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Dev A, Malhi K, Mahajan R. Ectodermal Dysplasia - An Overview and Update. Indian Dermatol Online J 2024; 15:405-414. [PMID: 38845644 PMCID: PMC11152464 DOI: 10.4103/idoj.idoj_599_23] [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] [Received: 08/05/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 06/09/2024] Open
Abstract
Ectodermal dysplasias are a heterogeneous group of disorders that are characterized by abnormal development of ectodermal structures like hair, teeth, nails, and sweat glands. Alhough they were earlier classified according to the structures affected and hence the clinical manifestations, recent developments inch towards a genetic basis for classification. They are currently divided into four groups of disorders based on the pathway involved, which includes the ectodysplasin/nuclear factor-kappa B (NFKB) pathway, wingless-type MMTV integration site family, member 10 ([wingless related integration site] WNT10), tumor protein p63 (TP63), and the structural group. In spite of attempts at the segregation of the various disorders, there is a great degree of overlap in clinical features among the conditions, which makes a thorough history-taking and clinical examination important in helping us arrive at a diagnosis and judge the various systems involved. A multidisciplinary approach forms the crux of the management of patients with ectodermal dysplasias and their families, with a focus on education, counseling, prosthesis, and an overall rehabilitative outlook. Special attention must also be paid to screening family members for varying severities of the disorders, and an attempt must be made at a genetic diagnosis with genetic counseling.
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Affiliation(s)
- Anubha Dev
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kittu Malhi
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Schneider H, Schweikl C, Faschingbauer F, Hadj-Rabia S, Schneider P. A Causal Treatment for X-Linked Hypohidrotic Ectodermal Dysplasia: Long-Term Results of Short-Term Perinatal Ectodysplasin A1 Replacement. Int J Mol Sci 2023; 24:ijms24087155. [PMID: 37108325 PMCID: PMC10138843 DOI: 10.3390/ijms24087155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
X-linked hypohidrotic ectodermal dysplasia (XLHED), caused by a genetic deficiency of ectodysplasin A1 (EDA1), is a rare developmental disorder of ectodermal derivatives such as hair, sweat glands, and teeth. The absence of sweat glands and perspiration can evoke life-threatening hyperthermia. As molecular genetic findings are not always conclusive, the concentrations of circulating EDA1 may help to distinguish between total and partial EDA1 deficiencies. We previously treated nine male patients with obvious signs of XLHED with a recombinant EDA1 replacement protein, Fc-EDA, either shortly after birth (n = 3) or by prenatal administration in gestational week 26 and beyond (n = 6). Here, we present the long-term follow-up for up to six years. In patients who had received Fc-EDA after birth, neither sweat glands nor sweating ability were detected at the age of 12-60 months. In contrast, prenatal EDA1 replacement resulted in ample sweat gland development and pilocarpine-inducible sweating in all treated subjects, who also attained more permanent teeth than their untreated affected relatives. Normal perspiration has persisted for six years in the two oldest boys treated repeatedly with Fc-EDA in utero. When they had a sauna, adequate thermoregulation was evidenced. Lower sweat production after single prenatal dosing may indicate a dose-response relationship. The absence of circulating EDA1 in five prenatally treated subjects proved that these children would have been unable to perspire if they had been left untreated. The sixth infant was shown to produce an EDA1 molecule that, albeit interacting with its cognate receptor, cannot activate EDA1 signaling. In conclusion, a causal treatment of XLHED before birth is feasible.
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Affiliation(s)
- Holm Schneider
- Center for Ectodermal Dysplasias & Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054 Erlangen, Germany
| | - Christine Schweikl
- Center for Ectodermal Dysplasias & Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054 Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Universitätsstraße 21-23, 91054 Erlangen, Germany
| | - Smail Hadj-Rabia
- Department of Dermatology and Reference Center for Rare Skin Diseases (MAGEC), Institut Imagine, Université de Paris-Centre, Hôpital Necker-Enfants Malades, 149 Rue de Sèvres, 75743 Paris, France
| | - Pascal Schneider
- Department of Immunobiology, University of Lausanne, Chemin des Boveresses 155, 1066 Epalinges, Switzerland
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3
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Schneider H, Hadj-Rabia S, Faschingbauer F, Bodemer C, Grange DK, Norton ME, Cavalli R, Tadini G, Stepan H, Clarke A, Guillén-Navarro E, Maier-Wohlfart S, Bouroubi A, Porte F. Protocol for the Phase 2 EDELIFE Trial Investigating the Efficacy and Safety of Intra-Amniotic ER004 Administration to Male Subjects with X-Linked Hypohidrotic Ectodermal Dysplasia. Genes (Basel) 2023; 14:153. [PMID: 36672894 PMCID: PMC9858920 DOI: 10.3390/genes14010153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/09/2023] Open
Abstract
X-linked hypohidrotic ectodermal dysplasia (XLHED) is a rare genetic disorder characte-rised by abnormal development of the skin and its appendages, such as hair and sweat glands, the teeth, and mucous glands of the airways, resulting in serious, sometimes life-threatening complications like hyperthermia or recurrent respiratory infections. It is caused by pathogenic variants of the ectodysplasin A gene (EDA). Most affected males are hemizygous for EDA null mutations that lead to the absence or inactivity of the signalling protein ectodysplasin A1 (EDA1) and, thus, to the full-blown phenotype with inability to perspire and few if any teeth. There are currently no long-term treatment options for XLHED. ER004 represents a first-in-class protein replacement molecule designed for specific, high-affinity binding to the endogenous EDA1 receptor (EDAR). Its proposed mechanism of action is the replacement of missing EDA1 in yet unborn patients with XLHED. Once bound to EDAR, ER004 activates the EDA/NFκB signalling pathway, which triggers the transcription of genes involved in the normal development of multiple tissues. Following preclinical studies, named-patient use cases demonstrated significant potential of ER004 in affected males treated in utero during the late second and third trimesters of pregnancy. In order to confirm these results, we started the EDELIFE trial, a prospective, open-label, genotype-match controlled, multicentre clinical study to investigate the efficacy and safety of intra-amniotic ER004 administration as a prenatal treatment for male subjects with XLHED. This article summarises the rationale, the study protocol, ethical issues of the trial, and potential pitfalls.
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Affiliation(s)
- Holm Schneider
- Center for Ectodermal Dysplasias and Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Smail Hadj-Rabia
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC), Hopital Universitaire Necker-Enfants Malades, Assistance Publique—Hospitals of Paris, University of Paris-Cité, 75743 Paris, France
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, University Hospital Erlangen, 91054 Erlangen, Germany
| | - Christine Bodemer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC), Hopital Universitaire Necker-Enfants Malades, Assistance Publique—Hospitals of Paris, University of Paris-Cité, 75743 Paris, France
| | - Dorothy K. Grange
- Department of Pediatrics, Division of Genetics and Genomic Medicine, Washington University, St. Louis, MO 63110, USA
| | - Mary E. Norton
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94143, USA
| | - Riccardo Cavalli
- Pediatric Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, 20122 Milan, Italy
| | - Gianluca Tadini
- Pediatric Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, 20122 Milan, Italy
| | - Holger Stepan
- Department of Obstetrics, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Angus Clarke
- Institute of Medical Genetics, Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, CF10 3AT, UK
| | - Encarna Guillén-Navarro
- Medical Genetics Section, Department of Pediatrics, Virgen de la Arrixaca University Hospital, IMIB-Arrixaca, University of Murcia, and CIBERER, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Sigrun Maier-Wohlfart
- Center for Ectodermal Dysplasias and Department of Pediatrics, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
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Ou S, Jeyalatha MV, Mao Y, Wang J, Chen C, Zhang M, Liu X, Liang M, Lin S, Wu Y, Li Y, Li W. The Role of Ectodysplasin A on the Ocular Surface Homeostasis. Int J Mol Sci 2022; 23:ijms232415700. [PMID: 36555342 PMCID: PMC9779463 DOI: 10.3390/ijms232415700] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/12/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
Ectodysplasin A (EDA), a ligand of the TNF family, plays an important role in maintaining the homeostasis of the ocular surface. EDA is necessary for the development of the meibomian gland, the lacrimal gland, as well as the proliferation and barrier function of the corneal epithelium. The mutation of EDA can induce the destruction of the ocular surface resulting in keratopathy, abnormality of the meibomian gland and maturation of the lacrimal gland. Experimental animal studies showed that a prenatal ultrasound-guided intra-amniotic injection or postnatal intravenous administration of soluble recombinant EDA protein can efficiently prevent the development of ocular surface abnormalities in EDA mutant animals. Furthermore, local application of EDA could restore the damaged ocular surface to some extent. Hence, a recombinant EDA-based therapy may serve as a novel paradigm to treat ocular surface disorders, such as meibomian gland dysfunction and corneal epithelium abnormalities.
