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Tu WT, Hou PC, Chen PC, Chen WR, Huang HY, Wang JY, Huang YT, Wu YH, Su CL, Tang YA, Iwata H, Natsuga K, Chao SC, Sun HS, Tang MJ, Lee JYY, McGrath JA, Hsu CK. Mutational analysis of epidermolysis bullosa in Taiwan by whole-exome sequencing complemented by RNA sequencing: a series of 77 patients. Orphanet J Rare Dis 2022; 17:451. [PMID: 36578049 PMCID: PMC9795651 DOI: 10.1186/s13023-022-02605-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/19/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a heterogeneous group of hereditary skin diseases characterized by skin fragility. Primary data on Taiwanese population remain scarce. METHODS We gathered clinical information from EB patients at National Cheng Kung University Hospital from January, 2012, to June, 2021. Diagnostic tests including transmission electron microscopy, immunofluorescence studies, and whole-exome sequencing (WES) were performed. The pathogenicity of novel splice-site mutations was determined through reverse transcriptase-PCR of skin mRNA followed by Sanger and/or RNA sequencing. RESULTS Seventy-seven EB patients from 45 families were included: 19 EB simplex, six junctional EB, and 52 dystrophic EB. Pathogenic variants were identified in 37 of 38 families (97.4%), in which WES was used as a first-line tool for mutational analysis; RNA sequencing determined pathogenic variants in the remaining one family. A total of 60 mutations in EB-related genes were identified, including 22 novel mutations. The mutations involved KRT5, KRT14, PLEC, COL17A1, LAMB3, LAMA3, ITGB4, and COL7A1. Over one-quarter of DEB patients had EB pruriginosa. CONCLUSIONS The distinct clinical presentation and molecular pathology of EB in Taiwan expand our understanding of this disorder. WES was an effective first-line diagnostic tool for identifying EB-associated variants. RNA sequencing complemented WES when multiple potentially pathogenic splice-site mutations were found.
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Affiliation(s)
- Wei-Ting Tu
- grid.64523.360000 0004 0532 3255Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan
| | - Ping-Chen Hou
- grid.64523.360000 0004 0532 3255Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan
| | - Peng-Chieh Chen
- grid.64523.360000 0004 0532 3255Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Rung Chen
- grid.64523.360000 0004 0532 3255Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan
| | - Hsin-Yu Huang
- grid.64523.360000 0004 0532 3255Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan
| | - Jing-Yu Wang
- grid.64523.360000 0004 0532 3255School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Huang
- grid.64523.360000 0004 0532 3255School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Huei Wu
- grid.64523.360000 0004 0532 3255Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Lin Su
- grid.64523.360000 0004 0532 3255International Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan
| | - Yen-An Tang
- grid.64523.360000 0004 0532 3255Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Center for Genomic Medicine, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Hiroaki Iwata
- grid.39158.360000 0001 2173 7691Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ken Natsuga
- grid.39158.360000 0001 2173 7691Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sheau-Chiou Chao
- grid.64523.360000 0004 0532 3255Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan
| | - H. Sunny Sun
- grid.64523.360000 0004 0532 3255Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan ,grid.64523.360000 0004 0532 3255Center for Genomic Medicine, Innovation Headquarters, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Jer Tang
- grid.64523.360000 0004 0532 3255International Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan
| | - Julia Yu-Yun Lee
- grid.64523.360000 0004 0532 3255Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan
| | - John A. McGrath
- grid.13097.3c0000 0001 2322 6764St. John’s Institute of Dermatology, King’s College London (Guy’s Campus), London, UK
| | - Chao-Kai Hsu
- Department of Dermatology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, Tainan City, Taiwan. .,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,International Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan.
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Cui LM, Jiang JY, Hu NN, Zou HE, Zhao BZ, Han CY, Yang K, Wang YP, Xing HX. Whole exome sequencing identified a novel compound heterozygous variation in COL7A1 gene causing dystrophic epidermolysis bullosa. Mol Genet Genomic Med 2022; 10:e1907. [PMID: 35225434 PMCID: PMC9034672 DOI: 10.1002/mgg3.1907] [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: 11/13/2021] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/23/2022] Open
Abstract
Dystrophic epidermolysis bullosa (DEB) is a series of severe genetic conditions affecting skin and nails caused by mutations in the COL7A1 gene. DEB has a strong phenotypic variability. In the present study, we recruited a case with a boy exhibiting typical DEB indication, and performed a clinical, genetic, and experimental investigation, followed by a prenatal diagnosis on their current pregnancy. Whole exome sequencing identified a novel compound heterozygous variation in COL7A1, consisting of two variants, namely c.191T>C (p.Leu64Pro) and c.5124G>A (p.Leu1708=) in the proband. In vitro study by minigene system indicated that c.5124G>A would result in an increased ratio of a transcript with exon‐skipping, which supported its pathogenicity. Further prenatal detection confirmed the genotype–phenotye co‐separation in this family. In conclusion, the findings in our study expanded the mutation spectrum of DEB, and emphasized the importance of paying attention to specific synonymous variants in the filtering process.
