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Luo C, Yang L, Huang Z, Su Y, Lu Y, Yu D, Zhang M, Wu K. Case report: A case of epidermolysis bullosa complicated with pyloric atresia and a literature review. Front Pediatr 2023; 11:1098273. [PMID: 37033187 PMCID: PMC10076629 DOI: 10.3389/fped.2023.1098273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023] Open
Abstract
Objective This article aims to explore the diagnosis, molecular characteristics, treatment, and prognosis of epidermolysis bullosa with pyloric atresia (EB-PA). Methods The clinical manifestations, diagnosis and treatment, and genetic characteristics of a patient with EB-PA admitted to our hospital were analysed. The disease subtypes, concomitant abnormalities, molecular characteristics, and prognosis of patients with EB-PA were summarized by searching the EB-PA-related literature since 2011. Results We present a very low birth weight female infant with skin blisters and pyloric obstruction. Exome sequencing revealed heterozygous mutations in the ITGB4 gene: c.794dupC (p. S265fs*5) and c.2962G > A (p.A988T). This infant was diagnosed with EB-PA. Coverage of the wounds and Penicillin were used to prevent infection, but the patient eventually developed severe sepsis. A literature review was carried out including 49 cases of EB-PA; among these cases, 34 were preterm infants, weighing between 930 and 3,640 g. Of these EB-PA patients, 28 had accompanying malformations, including urinary system malformations and aplasia cutis congenita (ACC). Thirty-two patients identified the subtype of EB-PA, of whom 25 were diagnosed with junctional epidermolysis bullosa (JEB), 6 with epidermolysis bullosa simplex (EBS), and 1 with dystrophic epidermolysis bullosa (DEB). Genetic testing was conducted on 23 patients, of whom 15 carried Integrin Beta-4 (ITGB4) gene mutations and one JEB patient carried an Integrin Alpha-6 (ITGA6) gene mutation; 4 of the 5 EBS patients had Plectin (PLEC) gene mutations, and the other had an ITGB4 mutation. ITGB4 mutation cases involved 29 mutation sites, primarily concentrated in the region encoding the integrin beta subunit; PLEC mutation cases involved 7 mutation sites. Among all cases, 43 underwent pyloric atresia surgery, of whom 24 died postoperatively, and 6 without surgery therapy died within a short period. Conclusion EB-PA is a rare genetic disorder characterized by increased skin fragility and PA involving mutations in the ITGB4, PLEC, or ITGA6 genes. EB-PA has a high incidence of complications and mortality, surgery and supportive therapy are currently the most common treatment options.
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Affiliation(s)
| | | | | | | | | | | | | | - Kai Wu
- Department of Pediatric Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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2
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Mariath LM, Santin JT, Schuler-Faccini L, Kiszewski AE. Inherited epidermolysis bullosa: update on the clinical and genetic aspects. An Bras Dermatol 2020; 95:551-569. [PMID: 32732072 PMCID: PMC7563003 DOI: 10.1016/j.abd.2020.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/17/2020] [Indexed: 12/14/2022] Open
Abstract
Inherited epidermolysis bullosa is a group of genetic diseases characterized by skin fragility and blistering on the skin and mucous membranes in response to minimal trauma. Epidermolysis bullosa is clinically and genetically very heterogeneous, being classified into four main types according to the layer of skin in which blistering occurs: epidermolysis bullosa simplex (intraepidermal), junctional epidermolysis bullosa (within the lamina lucida of the basement membrane), dystrophic epidermolysis bullosa (below the basement membrane), and Kindler epidermolysis bullosa (mixed skin cleavage pattern). Furthermore, epidermolysis bullosa is stratified into several subtypes, which consider the clinical characteristics, the distribution of the blisters, and the severity of cutaneous and extracutaneous signs. Pathogenic variants in at least 16 genes that encode proteins essential for the integrity and adhesion of skin layers have already been associated with different subtypes of epidermolysis bullosa. The marked heterogeneity of the disease, which includes phenotypes with a broad spectrum of severity and many causal genes, hinders its classification and diagnosis. For this reason, dermatologists and geneticists regularly review and update the classification criteria. This review aimed to update the state of the art on inherited epidermolysis bullosa, with a special focus on the associated clinical and genetic aspects, presenting data from the most recent reclassification consensus, published in 2020.
