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Meyermans R, Janssens S, Coussé A, Tinel S, Gorssen W, Lepot F, Hubin X, Mayeres P, Veulemans W, De Wilde N, Druet T, Georges M, Charlier C, Claerebout E, Buys N. Genetic and genomic analysis of Belgian Blue's susceptibility for psoroptic mange. Genet Sel Evol 2024; 56:52. [PMID: 38969989 PMCID: PMC11227209 DOI: 10.1186/s12711-024-00921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/01/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Psoroptic mange, caused by Psoroptes ovis mites, is affecting Belgian Blue cattle's welfare and production potential. The Belgian Blue cattle-known for its high degree of muscling, low feed conversion ratio and high beef quality-is highly susceptible for this disease. RESULTS In this study, we phenotyped 1975 Belgian Blue cattle from more than 100 different groups on commercial beef farms for their psoroptic mange susceptibility. Substantial individual differences were observed within these management groups, with lesion extent differences up to ± 15%. Animal models showed that estimated heritabilities were low for lesion extent and severe lesion extent (0.07 and 0.09, respectively) and 0.12 for the number of mites. A genome wide association study for mange susceptibility revealed signals on BTA6, BTA11, BTA15 and BTA24. In these regions, candidate genes GBA3, RAG2, and TRAF6 were identified. CONCLUSIONS Despite the challenges in phenotyping for psoroptic mange due to the timing of screening, the continuous evolution of lesions and different management conditions, we successfully conducted a study on the genetic susceptibility to psoroptic mange in Belgian Blue cattle. Our results clearly indicate that psoroptic mange is under polygenic control and the underlying candidate genes should be studied more thoroughly. This is the first study providing candidate genes for this complex disease. These results are already valuable for Belgian Blue breeding, however, further research is needed to unravel the architecture of this disease and to identify causal mutations.
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Affiliation(s)
- Roel Meyermans
- Center for Animal Breeding and Genetics, Department of Biosystems, KU Leuven, 3001, Leuven, Belgium.
| | - Steven Janssens
- Center for Animal Breeding and Genetics, Department of Biosystems, KU Leuven, 3001, Leuven, Belgium
| | - Annelies Coussé
- Center for Animal Breeding and Genetics, Department of Biosystems, KU Leuven, 3001, Leuven, Belgium
| | - Susanne Tinel
- Center for Animal Breeding and Genetics, Department of Biosystems, KU Leuven, 3001, Leuven, Belgium
| | - Wim Gorssen
- Center for Animal Breeding and Genetics, Department of Biosystems, KU Leuven, 3001, Leuven, Belgium
| | | | | | | | | | - Nathalie De Wilde
- Department of Translational Physiology, Infectiology and Public Health, UGent, 9820, Merelbeke, Belgium
| | - Tom Druet
- Unit of Animal Genomics, GIGA Institute and Faculty of Veterinary Medicine, Liège University, 4000, Liège, Belgium
| | - Michel Georges
- Unit of Animal Genomics, GIGA Institute and Faculty of Veterinary Medicine, Liège University, 4000, Liège, Belgium
| | - Carole Charlier
- Unit of Animal Genomics, GIGA Institute and Faculty of Veterinary Medicine, Liège University, 4000, Liège, Belgium
| | - Edwin Claerebout
- Department of Translational Physiology, Infectiology and Public Health, UGent, 9820, Merelbeke, Belgium
| | - Nadine Buys
- Center for Animal Breeding and Genetics, Department of Biosystems, KU Leuven, 3001, Leuven, Belgium
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Temboonnark P, Daengsuwan T. Netherton Syndrome in Thai Children: A Report of Two Cases With a Literature Review. Cureus 2024; 16:e62718. [PMID: 39036217 PMCID: PMC11259522 DOI: 10.7759/cureus.62718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/23/2024] Open
Abstract
Netherton syndrome (NS) is a severe autosomal recessive disorder characterized by the triad of congenital ichthyosiform erythroderma, trichorrhexis invaginata, and atopic diathesis. We report two cases that experienced severe congenital exfoliative dermatitis, recurrent infections, and allergic conditions. Examinations of hair under the light microscope revealed trichorrhexis invaginata. Whole exome sequencing identified homologous pathogenic mutations of SPINK5. Optimal skincare and proper nutritional support could improve patients' quality of life.
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Affiliation(s)
- Panipak Temboonnark
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, THA
- College of Medicine, Rangsit University, Bangkok, THA
| | - Tassalapa Daengsuwan
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, THA
- College of Medicine, Rangsit University, Bangkok, THA
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Bertrand C, Funaro D. Vulvovaginal involvement in Netherton syndrome: A case report. JAAD Case Rep 2024; 45:4-6. [PMID: 38333679 PMCID: PMC10847694 DOI: 10.1016/j.jdcr.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
- Cassandra Bertrand
- Department of Dermatology, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Deana Funaro
- Department of Dermatology, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
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4
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Kordeva SA, Batashki I, Tchernev G. Netherton syndrome in a Bulgarian patient : Presentation of a case and an update of therapeutic options. Wien Med Wochenschr 2023; 173:276-286. [PMID: 36695942 DOI: 10.1007/s10354-022-00999-y] [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: 09/07/2022] [Accepted: 12/15/2022] [Indexed: 01/26/2023]
Abstract
Comel-Netherton syndrome, or Netherton syndrome (NS), is a rare chronic genetic skin condition affecting the daily life of patients, which often results in poorly developed social skills and anxiety. Genetic predisposition plays a key role alongside the clinical findings, and clinicians must be aware of it as it can mimic other well-known skin conditions. Diagnosis is challenging both clinically and histologically. Clinically, it can mimic a severe form of atopic dermatitis, psoriasiform dermatitis overlapping with atopic dermatitis, or erythrokeratodermia variabilis. The difficulties in making histological diagnosis are similar, and it is often necessary to take several biopsies in order to clarify the diagnosis. Although retinoids are used for both psoriasis, erythrokeratodermia variabilis, and other congenital forms of keratodermia, the recommended treatment doses are different. This often results in poor treatment outcome. We present a 16-year-old patient previously diagnosed as erythrokeratodermia variabilis and treated with little to no improvement. Systemic therapy with acitretin 10 mg daily, local pimecrolimus 1%, emollients, and bilastine 20 mg once daily was initiated. Due to the limited application of retinoids and the difficulties in achieving permanent remission, modern medicine is faced with the challenge of seeking innovative therapeutic solutions. New hopes are placed on targeted or anti-cytokine therapy, based on inhibiting the inflammatory component of the disease. This article is mainly focused on innovative therapeutic options, including modern medications such as dupilumab, infliximab, secukinumab, anakinra, omalizumab, and others.
