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Kern JS, Sprecher E, Fernandez MF, Schauer F, Bodemer C, Cunningham T, Löwe S, Davis C, Sumeray M, Bruckner AL, Murrell DF. Efficacy and safety of Oleogel-S10 (birch triterpenes) for epidermolysis bullosa: results from the phase III randomized double-blind phase of the EASE study. Br J Dermatol 2023; 188:12-21. [PMID: 36689495 DOI: 10.1093/bjd/ljac001] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a heterogeneous group of rare, difficult-to-treat, inherited multisystem diseases affecting epithelial integrity. Patients with EB are affected by mechanical fragility of epithelial surfaces including the skin and, as a result, extensive recurrent blistering is a characteristic of the condition. Chronic wounds predispose patients with EB to the development of squamous cell carcinoma, which is a major cause of premature death. OBJECTIVES EASE was a double-blind, randomized, vehicle-controlled, phase III study to determine the efficacy and safety of the topical gel Oleogel-S10 (birch triterpenes) in EB. EASE was funded by Amryt Research Limited. METHODS Patients with dystrophic EB, junctional EB or Kindler EB and a target partial-thickness wound lasting ≥ 21 days and < 9 months that was 10-50 cm2, were enrolled and randomized via computer-generated allocation tables 1 : 1 to Oleogel-S10 or control gel - both with standard-of-care dressings. Study gel was applied to all wounds at least every 4 days. The primary endpoint was the proportion of patients with first complete closure of target wound within 45 days. RESULTS A total of 223 patients were enrolled and treated (109 treated with Oleogel-S10, 114 with control gel). The primary endpoint was met; Oleogel-S10 resulted in 41·3% of patients with first complete target wound closure within 45 days, compared with 28·9% in the control gel arm (relative risk 1·44, 95% confidence interval (CI) 1·01-2·05; P = 0·013). Adverse events (AEs) occurred with similar frequency for Oleogel-S10 (81·7%) compared with control gel (80·7%). AEs were predominantly of mild-to-moderate intensity (4·6% were severe). CONCLUSIONS Oleogel-S10 is the first therapy to demonstrate accelerated wound healing in EB. Oleogel-S10 was well -tolerated.
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Affiliation(s)
- Johannes S Kern
- Dermatology Department, Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Science, The University of Melbourne, Parkville, VIC, Australia
- Department of Dermatology, Alfred Hospital, Central Clinical School, Monash University, Melbourne, Australia
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Franziska Schauer
- Department of Dermatology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine Bodemer
- Department of Dermatology, Expert Centre for Genodermatoses (MAGEC) Necker-Enfants Malades Hospital, University Paris Centre, Paris, France
| | | | | | | | | | - Anna L Bruckner
- University of Colorado School of Medicine, Department of Dermatology, Aurora, CO, USA
| | - Dédée F Murrell
- Department of Dermatology, St. George Hospital, University of New South Wales, Sydney, NSW, Australia
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Novalia Rahmawati Sianipar R, Suryanegara L, Fatriasari W, Tangke Arung E, Wijaya Kusuma I, Setiati Achmadi S, Izyan Wan Azelee N, Ain Abdul Hamid Z. The Role of Selected Flavonoids from Bajakah Tampala (Spatholobus littoralis Hassk.) Stem on Cosmetic Properties: A Review. Saudi Pharm J 2023; 31:382-400. [PMID: 37026052 PMCID: PMC10071331 DOI: 10.1016/j.jsps.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Abstract
Cosmetics made from natural ingredients are increasingly popular because they contain bioactive compounds which can provide many health benefits, more environmentally friendly and sustainable. The health benefits obtained from natural-based ingredients include anti-aging, photoprotective, antioxidant, and anti-inflammatory. This article reviewed the potential of selected flavonoids from bajakah tampala (Spatholobus littoralis Hassk.) as the native plant in Indonesia. We present in silico, in vitro, in vivo, and clinical research data on the use of selected flavonoids that have been reported in other extracts.
