Refining the dermatological spectrum in primary immunodeficiency: mucosa-associated lymphoid tissue lymphoma translocation protein 1 deficiency mimicking Netherton/Omenn syndromes

The proteinase mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1), which forms part of the caspase recruitment domain-containing protein 11-B-cell lymphoma 10-MALT1 signalosome complex, plays a direct role in nuclear factor kappa B activation. Here, we describe the case of a female infant with severe immune dysregulation leading to recurrent systemic infections, failure to thrive and severe crises of ichthyosiform erythroderma with high levels of serum IgE. Hence, initial symptoms indicated Netherton syndrome or Omenn syndrome. Surprisingly, sequence analyses of SPINK5 and RAG1/RAG2, respectively, excluded these diseases. During the hospital stay the patient's health deteriorated, despite intensive care therapy, and she died. In order to delineate the diagnosis, whole-exome sequencing was performed. Two compound heterozygous mutations in MALT1 were found and verified by Sanger sequencing (exon 2 c.245T>C, exon 2 c.310dup), which led to a MALT1 deficiency at the protein level. Based on these results, an immunological analysis was performed, as was immunofluorescence staining of key skin proteins, to confirm a diagnosis of MALT1 deficiency. This case report provides a closer description of the clinical and histological skin phenotype of MALT1 deficiency, and we conclude that MALT1 deficiency must be considered a possible differential diagnosis of Netherton and Omenn syndromes. What's already known about this topic? Mucosa-associated lymphoid tissue lymphoma translocation protein 1 (MALT1) deficiency is a combined immunodeficiency. MALT1 is part of the caspase recruitment domain-containing protein 11-B-cell lymphoma 10-MALT1 signalosome complex, which is essential for nuclear factor kappa B activation. Current publications describe a phenotype of recurrent systemic infections; only in a few cases has an inflammatory involvement of the integument been described. What does this study add? A closer description of the cutaneous phenotype of MALT1 deficiency in a patient with two novel MALT1 mutations. Immune mapping of follicular epidermis shows lympho-epithelial Kazal-type-related inhibitor is reduced in MALT1 deficiency and absent on interfollicular staining. Clinically, MALT1 deficiency mimics Netherton syndrome and Omenn syndrome, and should be considered a differential diagnosis.

Sixteen novel mutations in PNPLA1 in patients with autosomal recessive congenital ichthyosis reveal the importance of an extended patatin domain in PNPLA1 that is essential for proper human skin barrier function

BACKGROUND

Autosomal recessive congenital ichthyosis (ARCI) is a genetically heterogeneous group of rare Mendelian skin disorders characterized by cornification and differentiation defects of keratinocytes. Mutations in nine genes including PNPLA1 are known to cause nonsyndromic forms of ARCI. To date, only 10 distinct pathogenic mutations in PNPLA1 have been reported.

OBJECTIVES

To identify new causative PNPLA1 mutations.

METHODS

We screened genetically unresolved cases, including our ARCI collection, comprising more than 700 families. Screening for mutations was performed either by direct Sanger sequencing or in combination with a multigene panel, followed by sequence and mutation analysis.

RESULTS

Here we report on 16 novel mutations present in patients from 17 families. While all previously reported mutations and most of our novel mutations are located within the core patatin domain, we report five novel PNPLA1 mutations that are downstream of this domain. Thus, as recently described for PNPLA2, we hypothesize that a region larger than the core domain is required for full enzymatic activity of PNPLA1 in human skin barrier formation.

CONCLUSIONS

We estimate the frequency of PNPLA1 mutations among patients with ARCI to be around 3%. Most of our patients were born as collodion babies and showed a relatively mild ichthyosis phenotype. In four unrelated patients we observed a cyclic scaling course, which seems to be a potential phenotypic variation in a small percentage of patients with PNPLA1 mutations. The variability of the clinical manifestations and the lack of typical clinical features are specific for patients with PNPLA1 mutations, and emphasize the importance of DNA sequencing for differential diagnosis of ARCIs.

Infrared observations of the saturnian system from voyager 1

During the passage of Voyager 1 through the Saturn system, the infrared instrument acquired spectral and radiometric data on Saturn, the rings, and Titan and other satellites. Infrared spectra of Saturn indicate the presence of H(2), CH(4), NH(3), PH(3), C(2)H(2), C(2)H(6), and possibly C(3)H(4) and C(3)H(8). A hydrogen mole fraction of 0.94 is inferred with an uncertainty of a few percent, implying a depletion of helium in the atmosphere of Saturn relative to that of Jupiter. The atmospheric thermal structure of Saturn shows hemisphere asymmetries that are consistent with a response to the seasonally varying insolation. Extensive small-scale latitudinal structure is also observed. On Titan, positive identifications of infrared spectral features are made for CH(4), C(2)H(2), C(2)H(4), C(2)H(6), and HCN; tentative identifications are made for C(3)H(4) and C(3)H(8). The infrared continuum opacity on Titan appears to be quite small between 500 and 600 cm(-1), implying that the solid surface is a major contributor to the observed emission over this spectral range; between 500 and 200 cm(-1) theopacity increases with decreasing wave number, attaining an optical thickness in excess of 2 at 200 cm(-1). Temperatures near the 1-millibar level are independent of longitude and local time but show a decrease of approximately 20 K between the equator and north pole, which suggests a seasonally dependent cyclostrophic zonal flow in the stratosphere of approximately 100 meters per second. Measurements of the C ring of Saturn yield a temperature of 85 +/- 1 K and an infrared optical depth of 0.09 +/- 0.01. Radiometer observations of sunlight transmitted through the ring system indicate an optical depth of 10(-1.3 +/-0.3) for the Cassini division. A phase integral of 1.02 +/- 0.06 is inferred for Rhea, which agrees with values for other icy bodies in the solar system. Rhea eclipse observations indicate the presence of surface materials with both high and low thermal inertias, the former most likely a blocky component and the latter a frost.