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Affiliation(s)
- Simona Atanasova Kordeva
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria.
| | - Ilia Batashki
- Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria
| | - Georgi Tchernev
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
- Department of Dermatology and Venereology, Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria
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5
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Nouwen AEM, Schappin R, Nguyen NT, Ragamin A, Bygum A, Bodemer C, Dalm VASH, Pasmans SGMA. Outcomes of Systemic Treatment in Children and Adults With Netherton Syndrome: A Systematic Review. Front Immunol 2022; 13:864449. [PMID: 35464459 PMCID: PMC9022473 DOI: 10.3389/fimmu.2022.864449] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 01/24/2023] Open
Abstract
Background Comèl-Netherton syndrome (NS) is a rare disease caused by pathogenic variants in the SPINK5 gene, leading to severe skin barrier impairment and proinflammatory upregulation. Given the severity of the disease, treatment of NS is challenging. Current treatment regimens are mainly topical and supportive. Although novel systemic treatment options for NS have been suggested in recent literature, little is known about their outcomes. Objective to provide an overview of systemic treatment options and their outcomes in adults and children with NS. Methods Embase, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to July 22, 2021. Empirical studies published in English language mentioning systemic treatment in NS were enrolled. Studies that did not define a treatment period or report at least one outcome were excluded. Methodological quality was evaluated by the Joanna Briggs Institute critical appraisal checklist for case reports or case series. Overall quality of evidence of the primary outcome, skin, was assessed by the GRADE approach. Results 36 case series and case reports were included. The effects of 15 systemic therapies were described in 48 patients, of which 27 were children. Therapies included retinoids, prednisolone, cyclosporine, immunoglobulins, and biologicals. In retinoids both worsening (4/15 cases) and improvement (6/15 cases) of the skin was observed. Use of prednisolone and cyclosporine was only reported in one patient. Immunoglobulins (13/15 cases) and biologicals (18/21 cases) showed improvement of the skin. Certainty of evidence was rated as very low. Conclusion NS is a rare disease, which is reflected in the scarce literature on systemic treatment outcomes in children and adults with NS. Studies showed large heterogeneity in outcome measures. Adverse events were scarcely reported. Long-term outcomes were reported in a minority of cases. Nonetheless, a general beneficial effect of systemic treatment was found. Immunoglobulins and biologicals showed the most promising results and should be further explored. Future research should focus on determining a core outcome set and measurement instruments for NS to improve quality of research. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=217933, PROSPERO (ID: 217933).
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Affiliation(s)
- Anouk E M Nouwen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Renske Schappin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - N Tan Nguyen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Aviël Ragamin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Christine Bodemer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC), Necker-Enfants Malades Hospital (AP-HP), Paris Centre University, Paris, France
| | - Virgil A S H Dalm
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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6
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Petrova E, Hovnanian A. Advances in understanding of Netherton syndrome and therapeutic implications. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1857724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Evgeniya Petrova
- Laboratory of genetic skin diseases, Université de Paris, Imagine Institute, INSERM UMR1163, Paris, France
| | - Alain Hovnanian
- Laboratory of genetic skin diseases, Université de Paris, Imagine Institute, INSERM UMR1163, Paris, France
- Departement of Genetics, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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7
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Aktas M, Salman A, Apti Sengun O, Comert Ozer E, Hosgoren Tekin S, Akin Cakici O, Demir G, Ergun T. Netherton syndrome: Temporary response to dupilumab. Pediatr Dermatol 2020; 37:1210-1211. [PMID: 32951242 DOI: 10.1111/pde.14362] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Netherton syndrome (NS) is an orphan disease characterized by congenital ichthyosis, hair abnormalities, and atopy, with limited treatment options. We achieved temporary improvement only during the initial 6 weeks of treatment with dupilumab, which differs from the sustained improvement observed in 2 other recently published cases. Although the clinical presentation of atopy and increased pre-allergic cytokines in NS patients suggest that dupilumab may be beneficial, larger studies are required.
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Affiliation(s)
- Meryem Aktas
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Andac Salman
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ozlem Apti Sengun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Comert Ozer
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | | | - Ozlem Akin Cakici
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Gizem Demir
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
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8
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Boer DEC, Mirzaian M, Ferraz MJ, Nadaban A, Schreuder A, Hovnanian A, van Smeden J, Bouwstra JA, Aerts JMFG. Glucosylated cholesterol in skin: Synthetic role of extracellular glucocerebrosidase. Clin Chim Acta 2020; 510:707-710. [PMID: 32946792 DOI: 10.1016/j.cca.2020.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/20/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
The existence of glucosylated cholesterol (GlcChol) in tissue has recently been recognized. GlcChol is generated from glucosylceramide (GlcCer) and cholesterol through transglucosylation by two retaining β-glucosidases, GBA and GBA2. Given the abundance of GBA, GlcCer and cholesterol in the skin's stratum corneum (SC), we studied the occurrence of GlcChol. A significant amount of GlcChol was detected in SC (6 pmol/mg weight). The ratio GlcChol/GlcCer is higher in SC than epidermis, 0.083 and 0.011, respectively. Examination of GlcChol in patients with Netherton syndrome revealed comparable levels (11 pmol/mg). Concluding, GlcChol was identified as a novel component in SC and is likely locally metabolized by GBA. The physiological function of GlcChol in the SC warrants future investigation.
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Affiliation(s)
- Daphne E C Boer
- Medical Biochemistry Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - Mina Mirzaian
- Medical Biochemistry Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - Maria J Ferraz
- Medical Biochemistry Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - Andreea Nadaban
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - Anne Schreuder
- Medical Biochemistry Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands
| | - Alain Hovnanian
- INSERM UMR1163, Imagine Institute, Paris Descartes University, 75015 Paris, France; Department of Genetics, Necker-Enfants Malades Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Jeroen van Smeden
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands; Centre for Human Drug Research, Leiden, the Netherlands
| | - Joke A Bouwstra
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, the Netherlands
| | - Johannes M F G Aerts
- Medical Biochemistry Leiden Institute of Chemistry, Leiden University, Leiden, the Netherlands.
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9
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Rodríguez-Manchón S, Pedrón-Giner C, Cañedo-Villarroya E, Muñoz-Codoceo RA, Hernández-Martín Á. Malnutrition in children with ichthyosis: Recommendations for monitoring from a multidisciplinary clinic experience. J Am Acad Dermatol 2020; 85:144-151. [PMID: 32585277 DOI: 10.1016/j.jaad.2020.06.064] [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: 01/28/2020] [Revised: 05/27/2020] [Accepted: 06/17/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Short stature has been reported in congenital ichthyoses (CI), but few data exist on patients' nutritional status. OBJECTIVE To describe the nutritional status at the first evaluation of children and young adults with CI. METHODS Prospective observational study of patients assessed at a multidisciplinary clinic. Clinical variables and ichthyosis severity were collected. Anthropometric assessment was made by measuring weight and height, and nutritional status was classified based on the World Health Organization definitions for malnutrition. Analytical assessment included markers of nutritional status, fat-soluble vitamins, and micronutrients. RESULTS We included 50 patients with a median age of 5 years (IQR, 1.6-10.3). Undernutrition was found in 32% of patients, and 75% of the undernourished children presented growth impairment. Younger children and those with severe ichthyoses were the most affected. Micronutrient deficiencies were found in 60% of patients. Deficiencies of selenium (34%), iron (28%), vitamin D (22%), and zinc (4%) were the most frequent findings. LIMITATIONS Our small sample includes a heterogeneous group of ichthyoses. CONCLUSION Children with CI appear to be at risk of undernutrition, especially at younger ages. Nutritional deficiencies are common and should be monitored. Growth failure in children with ichthyosis could be caused by undernutrition and aggravated by nutritional deficiencies.
