair of a COL7A1 splice-site mutation in exon 3 by homologous recombination (HR). We accomplished remarkably high HR frequencies of 89% with double nicking while at the same time keeping unwanted repair outcomes, such as non-homologous end joining (NHEJ), at a minimum (11%). We also investigated the effects of subtle differences in repair template design on HR rates and found that strategic template-nicking can enhance COL7A1-editing efficiency. In RDEB patient keratinocytes, application of double-nicking led to restoration and subsequent secretion of type VII collagen at high efficiency. Comprehensive analysis of 25 putative off-target sites revealed no off-target activity for double-nicking, while usage of Cas9 resulted in 54% modified alleles at one site. Taken together, our work provides a framework for efficient, precise, and safe repair of COL7A1, which lies at the heart of a future curative therapy of RDEB.
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254
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Pellegrini G, De Luca M. Living with Keratinocytes. Stem Cell Reports 2019; 11:1026-1033. [PMID: 30428385 PMCID: PMC6235013 DOI: 10.1016/j.stemcr.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 10/31/2022] Open
Abstract
A feature distinguishing human hematopoietic and epithelial stem cells from other equally fascinating stem cells is perhaps their easier translation into a clinical setting. We have devoted nearly our entire scientific career in trying to turn our understanding of epithelial stem cell biology into something that could help people suffering from virtually untreatable diseases of squamous epithelia. We have done that as a team, together with our numerous students, postdocs, technicians and valuable collaborators, clinicians, regulators, and, lately, industrial partners. We had rewarding successes and burning failures, but we always did our best. This award, given by friends and colleagues deserving it more than us, has been the most important recognition of our work. Below, we summarize our story.
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Affiliation(s)
- Graziella Pellegrini
- Center for Regenerative Medicine "Stefano Ferrari", Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Michele De Luca
- Center for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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255
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Bremer J, van der Heijden EH, Eichhorn DS, Meijer R, Lemmink HH, Scheffer H, Sinke RJ, Jonkman MF, Pasmooij AMG, Van den Akker PC. Natural Exon Skipping Sets the Stage for Exon Skipping as Therapy for Dystrophic Epidermolysis Bullosa. MOLECULAR THERAPY. NUCLEIC ACIDS 2019; 18:465-475. [PMID: 31670143 PMCID: PMC6831832 DOI: 10.1016/j.omtn.2019.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 02/04/2023]
Abstract
Dystrophic epidermolysis bullosa (DEB) is a devastating blistering disease affecting skin and mucous membranes. It is caused by pathogenic variants in the COL7A1 gene encoding type VII collagen, and can be inherited dominantly or recessively. Recently, promising proof-of-principle has been shown for antisense oligonucleotide (AON)-mediated exon skipping as a therapeutic approach for DEB. However, the precise phenotypic effect to be anticipated from exon skipping, and which patient groups could benefit, is not yet clear. To answer these questions, we studied new clinical and molecular data on seven patients from the Dutch EB registry and reviewed the literature on COL7A1 exon skipping variants. We found that phenotypes associated with dominant exon skipping cannot be distinguished from phenotypes caused by other dominant DEB variants. Recessive exon skipping phenotypes are generally relatively mild in the spectrum of recessive DEB. Therefore, for dominant DEB, AON-mediated exon skipping is unlikely to ameliorate the phenotype. In contrast, the overall severity of phenotypes associated with recessive natural exon skipping pivots toward the milder end of the spectrum. Consequently, we anticipate AON-mediated exon skipping for recessive DEB caused by bi-allelic null variants should lead to a clinically relevant improvement of this devastating phenotype.
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Affiliation(s)
- Jeroen Bremer
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Elisabeth H van der Heijden
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Daryll S Eichhorn
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Rowdy Meijer
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Henny H Lemmink
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hans Scheffer
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Richard J Sinke
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel F Jonkman
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anna M G Pasmooij
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Peter C Van den Akker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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256
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Basement membrane collagens and disease mechanisms. Essays Biochem 2019; 63:297-312. [PMID: 31387942 PMCID: PMC6744580 DOI: 10.1042/ebc20180071] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/09/2019] [Accepted: 07/22/2019] [Indexed: 12/28/2022]
Abstract
Basement membranes (BMs) are specialised extracellular matrix (ECM) structures and collagens are a key component required for BM function. While collagen IV is the major BM collagen, collagens VI, VII, XV, XVII and XVIII are also present. Mutations in these collagens cause rare multi-systemic diseases but these collagens have also been associated with major common diseases including stroke. Developing treatments for these conditions will require a collective effort to increase our fundamental understanding of the biology of these collagens and the mechanisms by which mutations therein cause disease. Novel insights into pathomolecular disease mechanisms and cellular responses to these mutations has been exploited to develop proof-of-concept treatment strategies in animal models. Combined, these studies have also highlighted the complexity of the disease mechanisms and the need to obtain a more complete understanding of these mechanisms. The identification of pathomolecular mechanisms of collagen mutations shared between different disorders represent an attractive prospect for treatments that may be effective across phenotypically distinct disorders.
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257
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Zhou X, Zhang Y, Zhao M, Jian Y, Huang J, Luo X, Yang J, Sun D. Surgical management of hand deformities in patients with recessive dystrophic epidermolysis bullosa. J Plast Surg Hand Surg 2019; 54:33-39. [PMID: 31502914 DOI: 10.1080/2000656x.2019.1661846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is a congenital disease caused by a mutation in the COL7A1 gene and frequently results in hand contractures and pseudosyndactyly. Although multiple treatments exist that can improve the hand malformations, there are currently still no radical cures for this disease because of its high recurrence rate. The present study reports our experiences on how to improve hand deformities in 11 RDEB patients with surgical management and postoperative skin dressings. Hand function was substantially improved after complete release of pseudosyndactyly and achievement of favorable digital web spaces. Patients were followed up for two years, and nine of which showed slight decrease in hand function characterized by re-narrowed web spaces, digit adhesion and flexed metacarpophalangeal (MP) and interphalangeal (IP) joints, while the last two patients underwent hand reoperation one year after their initial surgery because of recurrence. In conclusion, our results show that surgical correction followed by skin dressing changes is an effective approach to improving mitten-hand malformations in RDEB patients.
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Affiliation(s)
- Xianyu Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
| | - Yan Zhang
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
| | - Mengmeng Zhao
- Department of Radiology, Zhengzhou Central Hospital, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuluo Jian
- Department of Plastic and Reconstructive Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jinny Huang
- Department of Transplantation, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xusong Luo
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
| | - Di Sun
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, People's Republic of China
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258
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Kopecki Z. Tumour serine proteases C1r and C1s as novel biomarkers and therapeutic targets in invasive sporadic and recessive dystrophic epidermolysis bullosa-associated cutaneous squamous cell carcinoma. Br J Dermatol 2019; 182:530-531. [PMID: 31486079 DOI: 10.1111/bjd.18419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Z Kopecki
- Regenerative Medicine Laboratory, Future Industries Institute, University of South Australia, Adelaide, South Australia, Australia
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259
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Chacón‐Solano E, León C, Díaz F, García‐García F, García M, Escámez M, Guerrero‐Aspizua S, Conti C, Mencía Á, Martínez‐Santamaría L, Llames S, Pévida M, Carbonell‐Caballero J, Puig‐Butillé J, Maseda R, Puig S, de Lucas R, Baselga E, Larcher F, Dopazo J, del Río M. Fibroblast activation and abnormal extracellular matrix remodelling as common hallmarks in three cancer-prone genodermatoses. Br J Dermatol 2019; 181:512-522. [PMID: 30693469 PMCID: PMC6850467 DOI: 10.1111/bjd.17698] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Recessive dystrophic epidermolysis bullosa (RDEB), Kindler syndrome (KS) and xeroderma pigmentosum complementation group C (XPC) are three cancer-prone genodermatoses whose causal genetic mutations cannot fully explain, on their own, the array of associated phenotypic manifestations. Recent evidence highlights the role of the stromal microenvironment in the pathology of these disorders. OBJECTIVES To investigate, by means of comparative gene expression analysis, the role played by dermal fibroblasts in the pathogenesis of RDEB, KS and XPC. METHODS We conducted RNA-Seq analysis, which included a thorough examination of the differentially expressed genes, a functional enrichment analysis and a description of affected signalling circuits. Transcriptomic data were validated at the protein level in cell cultures, serum samples and skin biopsies. RESULTS Interdisease comparisons against control fibroblasts revealed a unifying signature of 186 differentially expressed genes and four signalling pathways in the three genodermatoses. Remarkably, some of the uncovered expression changes suggest a synthetic fibroblast phenotype characterized by the aberrant expression of extracellular matrix (ECM) proteins. Western blot and immunofluorescence in situ analyses validated the RNA-Seq data. In addition, enzyme-linked immunosorbent assay revealed increased circulating levels of periostin in patients with RDEB. CONCLUSIONS Our results suggest that the different causal genetic defects converge into common changes in gene expression, possibly due to injury-sensitive events. These, in turn, trigger a cascade of reactions involving abnormal ECM deposition and underexpression of antioxidant enzymes. The elucidated expression signature provides new potential biomarkers and common therapeutic targets in RDEB, XPC and KS. What's already known about this topic? Recessive dystrophic epidermolysis bullosa (RDEB), Kindler syndrome (KS) and xeroderma pigmentosum complementation group C (XPC) are three genodermatoses with high predisposition to cancer development. Although their causal genetic mutations mainly affect epithelia, the dermal microenvironment likely contributes to the physiopathology of these disorders. What does this study add? We disclose a large overlapping transcription profile between XPC, KS and RDEB fibroblasts that points towards an activated phenotype with high matrix-synthetic capacity. This common signature seems to be independent of the primary causal deficiency, but reflects an underlying derangement of the extracellular matrix via transforming growth factor-β signalling activation and oxidative state imbalance. What is the translational message? This study broadens the current knowledge about the pathology of these diseases and highlights new targets and biomarkers for effective therapeutic intervention. It is suggested that high levels of circulating periostin could represent a potential biomarker in RDEB.
