1
|
Zhou Z, Huang X, Tang X, Chen W, Chen Q, Zhang C, Li Y, Zhao D, Zheng Z, Hu S, Wang J, Kullo IJ, Ding K. Heterozygous nonsense variants in laminin subunit 3α resulting in Ebstein's anomaly. HGG ADVANCES 2023; 4:100227. [PMID: 37635785 PMCID: PMC10450520 DOI: 10.1016/j.xhgg.2023.100227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Ebstein's anomaly is a rare congenital heart disease characterized by tricuspid valve downward displacement and is associated with additional cardiac phenotypes such as left ventricle non-compaction. The genetic basis of Ebstein's anomaly has yet to be fully elucidated, although several genes (e.g., NKX2-5, MYH7, TPM1, and FLNA) may contribute to Ebstein's anomaly. Here, in two Ebstein's anomaly families (a three-generation family and a trio), we identified independent heterozygous nonsense variants in laminin subunit 3 α (LAMA3), cosegregated with phenotypes in families with reduced penetrance. Furthermore, knocking out Lama3 in mice revealed that haploinsufficiency of Lama3 led to Ebstein's malformation of the tricuspid valve and an abnormal basement membrane structure. In conclusion, we identified a novel gene-disease association of LAMA3 implicated in Ebstein's anomaly, and the findings extended our understanding of the role of the extracellular matrix in Ebstein's anomaly etiology.
Collapse
Affiliation(s)
- Zhou Zhou
- Department of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Xumei Huang
- Department of Cardiovascular Diseases, Wenzhou Central Hospital, Wenzhou, Zhejiang 325000, P.R. China
| | - Xia Tang
- State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai 200433, P.R. China
| | - Wen Chen
- Department of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Qianlong Chen
- Department of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Chaohui Zhang
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Yuxin Li
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Dachun Zhao
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, P.R. China
| | - Zhe Zheng
- Department of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Shengshou Hu
- Department of Laboratory Medicine, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, P.R. China
| | - Jikui Wang
- Henan Key Laboratory of Medical Tissue Regeneration, Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Keyue Ding
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
2
|
Liy-Wong C, Tarango C, Pope E, Coates T, Bruckner AL, Feinstein JA, Schwieger-Briel A, Hubbard LD, Jane C, Torres-Pradilla M, Zmazek M, Lara-Corrales I. Consensus guidelines for diagnosis and management of anemia in epidermolysis bullosa. Orphanet J Rare Dis 2023; 18:38. [PMID: 36823529 PMCID: PMC9948325 DOI: 10.1186/s13023-022-02448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/17/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Anemia is a common complication of severe forms of epidermolysis bullosa (EB). To date, there are no guidelines outlining best clinical practices to manage anemia in the EB population. The objective of this manuscript is to present the first consensus guidelines for the diagnosis and management of anemia in EB. RESULTS Due to the lack of high-quality evidence, a consensus methodology was followed. An initial survey exploring patient preferences, concerns and symptoms related to anemia was sent to EB patients and their family members. A second survey was distributed to EB experts and focused on screening, diagnosis, monitoring and management of anemia in the different types of EB. Information from these surveys was collated and used by the panel to generate 26 consensus statements. Consensus statements were sent to healthcare providers that care for EB patients through EB-Clinet. Statements that received more than 70% approval (completely agree/agree) were adopted. CONCLUSIONS The end result was a series of 6 recommendations which include 20 statements that will help guide management of anemia in EB patients. In patients with moderate to severe forms of EB, the minimum desirable level of Hb is 100 g/L. Treatment should be individualized. Dietary measures should be offered as part of management of anemia in all EB patients, oral iron supplementation should be used for mild anemia; while iron infusion is reserved for moderate to severe anemia, if Hb levels of > 80-100 g/L (8-10 g/dL) and symptomatic; and transfusion should be administered if Hb is < 80 g/L (8 g/dL) in adults and < 60 g/L (6 g/dL) in children.