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Affiliation(s)
- Li-Min Cui
- Prenatal Diagnosis Center, Langfang Maternal and Child Health Care Hospital, Langfang, China
| | - Jian-Ye Jiang
- Prenatal Diagnosis Center, Langfang Maternal and Child Health Care Hospital, Langfang, China
| | - Ning-Ning Hu
- Prenatal Diagnosis Center, Langfang Maternal and Child Health Care Hospital, Langfang, China
| | - Hong-En Zou
- Prenatal Diagnosis Center, Langfang Maternal and Child Health Care Hospital, Langfang, China
| | - Bao-Zhen Zhao
- Prenatal Diagnosis Center, Langfang Maternal and Child Health Care Hospital, Langfang, China
| | - Cong-Ying Han
- Prenatal Diagnosis Center, Langfang Maternal and Child Health Care Hospital, Langfang, China
| | - Kai Yang
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yi-Peng Wang
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Huan-Xia Xing
- Prenatal Diagnosis Center, Langfang Maternal and Child Health Care Hospital, Langfang, China
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3
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Ruszczak Z, Abdelhadi S. Learning from itch - epidermolysis bullosa is a genetically determined barrier disruption and a chronic inflammatory disease. J Eur Acad Dermatol Venereol 2021; 36:13-16. [PMID: 34897832 DOI: 10.1111/jdv.17821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Z Ruszczak
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates.,Division of Dermatology, Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - S Abdelhadi
- Division of Dermatology, Department of Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.,Pediatric Dermatology, Multidisciplinary Epidermolysis Bullosa Clinic, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Richey P, Holt M, Crotts S, Jabbari A. Pretibial dystrophic epidermolysis bullosa associated with aberrant exon splicing of type VII collagen. JAAD Case Rep 2019; 5:779-781. [PMID: 31516996 PMCID: PMC6728729 DOI: 10.1016/j.jdcr.2019.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patricia Richey
- Department of Dermatology, University of Iowa, Iowa City, Iowa
| | - Melia Holt
- Department of Dermatology, University of Iowa, Iowa City, Iowa
| | - Sydney Crotts
- Department of Dermatology, University of Iowa, Iowa City, Iowa
| | - Ali Jabbari
- Department of Dermatology, University of Iowa, Iowa City, Iowa.,Interdisciplinary Program in Immunology, University of Iowa, Iowa City, Iowa.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
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5
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Kitazawa T, Kawakami T, Matsuoka M, Kimura S, Soma Y, Nakano H. Splicing mutation in the COL7A1 gene mRNA exon 71 in a female patient with pretibial epidermolysis bullosa. J Dermatol 2016; 41:1018-9. [PMID: 25346305 DOI: 10.1111/1346-8138.12648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tomoko Kitazawa
- Department of Dermatology, St Marianna University School of Medicine, Kawasaki, Japan
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6
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Mahto A, McGrath JA, Deroide F, Rustin MHA. Late-onset pretibial recessive dystrophic epidermolysis bullosa. Clin Exp Dermatol 2013; 38:630-2. [PMID: 23786535 DOI: 10.1111/ced.12072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2012] [Indexed: 12/30/2022]
Abstract
Pretibial epidermolysis bullosa (EB) is a rare form of localized dystrophic EB, characterized by recurrent blistering and scarring plaques occurring predominantly in the pretibial area. In most cases, nail dystrophy, especially of the toenails, is also present. Often there are no clinical abnormalities at birth, and the disorder may only appear after several years. We report a patient who developed symptoms in his fifth decade. Genetic testing identified compound heterozygosity for two pathogenic mutations in the COL7A1 gene. This case highlights a rare variant of mechanobullous disease, and stresses the importance of molecular screening in establishing a correct diagnosis. Precisely why the disorder specifically localizes to the shins or why it may only become apparent in later life is not known.
