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Sarveswaran N, Pamela Y, Reddy AAN, Mustari AP, Parthasarathi A, Mancini AJ, Bishnoi A, Inamadar AC, Olabi B, Browne F, Deshmukh GN, McWilliam K, Vinay K, Srinivas S, Ibbs S, Natarajan S, Rao V, Zawar V, Gowda VK, Shaikh SS, Moss C, Woods CG, Drissi I. Midfacial toddler excoriation syndrome (MiTES): case series, diagnostic criteria and evidence for a pathogenic mechanism. Br J Dermatol 2024; 191:437-446. [PMID: 38591490 PMCID: PMC11324070 DOI: 10.1093/bjd/ljae151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND PRDM12 polyalanine tract expansions cause two different disorders: midfacial toddler excoriation syndrome (MiTES; itch with normal pain sensation associated with 18 homozygous alanines (18A); and congenital insensitivity to pain (CIP) with normal itch associated with 19 homozygous alanines (19A). Knowledge of the phenotype, genotype and disease mechanism of MiTES is incomplete. Why 18A vs. 19A PRDM12 can cause almost opposite phenotypes is unknown; no other polyalanine or polyglutamine tract expansion disease causes two such disparate phenotypes. OBJECTIVES To assess the genotype and phenotype of nine new, nine atypical and six previously reported patients diagnosed with MiTES. METHODS Using cell lines with homozygous PR domain zinc finger protein 12 (PRDM12) containing 12 alanines (12A; normal), 18A (MiTES) and 19A (CIP), we examined PRDM12 aggregation and subcellular localization by image-separation confocal microscopy and subcellular fractionation Western blotting. RESULTS MiTES presents in the first year of life; in all cases the condition regresses over the first decade, leaving scarring. The MiTES phenotype is highly distinctive. Features overlapping with PRDM12 CIP are rarely found. The genotype-phenotype study of the PRDM12 polyalanine tract shows that having 7-15 alanines is normal; 16-18 alanines is associated with MiTES; 19 alanines leads to CIP; and no clinically atypical cases of MiTES had a polyalanine tract expansion. PRDM12 aggregation and subcellular localization differed significantly between 18A and normal 12A cell lines and between 18A and 19A cell lines. MiTES is a new protein-aggregation disease. CONCLUSIONS We provide diagnostic criteria for MiTES and improved longitudinal data. MiTES and CIP are distinct phenotypes, despite their genotypes varying by a single alanine in the PRDM12 polyalanine tract. We found clear distinctions between the cellular phenotypes of normal, MiTES and CIP cells. We hypothesize that the developmental environment of the trigeminal ganglion is unique and critically sensitive to pre- and postnatal levels of PRDM12.
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Affiliation(s)
- Nivedita Sarveswaran
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Yunisa Pamela
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Akhila A N Reddy
- Dr. Anchala Skin Institute and Research Center, Hyderabad, India
| | - Akash P Mustari
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anthony J Mancini
- Division of Dermatology, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anuradha Bishnoi
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun C Inamadar
- Department of Dermatology, Shri BM Patil Medical College & Hospital, BLDE University, Bijapur, India
| | - Bayanne Olabi
- Department of Dermatology, Edinburgh Royal Infirmary, UK
| | - Fiona Browne
- Department of Paediatric Dermatology, Children’s Health Ireland (CHI) at Crumlin, Crumlin, Ireland
| | | | - Kenneth McWilliam
- Paediatric Neurology, Neurosciences Department, Royal Hospital for Children and Young People, Edinburgh, UK
| | - Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahana Srinivas
- Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Samantha Ibbs
- Department of Paediatric Dermatology, Birmingham Children’s Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | | | | | - Vijay Zawar
- Department of Dermatology, Dr. Vasantrao Pawar Medical College and Research Center, Nashik, India
| | - Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Samiha S Shaikh
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Celia Moss
- Department of Paediatric Dermatology, Birmingham Children’s Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Christopher G Woods
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | - Ichrak Drissi
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
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Has C. MiTES: itch or pain? Br J Dermatol 2024; 191:323-324. [PMID: 38736256 DOI: 10.1093/bjd/ljae198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 05/03/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Cristina Has
- Department of Dermatology, Medical Center University of Freiburg, Germany
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Mallya P, Ganigara A, Bhagya DV, Chandrika YR. Anaesthetic management in midface toddler excoriation syndrome (MiTES)- A case report. Indian J Anaesth 2023; 67:S304-S305. [PMID: 38187960 PMCID: PMC10768909 DOI: 10.4103/ija.ija_321_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/09/2023] [Accepted: 09/26/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Priyanka Mallya
- Department of Paediatric Anaesthesia, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Anuradha Ganigara
- Department of Anaesthesia, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - D V Bhagya
- Department of Anaesthesia, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Y R Chandrika