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260
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Uitto J. Epidermolysis bullosa: diagnostic guidelines in the laboratory setting. Br J Dermatol 2019; 182:526-527. [PMID: 31436321 DOI: 10.1111/bjd.18377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- J Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, U.S.A
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261
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Dwiyana RF, Gondokaryono SP, Rahardja JI, Arline Diana I, Yogya Y, Gunawan H. Clinical efficacy of dialkylcarbamoylchloride‐coated cotton acetate dressing versus combination of normal saline dressing and 2% mupirocin ointment in infected wounds of epidermolysis bullosa. Dermatol Ther 2019; 32:e13047. [DOI: 10.1111/dth.13047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Reiva Farah Dwiyana
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran—Dr. Hasan Sadikin General Hospital Bandung Indonesia
| | - Srie Prihianti Gondokaryono
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran—Dr. Hasan Sadikin General Hospital Bandung Indonesia
| | - July Iriani Rahardja
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran—Dr. Hasan Sadikin General Hospital Bandung Indonesia
| | - Inne Arline Diana
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran—Dr. Hasan Sadikin General Hospital Bandung Indonesia
| | - Yuri Yogya
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran—Dr. Hasan Sadikin General Hospital Bandung Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of MedicineUniversitas Padjadjaran—Dr. Hasan Sadikin General Hospital Bandung Indonesia
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262
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Has C, Liu L, Bolling MC, Charlesworth AV, El Hachem M, Escámez MJ, Fuentes I, Büchel S, Hiremagalore R, Pohla-Gubo G, van den Akker PC, Wertheim-Tysarowska K, Zambruno G. Clinical practice guidelines for laboratory diagnosis of epidermolysis bullosa. Br J Dermatol 2019; 182:574-592. [PMID: 31090061 PMCID: PMC7064925 DOI: 10.1111/bjd.18128] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
Linked Comment: https://doi.org/10.1111/bjd.18377. https://doi.org/10.1111/bjd.18829 available online
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - L Liu
- Viapath, St Thomas' Hospital, London, U.K
| | - M C Bolling
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A V Charlesworth
- Centre de Reference des Maladies Rares de la Peau et des Muqueuses d'Origine Génétique, L'Archet Hôpital, Nice, France
| | - M El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M J Escámez
- Bioengineering Department at Universidad Carlos III de Madrid (UC3M), Regenerative Medicine Unit at CIEMAT - U714 CIBER on Rare Diseases (ISCIII), Instituto de Investigación Sanitaria Fundación Jiménez Diaz (IISFJD), Madrid, Spain
| | - I Fuentes
- Fundación DEBRA Chile, Santiago, Chile.,Centro de Genética y Genómica, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - S Büchel
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Hiremagalore
- Adjunct Faculty, Centre for Human Genetics and Department of Dermatology and Pediatrics, Manipal Hospital, Bengaluru, India
| | - G Pohla-Gubo
- EB House Austria, Department of Dermatology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - P C van den Akker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - G Zambruno
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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263
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Vahidnezhad H, Youssefian L, Saeidian AH, Touati A, Pajouhanfar S, Baghdadi T, Shadmehri AA, Giunta C, Kraenzlin M, Syx D, Malfait F, Has C, Lwin SM, Karamzadeh R, Liu L, Guy A, Hamid M, Kariminejad A, Zeinali S, McGrath JA, Uitto J. Mutations in PLOD3, encoding lysyl hydroxylase 3, cause a complex connective tissue disorder including recessive dystrophic epidermolysis bullosa-like blistering phenotype with abnormal anchoring fibrils and type VII collagen deficiency. Matrix Biol 2019; 81:91-106. [DOI: 10.1016/j.matbio.2018.11.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 01/28/2023]
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264
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Guerrero-Aspizua S, Conti CJ, Escamez MJ, Castiglia D, Zambruno G, Youssefian L, Vahidnezhad H, Requena L, Itin P, Tadini G, Yordanova I, Martin L, Uitto J, Has C, Del Rio M. Assessment of the risk and characterization of non-melanoma skin cancer in Kindler syndrome: study of a series of 91 patients. Orphanet J Rare Dis 2019; 14:183. [PMID: 31340837 PMCID: PMC6657209 DOI: 10.1186/s13023-019-1158-6] [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: 06/07/2019] [Accepted: 07/18/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Kindler Syndrome (KS) is a rare genodermatosis characterized by skin fragility, skin atrophy, premature aging and poikiloderma. It is caused by mutations in the FERMT1 gene, which encodes kindlin-1, a protein involved in integrin signalling and the formation of focal adhesions. Several reports have shown the presence of non-melanoma skin cancers in KS patients but a systematic study evaluating the risk of these tumors at different ages and their potential outcome has not yet been published. We have here addressed this condition in a retrospective study of 91 adult KS patients, characterizing frequency, metastatic potential and body distribution of squamous cell carcinoma (SCC) in these patients. SCC developed in 13 of the 91 patients. RESULTS The youngest case arose in a 29-year-old patient; however, the cumulative risk of SCC increased to 66.7% in patients over 60 years of age. The highly aggressive nature of SCCs in KS was confirmed showing that 53.8% of the patients bearing SCCs develop metastatic disease. Our data also showed there are no specific mutations that correlate directly with the development of SCC; however, the mutational distribution along the gene appears to be different in patients bearing SCC from SCC-free patients. The body distribution of the tumor appearance was also unique and different from other bullous diseases, being concentrated in the hands and around the oral cavity, which are areas of high inflammation in this disease. CONCLUSIONS This study characterizes SCCs in the largest series of KS patients reported so far, showing the high frequency and aggressiveness of these tumors. It also describes their particular body distribution and their relationship with mutations in the FERMT-1 gene. These data reinforce the need for close monitoring of premalignant or malignant lesions in KS patients.
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Affiliation(s)
- Sara Guerrero-Aspizua
- Department of Bioengineering, Universidad Carlos III de Madrid, Leganés, Madrid, Spain.,Hospital Fundación Jiménez Díaz e Instituto de Investigación FJD, Madrid, Spain.,Epithelial Biomedicine Division, CIEMAT, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), U714, Madrid, Spain
| | - Claudio J Conti
- Department of Bioengineering, Universidad Carlos III de Madrid, Leganés, Madrid, Spain. .,Hospital Fundación Jiménez Díaz e Instituto de Investigación FJD, Madrid, Spain.
| | - Maria Jose Escamez
- Department of Bioengineering, Universidad Carlos III de Madrid, Leganés, Madrid, Spain.,Hospital Fundación Jiménez Díaz e Instituto de Investigación FJD, Madrid, Spain.,Epithelial Biomedicine Division, CIEMAT, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), U714, Madrid, Spain
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanna Zambruno
- Genetic and Rare Diseases Research Area, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Leila Youssefian
- Department of Medical Genetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Biotechnology Research Center, Department of Molecular Medicine, Pasteur Institute of Iran, Tehran, Iran
| | - Luis Requena
- Hospital Fundación Jiménez Díaz e Instituto de Investigación FJD, Madrid, Spain
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Gianluca Tadini
- Pediatric Dermatology, Department of Physiopathology and Transplantation, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Ivelina Yordanova
- Department of Dermatology and Venerology, Medical University Pleven, Pleven, Bulgaria
| | - Ludovic Martin
- Department of Dermatology, Angers University Hospital, Angers, France
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cristina Has
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - Marcela Del Rio
- Department of Bioengineering, Universidad Carlos III de Madrid, Leganés, Madrid, Spain.,Hospital Fundación Jiménez Díaz e Instituto de Investigación FJD, Madrid, Spain.,Epithelial Biomedicine Division, CIEMAT, Madrid, Spain.,Centre for Biomedical Network Research on Rare Diseases (CIBERER), U714, Madrid, Spain
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265
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Ceuppens SHE, Kimenai HJAN, Roodnat JI, Mertens Zur Borg IRAM, Duipmans JC, IJzermans JNM, Minnee RC. Living Donor Kidney Transplantation in a Patient With Epidermolysis Bullosa: A Case Report. Transplant Proc 2019; 51:3074-3076. [PMID: 31331719 DOI: 10.1016/j.transproceed.2019.04.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/05/2019] [Indexed: 11/29/2022]
Abstract
Severe recessive dystrophic epidermolysis bullosa is a very rare inherited disease with excessive blisters forming starting at birth. Surgical intervention in this population creates a challenge: preventing formation of new lesions while managing previously scarred tissues. We present a case of a 27-year-old patient with end-stage renal disease caused by rapidly progressive IgA nephropathy. Living donor kidney transplantation was performed under local, spinal and epidural anesthesia. Living kidney transplantation in epidermolysis bullosa patients with end-stage renal disease should not be a contraindication for transplantation and should be considered as a viable and feasible option after careful preparation.
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Affiliation(s)
- S H E Ceuppens
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - H J A N Kimenai
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - J I Roodnat
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | | | - J C Duipmans
- Department of Dermatology, University Medical Center Groningen, the Netherlands
| | - J N M IJzermans
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - R C Minnee
- Department of Surgery, Division of HPB & Transplant Surgery, Erasmus MC, Rotterdam, the Netherlands.
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266
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Vahidnezhad H, Youssefian L, Daneshpazhooh M, Mahmoudi H, Kariminejad A, Fischer J, Christiansen J, Schneider H, Guy A, Liu L, McGrath JA, Has C, Uitto J. Biallelic KRT5 mutations in autosomal recessive epidermolysis bullosa simplex, including a complete human keratin 5 "knock-out". Matrix Biol 2019; 83:48-59. [PMID: 31302245 DOI: 10.1016/j.matbio.2019.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/06/2023]
Abstract
Epidermolysis bullosa simplex (EBS) is usually inherited as an autosomal dominant disease due to monoallelic gain-of-function mutations in KRT5 or KRT14. Although autosomal recessive forms of EBS have been associated with mutations in at least 10 genes, recessive EBS due to homozygous biallelic KRT5 mutations has not been reported previously; it has been hypothesized that it would result in prenatal lethality. We sought the genetic causes of EB in a cohort of 512 distinct EB families by performing whole exome sequencing (WES) and using an EB-targeting next-generation sequencing (NGS) panel of 21 genes. The pathogenicity and consequences of the mutations were determined by expression profiling and at tissue and ultrastructural levels. Two pathogenic, homozygous missense variants of KRT5 in two patients with generalized EBS and a homozygous null mutation in a patient who died as a neonate from complications of EB were found. The two missense mutations disrupted keratin 5 expression on immunofluorescence microscopy, and the human "knock-out" of KRT5 showed no RNA and protein expression. Collectively, these findings identify biallelic KRT5 mutations with a phenotypic spectrum varying from mild, localized and generalized to perinatal lethal, expanding the genotypic profile of autosomal recessive EBS.
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Affiliation(s)
- Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA; Molecular Medicine Department, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran
| | - Leila Youssefian
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA; Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Genetics, Genomics and Cancer Biology PhD Program, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maryam Daneshpazhooh
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Judith Fischer
- Institute of Human Genetics, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Julie Christiansen
- Department of Dermatology and Venereology, Skanes University Hospital, Sweden
| | - Holm Schneider
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Alyson Guy
- Viapath, St Thomas' Hospital, London, UK
| | - Lu Liu
- Viapath, St Thomas' Hospital, London, UK
| | - John A McGrath
- St John's Institute of Dermatology, King's College London, Guy's Campus, London, UK
| | - Cristina Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
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267
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Xie D, Bilgic-Temel A, Abu Alrub N, Murrell DF. Alopecia in Autoimmune Blistering Diseases: A Systematic Review of Pathogenesis and Clinical Features of Disease. Skin Appendage Disord 2019; 5:263-275. [PMID: 31559249 DOI: 10.1159/000496836] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/10/2019] [Indexed: 11/19/2022] Open
Abstract
Background Autoimmune blistering diseases (AIBD) are characterised by the body's production of autoantibodies against structural proteins in the epidermis and/or the basement membrane on cutaneous and mucosal surfaces. Alopecia is a complication of AIBD that has generally been overlooked in patients with severe blistering diseases because it is regarded as a cosmetic issue. Yet recent research into quality of life tools has found that stigmatisation by appearance plays a significant role in blistering diseases. Aim To review the current literature detailing the pathogenesis and clinical presentations of alopecia in AIBD patients. Method We searched Medline, PubMed and EMBASE electronic databases up to September 2018, for empirical human and animal studies. Results Only 36 human studies including 223 patients (190 pemphigus, 25 pemphigoid, 5 epidermolysis bullosa acquisita, 2 dermatitis herpetiformis and 1 linear IgA disease) detailed demographic and clinical manifestations of alopecia. A range of hair evaluation methods was demonstrated to reach alopecia diagnosis. Furthermore, with no universal validated scoring system for alopecia severity, alopecia patterns have been summarised. Conclusion Previous randomised trials have not highlighted alopecia as an important outcome of AIBD, so epidemiological evaluation of the available literature has been helpful in summarising trends between existing studies and demonstrating inconsistencies.