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Kalantari Y, Sadeghi S, Asadi D, Goodarzi A. A literature review on Janus kinase (JAK) inhibitors for the treatment of immunobullous disorders. Int Immunopharmacol 2022; 110:108923. [PMID: 35717838 DOI: 10.1016/j.intimp.2022.108923] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/01/2023]
Abstract
Janus kinases (JAKs) are a group of intracytoplasmic tyrosine kinase proteins that bind to the cytoplasmic part of the transmembrane cytokine receptors and regulate signaling. The pathophysiology of various autoimmune and autoinflammatory conditions relies on JAK/STAT signaling and therefore, the inhibition of JAK/STAT pathways can be a promising treatment for such diseases, especially inflammatory skin conditions. The current study aimed to evaluate the efficacy of JAK inhibitors in the treatment of immunobullous diseases, including pemphigus, pemphigoid, dermatitis herpetiformis, and epidermolysis bullosa. The databases used to identify the studies were Web of Science, Scopus, and PubMed/Medline for studies published until 2/3/2022. The current review suggests that JAK inhibitors may be revolutionary for the future treatments of dermatologic conditions, especially autoimmune bullous disease. Results also indicated the effectiveness of JAK inhibitors for the treatment of immunobullous diseases.
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Affiliation(s)
- Yasamin Kalantari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran; Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Sadeghi
- Department of Pediatrics, Division of Dermatology, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Delaram Asadi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Development and clinical translation of ex vivo gene therapy. Comput Struct Biotechnol J 2022; 20:2986-3003. [PMID: 35782737 PMCID: PMC9218169 DOI: 10.1016/j.csbj.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 11/27/2022] Open
Abstract
Retroviral gene therapy has emerged as a promising therapeutic modality for multiple inherited and acquired human diseases. The capability of delivering curative treatment or mediating therapeutic benefits for a long-term period following a single application fundamentally distinguishes this medical intervention from traditional medicine and various lentiviral/γ-retroviral vector-mediated gene therapy products have been approved for clinical use. Continued advances in retroviral vector engineering, genomic editing, synthetic biology and immunology will broaden the medical applications of gene therapy and improve the efficacy and safety of the treatments based on genetic correction and alteration. This review will summarize the advent and clinical translation of ex vivo gene therapy, with the focus on the milestones during the exploitation of genetically engineered hematopoietic stem cells (HSCs) tackling a variety of pathological conditions which led to marketing approval. Finally, current statue and future prospects of gene editing as an alternative therapeutic approach are also discussed.
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Farokhforghani S, Fatemi MJ, Ghanooni P, Asadpour F, Araghi S, Nouri A. Epidermolysis Bullosa Registry Data in Iran. World J Plast Surg 2021; 10:99-103. [PMID: 34912673 PMCID: PMC8662693 DOI: 10.29252/wjps.10.3.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 06/11/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In many countries, there is no registry system to record data for Epidermolysis Bullosa patients. However, the first steps for establishing a registry system have been taken in Iran. Therefore, we decided to publish it for the first time. METHODS This was a prospective cross-sectional study. Data was obtained from 538 patients consecutively enrolled in the Iranian Epidermolysis Bullosa Registry, using a detailed instrument created by burn research center of Iran University of Medical Sciences, Tehran, Iran from Jan 2017 to Sep 2017. Patients' information such as age, gender, address, educational status, parents' family relationship and pathology result were recorded. Then a physician examined patients focusing on gastrointestinal system, teeth, ophthalmologic disorders, psychological problems and contracture of the upper and lower limbs and any other complaint. Data entered SPSS ver.19 and analyzed using ANOVA and LSD tests. RESULTS Overall, 538 EB patients were registered in Iran (6.72 patient in 100.000 person) with an approximately equal ratio between males and females. Among 103 patients whose disease type was determined by a pathologist, 78 patients (75.7%) had dystrophic type, 13 (12.6%) junctional, 9 (8.7%) simplex and 3 (2.9%) kindler type. The most common complaint of patients was dysphagia followed by tooth damage. CONCLUSION We stablished a data registry for EB patients for the first time in Iran. The frequency of EB in Iran is less than many other countries. However, data completion is to be done to include all patients as possible.
