1
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Liu T, Tang M, Liu J, Kong T, Tian Y, Yang S, Zhang J, Ji S, Lin Z, Xue R, Ding Y, Yang B, Liang Y. A combination therapy with secukinumab and dupilumab in Netherton syndrome: A prospective pilot study. J Am Acad Dermatol 2024:S0190-9622(24)02725-7. [PMID: 39182676 DOI: 10.1016/j.jaad.2024.07.1513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/14/2024] [Accepted: 07/27/2024] [Indexed: 08/27/2024]
Affiliation(s)
- Taoming Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Manman Tang
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiao Liu
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Tinghui Kong
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yuyang Tian
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Sai Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiao Zhang
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Suyun Ji
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhimiao Lin
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Ruzeng Xue
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Yan Ding
- Department of Dermatology, Hainan Provincial Hospital of Skin Disease, Haikou, People's Republic of China
| | - Bin Yang
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China.
| | - Yunsheng Liang
- Dermatology Hospital, Southern Medical University, Guangzhou, People's Republic of China.
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Kostova P, Petrova G, Shahid M, Papochieva V, Miteva D, Yordanova I, Drenovska K, Bradinova I, Janniger CK, Schwartz RA, Vassileva S. Netherton syndrome-A therapeutic challenge in childhood. Clin Case Rep 2024; 12:e8770. [PMID: 38634098 PMCID: PMC11021628 DOI: 10.1002/ccr3.8770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Key Clinical Message High-dose intravenous immunoglobulin exhibits great potential in the treatment of Netherton syndrome. Abstract Netherton syndrome (NS) is a rare autosomal recessive genodermatosis (OMIM #256500) characterized by superficial scaling, atopic manifestations, and multisystemic complications. It is caused by loss-of-function mutations in the SPINK5 gene, which encode a key kallikrein protease inhibitor. There are two subtypes of the syndrome that differ in clinical presentation and immune profile: ichthyosiform erythroderma and ichthyosis linearis circumflexa. NS is a multisystemic disease with numerous extracutaneous manifestations. Current therapy for patients with NS is mainly supportive, as there is no curative or specific treatment, especially for children with NS, but targeted therapies are being developed. We describe an 8-year-old boy with genetically proven NS treated with intravenous immunoglobulin for recurrent skin and systemic infections from infancy, growth retardation, and associated erythroderma. Under this therapy, his skin status, infectious exacerbations, and quality of life all improved. Knowledge of the cytokine-mediated pathogenesis of NS and the development of new biologic drugs open new possibilities for NS patients. However, the different therapeutic options have been applied in a limited number of cases, and variable responses have been shown. Randomized controlled trials with a sufficient number of patients stratified and treated according to their specific immune profile and clinical phenotype are needed to evaluate the safety and efficacy of treatment options for patients with NS.
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Affiliation(s)
- Polina Kostova
- Pediatric DepartmentMedical UniversitySofiaBulgaria
- Pediatric Clinic, UMHAT AlexandrovskaSofiaBulgaria
| | - Guergana Petrova
- Pediatric DepartmentMedical UniversitySofiaBulgaria
- Pediatric Clinic, UMHAT AlexandrovskaSofiaBulgaria
| | - Martin Shahid
- Department of Dermatology and VenereologyMedical UniversitySofiaBulgaria
- Dermatology Clinic UMHAT AlexandrovskaSofiaBulgaria
| | | | - Dimitrinka Miteva
- Pediatric DepartmentMedical UniversitySofiaBulgaria
- Pediatric Clinic, UMHAT AlexandrovskaSofiaBulgaria
| | - Ivelina Yordanova
- Department of Dermatology, Venereology and Allergology, Faculty of MedicineMedical University PlevenPlevenBulgaria
| | - Kossara Drenovska
- Department of Dermatology and VenereologyMedical UniversitySofiaBulgaria
- Dermatology Clinic UMHAT AlexandrovskaSofiaBulgaria
| | - Irena Bradinova
- National Genetic LaboratoryMedical University Sofia, University Hospital of Obstetrics and Gynecology “Maichin dom”SofiaBulgaria
| | - Camila K. Janniger
- Dermatology and PediatricsRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Robert A. Schwartz
- Dermatology, Pediatrics and PathologyRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Snejina Vassileva
- Department of Dermatology and VenereologyMedical UniversitySofiaBulgaria
- Dermatology Clinic UMHAT AlexandrovskaSofiaBulgaria
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3
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Bertrand C, Funaro D. Vulvovaginal involvement in Netherton syndrome: A case report. JAAD Case Rep 2024; 45:4-6. [PMID: 38333679 PMCID: PMC10847694 DOI: 10.1016/j.jdcr.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
