1
|
Feinstein JA, Jambal P, Peoples K, Lucky AW, Khuu P, Tang JY, Lara-Corrales I, Pope E, Wiss K, Hook KP, Levin LE, Morel KD, Paller AS, McCuaig CC, Powell J, Eichenfield LF, Price H, Levy ML, Schachner LA, Browning JC, Bayliss S, Jahnke M, Shwayder T, Glick SA, Bruckner AL. Assessment of the Timing of Milestone Clinical Events in Patients With Epidermolysis Bullosa From North America. JAMA Dermatol 2019; 155:196-203. [PMID: 30586139 DOI: 10.1001/jamadermatol.2018.4673] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Children with epidermolysis bullosa (EB) comprise a rare population with high morbidity and mortality. An improved understanding of the clinical trajectory of patients with EB, including age at time of clinical diagnosis and major clinical events, is needed to refine best practices and improve quality of life and clinical outcomes for patients with EB. Objectives To describe demographics, clinical characteristics, milestone diagnostic and clinical events (such as initial esophageal dilation), and outcomes in patients with EB using the Epidermolysis Bullosa Clinical Characterization and Outcomes Database and to determine what characteristics may be associated with overall EB severity and/or disease progression. Design, Setting, and Participants This cohort study included data on patients with EB who were enrolled in the Epidermolysis Bullosa Clinical Characterization and Outcomes Database from January 1, 2011, to June 30, 2017; 17 participating EB centers in the United States and Canada contributed data to this study. Exposures Type of EB, including recessive dystrophic epidermolysis bullosa (RDEB), junctional epidermolysis bullosa (JEB), dominant dystrophic epidermolysis bullosa (DDEB), and epidermolysis bullosa simplex (EBS). Main Outcomes and Measures Demographic information, clinical characteristics (including age at onset of signs of EB and subsequent clinical diagnosis), types of diagnostic testing performed, and milestone clinical events for patients with RDEB. Results Of 644 enrolled patients from 17 sites included in this study, 323 were male (50.2%), with a mean (SD) age of 14.4 (11.7) years; 283 (43.9%) had RDEB, 194 (30.1%) had EBS, 104 (16.2%) had DDEB, and 63 (9.8%) had JEB. Signs of disease were present at birth in 202 patients with RDEB (71.4%), 39 with JEB (61.9%), 60 with DDEB (57.7%), and 74 with EBS (38.1%). For those with signs of disease at birth, a clinical diagnosis was made at the time of birth in 135 patients with RDEB (67.0%), 31 with DDEB (52.6%), 35 with EBS, (47.3%) and 18 with JEB (46.2%). Patients with JEB had the highest rate of any confirmatory testing (51 of 63 [81.0%]), followed by RDEB (218 of 283 [77.0%]), DDEB (71 of 104 [68.3%]), and EBS (100 of 194 [51.5%]). For all types of EB, both electron microscopy and immunofluorescence microscopy were performed at younger ages than genetic analysis. Among 283 patients with RDEB, 157 (55.5%) had esophageal dilation, 104 (36.7%) had gastrostomy tube placement, 62 (21.9%) had hand surgery, 18 (6.4%) developed squamous cell carcinoma, and 19 (6.7%) died. Conclusions and Relevance The findings suggest that diagnostic testing for EB is more common for patients with severe phenotypes. Earlier diagnostic testing may enable improved characterizations of patients so that appropriate counseling and clinical care may be offered, especially pertaining to milestone events for those with RDEB.
