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Ouahed JD, Griffith A, Collen LV, Snapper SB. Breaking Down Barriers: Epithelial Contributors to Monogenic IBD Pathogenesis. Inflamm Bowel Dis 2024; 30:1189-1206. [PMID: 38280053 DOI: 10.1093/ibd/izad319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Indexed: 01/29/2024]
Abstract
Monogenic causes of inflammatory bowel diseases (IBD) are increasingly being discovered. To date, much attention has been placed in those resulting from inborn errors of immunity. Therapeutic efforts have been largely focused on offering personalized immune modulation or curative bone marrow transplant for patients with IBD and underlying immune disorders. To date, less emphasis has been placed on monogenic causes of IBD that pertain to impairment of the intestinal epithelial barrier. Here, we provide a comprehensive review of monogenic causes of IBD that result in impaired intestinal epithelial barrier that are categorized into 6 important functions: (1) epithelial cell organization, (2) epithelial cell intrinsic functions, (3) epithelial cell apoptosis and necroptosis, (4) complement activation, (5) epithelial cell signaling, and (6) control of RNA degradation products. We illustrate how impairment of any of these categories can result in IBD. This work reviews the current understanding of the genes involved in maintaining the intestinal barrier, the inheritance patterns that result in dysfunction, features of IBD resulting from these disorders, and pertinent translational work in this field.
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Affiliation(s)
- Jodie D Ouahed
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra Griffith
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren V Collen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Scott B Snapper
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
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2
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Mattioli G, Diociaiuti A, Rossi S, Zambruno G, Carlucci M, Pisaneschi E, El Hachem M. ITGB4-mutated Junctional Epidermolysis Bullosa without Pyloric Atresia Presenting with Severe Urinary Involvement and Late-onset Minimal Skin Fragility: Diagnostic and Therapeutic Challenges. Acta Derm Venereol 2022; 102:adv00706. [DOI: 10.2340/actadv.v102.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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3
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DeMaria KA, Fink C, Pepper M, Rieger K, Tan SY, Namjoshi SS. Intestinal Failure in Junctional Epidermolysis Bullosa: Mild Skin Disease, Severe Diarrhea. Dig Dis Sci 2022; 67:1740-1743. [PMID: 35147818 DOI: 10.1007/s10620-022-07410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Karen A DeMaria
- Division of Pediatric Gastroenterology, Stanford University School of Medicine & the Lucile Packard Children's Hospital, 750 Welch Road- Suite 116, Palo Alto, CA, 94304, USA.
| | - Christopher Fink
- Division of Pediatric Gastroenterology, Stanford University School of Medicine & the Lucile Packard Children's Hospital, 750 Welch Road- Suite 116, Palo Alto, CA, 94304, USA
| | - Michael Pepper
- Department of Pathology, Stanford University School of Medicine, Palo Alto, USA
| | - Kerri Rieger
- Department of Pathology, Stanford University School of Medicine, Palo Alto, USA
| | - Serena Y Tan
- Department of Pathology, Stanford University School of Medicine, Palo Alto, USA
| | - Shweta S Namjoshi
- Division of Pediatric Gastroenterology, Stanford University School of Medicine & the Lucile Packard Children's Hospital, 750 Welch Road- Suite 116, Palo Alto, CA, 94304, USA
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4
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Soyer T, Karaosmanoglu B, Taskiran EZ, Kiper PÖŞ, Karnak İ, Boduroğlu K, Utine GE. Biallelic ITGB4 variants in familial pyloric atresia without epidermolysis bullosa: Report of two families with five siblings. Am J Med Genet A 2021; 185:3427-3432. [PMID: 34403180 DOI: 10.1002/ajmg.a.62462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/11/2022]
Abstract
Pyloric atresia (PA) is a rare gastrointestinal anomaly that occurs either as an isolated lesion or in association with other congenital or hereditary anomalies. Familial occurrence of PA with epidermolysis bullosa (EB) has been well documented and variants in ITGA6, ITGB4, and PLEC are known to cause EB with PA. However, no gene variants have been defined in familial isolated PA. Five siblings with familial isolated PA are presented that suggest biallelic ITGB4 variants may underlie the development of PA without EB. Five siblings from two unrelated families with isolated PA were studied with exome sequencing (ES) to identify the genetic etiology in isolated familial cases. Exome sequencing was performed in one affected patient from each family. Validation and segregation studies were done by Sanger sequencing. Parents were first cousins in one family but there was no consanguinity in the other family. Type-2 PA was detected in both families and none of the probands had associated anomalies. All patients underwent successful gastroduodenostomy and have been under follow-up uneventfully. All patients had biallelic ITGB4 variants, c.2032G > T p.(Asp678Tyr) being a novel one. Biallelic ITGB4 variants may underlie the development of PA without associated EB. Further detection of variants in this gene may establish any possible genotype-phenotype correlations.