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Affiliation(s)
- Shangkun Ou
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Mani Vimalin Jeyalatha
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
| | - Yi Mao
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Junqi Wang
- Department of Ophthalmology, Graduate School of Medicine, Osaka 5650871, Japan
| | - Chao Chen
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Minjie Zhang
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Xiaodong Liu
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Minghui Liang
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Sijie Lin
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Yiming Wu
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361000, China
| | - Yixuan Li
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
| | - Wei Li
- Eye Institute of Xiamen University and Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361000, China
- Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361000, China
- Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, China
- Correspondence: ; Tel./Fax: +86-592-2183761
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Extended Overview of Ocular Phenotype with Recent Advances in Hypohidrotic Ectodermal Dysplasia. CHILDREN 2022; 9:children9091357. [PMID: 36138666 PMCID: PMC9497858 DOI: 10.3390/children9091357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
The term ectodermal dysplasias (EDs) describes a heterogeneous group of inherited developmental disorders that affect several tissues of ectodermal origin. The most common form of EDs is hypohidrotic ectodermal dysplasia (HED), which is characterized by hypodontia, hypotrichosis, and partial or total eccrine sweat gland deficiency. HED is estimated to affect at least 1 in 17,000 people worldwide. Patients with HED have characteristic facies with periorbital hyperpigmentation, depressed nasal bridge, malar hypoplasia, and absent or sparse eyebrows and eyelashes. The common ocular features of HED include madarosis, trichiasis, and ocular chronic surface disease due to dry eye syndrome, which manifests clinically with discomfort, photophobia, and redness. Dry eye is common in HED and results from a combination of ocular surface defects: mucus abnormalities (abnormal conjunctival mucinous glands), aqueous tear deficiency (abnormalities in the lacrimal gland) and lipid deficiency (due to the partial or total absence of the meibomian glands; modified sebaceous glands with the tarsal plate). Sight-threatening complications result from ocular surface disease, including corneal ulceration and perforation with subsequent corneal scarring and neovascularization. Rare ocular features have been reported and include bilateral or unilateral congenital cataracts, bilateral glaucoma, chorioretinal atrophy and atresia of the nasolacrimal duct. Recognition of the ocular manifestations of HED is required to perform clinical surveillance, instigate supportive and preventative treatment, and manage ocular complications.
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Willems M, Wells CF, Coubes C, Pequignot M, Kuony A, Michon F. Hypolacrimia and Alacrimia as Diagnostic Features for Genetic or Congenital Conditions. Invest Ophthalmol Vis Sci 2022; 63:3. [PMID: 35925585 PMCID: PMC9363675 DOI: 10.1167/iovs.63.9.3] [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: 11/24/2022] Open
Abstract
As part of the lacrimal apparatus, the lacrimal gland participates in the maintenance of a healthy eye surface by producing the aqueous part of the tear film. Alacrimia and hypolacrimia, which are relatively rare during childhood or young adulthood, have their origin in a number of mechanisms which include agenesia, aplasia, hypoplasia, or incorrect maturation of the gland. Moreover, impaired innervation of the gland and/or the cornea and alterations of protein secretion pathways can lead to a defective tear film. In most conditions leading to alacrimia or hypolacrimia, however, the altered tear film is only one of numerous defects that arise and therefore is commonly disregarded. Here, we have systematically reviewed all of those genetic conditions or congenital disorders that have alacrimia or hypolacrimia as a feature. Where it is known, we describe the mechanism of the defect in question. It has been possible to clearly establish the physiopathology of only a minority of these conditions. As hypolacrimia and alacrimia are rare features, this review could be used as a tool in clinical genetics to perform a quick diagnosis, necessary for appropriate care and counseling.
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Affiliation(s)
- Marjolaine Willems
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France.,Medical Genetic Department for Rare Diseases and Personalized Medicine, Reference Center AD SOOR, AnDDI-RARE, Montpellier University Hospital Center, Montpellier, France
| | - Constance F Wells
- Medical Genetic Department for Rare Diseases and Personalized Medicine, Reference Center AD SOOR, AnDDI-RARE, Montpellier University Hospital Center, Montpellier, France
| | - Christine Coubes
- Medical Genetic Department for Rare Diseases and Personalized Medicine, Reference Center AD SOOR, AnDDI-RARE, Montpellier University Hospital Center, Montpellier, France
| | - Marie Pequignot
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Alison Kuony
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France.,Université Paris Cité, CNRS, Institut Jacques Monod, Paris, France
| | - Frederic Michon
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
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Gökdere S, Schneider H, Hehr U, Willen L, Schneider P, Maier-Wohlfart S. Functional and clinical analysis of five EDA variants associated with ectodermal dysplasia but with a hard-to-predict significance. Front Genet 2022; 13:934395. [PMID: 35923710 PMCID: PMC9339965 DOI: 10.3389/fgene.2022.934395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022] Open
Abstract
Deficiency of ectodysplasin A1 (EDA1) due to variants of the gene EDA causes X-linked hypohidrotic ectodermal dysplasia (XLHED), a rare genetic condition characterized by abnormal development of ectodermal structures. XLHED is defined by the triad of hypotrichosis, hypo- or anhidrosis, and hypo- or anodontia. Anhidrosis may lead to life-threatening hyperthermia. A definite genetic diagnosis is, thus, important for the patients' management and amenability to a novel prenatal treatment option. Here, we describe five familial EDA variants segregating with the disease in three families, for which different prediction tools yielded discordant results with respect to their significance. Functional properties in vitro and levels of circulating serum EDA were compared with phenotypic data on skin, hair, eyes, teeth, and sweat glands. EDA1-Gly176Val, although associated with relevant hypohidrosis, still bound to the EDA receptor (EDAR). Subjects with EDA1-Pro389LeufsX27, -Ter392GlnfsX30, -Ser125Cys, and an EDA1 splice variant (c.924+7A > G) showed complete absence of pilocarpine-induced sweating. EDA1-Pro389LeufsX27 was incapable of binding to EDAR and undetectable in serum. EDA1-Ter392GlnfsX30, produced in much lower amounts than wild-type EDA1, could still bind to EDAR, and so did EDA1-Ser125Cys that was, however, undetectable in serum. The EDA splice variant c.924+7A > G resulted experimentally in a mix of wild-type EDA1 and EDA molecules truncated in the middle of the receptor-binding domain, with reduced EDA serum concentration. Thus, in vitro assays reflected the clinical phenotype in two of these difficult cases, but underestimated it in three others. Absence of circulating EDA seems to predict the full-blown phenotype of XLHED, while residual EDA levels may also be found in anhidrotic patients. This indicates that unborn subjects carrying variants of uncertain significance could benefit from an upcoming prenatal medical treatment even if circulating EDA levels or tests in vitro suggest residual EDA1 activity.
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Affiliation(s)
- Sare Gökdere
- Department of Pediatrics, Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
| | - Holm Schneider
- Department of Pediatrics, Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
| | - Ute Hehr
- Center for Human Genetics, Regensburg, Germany
| | - Laure Willen
- Department of Biochemistry, University of Lausanne, Lausanne, Switzerland
| | - Pascal Schneider
- Department of Biochemistry, University of Lausanne, Lausanne, Switzerland
| | - Sigrun Maier-Wohlfart
- Department of Pediatrics, Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
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Leo B, Schneider H, Hammersen J. Reproductive decision-making by women with X-linked hypohidrotic ectodermal dysplasia. J Eur Acad Dermatol Venereol 2022; 36:1863-1870. [PMID: 35611639 DOI: 10.1111/jdv.18267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In X-linked hypohidrotic ectodermal dysplasia (XLHED), ectodysplasin A1 (EDA1) deficiency results in malformation of hair, teeth, and sweat glands. Lack of sweating which can cause life-threatening hyperthermia is amenable to intrauterine therapy with recombinant EDA1. OBJECTIVES This study aimed at evaluating reproductive decision-making by women with XLHED and at clarifying the potential impact of a prenatal treatment option. METHODS In a retrospective cross-sectional analysis, a 75-item questionnaire filled in by 50 women with XLHED (age 19-49 years) was assessed. RESULTS 16 women (32%) prevented pregnancies because of the risk to pass on XLHED, 15 considered assisted reproduction for the same reason. Twelve women had a history of miscarriage, stillbirth or abortion, three women reported on previous abortion of affected fetuses. When imagining to be pregnant, all except one showed interest in prenatal diagnosis of XLHED and in the possibility of treatment before birth. In 13 out of 50 women (26%), XLHED if detected prenatally would have impact on the continuation of pregnancy. Among 35 mothers of at least one affected child, XLHED had rarely been diagnosed during the first pregnancy (17%) but regularly during subsequent pregnancies (77%). Becoming aware of the condition before birth had caused a moral conflict for 50% of these women. Subjects with an affected child less frequently considered assisted reproduction to prevent XLHED (p<0.05). In more than 66% of the women who reported an effect of XLHED on family planning, a prenatal treatment option for this disease would influence their decision-making. CONCLUSIONS Many pregnant XLHED carriers who seek prenatal diagnosis experience moral conflicts. A prenatal treatment option would have strong impact on reproductive decisions, underlining the importance of adequate professional counselling.
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Affiliation(s)
- B Leo
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - H Schneider
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - J Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Chaudhary AK, Gholse A, Nagarajaram HA, Dalal AB, Gupta N, Dutta AK, Danda S, Gupta R, Sankar HV, Bhavani GS, Girisha KM, Phadke SR, Ranganath P, Bashyam MD. Ectodysplasin pathogenic variants affecting the furin-cleavage site and unusual clinical features define X-linked hypohidrotic ectodermal dysplasia in India. Am J Med Genet A 2021; 188:788-805. [PMID: 34863015 DOI: 10.1002/ajmg.a.62579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/20/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022]
Abstract
Hypohidrotic ectodermal dysplasia (HED) is a rare genetic disorder caused by mutational inactivation of a developmental pathway responsible for generation of tissues of ectodermal origin. The X-linked form accounts for the majority of HED cases and is caused by Ectodysplasin (EDA) pathogenic variants. We performed a combined analysis of 29 X-linked hypohidrotic ectodermal dysplasia (XLHED) families (including 12 from our previous studies). In addition to the classical triad of symptoms including loss (or reduction) of ectodermal structures, such as hair, teeth, and sweat glands, we detected additional HED-related clinical features including facial dysmorphism and hyperpigmentation in several patients. Interestingly, global developmental delay was identified as an unusual clinical symptom in many patients. More importantly, we identified 22 causal pathogenic variants that included 15 missense, four small in-dels, and one nonsense, splice site, and large deletion each. Interestingly, we detected 12 unique (India-specific) pathogenic variants. Of the 29 XLHED families analyzed, 11 (38%) harbored pathogenic variant localized to the furin cleavage site. A comparison with HGMD revealed significant differences in the frequency of missense pathogenic variants; involvement of specific exons and/or protein domains and transition/transversion ratios. A significantly higher proportion of missense pathogenic variants (33%) localized to the EDA furin cleavage when compared to HGMD (7%), of which p.R155C, p.R156C, and p.R156H were detected in three families each. Therefore, the first comprehensive analysis of XLHED from India has revealed several unique features including unusual clinical symptoms and high frequency of furin cleavage site pathogenic variants.