Collapse
Affiliation(s)
- James A Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora.,Children's Hospital Colorado, Aurora
| | - Purevsuren Jambal
- Department of Dermatology, University of Colorado School of Medicine, Aurora
| | | | - Anne W Lucky
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Phuong Khuu
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, Stanford, California
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elena Pope
- Section of Dermatology, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen Wiss
- Division of Dermatology, Department of Medicine, University of Massachusetts Medical School, Worcester
| | - Kristen P Hook
- Department of Dermatology, University of Minnesota Medical School, Minneapolis
| | - Laura E Levin
- Department of Dermatology, Columbia Irving Medical Center, New York, New York
| | - Kimberly D Morel
- Department of Dermatology, Columbia Irving Medical Center, New York, New York.,Department of Pediatrics, Columbia Irving Medical Center, New York, New York
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | | | - Julie Powell
- CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Lawrence F Eichenfield
- Department of Dermatology, University of California San Diego, San Diego.,Department of Pediatrics, University of California San Diego, San Diego.,Department of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Harper Price
- Department of Dermatology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Moise L Levy
- Departments of Internal Medicine, Dell Medical School, University of Texas, Austin.,Departments of Pediatrics, Dell Medical School, University of Texas, Austin.,Department of Pediatric Dermatology, Dell Children's Medical Center, Austin, Texas
| | - Lawrence A Schachner
- Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
| | - John C Browning
- Department of Pediatric Dermatology, Children's Hospital San Antonio, San Antonio, Texas
| | - Susan Bayliss
- Division of Dermatology, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Marla Jahnke
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Tor Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Sharon A Glick
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn
| | - Anna L Bruckner
- Department of Pediatrics, University of Colorado School of Medicine, Aurora.,Children's Hospital Colorado, Aurora.,Department of Dermatology, University of Colorado School of Medicine, Aurora.,Associate Editor
| |
Collapse
|
2
|
Bhattacharjee O, Ayyangar U, Kurbet AS, Ashok D, Raghavan S. Unraveling the ECM-Immune Cell Crosstalk in Skin Diseases. Front Cell Dev Biol 2019; 7:68. [PMID: 31134198 PMCID: PMC6514232 DOI: 10.3389/fcell.2019.00068] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/09/2019] [Indexed: 01/06/2023] Open
Abstract
The extracellular matrix (ECM) is a complex network of proteins and proteoglycans secreted by keratinocytes, fibroblasts and immune cells. The function of the skin ECM has expanded from being a scaffold that provides structural integrity, to a more dynamic entity that is constantly remodeled to maintain tissue homeostasis. The ECM functions as ligands for cell surface receptors such as integrins, dystroglycans, and toll-like receptors (TLRs) and regulate cellular signaling and immune cell dynamics. The ECM also acts as a sink for growth factors and cytokines, providing critical cues during epithelial morphogenesis. Dysregulation in the organization and deposition of ECMs lead to a plethora of pathophysiological conditions that are exacerbated by aberrant ECM-immune cell interactions. In this review, we focus on the interplay between ECM and immune cells in the context of skin diseases and also discuss state of the art therapies that target the key molecular players involved.
Collapse
Affiliation(s)
- Oindrila Bhattacharjee
- School of Chemical and Biotechnology, Sastra University, Thanjavur, India
- Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Uttkarsh Ayyangar
- School of Chemical and Biotechnology, Sastra University, Thanjavur, India
- Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Ambika S. Kurbet
- School of Chemical and Biotechnology, Sastra University, Thanjavur, India
- Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Driti Ashok
- Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Srikala Raghavan
- Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| |
Collapse
|
3
|
Yoon D, Yoon D, Sim H, Hwang I, Lee JS, Chun W. Accelerated Wound Healing by Fibroblasts Differentiated from Human Embryonic Stem Cell-Derived Mesenchymal Stem Cells in a Pressure Ulcer Animal Model. Stem Cells Int 2018; 2018:4789568. [PMID: 30693037 PMCID: PMC6332923 DOI: 10.1155/2018/4789568] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/04/2018] [Accepted: 09/23/2018] [Indexed: 02/07/2023] Open
Abstract
Fibroblasts synthesize and secrete dermal collagen, matrix proteins, growth factors, and cytokines. These characteristics of fibroblasts provide a potential way for fibroblast therapy to treat skin ulcers more effectively than conventional therapies such as cytokine therapy and negative pressure wound therapy. However, the obstacle to the commercialization of fibroblast therapy is the limited supply of cells with consistent quality. In this study, we tested whether human embryonic stem cell-derived mesenchymal stem cells (hESC-MSCs) could be differentiated into fibroblasts considering that they have characteristics of high differentiation rates, unlimited proliferation possibility from a single colony, and homogeneity. As a result, hESC-MSC-derived fibroblasts (hESC-MSC-Fbs) showed a significant increase in the expression of type I and III collagen, fibronectin, and fibroblast-specific protein-1 (FSP-1). Besides, vessel formation and wound healing were enhanced in hESC-MSC-Fb-treated skin tissues compared to PBS- or hESC-MSC-treated skin tissues, along with decreased IL-6 expression at 4 days after the formation of pressure ulcer wound in a mouse model. In view of the limited available cell sources for fibroblast therapy, hESC-MSC-Fbs show a promising potential as a commercial cell therapy source to treat skin ulcers.
