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Clabbers J, Boesjes C, Spekhorst L, van Gisbergen MW, Maas E, Marshall J, Janssen R, Janssen M, Zuithoff N, Steijlen P, de Graaf M, van Geel M, de Bruin-Weller M, Gostyński A. Influence of pathogenic filaggrin variants on dupilumab treatment in atopic dermatitis. J Allergy Clin Immunol 2024; 153:1155-1161.e4. [PMID: 38272373 DOI: 10.1016/j.jaci.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/22/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND Pathogenic variants in filaggrin (FLG) are associated with an increased risk of atopic dermatitis (AD). OBJECTIVE We evaluated the influence of FLG variants on the effectiveness of dupilumab treatment in AD. METHODS This prospective observational study included adult AD patients treated with dupilumab from the BioDay registry. FLG was analyzed with single-molecule molecular inversion probe-targeted sequencing. Novel mutations were confirmed by Sanger sequencing. Eczema Area and Severity Index (EASI), Investigator Global Assessment (IGA), numeric rating scale (NRS) pruritus, Dermatology Quality of Life Index (DLQI), and Patient-Oriented Eczema Measure (POEM) were assessed at baseline and at weeks 16 and 52. The study was registered at ClinicalTrials.gov as NCT03549416. RESULTS Genetic analysis of the 285 included patients showed biallelic pathogenic variants (FLG-/-) in 41 (14%), monoallelic pathogenic variants (FLG-/+) in 64 (23%), and wild-type alleles (FLG+/+) in 180 patients (63%). Three novel pathogenic variants were found. We observed no clinically relevant differences in EASI, IGA, NRS pruritus, DLQI, or total POEM scores for patients with and without pathogenic FLG variants at all time points. The FLG-/- group showed significantly higher POEM flaking and dryness scores at week 16 (P < .001 and P = .002, respectively) and week 52 (P < .001 and P = .016, respectively) compared to FLG+/+ as well as significant differences compared to FLG-/+, while differences in delta scores were nonsignificant. CONCLUSION The effectiveness of dupilumab treatment in AD patients was not influenced by pathogenic FLG variants. However, patients with biallelic pathogenic FLG variants tended to have drier skin before and during dupilumab treatment compared to patients with monoallelic pathogenic variants or wild-type alleles.
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Affiliation(s)
- Julia Clabbers
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands; Department of Dermatology, Haga Hospital, The Hague, The Netherlands
| | - Celeste Boesjes
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lotte Spekhorst
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marike W van Gisbergen
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Emmy Maas
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Josephine Marshall
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Renske Janssen
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Miranda Janssen
- Department of Methodology and Statistics, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nicolaas Zuithoff
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Peter Steijlen
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michel van Geel
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | | | - Antoni Gostyński
- Department of Dermatology, Maastricht University Medical Centre+, Maastricht, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
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Investigations into the filaggrin null phenotype: showcasing the methodology for CRISPR/Cas9 editing of human keratinocytes. J Invest Dermatol 2023:S0022-202X(23)00165-3. [PMID: 36893939 DOI: 10.1016/j.jid.2023.02.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/20/2023] [Accepted: 02/11/2023] [Indexed: 03/09/2023]
Abstract
Ever since the association between filaggrin (FLG) loss-of-function mutations and ichthyosis vulgaris and atopic dermatitis disease onset was identified, filaggrins function has been under investigation. Intra-individual genomic predisposition, immunological confounders, and environmental interactions complicate the comparison between FLG genotypes and related causal effects. Using CRISPR/Cas9, we generated human FLG knockout (ΔFLG) N/TERT-2G keratinocytes. Filaggrin deficiency was demonstrated by immunohistochemistry of human epidermal equivalent (HEE) cultures. Next to (partial) loss of structural proteins (IVL, HRNR, KRT2, and TGM1), the stratum corneum was more dense and lacked the typical basket weave appearance. In addition, electrical impedance spectroscopy and transepidermal water loss analyses highlighted a compromised epidermal barrier in ΔFLG-HEEs. Correction of FLG reinstated the presence of keratohyalin granules in the stratum granulosum, filaggrin protein expression, and expression of aforementioned proteins. The beneficial effects on stratum corneum formation were reflected by normalization of EIS and TEWL. This study demonstrates the causal phenotypical and functional consequences of filaggrin deficiency, indicating filaggrin is not only central in epidermal barrier function but also vital for epidermal differentiation by orchestrating the expression of other important epidermal proteins. These observations pave the way to fundamental investigations into the exact role of filaggrin in skin biology and disease.