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Affiliation(s)
| | | | - Parinaz Ghanooni
- Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Faraz Asadpour
- Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Araghi
- Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Afshin Nouri
- Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
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Huitema L, Phillips T, Alexeev V, Igoucheva O. Immunological mechanisms underlying progression of chronic wounds in recessive dystrophic epidermolysis bullosa. Exp Dermatol 2021; 30:1724-1733. [PMID: 34142388 PMCID: PMC9290674 DOI: 10.1111/exd.14411] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
Hereditary epidermolysis bullosa (EB) is a mechanobullous skin fragility disorder characterized by defective epithelial adhesion, leading to mechanical stress‐induced skin blistering. Based on the level of tissue separation within the dermal‐epidermal junction, EB is categorized into simplex (EBS), junctional (JEB), dystrophic (DEB) and Kindler syndrome. There is no cure for EB, and painful chronic cutaneous wounds are one of the major complications in recessive (RDEB) patients. Although RDEB is considered a cutaneous disease, recent data support the underlying systemic immunological defects. Furthermore, chronic wounds are often colonized with pathogenic microbiota, leading to excessive inflammation and altered wound healing. Consequently, patients with RDEB suffer from a painful sensation of chronic, cutaneous itching/burning and an endless battle with bacterial infections. To improve their quality of life and life expectancy, it is important to prevent cutaneous infections, dampen chronic inflammation and stimulate wound healing. A clear scientific understanding of the immunological events underlying the maintenance of chronic poorly healing wounds in RDEB patients is necessary to improve disease management and better understand other wound healing disorders. In this review, we summarize current knowledge of the role of professional phagocytes, such as neutrophils, macrophages and dendritic cells, the role of T‐cell‐mediated immunity in lymphoid organs, and the association of microbiota with poor wound healing in RDEB. We conclude that RDEB patients have an underlying immunity defect that seems to affect antibacterial immunity.
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Affiliation(s)
- Leonie Huitema
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Taylor Phillips
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vitali Alexeev
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Olga Igoucheva
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Jiang X, Zhu Y, Sun H, Gu F. A Novel Mutation p.L461P in KRT5 Causing Localized Epidermolysis Bullosa Simplex. Ann Dermatol 2020; 33:11-17. [PMID: 33911807 PMCID: PMC7875216 DOI: 10.5021/ad.2021.33.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/29/2020] [Accepted: 06/17/2020] [Indexed: 11/08/2022] Open
Abstract
Background Epidermolysis bullosa (EB) is a rare genetic disease with widely different clinical manifestations, but the relationship between genotype and phenotype is not fully understood. In the present study, we recruited a Chinese family in which two members had been diagnosed with localized EB simplex (EBS), with clinical manifestation, including blisters and erosions on the soles of the feet since infancy. Objective To identify and confirm the genetic variation in a Chinese family diagnosed as localized EBS. Methods Our study included two patients, other healthy members of the family, and 100 normal controls. Genomic DNA samples were isolated from each participant, and then polymerase chain reaction (PCR) direct sequencing was performed. Results The results of PCR direct sequencing revealed a novel heterozygous missense mutation in codon 461 of exon 7 of KRT5 (c.1382T>C), which led to an amino acid change (p.L461P) in the patients with EBS but was absent in unaffected family members and 100 unrelated control samples. Conclusion The present study broadens the mutational spectrum of EBS, and this knowledge could be harnessed for prenatal screening, gene diagnosis, and gene therapy for localized EBS.
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Affiliation(s)
- Xin Jiang
- Department of Dermatology, Tongling People's Hospital, Anhui, China
| | - Yingyu Zhu
- Department of Dermatology, Tongling People's Hospital, Anhui, China
| | - Huihui Sun
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China.,Genetic Disease Center, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Feng Gu
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, China.,Genetic Disease Center, School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Diversity of Mechanisms Underlying Latent TGF-β Activation in Recessive Dystrophic Epidermolysis Bullosa. J Invest Dermatol 2020; 141:1450-1460.e9. [PMID: 33333127 DOI: 10.1016/j.jid.2020.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 12/13/2022]
Abstract
Injury- and inflammation-driven progressive dermal fibrosis is a severe manifestation of recessive dystrophic epidermolysis bullosa-a genetic skin blistering disease caused by mutations in COL7A1. TGF-β activation plays a prominent part in progressing dermal fibrosis. However, the underlying mechanisms are not fully elucidated. TGF-β is secreted in a latent form, which has to be activated for its biological functions. In this study, we determined that recessive dystrophic epidermolysis bullosa fibroblasts have an enhanced capacity to activate the latent form. Mechanistic and functional assessment demonstrated that this process depends on multiple latent TGF-β activators, including TSP-1, RGD-binding integrins, matrix metalloproteinases, and ROS, which act in concert, in a self-perpetuating feedback loop to progress fibrosis. Importantly, our study also disclosed keratinocytes as prominent facilitators of fibrosis in recessive dystrophic epidermolysis bullosa. They stimulate microenvironmental latent TGF-β activation through enhanced production of the above mediators. Collectively, our study provides data on the molecular mechanism behind dysregulated TGF-β signaling in recessive dystrophic epidermolysis bullosa, which are much needed for the development of evidence-based fibrosis-delaying treatments.