Collapse
Affiliation(s)
- Dajeong Yoon
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Dogeon Yoon
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Heejoong Sim
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Inseok Hwang
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Ji-Seon Lee
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Wook Chun
- Burn Institute, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
- Department of Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| |
Collapse
|
4
|
Uitto J, Has C, Vahidnezhad H, Youssefian L, Bruckner-Tuderman L. Molecular pathology of the basement membrane zone in heritable blistering diseases:: The paradigm of epidermolysis bullosa. Matrix Biol 2016; 57-58:76-85. [PMID: 27496350 DOI: 10.1016/j.matbio.2016.07.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/19/2016] [Accepted: 07/28/2016] [Indexed: 01/03/2023]
Abstract
Epidermolysis bullosa (EB), a phenotypically heterogeneous group of skin fragility disorders, is characterized by blistering and erosions with considerable morbidity and mortality. Mutations in as many as 18 distinct genes expressed at the cutaneous basement membrane zone have been shown to be associated with the blistering phenotype, attesting to the role of the corresponding proteins in providing stable association of the epidermis to the dermis through adhesion at the dermo-epidermal basement membrane zone. Thus, different forms of EB have been highly instructive in providing information on the physiological functions of these proteins as integral components of the supramolecular adhesion complexes. In addition, precise information of the underlying genes and distinct mutations in families with EB has been helpful in subclassification of the disease with prognostic implications, as well as for prenatal testing and preimplantation genetic diagnosis. Furthermore, knowledge of the types of mutations is a prerequisite for application of allele-specific treatment approaches that have been recently developed, including read-through of premature termination codon mutations and chaperone-facilitated intracellular transport of conformationally altered proteins to proper physiologic subcellular location. Collectively, EB serves as a paradigm of heritable skin diseases in which significant progress has been made in identifying the underlying genetic bases and associated aberrant pathways leading from mutations to the phenotype, thus allowing application of precision medicine for this, currently intractable group of diseases.
Collapse
Affiliation(s)
- Jouni Uitto
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Cristina Has
- Department of Dermatology, University of Freiburg, Freiburg, Germany
| | - Hassan Vahidnezhad
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Biotechnology Research Center, Department of Molecular Medicine, Pasteur Institute of Iran, Tehran, Iran
| | - Leila Youssefian
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | |
Collapse
|
5
|
Azagury A, Khoury L, Enden G, Kost J. Ultrasound mediated transdermal drug delivery. Adv Drug Deliv Rev 2014; 72:127-43. [PMID: 24463344 DOI: 10.1016/j.addr.2014.01.007] [Citation(s) in RCA: 133] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 12/24/2013] [Accepted: 01/14/2014] [Indexed: 01/06/2023]
Abstract
Transdermal drug delivery offers an attractive alternative to the conventional drug delivery methods of oral administration and injections. However, the stratum corneum serves as a barrier that limits the penetration of substances to the skin. Application of ultrasound (US) irradiation to the skin increases its permeability (sonophoresis) and enables the delivery of various substances into and through the skin. This review presents the main findings in the field of sonophoresis in transdermal drug delivery as well as transdermal monitoring and the mathematical models associated with this field. Particular attention is paid to the proposed enhancement mechanisms and future trends in the fields of cutaneous vaccination and gene therapy.