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Affiliation(s)
- Danica Xie
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Asli Bilgic-Temel
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia
| | - Nada Abu Alrub
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia
| | - Dédée F Murrell
- Department of Dermatology, St. George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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268
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Schwieger-Briel A, Ott H, Kiritsi D, Laszczyk-Lauer M, Bodemer C. Mechanism of Oleogel-S10: A triterpene preparation for the treatment of epidermolysis bullosa. Dermatol Ther 2019; 32:e12983. [PMID: 31168940 PMCID: PMC6771815 DOI: 10.1111/dth.12983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/08/2019] [Accepted: 06/03/2019] [Indexed: 12/24/2022]
Abstract
Epidermolysis bullosa (EB) is a group of rare heterogeneous, genetic disorders. Currently, there is no effective pharmacological or genetic therapy for all EB subtypes. Dry extract from birch bark and betulin upregulate some pro‐inflammatory mediators and downregulate others. The increase in pro‐inflammatory cytokines is temporary and attenuated over long‐term treatment. This inflammatory stimulus is thought to be prerequisite for a secondary anti‐inflammatory response. Dry extract from birch bark and its active marker substances have also been shown to increase the migration of primary human keratinocytes, accelerate wound closure, and promote differentiation of keratinocytes in vitro and in vivo—processes that are essential for reepithelialization and maintenance of the skin barrier. Comprehensive clinical data are available to support the use of Oleogel‐S10 in the treatment of partial thickness wounds of different etiologies, and a proof‐of‐concept Phase 2 study in patients with dystrophic EB has suggested the potential for faster reepithelialization of wounds treated with Oleogel‐S10.
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Affiliation(s)
- Agnes Schwieger-Briel
- Department of Pediatric Dermatology, University Childrens' Hospital Zurich, Zurich, Switzerland
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Dimitra Kiritsi
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | | | - Christine Bodemer
- Department of Dermatology, Institut Imagine, Necker Enfants Malades Hospital, Paris University, APHP 5; Centre for Genodermatoses (MAGEC); European Network for Rare Skin Diseases (ERN-SKIN), Paris, France
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269
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Frank J, Betz RC. Haaranomalien bei syndromalen Erkrankungen. Hautarzt 2019; 70:514-519. [DOI: 10.1007/s00105-019-4440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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270
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Xie D, Bilgic-Temel A, Abu Alrub N, Murrell DF. Pathogenesis and clinical features of alopecia in epidermolysis bullosa: A systematic review. Pediatr Dermatol 2019; 36:430-436. [PMID: 31177584 DOI: 10.1111/pde.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a group of rare genetic skin diseases characterized by the gene mutations encoding adhesion proteins within the skin. These adhesion proteins are also present in normal hair follicles. Anecdotally, there have been reports of scalp alopecia as a complication of EB and there are scattered cases in the literature, but alopecia has generally been overlooked in severe blistering diseases because it is regarded as a cosmetic issue. Therefore, there is no consensus about the natural history and clinical manifestations of alopecia in EB to allow potential intervention. OBJECTIVES To review the current literature detailing the pathogenesis and clinical presentations of alopecia in EB patients. METHODS Relevant human studies were searched in Medline, PubMed, and EMBASE electronic databases up to October 2018. RESULTS Only 15 reports detailed 29 EB patients with demographic and clinical manifestations of alopecia. Vertical biopsy sections were the most common method of alopecia diagnosis, and the most common pattern was patchy scalp alopecia (45%) followed by diffuse alopecia (41%). The most robust finding was nonspecific scarring alopecia in all dystrophic EB (DEB) patients and nonspecific nonscarring alopecia in most patients with EB simplex (EBS). CONCLUSIONS Hair abnormalities observed in EB are of variable severity despite there being no universal validated alopecia scoring system, with alopecia occurring secondary to blistering, or in areas prone to trauma.
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Affiliation(s)
- Danica Xie
- Department of Dermatology, St George Hospital, Kogarah, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Asli Bilgic-Temel
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nada Abu Alrub
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Kogarah, Australia.,Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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271
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Arslan E, Çermik TF, Koku Aksu AE, Gürel MS, Leblebici C. Detection of Squamous Cell Carcinoma Foci in a Patient with Dystrophic Epidermolysis Bullosa in 18F-FDG PET/CT. Mol Imaging Radionucl Ther 2019; 28:79-82. [PMID: 31237139 PMCID: PMC6592315 DOI: 10.4274/mirt.galenos.2018.96658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Dystrophic epidermolysis bullosa (DEB) is a rare, inherited skin fragility disorder characterized by blister formation in the sublamina densa. DEB is associated with aggressive squamous cell carcinoma (SCC) that has increased risk of metastases and poor prognosis. A 41-year-old woman with DEB underwent 18F-fluoro-2-deoxy-glucose positron emission tomography/computed tomography (18F-FDG PET/BT). PET/CT showed increased 18F-FDG uptakes in multifocal cutaneous lesions in both lower extremities. The patient was diagnosed with SCC via skin biopsy from the left lateral lower thigh. Ten months later, PET/CT showed increased FDG uptakes in the primary tumor area as well as the left inguinal and left supraclavicular lymph node regions. 18F-FDG PET/CT seems to be useful for re-staging and planning appropriate therapeutic strategy in DEB-patients with SCC.
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Affiliation(s)
- Esra Arslan
- University of Health Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tevfik Fikret Çermik
- University of Health Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Ayşe Esra Koku Aksu
- University of Health Sciences, İstanbul Training and Research Hospital, Clinic of Dermatology, İstanbul, Turkey
| | - Mehmet Salih Gürel
- University of Health Sciences, İstanbul Training and Research Hospital, Clinic of Dermatology, İstanbul, Turkey
| | - Cem Leblebici
- University of Health Sciences, İstanbul Training and Research Hospital, Clinic of Pathology, İstanbul, Turkey
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272
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De Luca M, Aiuti A, Cossu G, Parmar M, Pellegrini G, Robey PG. Advances in stem cell research and therapeutic development. Nat Cell Biol 2019; 21:801-811. [PMID: 31209293 DOI: 10.1038/s41556-019-0344-z] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 05/09/2019] [Indexed: 12/12/2022]
Abstract
Despite many reports of putative stem-cell-based treatments in genetic and degenerative disorders or severe injuries, the number of proven stem cell therapies has remained small. In this Review, we survey advances in stem cell research and describe the cell types that are currently being used in the clinic or are close to clinical trials. Finally, we analyse the scientific rationale, experimental approaches, caveats and results underpinning the clinical use of such stem cells.
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Affiliation(s)
- Michele De Luca
- Center for Regenerative Medicine "Stefano Ferrari", Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget) and Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giulio Cossu
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Malin Parmar
- Developmental and Regenerative Neurobiology, Department of Experimental Medical Science, Wallenberg Neuroscience Center, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Graziella Pellegrini
- Center for Regenerative Medicine "Stefano Ferrari", Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Pamela Gehron Robey
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
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273
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Martin K, Geuens S, Asche JK, Bodan R, Browne F, Downe A, García García N, Jaega G, Kennedy B, Mauritz PJ, Pérez F, Soon K, Zmazek V, Mayre-Chilton KM. Psychosocial recommendations for the care of children and adults with epidermolysis bullosa and their family: evidence based guidelines. Orphanet J Rare Dis 2019; 14:133. [PMID: 31186066 PMCID: PMC6560722 DOI: 10.1186/s13023-019-1086-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Epidermolysis Bullosa (EB) is a group of rare genetic disorders resulting in skin fragility and other symptoms. Commissioned by DEBRA International and funded by DEBRA Norway, this evidence-bases guideline provides recommendations to optimise psychosocial wellbeing in EB.An international multidisciplinary panel of social and health care professionals (HCP) and people living with EB was formed. A systematic international literature review was conducted by the panel following the Scottish Intercollegiate Guidelines Network (SIGN) methodology. The resulting papers underwent systematic selection and critique processes. Included papers were allocated to 6 different outcome groups to allow data synthesis and exploration: quality of life, coping, family, wellbeing, access to HCP and pain. Based on the evidence in those papers, recommendations were made for individuals living with EB, family and caregivers and HCP working in the field.Few studies have investigated interventions and which factors lead to better outcomes, but general recommendations can be made. EB is a complex disease impacting enormously on every aspect of psychosocial life. People and families living with EB need access to multidisciplinary support, including psychological guidance, in order to improve quality of life and psychosocial wellbeing. Interventions should stimulate social participation to prevent isolation. People with EB and their families should be able to access a supportive network. HCP should be well supported and educated about the complexity of EB. They should work collaboratively with those around the individual with EB (e.g. schools, employers etc.) to provide psychosocial opportunity and care.Attention should be paid to the psychosocial impact of EB as well as physical needs. Directions for research are indicated.