Collapse
Affiliation(s)
- Carmen Liy-Wong
- Division of Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
| | - Cristina Tarango
- grid.24827.3b0000 0001 2179 9593Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Elena Pope
- grid.17063.330000 0001 2157 2938Division of Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Thomas Coates
- grid.42505.360000 0001 2156 6853Keck School of Medicine, Division of Hematology/Oncology, Department of Pediatrics, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA USA
| | - Anna L. Bruckner
- grid.430503.10000 0001 0703 675XEpidermolysis Bullosa Clinic, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA
| | - James A. Feinstein
- grid.430503.10000 0001 0703 675XEpidermolysis Bullosa Clinic, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA
| | - Agnes Schwieger-Briel
- grid.412341.10000 0001 0726 4330Pediatric Skin Center, Department of Dermatology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Lynne D. Hubbard
- grid.420545.20000 0004 0489 3985Department of Nutrition and Dietetics, Rare Diseases Centre at St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Clapham Jane
- grid.420545.20000 0004 0489 3985Lead EB CNS, Rare Diseases Centre, St John’s Institute of Dermatology, St Thomas’ Hospital, Guy’s and St Thomas’ NHS Foundation Trust and DEBRA UK, London, UK
| | - Mauricio Torres-Pradilla
- grid.442070.5Fundación Universitaria de Ciencias de la Salud and Hospital de San José, Bogotá, Colombia
| | | | - Irene Lara-Corrales
- grid.17063.330000 0001 2157 2938Division of Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| |
Collapse
|
3
|
Greenblatt DT, Hubbard L, Bloor C, Card D, McGrath JA, Mellerio JE. Vitamin C concentrations in patients with epidermolysis bullosa. Br J Dermatol 2022; 187:808-810. [PMID: 35763388 DOI: 10.1111/bjd.21719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/12/2022] [Accepted: 06/26/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Danielle T Greenblatt
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, UK
| | - Lynne Hubbard
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, UK
| | - Christopher Bloor
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, UK
| | - David Card
- Nutristasis Unit, NHS Foundation Trust, Guy's and St Thomas, London, UK
| | - John A McGrath
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, UK
| | - Jemima E Mellerio
- St John's Institute of Dermatology, NHS Foundation Trust, Guy's and St Thomas, London, UK
| |
Collapse
|
4
|
Care of the Patient with Epidermolysis Bullosa. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-021-00484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
5
|
Jones VA, Patel PM, Valikodath T, Ashack KA. Dermatologic manifestations of pediatric cardiovascular diseases: Skin as a reflection of the heart. Pediatr Dermatol 2021; 38:1461-1474. [PMID: 34725847 DOI: 10.1111/pde.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cutaneous disease can often be an initial clue of an underlying cardiovascular disease. Many congenital conditions (ie, Noonan syndrome with multiple lentigines, Carney complex, and Fabry disease) and acquired conditions may present initially with specific cutaneous features that should prompt clinicians to conduct a full cardiac workup. Given the extensive number of conditions with both cardiovascular and cutaneous findings, this review will focus on diseases with cardiocutaneous pathology with hopes of raising clinician awareness of these associations to decrease morbidity and mortality, as several of these diseases often result in fatal outcomes.