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Affiliation(s)
- Ajay Kumar Chaudhary
- Laboratory of Molecular Oncology, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Aishwarya Gholse
- Laboratory of Computational Biology, Department of Systems and Computational Biology, School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Hampapathalu Adimurthy Nagarajaram
- Laboratory of Computational Biology, Department of Systems and Computational Biology, School of Life Sciences, University of Hyderabad, Hyderabad, India
| | - Ashwin Bhikaji Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Neerja Gupta
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Atanu Kumar Dutta
- Department of Clinical Genetics, Christian Medical College and Hospital, Vellore, India
| | - Sumita Danda
- Department of Clinical Genetics, Christian Medical College and Hospital, Vellore, India
| | - Rekha Gupta
- Department of Medical Genetics, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Hariharan V Sankar
- Department of Pediatrics, SAT Hospital, Medical College, Trivandrum, India
| | - Gandham SriLakshmi Bhavani
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Shubha Rao Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prajnya Ranganath
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India.,Department of Medical Genetics, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Murali Dharan Bashyam
- Laboratory of Molecular Oncology, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
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10
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Thornton CS, Puttagunta L, Helmersen D, Thakrar MV, Nagendran J, Lien D, Varughese RA. ANOTHER syndrome-Familial presentations of progressive lung disease leading to double lung transplantation: A case report and literature review. Respirol Case Rep 2021; 9:e0872. [PMID: 34765225 PMCID: PMC8569409 DOI: 10.1002/rcr2.872] [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] [Received: 09/22/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/08/2022] Open
Abstract
Ectodermal dysplasias (EDs) are a heterogeneous rare group of disorders with an incidence at 1/100,000 live births. Currently, there are limited case reports of patients requiring lung transplantation. Here, we report two brothers who present with a constellation of features including alopecia, nail dystrophy, ophthalmic complications, thyroid disease, hypohidrosis, ephelides, enteropathy and recurrent respiratory tract infections, known as ANOTHER syndrome, a rare autosomal recessive variant of ED. Both presented in early childhood with progressive respiratory decline and eventual failure. Chronic respiratory decline was refractory to standard therapy. Both patients required lung transplantation for sequelae of end-stage lung disease. Pathology demonstrated multifocal bronchiectasis with areas of fibrosis and small airway obstruction. ANOTHER syndrome is rare with a paucity of data in the literature. Given the limited therapeutic options available with natural progression towards respiratory failure, lung transplantation may be considered.
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Affiliation(s)
- Christina S. Thornton
- Division of Respirology, Department of MedicineCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Lakshmi Puttagunta
- Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Douglas Helmersen
- Division of Respirology, Department of MedicineCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Mitesh V. Thakrar
- Division of Respirology, Department of MedicineCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of SurgeryUniversity of AlbertaEdmontonAlbertaCanada
| | - Dale Lien
- Division of Pulmonary Medicine, Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Rhea A. Varughese
- Division of Respirology, Department of MedicineCumming School of Medicine, University of CalgaryCalgaryAlbertaCanada
- Division of Pulmonary Medicine, Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
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11
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Hennig V, Schuh W, Neubert A, Mielenz D, Jäck HM, Schneider H. Increased risk of chronic fatigue and hair loss following COVID-19 in individuals with hypohidrotic ectodermal dysplasia. Orphanet J Rare Dis 2021; 16:373. [PMID: 34479575 PMCID: PMC8414461 DOI: 10.1186/s13023-021-02011-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/24/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hypohidrotic ectodermal dysplasia (HED) is a group of genodermatoses in which deficient ectodysplasin A signalling leads to maldevelopment of skin appendages, various eccrine glands, and teeth. Individuals with HED often have disrupted epithelial barriers and, therefore, were suspected to be more susceptible to coronavirus infection. METHODS 56 households with at least one member who had coronavirus disease of 2019 (COVID-19) were enrolled in a longitudinal study to compare the course of illness, immune responses, and long-term consequences of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection in HED patients (n = 15, age 9-52 years) and control subjects of the same age group (n = 149). RESULTS In 14 HED patients, mild or moderate typical COVID-19 symptoms were observed that lasted for 4-45 days. Fever during the first days sometimes required external cooling measures. The course of COVID-19 was similar to that in control subjects if patients developed antibodies blocking the SARS-CoV-2 spike protein. Five out of six HED patients with completely abrogated ectodysplasin A signalling (83%) suffered from chronic, in two cases very severe fatigue following COVID-19, while only 25% of HED patients with residual activity of this pathway and 21% of control subjects recovering from COVID-19 experienced postinfectious fatigue. Hair loss after COVID-19 was also more frequent among HED patients (64%) than in the control group (13%). CONCLUSIONS HED appears to be associated with an increased risk of long-term consequences of a SARS-CoV-2 infection. Preventive vaccination against COVID-19 should be recommended for individuals affected by this rare genetic disorder.
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Affiliation(s)
- Verena Hennig
- Department of Pediatrics, University Hospital Erlangen, University of Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany
- Center for Ectodermal Dysplasias, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Schuh
- Division of Molecular Immunology, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Antje Neubert
- Department of Pediatrics, University Hospital Erlangen, University of Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany
| | - Dirk Mielenz
- Division of Molecular Immunology, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Hans-Martin Jäck
- Division of Molecular Immunology, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Holm Schneider
- Department of Pediatrics, University Hospital Erlangen, University of Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany.
- Center for Ectodermal Dysplasias, University Hospital Erlangen, University of Erlangen-Nürnberg, Erlangen, Germany.
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12
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Moura E, Daltro SRT, Sás DM, Engracia Filho JR, Farias MR, Pimpão CT. Genetic analysis of a possible case of canine X-linked ectodermal dysplasia. J Small Anim Pract 2021; 62:1127-1130. [PMID: 34076266 DOI: 10.1111/jsap.13385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/07/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Abstract
In the present report, we describe targeted next-generation sequencing of the EDA gene of a male poodle with a clinical and histopathological diagnosis of X-linked hypohidrotic ectodermal dysplasia. The result was compared with the reference sequence and with the result of the sequencing of a normal dog's EDA gene. No point variant, small deletion or insertion were found in the exons and splice sites, but a transition and a transversion were found in the intron 6' and 3' UTR, respectively. The cause of the dysplasia of the affected dog in this study is neither a point variant nor a small deletion or insertion in the exons and splice sites of the EDA gene. Therefore, patients with phenotype of XLHED may have other types of variants in the EDA gene or variants in other genes of the EDA signalling pathway.
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Affiliation(s)
- E Moura
- Service of Medical Genetics, Course of Veterinary Medicine, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - S R T Daltro
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - D M Sás
- Genotyping - Diagnósticos Genéticos, Botucatu, São Paulo, Brazil
| | - J R Engracia Filho
- Graduate Program in Animal Science, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - M R Farias
- Graduate Program in Animal Science, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - C T Pimpão
- Graduate Program in Animal Science, School of Life Sciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
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13
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Körber L, Schneider H, Fleischer N, Maier-Wohlfart S. No evidence for preferential X-chromosome inactivation as the main cause of divergent phenotypes in sisters with X-linked hypohidrotic ectodermal dysplasia. Orphanet J Rare Dis 2021; 16:98. [PMID: 33622384 PMCID: PMC7901220 DOI: 10.1186/s13023-021-01735-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND X-linked hypohidrotic ectodermal dysplasia (XLHED), a rare genetic disorder, affects the normal development of ectodermal derivatives, such as hair, skin, teeth, and sweat glands. It is caused by pathogenic variants of the gene EDA and defined by a triad of hypotrichosis, hypo- or anodontia, and hypo- or anhidrosis which may lead to life-threatening hyperthermia. Although female carriers are less severely affected than male patients, they display symptoms, too, with high phenotypic variability. This study aimed to elucidate whether phenotypic differences in female XLHED patients with identical EDA genotypes might be explained by deviating X-chromosome inactivation (XI) patterns. METHODS Six families, each consisting of two sisters with the same EDA variant and their parents (with either mother or father being carrier of the variant), participated in this study. XLHED-related data like sweating ability, dental status, facial dysmorphism, and skin issues were assessed. We determined the women`s individual XI patterns in peripheral blood leukocytes by the human androgen receptor assay and collated the results with phenotypic features. RESULTS The surprisingly large inter- and intrafamilial variability of symptoms in affected females was not explicable by the pathogenic variants. Our cohort showed no higher rate of nonrandom XI in peripheral blood leukocytes than the general female population. Furthermore, skewed XI patterns in favour of the mutated alleles were not associated with more severe phenotypes. CONCLUSIONS We found no evidence for preferential XI in female XLHED patients and no distinct correlation between XLHED-related phenotypic features and XI patterns. Phenotypic variability seems to be evoked by other genetic or epigenetic factors.
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Affiliation(s)
- Laura Körber
- Center for Ectodermal Dysplasias and Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany
| | - Holm Schneider
- Center for Ectodermal Dysplasias and Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany
| | | | - Sigrun Maier-Wohlfart
- Center for Ectodermal Dysplasias and Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany.