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Affiliation(s)
- K. Martin
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, B91 2JL, UK
| | - S. Geuens
- Universital Hospitals Leuven, Leuven, Belgium
| | - J. K. Asche
- DEBRA Norge and person living with JEB, Stavanger, Norway
| | - R. Bodan
- California State University, Fullerton, CA USA
| | - F. Browne
- Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - A. Downe
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | | | - G. Jaega
- Psychology graduate and person living with EBS, Liverpool, UK
| | - B. Kennedy
- Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - P. J. Mauritz
- The University Medical Center Groningen, Groningen, the Netherlands
| | | | - K. Soon
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - K. M. Mayre-Chilton
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
- DEBRA International, Vienna, Austria
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274
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Kern JS, Schwieger-Briel A, Löwe S, Sumeray M, Davis C, Martinez AE. Oleogel-S10 Phase 3 study "EASE" for epidermolysis bullosa: study design and rationale. Trials 2019; 20:350. [PMID: 31186047 PMCID: PMC6560757 DOI: 10.1186/s13063-019-3362-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Epidermolysis bullosa (EB) is a group of rare, genetic diseases that affect the integrity of epithelial tissues, most notably the skin. Patients experience recurrent skin wounding, with severity depending on type, sub-type, and mutation. Oleogel-S10, a formulation of birch bark extract, has demonstrated efficacy in a Phase 2 trial assessing re-epithelialization of wounds in EB. EASE (NCT03068780, EudraCT 2016–002066-32) is a randomized, Phase 3, placebo-controlled study designed to determine the efficacy of Oleogel-S10 versus placebo in patients with EB. Methods EASE is a Phase 3, two-phase study comprising a 90-day, double-blind, randomized, placebo-controlled phase, followed by 24 months of open-label, single-arm follow-up. Patients with junctional EB, dystrophic EB, or Kindler syndrome and target wounds (10 - 50cm2) present for > 21 days and < 9 months, are randomized in a 1:1 ratio to receive wound dressings according to local standard of care with or without Oleogel-S10. Placebo is based on the Oleogel-S10 vehicle, which is sunflower oil formulated to have a consistency indistinguishable from that of the active product. The primary endpoint of the trial, directed by the US health authority according to the required study endpoints for chronic cutaneous ulcer and burn wounds, is to compare the efficacy of Oleogel-S10 versus placebo according to the proportion of patients with complete closure of the target wound within 45 ± 7 days of treatment. Additional EB-focused endpoints include wound burden, patient-reported outcomes, and safety. Results Results of the primary endpoint are anticipated to be available by H2 2019. Trial registration ClinicalTrials.gov, NCT03068780. EudraCT, 2016–002066-32. Registered on 3 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3362-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes S Kern
- Dermatology Department, Royal Melbourne Hospital, Faculy of Medicine, Dentistry and Health Science, The University of Melbourne, Parkville, Victoria, Australia. .,Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.
| | - Agnes Schwieger-Briel
- Department of Dermatology, University Childrens' Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Anna E Martinez
- Department of Paediatric Dermatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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275
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Christofolini DM, Ceroni JRM, Soares GG, Lamy GB, Calvo ACN, Santos TAD, Sonoda BDB, Bianco B, Barbosa CP. Reproductive alternatives for patients with dystrophic epidermolysis bullosa. EINSTEIN-SAO PAULO 2019; 17:eRC4577. [PMID: 31215591 PMCID: PMC6559778 DOI: 10.31744/einstein_journal/2019rc4577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/20/2018] [Indexed: 11/29/2022] Open
Abstract
Epidermolysis bullosa describes a group of skin conditions caused by mutations in genes encoding proteins related to dermal-epidermal adhesion. In the United States, 50 cases of epidermolysis bullosa per 1 million live births are estimated, 92% of which classified as simplex, 5% dystrophic, 1% junctional and 2% non-classified. Dystrophic epidermolysis bullosa is associated with autosomal, dominant and recessive inheritance. Epidermolysis bullosa causes severe psychological, economic and social impacts, and there is currently no curative therapy, only symptom control. Embryonic selection is available for epidermolysis bullosa patients in order to prevent perpetuation of the condition in their offspring.
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276
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Chan JM, Weisman A, King A, Maksomski S, Shotwell C, Bailie C, Weaver H, Bodan R, Guerrero E, Zmazek M, Khuu P. Occupational therapy for epidermolysis bullosa: clinical practice guidelines. Orphanet J Rare Dis 2019; 14:129. [PMID: 31174559 PMCID: PMC6556021 DOI: 10.1186/s13023-019-1059-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/08/2019] [Indexed: 12/20/2022] Open
Abstract
The purpose of this article is to summarize the Dystrophic Epidermolysis Bullosa Research Association (DEBRA) International evidence-based Clinical Practice Guidelines (CPGs) for the provision of occupational therapy (OT) for children and adults living with inherited epidermolysis bullosa (EB). This is a rare genetic disorder characterized by skin fragility leading to blister formation occurring spontaneously or following minor trauma. Current OT practice for persons with EB is based on anecdotal care, clinical expertise and trial and error with collaboration between caregiver and patient. Intervention based on research is needed to establish a foundation of knowledge to guide international practitioners to create and improve standards of care and to be able to work effectively with those living with the rare diagnosis of this condition. This CPG was created by an international panel with expertise working with persons with EB. The panel was made up of 11 members including OT’s, a physiotherapist, a medical doctor, social worker, person with EB and a carer of a person with EB. It describes the development of recommendations for 5 outcomes determined by survey of persons with EB, caregivers, and experienced healthcare professionals. The outcomes include independence in activities of daily living (ADL), independence in instrumental ADL, maximization of hand function (non-surgical), fine motor development and retention, and oral feeding skills. The recommendations are supplemented with additional files that include photos and specific examples to further guide occupational therapists or, in situations where an OT is not available, other members of the healthcare team. As the disorder of EB is rare, evidence-based CPGs are needed to provide a base of knowledge and practice for OTs throughout the world with the goal of providing quality care to patients, while improving their functional independence and quality of life. In addition, this information is valuable as a basis for further research.
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Affiliation(s)
- Jennifer M Chan
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA.
| | - Amy Weisman
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA
| | - Alex King
- Phoenix Children's Hospital, Phoenix, USA
| | | | | | | | | | - Rebecca Bodan
- School of Nursing, California State University Fullerton, Fullerton, USA
| | | | | | - Phuong Khuu
- Department of Rehabilitation, Lucile Packard Children's Hospital Stanford, 321 Middlefield Road, Menlo Park, CA, 94025, USA
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277
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Lwin SM, Syed F, Di WL, Kadiyirire T, Liu L, Guy A, Petrova A, Abdul-Wahab A, Reid F, Phillips R, Elstad M, Georgiadis C, Aristodemou S, Lovell PA, McMillan JR, Mee J, Miskinyte S, Titeux M, Ozoemena L, Pramanik R, Serrano S, Rowles R, Maurin C, Orrin E, Martinez-Queipo M, Rashidghamat E, Tziotzios C, Onoufriadis A, Chen M, Chan L, Farzaneh F, Del Rio M, Tolar J, Bauer JW, Larcher F, Antoniou MN, Hovnanian A, Thrasher AJ, Mellerio JE, Qasim W, McGrath JA. Safety and early efficacy outcomes for lentiviral fibroblast gene therapy in recessive dystrophic epidermolysis bullosa. JCI Insight 2019; 4:126243. [PMID: 31167965 DOI: 10.1172/jci.insight.126243] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/17/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUNDRecessive dystrophic epidermolysis bullosa (RDEB) is a severe form of skin fragility disorder due to mutations in COL7A1 encoding basement membrane type VII collagen (C7), the main constituent of anchoring fibrils (AFs) in skin. We developed a self-inactivating lentiviral platform encoding a codon-optimized COL7A1 cDNA under the control of a human phosphoglycerate kinase promoter for phase I evaluation.METHODSIn this single-center, open-label phase I trial, 4 adults with RDEB each received 3 intradermal injections (~1 × 106 cells/cm2 of intact skin) of COL7A1-modified autologous fibroblasts and were followed up for 12 months. The primary outcome was safety, including autoimmune reactions against recombinant C7. Secondary outcomes included C7 expression, AF morphology, and presence of transgene in the injected skin.RESULTSGene-modified fibroblasts were well tolerated, without serious adverse reactions or autoimmune reactions against recombinant C7. Regarding efficacy, there was a significant (P < 0.05) 1.26-fold to 26.10-fold increase in C7 mean fluorescence intensity in the injected skin compared with noninjected skin in 3 of 4 subjects, with a sustained increase up to 12 months in 2 of 4 subjects. The presence of transgene (codon-optimized COL7A1 cDNA) was demonstrated in the injected skin at month 12 in 1 subject, but no new mature AFs were detected.CONCLUSIONTo our knowledge, this is the first human study demonstrating safety and potential efficacy of lentiviral fibroblast gene therapy with the presence of COL7A1 transgene and subsequent C7 restoration in vivo in treated skin at 1 year after gene therapy. These data provide a rationale for phase II studies for further clinical evaluation.TRIAL REGISTRATIONClincalTrials.gov NCT02493816.FUNDINGCure EB, Dystrophic Epidermolysis Bullosa Research Association (UK), UK NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, and Fondation René Touraine Short-Exchange Award.
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Affiliation(s)
- Su M Lwin
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Farhatullah Syed
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Wei-Li Di
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Tendai Kadiyirire
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Lu Liu
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Alyson Guy
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Anastasia Petrova
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Alya Abdul-Wahab
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Fiona Reid
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Rachel Phillips
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Maria Elstad
- School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
| | - Christos Georgiadis
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Sophia Aristodemou
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Patricia A Lovell
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - James R McMillan
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - John Mee
- Immunodermatology Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Snaigune Miskinyte
- INSERM UMR 1163, Imagine Institute, Université Paris Descartes Sorbonne Cite, Paris, France
| | - Matthias Titeux
- INSERM UMR 1163, Imagine Institute, Université Paris Descartes Sorbonne Cite, Paris, France
| | - Linda Ozoemena
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St Thomas' Hospital, London, United Kingdom
| | - Rashida Pramanik
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Sonia Serrano
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Racheal Rowles
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Clarisse Maurin
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Elizabeth Orrin
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Magdalena Martinez-Queipo
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom.,National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Ellie Rashidghamat
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Christos Tziotzios
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Alexandros Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Mei Chen
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Lucas Chan
- Department of Haematological Medicine, King's College London, The Rayne Institute, London, United Kingdom
| | - Farzin Farzaneh
- Department of Haematological Medicine, King's College London, The Rayne Institute, London, United Kingdom
| | - Marcela Del Rio
- Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT); Department of Biomedical Engineering, Carlos III University (UC3M); Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain
| | - Jakub Tolar
- Department of Pediatric Oncology, Hematology and Bone Marrow Transplant, University of Minnesota, Minneapolis, Minnesota, USA
| | - Johann W Bauer
- Department of Dermatology and EB House Austria, University Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Fernando Larcher
- Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT); Department of Biomedical Engineering, Carlos III University (UC3M); Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain
| | - Michael N Antoniou
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Alain Hovnanian
- INSERM UMR 1163, Imagine Institute, Université Paris Descartes Sorbonne Cite, Paris, France
| | - Adrian J Thrasher
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Jemima E Mellerio
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Waseem Qasim
- Infection, Immunity and Inflammation Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - John A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
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278
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Zidorio AP, Togo C, Jones R, Dutra E, de Carvalho K. Resting Energy Expenditure and Protein Balance in People with Epidermolysis Bullosa. Nutrients 2019; 11:E1257. [PMID: 31163622 PMCID: PMC6627554 DOI: 10.3390/nu11061257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/29/2022] Open
Abstract
Epidermolysis bullosa (EB) is a group of conditions characterized by severe fragility of the skin that causes recurring blistering. The recessive dystrophic subtype of EB (RDEB) has a strong impact on the nutritional status. We evaluated the resting energy expenditure (REE) and presence of protein catabolism in patients with RDEB. REE was assessed in 10 subjects (7 females; age range 4-33 years) by indirect calorimetry and using a predictive equation. Nitrogen balance was calculated by protein intake and 24 h urinary urea excretion estimations. An assessment of body surface area (BSA) with infected and non-infected skin lesions was applied to the nitrogen balance burn equation that was adapted to EB. The REE values predicted by the equation were consistently lower than the ones measured, except for two subjects. All subjects recorded high protein and energy intake, with protein intake being higher than 4 g protein/kg/day for five subjects. Even so, protein catabolism was observed in six subjects, three of whom had infected wounds. This study raises the hypothesis that the clinical and nutritional risks of people with RDEB are associated with an increased REE and negative nitrogen balance, which reinforces the importance of nutritional support.