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Affiliation(s)
- Silvia Rodríguez-Manchón
- Section of Paediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - Consuelo Pedrón-Giner
- Section of Paediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Elvira Cañedo-Villarroya
- Section of Paediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Rosa Ana Muñoz-Codoceo
- Section of Paediatric Gastroenterology and Nutrition, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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van Smeden J, Al-Khakany H, Wang Y, Visscher D, Stephens N, Absalah S, Overkleeft HS, Aerts JMFG, Hovnanian A, Bouwstra JA. Skin barrier lipid enzyme activity in Netherton patients is associated with protease activity and ceramide abnormalities. J Lipid Res 2020; 61:859-869. [PMID: 32265319 PMCID: PMC7269766 DOI: 10.1194/jlr.ra120000639] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/31/2020] [Indexed: 12/17/2022] Open
Abstract
Individuals with Netherton syndrome (NTS) have increased serine protease activity, which strongly impacts the barrier function of the skin epidermis and leads to skin inflammation. Here, we investigated how serine protease activity in NTS correlates with changes in the stratum corneum (SC) ceramides, which are crucial components of the skin barrier. We examined two key enzymes involved in epidermal ceramide biosynthesis, β-glucocerebrosidase (GBA) and acid-sphingomyelinase (ASM). We compared in situ expression levels and activities of GBA and ASM between NTS patients and controls and correlated the expression and activities with i) SC ceramide profiles, ii) in situ serine protease activity, and iii) clinical presentation of patients. Using activity-based probe labeling, we visualized and localized active epidermal GBA, and a newly developed in situ zymography method enabled us to visualize and localize active ASM. Reduction in active GBA in NTS patients coincided with increased ASM activity, particularly in areas with increased serine protease activity. NTS patients with scaly erythroderma exhibited more pronounced anomalies in GBA and ASM activities than patients with ichthyosis linearis circumflexa. They also displayed a stronger increase in SC ceramides processed via ASM. We conclude that changes in the localization of active GBA and ASM correlate with i) altered SC ceramide composition in NTS patients, ii) local serine protease activity, and iii) the clinical manifestation of NTS.
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Affiliation(s)
- Jeroen van Smeden
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands; Centre for Human Drug Research, Leiden, The Netherlands
| | - Hanin Al-Khakany
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Yichen Wang
- INSERM UMR1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Dani Visscher
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Nicole Stephens
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Samira Absalah
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Herman S Overkleeft
- Department of Bio-organic Synthesis, Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Johannes M F G Aerts
- Medical Biochemistry Leiden Institute of Chemistry, Leiden University, Leiden, The Netherlands
| | - Alain Hovnanian
- INSERM UMR1163, Imagine Institute, Paris Descartes University, Paris, France; Department of Genetics Necker-Enfants Malades Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Joke A Bouwstra
- Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands. mailto:
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11
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Glucocerebrosidase: Functions in and Beyond the Lysosome. J Clin Med 2020; 9:jcm9030736. [PMID: 32182893 PMCID: PMC7141376 DOI: 10.3390/jcm9030736] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023] Open
Abstract
Glucocerebrosidase (GCase) is a retaining β-glucosidase with acid pH optimum metabolizing the glycosphingolipid glucosylceramide (GlcCer) to ceramide and glucose. Inherited deficiency of GCase causes the lysosomal storage disorder named Gaucher disease (GD). In GCase-deficient GD patients the accumulation of GlcCer in lysosomes of tissue macrophages is prominent. Based on the above, the key function of GCase as lysosomal hydrolase is well recognized, however it has become apparent that GCase fulfills in the human body at least one other key function beyond lysosomes. Crucially, GCase generates ceramides from GlcCer molecules in the outer part of the skin, a process essential for optimal skin barrier property and survival. This review covers the functions of GCase in and beyond lysosomes and also pays attention to the increasing insight in hitherto unexpected catalytic versatility of the enzyme.
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12
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Affiliation(s)
- G M Murphy
- St John's Hospital for Diseases of the Skin, London
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13
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Abstract
Eczema and urticaria are common disorders encountered in pediatric patients, but they may occasionally be the presenting complaint in a child with an underlying rare disease. Immunodeficiency syndromes should be suspected when eczema is associated with neonatal onset, recurrent infections, chronic lymphadenopathy, or failure to thrive. Nutritional deficiencies and mycosis fungoides are in the differential diagnosis for a child with a recalcitrant eczematous eruption. Autoinflammatory syndromes should be suspected in a child with chronic urticaria, fever, and other systemic signs of inflammation. Although these disorders are rare, early recognition allows for appropriate treatment and decreased morbidity for the child.
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Affiliation(s)
- Molly J Youssef
- Department of Dermatology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA
| | - Yvonne E Chiu
- Section of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
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14
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Guerra L, Fortugno P, Sinistro A, Proto V, Zambruno G, Didona B, Castiglia D. Betapapillomavirus in multiple non-melanoma skin cancers of Netherton syndrome: Case report and published work review. J Dermatol 2015; 42:786-94. [DOI: 10.1111/1346-8138.12913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/20/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Liliana Guerra
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - Paola Fortugno
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - Anna Sinistro
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - Vittoria Proto
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - Giovanna Zambruno
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - Biagio Didona
- 1st Dermatology Division; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology; Istituto Dermopatico dell'Immacolata-IRCCS; Rome Italy
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15
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Solovan C, Doroftei F, Pinteala M, Chiriac A, Cristea C. Scanning electron microscopic examination of the hair shaft abnormalities in Netherton's syndrome. Int J Dermatol 2015; 54:693-4. [PMID: 25782715 DOI: 10.1111/ijd.12848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Caius Solovan
- Department of Dermatology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Florica Doroftei
- "Petru Poni" Institute of Macromolecular Chemistry, Iasi, Romania
| | - Mariana Pinteala
- "Petru Poni" Institute of Macromolecular Chemistry, Iasi, Romania
| | - Anca Chiriac
- Department of Dermatology, University Apollonia, Iasi, Romania
| | - Corina Cristea
- Department of Dermatology, Emergency City Hospital, Timisoara, Romania
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Intercellular skin barrier lipid composition and organization in Netherton syndrome patients. J Invest Dermatol 2013; 134:1238-1245. [PMID: 24292773 DOI: 10.1038/jid.2013.517] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 10/13/2013] [Accepted: 11/05/2013] [Indexed: 12/25/2022]
Abstract
Netherton syndrome (NTS) is a rare genetic skin disease caused by mutations in the serine protease inhibitor Kazal-type 5 gene, which encodes the lympho-epithelial Kazal-type-related inhibitor. NTS patients have profoundly impaired skin barrier function. As stratum corneum (SC) lipids have a crucial role in the skin barrier function, we investigated the SC lipid composition and organization in NTS patients. We studied the SC lipid composition by means of mass spectrometry, and the lipid organization was examined by infrared spectroscopy and X-ray diffraction. Decreased free fatty acid (FFA) chain length and increased levels of monounsaturated FFAs were observed in the SC of NTS patients compared with controls. Furthermore, the level of short-chain ceramides (CERs) was enhanced in NTS patients and a strong reduction in long-chain CER levels was seen in several patients. The changes in lipid composition modified the lipid organization leading to an increased disordering of the lipids compared with the controls. In addition, in a subgroup of patients the organization of the lipid layers changed dramatically. The altered FFA and CER profiles in NTS patients corresponded to changes in the expression of enzymes involved in SC lipid processing. The observed changes in lipid composition, lipid organization, and enzyme expression are likely to contribute to the barrier dysfunction in NTS.