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Affiliation(s)
- Luiza Monteavaro Mariath
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Juliana Tosetto Santin
- Postgraduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Dermatology Service, Santa Casa de Misericórdia de Porto Alegre/Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Ana Elisa Kiszewski
- Dermatology Service, Santa Casa de Misericórdia de Porto Alegre/Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Pediatric Dermatology Unit, Santa Casa de Misericórdia de Porto Alegre/Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.
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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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Mariath LM, Santin JT, Frantz JA, Doriqui MJR, Schuler-Faccini L, Kiszewski AE. Genotype-phenotype correlations on epidermolysis bullosa with congenital absence of skin: A comprehensive review. Clin Genet 2020; 99:29-41. [PMID: 32506467 DOI: 10.1111/cge.13792] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/25/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
Congenital absence of skin (CAS) is a clinical sign associated with the main types of epidermolysis bullosa (EB). Very few studies have investigated the genetic background that may influence the occurrence of this condition. Our objective was to investigate genotype-phenotype correlations on EB with CAS through a literature revision on the pathogenic variants previously reported. A total of 171 cases (49 EB simplex, EBS; 23 junctional EB, JEB; and 99 dystrophic EB, DEB), associated with 132 pathogenic variants in eight genes, were included in the genotype-phenotype analysis. In EBS, CAS showed to be a recurrent clinical sign in EBS with pyloric atresia (PA) and EBS associated with kelch-like protein 24; CAS was also described in patients with keratins 5/14 alterations, particularly involving severe phenotypes. In JEB, this is a common clinical sign in JEB with PA associated with premature termination codon variants and/or amino acid substitutions located in the extracellular domain of integrin α6β4 genes. In DEB with CAS, missense variants occurring close to non-collagenous interruptions of the triple-helix domain of collagen VII appear to influence this condition. This study is the largest review of patients with EB and CAS and expands the spectrum of known variants on this phenomenon.
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Affiliation(s)
- Luiza Monteavaro Mariath
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Tosetto Santin
- Postgraduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jeanine Aparecida Frantz
- Faculty of Medicine, Universidade Regional de Blumenau, Blumenau, Brazil.,Board of Directors, Debra-Brasil, Blumenau, Brazil
| | | | - Lavínia Schuler-Faccini
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Department of Genetics, Universidade Federal do Rio Grande do Sul and Instituto Nacional de Ciência e Tecnologia de Genética Médica Populacional (INaGeMP), Porto Alegre, Brazil
| | - Ana Elisa Kiszewski
- Section of Dermatology, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.,Section of Pediatric Dermatology, Hospital da Criança Santo Antônio, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
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5
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Mylonas KS, Hayes M, Ko LN, Griggs CL, Kroshinsky D, Masiakos PT. Clinical outcomes and molecular profile of patients with Carmi syndrome: A systematic review and evidence quality assessment. J Pediatr Surg 2019; 54:1351-1358. [PMID: 29935895 DOI: 10.1016/j.jpedsurg.2018.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/22/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE Carmi syndrome is a rare genetic disorder characterized by junctional epidermolysis bullosa (JEB) and pyloric atresia (PA). We reviewed the clinicopathologic and molecular features of patients with Carmi syndrome to identify predictors of clinical outcome and guide surgical PA repair. METHODS A PRISMA-compliant systematic literature review of PubMed, CINAHL, and the Cochrane Library was performed. RESULTS 63 original studies including a total of 100 patients were included. PA type 1 and 2 were equally prevalent (47.2%, 95% CI: 34.4-60.3). Heineke-Mikulicz pyloroplasty (96%, 95% CI: 78.8-99) and gastroduodenostomy (72%, 95% CI: 52.2-85.9) were the most common type 1 and 2 PA repairs, respectively. Seventy lethal cases were identified (74.5%, 95% CI: 64.8-83.5). Of the 73 patients that received an operation, 49 died (67.1%, 95% CI: 55.7-76.8) and 24 survived (32.9%, 95% CI: 23.2-44.3). Integrin α6β4 expression was absent or markedly reduced in lethal cases. Integrin α6, plectin-1, cephalic integrin β4 (exon 3 to intron 11), and premature termination codon mutations were also associated with poor prognosis. CONCLUSIONS Although Carmi syndrome typically has poor prognosis, 1 in 4 patients exhibits nonlethal phenotypes. Immunofluorescence mapping and genetic consultation can guide surgical intervention and provide valuable family planning information. EVIDENCE RATING/CLASSIFICATION Prognosis study, Level IV.