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Affiliation(s)
- Ana Paula Zidorio
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
| | - Camille Togo
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
| | - Rosie Jones
- Department of Dietetics, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
| | - Eliane Dutra
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
| | - Kenia de Carvalho
- Graduate Program in Human Nutrition, Faculty of Health Science, University of Brasilia, Campus Universitário Darcy Ribeiro; Brasília 70910-900, Brazil.
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279
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Atanasova VS, Pourreyron C, Farshchian M, Lawler M, Brown CA, Watt SA, Wright S, Warkala M, Guttmann-Gruber C, Hofbauer JP, Fuentes I, Prisco M, Rashidghamat E, Has C, Salas-Alanis JC, Palisson F, Hovnanian A, McGrath JA, Mellerio JE, Bauer JW, South AP. Identification of Rigosertib for the Treatment of Recessive Dystrophic Epidermolysis Bullosa-Associated Squamous Cell Carcinoma. Clin Cancer Res 2019; 25:3384-3391. [PMID: 30846478 PMCID: PMC8185613 DOI: 10.1158/1078-0432.ccr-18-2661] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/11/2019] [Accepted: 02/21/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Squamous cell carcinoma (SCC) of the skin is the leading cause of death in patients with the severe generalized form of the genetic disease recessive dystrophic epidermolysis bullosa (RDEB). Although emerging data are identifying why patients suffer this fatal complication, therapies for treatment of RDEB SCC are in urgent need.Experimental Design: We previously identified polo-like kinase 1 (PLK1) as a therapeutic target in skin SCC, including RDEB SCC. Here, we undertake a screen of 6 compounds originally designated as PLK1 inhibitors, and detail the efficacy of the lead compound, the multipathway allosteric inhibitor ON-01910, for targeting RDEB SCC in vitro and in vivo. RESULTS ON-01910 (or rigosertib) exhibited significant specificity for RDEB SCC: in culture rigosertib induced apoptosis in 10 of 10 RDEB SCC keratinocyte populations while only slowing the growth of normal primary skin cells at doses 2 orders of magnitude higher. Furthermore, rigosertib significantly inhibited the growth of two RDEB SCC in murine xenograft studies with no apparent toxicity. Mechanistically, rigosertib has been shown to inhibit multiple signaling pathways. Comparison of PLK1 siRNA with MEK inhibition, AKT inhibition, and the microtubule-disrupting agent vinblastine in RDEB SCC shows that only PLK1 reduction exhibits a similar sensitivity profile to rigosertib. CONCLUSIONS These data support a "first in RDEB" phase II clinical trial of rigosertib to assess tumor targeting in patients with late stage, metastatic, and/or unresectable SCC.
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Affiliation(s)
- Velina S Atanasova
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Celine Pourreyron
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
| | - Mehdi Farshchian
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Lawler
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christian A Brown
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen A Watt
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
| | - Sheila Wright
- Division of Cellular Medicine, University of Dundee, Dundee, United Kingdom
| | - Michael Warkala
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Christina Guttmann-Gruber
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - Josefina Piñón Hofbauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - Ignacia Fuentes
- Fundación DEBRA Chile, Santiago, Chile
- Centro de Genética y Genómica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Marco Prisco
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Elham Rashidghamat
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London, United Kingdom
| | - Cristina Has
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | | | - Francis Palisson
- Fundación DEBRA Chile, Santiago, Chile
- Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Alain Hovnanian
- INSERM UMR 1163, Paris, France
- Imagine Institute, Paris, France
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London, United Kingdom
| | - Jemima E Mellerio
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London, United Kingdom
| | - Johann W Bauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology, University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - Andrew P South
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania.
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280
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Mariath LM, Santin JT, Frantz JA, Doriqui MJR, Kiszewski AE, Schuler-Faccini L. An overview of the genetic basis of epidermolysis bullosa in Brazil: discovery of novel and recurrent disease-causing variants. Clin Genet 2019; 96:189-198. [PMID: 31001817 DOI: 10.1111/cge.13555] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/01/2019] [Accepted: 04/17/2019] [Indexed: 12/23/2022]
Abstract
Epidermolysis bullosa (EB) is a genodermatosis that encompasses a group of clinically and genetically heterogeneous disorders classified in four major types: EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and Kindler syndrome. Our aim was to characterize recurrent and novel mutations associated to EB in a sample of Brazilian patients. Eighty-seven patients (25 EBS, 4 JEB and 58 DEB) were studied. We performed a next-generation sequencing-based multigene panel through ion torrent technology including 11 genes: KRT5, KRT14, PLEC, TGM5, LAMA3, LAMB3, LAMC2, COL17A1, ITGB4, COL7A1, and FERMT1. A total of 72 different pathogenic or likely pathogenic variants were identified, 32 of them are novel. The causal variant was detected in 82 patients (efficiency of 94.3%). Pathogenic variants in the residue 125 of KRT14 were identified in 32% of all EBS patients. In DEB patients, four COL7A1 variants were quite frequent, some of them clustered in specific Brazilian regions. Our study extends the spectrum of known mutations in EB and describes, for the first time, the genetic profile of EB patients from Brazil.
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Affiliation(s)
- Luiza M Mariath
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana T Santin
- Postgraduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jeanine A Frantz
- Faculty of Medicine, Universidade Regional de Blumenau, Blumenau, Brazil.,Board of Directors, DEBRA Brasil (Epidermolysis Bullosa Research Association of Brazil), Blumenau, Brazil
| | - Maria J R Doriqui
- Section of Medical Genetics, Hospital Infantil Dr. Juvêncio Mattos, São Luís, Brazil
| | - Ana E Kiszewski
- Section of Dermatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Section of Pediatric Dermatology, Hospital da Criança Santo Antônio, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Lavínia Schuler-Faccini
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Genetics, Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, Brazil
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281
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Hammersen J, Neuner A, Wild F, Schneider H. Attenuation of Severe Generalized Junctional Epidermolysis Bullosa by Systemic Treatment with Gentamicin. Dermatology 2019; 235:315-322. [PMID: 31132778 DOI: 10.1159/000499906] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/25/2019] [Indexed: 11/19/2022] Open
Abstract
Severe generalized junctional epidermolysis bullosa (JEB), a lethal genodermatosis, is mainly caused by premature termination codons (PTCs) in one of the three genes encoding the anchoring protein laminin-332. Only symptomatic treatment has been established; overcoming PTCs by aminoglycosides may represent an interesting alternative. This retrospective study aimed at assessing for the first time the clinical effects of systemic gentamicin application in infants with severe generalized JEB. Five patients, homozygous or compound-heterozygous for PTCs in the gene LAMB3, were treated with gentamicin which was administered intravenously or by intramuscular injection at doses of 7.5 mg/kg/d for three weeks. Skin biopsies were investigated by immunofluorescence analyses. Clinical effects of the medication were recorded with a parent questionnaire and by assessing weight-for-age charts. Gentamicin application was well tolerated, long hospitalization was not required. Low levels of laminin-332 could be detected in a skin sample obtained after treatment. Gentamicin had a positive impact on skin fragility and daily life in four patients but did not influence weight gain and failed to reverse the lethal course of the disease. Gentamicin injections should be considered regularly in cases of severe generalized JEB caused by PTCs as they may attenuate JEB symptoms without impeding quality of life.
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Affiliation(s)
- Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany,
| | - Andrea Neuner
- Nikolaus Fiebiger Center for Molecular Medicine, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Florian Wild
- Department of Pediatrics, Hospital St. Elisabeth, Neuburg an der Donau, Germany
| | - Holm Schneider
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
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282
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Stawczyk-Macieja M, Wertheim-Tysarowska K, Jakubowski R, Szczerkowska-Dobosz A, Krygier M, Wilkowska A, Sawicka J, Nowak W, Bal J, Nowicki R. A novel de novo mutation p.Ala428Asp in KRT5 gene as a cause of localized epidermolysis bullosa simplex. Exp Dermatol 2019; 28:1131-1134. [PMID: 30240119 DOI: 10.1111/exd.13788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 07/23/2018] [Accepted: 08/28/2018] [Indexed: 11/30/2022]
Abstract
Epidermolysis bullosa is a group of inherited blistering skin diseases resulting in most cases from missense mutations in KRT5 and KRT14 genes encoding the basal epidermal keratins 5 and 14. Here, we present a patient diagnosed with a localized subtype of epidermolysis bullosa simplex caused by a heterozygous mutation p.Ala428Asp in the KRT5 gene, that has not been previously identified. Moreover, a bioinformatic analysis of the novel mutation was performed, showing changes in the interaction network between the proteins. Identification of novel mutations and genotype-phenotype correlations allow to better understanding of underlying pathophysiologic bases and is important for genetic counselling, patients' management, and disease course prediction.
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Affiliation(s)
- Marta Stawczyk-Macieja
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Rafał Jakubowski
- Centre of New Technologies, University of Warsaw, Warsaw, Poland
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Magdalena Krygier
- Department of Biology and Genetics, Medical University of Gdańsk, Gdańsk, Poland
| | - Aleksandra Wilkowska
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Justyna Sawicka
- Department of Medical Genetics, Institute of Mother and Child Warsaw, Warsaw, Poland
| | - Wiesław Nowak
- Institute of Physics, Faculty of Physics, Astronomy and Informatics, Nicolaus Copernicus University, Torun, Poland
| | - Jerzy Bal
- Department of Medical Genetics, Institute of Mother and Child Warsaw, Warsaw, Poland
| | - Roman Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
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283
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De Rosa L, Secone Seconetti A, De Santis G, Pellacani G, Hirsch T, Rothoeft T, Teig N, Pellegrini G, Bauer JW, De Luca M. Laminin 332-Dependent YAP Dysregulation Depletes Epidermal Stem Cells in Junctional Epidermolysis Bullosa. Cell Rep 2019; 27:2036-2049.e6. [PMID: 31091444 DOI: 10.1016/j.celrep.2019.04.055] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/12/2019] [Accepted: 04/10/2019] [Indexed: 01/09/2023] Open
Abstract
Laminin 332-deficient junctional epidermolysis bullosa (JEB) is a severe genetic skin disease. JEB is marked by epidermal stem cell depletion, the origin of which is unknown. We show that dysregulation of the YAP and TAZ pathway underpins such stem cell depletion. Laminin 332-mediated YAP activity sustains human epidermal stem cells, detected as holoclones. Ablation of YAP selectively depletes holoclones, while enforced YAP blocks conversion of stem cells into progenitors and indefinitely extends the keratinocyte lifespan. YAP is dramatically decreased in JEB keratinocytes, which contain only phosphorylated, inactive YAP. In normal keratinocytes, laminin 332 and α6β4 ablation abolish YAP activity and recapitulate the JEB phenotype. In JEB keratinocytes, laminin 332-gene therapy rescues YAP activity and epidermal stem cells in vitro and in vivo. In JEB cells, enforced YAP recapitulates laminin 332-gene therapy, thus uncoupling adhesion from proliferation in epidermal stem cells. This work has important clinical implication for ex vivo gene therapy of JEB.