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Affiliation(s)
- A Mahto
- Department of Dermatology, Royal Free Hospital, London, UK.
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7
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Apalla Z, Lallas A, Karakyriou E, Karatolias A, Sotiriou E, Chaidemenos G. Pretibial epidermolysis bullosa mimicking hypertrophic lichen planus. Int J Dermatol 2013; 53:e197-9. [PMID: 23432314 DOI: 10.1111/j.1365-4632.2012.05778.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zoe Apalla
- State Hospital of Dermatologic and Venereologic Diseases, Thessaloniki, Greece
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8
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Almeida HLD, Monteiro LMA, Goetze FM, Silva RME, Rocha NM. Clinical variability in dystrophic epidermolysis bullosa and findings with scanning electron microscopy. An Bras Dermatol 2012; 87:127-30. [PMID: 22481662 DOI: 10.1590/s0365-05962012000100017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 08/20/2011] [Indexed: 11/21/2022] Open
Abstract
In dystrophic epidermolysis bullosa, the genetic defect of anchoring fibrils leads to cleavage beneath the basement membrane and its consequent loss. A 46 year-old female patient presented blisters with a pretibial distribution associated with nail dystrophy. Her two children had hyponychia and anonychia, which affected all toe nails and the thumb, forefinger and middle finger. DNA sequencing identified in exon 75 of COL7A1 gene a pathologic mutation: c.6235G>A (p.Gly2079Arg). Immunomapping of a blister demonstrated collagen IV (basal membrane) in the blister roof and collagen VII in its floor, confirming dystrophic epidermolysis bullosa. Scanning electron microscopy of an inverted blister showed net-forming collagen attached to the blister roof . The variability found in this family has already been reported and confirms, on a clinical basis, the nail subtype as a dystrophic variant.
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9
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Aoki M, Niimi Y, Ishiko A, Kawana S. Pretibial dystrophic epidermolysis bullosa with localized cutaneous amyloidosis: coincidental or secondary amyloidosis? J Dermatol 2010; 37:259-63. [PMID: 20507391 DOI: 10.1111/j.1346-8138.2009.00794.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Here, we describe the case of a patient with pretibial dystrophic epidermolysis bullosa (PDEB) with amyloid deposition. The patient was a 40-year-old Japanese woman who presented a blistering eruption in the pretibial area with flat violaceous-brown lichenoid papules. The histology of the blister revealed a subepidermal bulla with antibodies bound to basement membrane antigens on the blister roof by immunoflourescent mapping. Electron microscopy revealed a blister cleavage plane below the lamina densa. The histology of the lichenoid papules showed amyloid deposition in the papillary dermis. Because it was confined to just beneath the bulla base of the blister specimen, the amyloid deposition may have been derived from degenerated keratinocytes induced by damage to the epidermal-dermal junction due to blister formation in PDEB in this case. PDEB, in general, is often misdiagnosed as lichen amyloidosis; however, some PDEB cases could actually be associated with amyloid deposition.
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Affiliation(s)
- Mikako Aoki
- Department of Dermatology, Nippon Medical School Musashikosugi Hospital, Kawasaki City, Kanagawa, Japan.
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10
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Lee HS, Park K, son SJ, Song KY, Kim SE. Pretibial epidermolysis bullosa: is this case a new subtype with loss of types IV and VII collagen? Int J Dermatol 2009; 48:879-81. [DOI: 10.1111/j.1365-4632.2008.03983.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Hamada T, Fukuda S, Ishii N, Abe T, Nagata K, Koro O, Hatano Y, Nakano H, Sawamura D, Hashimoto T. A Japanese family with dominant pretibial dystrophic epidermolysis bullosa: Identification of a new glycine substitution in the triple-helical collagenous domain of type VII collagen. J Dermatol Sci 2009; 54:212-4. [PMID: 19269793 DOI: 10.1016/j.jdermsci.2009.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 02/04/2009] [Accepted: 02/05/2009] [Indexed: 11/26/2022]
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12
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Gardella R, Castiglia D, Posteraro P, Bernardini S, Zoppi N, Paradisi M, Tadini G, Barlati S, McGrath JA, Zambruno G, Colombi M. Genotype-phenotype correlation in italian patients with dystrophic epidermolysis bullosa. J Invest Dermatol 2002; 119:1456-62. [PMID: 12485454 DOI: 10.1046/j.1523-1747.2002.19606.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Dystrophic epidermolysis bullosa (DEB) is a rare skin disorder that is clinically heterogeneous and is transmitted either in dominant (DDEB) or recessive (RDEB) mode. Nevertheless, all variants of DEB are caused by mutations in type VII collagen gene (COL7A1). We report an analysis of COL7A1 mutations in 51 Italian DEB patients, 27 affected with Hallopeau-Siemens RDEB, 19 with non Hallopeau-Siemens RDEB, two with DDEB, two with pretibial RDEB, and one with inversa RDEB. Forty-one mutations were identified, 18 of which are novel. Mutation consequences were analyzed at the mRNA and protein level and genotype-phenotype correlation was determined. Recessive inheritance of a new case of pretibial RDEB was also established. In RDEB patients, six recurrent mutations were identified: 7344G-->A, 425A-->G, 8441-14del21, 4783-1G-->A, 497insA, and G1664A, the last three being found only in Italian patients. Indeed, haplotype analysis supported propagation of ancestral mutated alleles within the Italian population for these particular mutations. Altogether recurrent mutations account for approximately 43% of RDEB alleles in Italian patients and therefore new DEB patients should first be screened for the presence of these mutations.
