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Park S, Bell A, Gibson R, Masson R, Daveluy S, Goldberg S, Hsiao J, Porter M, Kirby J, Piguet V. Advances in Hidradenitis Suppurativa Pathogenesis and Therapies from the Symposium on HS Advances 2023. J Invest Dermatol 2024; 144:1681-1684. [PMID: 39034061 DOI: 10.1016/j.jid.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 07/23/2024]
Affiliation(s)
- Sarah Park
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alexis Bell
- Mary Washington Healthcare, Fredericksburg, Virginia, USA
| | - Ruby Gibson
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Rahul Masson
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan, USA
| | - Stephanie Goldberg
- General Surgery and Trauma, Mary Washington Medical Center, Fredericksburg, Virginia, USA
| | - Jennifer Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, California, USA
| | - Martina Porter
- Harvard Medical School, Department of Dermatology, Boston, Massachusetts, USA
| | - Joslyn Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vincent Piguet
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Canada.
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Balić A, Marinović B, Bukvić Mokos Z. The genetic aspects of hidradenitis suppurativa. Clin Dermatol 2023; 41:551-563. [PMID: 37652193 DOI: 10.1016/j.clindermatol.2023.08.022] [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: 09/02/2023]
Abstract
Genetic aspects have a substantial role in hidradenitis suppurativa (HS) pathogenesis. A positive family history of HS occurs in about one-third of HS cases and is significantly higher in patients with early onset of the disease. Recent twin studies have shown a high heritability in HS, fortifying the importance of genetic factors in disease pathogenesis. Based on existing knowledge on the genomics of HS, the disease can be categorized as familial HS, sporadic, syndromic HS, and "HS plus" associated with other syndromes. In familial HS, autosomal dominant transmission is proposed, and monogenic inheritance is rare. This monogenic trait is related to mutations of γ-secretase component genes and Notch signaling or defects in inflammasome function. With newly discovered gene mutations, such as those related to innate and adaptive immunity, skin microbiome, inflammasome, epidermal homeostasis, and keratinization pathway, we can define HS as a polygenic, multifactorial, autoinflammatory disease. To fully elucidate the genetic aspects of HS, we need extensive, long-term global collaborations.
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Affiliation(s)
- Anamaria Balić
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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Sun Q, Broadaway KA, Edmiston SN, Fajgenbaum K, Miller-Fleming T, Westerkam LL, Melendez-Gonzalez M, Bui H, Blum FR, Levitt B, Lin L, Hao H, Harris KM, Liu Z, Thomas NE, Cox NJ, Li Y, Mohlke KL, Sayed CJ. Genetic Variants Associated With Hidradenitis Suppurativa. JAMA Dermatol 2023; 159:930-938. [PMID: 37494057 PMCID: PMC10372759 DOI: 10.1001/jamadermatol.2023.2217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 07/27/2023]
Abstract
Importance Hidradenitis suppurativa (HS) is a common and severely morbid chronic inflammatory skin disease that is reported to be highly heritable. However, the genetic understanding of HS is insufficient, and limited genome-wide association studies (GWASs) have been performed for HS, which have not identified significant risk loci. Objective To identify genetic variants associated with HS and to shed light on the underlying genes and genetic mechanisms. Design, Setting, and Participants This genetic association study recruited 753 patients with HS in the HS Program for Research and Care Excellence (HS ProCARE) at the University of North Carolina Department of Dermatology from August 2018 to July 2021. A GWAS was performed for 720 patients (after quality control) with controls from the Add Health study and then meta-analyzed with 2 large biobanks, UK Biobank (247 cases) and FinnGen (673 cases). Variants at 3 loci were tested for replication in the BioVU biobank (290 cases). Data analysis was performed from September 2021 to December 2022. Main Outcomes and Measures Main outcome measures are loci identified, with association of P < 1 × 10-8 considered significant. Results A total of 753 patients were recruited, with 720 included in the analysis. Mean (SD) age at symptom onset was 20.3 (10.57) years and at enrollment was 35.3 (13.52) years; 360 (50.0%) patients were Black, and 575 (79.7%) were female. In a meta-analysis of the 4 studies, 2 HS-associated loci were identified and replicated, with lead variants rs10512572 (P = 2.3 × 10-11) and rs17090189 (P = 2.1 × 10-8) near the SOX9 and KLF5 genes, respectively. Variants at these loci are located in enhancer regulatory elements detected in skin tissue. Conclusions and Relevance In this genetic association study, common variants associated with HS located near the SOX9 and KLF5 genes were associated with risk of HS. These or other nearby genes may be associated with genetic risk of disease and the development of clinical features, such as cysts, comedones, and inflammatory tunnels, that are unique to HS. New insights into disease pathogenesis related to these genes may help predict disease progression and novel treatment approaches in the future.