- Department of Anaesthesia, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
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Rienzo M, Di Zazzo E, Casamassimi A, Gazzerro P, Perini G, Bifulco M, Abbondanza C. PRDM12 in Health and Diseases. Int J Mol Sci 2021; 22:ijms222112030. [PMID: 34769459 PMCID: PMC8585061 DOI: 10.3390/ijms222112030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/18/2022] Open
Abstract
PRDM12 is a member of the PRDI-BF1 (positive regulatory domain I-binding factor 1) homologous domain (PRDM)-containing protein family, a subfamily of Kruppel-like zinc finger proteins, controlling key processes in the development of cancer. PRDM12 is expressed in a spatio-temporal manner in neuronal systems where it exerts multiple functions. PRDM12 is essential for the neurogenesis initiation and activation of a cascade of downstream pro-neuronal transcription factors in the nociceptive lineage. PRDM12 inactivation, indeed, results in a complete absence of the nociceptive lineage, which is essential for pain perception. Additionally, PRDM12 contributes to the early establishment of anorexigenic neuron identity and the maintenance of high expression levels of pro-opiomelanocortin, which impacts on the program bodyweight homeostasis. PRDMs are commonly involved in cancer, where they act as oncogenes/tumor suppressors in a “Yin and Yang” manner. PRDM12 is not usually expressed in adult normal tissues but its expression is re-activated in several cancer types. However, little information is currently available on PRDM12 expression in cancers and its mechanism of action has not been thoroughly described. In this review, we summarize the recent findings regarding PRDM12 by focusing on four main biological processes: neurogenesis, pain perception, oncogenesis and cell metabolism. Moreover, we wish to highlight the importance of future studies focusing on the PRDM12 signaling pathway(s) and its role in cancer onset and progression.
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Affiliation(s)
- Monica Rienzo
- Department of Environmental, Biological, and Pharmaceutical Sciences and Technologies, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy;
| | - Erika Di Zazzo
- Department of Medicine and Health Sciences “V. Tiberio”, University of Molise, 86100 Campobasso, Italy;
| | - Amelia Casamassimi
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio, 80138 Naples, Italy;
- Correspondence:
| | - Patrizia Gazzerro
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Salerno, Italy;
| | - Giovanni Perini
- Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy;
| | - Maurizio Bifulco
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Ciro Abbondanza
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio, 80138 Naples, Italy;
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Landy MA, Goyal M, Casey KM, Liu C, Lai HC. Loss of Prdm12 during development, but not in mature nociceptors, causes defects in pain sensation. Cell Rep 2021; 34:108913. [PMID: 33789102 PMCID: PMC8048104 DOI: 10.1016/j.celrep.2021.108913] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/11/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
Prdm12 is a key transcription factor in nociceptor neurogenesis. Mutations of Prdm12 cause congenital insensitivity to pain (CIP) from failure of nociceptor development. However, precisely how deletion of Prdm12 during development or adulthood affects nociception is unknown. Here, we employ tissue- and temporal-specific knockout mouse models to test the function of Prdm12 during development and in adulthood. We find that constitutive loss of Prdm12 causes deficiencies in proliferation during sensory neurogenesis. We also demonstrate that conditional knockout from dorsal root ganglia (DRGs) during embryogenesis causes defects in nociception. In contrast, we find that, in adult DRGs, Prdm12 is dispensable for most pain-sensation and injury-induced hypersensitivity. Using transcriptomic analysis, we find mostly unique changes in adult Prdm12 knockout DRGs compared with embryonic knockout and that PRDM12 is likely a transcriptional activator in the adult. Overall, we find that the function of PRDM12 changes over developmental time.
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Affiliation(s)
- Mark A Landy
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Megan Goyal
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Katherine M Casey
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Chen Liu
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX 75390, USA; Department of Internal Medicine, Hypothalamic Research Center, Dallas, TX 75390, USA
| | - Helen C Lai
- Department of Neuroscience, UT Southwestern Medical Center, Dallas, TX 75390, USA.
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Noguera-Morel L, Ortiz-Cabrera NV, Campos M, Hernández-Martín Á, Torrelo A. A case of mid-face toddler excoriation syndrome (MiTES). Pediatr Dermatol 2020; 37:345-346. [PMID: 31930564 DOI: 10.1111/pde.14081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The term mid-face toddler excoriation syndrome (MiTES) has been proposed to describe a rare condition that arises in infancy as is characterized by self-inflicted excoriations. It is considered to be a milder variant of hereditary sensory-autonomic neuropathy (HSAN) type VIII. We present an 8-year-old boy with lesions on the mid-face that were admittedly self-induced and associated with an abnormally high pain threshold. The diagnosis and management of MiTES is reviewed.
