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Schmuth M, Martinz V, Janecke AR, Fauth C, Schossig A, Zschocke J, Gruber R. Inherited ichthyoses/generalized Mendelian disorders of cornification. Eur J Hum Genet 2013; 21:123-33. [PMID: 22739337 PMCID: PMC3548255 DOI: 10.1038/ejhg.2012.121] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/08/2022] Open
Abstract
Inherited ichthyoses, defined as the generalized form of Mendelian disorders of cornification, are characterized by visible scaling and/or hyperkeratosis of most or all of the skin. This etiologically and phenotypically heterogenous group of conditions is caused by mutations in various different genes important for keratinocyte differentiation and epidermal barrier function. Diagnosing a specific entity is a particular challenge for the nonspecialist presented with the common clinical scaling. For the clinician, this review outlines an algorithmic approach for utilizing diagnostic clues to narrow down the differential diagnosis and to guide further testing and treatment options.
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Affiliation(s)
- Matthias Schmuth
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
| | - Verena Martinz
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
| | - Andreas R Janecke
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
- Department of Pediatrics II, Innsbruck Medical University, Innsbruck, Austria
| | - Christine Fauth
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Schossig
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
| | - Johannes Zschocke
- Division of Human Genetics, Innsbruck Medical University, Innsbruck, Austria
| | - Robert Gruber
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
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Revised nomenclature and classification of inherited ichthyoses: results of the First Ichthyosis Consensus Conference in Sorèze 2009. J Am Acad Dermatol 2010; 63:607-41. [PMID: 20643494 DOI: 10.1016/j.jaad.2009.11.020] [Citation(s) in RCA: 454] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 10/30/2009] [Accepted: 11/17/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Inherited ichthyoses belong to a large, clinically and etiologically heterogeneous group of mendelian disorders of cornification, typically involving the entire integument. Over the recent years, much progress has been made defining their molecular causes. However, there is no internationally accepted classification and terminology. OBJECTIVE We sought to establish a consensus for the nomenclature and classification of inherited ichthyoses. METHODS The classification project started at the First World Conference on Ichthyosis in 2007. A large international network of expert clinicians, skin pathologists, and geneticists entertained an interactive dialogue over 2 years, eventually leading to the First Ichthyosis Consensus Conference held in Sorèze, France, on January 23 and 24, 2009, where subcommittees on different issues proposed terminology that was debated until consensus was reached. RESULTS It was agreed that currently the nosology should remain clinically based. "Syndromic" versus "nonsyndromic" forms provide a useful major subdivision. Several clinical terms and controversial disease names have been redefined: eg, the group caused by keratin mutations is referred to by the umbrella term, "keratinopathic ichthyosis"-under which are included epidermolytic ichthyosis, superficial epidermolytic ichthyosis, and ichthyosis Curth-Macklin. "Autosomal recessive congenital ichthyosis" is proposed as an umbrella term for the harlequin ichthyosis, lamellar ichthyosis, and the congenital ichthyosiform erythroderma group. LIMITATIONS As more becomes known about these diseases in the future, modifications will be needed. CONCLUSION We have achieved an international consensus for the classification of inherited ichthyosis that should be useful for all clinicians and can serve as reference point for future research.
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McNay MB, Fleming JE. Forty years of obstetric ultrasound 1957-1997: from A-scope to three dimensions. ULTRASOUND IN MEDICINE & BIOLOGY 1999; 25:3-56. [PMID: 10048801 DOI: 10.1016/s0301-5629(98)00129-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this article, we record the history of obstetric ultrasound as it developed worldwide in the second half of the twentieth century. The technological advances during this period saw the evolution of equipment from the original adapted metal flaw detectors producing a simple A-scan to the modern, purpose built, real-time colour flow machines with three-dimensional capability (Fig. 1). Clinically, ultrasound began as a research tool, but the poor quality of the images led to the ridicule of many of the early investigators. However, because of their perseverance, ultrasound developed into an imaging modality providing immense diagnostic capabilities and facilitating with precision many invasive procedures, diagnostic and therapeutic, both of which have made significant contributions to patient care. In this history, we recall the people, the personalities, and the problems they encountered during the development of ultrasound and how these problems were resolved, so that ultrasound now is available for use in the care of pregnant women throughout the developed world.