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Krämer S, Lucas J, Gamboa F, Peñarrocha Diago M, Peñarrocha Oltra D, Guzmán‐Letelier M, Paul S, Molina G, Sepúlveda L, Araya I, Soto R, Arriagada C, Lucky AW, Mellerio JE, Cornwall R, Alsayer F, Schilke R, Antal MA, Castrillón F, Paredes C, Serrano MC, Clark V. Clinical practice guidelines: Oral health care for children and adults living with epidermolysis bullosa. SPECIAL CARE IN DENTISTRY 2020; 40 Suppl 1:3-81. [PMID: 33202040 PMCID: PMC7756753 DOI: 10.1111/scd.12511] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features. AIMS To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, principles of sedation, and general anesthesia for children and adults with EB undergoing dental treatment. METHODS Systematic literature search, panel discussion including clinical experts and patient representatives from different centers around the world, external review, and guideline piloting. RESULTS This article has been divided into five chapters: (i) general information on EB for the oral health care professional, (ii) systematic literature review on the oral manifestations of EB, (iii) oral health care and dental treatment for children and adults living with EB-clinical practice guidelines, (iv) dental implants in patients with RDEB-clinical practice guidelines, and (v) sedation and anesthesia for adults and children with EB undergoing dental treatment-clinical practice guidelines. Each chapter provides recommendations on the management of the different clinical procedures within dental practice, highlighting the importance of patient-clinician partnership, impact on quality of life, and the importance of follow-up appointments. Guidance on the use on nonadhesive wound care products and emollients to reduce friction during patient care is provided. CONCLUSIONS Oral soft and hard tissue manifestations of inherited EB have unique patterns of involvement associated with each subtype of the condition. Understanding each subtype individually will help the professionals plan long-term treatment approaches.
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Affiliation(s)
- Susanne Krämer
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
| | - James Lucas
- Dental DepartmentRoyal Children's HospitalMelbourneAustralia
| | | | | | | | - Marcelo Guzmán‐Letelier
- Hospital Base ValdiviaValdiviaChile
- Facultad de OdontologiaUniversidad San SebastiánValdiviaChile
| | | | - Gustavo Molina
- Universidad Nacional de CórdobaArgentina
- Universidad Católica de CórdobaArgentina
| | | | - Ignacio Araya
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
- Hospital Santiago OrienteMaxillofacial Surgery UnitChile
| | - Rubén Soto
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
| | | | - Anne W Lucky
- Cincinnati Children's Epidermolysis Bullosa CenterCincinnati Children's HospitalCincinnatiOhioUSA
- The University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Jemima E Mellerio
- St John's Institute of DermatologyGuy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Roger Cornwall
- Cincinnati Children's Epidermolysis Bullosa CenterCincinnati Children's HospitalCincinnatiOhioUSA
| | - Fatimah Alsayer
- Royal National ENT and Eastman Dental HospitalsUniversity College London HospitalsLondonUK
| | - Reinhard Schilke
- Hannover Medical SchoolDepartment of Conservative DentistryPeriodontology and Preventive DentistryHannoverGermany
| | | | | | - Camila Paredes
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
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Slac2-b Coordinates Extracellular Vesicle Secretion to Regulate Keratinocyte Adhesion and Migration. J Invest Dermatol 2020; 141:523-532.e2. [PMID: 32890627 DOI: 10.1016/j.jid.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/21/2022]
Abstract
Slac2-b, also known as exophilin-5, is a Rab27b effector protein with a role in exosome transport and is encoded by the EXPH5 gene. We previously described biallelic loss-of-function mutations in EXPH5 in an autosomal recessive form of epidermolysis bullosa simplex. However, how the loss of Slac2-b expression leads to skin fragility and erosions is unknown. In this study, we demonstrate that keratinocytes (KCs) isolated from two different individuals with mutations in EXPH5 have significant defects in cell‒matrix adhesion. EXPH5-mutant KCs also showed increased perinuclear accumulation and significantly reduced trafficking of CD63+ vesicles. These phenotypes were also seen in Slac2-b‒deficient KCs. This was coincident with a reduction in Rab27a protein expression in Slac2-b‒mutant KCs as well as reduced secretion of extracellular vesicles containing extracellular matrix proteins. Live imaging analysis revealed a strong correlation between CD63+ vesicle trafficking to the plasma membrane and focal adhesion dynamics. These findings support a role for Slac2-b in regulating local focal adhesion dynamics to support effective KC adhesion and provide insight into the underlying pathophysiology of inherited skin blistering.