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van Smeden J, Janssens M, Gooris GS, Bouwstra JA. The important role of stratum corneum lipids for the cutaneous barrier function. Biochim Biophys Acta Mol Cell Biol Lipids 2013; 1841:295-313. [PMID: 24252189 DOI: 10.1016/j.bbalip.2013.11.006] [Citation(s) in RCA: 334] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/08/2013] [Accepted: 11/10/2013] [Indexed: 01/28/2023]
Abstract
The skin protects the body from unwanted influences from the environment as well as excessive water loss. The barrier function of the skin is located in the stratum corneum (SC). The SC consists of corneocytes embedded in a lipid matrix. This lipid matrix is crucial for the lipid skin barrier function. This paper provides an overview of the reported SC lipid composition and organization mainly focusing on healthy and diseased human skin. In addition, an overview is provided on the data describing the relation between lipid modulations and the impaired skin barrier function. Finally, the use of in vitro lipid models for a better understanding of the relation between the lipid composition, lipid organization and skin lipid barrier is discussed. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. Guest Editors: Kenneth R. Feingold and Peter Elias.
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Affiliation(s)
- J van Smeden
- Department of Drug Delivery Technology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - M Janssens
- Department of Drug Delivery Technology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - G S Gooris
- Department of Drug Delivery Technology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - J A Bouwstra
- Department of Drug Delivery Technology, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.
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Abstract
Management of ichthyoses is a complex and continuously dynamic process. Primary treatments of ichthyosis are by means of topical moisturizers and topical medications. Patients and families need to have reasonable and realistic expectations when it comes to topical therapy. Topical medications cannot cure the scaling, but can gradually reduce it and thus improve their condition. No one treatment regimen works for everyone, and the best topical therapy for each patient may be the result of months (or years) of painstaking effort on both the physician's and the patient's behalf. As patients get older and their activities and lifestyles change, so should their topical treatment regimen. Bear in mind that the more complex the skin care regimen and costly the topical treatments, the less likely a patient and their family will be compliant.
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Affiliation(s)
- Philip Fleckman
- Dermatology, University of Washington, Seattle, WA 98105, USA.
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19
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de Oliveira FL, Vasconcellos BO, de Morais TS, Nascimento MB, Teles R, da Costa Nery JA, Miranda MJS, Azulay-Abulafia L. Netherton's syndrome and lepromatous leprosy: a mere coincidence? Int J Dermatol 2013; 52:186-90. [PMID: 23347305 DOI: 10.1111/j.1365-4632.2012.05620.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Netherton's syndrome (NS) is a rare autosomal recessive condition, first described in 1958, which involves a complex immunological dysfunction, ichthyosiform dermatitis, and erythroderma, characteristic defects of the hair shaft and atopy. Recurrent bacterial infection in the skin of patients with NS is frequent. METHODS This paper represents the first case report of leprosy and concurrent NS. DISCUSSION This case merits discussion among doctors in endemic and non-endemic areas to evaluate the chronic use of systemic corticosteroids as a risk factor for leprosy. The present patient came from an endemic area of leprosy and was treated chronically with systemic corticosteroids for erythroderma. This treatment, along with the immunodeficiency related to the syndrome and caused by a genetic mutation in SPINK5, may be a facilitating factor for the infection.
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Affiliation(s)
- Felipe Ladeira de Oliveira
- Section for Sexually Transmitted Diseases and Leprosy, Professor RD Azulay Institute of Dermatology, Hospital Santa Casa da Misericórdia, Rio de Janeiro, Brazil
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20
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Leiding JW, Holland SM. Warts and all: human papillomavirus in primary immunodeficiencies. J Allergy Clin Immunol 2012; 130:1030-48. [PMID: 23036745 DOI: 10.1016/j.jaci.2012.07.049] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/06/2012] [Accepted: 07/25/2012] [Indexed: 01/19/2023]
Abstract
Infection with human papillomavirus (HPV) is almost universal and eventually asymptomatic, but pathologic infection with HPV is severe, recurrent, and recalcitrant to therapy. It is also an underappreciated manifestation of primary immunodeficiency. Mutations in EVER1, EVER2, GATA2, CXCR4, and dedicator of cytokinesis 8 (DOCK8) are typically associated with extensive HPV infections, whereas several other primary immune defects result in severe HPV much less frequently. We review immunodeficiencies with severe HPV infections and the mechanisms underlying them.
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Affiliation(s)
- Jennifer W Leiding
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1684, USA.
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21
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Benzon H, Thompson J, Nardone H, Ohlms L, McGill T, Holzman RS. Anesthetic considerations in Netherton Syndrome. Paediatr Anaesth 2012; 22:410-1. [PMID: 22380746 DOI: 10.1111/j.1460-9592.2012.03815.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Diseases of Periocular Hair. Surv Ophthalmol 2011; 56:416-32. [DOI: 10.1016/j.survophthal.2011.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/23/2022]
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23
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Bingol B, Tasdemir S, Gunenc Z, Abike F, Esenkaya S, Tavukcuoglu S, Berkil H. Prenatal diagnosis of Comel-Netherton syndrome with PGD, case report and review article. J Assist Reprod Genet 2011; 28:615-20. [PMID: 21573681 DOI: 10.1007/s10815-011-9568-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022] Open
Affiliation(s)
- Banu Bingol
- Gayrettepe Florence Nightingale Hospital, Department of Obstetrics and Gynecology, Istanbul Bilim University, Istanbul, Turkey.