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Takizawa Y, Shimizu H, Pulkkinen L, Hiraoka Y, McGrath JA, Suzumori K, Aiso S, Uitto J, Nishikawa T. Novel mutations in the LAMB3 gene shared by two Japanese unrelated families with Herlitz junctional epidermolysis bullosa, and their application for prenatal testing. J Invest Dermatol 1998; 110:174-8. [PMID: 9457915 DOI: 10.1046/j.1523-1747.1998.00105.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The LAMB3 gene encoding the beta3 chain of laminin 5 is a candidate gene for mutations in the autosomal recessive blistering skin disorder, junctional epidermolysis bullosa. In this study, we performed genetic analyses in two unrelated Japanese families with Herlitz junctional epidermolysis bullosa and identified two novel nonsense mutations in the LAMB3 gene. One of them, Q166X (CAG --> TAG), was found in the maternal allele of family 1 and the paternal allele of family 2. Conversely, the other mutation, W610X (TGG --> TGA), was found in the paternal allele of family 1 and the maternal allele of family 2. Thus, probands of both families were compound heterozygotes for these nonsense mutations. Haplotype analyses with intragenic LAMB3 polymorphisms suggested that both mutations had arisen independently in these two families. Both mutations create a premature translation termination codon predicting truncated beta3 chains that lead to absent expression of laminin 5 in the epidermal basement membrane zone. Based on these results, DNA-based prenatal diagnosis was performed by chorionic villus sampling for subsequent pregnancies in both families. Both fetuses were found to be heterozygous carriers of the W610X mutation together with a normal LAMB3 allele, indicating that they were phenotypically unaffected. These findings expand the repertoire of LAMB3 mutations in junctional epidermolysis bullosa, and emphasize the notion that premature termination codons in both alleles of the laminin 5 genes result in Herlitz junctional epidermolysis bullosa.
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Affiliation(s)
- Y Takizawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Schorderet DF, Huber M, Laurini RN, Von Moos G, Gianadda B, Délèze G, Hohl D. Prenatal diagnosis of lamellar ichthyosis by direct mutational analysis of the keratinocyte transglutaminase gene. Prenat Diagn 1997; 17:483-6. [PMID: 9178327 DOI: 10.1002/(sici)1097-0223(199705)17:5<483::aid-pd80>3.0.co;2-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Autosomal recessive lamellar ichthyosis (LI) is a rare inherited disease of cornification of the skin. Recently, the gene responsible for type I LI has been identified and mutations have been described. The identification of mutations in families at risk for LI allows a precise and rapid prenatal diagnosis. A family with a previously unreported mutation is described and a prenatal diagnosis based on a simple polymerase chain reaction (PCR) approach is outlined. The molecular diagnosis was confirmed on post-mortem examination of the skin.
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Krous HF. Lethal Dowling-Meara-type epidermolysis bullosa simplex in a young infant. PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1995; 15:191-200. [PMID: 8736610 DOI: 10.3109/15513819509026953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- H F Krous
- Department of Pathology, Children's Hospital-San Diego, California 92123, USA
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Akiyama M, Holbrook KA. Analysis of skin-derived amniotic fluid cells in the second trimester; detection of severe genodermatoses expressed in the fetal period. J Invest Dermatol 1994; 103:674-7. [PMID: 7963655 DOI: 10.1111/1523-1747.ep12398465] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Amniotic fluid contains skin-derived cells. To determine whether populations of amniotic fluid cells reflect genetic conditions, we surveyed the population of amniotic fluid cells from 36 fetuses at 16-21 weeks estimated gestational age at risk for junctional epidermolysis bullosa, recessive dystrophic epidermolysis bullosa, epidermolysis bullosa Dowling-Meara, harlequin ichthyosis, lamellar ichthyosis (nonbullous congenital ichthyosiform erythroderma), or Sjögren-Larson syndrome. Periderm cells, keratinocytes, cells of unknown epithelial origin, fibroblasts, fibrin clots, and urinary cast-like materials were seen in the amniotic fluid from normal fetuses. A large number of small macrophages phagocytizing collagen fibers was found in the amniotic fluid from all recessive dystrophic epidermolysis bullosa, some junctional epidermolysis bullosa fetuses, and a single epidermolysis bullosa Dowling-Meara fetus. Immuno-gold electron microscopy with anti-lysozyme and anti-CD68 antibodies confirmed that the cells morphologically identified as macrophages were active macrophages containing many lysosomes. The percentage of macrophages/total amniotic fluid cells in amniotic fluid samples from the fetuses affected with recessive dystrophic epidermolysis bullosa was significantly increased (12.30 +/- 0.20%) compared with that in the amniotic fluid from normal fetuses (1.30 +/- 0.65%) (p < 0.001). In amniotic fluid samples from fetuses affected with harlequin ichthyosis and lamellar ichthyosis, clumps of keratinized cells that contained disease-specific abnormal granules and lipid droplets were observed. These results indicate that the morphologic analysis of amniotic fluid cells can provide important supportive information for the prenatal diagnosis of several severe genodermatoses.
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Affiliation(s)
- M Akiyama
- Department of Biological Structure, University of Washington School of Medicine, Seattle
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Abstract
The neuronal ceroid-lipofuscinoses (NCL) are autosomal-recessive disorders in childhood of unknown enzymatic origin. They can be recognized by the presence of abnormal lipopigments identified by electron microscopy. Based on the study of circulating lymphocytes, individual clinical subtypes of NCL can be correlated. Prenatal diagnosis of NCL with the electron microscope is now feasible for the infantile (Finnish) from (INCL) and late-infantile form (LINCL). INCL-specific granular lipopigments are present in endothelial cells of biopsied chorion stroma vessels of homozygously affected fetuses. In LINCL, disease-typical curvilinear bodies can be identified in uncultured amniotic fluid cells. Prenatal ultrastructural recognition of juvenile NCL (JNCL) is still controversial as only one single case has been reported. Electron microscopic findings can also be corroborated by genetic analysis in INCL and JNCL because the defective genes have been localized to chromosomes 1 and 16, respectively, but not in LINCL. Documentation of the index patients in the family is essential before prenatal diagnosis, and post-abortive confirmation of fetal NCL is also desirable.