Collapse
Affiliation(s)
- Aharon Azagury
- Department of Chemical Engineering, Ben-Gurion University, Beer-Sheva 84105, Israel
| | - Luai Khoury
- Department of Biomedical Engineering, Ben-Gurion University, Beer-Sheva 84105, Israel
| | - Giora Enden
- Department of Biomedical Engineering, Ben-Gurion University, Beer-Sheva 84105, Israel
| | - Joseph Kost
- Department of Chemical Engineering, Ben-Gurion University, Beer-Sheva 84105, Israel.
| |
Collapse
|
6
|
Kern JS, Has C. Update on diagnosis and therapy of inherited epidermolysis bullosa. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.3.6.721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Kopecki Z, Arkell RM, Strudwick XL, Hirose M, Ludwig RJ, Kern JS, Bruckner-Tuderman L, Zillikens D, Murrell DF, Cowin AJ. Overexpression of the Flii
gene increases dermal-epidermal blistering in an autoimmune ColVII mouse model of epidermolysis bullosa acquisita. J Pathol 2011; 225:401-13. [PMID: 21984127 DOI: 10.1002/path.2973] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 07/18/2011] [Indexed: 11/06/2022]
Affiliation(s)
- Zlatko Kopecki
- Women's and Children's Health Research Institute, 72 King William Road, North Adelaide, SA, Australia
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Pompholyx is a vesicobullous disorder of the palms and soles. The condition is hard to treat because of the peculiarities of the affected skin, namely the thick horny layer and richness of the sweat glands. In this article, we review the available therapies, and score the treatments according to the level of evidence. The cornerstones of topical therapy are corticosteroids, although calcineurin inhibitors also seem to be effective. Topical photochemotherapy with methoxsalen (8-methoxypsoralen) is as effective as systemic photochemotherapy or high-dose UVA-1 irradiation. Systemic therapy is often necessary in bullous pompholyx. Corticosteroids are commonly used although no controlled study has been published to date. For recalcitrant cases, corticosteroids are combined with immunosuppressants. Alitretinoin has efficacy in chronic hand dermatitis including pompholyx. Another evolving treatment seems to be the intradermal injection of botulinum toxin. Radiotherapy might be an option for selected patients not responding to conventional treatment. In practice, patients benefit most from a combination of treatments.
Collapse
Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden Friedrichstadt, Germany.
| |
Collapse
|
9
|
Kiuru M, Itoh M, Cairo MS, Christiano AM. Bone marrow stem cell therapy for recessive dystrophic epidermolysis bullosa. Dermatol Clin 2010; 28:371-82, xii-xiii. [PMID: 20447506 DOI: 10.1016/j.det.2010.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is a severe inherited blistering disease caused by mutations in the type VII collagen gene, resulting in defective anchoring fibrils at the epidermal-dermal junction. At present, no curative treatment for RDEB exists. Mounting evidence on reprogramming of bone marrow stem cells into skin has prompted the authors and others to develop novel strategies for treatment of RDEB. The rationale for bone marrow stem cell therapies for RDEB is based on the evidence that bone marrow-derived cells are guided into becoming skin cells, given the right microenvironment. Preclinical studies in mouse models have shown that wild-type bone marrow-derived cells can ameliorate the phenotype of RDEB and improve survival by restoring the expression of type VII collagen and the anchoring fibrils. At present, several clinical studies are ongoing around the world to study the therapeutic effects of bone marrow stem cell transplantation for RDEB. These studies provide a framework for future development of standardized, effective methods for stem cell transplantation to cure severe inherited skin diseases, including RDEB.