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Affiliation(s)
- Konstantinos S Mylonas
- Harvard Medical School, Boston, MA, USA; Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA.
| | - Meaghan Hayes
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren N Ko
- Harvard Medical School, Boston, MA, USA; Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Cornelia L Griggs
- Harvard Medical School, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, MA, USA; Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter T Masiakos
- Harvard Medical School, Boston, MA, USA; Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA, USA
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6
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Bhattacharjee O, Ayyangar U, Kurbet AS, Ashok D, Raghavan S. Unraveling the ECM-Immune Cell Crosstalk in Skin Diseases. Front Cell Dev Biol 2019; 7:68. [PMID: 31134198 PMCID: PMC6514232 DOI: 10.3389/fcell.2019.00068] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/09/2019] [Indexed: 01/06/2023] Open
Abstract
The extracellular matrix (ECM) is a complex network of proteins and proteoglycans secreted by keratinocytes, fibroblasts and immune cells. The function of the skin ECM has expanded from being a scaffold that provides structural integrity, to a more dynamic entity that is constantly remodeled to maintain tissue homeostasis. The ECM functions as ligands for cell surface receptors such as integrins, dystroglycans, and toll-like receptors (TLRs) and regulate cellular signaling and immune cell dynamics. The ECM also acts as a sink for growth factors and cytokines, providing critical cues during epithelial morphogenesis. Dysregulation in the organization and deposition of ECMs lead to a plethora of pathophysiological conditions that are exacerbated by aberrant ECM-immune cell interactions. In this review, we focus on the interplay between ECM and immune cells in the context of skin diseases and also discuss state of the art therapies that target the key molecular players involved.
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Affiliation(s)
- Oindrila Bhattacharjee
- School of Chemical and Biotechnology, Sastra University, Thanjavur, India.,Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Uttkarsh Ayyangar
- School of Chemical and Biotechnology, Sastra University, Thanjavur, India.,Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Ambika S Kurbet
- School of Chemical and Biotechnology, Sastra University, Thanjavur, India.,Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Driti Ashok
- Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
| | - Srikala Raghavan
- Institute for Stem Cell Biology and Regenerative Medicine, GKVK Campus, Bangalore, India
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Sánchez-Jimeno C, Escámez M, Ayuso C, Trujillo-Tiebas M, del Río M. Genetic Diagnosis of Epidermolysis Bullosa: Recommendations From an Expert Spanish Research Group. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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8
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Ko L, Griggs CL, Mylonas KS, Masiakos PT, Kroshinsky D. A Nonlethal Case of Junctional Epidermolysis Bullosa and Congenital Pyloric Atresia: Compound Heterozygosity in a Patient with a Novel Integrin Beta 4 Gene Mutation. J Pediatr 2018; 193:261-264.e1. [PMID: 29198538 DOI: 10.1016/j.jpeds.2017.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 12/16/2022]
Abstract
We report a case of nonfatal junctional epidermolysis bullosa and pyloric atresia in a newborn. We identified a substitution (c.914C>T) for the integrin β4 gene that has been associated with favorable outcome. A novel mutation (c.2011T>G) of unknown significance was also found in this patient who is now thriving.