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Affiliation(s)
- H H Goebel
- Department of Neuropathology, Mainz University Medical Center, Germany
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Rothnagel JA, Longley MA, Holder RA, Küster W, Roop DR. Prenatal diagnosis of epidermolytic hyperkeratosis by direct gene sequencing. J Invest Dermatol 1994; 102:13-6. [PMID: 7507150 DOI: 10.1111/1523-1747.ep12371723] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Epidermolytic hyperkeratosis (bullous congenital ichthyosiform erythroderma) is an autosomal dominant skin disorder caused by defects in the suprabasal keratins. Recently, mutations in the keratins 1 and 10 have been identified in patients with this disease. In this study, direct gene sequencing was used to establish the prenatal diagnosis in 15-week gestation twins at risk for epidermolytic hyperkeratosis. Direct sequence analysis of genomic DNA from the affected father and from both chorionic villus samples revealed a tyrosine to asparagine mutation at position 14 within the highly conserved 1A alpha-helical segment of keratin 10. None of the unaffected family members that were analyzed exhibit this mutation nor have polymorphic variations been observed in the normal population at this position. This residue is invariant in all type I keratins sequenced to date and is also conserved in related intermediate filament proteins such as vimentin and lamin. Given this high degree of conservation it is probable that any mutation at this position is deleterious and will result in disease.
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Affiliation(s)
- J A Rothnagel
- Department of Cell Biology, Baylor College of Medicine, Houston, Texas 77030
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Hovnanian A, Pollack E, Hilal L, Rochat A, Prost C, Barrandon Y, Goossens M. A missense mutation in the rod domain of keratin 14 associated with recessive epidermolysis bullosa simplex. Nat Genet 1993; 3:327-32. [PMID: 7526933 DOI: 10.1038/ng0493-327] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Epidermolysis bullosa simplex (EBS) is a group of epidermal blistering diseases almost invariably transmitted as a dominant trait, which has recently been shown to arise from mutations in keratins 14 and 5 (K14 and K5). We describe a family with recessive EBS in which the disease is tightly linked to the substitution of the highly conserved glutamic acid-144 to alanine in the first helical segment of the rod domain of keratin 14. In contrast, linkage with keratin 5 was excluded. The loss of an ionic interaction with keratin 5 is likely to affect K14-K5 heterodimer formation. Our data suggest that this mutation underlies EBS in our family, and that mutations in keratin genes may impair the mechanical integrity of basal keratinocytes in a recessive as well as dominant fashion.
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Affiliation(s)
- A Hovnanian
- Laboratoire de Génétique moléculaire, INSERM U.91, Hôpital Henri Mondor, Créteil, France
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Weidenthaler B, Hausser I, Anton-Lamprecht I. Is filaggrin really a filament-aggregating protein in vivo? Arch Dermatol Res 1993; 285:111-20. [PMID: 8503690 DOI: 10.1007/bf01112911] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Filaggrin, a basic protein of the stratum corneum, was named as such because of its capability to aggregate keratin intermediate filaments in vitro. To investigate its filament-aggregating capability in vivo, we performed immunoelectron microscopy in three autosomal dominant genodermatoses serving as in vivo models of abnormalities of keratin filament aggregation. In bullous congenital ichthyosiform erythroderma Brocq and epidermolytic palmoplantar keratoderma Voerner suprabasal clumping of keratin filaments prevents the normal spreading of keratohyalin between keratin filaments. Keratohyalin granules, either isolated or attached to clumped keratins, were specifically labelled by the anti-filaggrin antibody, whereas tonofilament clumps did not show any reaction. In epidermolysis bullosa herpetiformis Dowling-Meara the abnormal filament aggregation occurred in basal cell keratins where no reaction of the anti-filaggrin antibody was detected. In high level keratinocytes with normal distribution of tonofilaments, normal stellate keratohyalin reacted specifically. In all instances keratin filament clumping occurred independently of, and spatially separated from, the first signs of profilaggrin synthesis and keratohyalin granule formation. Thus, in these disorders, filaggrin is not involved in filament aggregation.