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Spedicati B, Morgan A, Pianigiani G, Musante L, Rubinato E, Santin A, Nardone GG, Faletra F, Girotto G. Challenging Occam’s Razor: Dual Molecular Diagnoses Explain Entangled Clinical Pictures. Genes (Basel) 2022; 13:genes13112023. [PMID: 36360260 PMCID: PMC9690221 DOI: 10.3390/genes13112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Dual molecular diagnoses are defined as the presence of pathogenic variants at two distinct and independently segregating loci that cause two different Mendelian conditions. In this study, we report the identification of double genetic disorders in a series of patients with complex clinical features. In the last 24 months, 342 syndromic patients have been recruited and clinically characterised. Whole Exome Sequencing analysis has been performed on the proband and on both parents and identified seven patients affected by a dual molecular diagnosis. Upon a detailed evaluation of both their clinical and molecular features, subjects are able to be divided into two groups: (A) five patients who present distinct phenotypes, due to each of the two different underlying genetic diseases; (B) two patients with overlapping clinical features that may be underpinned by both the identified genetic variations. Notably, only in one case a multilocus genomic variation was already suspected during the clinical evaluation. Overall, our findings highlight how dual molecular diagnoses represent a challenging model of complex inheritance that should always be considered whenever a patient shows atypical clinical features. Indeed, an accurate genetic characterisation is of the utmost importance to provide patients with a personalised and safe clinical management.
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Affiliation(s)
- Beatrice Spedicati
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | - Anna Morgan
- Institute for Maternal and Child Health-I.R.C.C.S. “Burlo Garofolo”, 34137 Trieste, Italy
| | - Giulia Pianigiani
- Institute for Maternal and Child Health-I.R.C.C.S. “Burlo Garofolo”, 34137 Trieste, Italy
- Correspondence: ; Tel.: +39-040-3785539
| | - Luciana Musante
- Institute for Maternal and Child Health-I.R.C.C.S. “Burlo Garofolo”, 34137 Trieste, Italy
| | - Elisa Rubinato
- Institute for Maternal and Child Health-I.R.C.C.S. “Burlo Garofolo”, 34137 Trieste, Italy
| | - Aurora Santin
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
| | | | - Flavio Faletra
- Institute for Maternal and Child Health-I.R.C.C.S. “Burlo Garofolo”, 34137 Trieste, Italy
| | - Giorgia Girotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy
- Institute for Maternal and Child Health-I.R.C.C.S. “Burlo Garofolo”, 34137 Trieste, Italy
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Nagtzaam IF, van Leersum FS, Kouwenberg LC, Blok MJ, Vreeburg M, Steijlen PM, Gostyński A, van Geel M. STS pathogenic variants in a Dutch patient cohort clinically suspected for X-linked ichthyosis show genetic heterogeneity. Br J Dermatol 2022; 187:820-822. [PMID: 35822528 PMCID: PMC9804759 DOI: 10.1111/bjd.21775] [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] [Received: 03/04/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 01/09/2023]
Abstract
Abstract
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Affiliation(s)
- Ivo F. Nagtzaam
- Department of Dermatology,GROW‐School for Oncology and ReproductionMaastricht UniversityMaastrichtthe Netherlands
| | - Frank S. van Leersum
- Department of Dermatology,GROW‐School for Oncology and ReproductionMaastricht UniversityMaastrichtthe Netherlands
| | - Laurie C.M. Kouwenberg
- Department of Dermatology,GROW‐School for Oncology and ReproductionMaastricht UniversityMaastrichtthe Netherlands
| | - Marinus J. Blok
- GROW‐School for Oncology and ReproductionMaastricht UniversityMaastrichtthe Netherlands,Department of Clinical GeneticsMaastricht University Medical Centre+Maastrichtthe Netherlands
| | - Maaike Vreeburg
- Department of Clinical GeneticsMaastricht University Medical Centre+Maastrichtthe Netherlands
| | - Peter M. Steijlen
- Department of Dermatology,GROW‐School for Oncology and ReproductionMaastricht UniversityMaastrichtthe Netherlands
| | - Antoni Gostyński
- Department of Dermatology,GROW‐School for Oncology and ReproductionMaastricht UniversityMaastrichtthe Netherlands
| | - Michel van Geel
- Department of Dermatology,GROW‐School for Oncology and ReproductionMaastricht UniversityMaastrichtthe Netherlands,Department of Clinical GeneticsMaastricht University Medical Centre+Maastrichtthe Netherlands