Infrared observations of the neptunian system

The infrared interferometer spectrometer on Voyager 2 obtained thermal emission spectra of Neptune with a spectral resolution of 4.3 cm(-1). Measurements of reflected solar radiation were also obtained with a broadband radiometer sensitive in the visible and near infrared. Analysis of the strong C(2)H(2) emission feature at 729 cm(-1) suggests an acetylene mole fraction in the range between 9 x 10(-8) and 9 x 10(-7). Vertical temperature profiles were derived between 30 and 1000 millibars at 70 degrees and 42 degrees S and 30 degrees N. Temperature maps of the planet between 80 degrees S and 30 degrees N were obtained for two atmospheric layers, one in the lower stratosphere between 30 and 120 millibars and the other in the troposphere between 300 and 1000 millibars. Zonal mean temperatures obtained from these maps and from latitude scans indicate a relatively warm pole and equator with cooler mid-latitudes. This is qualitatively similar to the behavior found on Uranus even though the obliquities and internal heat fluxes of the two planets are markedly different. Comparison of winds derived from images with the vertical wind shear calculated from the temperature field indicates a general decay of wind speed with height, a phenomenon also observed on the other three giant planets. Strong, wavelike longitudinal thermal structure is found, some of which appears to be associated with the Great Dark Spot. An intense, localizd cold region is seen in the lower stratosphere, which does not appear to be correlated with any visible feature. A preliminary estimate of the effective temperature of the planet yields a value of 59.3 +/- 1.0 kelvins. Measurements of Triton provide an estimate of the daytime surface temperature of 38(+3)(-4) kelvins.

Middle-latency somatosensory evoked potentials after stimulation of the radial and median nerves: component structure and scalp topography

Somatosensory evoked potentials (SEPs) after radial nerve stimulation are studied less frequently than those after median nerve stimulation. Therefore, little is known about their component structure and scalp topography. We investigated radial nerve SEPs after electrical stimulation at the left wrist. For comparison, the median nerve was also stimulated at the wrist. SEPs were recorded with 15 scalp electrodes (bandpass 0.5-200 Hz) in 27 healthy subjects. The waveform of the radial nerve SEP at a contralateral parietal lead was comparable to that of the median nerve SEP, consisting of P14, N20, P30, and N60. In spite of comparable stimulus intensities, SEP amplitudes were smaller after radial than after median nerve stimulation. Significant latency differences were found only for N20 (earlier for median nerve) and P30 (earlier for radial nerve). The duration of the primary complex N20-P30 thus was significantly shorter for the radial nerve. Whereas N20 and P30 were present with either earlobe or frontal reference, N60 had a prerolandic maximum and was best recorded with a bipolar transverse derivation. In addition, another middle-latency negativity (N110) was found near the secondary somatosensory cortex, which had previously been described only for radial nerve stimulation. In standard SEP derivations, the N110 is riding on the ascending limb of the vertex negativity. It could best be recorded in low temporal leads versus a midline reference. The scalp topographies of P30, N60, and N110 were similar for radial and median nerve stimulation.

Topography of middle-latency somatosensory evoked potentials following painful laser stimuli and non-painful electrical stimuli

The aim of this study was to compare cerebral evoked potentials following selective activation of A beta and A delta fibers. In 15 healthy subjects, A beta fibers were activated by electrical stimulation of the left radial nerve at the wrist. A delta fibers were activated by short painful radiant heat pulses, applied to the dorsum of the left hand by a CO2 laser. Evoked potentials were recorded with 15-27 scalp electrodes, evenly distributed over both hemispheres (bandpass 0.5-200 Hz). The laser-evoked potentials exhibited a component with a mean peak latency of 176 msec (N170). Its scalp topography showed a parieto-temporal maximum contralateral to the stimulus side. In contrast, the subsequent vertex negativity (N240), which appeared about 60 msec later, had a symmetrical scalp distribution. Electrically evoked potentials showed a component at 110 msec (N110), that had a topography similar to the laser-evoked N170. The topographies of the N170 and N110 suggest that they may both be generated in the secondary somatosensory cortex. There was no component in the electrically evoked potential that had a comparable interpeak latency to the following vertex potential: for N60 it was longer, for N110 it was shorter. On the other hand, in the laser-evoked potentials no component could be identified the topography of which corresponded to the primary cortical component N20 following electrical stimulation.