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Affiliation(s)
- B Weidenthaler
- Institut für Ultrastrukturforschung der Haut, Hautklinik der Ruprecht-Karls-Universität Heidelberg, Germany
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12
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Hovnanian A, Duquesnoy P, Blanchet-Bardon C, Knowlton RG, Amselem S, Lathrop M, Dubertret L, Uitto J, Goossens M. Genetic linkage of recessive dystrophic epidermolysis bullosa to the type VII collagen gene. J Clin Invest 1992; 90:1032-6. [PMID: 1355776 PMCID: PMC329960 DOI: 10.1172/jci115916] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Generalized mutilating recessive dystrophic epidermolysis bullosa (RDEB) is characterized by extreme skin fragility owing to loss of dermal-epidermal adherence. Immunohistochemical studies have implicated type VII collagen, the major component of anchoring fibrils, in the etiology of RDEB. In this study, we demonstrate genetic linkage of the type VII collagen gene and the generalized mutilating RDEB phenotype. We first identified a Pvull polymorphic site by digestion of an amplified product of the type VII collagen gene, which was shown to reside within the coding region. Genetic linkage analysis between this marker and the RDEB phenotype in 19 affected families which were informative for this polymorphism showed no recombination events, and gave a maximum lod score of 3.97 at a recombination fraction (theta) of 0, demonstrating that this DNA region is involved in this form of RDEB. These data provide strong evidence that the type VII collagen gene, which has also been linked with the dominant form of the disease, harbors the mutation(s) causing the generalized mutilating form of RDEB in these families, thus underscoring the major functional importance of type VII collagen in basement membrane zone stability.
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Affiliation(s)
- A Hovnanian
- Laboratoire de Génétique moléculaire, Institut National de la Santé et de Recherche Médicale (INSERM) Unité 91, Hôpital Henri Mondor, Créteil, France
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Holbrook KA, Wapner R, Jackson L, Zaeri N. Diagnosis and prenatal diagnosis of epidermolysis bullosa herpetiformis (Dowling-Meara) in a mother, two affected children, and an affected fetus. Prenat Diagn 1992; 12:725-39. [PMID: 1438067 DOI: 10.1002/pd.1970120906] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In utero skin biopsy was performed on a fetus at risk of an uncertain form of epidermolysis bullosa (EB). The mother had produced two affected offspring diagnosed variously as having junctional or dystrophic EB. The two offspring and the fetus were products of different fathers. The mother claimed to have no disease and on clinical examination was without blisters. Examination of the fetal skin biopsy by light and electron microscopy revealed separation of the epidermal sheet from the majority of the biopsy sample, although occasional remnants of basal cells remained associated with the basement membrane. Aggregations of keratin filaments were observed within basal cells of the detached epidermis and in the attached basal cell remnants. The diagnosis was thus suggested to be epidermolysis bullosa Dowling-Meara. Re-review of the clinical and laboratory data from the affected infants revealed a clinical and histological pattern consistent with this diagnosis. Further discussion with the mother revealed that her skin had blistered as a child and that she presently had hyperkeratotic palms and soles. This history is consistent with the autosomal dominantly inherited epidermolysis bullosa herpetiformis (Dowling-Meara). This is the first reported prenatal diagnosis of EB Dowling-Meara. The morphological criteria of intraepidermal blistering and clumped keratin filaments within basal and immediately suprabasal cells characteristic of an affected individual postnatally also identified an affected fetus. There is, however, insufficient experience to be certain that these findings will hold from region to region in the body or among all affected fetuses, and thus prenatal diagnosis on a morphological basis should still be made with caution.
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Affiliation(s)
- K A Holbrook
- Department of Biological Structure, University of Washington School of Medicine, Seattle 98195
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Shulman LP, Elias S, Andersen RN, Phillips OP, Milunsky A, Holbrook KA, Smith LT, Fine JD, Simpson JL. Alpha-fetoprotein and acetylcholinesterase are not predictive of fetal junctional epidermolysis bullosa, Herlitz variant. Prenat Diagn 1991; 11:813-8. [PMID: 1721712 DOI: 10.1002/pd.1970111102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Junctional epidermolysis bullosa, Herlitz variant (junctional EB-Herlitz) is a lethal autosomal recessive skin disorder currently amenable to prenatal diagnosis only by direct analysis of fetal skin. However, elevated levels of alpha-fetoprotein, as well as the presence of acetylcholinesterase in amniotic fluid, have been associated with other severe fetal genodermatoses. Fetal skin samplings were performed in ten pregnancies at risk for fetal junctional EB-Herlitz, with three fetuses affected on the basis of electron microscopic detection of blisters within the lamina lucida and abnormal hemidesmosomes. In neither affected nor unaffected pregnancies were maternal serum or amniotic fluid alpha-fetoprotein levels elevated. Moreover, alpha-fetoprotein levels in both maternal serum and amniotic fluid were not statistically different comparing affected and unaffected fetuses. Acetylcholinesterase was not present in the amniotic fluid samples of the three affected pregnancies. Unlike other severe fetal genodermatoses, neither alpha-fetoprotein nor acetylcholinesterase was predictive of junctional EB-Herlitz.
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Affiliation(s)
- L P Shulman
- Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103-2896
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Suzumori K, Kanzaki T. Prenatal diagnosis of harlequin ichthyosis by fetal skin biopsy; report of two cases. Prenat Diagn 1991; 11:451-7. [PMID: 1754561 DOI: 10.1002/pd.1970110707] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Two cases of harlequin ichthyosis were successfully diagnosed prenatally by fetal skin biopsy. The aborted fetuses were later confirmed to be afflicted with this very unusual skin disease. Both families had a previous history of harlequin ichthyosis. In performing the biopsy, it was found that amniotic fluid cytology can also be very helpful in the diagnosis of this kind of severe ichthyosis. With regard to these families, the disease may have been transmitted in an autosomal dominant fashion, and not in a recessive manner as is commonly believed.