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14
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Ostedgaard LS, Price MP, Whitworth KM, Abou Alaiwa MH, Fischer AJ, Warrier A, Samuel M, Spate LD, Allen PD, Hilkin BM, Romano Ibarra GS, Ortiz Bezara ME, Goodell BJ, Mather SE, Powers LS, Stroik MR, Gansemer ND, Hippee CE, Zarei K, Goeken JA, Businga TR, Hoffman EA, Meyerholz DK, Prather RS, Stoltz DA, Welsh MJ. Lack of airway submucosal glands impairs respiratory host defenses. eLife 2020; 9:59653. [PMID: 33026343 PMCID: PMC7541087 DOI: 10.7554/elife.59653] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Submucosal glands (SMGs) are a prominent structure that lines human cartilaginous airways. Although it has been assumed that SMGs contribute to respiratory defense, that hypothesis has gone without a direct test. Therefore, we studied pigs, which have lungs like humans, and disrupted the gene for ectodysplasin (EDA-KO), which initiates SMG development. EDA-KO pigs lacked SMGs throughout the airways. Their airway surface liquid had a reduced ability to kill bacteria, consistent with SMG production of antimicrobials. In wild-type pigs, SMGs secrete mucus that emerges onto the airway surface as strands. Lack of SMGs and mucus strands disrupted mucociliary transport in EDA-KO pigs. Consequently, EDA-KO pigs failed to eradicate a bacterial challenge in lung regions normally populated by SMGs. These in vivo and ex vivo results indicate that SMGs are required for normal antimicrobial activity and mucociliary transport, two key host defenses that protect the lung.
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Affiliation(s)
- Lynda S Ostedgaard
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Margaret P Price
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | | | - Mahmoud H Abou Alaiwa
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Anthony J Fischer
- Department of Pediatrics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Akshaya Warrier
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Melissa Samuel
- Division of Animal Science, University of Missouri, Columbia, United States
| | - Lee D Spate
- Division of Animal Science, University of Missouri, Columbia, United States
| | - Patrick D Allen
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Brieanna M Hilkin
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Guillermo S Romano Ibarra
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Miguel E Ortiz Bezara
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Brian J Goodell
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Steven E Mather
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Linda S Powers
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Mallory R Stroik
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Nicholas D Gansemer
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Camilla E Hippee
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Keyan Zarei
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States.,Department of Biomedical Engineering, University of Iowa, Iowa City, United States
| | - J Adam Goeken
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Thomas R Businga
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Eric A Hoffman
- Department of Biomedical Engineering, University of Iowa, Iowa City, United States.,Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - David K Meyerholz
- Department of Pathology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Randall S Prather
- Division of Animal Science, University of Missouri, Columbia, United States
| | - David A Stoltz
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States.,Department of Biomedical Engineering, University of Iowa, Iowa City, United States.,Department of Molecular Physiology and Biophysics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States
| | - Michael J Welsh
- Department of Internal Medicine and Pappajohn Biomedical Institute Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States.,Department of Molecular Physiology and Biophysics, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, United States.,Howard Hughes Medical Institute, University of Iowa, Iowa City, United States
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15
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Wohlfart S, Schneider H. Variants of the ectodysplasin A1 receptor gene underlying homozygous cases of autosomal recessive hypohidrotic ectodermal dysplasia. Clin Genet 2020; 95:427-432. [PMID: 30623979 DOI: 10.1111/cge.13503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/20/2018] [Accepted: 01/05/2019] [Indexed: 11/28/2022]
Abstract
Hypohidrotic ectodermal dysplasia (HED) is a rare genetic condition resulting from defective development of ectodermal derivatives, such as hair, teeth, and sweat glands. Autosomal recessive (AR) forms of HED may be caused by pathogenic variants of the ectodysplasin A1 receptor (EDAR) gene that encodes a receptor involved in the NF-κB signaling pathway. Here, we describe three cases of AR-HED in families of Turkish, Austrian, and German-American origin (with or without known consanguinity). In these cases, two out-of-frame deletions and a pathogenic missense variant of EDAR were found to be disease-causing due to reduced availability of the respective messenger RNA or impaired interaction of the encoded protein with its binding partner leading to diminished signal transduction. The same missense variant, c.1258C>T (p.Arg420Trp), has actually been reported to be restricted to the Icelandic population and to be associated with non-syndromic tooth agenesis but not HED. As our patient has no known relationship to Icelandic individuals and displays a rather severe HED phenotype, we suggest that EDAR-Arg420Trp is a more widespread variant, possibly with variable clinical expressivity.
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Affiliation(s)
- Sigrun Wohlfart
- Center for Ectodermal Dysplasias and Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Holm Schneider
- Center for Ectodermal Dysplasias and Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
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16
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Körber I, Klein OD, Morhart P, Faschingbauer F, Grange DK, Clarke A, Bodemer C, Maitz S, Huttner K, Kirby N, Durand C, Schneider H. Safety and immunogenicity of Fc-EDA, a recombinant ectodysplasin A1 replacement protein, in human subjects. Br J Clin Pharmacol 2020; 86:2063-2069. [PMID: 32250462 PMCID: PMC7495278 DOI: 10.1111/bcp.14301] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/20/2020] [Accepted: 03/16/2020] [Indexed: 12/20/2022] Open
Abstract
In X‐linked hypohidrotic ectodermal dysplasia, the most frequent ectodermal dysplasia, an inherited deficiency of the signalling protein ectodysplasin A1 (EDA1) impairs the development of the skin and its appendages, various eccrine glands, and dentition. The severe hypohidrosis common to X‐linked hypohidrotic ectodermal dysplasia patients may lead to life‐threatening hyperthermia, especially during hot weather or febrile illness. Fc‐EDA, an EDA1 replacement protein known to prevent the disease in newborn animals, was tested in 2 clinical trials (human adults and neonates) and additionally administered under compassionate use to 3 infants in utero. The data support the safety of Fc‐EDA and efficacy if applied prenatally. Anti‐drug antibodies were detected after intravenous administration in adult males and nonpregnant females, but not in pregnant women when Fc‐EDA was delivered intra‐amniotically. Most importantly, there was no detectable immune response to the investigational drug in neonates treated by intravenous infusions and in infants who had received Fc‐EDA in utero. In conclusion, the safety profile of this drug encourages further development of prenatal EDA1 replacement therapy.
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Affiliation(s)
- Iris Körber
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Germany
| | | | - Patrick Morhart
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Germany
| | | | | | | | | | - Silvia Maitz
- San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy
| | | | - Neil Kirby
- Edimer Pharmaceuticals, Cambridge, MA, USA
| | | | - Holm Schneider
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Germany
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17
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Anbouba GM, Carmany EP, Natoli JL. The characterization of hypodontia, hypohidrosis, and hypotrichosis associated with X-linked hypohidrotic ectodermal dysplasia: A systematic review. Am J Med Genet A 2020; 182:831-841. [PMID: 31981414 DOI: 10.1002/ajmg.a.61493] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 01/12/2023]
Abstract
The objective of this study was to review the published literature on X-linked hypohidrotic ectodermal dysplasia (XLHED) for the prevalence and characteristics of three features of XLHED: hypodontia, hypohidrosis, and hypotrichosis. A systematic search of English-language articles was conducted in May 2019 to identify publications with information on any of the three features of XLHED. We excluded studies with five or fewer participants, that did not specify X-linked inheritance or an EDA mutation, and discussed only management of features. The weighted means for total missing teeth, location of missing teeth, prevalence of reduced and absent sweating ability, and sparse or absent hair were analyzed across all studies. Additional findings for hypodontia, hypohidrosis, and hypotrichosis were summarized qualitatively. Twenty publications (18 studies) were accepted. Reported findings for males tended to be more informative than for carrier females. The weighted mean for missing teeth for affected males was 22.4 (range: 10-28) and carrier females was 3.4 (range: 0-22). The most common conserved teeth for males were the canines. The most common missing teeth for females were the maxillary lateral incisors. The weighted mean prevalence of reduced or absent sweating ability was 95.7% for males and 71.6% for females. The weighted mean prevalence for hypotrichosis was 88.1% for males and 61.6% for females. This systematic review provides insight into the prevalence, characteristics, and variability of the three classic features of XLHED. These findings provide detailed natural history information for families with XLHED as well as key characteristics that can aid in diagnosis.
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Affiliation(s)
- Grace M Anbouba
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin.,Wayne State University School of Medicine, Detroit, Michigan
| | - Erin P Carmany
- Wayne State University School of Medicine, Detroit, Michigan
| | - Jaime L Natoli
- Kaiser Permanente Southern California, Pasadena, California
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18
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Wohlfart S, Meiller R, Hammersen J, Park J, Menzel-Severing J, Melichar VO, Huttner K, Johnson R, Porte F, Schneider H. Natural history of X-linked hypohidrotic ectodermal dysplasia: a 5-year follow-up study. Orphanet J Rare Dis 2020; 15:7. [PMID: 31924237 PMCID: PMC6954509 DOI: 10.1186/s13023-019-1288-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023] Open
Abstract
Background X-linked hypohidrotic ectodermal dysplasia (XLHED) is caused by pathogenic variants of the gene EDA disrupting the prenatal development of ectodermal derivatives. Cardinal symptoms are hypotrichosis, lack of teeth, and hypo- or anhidrosis, but the disease may also evoke other clinical problems. This study aimed at investigating the clinical course of XLHED in early childhood as the basis for an evaluation of the efficacy of potential treatments. Methods 25 children (19 boys and 6 girls between 11 and 35 months of age) with genetically confirmed XLHED were enrolled in a long-term natural history study. Clinical data were collected both retrospectively using parent questionnaires and medical records (pregnancy, birth, infancy) and prospectively until the age of 60 months. General development, dentition, sweating ability, ocular, respiratory, and skin involvement were assessed by standardized clinical examination and yearly quantitative surveys. Results All male subjects suffered from persistent anhidrosis and heat intolerance, although a few sweat ducts were detected in some patients. Sweating ability of girls with XLHED ranged from strongly reduced to almost normal. In the male subjects, 1–12 deciduous teeth erupted and 0–8 tooth germs of the permanent dentition became detectable. Tooth numbers were higher but variable in the female group. Most affected boys had no more than three if any Meibomian glands per eyelid, most girls had fewer than 10. Many male subjects developed additional, sometimes severe health issues, such as obstructive airway conditions, chronic eczema, or dry eye disease. Adverse events included various XLHED-related infections, unexplained fever, allergic reactions, and retardation of psychomotor development. Conclusions This first comprehensive study of the course of XLHED confirmed the early involvement of multiple organs, pointing to the need of early therapeutic intervention.