Collapse
Affiliation(s)
- Virginia A Jones
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Payal M Patel
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tom Valikodath
- Cincinnati Children's Hospital Medical Center Heart Institute, Cincinnati, Ohio, USA
| | - Kurt A Ashack
- Dermatology Associates of West Michigan, Grand Rapids, Michigan, USA
| |
Collapse
|
6
|
Manjunath S, Mahajan R, De D, Handa S, Attri S, Behera BN, Bhasin SL, Bolia R. The severity of malnutrition in children with epidermolysis bullosa correlates with disease severity. Sci Rep 2021; 11:16827. [PMID: 34413404 PMCID: PMC8377149 DOI: 10.1038/s41598-021-96354-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
WHO defines malnutrition as severe if the z-scores are less than - 3 Standard deviation (SD), moderate if between - 2 and - 3 SD and mild if between - 2 SD to - 1 SD. This study was aimed to assess nutritional aspects of Indian children suffering from EB and to evaluate the effect of severity of EB on the severity of malnutrition. In this study, pediatric EB patients were evaluated prospectively for baseline nutritional status using anthropometric parameters and WHO growth charts, and its correlation with disease severity using instrument for Scoring Clinical Outcomes for Research of Epidermolysis Bullosa-iscorEB. In second phase, an individualized diet chart was given to meet the energy, protein and micronutrients needs and its effects were observed after 6 months. The median age of participants was 3 years (IQR-9). Of 57 patients, malnutrition was seen in 40.35% patients (22.81%-moderate and 17.54%-severe), and significantly correlated with iscorEB (r = 0.45, p < 0.0001). On bivariate regression analysis, iscorEB was independently associated with moderate-to-severe malnutrition (p = 0.047; OR 1.038, CI 1.011-1.066). iscorEB enabled the identification of patients with moderate-to-severe malnutrition with an Area Under Receiver Operating Curve (AUROC) of 0.72 (95%CI 0.58-0.85; p < 0.005). In phase 2, there was significant improvement in nutritional status in children with recessive dystrophic EB (RDEB) and dominant dystrophic EB (DDEB) subtype (p < 0.0001). The severity of malnutrition in EB children significantly correlates with disease severity, and is an independent predictor of moderate-to-severe malnutrition.
Collapse
Affiliation(s)
- Seema Manjunath
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India.
| | - Dipankar De
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Sanjeev Handa
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Savita Attri
- Department of Pediatric Biochemistry, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Banchha Nidhi Behera
- Department of Dietetics, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Sadhna Lal Bhasin
- Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Rishi Bolia
- Department of Pediatric Gastroenterology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| |
Collapse
|
7
|
Tang JY, Marinkovich MP, Lucas E, Gorell E, Chiou A, Lu Y, Gillon J, Patel D, Rudin D. A systematic literature review of the disease burden in patients with recessive dystrophic epidermolysis bullosa. Orphanet J Rare Dis 2021; 16:175. [PMID: 33849616 PMCID: PMC8045359 DOI: 10.1186/s13023-021-01811-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/31/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/OBJECTIVE Recessive dystrophic epidermolysis bullosa (RDEB) is a genetic collagen disorder characterized by skin fragility leading to blistering, wounds, and scarring. There are currently no approved curative therapies. The objective of this manuscript is to provide a comprehensive literature review of the disease burden caused by RDEB. METHODS A systematic literature review was conducted in MEDLINE and Embase in accordance with PRISMA guidelines. Observational and interventional studies on the economic, clinical, or humanistic burden of RDEB were included. RESULTS Sixty-five studies were included in the review. Patients had considerable wound burden, with 60% reporting wounds covering more than 30% of their body. Increases in pain and itch were seen with larger wound size. Chronic wounds were larger and more painful than recurrent wounds. Commonly reported symptoms and complications included lesions and blistering, anemia, nail dystrophy and loss, milia, infections, musculoskeletal contractures, strictures or stenoses, constipation, malnutrition/nutritional problems, pseudosyndactyly, ocular manifestations, and dental caries. Many patients underwent esophageal dilation (29-74%; median dilations, 2-6) and gastrostomy tube placement (8-58%). In the severely affected population, risk of squamous cell carcinoma (SCC) was 76% and mortality from SCC reached 84% by age 40. Patients with RDEB experienced worsened quality of life (QOL), decreased functioning and social activities, and increased pain and itch when compared to other EB subtypes, other skin diseases, and the general population. Families of patients reported experiencing high rates of burden including financial burden (50-54%) and negative impact on private life (79%). Direct medical costs were high, though reported in few studies; annual payer-borne total medical costs in Ireland were $84,534 and annual patient-borne medical costs in Korea were $7392. Estimated annual US costs for wound dressings ranged from $4000 to $245,000. Patients spent considerable time changing dressings: often daily (13-54% of patients) with up to three hours per change (15-40%). CONCLUSION Patients with RDEB and their families/caregivers experience significant economic, humanistic, and clinical burden. Further research is needed to better understand the costs of disease, how the burden of disease changes over the patient lifetime and to better characterize QOL impact, and how RDEB compares with other chronic, debilitating disorders.