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Affiliation(s)
- K Suzumori
- Department of Obstetrics and Gynecology, Nagoya City University, Medical School, Japan
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Fine JD, Holbrook KA, Elias S, Anton-Lamprecht I, Rauskolb R. Applicability of 19-DEJ-1 monoclonal antibody for the prenatal diagnosis or exclusion of junctional epidermolysis bullosa. Prenat Diagn 1990; 10:219-29. [PMID: 2195497 DOI: 10.1002/pd.1970100403] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recently a monoclonal antibody (19-DEJ-1) was produced with binding specificity for the mid-lamina lucida of the skin dermo-epidermal junction, in very close association with overlying hemidesmosomes. Since skin cleavage occurs within the lamina lucida in the inherited blistering disorder, junctional epidermolysis bullosa (EB), and is associated with aberrations in the morphology and/or number of hemidesmosomes in such tissue, we have sought to determine whether this monoclonal antibody could be used for prenatal diagnosis. Fetoscopy-directed skin biopsies were obtained from two fetuses at risk for junctional EB and post-mortem samples from two other fetuses with the Herlitz type of junctional EB, the latter after prenatal diagnosis by electron microscopy and termination of each pregnancy. Specimens were examined in part by light and electron microscopy for evidence of skin cleavage or other alterations in morphology, and in part by indirect immunofluorescence for altered basement membrane antigenicity. Three of four fetuses were shown to have intra-lamina lucida blister formation indicative of, and hemidesmosome hypoplasia proving, junctional EB. Each was also shown to lack expression of GB3 and 19-DEJ-1 antigens, consistent with findings noted postnatally in junctional EB; diagnosis was confirmed in each at the time of therapeutic abortion. A fourth fetus had no abnormalities detected; lack of disease involvement was confirmed at the time of delivery, and subsequently over 8 months of careful serial evaluation. We conclude that 19-DEJ-1 monoclonal antibody is an accurate and sensitive immunohistochemical probe for junctional EB, and may be employed in the prenatal diagnostic evaluation of fetuses at risk for this disorder.
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Affiliation(s)
- J D Fine
- Department of Dermatology, School of Medicine, University of Alabama, Birmingham
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17
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Bakharev VA, Aivazyan AA, Karetnikova NA, Mordovtsev VN, Yantovsky YuR. Fetal skin biopsy in prenatal diagnosis of some genodermatoses. Prenat Diagn 1990; 10:1-12. [PMID: 2179936 DOI: 10.1002/pd.1970100102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Various methods of obtaining fetal skin for prenatal diagnosis of certain autosomal-recessive congenital genodermatoses have been assessed. An attempt was made to obtain fetal skin by fetoscopy in 15 patients prior to pregnancy termination for a variety of medical reasons at 18-26 weeks. Specimens were obtained only in five cases (8 successful attempts out of 48). In twelve cases, of which five had a history of a child with junctional (Herlitz type) or dystrophic (Hallopeau-Siemens type) epidermolysis bullosa or non-bullous congenital ichthyosiform erythroderma at 16-25 weeks of pregnancy, fetal skin was obtained without fetoscopy under direct ultrasonic control. Specimens were obtained in all cases (33 successful attempts out of 39). In three cases, fetal pathology was diagnosed by the method of semi-thin and ultra-thin skin sections, and the respective pregnancies were terminated.
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Affiliation(s)
- V A Bakharev
- All-Union Research Centre for Maternal and Child Health, U.S.S.R. Ministry of Health, Moscow
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Hausser I, Anton-Lamprecht I. Ultrastructure of first trimester chorionic villi with regard to the prenatal diagnosis of genodermatoses. Prenat Diagn 1988; 8:511-24. [PMID: 3222218 DOI: 10.1002/pd.1970080706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Hopes are held out for chorion villus sampling, a technique which is gaining more and more importance for the first trimester prenatal diagnosis of chromosomal aberrations and metabolic abnormalities. A variety of inherited skin diseases can be diagnosed postnatally and prenatally (in the second trimester) by ultrastructural diagnostic markers. For evaluation of prenatal diagnosis in the first trimester, we investigated chorionic villi derived from the trophoblast layer of the early pregnancy by light microscopy and conventional electron microscopy. The ultrastructure of the cellular layers covering the villi, i.e., the inner cytotrophoblast and the outer syncytiotrophoblast, as well as that of the connective tissue of the inner extraembryonic mesoderm, are thoroughly described in relation to the ultrastructural changes in certain genodermatoses including epidermolyses and keratinization disorders. We found that chorionic villi have only a few of the characteristics differentiated in skin, and none of the structures which are relevant to the diagnosis of genodermatoses. In our view, the ultrastructural approach is not suitable for first trimester prenatal diagnosis of genodermatoses in chorionic villi.