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Affiliation(s)
- Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Beren Karaosmanoglu
- Department of Medical Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ekim Z Taskiran
- Department of Medical Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | | | - İbrahim Karnak
- Department of Pediatric Surgery, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Koray Boduroğlu
- Department of Pediatric Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gülen Eda Utine
- Department of Pediatric Genetics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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5
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Wee LWY, Tan EC, Bishnoi P, Ng YZ, Lunny DP, Lim HW, Lee SP, Ong C, Yap TL, Mok YH, Low MY, Chu-Tian Chow C, Derrick L, Common JEA, Birgitte Lane E, Koh MJA. Epidermolysis bullosa with pyloric atresia associated with compound heterozygous ITGB4 pathogenic variants: Minimal skin involvement but severe mucocutaneous disease. Pediatr Dermatol 2021; 38:908-912. [PMID: 34152038 DOI: 10.1111/pde.14668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a case of junctional epidermolysis bullosa with pyloric atresia (JEB-PA) with minimal skin involvement but severe protein-losing enteropathy and airway involvement. Genetic analysis revealed heterozygous mutations in the ITGB4 gene encoding integrin β4 protein. Parental testing confirmed inheritance of frameshift variant (c.794dupC) as maternal and splice site variant (c.1608C>T/p.Cys536Cys) as paternal. Immunofluorescence mapping of her skin revealed a subepidermal blister with decreased and frayed integrin β4 at both the floor and the roof of the blister, while the intestinal mucosa showed complete absence of integrin β4. We review the literature and discuss the differential expression of integrins in the skin and gastrointestinal tract, as well as the role of chronic inflammation in the pathogenesis of EB.
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Affiliation(s)
- Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ene Choo Tan
- Research Laboratory, KK Women's and Children's Hospital, Singapore, Singapore.,Genetics Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Priya Bishnoi
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yi Zhen Ng
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Declan Patrick Lunny
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Hwee-Woon Lim
- Research Laboratory, KK Women's and Children's Hospital, Singapore, Singapore
| | - Siew-Peng Lee
- Research Laboratory, KK Women's and Children's Hospital, Singapore, Singapore
| | - Christina Ong
- Paediatric Gastroenterology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Te Lu Yap
- Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yee Hui Mok
- Children's Intensive Care, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mei Yi Low
- Paediatric ENT, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Lian Derrick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - John Edmund Armourer Common
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Ellen Birgitte Lane
- Institute of Medical Biology and Skin Research Institute of Singapore, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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6
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Ellis C, Eason C, Snyder A, Siegel M, Pai GS, Ryan E, Pfendner EG, Lee LW. Novel missense p.R252L mutation of ITGB4 compounded with known 3793+1G>A mutation associated with nonlethal epidermolysis bullosa-pyloric atresia with obstructive uropathy. JAAD Case Rep 2021; 11:63-68. [PMID: 33937469 PMCID: PMC8076645 DOI: 10.1016/j.jdcr.2021.03.016] [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: 11/29/2022] Open
Affiliation(s)
- Carter Ellis
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Chelsea Eason
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Alan Snyder
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mark Siegel
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Gurpur Shashidhar Pai
- Department of Genetics, Medical University of South Carolina, Charleston, South Carolina
| | - Erin Ryan
- Clinical Genomics Program, GeneDx Inc, Gaithersburg, Maryland
| | - Ellen G Pfendner
- Epidermolysis Bullosa Diagnostics Program, GeneDx Inc, Gaithersburg, Maryland
| | - Lara Wine Lee