Collapse
Affiliation(s)
- Jean Yuh Tang
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - M Peter Marinkovich
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Eleanor Lucas
- Pharmerit - An OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, 20814, USA
| | - Emily Gorell
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Albert Chiou
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Ying Lu
- Department of Dermatology, Stanford Universixsty School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA
| | - Jodie Gillon
- Abeona Therapeutics Inc, 1330 Avenue of the Americas, New York, NY, 10019, USA
| | - Dipen Patel
- Pharmerit - An OPEN Health Company, 4350 East West Highway, Suite 1100, Bethesda, MD, 20814, USA
| | - Dan Rudin
- Abeona Therapeutics Inc, 1330 Avenue of the Americas, New York, NY, 10019, USA.
| |
Collapse
|
8
|
The analysis of echocardiographic results in patients suffering from epidermolysis bullosa. Postepy Dermatol Alergol 2021; 37:871-878. [PMID: 33603603 PMCID: PMC7874876 DOI: 10.5114/ada.2020.102101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Cardiac abnormalities revealed in patients suffering from epidermolysis bullosa (EB) include dilated cardiomyopathy (DC) and aortopathy. DC is a rare but serious complication associated with an increased mortality, predominantly observed in recessive dystrophic EB. Echocardiography is the most available diagnostic tool used to detect heart disease in EB patients. Aim To analyse echocardiographic results obtained in Polish EB patients and compare them between the EB group and healthy persons. Material and methods We analysed retrospectively echocardiograms of 23 patients with EB (14 F, mean age 17.3 years) performed from 2017 to 2019. The incidence of left ventricular (LV) systolic and diastolic dysfunction, right heart disease and congenital heart disease was evaluated. A comparison of echo-parameters between EB patients and 20 matched healthy subjects was performed. Results We did not find any cases of DC and aortopathy in the EB group. One bicuspid aortic valve case was revealed. Analysis of LV diastolic parameters showed that the mean value of mitral A velocity was significantly higher and the pulmonary venous flow D velocity was lower in the EB group than in controls. Tissue Doppler analysis revealed lower values of E’ velocities of mitral annulus in the EB group, what may suggest discreetly slower LV relaxation, however, this will definitely require further research. Conclusions Although most EB patients do not present cardiac symptoms, there is still a risk of developing cardiomyopathy associated with poor prognosis. It seems reasonable to perform a scheduled echocardiographic screening including LV systolic and diastolic function assessment to detect preclinical cardiac abnormalities.
Collapse
|
9
|
Salera S, Tadini G, Rossetti D, Grassi FS, Marchisio P, Agostoni C, Giavoli C, Rodari G, Guez S. A nutrition-based approach to epidermolysis bullosa: Causes, assessments, requirements and management. Clin Nutr 2019; 39:343-352. [PMID: 30857908 DOI: 10.1016/j.clnu.2019.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/23/2019] [Accepted: 02/15/2019] [Indexed: 12/15/2022]
Abstract
Inherited epidermolysis bullosa (EB) is a clinically and genetically heterogeneous group of rare diseases characterized by skin and mucous membrane fragility. EB primarily involves the skin and, in specific subtypes, the mucous membrane, resulting in complications which can strongly affect nutritional status (e.g. gastrointestinal complications, hand deformities, pain). The aims of nutritional support mainly include improving nutritional status, alleviating the stress of oral feeding and minimizing nutritional deficiencies, thus consequently improving growth, pubertal development, bowel function, immune status and wound healing. The aim of this review is to discuss knowledge of different aspects of the disease related to nutrition and growth.