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12
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Véliz S, Huber H, Yubero MJ, Fuentes I, Alsayer F, Krämer SM. Early teeth extraction in patients with generalized recessive dystrophic epidermolysis bullosa: A case series. SPECIAL CARE IN DENTISTRY 2020; 40:561-565. [PMID: 32880999 DOI: 10.1111/scd.12515] [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: 07/08/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To present early teeth extractions as a treatment option in severe dental crowding in patients with generalized recessive dystrophic epidermolysis bullosa (RDEB). MATERIALS AND METHODS Three patients with generalized RDEB were treated with early teeth extractions to prevent severe dental crowding. RESULTS Two patients had bilateral upper first premolars extraction, and the third patient had permanent maxillary canine extraction. Crowding was avoided, and no further orthodontic treatment was necessary. CONCLUSION Considering the challenges of severe mucosal fragility and microstomia in patients with generalized RDEB, early teeth extractions are a reasonable option as an orthodontic management. This approach reduces the severity of dental crowding as the child gets older and reduces the need for orthodontic appliances. Individual factors such as access to dental care, general health, and oral health have an important impact on the decision-making process. Orthodontic treatment planning should include a multidisciplinary team.
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Affiliation(s)
| | - Hinrich Huber
- Faculty of Dentistry, Universidad of Chile, Santiago, Chile
| | - María Joao Yubero
- DEBRA Chile Foundation, Santiago, Chile.,Faculty of Medicine Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ignacia Fuentes
- DEBRA Chile Foundation, Santiago, Chile.,Research Scientist, Genetics and Genomic Center, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Fatimah Alsayer
- Honorary Clinical Senior Lecturer, Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, London, United Kingdom
| | - Susanne M Krämer
- Faculty of Dentistry, Universidad of Chile, Santiago, Chile.,DEBRA Chile Foundation, Santiago, Chile
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Mellerio JE, Uitto J. Meeting Report: The First Global Congress on Epidermolysis Bullosa, EB2020 London: Toward Treatment and Cure. J Invest Dermatol 2020; 140:1681-1687. [DOI: 10.1016/j.jid.2020.05.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 02/08/2023]
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Pemmari T, Ivanova L, May U, Lingasamy P, Tobi A, Pasternack A, Prince S, Ritvos O, Makkapati S, Teesalu T, Cairo MS, Järvinen TAH, Liao Y. Exposed CendR Domain in Homing Peptide Yields Skin-Targeted Therapeutic in Epidermolysis Bullosa. Mol Ther 2020; 28:1833-1845. [PMID: 32497513 PMCID: PMC7403337 DOI: 10.1016/j.ymthe.2020.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/05/2020] [Accepted: 05/14/2020] [Indexed: 01/12/2023] Open
Abstract
Systemic skin-selective therapeutics would be a major advancement in the treatment of diseases affecting the entire skin, such as recessive dystrophic epidermolysis bullosa (RDEB), which is caused by mutations in the COL7A1 gene and manifests in transforming growth factor-β (TGF-β)-driven fibrosis and malignant transformation. Homing peptides containing a C-terminal R/KXXR/K motif (C-end rule [CendR] sequence) activate an extravasation and tissue penetration pathway for tumor-specific drug delivery. We have previously described a homing peptide CRKDKC (CRK) that contains a cryptic CendR motif and homes to angiogenic blood vessels in wounds and tumors, but it cannot penetrate cells or tissues. In this study, we demonstrate that removal of the cysteine from CRK to expose the CendR sequence confers the peptide novel ability to home to normal skin. Fusion of the truncated CRK (tCRK) peptide to the C terminus of an extracellular matrix protein decorin (DCN), a natural TGF-β inhibitor, resulted in a skin-homing therapeutic molecule (DCN-tCRK). Systemic DCN-tCRK administration in RDEB mice led to inhibition of TGF-β signaling in the skin and significant improvement in the survival of RDEB mice. These results suggest that DCN-tCRK has the potential to be utilized as a novel therapeutic compound for the treatment of dermatological diseases such as RDEB.