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Affiliation(s)
- I Hausser
- Institut für Ultrastrukturforschung der Haut, Hautklinik der Ruprecht-Karls-Universität Heidelberg, F.R.G
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Affiliation(s)
- B A Dale
- Department of Periodontics, University of Washington, Schools of Dentistry and Medicine, Seattle 98195
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Eady RA, Gunner DB, Carbone LD, Bricarelli FD, Gosden CM, Rodeck CH. Prenatal diagnosis of bullous ichthyosiform erythroderma: detection of tonofilament clumps in fetal epidermal and amniotic fluid cells. J Med Genet 1986; 23:46-51. [PMID: 3512829 PMCID: PMC1049540 DOI: 10.1136/jmg.23.1.46] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The prenatal diagnosis of bullous ichthyosiform erythroderma (BIE) has been achieved at 20 weeks' gestation by electron microscopic identification of a pathognomonic cytoskeletal abnormality within fetal epidermal cells obtained by fetoscopic skin biopsy. The same abnormality was also observed in skin derived amniotic fluid cells. The question whether amniocentesis might be used instead of fetoscopy for future prenatal detection of BIE is discussed.
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Arnold ML, Anton-Lamprecht I. Problems in prenatal diagnosis of the ichthyosis congenita group. Hum Genet 1985; 71:301-11. [PMID: 4077047 DOI: 10.1007/bf00388455] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The late onset of normal keratinization after week 24 menstrual age (MA) of fetal life is the cause of considerable problems with the prenatal diagnosis of congenital ichthyosis. This paper summarizes the experiences with prenatal diagnosis in nine pregnancies at risk of congenital ichthyosis and one at risk of chondrodysplasia punctata, rhizomelic type. An important prerequisite--and the main problem--is the manifestation of the mutant genes early enough in fetal life to allow a safe exclusion. Continuous precocious keratinization of the interfollicular epidermis, hyperkeratosis, and/or specific markers of congenital ichthyosis such as various types of lipid inclusions had been expected. With a normal ultrastructure and development of fetal epidermis no evidence of ichthyosis was present in eight cases; all eight children were born healthy. Regional variations of the onset of keratinization of the interfollicular epidermis, observed in one of these eight fetuses as well as in one fetus at risk (but normal for) recessive dystrophic epidermolysis bullosa, posed considerable problems and might lead to a false-positive diagnosis. Examination after birth allowed one to localize these regions to areas close to the mamillae. Regional variations in addition to the well-known cranio-caudal gradient thus are normal findings: both children have normal skin. One fetus at risk of non-bullous congenital ichthyosiform erythroderma (type II) was involved without prenatal manifestation of interfollicular keratinization, specific markers, or increased numbers of cornified cells in the pilosebaceous follicles at 20 weeks MA. A slightly more irregular pattern of the horn cell contents was not regarded as sufficient evidence alone to indicate congenital ichthyosis. A severely affected boy was born in week 34 MA. Similarly the fetus at risk of chondrodysplasia punctata showed no skin abnormalities, neither at fetoscopy (week 22 MA) nor after abortion (week 24 MA) although based on other clinical features it was clearly affected. Thus, this genodermatosis cannot be diagnosed prenatally by its keratinization disturbances. In future cases, precocious keratinization and hyperkeratosis cannot be expected to be expressed before week 24 MA, and minor signs, such as irregularities of horn cell contents, have to be taken as an indication of involvement. Multiple biopsies are required, and a safe exclusion may be impossible before week 22 MA.
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MacLeod PM, Dolman CL, Nickel RE, Chang E, Nag S, Zonana J, Silvey K. Prenatal diagnosis of neuronal ceroid-lipofuscinoses. AMERICAN JOURNAL OF MEDICAL GENETICS 1985; 22:781-9. [PMID: 4073127 DOI: 10.1002/ajmg.1320220413] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report on the successful prenatal diagnosis of the late infantile "Jansky-Bielschowsky" variant of the neuronal ceroid-lipofuscinoses (NCL). The fetus was studied at 16 weeks of gestation because of an affected sib. Uncultured amniotic fluid cells were studied by conventional electron microscopic techniques. About one-third of a subpopulation of dark, elongated cells contained one or more deposits of curvilinear cytosomes bound by a single unit membrane. These findings were considered typical of the late infantile variant of NCL. After delivery at term, a skin punch biopsy and a buffy coat preparation from the baby were examined and found to have similar characteristic inclusions, which confirmed our prenatal diagnosis.