Collapse
Affiliation(s)
- Simona Salera
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy.
| | - Gianluca Tadini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy
| | - Donata Rossetti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Francesca Sofia Grassi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Paola Marchisio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy; Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università di Milano, 20122, Milano, Italy
| | - Carlo Agostoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Media Intensità di Cura, 20122, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy
| | - Claudia Giavoli
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinologia, 20122, Milano, Italy
| | - Giulia Rodari
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122, Milano, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Endocrinologia, 20122, Milano, Italy
| | - Sophie Guez
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, 20122, Milano, Italy
| |
Collapse
|
10
|
Imbernón-Moya A, Maseda-Pedrero R, Feito M, de Lucas R. Dilated Cardiomyopathy in a Child with Recessive Dystrophic Epidermolysis Bullosa. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
11
|
Schwieger-Briel A, Fuentes I, Castiglia D, Barbato A, Greutmann M, Leppert J, Duchatelet S, Hovnanian A, Burattini S, Yubero MJ, Ibañez-Arenas R, Rebolledo-Jaramillo B, Gräni C, Ott H, Theiler M, Weibel L, Paller AS, Zambruno G, Fischer J, Palisson F, Has C. Epidermolysis Bullosa Simplex with KLHL24 Mutations Is Associated with Dilated Cardiomyopathy. J Invest Dermatol 2018; 139:244-249. [PMID: 30120936 DOI: 10.1016/j.jid.2018.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/27/2018] [Accepted: 07/13/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Agnes Schwieger-Briel
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland; Epidermolysis bullosa Centre, Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| | - Ignacia Fuentes
- Fundación DEBRA Chile, Santiago, Chile; Centro de Genética y Genómica, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Antonio Barbato
- Emergency Medicine and Hypertension Unit, Department of Clinical Medicine and Surgery, Federico II University Medical School, Naples, Italy
| | - Matthias Greutmann
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Juna Leppert
- Epidermolysis bullosa Centre, Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Sabine Duchatelet
- INSERM, Laboratory of Genetic Skin Diseases, Imagine Institute and Paris Descartes University, Paris, France
| | - Alain Hovnanian
- INSERM, Laboratory of Genetic Skin Diseases, Imagine Institute and Paris Descartes University, Paris, France
| | | | - M Joao Yubero
- Fundación DEBRA Chile, Santiago, Chile; Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Rodrigo Ibañez-Arenas
- Fundación DEBRA Chile, Santiago, Chile; Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Department of Cardiology, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Boris Rebolledo-Jaramillo
- Centro de Genética y Genómica, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Christoph Gräni
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, Zurich, Switzerland
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hanover, Germany
| | - Martin Theiler
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Lisa Weibel
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland; Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Judith Fischer
- Department of Human Genetics, Medical Center-University of Freiburg, Germany
| | - Francis Palisson
- Fundación DEBRA Chile, Santiago, Chile; Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Dermatology Department, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Cristina Has
- Epidermolysis bullosa Centre, Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
| |
Collapse
|
12
|
Imbernón-Moya A, Maseda-Pedrero R, Feito M, de Lucas R. Dilated Cardiomyopathy in a Child with Recessive Dystrophic Epidermolysis Bullosa. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:81-83. [PMID: 29699768 DOI: 10.1016/j.ad.2017.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/15/2017] [Accepted: 10/22/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- A Imbernón-Moya
- Departamento de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España.