Infrared Observations of the Uranian System

The infrared interferometer spectrometer (IRIS) on Voyager 2 recorded thermal emission spectra of Uranus between 200 and 400 cm(-1) and of Miranda and Ariel between 200 and 500 cm(-1) with a spectral resolution of 4.3 cm(-1). Reflected solar radiation was also measured with a single-channel radiometer sensitive in the visible and near infrared. By combining IRIS spectra with radio science results, a mole fraction for atmospheric helium of 0.15 +/- 0.05 (mass fraction, 0.26 +/- 0.08) is found. Vertical temperature profiles between 60 and 900 millibars were derived from average polar and equatorial spectra. Temperatures averaged over a layer between 400 to 900 millibars show nearly identical values at the poles and near the equator but are 1 or 2 degrees lower at mid-latitudes in both hemispheres. The cooler zone in the southern hemisphere appears darker in reflected sunlight than the adjacent areas. An upper limit for the effective temperature of Uranus is 59.4 kelvins. Temperatures of Miranda and Ariel at the subsolar point are 86 +/- 1 and 84 +/- 1 kelvins, respectively, implying Bond albedos of 0.24 +/- 0.06 and 0.31 +/- 0.06, respectively. Estimates of phase integrals suggest that these satellites have unusual surface microstructure.

Infrared Observations of the Saturnian System from Voyager 2

During the passage of Voyager 2 through the Saturn system, infrared spectral and radiometric data were obtained for Saturn, Titan, Enceladus, Tethys, Iapetus, and the rings. Combined Voyager 1 and Voyager 2 observations of temperatures in the upper troposphere of Saturn indicate a seasonal asymmetry between the northern and southern hemispheres, with superposed small-scale meridional gradients. Comparison of high spatial resolution data from the two hemispheres poleward of 60 degrees latitude suggests an approximate symmetry in the small-scale structure, consistent with the extension of a symmetric system of zonal jets into the polar regions. Longitudinal variations of 1 to 2 K are observed. Disk- averaged infrared spectra of Titan show little change over the 9-month interval between Voyager encounters. By combining Voyager 2 temperature measurements with ground-based geometric albedo determinations, phase integrals of 0.91 +/- 0.13 and 0.89 +/- 0.09 were derived for Tethys and Enceladus, respectively. The subsolar point temperature of dark material on Iapetus must exceed 110 K. Temperatures (and infrared optical depths) for the A and C rings and for the Cassini division are 69 +/- 1 K (0.40 +/- 0.05), 85 +/- 1 K (0.10 +/- 0.03), and 85 +/- 2 K (0.07 +/- 0.04), respectively.

Infrared Observations of the Jovian System from Voyager 2

Infrared spectra obtainedfrom Voyager 2 have provided additional data on the Jovian system, complementing those obtained from Voyager 1. The abundance ratio of ethane to acetylene in Jupiter's atmosphere appears to be about three times larger in the polar regions than at lower latitudes. A decidedly hemispherical asymmetry exists, with somewhat higher ratios prevailing in northern latitudes. An overall increase in the abundance ratio by a factor of about 1.7 appears to have occurred between the Voyager 1 and 2 encounters. Global brightness temperature maps of Jupiter at 226 and 602 cm(-1) exhibit a large amount of local- and planetary-scale structure, as well as temporal variability. Although heterogeneous cloud structure and ammonia concentration in the lower troposphere may contribute to the appearance of the 226-cm(-1) map, the detail in the 602-cm(-1) maps probably represents the actual horizontal thermal structure near the tropopause and suggests that dynamical heating and cooling processes are important. Low-latitude surface temperatures on the Galilean satellites rangefrom approximately 80 K on the dark sides to 155 K at the subsolar point on Callisto. Below a thin insulating layer, the thermal inertia of Callisto is somewhat greater than that of Earth's moon. Upper limits on the infrared optical depth of the Jovian ring rangingfrom approximately 3 x 10(-4) at 250 cm(-1) to 3 x 10(-3) at 600 cm(-1) have been found.

Discovery of Currently Active Extraterrestrial Volcanism

The infrared spectroscopy and radiometry investigation has obtained spectra of Jupiter and its satellites between approximately 180 and 2500 cm(-1) with a spectral resolution of 4.3 cm(-1). The Jupiter spectra show clear evidence of H(2), CH(4) C(2)H(2), C(2)H(6), CH(3)D, NH(3), PH(3), H(2)O, and GeH(4). A helium concentration of 0.11 +/- 0.03 by volume is obtained. Meridional temperature cross sections show considerable structure. At high latitudes, the stratosphere is warmer in the north than in the south. The upper troposphere and lower stratosphere are locally cold over the Great Red Spot. Amalthea is warmer than expected. Considerable thermal structure is observed on Io, including a relatively hot region in the vicinity of a volcanic feature.