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Hake L, Süßmuth K, Komlosi K, Kopp J, Drerup C, Metze D, Traupe H, Hausser I, Eckl KM, Hennies HC, Fischer J, Oji V. Quality of life and clinical characteristics of self-improving congenital ichthyosis within the disease spectrum of autosomal recessive congenital ichthyosis. J Eur Acad Dermatol Venereol 2021; 36:582-591. [PMID: 34908195 DOI: 10.1111/jdv.17873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Autosomal recessive congenital ichthyosis (ARCI) is a heterogeneous group of ichthyoses presenting at birth. Self-improving congenital ichthyosis (SICI) is a subtype of ARCI and is diagnosed when skin condition improves remarkably (within years) after birth. So far, there is sparse data on SICI and quality of life (QoL) in this ARCI subtype. This study aims to further delineate the clinical spectrum of SICI as a rather unique subtype of ARCI. OBJECTIVES This prospective study included 78 patients (median age: 15 years) with ARCI who were subdivided in SICI (n=18) and non-SICI patients (nSICI, n=60) by their ARCI phenotype. METHODS Quality of life (QoL) was assessed using the (Children's) Dermatology Life Quality Index. Statistical analysis was performed with Chi-square- and t-tests. RESULTS The genetically confirmed SICI patients presented causative mutations in the following genes: ALOXE3 (8/16; 50.0%), ALOX12B (6/16; 37.5%), PNPLA1 (1/16; 6.3%) and CYP4F22 (1/16; 6.3%). Hypo-/anhidrosis and insufficient Vitamin D levels (< 30 ng/ml) were often seen in SICI patients. Brachydactyly (a shortening of the 4th and 5th finger) was statistically more frequent in SICI (p=0.023) than nSICI patients. A kink of the ear's helix was seen in half of the SICI patients and tends to occur more frequently in patients with ALOX12B mutations (p=0.005). QoL was less impaired in patients under the age of 16, regardless of ARCI type. CONCLUSIONS SICI is an underestimated, milder clinical variant of ARCI including distinct features such as brachydactyly and kinking of the ears. Clinical experts should be aware of these features when seeing neonates with a collodion membrane. SICI patients should be regularly checked for clinical parameters such as hypo-/anhidrosis or vitamin D levels and monitored for changes in quality of life.
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Affiliation(s)
- L Hake
- Department of Dermatology, Elbe Klinikum Buxtehude, Buxtehude, Germany
| | - K Süßmuth
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - K Komlosi
- Institute of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Kopp
- Institute of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Drerup
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - D Metze
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - H Traupe
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - I Hausser
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - K M Eckl
- Department of Biological and Geographical Sciences, University of Huddersfield, Huddersfield, United Kingdom.,Division of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria.,Department of Biology, Edge Hill University, Ormskirk, UK
| | - H C Hennies
- Department of Biological and Geographical Sciences, University of Huddersfield, Huddersfield, United Kingdom.,Cologne Center for Genomics, University Hospital Cologne, Cologne, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - V Oji
- Department of Dermatology, University Hospital Münster, Münster, Germany
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Bradshaw LE, Haines RH, Thomas KS, Chalmers JR, Irvine AD, Williams HC, Brown SJ. Clinical examination for hyperlinear palms to determine filaggrin genotype: A diagnostic test accuracy study. Clin Exp Allergy 2021; 51:1421-1428. [PMID: 34608691 DOI: 10.1111/cea.