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Affiliation(s)
- Laura De Rosa
- Centre for Regenerative Medicine "Stefano Ferrari," Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Secone Seconetti
- Centre for Regenerative Medicine "Stefano Ferrari," Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio De Santis
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Pellacani
- Department of Surgery, Medicine, Dentistry, and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Tobias Hirsch
- Department of Plastic Surgery, Burn Centre, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Tobias Rothoeft
- Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Ruhr-University Bochum, Germany
| | - Norbert Teig
- Department of Neonatology and Pediatric Intensive Care, University Children's Hospital, Ruhr-University Bochum, Germany
| | - Graziella Pellegrini
- Centre for Regenerative Medicine "Stefano Ferrari," Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Surgery, Medicine, Dentistry, and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Johann W Bauer
- EB House Austria and Department of Dermatology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - Michele De Luca
- Centre for Regenerative Medicine "Stefano Ferrari," Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy.
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284
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Bonafont J, Mencía Á, García M, Torres R, Rodríguez S, Carretero M, Chacón-Solano E, Modamio-Høybjør S, Marinas L, León C, Escamez MJ, Hausser I, Del Río M, Murillas R, Larcher F. Clinically Relevant Correction of Recessive Dystrophic Epidermolysis Bullosa by Dual sgRNA CRISPR/Cas9-Mediated Gene Editing. Mol Ther 2019; 27:986-998. [PMID: 30930113 PMCID: PMC6520462 DOI: 10.1016/j.ymthe.2019.03.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022] Open
Abstract
Gene editing constitutes a novel approach for precisely correcting disease-causing gene mutations. Frameshift mutations in COL7A1 causing recessive dystrophic epidermolysis bullosa are amenable to open reading frame restoration by non-homologous end joining repair-based approaches. Efficient targeted deletion of faulty COL7A1 exons in polyclonal patient keratinocytes would enable the translation of this therapeutic strategy to the clinic. In this study, using a dual single-guide RNA (sgRNA)-guided Cas9 nuclease delivered as a ribonucleoprotein complex through electroporation, we have achieved very efficient targeted deletion of COL7A1 exon 80 in recessive dystrophic epidermolysis bullosa (RDEB) patient keratinocytes carrying a highly prevalent frameshift mutation. This ex vivo non-viral approach rendered a large proportion of corrected cells producing a functional collagen VII variant. The effective targeting of the epidermal stem cell population enabled long-term regeneration of a properly adhesive skin upon grafting onto immunodeficient mice. A safety assessment by next-generation sequencing (NGS) analysis of potential off-target sites did not reveal any unintended nuclease activity. Our strategy could potentially be extended to a large number of COL7A1 mutation-bearing exons within the long collagenous domain of this gene, opening the way to precision medicine for RDEB.
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Affiliation(s)
- Jose Bonafont
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Ángeles Mencía
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Marta García
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Raúl Torres
- Molecular Cytogenetics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Sandra Rodríguez
- Molecular Cytogenetics Unit, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Marta Carretero
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Esteban Chacón-Solano
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Silvia Modamio-Høybjør
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain
| | - Lucía Marinas
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain
| | - Carlos León
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - María J Escamez
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Ingrid Hausser
- Institute of Pathology IPH, Heidelberg University Hospital, Heidelberg, Germany
| | - Marcela Del Río
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain; Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain
| | - Rodolfo Murillas
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain; Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.
| | - Fernando Larcher
- Department of Biomedical Engineering, Carlos III University (UC3M), Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER) U714, Madrid, Spain; Fundación Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain; Epithelial Biomedicine Division, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), Madrid, Spain.
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285
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Matsumura W, Fujita Y, Shinkuma S, Suzuki S, Yokoshiki S, Goto H, Hayashi H, Ono K, Inoie M, Takashima S, Nakayama C, Nomura T, Nakamura H, Abe R, Sato N, Shimizu H. Cultured Epidermal Autografts from Clinically Revertant Skin as a Potential Wound Treatment for Recessive Dystrophic Epidermolysis Bullosa. J Invest Dermatol 2019; 139:2115-2124.e11. [PMID: 31054844 DOI: 10.1016/j.jid.2019.03.1155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/05/2019] [Accepted: 03/20/2019] [Indexed: 01/19/2023]
Abstract
Inherited skin disorders have been reported recently to have sporadic normal-looking areas, where a portion of the keratinocytes have recovered from causative gene mutations (revertant mosaicism). We observed a case of recessive dystrophic epidermolysis bullosa treated with cultured epidermal autografts (CEAs), whose CEA-grafted site remained epithelized for 16 years. We proved that the CEA product and the grafted area included cells with revertant mosaicism. Based on these findings, we conducted an investigator-initiated clinical trial of CEAs from clinically revertant skin for recessive dystrophic epidermolysis bullosa. The donor sites were analyzed by genetic analysis, immunofluorescence, electron microscopy, and quantification of the reverted mRNA with deep sequencing. The primary endpoint was the ulcer epithelization rate per patient at 4 weeks after the last CEA application. Three patients with recessive dystrophic epidermolysis bullosa with 8 ulcers were enrolled, and the epithelization rate for each patient at the primary endpoint was 87.7%, 100%, and 57.0%, respectively. The clinical effects were found to persist for at least 76 weeks after CEA transplantation. One of the three patients had apparent revertant mosaicism in the donor skin and in the post-transplanted area. CEAs from clinically normal skin are a potentially well-tolerated treatment for recessive dystrophic epidermolysis bullosa.
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Affiliation(s)
- Wakana Matsumura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yasuyuki Fujita
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Satoru Shinkuma
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Dermatology, Niigata University, Niigata, Japan
| | - Shotaro Suzuki
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Saki Yokoshiki
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hideki Goto
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan; Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Hiroshi Hayashi
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Kota Ono
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | | | - Shota Takashima
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Chihiro Nakayama
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Toshifumi Nomura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hideki Nakamura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Riichiro Abe
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Dermatology, Niigata University, Niigata, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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286
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Golchin A, Farahany TZ, Khojasteh A, Soleimanifar F, Ardeshirylajimi A. The Clinical Trials of Mesenchymal Stem Cell Therapy in Skin Diseases: An Update and Concise Review. Curr Stem Cell Res Ther 2019; 14:22-33. [PMID: 30210006 DOI: 10.2174/1574888x13666180913123424] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 08/15/2018] [Accepted: 09/04/2018] [Indexed: 12/13/2022]
Abstract
The skin is one of the crucial body organs with anatomy and physiology linked to various disorders including congenital and acquired diseases. Nowadays, mesenchymal stem cell (MSCs)- based therapy has appeared as a promising therapeutic field, in which many see opportunities to cure the costliest and incurable diseases. However, one question to be asked is that if the use of MSCs in clinical trials studies and diseases treatment has improved. In this study, the clinical trials using MSCs in skin diseases were reviewed. A remarkable number of clinical trial studies are in progress in this field; however, only a few of them have led to tangible benefits for patients. The relevant papers and ongoing clinical trials that address MSC's therapeutic goals for various skin disorders were examined. This review can be very useful for both the dermatologists and basic skin researchers interested in contributing to stem cell-based therapeutic researches in the area of skin disorders.
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Affiliation(s)
- Ali Golchin
- Department of Tissue engineering and Applied Cell Sciences, Student Research Committee, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Z Farahany
- Department of Biology, School of Advanced Technologies in Medicine, Islamic Azad University Medical Branch of Tehran, Tehran, Iran
| | - Arash Khojasteh
- Department of Tissue engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Soleimanifar
- Dietary Supplements and Probiotic Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Abdolreza Ardeshirylajimi
- Department of Tissue engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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287
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CRISPR/Cas9 gene editing for genodermatoses: progress and perspectives. Emerg Top Life Sci 2019; 3:313-326. [DOI: 10.1042/etls20180148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 12/17/2022]
Abstract
Abstract
Genodermatoses constitute a clinically heterogeneous group of devastating genetic skin disorders. Currently, therapy options are largely limited to symptomatic treatments and although significant advances have been made in ex vivo gene therapy strategies, various limitations remain. However, the recent technical transformation of the genome editing field promises to overcome the hurdles associated with conventional gene addition approaches. In this review, we discuss the need for developing novel treatments and describe the current status of gene editing for genodermatoses, focusing on a severe blistering disease called epidermolysis bullosa (EB), for which significant progress has been made. Initial research utilized engineered nucleases such as transcription activator-like effector nucleases and meganucleases. However, over the last few years, clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9 (CRISPR/Cas9) have upstaged older generation gene editing tools. We examine different strategies for CRISPR/Cas9 application that can be employed depending on the type and position of the mutation as well as the mode of its inheritance. Promising developments in the field of base editing opens new avenues for precise correction of single base substitutions, common in EB and other genodermatoses. We also address the potential limitations and challenges such as safety concerns and delivery efficiency. This review gives an insight into the future of gene editing technologies for genodermatoses.
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288
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Castelo B, Viñal D, Maseda R, Ostios L, Sánchez D, García-Salvatierra B, Escámez MJ, Martínez-Santamaría L, Del Río M, Mora-Rillo M, Vilches Y, Beato MJ, López Gutiérrez JC, Romero N, Santos C, Miranda J, de Lucas R. Epidemiology and natural history of cutaneous squamous cell carcinoma in recessive dystrophic epidermolysis bullosa patients: 20 years' experience of a reference centre in Spain. Clin Transl Oncol 2019; 21:1573-1577. [PMID: 30864020 DOI: 10.1007/s12094-019-02073-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/23/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the leading cause of death in patients with recessive dystrophic epidermolysis bullosa (RDEB). We provide the management and prognosis of cSCC in RDEB patients at a Spanish reference center. MATERIALS AND METHODS We retrospectively included patients with RDEB attended in La Paz University Hospital from November 1988 to October 2018. RESULTS Fourteen patients developed at least one cSCC. Tumors were predominantly well differentiated. Nearly half of the tumors have recurred. Median time to first recurrence was 23.4 months (95% CI: 17.2-29.5). Five patients have developed distant metastases. Median overall survival (mOS) was 136.5 months since the diagnosis of the first cSCC (95% CI: 30.6-242.3). When distant metastases occurred, mOS was 6.78 months (95% CI: 1.94-11.61). CONCLUSIONS cSCC is a life-threatening complication of RDEB patients. Although tumors are usually well differentiated, they tend to relapse. This is the first Spanish report of cSCC arising in RDEB patients.