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Affiliation(s)
- Sigrun Wohlfart
- Center for Ectodermal Dysplasias & Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany.
| | - Ralph Meiller
- Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Johanna Hammersen
- Center for Ectodermal Dysplasias & Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany
| | - Jung Park
- Center for Ectodermal Dysplasias & Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany
| | | | - Volker O Melichar
- Center for Ectodermal Dysplasias & Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany
| | | | | | | | - Holm Schneider
- Center for Ectodermal Dysplasias & Department of Pediatrics, University Hospital Erlangen, Loschgestr. 15, 91054, Erlangen, Germany
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19
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Martínez-Romero MC, Ballesta-Martínez MJ, López-González V, Sánchez-Soler MJ, Serrano-Antón AT, Barreda-Sánchez M, Rodriguez-Peña L, Martínez-Menchon MT, Frías-Iniesta J, Sánchez-Pedreño P, Carbonell-Meseguer P, Glover-López G, Guillén-Navarro E. EDA, EDAR, EDARADD and WNT10A allelic variants in patients with ectodermal derivative impairment in the Spanish population. Orphanet J Rare Dis 2019; 14:281. [PMID: 31796081 PMCID: PMC6892193 DOI: 10.1186/s13023-019-1251-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 11/05/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Ectodermal dysplasias (ED) are a group of genetic conditions affecting the development and/or homeostasis of two or more ectodermal derivatives. An attenuated phenotype is considered a non-syndromic trait when the patient is affected by only one impaired ectodermal structure, such as in non-syndromic tooth agenesis (NSTA) disorder. Hypohidrotic ectodermal dysplasia (HED) is the most highly represented ED. X-linked hypohidrotic ectodermal dysplasia (XLHED) is the most common subtype, with an incidence of 1/50,000-100,000 males, and is associated with the EDA gene (Xq12-q13.1); the dominant and recessive subtypes involve the EDAR (2q13) and EDARADD (1q42.3) genes, respectively. The WNT10A gene (2q35) is associated more frequently with NSTA. Our goal was to determine the mutational spectrum in a cohort of 72 Spanish patients affected by one or more ectodermal derivative impairments referred to as HED (63/72) or NSTA (9 /72) to establish the prevalence of the allelic variants of the four most frequently associated genes. Sanger sequencing of the EDA, EDAR, EDARADD and WNT10A genes and multiplex ligation-dependent probe amplification (MLPA) were performed. RESULTS A total of 61 children and 11 adults, comprising 50 males and 22 females, were included. The average ages were 5.4 and 40.2 years for children and adults, respectively. A molecular basis was identified in 51/72 patients, including 47/63 HED patients, for whom EDA was the most frequently involved gene, and 4/9 NSTA patients, most of whom had variants of WNT10A. Among all the patients, 37/51 had variants of EDA, 8/51 had variants of the WNT10A gene, 4/51 had variants of EDAR and 5/51 had variants of EDARADD. In 42/51 of cases, the variants were inherited according to an X-linked pattern (27/42), with the remaining showing an autosomal dominant (10/42) or autosomal recessive (5/42) pattern. Among the NSTA patients, 3/9 carried pathogenic variants of WNT10A and 1/9 carried EDA variants. A total of 60 variants were detected in 51 patients, 46 of which were different, and out of these 46 variants, 12 were novel. CONCLUSIONS This is the only molecular study conducted to date in the Spanish population affected by ED. The EDA, EDAR, EDARADD and WNT10A genes constitute the molecular basis in 70.8% of patients with a 74.6% yield in HED and 44.4% in NSTA. Twelve novel variants were identified. The WNT10A gene has been confirmed as the second molecular candidate that has been identified and accounts for one-half of non-EDA patients and one-third of NSTA patients. Further studies using next generation sequencing (NGS) will help to identify other contributory genes in the remaining uncharacterized Spanish patients.
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Affiliation(s)
- María Carmen Martínez-Romero
- Centro de Bioquímica y Genética Clínica, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB- Arrixaca. Murcia. CIBERER-ISCIII, Madrid, Spain.,Programa de doctorado en Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - María Juliana Ballesta-Martínez
- Sección Genética Médica. Servicio de Pediatría. Hospital Clínico Universitario Virgen de la Arrixaca. IMIB- Arrixaca, Universidad de Murcia. CIBERER-ISCIII, Madrid, Spain.,Cátedra de Genética. Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Vanesa López-González
- Sección Genética Médica. Servicio de Pediatría. Hospital Clínico Universitario Virgen de la Arrixaca. IMIB- Arrixaca, Universidad de Murcia. CIBERER-ISCIII, Madrid, Spain.,Cátedra de Genética. Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - María José Sánchez-Soler
- Sección Genética Médica. Servicio de Pediatría. Hospital Clínico Universitario Virgen de la Arrixaca. IMIB- Arrixaca, Universidad de Murcia. CIBERER-ISCIII, Madrid, Spain.,Cátedra de Genética. Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Ana Teresa Serrano-Antón
- Sección Genética Médica. Servicio de Pediatría. Hospital Clínico Universitario Virgen de la Arrixaca. IMIB- Arrixaca, Universidad de Murcia. CIBERER-ISCIII, Madrid, Spain
| | - María Barreda-Sánchez
- Cátedra de Genética. Facultad de Ciencias de la Salud, Universidad Católica de Murcia (UCAM), Murcia, Spain
| | - Lidya Rodriguez-Peña
- Sección Genética Médica. Servicio de Pediatría. Hospital Clínico Universitario Virgen de la Arrixaca. IMIB- Arrixaca, Universidad de Murcia. CIBERER-ISCIII, Madrid, Spain
| | - María Teresa Martínez-Menchon
- Servicio de Dermatología. Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - José Frías-Iniesta
- Servicio de Dermatología. Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Paloma Sánchez-Pedreño
- Servicio de Dermatología. Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Pablo Carbonell-Meseguer
- Centro de Bioquímica y Genética Clínica, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB- Arrixaca. Murcia. CIBERER-ISCIII, Madrid, Spain
| | - Guillermo Glover-López
- Centro de Bioquímica y Genética Clínica, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB- Arrixaca. Murcia. CIBERER-ISCIII, Madrid, Spain
| | - Encarna Guillén-Navarro
- Departamento de Cirugía, Pediatría, Obstetricia y Ginecología. Facultad de Medicina, Universidad de Murcia, Murcia, Spain. .,Sección Genética Médica (Hospital Materno-Infantil. Planta 0), Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, El Palmar, CP 30120, Murcia, Spain.
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Kuony A, Ikkala K, Kalha S, Magalhães AC, Pirttiniemi A, Michon F. Ectodysplasin-A signaling is a key integrator in the lacrimal gland-cornea feedback loop. Development 2019; 146:dev.176693. [PMID: 31221639 DOI: 10.1242/dev.176693] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 06/17/2019] [Indexed: 01/26/2023]
Abstract
A lack of ectodysplasin-A (Eda) signaling leads to dry eye symptoms, which have so far only been associated with altered Meibomian glands. Here, we used loss-of-function (Eda -/-) mutant mice to unravel the impact of Eda signaling on lacrimal gland formation, maturation and subsequent physiological function. Our study demonstrates that Eda activity is dispensable during lacrimal gland embryonic development. However, using a transcriptomic approach, we show that the Eda pathway is necessary for proper cell terminal differentiation in lacrimal gland epithelium and correlated with modified expression of secreted factors commonly found in the tear film. Finally, we discovered that lacrimal glands present a bilateral reduction of Eda signaling activity in response to unilateral corneal injury. This observation hints towards a role for the Eda pathway in controlling the switch from basal to reflex tears, to support corneal wound healing. Collectively, our data suggest a crucial implication of Eda signaling in the cornea-lacrimal gland feedback loop, both in physiological and pathophysiological conditions. Our findings demonstrate that Eda downstream targets could help alleviate dry eye symptoms.