Collapse
Affiliation(s)
- Maija Kiuru
- Department of Dermatology, Columbia University, New York, NY 10032, USA
| | | | | | | |
Collapse
|
10
|
Yan WF, Murrell DF. Fibroblast-based cell therapy strategy for recessive dystrophic epidermolysis bullosa. Dermatol Clin 2010; 28:367-70, xii. [PMID: 20447505 DOI: 10.1016/j.det.2010.01.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dystrophic epidermolysis bullosa (DEB) is a severe skin fragility disorder associated with trauma-induced blistering, progressive soft tissue scarring, and increased risk of skin cancer. DEB is caused by mutations in the COL7A1 gene which result in reduced, truncated, or absent type VII collagen, and anchoring fibrils at the dermal-epidermal junction (DEJ). Because no topical wound-healing agents have shown unequivocal benefit in the treatment of DEB, alternative approaches are needed. The purpose of cell therapy for recessive DEB is to increase the amount of collagen VII in the basement membrane zone in order to heal wounds and prevent further wound formation. Fibroblast-based cell therapy is safe and easy to work with, has few side effects, can dramatically restore stable collagen VII at the DEJ, and can normalize the substructure changes of DEB for at least a few months. Even though the mechanism and the duration of newly produced collagen VII at the DEJ are still unknown, this form of cell therapy provides a new effective approach to the treatment of recessive DEB.
Collapse
Affiliation(s)
- W F Yan
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia
| | | |
Collapse
|
11
|
Anesthesia for balloon dilatation of esophageal strictures in children with epidermolysis bullosa dystrophica: from intubation to sedation. Curr Opin Anaesthesiol 2010; 23:518-22. [DOI: 10.1097/aco.0b013e32833bb50b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Minicucci EM, Barraviera SRCS, Miot H, Almeida-Lopes L. Low-level laser therapy for the treatment of epidermolysis bullosa: A case report. J COSMET LASER THER 2010; 12:203-5. [DOI: 10.3109/14764172.2010.502460] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Abstract
Dystrophic epidermolysis bullosa (DEB) is relatively well understood. Potential therapies are in development. This article describes the pathogenesis and clinical features of DEB. It also describes therapeutic options and the future of molecular therapies.
Collapse
|
14
|
Munro CS. Molecular genetics of the skin: the implications of understanding. Clin Med (Lond) 2009; 9:591-2. [PMID: 20095307 PMCID: PMC4952303 DOI: 10.7861/clinmedicine.9-6-591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
During recent decades, discoveries in genetic skin disease have produced insights into the biology of the skin, and in some cases permitted preventive prenatal diagnosis, but application of this knowledge in palliation or cure remains a tantalising prospect.
Collapse
Affiliation(s)
- Colin S Munro
- Alan Lyell Centre for Dermatology, Southern General Hospital, Glasgow.
| |
Collapse
|
15
|
Uitto J. Progress in heritable skin diseases: translational implications of mutation analysis and prospects of molecular therapies*. Acta Derm Venereol 2009; 89:228-35. [PMID: 19479117 DOI: 10.2340/00015555-0648] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Epidermolysis bullosa, a group of blistering disorders, serves as the paradigm of the tremendous progress made in understanding the molecular genetics of heritable skin diseases. Mutations in 10 distinct genes have been disclosed in the classic forms of epidermolysis bullosa, and the level of expression of the mutated genes within the cutaneous basement membrane zone, the types and combinations of mutations and their consequences at the mRNA and protein levels, when placed in the context of the individual's genetic background and exposure to environmental trauma, all determine the subtype and the phenotypic severity in each case. The translational implications of mutation analysis include improved diagnosis and subclassification, refined genetic counseling of families at risk, and development of DNA-based pre natal and preimplantation genetic diagnosis. The prospects of molecular therapies for epidermolysis bullosa include further development of strategies for gene therapy, protein replacement therapy and cell-based therapies, including stem cell therapy and bone marrow transfer. Collectively, advances in the molecular genetics of heritable skin diseases clearly emphasize the value of basic research for improved diagnostics and patient care for genetic skin diseases.