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25
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Renner E, Rieber N, Klein C, Albert M. Angeborene Immundefekte als Multisystemerkrankungen. Monatsschr Kinderheilkd 2009. [DOI: 10.1007/s00112-009-1987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Renner ED, Hartl D, Rylaarsdam S, Young ML, Monaco-Shawver L, Kleiner G, Markert ML, Stiehm ER, Belohradsky BH, Upton MP, Torgerson TR, Orange JS, Ochs HD. Comèl-Netherton syndrome defined as primary immunodeficiency. J Allergy Clin Immunol 2009; 124:536-43. [PMID: 19683336 PMCID: PMC3685174 DOI: 10.1016/j.jaci.2009.06.009] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 05/12/2009] [Accepted: 06/02/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mutations in serine protease inhibitor Kazal-type 5 (SPINK5), encoding the serine protease inhibitor lympho-epithelial Kazal-type 5 related inhibitor (LEKTI), cause Comèl-Netherton syndrome, an autosomal-recessive disease characterized by congenital ichthyosis, bamboo hair, and atopic diathesis. Despite increased frequency of infections, the immunocompetence of patients with Comèl-Netherton syndrome has not been extensively investigated. OBJECTIVE To define Comèl-Netherton syndrome as a primary immunodeficiency disorder and to explore the benefit of intravenous immunoglobulin replacement therapy. METHODS We enrolled 9 patients with Comèl-Netherton syndrome, sequenced SPINK5, and analyzed LEKTI expression by immunohistochemistry. Immune function was assessed by measuring cognate immunity, serum cytokine levels, and natural killer cell cytotoxicity. RESULTS All patients presented with recurrent skin infections caused predominantly by Staphylococcus aureus. All but 1 reported recurrent respiratory tract infections; 78% had sepsis and/or pneumonia; 67% had recurrent gastrointestinal disease and failure to thrive. Mutations in SPINK5-including 6 novel mutations-were identified in 8 patients. LEKTI expression was decreased or absent in all patients. Immunologic evaluation revealed reduced memory B cells and defective responses to vaccination with Pneumovax and bacteriophage phiX174, characterized by impaired antibody amplification and class-switching. Immune dysregulation was suggested by a skewed T(h)1 phenotype and elevated proinflammatory cytokine levels, whereas serum concentrations of the chemokine (C-C motif) ligand 5 and natural killer cell cytotoxicity were decreased. Treatment with intravenous immunoglobulin resulted in remarkable clinical improvement and temporarily increased natural killer cell cytotoxicity. CONCLUSION These data provide new insights into the immunopathology of Comèl-Netherton syndrome and demonstrate that this multisystem disorder, characterized by lack of LEKTI expression in epithelial cells, is complicated by cognate and innate immunodeficiency that responds favorably to intravenous immunoglobulin therapy.
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Affiliation(s)
- Ellen D Renner
- Dr v Haunersches Kinderspital, Ludwig-Maximilians-Universität, Munich, Germany
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27
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Ming JE, Stiehm ER. Genetic syndromic immunodeficiencies with antibody defects. Immunol Allergy Clin North Am 2009; 28:715-36, vii. [PMID: 18940571 DOI: 10.1016/j.iac.2008.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article reviews the major syndromic immunodeficiencies with significant antibody defects, many of which may require intravenous immunogammaglobulin therapy. The authors define syndromic immunodeficiency as an illness associated with a characteristic group of phenotypic abnormalities or laboratory features that comprise a recognizable syndrome. Many are familial with a defined inheritance pattern. Immunodeficiency may not be a major part of the illness and may not be present in all patients; thus, these conditions differ from primary immunodeficiency syndromes, in which immune abnormalities are a consistent and prominent feature of their disease.
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Affiliation(s)
- Jeffrey E Ming
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, 3615 Civic Center Boulevard, Philadelphia, PA 19104, USA
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28
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Hosomi N, Fukai K, Nakanishi T, Funaki S, Ishii M. Caspase-1 activity of stratum corneum and serum interleukin-18 level are increased in patients with Netherton syndrome. Br J Dermatol 2008; 159:744-6. [PMID: 18616770 DOI: 10.1111/j.1365-2133.2008.08706.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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29
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The genetics of hair shaft disorders. J Am Acad Dermatol 2008; 59:1-22; quiz 23-6. [DOI: 10.1016/j.jaad.2008.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 04/03/2008] [Accepted: 04/07/2008] [Indexed: 11/23/2022]
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30
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Cernik C, Trevino J, Janik M. An unusual dermatitis with annular lesions. Pediatr Dermatol 2008; 25:253-4. [PMID: 18429793 DOI: 10.1111/j.1525-1470.2008.00622.x] [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: 11/28/2022]
Affiliation(s)
- Christina Cernik
- Northeastern Ohio Universities College of Medicine, Medina, Ohio 44256, USA.
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31
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Elias PM, Williams ML, Holleran WM, Jiang YJ, Schmuth M. Pathogenesis of permeability barrier abnormalities in the ichthyoses: inherited disorders of lipid metabolism. J Lipid Res 2008; 49:697-714. [PMID: 18245815 DOI: 10.1194/jlr.r800002-jlr200] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Many of the ichthyoses are associated with inherited disorders of lipid metabolism. These disorders have provided unique models to dissect physiologic processes in normal epidermis and the pathophysiology of more common scaling conditions. In most of these disorders, a permeability barrier abnormality "drives" pathophysiology through stimulation of epidermal hyperplasia. Among primary abnormalities of nonpolar lipid metabolism, triglyceride accumulation in neutral lipid storage disease as a result of a lipase mutation provokes a barrier abnormality via lamellar/nonlamellar phase separation within the extracellular matrix of the stratum corneum (SC). Similar mechanisms account for the barrier abnormalities (and subsequent ichthyosis) in inherited disorders of polar lipid metabolism. For example, in recessive X-linked ichthyosis (RXLI), cholesterol sulfate (CSO(4)) accumulation also produces a permeability barrier defect through lamellar/nonlamellar phase separation. However, in RXLI, the desquamation abnormality is in part attributable to the plurifunctional roles of CSO(4) as a regulator of both epidermal differentiation and corneodesmosome degradation. Phase separation also occurs in type II Gaucher disease (GD; from accumulation of glucosylceramides as a result of to beta-glucocerebrosidase deficiency). Finally, failure to assemble both lipids and desquamatory enzymes into nascent epidermal lamellar bodies (LBs) accounts for both the permeability barrier and desquamation abnormalities in Harlequin ichthyosis (HI). The barrier abnormality provokes the clinical phenotype in these disorders not only by stimulating epidermal proliferation, but also by inducing inflammation.
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Affiliation(s)
- Peter M Elias
- Dermatology Services, Veterans Affairs Medical Center, University of California, San Francisco, CA, USA.
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32
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Abstract
Netherton's syndrome (NS) is a rare autosomal recessive disease comprised of ichthyosis in the form of ichthyosis linearis circumflexa, hair shaft defects and atopic manifestations with an elevated IgE level. Various therapeutic options have been used in NS with variable success. Tacrolimus and pimecrolimus belong to the family of calcineurin inhibitors. They bind cytoplasmic proteins and the resulting complex binds calcineurin, inhibiting its ability to dephosphorylate the nuclear factor of activated T cells, thus suppressing gene transcription. There have been conflicting reports of the usefulness of tacrolimus in NS patients, with systemic absorption being the main adverse outcome. Here we report four Saudi siblings (two boys and two girls) with NS who were treated with topical tacrolimus and pimecrolimus with good control of their skin disease without any toxic effect. To our knowledge, this is the second report of the use of topical pimecrolimus in NS in the English literature.