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Affiliation(s)
- Lucero Noguera-Morel
- Department of Dermatology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
| | | | - Minia Campos
- Department of Dermatology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Antonio Torrelo
- Department of Dermatology, Hospital Universitario Infantil Niño Jesús, Madrid, Spain
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Inamadar AC, Vinay K, Olabi B, Sarveswaran N, Bishnoi A, Woods CG, Moss C. Extending the phenotype of midface toddler excoriation syndrome (MiTES): Five new cases in three families with PR domain containing protein 12 (PRDM12) mutations. J Am Acad Dermatol 2019; 81:1415-1417. [PMID: 31128170 DOI: 10.1016/j.jaad.2019.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Arun C Inamadar
- Department of Dermatology, Shri BM Patil Medical College & Hospital, BLDE (Deemed to be University), Bijapur, India
| | - Keshavmurthy Vinay
- Department of Dermatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Bayanne Olabi
- Department of Dermatology, Edinburgh Royal Infirmary, United Kingdom
| | | | - Anuradha Bishnoi
- Department of Dermatology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Christopher G Woods
- Cambridge Institute for Medical Research, United Kingdom; Department of Medical Genetics, University of Cambridge, United Kingdom
| | - Celia Moss
- Department of Dermatology, Birmingham Children's Hospital, United Kingdom; College of Medical and Dental Sciences, University of Birmingham, United Kingdom.
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Greenblatt DT, Mellerio JE. Itch and scratch: could pain be the catch? Br J Dermatol 2018; 179:1029. [DOI: 10.1111/bjd.17119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D. T. Greenblatt
- St John's Institute of Dermatology, Guy's and St Thomas’ NHS Foundation Trust; Westminster Bridge Road London SE1 7EH U.K
| | - J. E. Mellerio
- St John's Institute of Dermatology, Guy's and St Thomas’ NHS Foundation Trust; Westminster Bridge Road London SE1 7EH U.K
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9
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Moss C, Srinivas SM, Sarveswaran N, Nahorski M, Gowda VK, Browne FM, Woods G. Midface toddler excoriation syndrome (MiTES) can be caused by autosomal recessive biallelic mutations in a gene for congenital insensitivity to pain, PRDM12. Br J Dermatol 2018; 179:1135-1140. [PMID: 29949203 DOI: 10.1111/bjd.16893] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Midface toddler excoriation syndrome (MiTES) is a condition recently reported in three unrelated children. Habitual scratching from the first year of life inflicted deep, chronic, scarring wounds around the nose and eyes. One child had a mild neurological deficit but there was no other evidence of insensitivity to pain. Bilateral distribution and localization to the midface distinguish MiTES from other causes of self-inflicted skin damage such as trigeminal trophic syndrome. An earlier study of five siblings from a consanguineous Irish family, with lesions corresponding to MiTES plus other sensory deficits, showed homozygous mutations in a gene for hereditary sensory and autonomic neuropathy type VIII (HSAN8), PRDM12. OBJECTIVES To study further cases of MiTES, including analysis of PRDM12. METHODS We describe five further children, from four families, with facial lesions typical of MiTES, in whom mutation analysis of PRDM12 was carried out. RESULTS Homozygous or compound heterozygous pathogenic expansions of the PRDM12 polyalanine tract were found in four of five affected individuals, in three families. CONCLUSIONS Our finding of autosomal recessive mutations in PRDM12 in four of five patients with MiTES extends the phenotypic spectrum of PRDM12 mutations, which usually cause HSAN8, characterized by mutilating self-inflicted wounds of the extremities, lips and tongue. By contrast, MiTES shows severe midfacial lesions with little if any evidence of generalized pain insensitivity. The condition is probably genetically heterogeneous, and other congenital insensitivity to pain and HSAN genes such as SCN11A may be implicated. This new understanding of the nature of MiTES, which can masquerade as factitious disease, will facilitate appropriate management.
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Affiliation(s)
- C Moss
- Birmingham Women's and Children's Hospital, Birmingham, U.K
- University of Birmingham, Birmingham, U.K
| | - S M Srinivas
- Department of Pediatric Dermatology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - N Sarveswaran
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, U.K
| | - M Nahorski
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, U.K
| | - V K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - F M Browne
- Department of Dermatology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - G Woods
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, U.K
- Department of Medical Genetics, University of Cambridge, Cambridge, U.K
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