| | - R Maseda-Pedrero
- Departamento de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - M Feito
- Departamento de Dermatología, Hospital Universitario La Paz, Madrid, España
| | - R de Lucas
- Departamento de Dermatología, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
13
|
|
14
|
Li AW, Prindaville B, Bateman ST, Gibson TE, Wiss K. Inpatient management of children with recessive dystrophic epidermolysis bullosa: A review. Pediatr Dermatol 2017; 34:647-655. [PMID: 28944966 DOI: 10.1111/pde.13276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Recessive dystrophic epidermolysis bullosa is a disorder marked by skin and mucosal blistering after minimal trauma. Even the most routine procedures in the hospital, if done incorrectly, can precipitate extensive skin loss, pain, and scarring. Most providers have little experience working with patients with this degree of skin fragility. When a person with recessive dystrophic epidermolysis bullosa is admitted to the hospital, there are multiple considerations to keep in mind while strategizing an effective care plan: avoidance of new blisters with a "hands-off" approach; careful consideration of all indwelling devices; symptomatic management of pain, itch, and anxiety; coordination of dressing changes; aggressive treatment of skin infections; environmental and staffing considerations; and awareness of other chronic complications that affect care, such as anemia, malnutrition, and chronic pain. To minimize discomfort for patients with recessive dystrophic epidermolysis bullosa during the hospital stay, inpatient care teams should understand these considerations and modify the care plan accordingly. Prior preparation by the hospital facility and inpatient care team will facilitate the delivery of safe and effective care and greatly improve the overall patient experience.
Collapse
Affiliation(s)
- Alvin W Li
- School of Medicine, Yale University, New Haven, CT, USA
| | - Brea Prindaville
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Scot T Bateman
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy E Gibson
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.,Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| |
Collapse
|
15
|
Batalla A, Vicente A, Bartrons J, Prada F, Fortuny C, González-Enseñat M. Cardiomyopathy in Patients With Hereditary Bullous Epidermolysis. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
16
|
Cardiomyopathy in Patients With Hereditary Bullous Epidermolysis. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:544-549. [PMID: 28364942 DOI: 10.1016/j.ad.2017.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/28/2017] [Accepted: 01/31/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE In recent decades, an association has been reported between epidermolysis bullosa (EB) and dilated cardiomyopathy (DC). DC is typically in an advanced phase when detected, leading to a poorer prognosis. Our objective was to determine the prevalence of DC in patients with EB seen in Hospital San Joan de Déu in Barcelona, Spain, between May 1986 and April 2015. METHODS This was a descriptive, cross-sectional chart-review study in which we recorded the type and main subtypes of EB and the presence or absence of DC. RESULTS Fifty-seven patients with EB were found, 19 with EB simplex, 10 with junctional EB, 27 with dystrophic EB (14 dominant dystrophic and 13 recessive dystrophic), and just 1 with Kindler syndrome. DC was detected in only 2 patients with recessive dystrophic EB. Twenty-three patients had presented factors that could have had a causal relationship with the potential onset of DC. CONCLUSION DC is a possible complication of EB, particularly in recessive dystrophic EB. Periodic follow-up should be performed to make an early diagnosis and start treatment.
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW Epidermolysis bullosa is a hereditary skin disorder characterized by skin fragility. However, the disease can manifest in many different organ systems, therefore children born with epidermolysis bullosa may have life long, complex medical needs. In this review, we will use a system-based approach to highlight important aspects of disease management and recent advancements in each of the areas. In addition, we will overview some of the cutting edge therapeutic developments in epidermolysis bullosa. RECENT FINDINGS Recent advancements in supportive care of epidermolysis bullosa with focus on wound, pain, pruritus and nutrition status were discussed. Clinical surveillance and complication prevention are critical to improve clinical outcomes. Generalized epidermolysis bullosa is a systemic disease with increased morbidity and mortality; therefore, complex care using a multidisciplinary approach will provide the greatest benefits for patients. Current targeted treatments for epidermolysis bullosa aim at restoring the skin integrity using protein, cell, and gene therapies. SUMMARY Improvement in care of epidermolysis bullosa in recent years results from keen clinical observation, novel molecular targeting, and the embracement of translational research.