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Affiliation(s)
- Toini Pemmari
- Faculty of Medicine and Health Technology, Tampere University & Tampere University Hospital, 33520 Tampere, Finland
| | - Larisa Ivanova
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
| | - Ulrike May
- Faculty of Medicine and Health Technology, Tampere University & Tampere University Hospital, 33520 Tampere, Finland
| | - Prakash Lingasamy
- Laboratory of Cancer Biology, Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia
| | - Allan Tobi
- Laboratory of Cancer Biology, Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia
| | - Anja Pasternack
- Department of Physiology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Stuart Prince
- Faculty of Medicine and Health Technology, Tampere University & Tampere University Hospital, 33520 Tampere, Finland
| | - Olli Ritvos
- Department of Physiology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
| | - Shreya Makkapati
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA
| | - Tambet Teesalu
- Laboratory of Cancer Biology, Institute of Biomedicine and Translational Medicine, University of Tartu, 50411 Tartu, Estonia; Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, 10901 North Torrey Pines Road, La Jolla, CA 92037, USA; Center for Nanomedicine, University of California, Santa Barbara, CA 93106, USA
| | - Mitchell S Cairo
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA; Department of Microbiology and Immunology, New York Medical College, Valhalla, NY 10595, USA; Department of Pathology, New York Medical College, Valhalla, NY 10595, USA; Department of Medicine, New York Medical College, Valhalla, NY 10595, USA; Deparmtent of Cell Biology and Anatomy, New York Medical College, Valhalla, NY 10595, USA
| | - Tero A H Järvinen
- Faculty of Medicine and Health Technology, Tampere University & Tampere University Hospital, 33520 Tampere, Finland.
| | - Yanling Liao
- Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA.
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Yang N, Ma Y, Yao H, Chang Q, Zhang V, Liang Z, Cai X. Novel biallelic variants in COL7A1 cause recessive dystrophic epidermolysis bullosa. Mol Genet Genomic Med 2020; 8:e1347. [PMID: 32537942 PMCID: PMC7434731 DOI: 10.1002/mgg3.1347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/17/2022] Open
Abstract
Background Autosomal recessive dystrophic epidermolysis bullosa (RDEB) is an incurable and severe inherited skin disorder characterized by recurrent blistering at the sublamina densa beneath the cutaneous basement membrane. It is caused by biallelic loss‐of‐function mutation in the gene encoding type VII collagen (COL7A1). This study aimed to identify the causative variants of a Chinese RDEB patient and further provide prenatal diagnosis for the ongoing risk pregnancy of the proband's mother. Methods Clinical exome sequencing (CES) has been performed and an in‐house pipeline was used to conduct a phenotype‐driven data analysis. A minigene assay was used to verify the pathogenicity of a novel splice site variant in the COL7A1. Results Here we report two compound heterozygous variants in COL7A1, c.3867delT (p.G1290Efs*35) and c.5532+4_5532+5delAG, identified in a RDEB patient by CES. The minigene assay confirmed that thec.5532+4_5532+5delAGchange was a noncanonic splice site variant leading to in an in‐frame deletion of exon 64. Prenatal diagnosis indicated that the present pregnancy of the patient's mother was not affected. Conclusion Our study expands the mutation spectrum of COL7A1 and demonstrated that CES and minigene assays were efficient tools for RDEB molecular diagnoses.
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Affiliation(s)
- Neng Yang
- Key Laboratory of Freshwater Fish Reproduction and Development, Ministry of Education, Laboratory of Molecular Developmental Biology, School of Life Sciences, Southwest University, Chongqing, China.,Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yongyi Ma
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Hong Yao
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Qing Chang
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Victor Zhang
- Department of Human and Molecular Genetics, Baylor College of Medicine, Houston, TX, USA.,AmCare Genomics Lab, Guangzhou, China
| | - Zhiqing Liang
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiongwei Cai
- Department of Gynecology & Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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