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Affiliation(s)
- Quan Sun
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | | | - Sharon N. Edmiston
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Kristen Fajgenbaum
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Tyne Miller-Fleming
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linnea Lackstrom Westerkam
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- University of North Carolina at Chapel Hill School of Medicine
| | | | - Helen Bui
- Department of Internal Medicine, University of North Carolina at Chapel Hill School of Medicine
| | | | - Brandt Levitt
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Lan Lin
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Honglin Hao
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill
- Sociology Department, University of North Carolina at Chapel Hill
| | - Zhi Liu
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Nancy J. Cox
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill
- Department of Genetics, University of North Carolina at Chapel Hill
| | - Karen L. Mohlke
- Department of Genetics, University of North Carolina at Chapel Hill
| | - Christopher J. Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
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Mintoff D, Pace NP, Borg I. Interpreting the spectrum of gamma-secretase complex missense variation in the context of hidradenitis suppurativa—An in-silico study. Front Genet 2022; 13:962449. [PMID: 36118898 PMCID: PMC9478468 DOI: 10.3389/fgene.2022.962449] [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: 06/06/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a disease of the pilosebaceous unit characterized by recurrent nodules, abscesses and draining tunnels with a predilection to intertriginous skin. The pathophysiology of HS is complex. However, it is known that inflammation and hyperkeratinization at the hair follicle play crucial roles in disease manifestation. Genetic and environmental factors are considered the main drivers of these two pathophysiological processes. Despite a considerable proportion of patients having a positive family history of disease, only a minority of patients suffering from HS have been found to harbor monogenic variants which segregate to affected kindreds. Most of these variants are in the ɣ secretase complex (GSC) protein-coding genes. In this manuscript, we set out to characterize the burden of missense pathogenic variants in healthy reference population using large scale genomic dataset thereby providing a standard for comparing genomic variation in GSC protein-coding genes in the HS patient cohort.
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Affiliation(s)
- Dillon Mintoff
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Nikolai P. Pace
- Centre for Molecular Biology and Biobanking, University of Malta, Msida, Malta
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- *Correspondence: Nikolai P. Pace,
| | - Isabella Borg
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Centre for Molecular Biology and Biobanking, University of Malta, Msida, Malta
- Department of Pathology, Mater Dei Hospital, Msida, Malta
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Kjaersgaard Andersen R, Clemmensen SB, Larsen LA, Hjelmborg JVB, Ødum N, Jemec GBE, Christensen K. Evidence of gene-gene interaction in Hidradenitis suppurativa - A nationwide register study of Danish twins. Br J Dermatol 2021; 186:78-85. [PMID: 34289077 DOI: 10.1111/bjd.20654] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a recurrent inflammatory skin disease that, apart from rare causative loss-of-function mutations, has a widely unknown genetic aetiology. Our objective was to estimate the relative importance of genetic and environmental factors underlying HS susceptibility. METHODS Through the Danish Twin Registry and the Danish National Patient Registry we joined information on zygosity with that of HS status. HS cases were identified by International Code of Diseases 8 (705.91) and 10 (L73.2). Heritability was assessed by the classic biometric model and the possibility of gene-gene interaction through the multi-locus modeling approach. RESULTS Amongst 100,044 registered twins, we found 170 twins (from 163 pairs) diagnosed with HS. The seven concordant pairs were all monozygotic, and monozygotic twins had a casewise concordance rate of 28% (95% CI: 7%; 49%), corresponding to a familial risk of 73 (95% CI 13; 133) times that of the background population. The biometrical modelling suggested a heritability of 0.80 (95% CI 0.67; 0.93), and the multilocus index estimate was 230 (95% CI: 60; 400). This is highly indicative of gene-gene interactions, with the possibility of up to six interacting loci. CONCLUSION This twin study is substantially larger, and employs a more valid phenotype than prior studies. Genetics account for the majority of the HS susceptibility, and HS is most likely caused by gene-gene interactions rather than monogenetic mutations or solely additive genetic factors. New approaches aimed at assessing potential interactions at a SNP-SNP level should be implemented in future HS genome-wide association studies.
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Affiliation(s)
| | - S B Clemmensen
- Danish Twin Registry, Department of Epidemiology, Biostatistics and Biodemography, University of southern Denmark, Odense, Denmark
| | - L A Larsen
- Danish Twin Registry, Department of Epidemiology, Biostatistics and Biodemography, University of southern Denmark, Odense, Denmark
| | - J V B Hjelmborg
- Danish Twin Registry, Department of Epidemiology, Biostatistics and Biodemography, University of southern Denmark, Odense, Denmark
| | - N Ødum
- LEO Foundation Skin Immunology Research Center, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde
| | - K Christensen
- Danish Twin Registry, Department of Epidemiology, Biostatistics and Biodemography, University of southern Denmark, Odense, Denmark
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