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Affiliation(s)
- Lauren Ko
- Harvard Medical School, Boston, MA; Department of Dermatology, Massachusetts General Hospital, Boston, MA
| | - Cornelia L Griggs
- Harvard Medical School, Boston, MA; Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Konstantinos S Mylonas
- Harvard Medical School, Boston, MA; Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA.
| | - Peter T Masiakos
- Harvard Medical School, Boston, MA; Division of Pediatric Surgery, Massachusetts General Hospital, Boston, MA
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, MA; Department of Dermatology, Massachusetts General Hospital, Boston, MA
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Sánchez-Jimeno C, Escámez MJ, Ayuso C, Trujillo-Tiebas MJ, Del Río M. Genetic diagnosis of epidermolysis bullosa: recommendations from an expert Spanish research group. ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:104-122. [PMID: 29180129 DOI: 10.1016/j.ad.2017.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 12/15/2022] Open
Abstract
Epidermolysis bullosa (EB) is a rare genetic disease that causes mucocutaneous fragility. It comprises a clinically and genetically heterogeneous group of disorder characterized by spontaneous or contact/friction-induced blistering. EB is classified into 4 types-simplex, junctional, dystrophic, and Kindler syndrome-and 30 subtypes. The disease is caused by defects in proteins implicated in dermal-epidermal adhesion. At least 19 genes have been characterized and more than 1000 mutations identified, thus rendering diagnosis complex. Molecular diagnosis of EB is the last stage of a laborious process that starts with a detailed clinical history compilation and careful procurement of a skin fresh biopsy that includes an area where the epidermis detaches from the dermis. The detachment area makes it possible to establish the cleavage plane by antigen mapping and, in the best scenario, to identify a single candidate gene to search for pathogenic mutations. The results of the molecular diagnosis enable the physician to provide appropriate genetic counseling (inheritance pattern, risk of recurrence, and options for prenatal and preimplantation diagnosis) and implement subsequent preventive programs, as well as to establish a reasonable clinical prognosis facilitating access to specific therapy and rehabilitation. Lastly, molecular diagnosis is essential for the participation of patients in clinical trials, a critical issue given the current incurable status of EB. The present guidelines aim to disseminate the procedure for diagnosing EB in our laboratory and thus avoid suboptimal or incomplete clinical diagnoses. The recommendations we provide are the result of more than 10 years' experience in the molecular diagnosis of EB in Spain.
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Affiliation(s)
- C Sánchez-Jimeno
- Departamento de Genética, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, CIBER de Enfermedades Raras (ISCIII) U704, Madrid, España
| | - M J Escámez
- Departamento de Bioingeniería, Universidad Carlos III de Madrid; Unidad de Medicina Regenerativa, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), IIS-Fundación Jiménez Díaz, CIBER de Enfermedades Raras (ISCIII) U714, Madrid, España
| | - C Ayuso
- Departamento de Genética, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, CIBER de Enfermedades Raras (ISCIII) U704, Madrid, España
| | - M J Trujillo-Tiebas
- Departamento de Genética, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, CIBER de Enfermedades Raras (ISCIII) U704, Madrid, España.
| | - M Del Río
- Departamento de Bioingeniería, Universidad Carlos III de Madrid; Unidad de Medicina Regenerativa, Centro de Investigaciones Energéticas Medioambientales y Tecnológicas (CIEMAT), IIS-Fundación Jiménez Díaz, CIBER de Enfermedades Raras (ISCIII) U714, Madrid, España.
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Hashimoto T, Hirako Y, Tsuruta D. β4 integrin in hereditary and acquired mucocutaneous diseases. Exp Dermatol 2016; 25:267-8. [PMID: 26836047 DOI: 10.1111/exd.12961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Takashi Hashimoto
- Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Yoshiaki Hirako
- Division of Biological Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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