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Affiliation(s)
- Alison Kuony
- Institute of Biotechnology, Helsinki Institute of Life Science, Developmental Biology Program, University of Helsinki, 00790 Helsinki, Finland.,Institut Jacques Monod, Université Denis Diderot - Paris 7, CNRS UMR 7592, Buffon building, 15 rue Hélène Brion, 75205 Paris Cedex 13, France
| | - Kaisa Ikkala
- Institute of Biotechnology, Helsinki Institute of Life Science, Developmental Biology Program, University of Helsinki, 00790 Helsinki, Finland
| | - Solja Kalha
- Institute of Biotechnology, Helsinki Institute of Life Science, Developmental Biology Program, University of Helsinki, 00790 Helsinki, Finland
| | - Ana Cathia Magalhães
- Institute of Biotechnology, Helsinki Institute of Life Science, Developmental Biology Program, University of Helsinki, 00790 Helsinki, Finland.,Institute for Neurosciences of Montpellier, INSERM UMR1051, University of Montpellier, 34295 Montpellier, France
| | - Anniina Pirttiniemi
- Institute of Biotechnology, Helsinki Institute of Life Science, Developmental Biology Program, University of Helsinki, 00790 Helsinki, Finland
| | - Frederic Michon
- Institute of Biotechnology, Helsinki Institute of Life Science, Developmental Biology Program, University of Helsinki, 00790 Helsinki, Finland .,Institute for Neurosciences of Montpellier, INSERM UMR1051, University of Montpellier, 34295 Montpellier, France
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21
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Margolis CA, Schneider P, Huttner K, Kirby N, Houser TP, Wildman L, Grove GL, Schneider H, Casal ML. Prenatal Treatment of X-Linked Hypohidrotic Ectodermal Dysplasia using Recombinant Ectodysplasin in a Canine Model. J Pharmacol Exp Ther 2019; 370:806-813. [PMID: 31000577 DOI: 10.1124/jpet.118.256040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/08/2019] [Indexed: 11/22/2022] Open
Abstract
X-linked hypohidrotic ectodermal dysplasia (XLHED) is caused by defects in the EDA gene that inactivate the function of ectodysplasin A1 (EDA1). This leads to abnormal development of eccrine glands, hair follicles, and teeth, and to frequent respiratory infections. Previous studies in the naturally occurring dog model demonstrated partial prevention of the XLHED phenotype by postnatal administration of recombinant EDA1. The results suggested that a single or two temporally spaced injections of EDI200 prenatally might improve the clinical outcome in the dog model. Fetuses received ultrasound-guided EDI200 intra-amniotically at gestational days 32 and 45, or 45 or 55 alone (of a 65-day pregnancy). Growth rates, lacrimation, hair growth, meibomian glands, sweating, dentition, and mucociliary clearance were compared in treated and untreated XLHED-affected dogs, and in heterozygous and wild-type control dogs. Improved phenotypic outcomes were noted in the earlier and more frequently treated animals. All animals treated prenatally showed positive responses compared with untreated dogs with XLHED, most notably in the transfer of moisture through paw pads, suggesting improved onset of sweating ability and restored meibomian gland development. These results exemplify the feasibility of ultrasound-guided intra-amniotic injections for the treatment of developmental disorders, with improved formation of specific EDA1-dependent structures in dogs with XLHED.
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Affiliation(s)
- Carol A Margolis
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Pascal Schneider
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Kenneth Huttner
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Neil Kirby
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Timothy P Houser
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Lee Wildman
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Gary L Grove
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Holm Schneider
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
| | - Margret L Casal
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania (C.A.M., M.L.C.); Department of Biochemistry, University of Lausanne, Lausanne, Switzerland (P.S.); Edimer Pharmaceuticals, Cambridge, Massachusetts (K.H., N.K.); cyberDERM, Inc., Broomall, Pennsylvania (T.P.H., L.W., G.L.G.); and Universitätsklinikum Erlangen, Kinder- und Jugendklinik, Erlangen, Germany (H.S.)
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22
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Hammersen J, Wohlfart S, Goecke TW, Köninger A, Stepan H, Gallinat R, Morris S, Bücher K, Clarke A, Wünsche S, Beckmann MW, Schneider H, Faschingbauer F. Reliability of prenatal detection of X-linked hypohidrotic ectodermal dysplasia by tooth germ sonography. Prenat Diagn 2018; 39:796-805. [PMID: 30394555 DOI: 10.1002/pd.5384] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE In X-linked hypohidrotic ectodermal dysplasia (XLHED), dysfunction of ectodysplasin A1 (EDA1) due to EDA mutations results in malformation of hair, teeth, and sweat glands. Hypohidrosis, which can cause life-threatening hyperthermia, is amenable to intrauterine therapy with recombinant EDA1. This study aimed at evaluating tooth germ sonography as a noninvasive means to identify affected fetuses in pregnant carrier women. METHODS Sonography, performed at 10 study sites between gestational weeks 18 and 28, led to the diagnosis of XLHED if fewer than six tooth germs were detected in mandible or maxilla. The assessment was verified postnatally by EDA sequencing and/or clinical findings. Estimated fetal weights and postnatal weight gain of boys with XLHED were assessed using appropriate growth charts. RESULTS In 19 of 38 sonographic examinations (23 male and 13 female fetuses), XLHED was detected prenatally. The prenatal diagnosis proved to be correct in 37 cases; one affected male fetus was missed. Specificity and positive predictive value were both 100%. Tooth counts obtained by clinical examination corresponded well with findings on panoramic radiographs. We observed no weight deficits of subjects with XLHED in utero but occasionally during infancy. CONCLUSION Tooth germ sonography is highly specific and reliable in detecting XLHED prenatally.
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Affiliation(s)
- Johanna Hammersen
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
| | - Sigrun Wohlfart
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
| | - Tamme W Goecke
- Department of Gynecology and Obstetrics, RWTH Aachen, Aachen, Germany
| | - Angela Köninger
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany
| | - Holger Stepan
- Department of Obstetrics, University Hospital Leipzig, Leipzig, Germany
| | - Ralph Gallinat
- Frauenärztliche Gemeinschaftspraxis Günzburg-Ichenhausen, Günzburg, Germany
| | - Susan Morris
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Katharina Bücher
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Angus Clarke
- Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK.,Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Wünsche
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
| | - Matthias W Beckmann
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
| | - Holm Schneider
- Center for Ectodermal Dysplasias, University Hospital Erlangen, Erlangen, Germany
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23
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Ferstl P, Wohlfart S, Schneider H. Sweating ability of patients with p63-associated syndromes. Eur J Pediatr 2018; 177:1727-1731. [PMID: 30088137 DOI: 10.1007/s00431-018-3227-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 12/22/2022]
Abstract
Sweating deficiency has been reported to represent a cardinal symptom of ectrodactyly-ectodermal dysplasia-cleft lip/palate syndrome and ankyloblepharon-ectodermal dysplasia-cleft lip/palate syndrome, two rare p63-associated disorders. According to online resources, hypohidrosis may lead to most life-threatening complications in affected patients. Thus, counseling on the prevention of hyperthermia would be indispensable in case of such syndromes, although detailed information on this issue is missing in the literature. We investigated 14 individuals with ectrodactyly-ectodermal dysplasia-cleft lip/palate syndrome (age range 2-48 years) and 9 individuals with ankyloblepharon-ectodermal dysplasia-cleft lip/palate syndrome (0.5-60 years of age) by confocal laser scanning microscopy to determine their palmar sweat duct density and by quantification of pilocarpine-induced sweating. Genotype-phenotype correlations were assessed. In 12 of 23 patients (52%), a normal amount of sweat ducts was detected. These individuals (9 with ectrodactyly-ectodermal dysplasia-cleft lip/palate syndrome, 3 with ankyloblepharon-ectodermal dysplasia-cleft lip/palate syndrome) produced sufficient sweat volumes (≥ 20 μl) in response to pilocarpine. All other patients had clearly reduced sweating ability and fewer sweat glands, but no anhidrosis. Alteration of a specific proline residue (Pro590) of p63 was consistently linked to impaired perspiration.Conclusion: Hypohidrosis in p63-associated syndromes is less common and potentially less severe than previously thought and may be attributable to certain genotypes. What is Known: • Hypohidrosis which has been listed as a cardinal symptom of AEC and EEC syndromes may lead to life-threatening hyperthermia. What is New: • Patients with EEC and AEC syndromes often can sweat normally. • Hypohidrosis seems to be attributed to certain TP63 genotypes.
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Affiliation(s)
- Paul Ferstl
- Center for Ectodermal Dysplasias, University of Erlangen-Nürnberg, Erlangen, Germany.,Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany
| | - Sigrun Wohlfart
- Center for Ectodermal Dysplasias, University of Erlangen-Nürnberg, Erlangen, Germany.,Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany
| | - Holm Schneider
- Center for Ectodermal Dysplasias, University of Erlangen-Nürnberg, Erlangen, Germany. .,Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestr. 15, 91054, Erlangen, Germany.
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24
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Li S, Zhou J, Zhang L, Li J, Yu J, Ning K, Qu Y, He H, Chen Y, Reinach PS, Liu C, Liu Z, Li W. Ectodysplasin A regulates epithelial barrier function through sonic hedgehog signalling pathway. J Cell Mol Med 2018; 22:230-240. [PMID: 28782908 PMCID: PMC5742694 DOI: 10.1111/jcmm.13311] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022] Open
Abstract
Ectodysplasin A (Eda), a member of the tumour necrosis factor superfamily, plays an important role in ectodermal organ development. An EDA mutation underlies the most common of ectodermal dysplasias, that is X-linked hypohidrotic ectodermal dysplasia (XLHED) in humans. Even though it lacks a developmental function, the role of Eda during the postnatal stage remains elusive. In this study, we found tight junctional proteins ZO-1 and claudin-1 expression is largely reduced in epidermal, corneal and lung epithelia in Eda mutant Tabby mice at different postnatal ages. These declines are associated with tail ulceration, corneal pannus formation and lung infection. Furthermore, topical application of recombinant Eda protein markedly mitigated corneal barrier dysfunction. Using cultures of a human corneal epithelial cell line and Tabby mouse skin tissue explants, Eda up-regulated expression of ZO-1 and claudin-1 through activation of the sonic hedgehog signalling pathway. We conclude that EDA gene expression contributes to the maintenance of epithelial barrier function. Such insight may help efforts to identify novel strategies for improving management of XLHED disease manifestations in a clinical setting.