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Affiliation(s)
- Ghada Bin Saif
- Division of Dermatology, Department of Medicine, King Fahad National Guard Hospital, King Abdulaziz Medical City-Riyadh, Saudi Arabia
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33
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Borgoño CA, Michael IP, Komatsu N, Jayakumar A, Kapadia R, Clayman GL, Sotiropoulou G, Diamandis EP. A potential role for multiple tissue kallikrein serine proteases in epidermal desquamation. J Biol Chem 2006; 282:3640-52. [PMID: 17158887 DOI: 10.1074/jbc.m607567200] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Desquamation of the stratum corneum is a serine protease-dependent process. Two members of the human tissue kallikrein (KLK) family of (chymo)tryptic-like serine proteases, KLK5 and KLK7, are implicated in desquamation by digestion of (corneo)desmosomes and inhibition by desquamation-related serine protease inhibitors (SPIs). However, the epidermal localization and specificity of additional KLKs also supports a role for these enzymes in desquamation. This study aims to delineate the probable contribution of KLK1, KLK5, KLK6, KLK13, and KLK14 to desquamation by examining their interactions, in vitro, with: 1) colocalized SPI, lympho-epithelial Kazal-type-related inhibitor (LEKTI, four recombinant fragments containing inhibitory domains 1-6 (rLEKTI(1-6)), domains 6-8 and partial domain 9 (rLEKTI(6-9')), domains 9-12 (rLEKTI(9-12)), and domains 12-15 (rLEKTI(12-15)), secretory leukocyte protease inhibitor, and elafin and 2) their ability to digest the (corneo)desmosomal cadherin, desmoglein 1. KLK1 was not inhibited by any SPI tested. KLK5, KLK6, KLK13, and KLK14 were potently inhibited by rLEKTI(1-6), rLEKTI(6-9'), and rLEKTI(9-12) with Ki values in the range of 2.3-28.4 nm, 6.1-221 nm, and 2.7-416 nm for each respective fragment. Only KLK5 was inhibited by rLEKTI(12-15) (Ki = 21.8 nm). No KLK was inhibited by secretory leukocyte protease inhibitor or elafin. Apart from KLK13, all KLKs digested the ectodomain of desmoglein 1 within cadherin repeats, Ca2+ binding sites, or in the juxtamembrane region. Our study indicates that multiple KLKs may participate in desquamation through cleavage of desmoglein 1 and regulation by LEKTI. These findings may have clinical implications for the treatment of skin disorders in which KLK activity is elevated.
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Affiliation(s)
- Carla A Borgoño
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario M5G 1X5, Canada
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Abstract
Netherton syndrome is a rare disorder inherited in an autosomal recessive pattern consisting of ichthyosiform dermatosis, hair shaft abnormalities (trichorrhexis invaginata), and an atopic diathesis. Patients with Netherton syndrome have been found to have a mutation on chromosome 5q32 in a gene named SPINK5 (serine protease inhibitor, Kazal type-5), which encodes an inhibitor of serine proteases called LEKTI. We report a female patient with previously undiagnosed Netherton syndrome who presented to participate in a clinical research trial investigating the benefit of topical tacrolimus 0.03% ointment [Protopic (Fujisawa Pharmaceutical Co. Ltd., Japan)] for the treatment of atopic dermatitis. This patient was confirmed to have a gene mutation in SPINK5. Current literature suggests a relative contraindication for use of topical tacrolimus in patients with Netherton syndrome owing to concern for increased systemic absorption of the drug. Our patient was not able to tolerate topical tacrolimus owing to local irritation, and did not derive any benefit from therapy. Though rare, when evaluating patients with a possible diagnosis of atopic dermatitis, an index of suspicion for Netherton Syndrome must be maintained. History and overall clinical findings, especially in regards to examination of the hair, will aid in diagnosis.
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Affiliation(s)
- Joannie D Sun
- Department of Dermatology, Irvine College of Medicine, University of California, Orange, CA 92868, USA
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Serra-Guillén C, Torrelo A, Drake M, Armesto S, Fernández-Llaca H, Zambrano A. [Netherton syndrome]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:348-50. [PMID: 16956571 DOI: 10.1016/s0001-7310(06)73417-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Netherton syndrome is a rare disease inherited as an autosomal recessive trait due to mutations in the SPINK5 gene. It is characterized by the triad of ichthyosiform dermatosis, alterations of the hair shaft and immunological disorders. We present the case of a 12-year-old girl with the triad of ichthyosis linearis circumflexa, trichorrhexis invaginata and atopic dermatitis, characteristic of Netherton syndrome.
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Abstract
Hair shaft abnormalities are fascinating and can provide a diagnostic challenge. Current knowledge of structural changes in hair has been amplified by scanning and transmission electron microscopy (SEM and TEM). Dermatologists using the light microscope and polarization in the office can diagnose the great majority of hair shaft defects. A number of these defects are illustrated here.
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Affiliation(s)
- David A Whiting
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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37
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Geyer AS, Ratajczak P, Pol-Rodriguez M, Millar WS, Garzon M, Richard G. Netherton Syndrome with Extensive Skin Peeling and Failure to Thrive due to a Homozygous Frameshift Mutation in SPINK5. Dermatology 2005; 210:308-14. [PMID: 15942217 DOI: 10.1159/000084755] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Accepted: 08/30/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Netherton syndrome (NTS) is a rare autosomal recessive multisystem disorder characterized by congenital erythroderma and ichthyosis, hair shaft abnormalities and immune dysregulation. The disorder is caused by deleterious mutations in the SPINK5 gene, encoding the serine protease inhibitor LEKTI. OBJECTIVE Our objective was to investigate if the erythrodermic variant of peeling skin syndrome is also caused by SPINK5 mutations and to study the consequences of the disease on infantile brain development. METHODS In an infant with extensive erythroderma, peeling skin and failure to thrive, we analyzed the SPINK5 gene for pathogenic mutations by direct DNA sequencing and performed repeated brain MRI studies with diffusion-weighted imaging. RESULTS We identified a homozygous 4-base-pair insertion in exon 5 of SPINK5, which introduces a premature termination codon and appears to be a common mutation among West Indies islanders. MRI analyses revealed a persistent diffuse volume loss. CONCLUSION Our results confirm that early truncation mutations of the coding sequence of SPINK5 produce a severe phenotype and that generalized peeling skin is one of the manifestations of NTS. We further demonstrate for the first time that NTS may be associated with MRI abnormalities indicative of a permanent tissue injury of the brain.