Collapse
|
18
|
Ryan TD, Lucky AW, King EC, Huang G, Towbin JA, Jefferies JL. Ventricular dysfunction and aortic dilation in patients with recessive dystrophic epidermolysis bullosa. Br J Dermatol 2015; 174:671-3. [PMID: 26370777 DOI: 10.1111/bjd.14168] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- T D Ryan
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-2003, U.S.A.
| | - A W Lucky
- The Epidermolysis Bullosa Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-2003, U.S.A
| | - E C King
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-2003, U.S.A
| | - G Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-2003, U.S.A
| | - J A Towbin
- Heart Institute, Le Bonheur Children's Hospital, Memphis, TN, U.S.A
| | - J L Jefferies
- The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229-2003, U.S.A
| |
Collapse
|
19
|
Goldschneider KR, Good J, Harrop E, Liossi C, Lynch-Jordan A, Martinez AE, Maxwell LG, Stanko-Lopp D. Pain care for patients with epidermolysis bullosa: best care practice guidelines. BMC Med 2014; 12:178. [PMID: 25603875 PMCID: PMC4190576 DOI: 10.1186/s12916-014-0178-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 09/09/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) comprises a group of rare disorders that have multi-system effects and patients present with a number of both acute and chronic pain care needs. Effects on quality of life are substantial. Pain and itching are burdensome daily problems. Experience with, and knowledge of, the best pain and itch care for these patients is minimal. Evidence-based best care practice guidelines are needed to establish a base of knowledge and practice for practitioners of many disciplines to improve the quality of life for both adult and pediatric patients with EB. METHODS The process was begun at the request of Dystrophic Epidermolysis Bullosa Research Association International (DEBRA International), an organization dedicated to improvement of care, research and dissemination of knowledge for EB patients worldwide. An international panel of experts in pain and palliative care who have extensive experience caring for patients with EB was assembled. Literature was reviewed and systematically evaluated. For areas of care without direct evidence, clinically relevant literature was assessed, and rounds of consensus building were conducted. The process involved a face-to-face consensus meeting that involved a family representative and methodologist, as well as the panel of clinical experts. During development, EB family input was obtained and the document was reviewed by a wide variety of experts representing several disciplines related to the care of patients with EB. RESULTS The first evidence-based care guidelines for the care of pain in EB were produced. The guidelines are clinically relevant for care of patients of all subtypes and ages, and apply to practitioners of all disciplines involved in the care of patients with EB. When the evidence suggests that the diagnosis or treatment of painful conditions differs between adults and children, it will be so noted. CONCLUSIONS Evidence-based care guidelines are a means of standardizing optimal care for EB patients, whose disease is often times horrific in its effects on quality of life, and whose care is resource-intensive and difficult. The guideline development process also highlighted areas for research in order to improve further the evidence base for future care.
Collapse
Affiliation(s)
- Kenneth R Goldschneider
- Pain Management Center, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | - Julie Good
- Lucille Packard Children's Hospital, Department of Anesthesia (by courtesy, Pediatrics), Stanford University, Stanford, California, USA.
| | - Emily Harrop
- Helen and Douglas Hospices, Oxford and John Radcliffe Hospital, Oxford, USA.
| | - Christina Liossi
- University of Southampton, Southampton, UK.
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
| | - Anne Lynch-Jordan
- Pain Management Center and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| | - Anna E Martinez
- National Paediatric Epidermolysis Bullosa Centre, Great Ormond Street Hospital NHS Foundation Trust, London, UK.