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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Muensterer OJ, Paul NW. Über die Problematik der klinischen Entscheidungsfindung aufgrund von Fallbeschreibungen – ethische Implikationen am Beispiel eines Falls von Carmi Syndrom. Ethik Med 2020. [DOI: 10.1007/s00481-020-00591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ZusammenfassungBei extrem seltenen Erkrankungen bilden Fallbeschreibungen oft die einzige Datengrundlage für klinische Entscheidungen. Das Carmi Syndrom ist eine seltene Kombination von Epidermolysis bullosa und Pylorusatresie. Während der Betreuung einer betroffenen Patientin fielen unterschiedliche Wahrnehmungen über die publizierten Mortalitätsraten auf. Daraufhin wurde die Hypothese untersucht, ob sich die kumulativen Mortalitätsraten von Einzelfallbeschreibungen und Mehrfachfallbeschreibungen unterscheiden, um so eine mögliche Verzerrung der Prognose in ihren Auswirkungen auf klinische und ethische Einschätzungen des Falls zu überprüfen.Ein Mädchen wurde in der Schwangerschaftswoche 33 mit Carmi Syndrom geboren. Zusammen mit dem klinischen Ethikkomitee wurden Behandlungsoptionen diskutiert, einschließlich einer palliativen Behandlung oder einer operativen Gastrojejunostomie. Da etwa ein Drittel der in Fallbeschreibungen publizierten Kinder nach einer Operation überlebten, entschieden wir uns auch vor dem Hintergrund unsicherer Prognosen für das chirurgische Vorgehen. Die Patientin starb 4 Wochen später nach multiplen Komplikationen.Die Datenbank PubMed wurde nach Publikationen über Carmi Syndrom durchsucht. Das Outcome von Einzelfallbeschreibungen wurde mit dem von Mehrfachfallbeschreibungen verglichen.Insgesamt wurden 102 Fälle von Carmi Syndrom identifiziert. Die Mortalität bei Einzelfallbeschreibungen belief sich auf 17 von 27 Fällen (63 %), während 62 von 74 Patienten von Mehrfachfallbeschreibungen starben (84 %, p = 0,036).Beim Carmi Syndrom unterscheidet sich die publizierte Mortalität zwischen Einfach- und Mehrfachfallbeschreibungen, möglicherweise aufgrund einer Kombination von Selektions- und Publikationsbias. Die Unterschätzung der tatsächlichen Mortalitätsrate kann zu unangebracht intensiven Therapieansätzen führen. Kliniker und Ethiker sollten daher vorsichtig sein, ihre Entscheidungen bei seltenen oder neuartigen Erkrankungen auf kumulative Erfahrungen von Fallbeschreibungen, insbesondere von Einzelfallbeschreibungen, zu basieren, die positive Verläufe von Behandlungen zu betonen scheinen.
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Verma KP, Robertson SJ, Winship IM. Phenotypic discordance between siblings with junctional epidermolysis bullosa-pyloric atresia. Clin Exp Dermatol 2020; 45:793-795. [PMID: 32359087 DOI: 10.1111/ced.14223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- K P Verma
- Department of Genomic Medicine and Parkville Familial Cancer Centre, Royal Melbourne Hospital, Melbourne, Australia
| | - S J Robertson
- Department of Dermatology, Royal Melbourne Hospital, Melbourne, Australia
| | - I M Winship
- Department of Genomic Medicine and Parkville Familial Cancer Centre, Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
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Nanda A, Liu L, Al-Ajmi H, Al-Saleh QA, Al-Fadhli S, Anim JT, Ozoemena L, Mellerio JE, McGrath JA. Clinical subtypes and molecular basis of epidermolysis bullosa in Kuwait. Int J Dermatol 2018; 57:1058-1067. [PMID: 30011071 DOI: 10.1111/ijd.14099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/15/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a clinically and genetically heterogeneous blistering skin disease, but in countries such as Kuwait, there are very limited data on the clinical and molecular pathology of EB. To improve understanding of EB in Kuwait, we report the experience of a local tertiary referral center over a 17.5 year period (January 2000-June 2017) in establishing clinical and molecular diagnoses. METHODS Review of hospital records and diagnostic reports. Individual cases were diagnosed by combinations of clinical assessment, skin biopsy (immunohistochemistry and transmission electron microscopy), Sanger sequencing of EB genes, and whole exome sequencing. RESULTS Fifty-four families with EB were registered with the clinic over this period, 41 of whom (84 patients) participated in diagnostic studies. Thirty-seven of these 41 families had consanguineous marriages; 34 had recessive forms of EB, while only seven had dominant subtypes. Recurrent mutations were observed in epidermal dystonin, transglutaminase 5, and type VII collagen. CONCLUSIONS The prevalence of EB in Kuwait is approximately three times that of internationally cited rates with an over-representation of autosomal recessive variants. Establishing the molecular basis of EB in Kuwait with accurate diagnostic subtyping provides a basis for determining healthcare requirements and improving patient management of EB.