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Affiliation(s)
- Rita Gardella
- Division of Biology and Genetics, Department of Biomedical Sciences and Biotechnology, Medical Faculty, University of Brescia, Italy
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13
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Betts CM, Posteraro P, Costa AM, Varotti C, Schubert M, Bruckner-Tuderman L, Castiglia D. Pretibial dystrophic epidermolysis bullosa: a recessively inherited COL7A1 splice site mutation affecting procollagen VII processing. Br J Dermatol 1999; 141:833-9. [PMID: 10583163 DOI: 10.1046/j.1365-2133.1999.03155.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pretibial epidermolysis bullosa (PEB) is a rare form of localized epidermolysis bullosa dystrophica (EBD), a heterogeneous group of inherited, blistering diseases characterized by scarring, loss of dermal-epidermal adhesion and altered anchoring fibrils (AF). Mutations in the type VII collagen gene (COL7A1) underlie EBD and in a dominant PEB family a glycine substitution mutation has been identified. We report a 33-year-old man affected by PEB showing abnormal AF and reduced immunostaining for type VII collagen. Mutation search in the COL7A1 gene revealed a 14 bp deletion in the 115 exon-intron boundary (33563del14), which resulted in the in-frame skipping of exon 115 with elimination of 29 amino acids from the pro-alpha1(VII) polypeptide chain. As a consequence, procollagen VII failed to be processed to mature collagen VII and accumulated at the dermal-epidermal junction, as revealed by immunofluorescence staining using a NC-2 domain-specific antibody. The proband's father was a clinically unaffected heterozygous carrier of mutation 33563del14, whereas the maternal pathogenetic mutation has still not been identified. This represents the first report of a recessive deletion mutation in PEB and extends the range of EBD phenotypes associated with mutation 33563del14.
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Affiliation(s)
- C M Betts
- Department of Experimental Pathology, Università degli Studi di Bologna, Bologna, Italy.
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Affiliation(s)
- L Soriano
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
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Naeyaert JM, Nuytinck L, De Bie S, Beele H, Kint A, De Paepe A. Genetic linkage between the collagen type VII gene COL7A1 and pretibial epidermolysis bullosa with lichenoid features. J Invest Dermatol 1995; 104:803-5. [PMID: 7738360 DOI: 10.1111/1523-1747.ep12606999] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pretibial epidermolysis bullosa is a rare form of dominant dystrophic epidermolysis bullosa. The disease was diagnosed after considerable delay in a large Belgian family and was remarkable for its late age at onset and its misleading clinical presentation in the proband, which strongly resembled keratosis lichenoides chronica. Both recessively and dominantly inherited forms of dystrophic epidermolysis bullosa have been shown to be linked to the collagen type VII gene, COL7A1. Two-point linkage analysis with two intragenic polymorphisms (PvuII, AluI) in COL7A1 was performed. Strong genetic linkage between the disease in this family and COL7A1 was demonstrated by a lod score of 4.45 (theta = 0) for the AluI polymorphism. The observed intrafamilial variability of clinical phenotypes contradicts the presently proposed classification of dominantly inherited dystrophic epidermolysis bullosa.
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Affiliation(s)
- J M Naeyaert
- Department of Dermatology, University Hospital, Gent, Belgium
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