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/20/2021] [Accepted: 09/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Palmar hyperlinearity is a feature of ichthyosis vulgaris, the monogenic skin disorder caused by FLG loss-of-function mutations. OBJECTIVE To investigate how well the presence or absence of hyperlinear palms (HLP) detect FLG genotype in children. METHODS STARD criteria are used to report this diagnostic accuracy study. Phenotype and genotype data (four most prevalent FLG null mutations) were obtained from a total of 3656 children in three studies: the UK CLOTHES trial (children 1-5 years with moderate-severe atopic eczema); UK BEEP trial (2 year olds at high risk of developing atopic eczema); UK-Irish eczema case collection (0-16 year olds with atopic eczema). All participants included in analyses of HLP as the index test and FLG genotype as the reference were of white European ancestry. RESULTS Thirty-two percent of participants (1159/3656) had FLG null mutation(s) and 37% (1347/3656) had HLP. In 13% (464/3656), HLP was recorded as 'unsure' or not recorded. The sensitivity and specificity of HLP for detecting FLG mutations in each of the studies was: 67% (95% CI 55-78%) and 75% (67-82%) in CLOTHES; 46% (36-55%) and 89% (86-91%) in BEEP; 72% (68-75%) and 60% (57-62%) in the UK-Irish case collection. Positive and negative likelihood ratios were: 2.73 (1.95-3.81) and 0.44 (0.31-0.62) in CLOTHES; 4.02 (2.99-5.40) and 0.61 (0.52-0.73) in BEEP; 1.79 (1.66-1.93) and 0.47 (0.42-0.53) in the UK-Irish collection. DISCUSSION Trained observers were able to define palmar hyperlinearity in the majority (3191/3656, 87%) of cases. The presence of HLP is not a reliable sign to detect FLG mutations, but the absence of HLP excludes FLG null genotype with a reasonable degree of certainty.
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Affiliation(s)
- Lucy E Bradshaw
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Rachel H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Sara J Brown
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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Looman KIM, van Mierlo MMF, van Zelm MC, Hu C, Duijts L, de Jongste JC, Nijsten T, Pardo LM, Kiefte-de Jong JC, Moll HA, Pasmans SGMA. Increased Th22 cell numbers in a general pediatric population with filaggrin haploinsufficiency: The Generation R Study. Pediatr Allergy Immunol 2021; 32:1360-1368. [PMID: 33715246 PMCID: PMC8451856 DOI: 10.1111/pai.13502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mutations in the filaggrin gene (FLG) affect epidermal barrier function and increase the risk of atopic dermatitis (AD). We hypothesized that FLG mutations affect immune cell composition in a general pediatric population. Therefore, we investigated whether school-aged children with and without FLG mutations have differences in T- and B-cell subsets. METHODS This study was embedded in a population-based prospective cohort study, the Generation R Study, and included 523 children of European genetic ancestry aged 10 years. The most common FLG mutations in the European population (R501X, S1085CfsX36, R2447X, and S3247X) were genotyped. Additionally, 11-color flow cytometry was performed on peripheral blood samples to determine helper T (Th), regulatory T (Treg), and CD27+ and CD27- memory B cells. Subset analysis was performed in 358 non-AD and 102 AD cases, assessed by parental questionnaires. RESULTS FLG mutations were observed in 8.4% of the total population and in 15.7% of the AD cases. Children with any FLG mutation had higher Th22 cell numbers compared to FLG wild-type children in the general and non-AD population. Children with and without FLG mutations had no difference in Th1, Th2, Th17, Treg, or memory B-cell numbers. Furthermore, in children with AD, FLG mutation carriership was not associated with differences in T- and B-cell subsets. CONCLUSIONS School-aged children of a general population with FLG mutations have higher Th22 cell numbers, which reflects the immunological response to the skin barrier dysfunction. FLG mutations did not otherwise affect the composition of the adaptive immunity in this general pediatric population.
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Affiliation(s)
- Kirsten I M Looman
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of General Pediatrics, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Minke M F van Mierlo
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Menno C van Zelm
- Department Immunology and Pathology, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Chen Hu
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan C de Jongste
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Luba M Pardo
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care, Leiden University Medical Center/LUMC Campus, Leiden, The Netherlands
| | - Henriëtte A Moll
- Department of General Pediatrics, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam-Sophia Children's Hospital-Center of Pediatric Dermatology, Rotterdam, The Netherlands
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