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Affiliation(s)
- Arti Nanda
- As'ad Al-Hamad Dermatology Center, Salmiya, Kuwait
| | - Lu Liu
- National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St. Thomas' Hospital, London, UK
| | | | | | - Suad Al-Fadhli
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Kuwait University, Safat, Kuwait
| | - John T Anim
- Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Linda Ozoemena
- National Diagnostic Epidermolysis Bullosa Laboratory, Viapath, St. Thomas' Hospital, London, UK
| | - Jemima E Mellerio
- St. John's Institute of Dermatology, King's College London, Guy's Campus, London, UK
| | - John A McGrath
- St. John's Institute of Dermatology, King's College London, Guy's Campus, London, UK
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Masunaga T, Niizeki H, Yasuda F, Yoshida K, Amagai M, Ishiko A. Splicing abnormality of integrin β4 gene (ITGB4) due to nucleotide substitutions far from splice site underlies pyloric atresia-junctional epidermolysis bullosa syndrome. J Dermatol Sci 2015; 78:61-6. [DOI: 10.1016/j.jdermsci.2015.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/24/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
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Schumann H, Kiritsi D, Pigors M, Hausser I, Kohlhase J, Peters J, Ott H, Hyla-Klekot L, Gacka E, Sieron AL, Valari M, Bruckner-Tuderman L, Has C. Phenotypic spectrum of epidermolysis bullosa associated with α6β4 integrin mutations. Br J Dermatol 2014; 169:115-24. [PMID: 23496044 DOI: 10.1111/bjd.12317] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Integrin α6β4 is a transmembrane receptor and a key component of the hemidesmosome anchoring complex. It is involved in cell-matrix adhesion and signalling in various tissues. Mutations in the ITGA6 and ITGB4 genes coding for α6β4 integrin compromise dermal-epidermal adhesion and are associated with skin blistering and pyloric atresia (PA), a disorder known as epidermolysis bullosa with PA (EB-PA). OBJECTIVES To elucidate the molecular pathology of skin fragility in eight cases, disclose the underlying ITGA6 and ITGB4 mutations and study genotype-phenotype correlations. METHODS DNA was isolated from ethylenediaminetetraacetic acid-blood samples, and the coding exons and exon-intron boundaries of ITGA6 and ITGB4 were amplified by polymerase chain reaction (PCR), and directly sequenced. Skin samples were submitted to immunofluorescence mapping with antibodies to adhesion proteins of the dermal-epidermal junction. Primary keratinocytes were isolated, and used for RNA and protein extraction, reverse transcription PCR and immunoblotting. Ultrastructural analysis of the skin was performed in one patient. RESULTS We disclose 10 novel mutations, one in ITGA6 and nine in ITGB4. Skin cleavage was either intraepidermal or junctional. Lethal outcome and PA correlated with loss-of-function mutations in two cases. Solely mild skin involvement was associated with deletion of the C-terminus of β4 integrin. Combinations of missense, nonsense or frameshift mutations caused severe urinary tract involvement in addition to skin fragility in five cases. CONCLUSIONS The present study reveals novel ITGA6 and ITGB4 gene mutations and supports previous reports showing that the phenotype may lack PA and be limited to skin and nail involvement. In four out of six cases of EB-PA, life expectancy was not impaired. A high frequency of urinary tract involvement was found in this study, and represented the main cause of morbidity. Low levels of β4 integrin expression were compatible with hemidesmosomal integrity and a mild skin phenotype.
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Affiliation(s)
- H Schumann
- Department of Dermatology, University Medical Center Freiburg, Hauptstr 7, 79104 Freiburg, Germany
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Abstract
Epidermolysis bullosa (EB) with pyloric atresia (PA) is a rare form of EB. This article describes the clinical and pathologic features and molecular genetics of EB-PA, the mutations in the alpha(6)beta(4) integrin and plectin genes that cause EB-PA, and the clinical implications of molecular genetics on EB-PA.
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Affiliation(s)
- Hye Jin Chung
- Department of Dermatology and Cutaneous Biology, Jefferson Medical College, Jefferson Institute of Molecular Medicine, Thomas Jefferson University, 233 South 10th Street, Suite 450 BLSB, Philadelphia, PA 19107, USA
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