| | - Lynne G Maxwell
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
| | - Danette Stanko-Lopp
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
| |
Collapse
|
20
|
Multicentre consensus recommendations for skin care in inherited epidermolysis bullosa. Orphanet J Rare Dis 2014; 9:76. [PMID: 24884811 PMCID: PMC4110526 DOI: 10.1186/1750-1172-9-76] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/16/2014] [Indexed: 12/22/2022] Open
Abstract
Background Inherited epidermolysis bullosa (EB) comprises a highly heterogeneous group of rare diseases characterized by fragility and blistering of skin and mucous membranes. Clinical features combined with immunofluorescence antigen mapping and/or electron microscopy examination of a skin biopsy allow to define the EB type and subtype. Molecular diagnosis is nowadays feasible in all EB subtypes and required for prenatal diagnosis. The extent of skin and mucosal lesions varies greatly depending on EB subtype and patient age. In the more severe EB subtypes lifelong generalized blistering, chronic ulcerations and scarring sequelae lead to multiorgan involvement, major morbidity and life-threatening complications. In the absence of a cure, patient management remains based on preventive measures, together with symptomatic treatment of cutaneous and extracutaneous manifestations and complications. The rarity and complexity of EB challenge its appropriate care. Thus, the aim of the present study has been to generate multicentre, multidisciplinary recommendations on global skin care addressed to physicians, nurses and other health professionals dealing with EB, both in centres of expertise and primary care setting. Methods Almost no controlled trials for EB treatment have been performed to date. For this reason, recommendations were prepared by a multidisciplinary team of experts from different European EB centres based on available literature and expert opinion. They have been subsequently revised by a panel of external experts, using an online-modified Delphi method to generate consensus. Results Recommendations are reported according to the age of the patients. The major topics treated comprise the multidisciplinary approach to EB patients, global skin care including wound care, management of itching and pain, and early diagnosis of squamous cell carcinoma. Aspects of therapeutic patient education, care of disease burden and continuity of care are also developed. Conclusion The recommendations are expected to be useful for daily global care of EB patients, in particular in the community setting. An optimal management of patients is also a prerequisite to allow them to benefit from the specific molecular and cell-based treatments currently under development.
Collapse
|
21
|
|
22
|
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of inherited skin diseases characterized by increased skin fragility and variable degrees of extracutaneous involvement. The clinical spectrum ranges from localized skin disease to a life-threatening and disabling disease with extensive extracutaneous involvement. All four major types of EB, namely EB simplex, Junctional EB, Dystrophic EB and Kindler syndrome, can present with blistering and erosions at birth and cannot be distinguished clinically in the newborn period. The extensive differential diagnosis of blistering and erosions in the neonate must be considered and common etiologies ruled out. The diagnosis of EB can be confirmed via a skin biopsy for immunoflourescence mapping. This review discusses the four major subtypes of EB and their associated extracutaneous features. The evaluation of a newborn suspected of having EB, including diagnosis and management, is also reviewed.
Collapse
Affiliation(s)
- Mercedes E Gonzalez
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
| |
Collapse
|
23
|
Ryan TD, Ware SM, Lucky AW, Towbin JA, Jefferies JL, Hinton RB. Left ventricular noncompaction cardiomyopathy and aortopathy in a patient with recessive dystrophic epidermolysis bullosa. Circ Heart Fail 2012; 5:e81-2. [PMID: 22991407 DOI: 10.1161/circheartfailure.112.969675] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas D Ryan
- The Heart Institute, Divisions of Cardiology and Molecular Cardiovascular Biology, and Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | | | | | | | | |
Collapse
|
24
|
Salas-Alanis JC, Cepeda-Valdes R, Mellerio JE, Christiano AM, Uitto J. Progress in epidermolysis bullosa: summary of a workshop in CILAD-2010*. Int J Dermatol 2012; 51:682-7. [DOI: 10.1111/j.1365-4632.2011.05130.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Fu T, Lingala B, Kent K, Bachrach L, Bruckner A. Patterns of bone mineral acquisition in children with epidermolysis bullosa: a longitudinal study. Br J Dermatol 2011; 165:1081-6. [DOI: 10.1111/j.1365-2133.2011.10517.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Bibliography. Obstetric and gynaecological anesthesia. Current world literature. Curr Opin Anaesthesiol 2011; 24:354-6. [PMID: 21637164 DOI: 10.1097/aco.0b013e328347b491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Taibjee SM, Moss C. Dilated cardiomyopathy in epidermolysis bullosa: a retrospective, multicenter study-response. Pediatr Dermatol 2010; 27:679; author reply 679-80. [PMID: 21138471 DOI: 10.1111/j.1525-1470.2010.01339.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|