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Dale BA, Holbrook KA, Kimball JR, Hoff M, Sun TT. Expression of epidermal keratins and filaggrin during human fetal skin development. J Biophys Biochem Cytol 1985; 101:1257-69. [PMID: 2413039 PMCID: PMC2113922 DOI: 10.1083/jcb.101.4.1257] [Citation(s) in RCA: 247] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The major structural proteins of epithelia, the keratins, and the keratin filament-associated protein, filaggrin, were analyzed in more than 50 samples of human embryonic and fetal skin by one-dimensional SDS PAGE and immunoblotting with monoclonal and polyclonal antibodies. Companion samples were examined by immunohistochemistry and electron microscopy. Based on structural characteristics of the epidermis, four periods of human epidermal development were identified. The first is the embryonic period (before 9 wk estimated gestational age), and the others are within the fetal period: stratification (9-14 wk), follicular keratinization (14-24 wk), and interfollicular keratinization (beginning at approximately 24 wk). Keratin proteins of both the acidic (AE1-reactive, type I) and the basic (AE3-reactive, type II) subfamilies were present throughout development. Keratin intermediate filaments were recognized in the tissue by electron microscopy and immunohistochemical staining. Keratins of 50 and 58 kD were present in the epidermis at all ages studied (8 wk to birth), and those of 56.5 and 67 kD were expressed at the time of stratification and increased in abundance as development proceeded. 40- and 52-kD keratins were present early in development but disappeared with keratinization. Immunohistochemical staining suggested the presence of keratins of 50 and 58 kD in basal cells, 56.5 and 67 kD in intermediate cells, and 40 and 52 kD in the periderm as well as in the basal cells between the time of stratification and birth. Filaggrin was first detected biochemically at approximately 15 wk and was localized immunohistochemically in the keratinizing cells that surround hair follicles. It was identified 8-10 wk later in the granular and cornified cell layers of keratinized interfollicular epidermis. These results demonstrate the following. An intimate relationship exists between expression of structural proteins and morphologic changes during development of the epidermis. The order of expression of individual keratins is consistent with the known expression of keratins in simple vs. stratified vs. keratinized epithelia. Expression of keratins typical of stratified epithelia (50 and 58 kD) precedes stratification, and expression of keratins typical of keratinization (56.5 and 67 kD) precedes keratinization, which suggests that their expression marks the tissue commitment to those processes. Because only keratins that have been demonstrated in various adult tissues are expressed during fetal development, we conclude that there are no "fetal" keratins per se.(ABSTRACT TRUNCATED AT 400 WORDS)
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Arnold ML, Rauskolb R, Anton-Lamprecht I, Schinzel A, Schmid W. Prenatal diagnosis of anhidrotic ectodermal dysplasia. Prenat Diagn 1984; 4:85-98. [PMID: 6739441 DOI: 10.1002/pd.1970040202] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This paper reports on successful prenatal diagnosis of X-linked anhidrotic ectodermal dysplasia (AED) by means of light and electron microscopy on fetal skin biopsies obtained under fetoscopy. In the present family two brothers of the proband were severely affected with the full symptomatology of AED, the pregnant female and her mother revealed minor symptoms with patches of skin lacking vellus hair. Control of lesional skin of the affected family members by electron microscopy revealed no ultrastructural abnormalities. However, all biopsies lacked skin appendages including hair follicles, sebaceous glands, and sweat glands. The lack of pilosebaceous follicles can be used as a diagnostic criterion since these structures are fully developed in normal fetuses of 20 weeks whereas the development of sweat glands does not start before week 20 to 24 of fetal life. Skin biopsies were taken from various regions of the fetus at risk via fetoscopy in week 20 and processed for light and electron microscopy. All samples revealed complete absence of all skin appendages in contrast to a total of 61 non-AED fetuses. Thus positive prenatal diagnosis of AED was made and the pregnancy was terminated. Control investigations after abortion confirmed the diagnosis.
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Löfberg L, Gustavii B. "Blind" versus direct vision technique for fetal skin sampling in cases for prenatal diagnosis. Clin Genet 1984; 25:37-41. [PMID: 6368057 DOI: 10.1111/j.1399-0004.1984.tb00460.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Seven fetuses at risk of developing a serious inherited skin disorder (epidermolysis bullosa atrophicans generalisata gravis in 4, bullous ichthyosiform erythroderma in 2, and non-bullous ichthyosiform erythroderma in 1) were subjected to prenatal diagnosis by fetal skin sampling. The conventional "blind" biopsy procedure was used in the first 3 cases; a two-cannula technique (one cannula for the optic instrument and the other for the biopsy forceps) that permits biopsy of the skin under direct vision, was employed in the remaining 4 cases. With the "blind" technique, 8 to 10 biopsy specimens had to be taken to ensure that enough skin material would be available for the microscopic examination; only one specimen out of every two was found to consist of skin; the remainder comprised fetal membranes, myometrium, or trophoblast. In one case where the "blind" procedure has been used, leakage of amniotic fluid occurred and labor started in the 33rd week. With the two-cannula technique, the number of biopsy samples could be confined to two or three, and all proved to be of skin.
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Abstract
It is the goal of the present article to review the state of knowledge of human skin development and to indicate some of the questions being approached in current studies of human fetal skin. Because of the breadth of the topic, the discussion will be limited to two ages during gestation that correspond to periods when samples of fetal skin or amniotic fluid cells (which in part are derived from the skin) are used to evaluate the condition of the fetus. These periods correspond to ages when amniocentesis (14-16 weeks) and fetoscopy accompanied by fetal skin biopsy (19-20 weeks) are performed.