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Affiliation(s)
- Adam S Geyer
- Department of Dermatology, Columbia University Medical Center, Columbia University, New York, NY, USA
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Raghunath M, Tontsidou L, Oji V, Aufenvenne K, Schürmeyer-Horst F, Jayakumar A, Ständer H, Smolle J, Clayman GL, Traupe H. SPINK5 and Netherton Syndrome: Novel Mutations, Demonstration of Missing LEKTI, and Differential Expression of Transglutaminases. J Invest Dermatol 2004; 123:474-83. [PMID: 15304086 DOI: 10.1111/j.0022-202x.2004.23220.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Netherton syndrome (NTS) is an autosomal recessive congenital ichthyosis featuring chronic inflammation of the skin, hair anomalies, epidermal hyperplasia with an impaired epidermal barrier function, failure to thrive and atopic manifestations. The disease is caused by mutations in the SPINK5 gene encoding the serine proteinase inhibitor lympho-epithelial Kazal-type inhibitor (LEKTI). Sequence analyses of SPINK5 in seven NTS patients from five different families allowed us to identify two known and three novel mutations all creating premature termination codons. We developed a monoclonal antibody giving a strong signal for LEKTI in the stratum granulosum of normal skin and demonstrated absence of the protein in NTS epidermis. Immunoblot analysis revealed presence of full length LEKTI and of LEKTI cleavage fragments in normal hair roots, whereas in NTS hair roots LEKTI and its cleavage products were completely missing. Transglutaminase1 activity was present throughout almost the entire suprabasal epidermis in NTS, whereas in normal skin it is restricted to the stratum granulosum. In contrast, immunostaining for transglutaminase3 was absent or faint. Moreover, comparable with the altered pattern in psoriatic skin the epidermis in NTS strongly expressed the serine proteinase inhibitor SKALP/elafin and the anti-microbial protein human beta-defensin 2. These studies demonstrate LEKTI deficiency in the epidermis and in hair roots at the protein level and an aberrant expression of other proteins, especially transglutaminase1 and 3, which may account for the impaired epidermal barrier in NTS.
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Affiliation(s)
- Michael Raghunath
- Department of Dermatology, University Hospital, University of Münster, Von-Esmarch-Strasse 58, D-48149 Münster, Germany
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Ming JE, Stiehm ER, Graham JM. Syndromic immunodeficiencies: genetic syndromes associated with immune abnormalities. Crit Rev Clin Lab Sci 2004; 40:587-642. [PMID: 14708957 DOI: 10.1080/714037692] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In syndromic immunodeficiencies, clinical features not directly associated with the immune defect are prominent. Patients may present with either infectious complications or extra-immune medical issues. In addition to the immunologic abnormality, a wide range of organ systems may be affected. Patients may present with disturbances in skeletal, neurologic, dermatologic, or gastrointestinal function or development. These conditions can be caused by developmental abnormalities, chromosomal aberrations, metabolic disorders, or teratogens. For a number of these conditions, recent advances have resulted in an enhanced understanding of their genetic basis. The finding of immune deficits in a number of defined syndromes with congenital anomalies suggests that an underlying genetic syndrome should be considered in those patients in whom a significant non-immune feature is present.
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Affiliation(s)
- Jeffrey E Ming
- Department of Pediatrics, Division of Human Genetics and Molecular Biology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Moskowitz DG, Fowler AJ, Heyman MB, Cohen SP, Crumrine D, Elias PM, Williams ML. Pathophysiologic basis for growth failure in children with ichthyosis: an evaluation of cutaneous ultrastructure, epidermal permeability barrier function, and energy expenditure. J Pediatr 2004; 145:82-92. [PMID: 15238912 DOI: 10.1016/j.jpeds.2004.03.052] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Because an impaired epidermal permeability barrier is present in many of the ichthyoses, we examined the contribution of barrier failure to caloric requirements in children with ichthyosis and growth failure. STUDY DESIGN Transepidermal water loss (TEWL) and ultrastructural parameters of the permeability barrier were evaluated in 10 hospitalized children with ichthyosis and growth failure. Nutritional intake, resting energy expenditure, and calories lost as heat of evaporation were determined. RESULTS Mean basal TEWL rates were markedly elevated in all study patients in comparison to the expected upper limit of normal (39.6+/-20.6 vs 8.7 mL/m(2) per hour). The severity of abnormalities in the ultrastructure of permeability barrier-related structures, assessed semiquantitatively, correlated significantly to mean basal TEWL rates (P <.001). Total body daily TEWL was elevated (746 +/- 468 vs 209 mL/d), resulting in a caloric drain of 433 +/- 272 kcal/d (21 +/- 9.8 kcal/kg per day) through heat of evaporation. Nutrient intake exceeded requirements in all, but resting energy expenditure exceeded predicted in 5 of 6 patients and correlated significantly with mean basal TEWL rates (P <.005). CONCLUSIONS A defective permeability barrier in children with ichthyosis can result in ample chronic losses of water and calories to impair growth.
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Affiliation(s)
- David G Moskowitz
- Department of Dermatolog, University of California San Francisco, and the Department of Veterans Affairs Medical Center, San Francisco, 94143, USA
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Fowler AJ, Moskowitz DG, Wong A, Cohen SP, Williams ML, Heyman MB. Nutritional status and gastrointestinal structure and function in children with ichthyosis and growth failure. J Pediatr Gastroenterol Nutr 2004; 38:164-9. [PMID: 14734878 DOI: 10.1097/00005176-200402000-00012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
UNLABELLED Growth failure occurs in several of the ichthyoses, a heterogeneous group of inherited disorders characterized by thickened or scaly skin. This suggests that there may be common pathogenic mechanisms causing failure to thrive. Previous studies have proposed that a hypermetabolic state induced by epidermal inflammation and hyperproliferation or enteropathy leading to malabsorption and nutritional deficiencies might account for the growth failure in icthyosis. OBJECTIVE The purpose of this study was to examine the extent of enteropathy and nutritional deficiency in children with severe ichthyosis and growth failure. METHODS Ten children with different types of ichthyoses and growth failure were studied. RESULTS Evaluation of gastrointestinal structure and function revealed few abnormalities other than mild fat malabsorption in two patients. Total caloric intake exceeded established requirements for age, height, and weight in all patients. Deficiencies of fat-soluble vitamins were identified in a few subjects. Mild elevations in total calcium and magnesium blood level, elevated hematocrit levels, and constipation were observed in many patients. CONCLUSIONS Nutritional deficiencies and gastrointestinal abnormalities are uncommon in children with ichthyosis and failure to thrive. Chronic hypovolemia caused by impaired epidermal permeability barrier may be common in this population.
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Affiliation(s)
- Ashley J Fowler
- Department of Dermatology, University of California San Francisco, San Francisco, California 94143, USA
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De Vera M, Yu BH. Recurrent staphylococcal infections and chronic dermatitis in a 45-year-old man. Ann Allergy Asthma Immunol 2003; 91:244-50. [PMID: 14533655 DOI: 10.1016/s1081-1206(10)63525-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michelle De Vera
- Rush Presbyterian-St. Luke's Medical Center and Cook County Hospital, Chicago, Illinois 60612, USA.