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Affiliation(s)
- B Castelo
- Department of Medical Oncology, La Paz University Hospital, Paseo de la castellana 261, 28046, Madrid, Spain
| | - D Viñal
- Department of Medical Oncology, La Paz University Hospital, Paseo de la castellana 261, 28046, Madrid, Spain.
| | - R Maseda
- Department of Dermatology, La Paz University Hospital, Madrid, Spain
| | - L Ostios
- Department of Medical Oncology, La Paz University Hospital, Paseo de la castellana 261, 28046, Madrid, Spain
| | - D Sánchez
- Department of Medical Oncology, La Paz University Hospital, Paseo de la castellana 261, 28046, Madrid, Spain
| | | | - M J Escámez
- Department of Bio-Engineering, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), IIS-Fundación Jiménez Díaz (IISFJD), CIBER on Rare Diseases (U714 CIBERER-ISCIII), Carlos III University, Madrid (UC3M), Madrid, Spain
| | - L Martínez-Santamaría
- Department of Bio-Engineering, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), IIS-Fundación Jiménez Díaz (IISFJD), CIBER on Rare Diseases (U714 CIBERER-ISCIII), Carlos III University, Madrid (UC3M), Madrid, Spain
| | - M Del Río
- Department of Bio-Engineering, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), IIS-Fundación Jiménez Díaz (IISFJD), CIBER on Rare Diseases (U714 CIBERER-ISCIII), Carlos III University, Madrid (UC3M), Madrid, Spain
| | - M Mora-Rillo
- Infectious Diseases Unit, Internal Medicine Department, La Paz University Hospital IdiPAZ, Madrid, Spain
| | - Y Vilches
- Department of Palliative Care, La Paz University Hospital, Madrid, Spain
| | - M J Beato
- Department of Pathology, La Paz University Hospital, Madrid, Spain
| | | | - N Romero
- DEBRA (Dystrophic Epidermolysis Bullosa Research Association), Madrid, Spain
| | - C Santos
- DEBRA (Dystrophic Epidermolysis Bullosa Research Association), Madrid, Spain
| | - J Miranda
- Department of Medical Oncology, La Paz University Hospital, Paseo de la castellana 261, 28046, Madrid, Spain
| | - R de Lucas
- Department of Dermatology, La Paz University Hospital, Madrid, Spain
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289
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Wright JT, Fete M, Schneider H, Zinser M, Koster MI, Clarke AJ, Hadj-Rabia S, Tadini G, Pagnan N, Visinoni AF, Bergendal B, Abbott B, Fete T, Stanford C, Butcher C, D'Souza RN, Sybert VP, Morasso MI. Ectodermal dysplasias: Classification and organization by phenotype, genotype and molecular pathway. Am J Med Genet A 2019; 179:442-447. [PMID: 30703280 PMCID: PMC6421567 DOI: 10.1002/ajmg.a.61045] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022]
Abstract
An international advisory group met at the National Institutes of Health in Bethesda, Maryland in 2017, to discuss a new classification system for the ectodermal dysplasias (EDs) that would integrate both clinical and molecular information. We propose the following, a working definition of the EDs building on previous classification systems and incorporating current approaches to diagnosis: EDs are genetic conditions affecting the development and/or homeostasis of two or more ectodermal derivatives, including hair, teeth, nails, and certain glands. Genetic variations in genes known to be associated with EDs that affect only one derivative of the ectoderm (attenuated phenotype) will be grouped as non-syndromic traits of the causative gene (e.g., non-syndromic hypodontia or missing teeth associated with pathogenic variants of EDA "ectodysplasin"). Information for categorization and cataloging includes the phenotypic features, Online Mendelian Inheritance in Man number, mode of inheritance, genetic alteration, major developmental pathways involved (e.g., EDA, WNT "wingless-type," TP63 "tumor protein p63") or the components of complex molecular structures (e.g., connexins, keratins, cadherins).
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Affiliation(s)
- John Timothy Wright
- Department of Pediatric Dentistry, Bauer Hall CB#7450, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina
| | - Mary Fete
- National Foundation for Ectodermal Dysplasias, Fairview Heights, Illinois
| | - Holm Schneider
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Madelaine Zinser
- National Foundation for Ectodermal Dysplasias, Fairview Heights, Illinois
| | - Maranke I Koster
- NFED Scientific Advisory Council, Fairview Heights, Illinois
- Dermatology and Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angus J Clarke
- Cancer & Genetics, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Smail Hadj-Rabia
- Department of Dermatology, Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), INSERM U1163, Descartes - Sorbonne Paris Cité University, Imagine Institute, Necker-Enfants Malades Universitary Hospital, Paris, France
| | - Gianluca Tadini
- Center for Inherited Cutaneous Diseases, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Nina Pagnan
- Department of Genetics, Federal University of Parana, Curitiba, Brazil
| | | | - Birgitta Bergendal
- National Oral Disability Center for Rare Disorders, The Institute for Postgraduate Dental Education, Jönköping, Sweden
| | - Becky Abbott
- NFED for Treatment & Research, Fairview Heights, Illinois
| | - Timothy Fete
- NFED Scientific Advisory Council, Fairview Heights, Illinois
- Department of Child Health, University of Missouri, Columbia, Missouri
| | - Clark Stanford
- NFED Scientific Advisory Council, Fairview Heights, Illinois
- University of Illinois at Chicago College of Dentistry, Chicago, Illinois
| | - Clayton Butcher
- Departments of Medicine and Child Health, University of Missouri School of Medicine, Columbia, Missouri
| | - Rena N D'Souza
- Academic Affairs and Education, Health Sciences, The University of Utah, Salt Lake City, Utah
| | - Virginia P Sybert
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Maria I Morasso
- Laboratory of Skin Biology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD
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290
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Saunderson RB, Vekic DA, Mallitt K, Mahon C, Robertson SJ, Wargon O. A retrospective cohort study evaluating the accuracy of clinical diagnosis compared with immunofluorescence and electron microscopy in children with inherited epidermolysis bullosa. Br J Dermatol 2019; 180:1258-1259. [PMID: 30657165 DOI: 10.1111/bjd.17648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R B Saunderson
- Department of Dermatology, Royal North Shore Hospital, Reserve Road St Leonards, Saint Leonards, NSW, 2065, Australia
| | - D A Vekic
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, 1871, Australia
| | - K Mallitt
- School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia
| | - C Mahon
- Department of Dermatology, Bristol Royal Infirmary, Bristol, BS2 8HW, U.K.,Department of Dermatology, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, U.K
| | - S J Robertson
- Department of Dermatology, The Skin and Cancer Foundation, Level 1, 80 Drummond Street, Carlton, Melbourne, Victoria, 3053, Australia
| | - O Wargon
- Department of Dermatology, Sydney Children's Hospital Randwick, Randwick, NSW, Australia
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291
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Lykova SG, Maksimova YV, Nemchaninova OB, Guseva SN, Omigov VV, Aidagulova SV. [Inherited epidermolysis bullosa]. Arkh Patol 2019; 80:54-60. [PMID: 30059072 DOI: 10.17116/patol201880454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To summarize an update on epidermolysis bullosa as a polymorphic group of inherited diseases with a failure of epidermal-dermal integrity. Emphasis is placed on the role of transmission electron microscopy in diagnosis and search directions for new types of the abnormality and its molecular markers. Despite numerous mutations in the genes encoding the components of desmosomes and epithelial basement membrane, the stereotyped manifestations of pathological processes in the group of epidermolysis bullosa have been identified. The paper gives a positive result of cell and gene therapies used by European scientists in the treatment of a 7-year-old child with borderline epidermolysis bullosa, which opens up new prospects for patients with butterfly disease that has long been considered fatal.
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Affiliation(s)
- S G Lykova
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
| | - Yu V Maksimova
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
| | - O B Nemchaninova
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
| | - S N Guseva
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
| | - V V Omigov
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
| | - S V Aidagulova
- Novosibirsk State Medical University, Ministry of Health of Russia, Novosibirsk, Russia
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292
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Han YM, Lee N, Byun SY, Cheon SJ, Ko HC. Bart's Syndrome with Novel Frameshift Mutations in the COL7A1 Gene. Fetal Pediatr Pathol 2019; 38:72-79. [PMID: 30523708 DOI: 10.1080/15513815.2018.1543370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Bart's syndrome, a hereditary mechanobullous disorder characterized by aplasia cutis congenita (ACC) with epidermolysis bullosa (EB), has not been genotyped frequently. CASE REPORT A full-term female neonate had well-demarcated absence of skin on both legs at birth, with blisters and erosive patches developing immediately after birth. Electron microscopy showed blister formation under the lamina densa layer. Genetic studies revealed two heterogenous frameshift mutations in exons 31 and 109 of COL7A1. A diagnosis of Bart's syndrome, recessive dystrophic EB with ACC, was made. There was no pyloric atresia or ureteral stenosis, but congenital hypothyroidism was diagnosed 42 days after birth. CONCLUSION The novel frameshift mutations in COL7A1 may result in Bart's syndrome and suggest the importance of genetic testing in diagnosis of this disease.
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Affiliation(s)
- Young Mi Han
- a Department of Pediatrics , Pusan National University Children's Hospital , Yangsan , Republic of Korea.,b Department of Pediatrics , Pusan National University School of Medicine , Yangsan , Republic of Korea
| | - Narae Lee
- a Department of Pediatrics , Pusan National University Children's Hospital , Yangsan , Republic of Korea.,b Department of Pediatrics , Pusan National University School of Medicine , Yangsan , Republic of Korea
| | - Shin Yun Byun
- a Department of Pediatrics , Pusan National University Children's Hospital , Yangsan , Republic of Korea.,b Department of Pediatrics , Pusan National University School of Medicine , Yangsan , Republic of Korea
| | - Sang-Jin Cheon
- c Department of Dermatology , Pusan National University Yangsan Hospital , Yangsan , Republic of Korea
| | - Hyun-Chang Ko
- c Department of Dermatology , Pusan National University Yangsan Hospital , Yangsan , Republic of Korea.,d Department of Dermatology , Pusan National University School of Medicine , Yangsan , Republic of Korea
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293
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294
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Condrat I, He Y, Cosgarea R, Has C. Junctional Epidermolysis Bullosa: Allelic Heterogeneity and Mutation Stratification for Precision Medicine. Front Med (Lausanne) 2019; 5:363. [PMID: 30761300 PMCID: PMC6362712 DOI: 10.3389/fmed.2018.00363] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
Junctional epidermolysis bullosa (JEB) is a hereditary blistering disease caused by reduced dermal-epidermal adhesion due to deficiencies of one of the proteins, laminin-332, type XVII collagen, integrin α6β4 or integrin α3. Significant progress has been achieved in the development of therapies for EB, such as bone-marrow transplantation, local or systemic injections with fibroblasts or mesenchymal stromal cells, readthrough of premature termination codons, or exon skipping. These were tailored in particular for dystrophic EB, which is caused by type VII collagen deficiency and have not yet reached broad clinical practice. Recently, pioneering combined gene and stem cell therapy was successful in treating one boy with junctional EB. Beside these exclusive approaches, no specific therapy to amend the major clinical features, skin and mucosal blistering and non-healing wounds is available to date. Here we extend the mutational spectrum of junctional EB, provide a stratification of COL17A1 mutations and discuss potential molecular therapeutic approaches.