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Anton-Lamprecht I. Genetically induced abnormalities of epidermal differentiation and ultrastructure in ichthyoses and epidermolyses: pathogenesis, heterogeneity, fetal manifestation, and prenatal diagnosis. J Invest Dermatol 1983; 81:149s-56s. [PMID: 6345689 DOI: 10.1111/1523-1747.ep12540961] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Comparative ultrastructural investigations on the pathomorphogenesis of inherited ichthyoses and epidermolyses have shown that such heterogeneous skin disorders may serve as model systems for genetic interactions with developmental processes, such as keratinization, or functional systems, such as dermal-epidermal junctional integrity. Most interesting from the morphologic point of view are dominantly inherited skin disorders in the ichthyosis and epidermolysis bullosa groups in which primary structural defects of structural proteins have been demonstrated that seem to be under the direct control of the mutant gene. Such structural abnormalities concern keratohyalin in autosomal-dominant ichthyosis vulgaris, the tonofilament system in hystrix-like ichthyoses, and the anchoring fibrils in dominant dystrophic epidermolyses. Taking bullous congenital ichthyosiform erythroderma (epidermolytic hyperkeratosis) as a central example, we discuss the stability of such structural defects, the heterogeneity in the ultrastructural abnormalities of clinically closely similar entities (ichthyosis hystrix Curth-Macklin, congenital reticulate ichthyosiform erythroderma), and, in the latter keratinization disorder, the presence of an unusual filament system of unknown biochemical composition in the abnormal keratinocytes. Expression of mutant genes during fetal life and fetal manifestation of such abnormalities are a precondition for the prenatal diagnosis of genetic skin disorders (bullous ichthyosiform erythroderma, epidermolysis bullosa dystrophica Hallopeau-Siemens, Herlitz syndrome). Finally, problems related to the differentiation of mutant keratinocytes and of amniotic fluid cells of fetuses at risk of genetic skin disorders under the in vitro conditions of primary cell cultures are briefly discussed.
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Abstract
Disturbances in the process of normal cornification leading to pathologic scaling provide the pathophysiologic basis for the ichthyoses. These disturbances may result from either abnormalities in protein metabolism (keratinization) (i.e., the "bricks") or in lipid metabolism (i.e., the "mortar") (Fig. 1). The evidence linking the various ichthyoses to defects in protein or lipid metabolism have been reviewed. It is likely that future advances will lead not only to a more complete understanding of the pathogenesis of these disorders, but also will shed significant light on the normal stratum corneum functions of barrier formation and desquamation, as well as lead the way to more rational and effective therapies. In recent years, prenatal diagnosis has been successfully performed in several of the ichthyoses. It is likely that improvements in our ability to prenatally diagnose those disorders will advance hand-in-hand with further progress in unraveling their underlying causes.
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Abstract
The technics of fetoscopy and fetal skin biopsy have expanded our capabilities for antenatal diagnosis of certain hereditary skin disorders (genodermatoses). The fetus and placenta can be visualized directly and skin biopsy specimens can be obtained for light and electron microscopic studies, tissue culture, and biochemical analysis. These technics have been utilized successfully in the prenatal diagnosis or exclusion of epidermolysis bullosa, epidermolytic hyperkeratosis, and harlequin ichthyosis in fetuses known to be at risk for these disorders, and they offer tremendous potential for prenatal diagnosis in a variety of other genodermatoses. Studies of tissue obtained by this procedure will undoubtedly expand our knowledge of the morphogenesis and biochemistry of fetal skin and will provide needed baseline data for the further development of these technics.
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Holbrook KA, Dale BA, Sybert VP, Sagebiel RW. Epidermolytic hyperkeratosis: ultrastructure and biochemistry of skin and amniotic fluid cells from two affected fetuses and a newborn infant. J Invest Dermatol 1983; 80:222-7. [PMID: 6187867 DOI: 10.1111/1523-1747.ep12534504] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Skin biopsy samples and amniotic fluid cells obtained in utero from two fetuses at risk for epidermolytic hyperkeratosis were examined by light and electron microscopy. Both fetuses were affected; the second was carried to term. Epidermal extracts were prepared from blisters of the newborn for analysis of keratin and filaggrin proteins. Abnormal clumps of keratin filaments were present in all layers of the prekeratinized fetal epidermis except the periderm and stratum germinativum. A significant population of amniotic fluid cells also contained the filament aggregations. Prenatal diagnosis of the disease should be possible using cells obtained at amniocentesis, thus avoiding fetal skin biopsy. Biochemical studies showed abnormalities in keratin and filaggrin proteins. The structural alterations in the tissue might be a consequence of altered interaction between these two abnormal epidermal proteins.
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Anton-Lamprecht I, Rauskolb R, Jovanovic V, Kern B, Arnold ML, Schenck W. Prenatal diagnosis of epidermolysis bullosa dystrophica Hallopeau-Siemens with electron microscopy of fetal skin. Lancet 1981; 2:1077-9. [PMID: 6118526 DOI: 10.1016/s0140-6736(81)91278-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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