Collapse
Affiliation(s)
- Jouni Uitto
- Department of Dermatology, and Cutaneous Biology , Jefferson Medical College, and Jefferson Institute of Molecular Medicine, Thomas Jefferson University , 233 South 10th Street, Suite 450 BLSB, USA.
| |
Collapse
|
16
|
Kern JS, Loeckermann S, Fritsch A, Hausser I, Roth W, Magin TM, Mack C, Müller ML, Paul O, Ruther P, Bruckner-Tuderman L. Mechanisms of fibroblast cell therapy for dystrophic epidermolysis bullosa: high stability of collagen VII favors long-term skin integrity. Mol Ther 2009; 17:1605-15. [PMID: 19568221 PMCID: PMC2835252 DOI: 10.1038/mt.2009.144] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 06/05/2009] [Indexed: 02/02/2023] Open
Abstract
Here, we report on the first systematic long-term study of fibroblast therapy in a mouse model for recessive dystrophic epidermolysis bullosa (RDEB), a severe skin-blistering disorder caused by loss-of-function of collagen VII. Intradermal injection of wild-type (WT) fibroblasts in >50 mice increased the collagen VII content at the dermal-epidermal junction 3.5- to 4.7-fold. Although the active biosynthesis lasted <28 days, collagen VII remained stable and dramatically improved skin integrity and resistance to mechanical forces for at least 100 days, as measured with a digital 3D-skin sensor for shear forces. Experiments using species-specific antibodies, collagen VII-deficient fibroblasts, gene expression analyses, and cytokine arrays demonstrated that the injected fibroblasts are the major source of newly deposited collagen VII. Apart from transitory mild inflammation, no adverse effects were observed. The cells remained within an area
Collapse
Affiliation(s)
- Johannes S Kern
- Deparment of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
|
18
|
Abstract
The collagens represent a family of trimeric extracellular matrix molecules used by cells for structural integrity and other functions. The three alpha chains that form the triple helical part of the molecule are composed of repeating peptide triplets of glycine-X-Y. X and Y can be any amino acid but are often proline and hydroxyproline, respectively. Flanking the triple helical regions (i.e., Col domains) are non-glycine-X-Y regions, termed non-collagenous domains. These frequently contain recognizable peptide modules found in other matrix molecules. Proper tissue function depends on correctly assembled molecular aggregates being incorporated into the matrix. This review highlights some of the structural characteristics of collagen types I-XXVIII.
Collapse
|
19
|
Molecular therapies for heritable blistering diseases. Trends Mol Med 2009; 15:285-92. [DOI: 10.1016/j.molmed.2009.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/07/2009] [Accepted: 05/07/2009] [Indexed: 11/16/2022]
|
20
|
Anum EA, Hill LD, Pandya A, Strauss JF. Connective tissue and related disorders and preterm birth: clues to genes contributing to prematurity. Placenta 2009; 30:207-15. [PMID: 19152976 DOI: 10.1016/j.placenta.2008.12.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2008] [Revised: 12/15/2008] [Accepted: 12/16/2008] [Indexed: 01/09/2023]
Abstract
To identify candidate genes contributing to preterm birth, we examined the existing literature on the association between known disorders of connective tissue synthesis and metabolism and related diseases and prematurity. Our hypothesis was that abnormal matrix metabolism contributes to prematurity by increasing risk of preterm premature rupture of membranes (PPROM) and cervical incompetence. Based on this review, we identified gene mutations inherited by the fetus that could predispose to preterm birth as a result of PPROM. The responsible genes include COL5A1, COL5A2, COL3A1, COL1A1, COL1A2, TNXB, PLOD1, ADAMTS2, CRTAP, LEPRE1 and ZMPSTE24. Marfan syndrome, caused by FBN1 mutations, and polymorphisms in the COL1A1 and TGFB1 genes have been associated with cervical incompetence. We speculate that an analysis of sequence variation at the loci noted above will reveal polymorphisms that may contribute to susceptibility to PPROM and cervical incompetence in the general population.
Collapse
Affiliation(s)
- E A Anum
- Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | | | | | | |
Collapse
|
21
|
|