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Affiliation(s)
- Irina Condrat
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Yinghong He
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rodica Cosgarea
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Cristina Has
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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295
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Kristensen MH, Schmidt SAJ, Kibsgaard L, Mogensen M, Sommerlund M, Koppelhus U. Validity of first-time diagnoses of congenital epidermolysis bullosa in the Danish National Patient Registry and the Danish Pathology Registry. Clin Epidemiol 2019; 11:115-124. [PMID: 30697082 PMCID: PMC6340365 DOI: 10.2147/clep.s184742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Congenital epidermolysis bullosa (CEB) is a group of rare monogenic genodermatoses. Phenotypically, the diseases vary in both severity and dissemination, which complicates studies of their epidemiology. To investigate the potential of using the Danish National Patient Registry (DNPR) for epidemiological research on CEB, we examined the positive predictive value (PPV) of a first-time diagnosis of CEB. Methods We identified patients with a record of CEB in DNPR and the Danish Pathology Registry (DPR) during January 1, 1977, until December 31, 2015. We restricted diagnoses from two dermatological departments and one regional hospital. Diagnoses in the DNPR are coded by the eighth and tenth revisions of the ICD (ICD-8 and ICD-10) and in the DPR by the Systematized Nomenclature of Medicine (SNOMED). We used clinical description in medical records, family history, histological findings, and molecular genetic investigations to validate diagnoses and classified them as rejected and confirmed. We estimated PPVs for any diagnosis, according to coding systems used, and for additional subdivisions of ICD-10 codes. Results We identified 116 cases from the hospital departments investigated and evaluated 96 medical records for validity. The overall PPV for probable CEB was 62.5% (95% CI: 52.5–71.5). For ICD-8, ICD-10, and SNOMED codes, the PPVs were 30.8% (95% CI: 11.4–57.7), 76.7% (95% CI: 65.8–84.9), and 0.0% (95% CI: 0.0–21.7), respectively. For the ICD-10 codes, we found the highest PPVs for diagnoses arising from the dermatological departments. For subdivisions of ICD-10 codes, PPVs were high for epidermolysis bullosa simplex and dystrophica. Conclusion The PPVs for first-time diagnoses of CEB registered in the two Danish nationwide registries investigated, DNPR and DPR, ranged from low to average. We therefore recommend that these data be used with caution and restricted to ICD-10 diagnoses from specialized dermatological departments.
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Affiliation(s)
| | | | - Line Kibsgaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark,
| | - Mette Mogensen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mette Sommerlund
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark,
| | - Uffe Koppelhus
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark,
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296
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Zeng M, Zhou D, Alshehri F, Lara-Sáez I, Lyu Y, Creagh-Flynn J, Xu Q, A S, Zhang J, Wang W. Manipulation of Transgene Expression in Fibroblast Cells by a Multifunctional Linear-Branched Hybrid Poly(β-Amino Ester) Synthesized through an Oligomer Combination Approach. NANO LETTERS 2019; 19:381-391. [PMID: 30565945 DOI: 10.1021/acs.nanolett.8b04098] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Delivery of functional genetic materials into fibroblast cells to manipulate the transgene expression is of great significance in skin gene therapy. Despite numerous polymeric gene delivery systems having been developed, highly safe and efficient fibroblast gene transfection has not yet been achieved. Here, through a new linear oligomer combination strategy, linear poly(β-amino ester) oligomers are connected by the branching units, forming a new type of poly(β-amino ester). This new multifunctional linear-branched hybrid poly(β-amino ester) (LBPAE) shows high-performance fibroblast gene transfection. In human primary dermal fibroblasts (HPDFs) and mouse embryo fibroblasts (3T3s), ultrahigh transgene expression is achieved by LBPAE: up to 3292-fold enhancement in Gaussia luciferase (Gluc) expression and nearly 100% of green fluorescence protein expression are detected. Concurrently, LBPAE is of high in vitro biocompatibility. In depth mechanistic studies reveal that versatile LBPAE can navigate multiple extra- and intracellular barriers involved in the fibroblast gene transfection. More importantly, LBPAE can effectively deliver minicircle DNA encoding COL7A1 gene (a large and functional gene construct) to substantially upregulate the expression of type VII collagen (C7) in HPDFs, demonstrating its great potential in the treatment of C7-deficiency related genodermatoses such as recessive dystrophic epidermolysis bullosa.
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Affiliation(s)
- Ming Zeng
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
- Department of Dermatology , the First Affiliated Hospital of Anhui Medical University , Hefei 230022 , China
| | - Dezhong Zhou
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
- School of Chemical Engineering and Technology (SCET) , Xi'an Jiaotong University , Xi'an , Shaanxi , China
| | - Fatma Alshehri
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
| | - Irene Lara-Sáez
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
| | - Yuanning Lyu
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
| | - Jack Creagh-Flynn
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
| | - Qian Xu
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
| | - Sigen A
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
| | - Jing Zhang
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
| | - Wenxin Wang
- Charles Institute of Dermatology, School of Medicine , University College Dublin , Dublin 4 , Ireland
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297
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Bremer J, Akker P. Therapies for epidermolysis bullosa: delivery is key. Br J Dermatol 2019; 180:17-19. [PMID: 30604552 PMCID: PMC6850462 DOI: 10.1111/bjd.17324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Linked Article: https://doi.org/10.1111/bjd.17075.
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Affiliation(s)
- J. Bremer
- Department of Genetics University of Groningen University Medical Center Groningen Groningen the Netherlands
| | - P.C. Akker
- Department of Genetics University of Groningen University Medical Center Groningen Groningen the Netherlands
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298
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Lalor L, Titeux M, Palisson F, Fuentes I, Yubero MJ, Tasanen K, Huilaja L, Has C, Tadini G, Haggstrom AN, Hovnanian A, Lucky AW. Epidermolysis bullosa simplex-generalized severe type due to keratin 5 p.Glu477Lys mutation: Genotype-phenotype correlation and in silico modeling analysis. Pediatr Dermatol 2019; 36:132-138. [PMID: 30515866 DOI: 10.1111/pde.13722] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVES Epidermolysis bullosa is a group of diseases caused by mutations in skin structural proteins. Availability of genetic sequencing makes identification of causative mutations easier, and genotype-phenotype description and correlation are important. We describe six patients with a keratin 5 mutation resulting in a glutamic acid to lysine substitution at position 477 (p.Glu477Lys) who have a distinctive, severe and sometimes fatal phenotype. We also perform in silico modeling to show protein structural changes resulting in instability. METHODS In this case series, we collected clinical data from six patients with this mutation identified from their national or local epidermolysis bullosa databases. We performed in silico modeling of the keratin 5-keratin 14 coil 2B complex using CCBuilder and rendered with Pymol (Schrodinger, LLC, New York, NY). RESULTS Features include aplasia cutis congenita, generalized blistering, palmoplantar keratoderma, onychodystrophy, airway and developmental abnormalities, and a distinctive reticulated skin pattern. Our in silico model of the keratin 5 p.Glu477Lys mutation predicts conformational change and modification of the surface charge of the keratin heterodimer, severely impairing filament stability. CONCLUSIONS Early recognition of the features of this genotype will improve care. In silico analysis of mutated keratin structures provides useful insights into structural instability.
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Affiliation(s)
- Leah Lalor
- Division of Pediatric Dermatology, MCW Department of Dermatology, Milwaukee, Wisconsin
| | - Matthias Titeux
- Laboratory of Genetic Skin Diseases, Inserm UMR1163, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cite, Paris, France
| | - Francis Palisson
- Fundacion DEBRA Chile, Santiago, Chile.,Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Ignacia Fuentes
- Fundacion DEBRA Chile, Santiago, Chile.,Centro de Genetica y Genomica, Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - María J Yubero
- Fundacion DEBRA Chile, Santiago, Chile.,Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Kaisa Tasanen
- Department of Dermatology, Pedego Research Unit, Oulu Center for Cell-Matrix Research, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Laura Huilaja
- Department of Dermatology, Pedego Research Unit, Oulu Center for Cell-Matrix Research, MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Cristina Has
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Gianluca Tadini
- Pediatric Dermatology, Fondazione IRCC Ca'Granda - Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Anita N Haggstrom
- Department of Dermatology and Pediatrics, Indiana University, Indianapolis, Indiana
| | - Alain Hovnanian
- Laboratory of Genetic Skin Diseases, Inserm UMR1163, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cite, Paris, France
| | - Anne W Lucky
- Epidermolysis Bullosa Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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299
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Kamaguchi M, Iwata H, Nishie W, Toyonaga E, Ujiie H, Natsuga K, Kitagawa Y, Shimizu H. The direct binding of collagen XVII and collagen IV is disrupted by pemphigoid autoantibodies. J Transl Med 2019; 99:48-57. [PMID: 30089857 DOI: 10.1038/s41374-018-0113-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/11/2018] [Accepted: 07/09/2018] [Indexed: 12/26/2022] Open
Abstract
The basement membrane zone (BMZ) is framed by hemidesmosomes and extracellular matrix (ECM) including collagen IV (COL4). Hemidesmosomes are multiprotein complexes that include collagen XVII (COL17). BMZ proteins can be targeted in autoimmune subepidermal blistering diseases, e.g., pemphigoid targeting COL17. The blistering mechanisms in pemphigoid have not been fully elucidated, especially in mucous membrane pemphigoid (MMP), which mainly affects the mucosa. In this study, we showed that oral lesions in pemphigoid may be attributed to the inhibition of protein-protein interactions by autoantibodies. Using immunoprecipitation, we revealed that COL17 directly binds to COL4 in normal human keratinocytes and normal human oral keratinocytes. In particular, the C-terminus of COL17 is binding site to COL4 in oral keratinocytes. The precise COL4-binding region on COL17 was determined by protein-protein binding assay to be from amino acid Gly1175 to Asp1340 on the C-terminus. MMP-IgG or mAb recognizing the C-terminus hindered the interaction of COL17 with COL4 in oral keratinocytes. Furthermore, keratinocyte adhesion strength to COL4-coated plates was significantly reduced by the treatment of mAb against the C-terminus. In addition, the inflammatory infiltrates around perilesions were significantly less in MMP compared to BP. These results indicate that pemphigoid IgG targeting the C-terminus plays a pathogenic role in blister formation in the oral mucosa to inhibit protein interactions with less inflammation.
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Affiliation(s)
- Mayumi Kamaguchi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, 060-8638, Japan
- Department of Oral Diagnosis and Medicine, Hokkaido University Graduate School of Dental Medicine, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, 060-8638, Japan.
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, 060-8638, Japan
| | - Ellen Toyonaga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, 060-8638, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, 060-8638, Japan
| | - Ken Natsuga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, 060-8638, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Hokkaido University Graduate School of Dental Medicine, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, 060-8638, Japan
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300
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Hubbard LD, Mayre‐Chilton K. Retrospective longitudinal study of osteoporosis in adults with recessive dystrophic epidermolysis bullosa. Clin Case Rep 2019; 7:58-63. [PMID: 30656009 PMCID: PMC6333067 DOI: 10.1002/ccr3.1898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022] Open
Abstract
This retrospective study looks at bone mineral density of people with recessive dystrophic epidermolysis bullosa as assessed by dual-energy x-ray absorptiometry. Data were collected in 34 patients aged 16-35 years. Statistical analysis showed immobility, low body mass index, and pubertal delay was associated with osteoporosis.
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Affiliation(s)
- Lynne D. Hubbard
- Department of Nutrition and DieteticsGuy’s and St. Thomas’ NHS Foundation TrustLondonUK
| | - Kattya Mayre‐Chilton
- Department of Nutrition and DieteticsGuy’s and St. Thomas’ NHS Foundation TrustLondonUK
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