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Affiliation(s)
- B Grimbacher
- Department of Rheumatology and Clinical Immunology, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106 Freiburg, Germany
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Affiliation(s)
- Joy M Twersky
- Department of Pediatric Dermatology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Yerebakan O, Uğuz A, Keser I, Lüleci G, Ciftçioğlu MA, Başaran E, Alpsoy E. Netherton syndrome associated with idiopathic congenital hemihypertrophy. Pediatr Dermatol 2002; 19:345-8. [PMID: 12220283 DOI: 10.1046/j.1525-1470.2002.00098.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Netherton syndrome is a rare genodermatosis comprised of anichthyosiform dermatitis, hair shaft defects, and atopic features. Other problems associated with Netherton syndrome are delayed growth and development, immune abnormalities, recurrent infections, and intermittent aminoaciduria. We describe an 18-month-old girl with Netherton syndrome who had idiopathic congenital hemihypertrophy on her right side with contralateral benign nephromegaly in addition to the characteristic clinical signs of the syndrome. To our knowledge, this is the first case of Netherton syndrome associated with idiopathic congenital hemihypertrophy to be reported.
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Affiliation(s)
- Ozlem Yerebakan
- Departments of Dermatology, Pediatric Immunology, Medical Genetics, and Pathology, Akdeniz University School of Medicine, Antalya, Turkey.
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Komatsu N, Takata M, Otsuki N, Ohka R, Amano O, Takehara K, Saijoh K. Elevated stratum corneum hydrolytic activity in Netherton syndrome suggests an inhibitory regulation of desquamation by SPINK5-derived peptides. J Invest Dermatol 2002; 118:436-43. [PMID: 11874482 DOI: 10.1046/j.0022-202x.2001.01663.x] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Netherton syndrome is a congenital ichthyosis associated with erythroderma, hair shaft defects, and atopic features. The mutations of the secretory serine protease inhibitor Kazal-type 5 gene have been identified in Netherton syndrome patients; however, the actual physiologic substrates of the serine protease inhibitor Kazal-type 5 proprotein are unknown, and how the genetic defects cause characteristic skin phenotype remains uncertain. Here, we describe the serine protease inhibitor Kazal-type 5 gene mutations, including two novel non-sense mutations, and genotype-phenotype correlation in three Netherton syndrome patients in two unrelated Japanese families. Furthermore, based on the reappraisal of the structure of the serine protease inhibitor Kazal-type 5 proprotein, demonstration of the presence of carboxypeptidase in normal keratinocytes, and the observation of mRNA localization of the serine protease inhibitor Kazal-type 5 transcripts in the uppermost epidermis as well as pilosebaceous units, we propose a hypothetical model of proteolytic processing of the serine protease inhibitor Kazal-type 5 proprotein in the epidermis and inhibitory regulation of corneocyte desquamation by a set of serine protease inhibitor Kazal-type 5-derived peptides. This hypothesis is supported by the marked increase of trypsin-like hydrolytic activity demonstrated in stratum corneum samples from our Netherton syndrome patients. The findings in this study suggest that the defective inhibitory regulation of desquamation due to the serine protease inhibitor Kazal-type 5 gene mutations may cause over-desquamation of corneocytes in Netherton syndrome, leading to severe skin permeability barrier dysfunction.
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Affiliation(s)
- Nahoko Komatsu
- Department of Dermatology, School of Medicine, Kanazawa University, Kanazawa, Japan.
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Sprecher E, Chavanas S, DiGiovanna JJ, Amin S, Nielsen K, Prendiville JS, Silverman R, Esterly NB, Spraker MK, Guelig E, de Luna ML, Williams ML, Buehler B, Siegfried EC, Van Maldergem L, Pfendner E, Bale SJ, Uitto J, Hovnanian A, Richard G. The spectrum of pathogenic mutations in SPINK5 in 19 families with Netherton syndrome: implications for mutation detection and first case of prenatal diagnosis. J Invest Dermatol 2001; 117:179-87. [PMID: 11511292 DOI: 10.1046/j.1523-1747.2001.01389.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Comèl-Netherton syndrome is an autosomal recessive multisystemic disorder characterized by localized or generalized congenital ichthyosis, hair shaft abnormalities, immune deficiency, and markedly elevated IgE levels. Life-threatening complications during infancy include temperature and electrolyte imbalance, recurrent infections, and failure to thrive. To study the clinical presentations of the Comèl-Netherton syndrome and its molecular cause, we ascertained 19 unrelated families of various ethnic backgrounds. Results of initial linkage studies mapped the Comèl-Netherton syndrome in 12 multiplex families to a 12 cM interval on 5q32, thus confirming genetic homogeneity of Comèl-Netherton syndrome across families of different origins. The Comèl-Netherton syndrome region harbors the SPINK5 gene, which encodes a multidomain serine protease inhibitor (LEKTI) predominantly expressed in epithelial and lymphoid tissues. Recently, recessive mutations in SPINK5 were identified in several Comèl-Netherton syndrome patients from consanguineous families. We used heteroduplex analysis followed by direct DNA sequencing to screen all 33 exons and flanking intronic sequences of SPINK5 in the affected individuals of our cohort. Mutation analysis revealed 17 distinct mutations, 15 of which were novel, segregating in 14 Comèl-Netherton syndrome families. The nucleotide changes included four non-sense mutations, eight small deletions or insertions leading to frameshift, and five splice site defects, all of which are expected to result in premature terminated or altered translation of SPINK5. Almost half of the mutations clustered between exons 2 and 8, including two recurrent mutations. Genotype-phenotype correlations suggested that homozygous nucleotide changes resulting in early truncation of LEKT1 are associated with a severe phenotype. For the first time, we used molecular data to perform prenatal testing, thus demonstrating the feasibility of molecular diagnosis in the Comèl-Netherton syndrome.
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Affiliation(s)
- E Sprecher
- Department of Dermatology and Cutaneous Biology and Jefferson Institute of Molecular Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA
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Gambichler T, Senger E, Altmeyer P, Hoffmann K. Clearance of ichthyosis linearis circumflexa with balneophototherapy. J Eur Acad Dermatol Venereol 2000; 14:397-9. [PMID: 11305383 DOI: 10.1046/j.1468-3083.2000.00116.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a 13-year-old boy suffering from severe ichthyosis linearis circumflexa. Evidence of hair shaft abnormalities and impaired immunity could not be found. The patient was treated with salt water baths and artificial UVB radiation (balneophototherapy) 3-5 times weekly. After 40 treatments with balneophototherapy the skin lesions were almost completely cleared and maintenance UVB monotherapy was performed twice weekly for 2 months. After 4 months, however, the disease relapsed. Balneophototherapy presents a potentially effective and well tolerated phototherapeutic option for ichthyosis linearis circumflexa. As only short periods of remission may be expected, intermittent balneophototherapy would be probably necessary to control the disease.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Germany.
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