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Affiliation(s)
- Sanming Li
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Jing Zhou
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Liying Zhang
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Juan Li
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Jingwen Yu
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Ke Ning
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Yangluowa Qu
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Hui He
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | - Yongxiong Chen
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
| | | | - Chia‐Yang Liu
- School of Optometry BloomingtonIndiana University BloomingtonBloomingtonINUSA
| | - Zuguo Liu
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
- Xiamen University affiliated Xiamen Eye CenterXiamenFujianChina
| | - Wei Li
- Eye Institute of Xiamen UniversityXiamenFujianChina
- Medical College of Xiamen UniversityXiamenFujianChina
- Fujian Provincial Key Laboratory of Ophthalmology and Visual ScienceXiamenFujianChina
- Xiamen University affiliated Xiamen Eye CenterXiamenFujianChina
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25
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Higashino T, Lee JYW, McGrath JA. Advances in the genetic understanding of hypohidrotic ectodermal dysplasia. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1405806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Toshihide Higashino
- St John’s Institute of Dermatology, King’s College London, Guy’s Hospital, London, UK
- Department of Integrative Physiology and Bio-Nano Medicine, National Defense Medical College, Tokorozawa, Japan
| | - John Y. W. Lee
- St John’s Institute of Dermatology, King’s College London, Guy’s Hospital, London, UK
| | - John A. McGrath
- St John’s Institute of Dermatology, King’s College London, Guy’s Hospital, London, UK
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Li S, Zhou J, Bu J, Ning K, Zhang L, Li J, Guo Y, He X, He H, Cai X, Chen Y, Reinach PS, Liu Z, Li W. Ectodysplasin A protein promotes corneal epithelial cell proliferation. J Biol Chem 2017; 292:13391-13401. [PMID: 28655773 DOI: 10.1074/jbc.m117.803809] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Indexed: 11/06/2022] Open
Abstract
The EDA gene encodes ectodysplasin A (Eda), which if mutated causes X-linked hypohidrotic ectodermal dysplasia (XLHED) disease in humans. Ocular surface changes occur in XLHED patients whereas its underlying mechanism remains elusive. In this study, we found Eda was highly expressed in meibomian glands, and it was detected in human tears but not serum. Corneal epithelial integrity was defective and the thickness was reduced in the early postnatal stage of Eda mutant Tabby mice. Corneal epithelial cell proliferation decreased and the epithelial wound healing was delayed in Tabby mice, whereas it was restored by exogenous Eda. Eda exposure promoted mouse corneal epithelial wound healing during organ culture, whereas scratch wound assay showed that it did not affect human corneal epithelial cell line migration. Epidermal growth factor receptor (EGFR), phosphorylated EGFR (p-EGFR), and phosphorylated ERK1/2 (p-ERK) were down-regulated in Tabby mice corneal epithelium. Eda treatment up-regulated the expression of Ki67, EGFR, p-EGFR, and p-ERK in human corneal epithelial cells in a dose-dependent manner. In conclusion, Eda protein can be secreted from meibomian glands and promotes corneal epithelial cell proliferation through regulation of the EGFR signaling pathway. Eda release into the tears plays an essential role in the maintenance of corneal epithelial homeostasis.
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Affiliation(s)
- Sanming Li
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Jing Zhou
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Jinghua Bu
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Ke Ning
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Liying Zhang
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Juan Li
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Yuli Guo
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Xin He
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Hui He
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Xiaoxin Cai
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | - Yongxiong Chen
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and
| | | | - Zuguo Liu
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102.,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and.,the Xiamen University affiliated Xiamen Eye Center, Xiamen, Fujian 361000
| | - Wei Li
- From the Eye Institute of Xiamen University, Xiamen, Fujian 361102, .,the Medical College of Xiamen University, Xiamen, Fujian 361102.,the Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian 361102, and.,the Xiamen University affiliated Xiamen Eye Center, Xiamen, Fujian 361000
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May AJ, Headon D, Rice DP, Noble A, Tucker AS. FGF and EDA pathways control initiation and branching of distinct subsets of developing nasal glands. Dev Biol 2016; 419:348-356. [PMID: 27590203 PMCID: PMC5145808 DOI: 10.1016/j.ydbio.2016.08.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/27/2016] [Accepted: 08/29/2016] [Indexed: 12/19/2022]
Abstract
Hypertrophy, hyperplasia and altered mucus secretion from the respiratory submucosal glands (SMG) are characteristics of airway diseases such as cystic fibrosis, asthma and chronic bronchitis. More commonly, hyper-secretion of the nasal SMGs contributes to allergic rhinitis and upper airway infection. Considering the role of these glands in disease states, there is a significant dearth in understanding the molecular signals that regulate SMG development and patterning. Due to the imperative role of FGF signalling during the development of other branched structures, we investigated the role of Fgf10 during initiation and branching morphogenesis of murine nasal SMGs. Fgf10 is expressed in the mesenchyme around developing SMGs while expression of its receptor Fgfr2 is seen within glandular epithelial cells. In the Fgf10 null embryo, Steno's gland and the maxillary sinus gland were completely absent while other neighbouring nasal glands showed normal duct elongation but defective branching. Interestingly, the medial nasal glands were present in Fgf10 homozygotes but missing in Fgfr2b mutants, with expression of Fgf7 specifically expressed around these developing glands, indicating that Fgf7 might compensate for loss of Fgf10 in this group of glands. Intriguingly the lateral nasal glands were only mildly affected by loss of FGF signalling, while these glands were missing in Eda mutant mice, where the Steno's and maxillary sinus gland developed as normal. This analysis reveals that regulation of nasal gland development is complex with different subsets of glands being regulated by different signalling pathways. This analysis helps shed light on the nasal gland defects observed in patients with hypohidrotic ectodermal dysplasia (HED) (defect EDA pathway) and LADD syndrome (defect FGFR2b pathway).
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Affiliation(s)
- Alison J May
- Department of Craniofacial Development and Stem Cell Biology, Guy's Hospital, King's College London, United Kingdom
| | - Denis Headon
- The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, United Kingdom
| | - David P Rice
- Orthodontics, Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki 00014, Finland; Orthodontics, Department of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki 00290, Finland
| | - Alistair Noble
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, United Kingdom
| | - Abigail S Tucker
- Department of Craniofacial Development and Stem Cell Biology, Guy's Hospital, King's College London, United Kingdom.
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Shawky RM, Gamal R. Christ-Siemens-Touraine syndrome with cleft palate, absent nipples, gallstones and mild mental retardation in an Egyptian child. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2016. [DOI: 10.1016/j.ejmhg.2015.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Mutational spectrum in 101 patients with hypohidrotic ectodermal dysplasia and breakpoint mapping in independent cases of rare genomic rearrangements. J Hum Genet 2016; 61:891-897. [PMID: 27305980 DOI: 10.1038/jhg.2016.75] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 11/08/2022]
Abstract
Hypohidrotic ectodermal dysplasia (HED), a rare and heterogeneous hereditary disorder, is characterized by deficient development of multiple ectodermal structures including hair, sweat glands and teeth. If caused by mutations in the genes EDA, EDA1R or EDARADD, phenotypes are often very similar as the result of a common signaling pathway. Single-nucleotide polymorphisms (SNPs) affecting any gene product in this pathway may cause inter- and intrafamilial variability. In a cohort of 124 HED patients, genotyping was attempted by Sanger sequencing of EDA, EDA1R, EDARADD, TRAF6 and EDA2R and by multiplex ligation-dependent probe amplification (MLPA). Pathogenic mutations were detected in 101 subjects with HED, affecting EDA, EDA1R and EDARADD in 88%, 9% and 3% of the cases, respectively, and including 23 novel mutations. MLPA revealed exon copy-number variations in five unrelated HED families (two deletions and three duplications). In four of them, the genomic breakpoints could be localized. The EDA1R variant rs3827760 (p.Val370Ala), known to lessen HED-related symptoms, was found only in a single individual of Asian origin, but in none of the 123 European patients. Another SNP, rs1385699 (p.Arg57Lys) in EDA2R, however, appeared to have some impact on the hair phenotype of European subjects with EDA mutations.
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Abstract
Genetic skin diseases, or genodermatoses, often have extracutaneous manifestations. Ocular manifestations in particular can have significant clinical implications, like blindness. Other manifestations, such as the corneal opacities that occur in X-linked ichthyosis, are asymptomatic but characteristic of a particular genodermatosis. Ophthalmologic examination can aid in diagnosis when characteristic findings are seen. The genodermatoses with ocular manifestations will be reviewed, but neurocutaneous, syndromes, genetic pigmentary disorders, and genetic metabolic diseases are not included because they are covered elsewhere in this issue.
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Affiliation(s)
- Melinda Jen
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia; Departments of Pediatrics and Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3550 Market St, Second floor, Philadelphia, PA, 19104.
| | - Sudha Nallasamy
- The Vision Center, Children's Hospital Los Angeles; Department of Ophthalmology, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, MS #88, Los Angeles, CA, 90027
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Wohlfart S, Söder S, Smahi A, Schneider H. A novel missense mutation in the geneEDARADDassociated with an unusual phenotype of hypohidrotic ectodermal dysplasia. Am J Med Genet A 2015; 170A:249-53. [DOI: 10.1002/ajmg.a.37412] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/18/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Sigrun Wohlfart
- Department of Pediatrics; German Competence Center for Children with Ectodermal Dysplasias; University Hospital Erlangen; Erlangen Germany
| | - Stephan Söder
- Department of Pathology; University Hospital Erlangen; Erlangen Germany
| | - Asma Smahi
- Department of Genetics; INSERM U781; Hôpital Necker-Enfants Malades; Paris France
| | - Holm Schneider
- Department of Pediatrics; German Competence Center for Children with Ectodermal Dysplasias; University Hospital Erlangen; Erlangen Germany
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Molecular basis of hypohidrotic ectodermal dysplasia: an update. J Appl Genet 2015; 57:51-61. [PMID: 26294279 PMCID: PMC4731439 DOI: 10.1007/s13353-015-0307-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 07/15/2015] [Accepted: 07/19/2015] [Indexed: 01/16/2023]
Abstract
Recent advances in understanding the molecular events underlying hypohidrotic ectodermal dysplasia (HED) caused by mutations of the genes encoding proteins of the tumor necrosis factor α (TNFα)-related signaling pathway have been presented. These proteins are involved in signal transduction from ectoderm to mesenchyme during development of the fetus and are indispensable for the differentiation of ectoderm-derived structures such as eccrine sweat glands, teeth, hair, skin, and/or nails. Novel data were reviewed and discussed on the structure and functions of the components of TNFα-related signaling pathway, the consequences of mutations of the genes encoding these proteins, and the prospect for further investigations, which might elucidate the origin of HED.
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May A, Tucker A. Understanding the development of the respiratory glands. Dev Dyn 2015; 244:525-39. [PMID: 25648514 DOI: 10.1002/dvdy.24250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/08/2014] [Accepted: 12/11/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The submucosal glands (SMGs) of the respiratory system are specialized structures essential for maintaining airway homeostasis. The significance of SMGs is highlighted by their involvement in respiratory diseases such as cystic fibrosis, asthma and chronic bronchitis, where their phenotype and function are severely altered. Uncovering the normal development of the airway SMGs is essential to elucidate their role in these disorders, however, very little is known about the cellular mechanisms and intracellular signals involved in their morphogenesis. RESULTS This review describes in detail the embryonic developmental journey of the nasal SMGs and the postnatal development of the tracheal SMGs in the mouse. Current knowledge of the genes and signalling molecules involved in SMG organogenesis is also explored. CONCLUSION Here we review the temporal localisation and development of the murine respiratory glands in the hope of stimulating further research into the mechanisms required for successful SMG patterning and function.
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Affiliation(s)
- Alison May
- Department of Craniofacial Development and Stem Cell Biology, King's College London, London, United Kingdom
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Kaercher T, Dietz J, Jacobi C, Berz R, Schneider H. Diagnosis of X-Linked Hypohidrotic Ectodermal Dysplasia by Meibography and Infrared Thermography of the Eye. Curr Eye Res 2014; 40:884-90. [PMID: 25310457 DOI: 10.3109/02713683.2014.967869] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE X-linked hypohidrotic ectodermal dysplasia (XLHED) is the most common form of ectodermal dysplasia. Clinical characteristics include meibomian gland disorder and the resulting hyperevaporative dry eye. In this study, we evaluated meibography and ocular infrared thermography as novel methods to diagnose XLHED. METHODS Eight infants, 12 boys and 14 male adults with XLHED and 12 healthy control subjects were subjected to a panel of tests including the ocular surface disease index (OSDI), meibography and infrared thermography, non-invasive measurement of tear film break-up time (NIBUT) and osmolarity, Schirmer's test, lissamine green staining and fluorescein staining. Sensitivity and specificity were determined for single tests and selected test combinations. RESULTS Meibography had 100% sensitivity and specificity for identifying XLHED. Infrared thermography, a completely non-invasive procedure, revealed a typical pattern for male subjects with XLHED. It was, however, less sensitive (86% for adults and 67% for children) than meibography or a combination of established routine tests. In adults, OSDI and NIBUT were the best single routine tests (sensitivity of 86% and 71%, respectively), whereas increased tear osmolarity appeared as a rather unspecific ophthalmic symptom. In children, NIBUT was the most convincing routine test (sensitivity of 91%). CONCLUSIONS Meibography is the most reliable ophthalmic examination to establish a clinical diagnosis in individuals with suspected hypohidrotic ectodermal dysplasia, even before genetic test results are available. Tear film tests and ocular surface staining are less sensitive in children, but very helpful for estimating the severity of ocular surface disease in individuals with known XLHED.
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Pharmacological stimulation of Edar signaling in the adult enhances sebaceous gland size and function. J Invest Dermatol 2014; 135:359-368. [PMID: 25207818 PMCID: PMC4269545 DOI: 10.1038/jid.2014.382] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 08/17/2014] [Accepted: 08/20/2014] [Indexed: 01/16/2023]
Abstract
Impaired Ectodysplasin A (EDA) – EDA receptor (EDAR) signaling affects ectodermally derived structures including teeth, hair follicles and cutaneous glands. X-linked hypohidrotic ectodermal dysplasia (XLHED), resulting from EDA deficiency, can be rescued with lifelong benefits in animal models by stimulation of ectodermal appendage development with EDAR agonists. Treatments initiated later in the developmental period restore progressively fewer of the affected structures. It is unknown whether EDAR stimulation in adults with XLHED might have beneficial effects. In adult Eda mutant mice treated for several weeks with agonist anti-EDAR antibodies, we find that sebaceous glands size and function can be restored to wild type levels. This effect is maintained upon chronic treatment but reverses slowly upon cessation of treatment. Sebaceous glands in all skin regions respond to treatment, though to varying degrees, and this is accompanied in both Eda mutant and wild type mice by sebum secretion to levels higher than those observed in untreated controls. Edar is expressed at the periphery of the glands, suggesting a direct homeostatic effect of Edar stimulation on the sebaceous gland. Sebaceous gland size and sebum production may serve as biomarkers for EDAR stimulation, and EDAR agonists may improve skin dryness and eczema frequently observed in XLHED.
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36
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Prenatal therapy in developmental disorders: drug targeting via intra-amniotic injection to treat X-linked hypohidrotic ectodermal dysplasia. J Invest Dermatol 2014; 134:2985-2987. [PMID: 24950237 DOI: 10.1038/jid.2014.264] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Burger K, Schneider AT, Wohlfart S, Kiesewetter F, Huttner K, Johnson R, Schneider H. Genotype-phenotype correlation in boys with X-linked hypohidrotic ectodermal dysplasia. Am J Med Genet A 2014; 164A:2424-32. [PMID: 24715423 DOI: 10.1002/ajmg.a.36541] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/16/2014] [Indexed: 11/06/2022]
Abstract
X-linked hypohidrotic ectodermal dysplasia (XLHED), the most frequent form of ectodermal dysplasia, is a genetic disorder of ectoderm development characterized by malformation of multiple ectodermal structures such as skin, hair, sweat and sebaceous glands, and teeth. The disease is caused by a broad spectrum of mutations in the gene EDA. Although XLHED symptoms show inter-familial and intra-familial variability, genotype-phenotype correlation has been demonstrated with respect to sweat gland function. In this study, we investigated to which extent the EDA genotype correlates with the severity of XLHED-related skin and hair signs. Nineteen male children with XLHED (age range 3-14 years) and seven controls (aged 6-14 years) were examined by confocal microscopy of the skin, quantification of pilocarpine-induced sweating, semi-quantitative evaluation of full facial photographs with respect to XLHED-related skin issues, and phototrichogram analysis. All eight boys with known hypomorphic EDA mutations were able to produce at least some sweat and showed less severe cutaneous signs of XLHED than the anhidrotic XLHED patients (e.g., perioral and periorbital eczema or hyperpigmentation, regional hyperkeratosis, characteristic wrinkles under the eyes). As expected, individuals with XLHED had significantly less and thinner hair than healthy controls. However, there were also significant differences in hair number, diameter, and other hair characteristics between the group with hypomorphic EDA mutations and the anhidrotic patients. In summary, this study indicated a remarkable genotype-phenotype correlation of skin and hair findings in prepubescent males with XLHED.
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Affiliation(s)
- Kristin Burger
- Department of Pediatrics, German Competence Center for Children with Ectodermal Dysplasias, University Hospital Erlangen, University of Erlangen-Nürnberg, Germany
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Callea M, Teggi R, Yavuz I, Tadini G, Priolo M, Crovella S, Clarich G, Grasso DL. Ear nose throat manifestations in hypoidrotic ectodermal dysplasia. Int J Pediatr Otorhinolaryngol 2013; 77:1801-4. [PMID: 24080322 DOI: 10.1016/j.ijporl.2013.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 08/31/2013] [Accepted: 09/04/2013] [Indexed: 11/28/2022]
Abstract
The ectodermal dysplasias (EDs) are a large and complex group of inherited disorders. In various combinations, they all share anomalies in ectodermal derived structures: hair, teeth, nails and sweat gland function. Clinical overlap is present among EDs. Few causative genes have been identified, to date. Altered gene expression is not limited to the ectoderm but a concomitant effect on developing mesenchymal structures, with modification of ectodermal-mesenchymal signaling, takes place. The two major categories of ED include the hidrotic and hypohidrotic form, the latter more frequent; they differentiate each other for the presence or absence of sweat glands. We report Ear Nose Throat manifestations of ED, linked to the reduction of mucous glands in the nasal fossae with reduced ciliar function, and decrease salivary glands function. Often patients report an increased rate of infections of the upper respiratory tract and of the ear. Nasal obstruction due to the presence of nasal crusting, hearing loss and throat hoarseness are the most represented symptoms. Environmental measures, including a correct air temperature and humidification, is mandatory above all in subjects affected by hypohidrotic form.
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Affiliation(s)
- Michele Callea
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
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