- Cassandra Bertrand
- Department of Dermatology, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Deana Funaro
- Department of Dermatology, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Quebec, Canada
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4
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Petrova E, López-Gay JM, Fahrner M, Leturcq F, de Villartay JP, Barbieux C, Gonschorek P, Tsoi LC, Gudjonsson JE, Schilling O, Hovnanian A. Comparative analyses of Netherton syndrome patients and Spink5 conditional knock-out mice uncover disease-relevant pathways. Commun Biol 2024; 7:152. [PMID: 38316920 PMCID: PMC10844249 DOI: 10.1038/s42003-024-05780-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024] Open
Abstract
Netherton syndrome (NS) is a rare skin disease caused by loss-of-function mutations in the serine peptidase inhibitor Kazal type 5 (SPINK5) gene. Disease severity and the lack of efficacious treatments call for a better understanding of NS mechanisms. Here we describe a novel and viable, Spink5 conditional knock-out (cKO) mouse model, allowing to study NS progression. By combining transcriptomics and proteomics, we determine a disease molecular profile common to mouse models and NS patients. Spink5 cKO mice and NS patients share skin barrier and inflammation signatures defined by up-regulation and increased activity of proteases, IL-17, IL-36, and IL-20 family cytokine signaling. Systemic inflammation in Spink5 cKO mice correlates with disease severity and is associated with thymic atrophy and enlargement of lymph nodes and spleen. This systemic inflammation phenotype is marked by neutrophils and IL-17/IL-22 signaling, does not involve primary T cell immunodeficiency and is independent of bacterial infection. By comparing skin transcriptomes and proteomes, we uncover several putative substrates of tissue kallikrein-related proteases (KLKs), demonstrating that KLKs can proteolytically regulate IL-36 pro-inflammatory cytokines. Our study thus provides a conserved molecular framework for NS and reveals a KLK/IL-36 signaling axis, adding new insights into the disease mechanisms and therapeutic targets.
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Affiliation(s)
- Evgeniya Petrova
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute and University of Paris, Paris, France.
| | - Jesús María López-Gay
- Institut Curie, PSL Research University, CNRS UMR 3215, INSERM U934, Paris, F-75248, Cedex 05, France
- Sorbonne University, UPMC University Paris 06, CNRS, CNRS UMR 3215, INSERM U934, F-75005, Paris, France
| | - Matthias Fahrner
- Institute for Surgical Pathology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK) and Cancer Research Center (DKFZ), Freiburg, Germany
| | - Florent Leturcq
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute and University of Paris, Paris, France
| | - Jean-Pierre de Villartay
- Imagine Institute, Laboratory "Genome Dynamics in the Immune System", INSERM UMR 11635, Paris, France
| | - Claire Barbieux
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute and University of Paris, Paris, France
| | - Patrick Gonschorek
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, CH-1015, Switzerland
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Computational Medicine & Bioinformatics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Oliver Schilling
- Institute for Surgical Pathology, Medical Center, Faculty of Medicine, University of Freiburg, Germany; German Cancer Consortium (DKTK) and Cancer Research Center (DKFZ), Freiburg, Germany
| | - Alain Hovnanian
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute and University of Paris, Paris, France.
- Department of Genomic Medicine of rare diseases, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France.
- University of Paris Cité, Paris, France.
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5
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Kordeva SA, Batashki I, Tchernev G. Netherton syndrome in a Bulgarian patient : Presentation of a case and an update of therapeutic options. Wien Med Wochenschr 2023; 173:276-286. [PMID: 36695942 DOI: 10.1007/s10354-022-00999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/15/2022] [Indexed: 01/26/2023]
Abstract
Comel-Netherton syndrome, or Netherton syndrome (NS), is a rare chronic genetic skin condition affecting the daily life of patients, which often results in poorly developed social skills and anxiety. Genetic predisposition plays a key role alongside the clinical findings, and clinicians must be aware of it as it can mimic other well-known skin conditions. Diagnosis is challenging both clinically and histologically. Clinically, it can mimic a severe form of atopic dermatitis, psoriasiform dermatitis overlapping with atopic dermatitis, or erythrokeratodermia variabilis. The difficulties in making histological diagnosis are similar, and it is often necessary to take several biopsies in order to clarify the diagnosis. Although retinoids are used for both psoriasis, erythrokeratodermia variabilis, and other congenital forms of keratodermia, the recommended treatment doses are different. This often results in poor treatment outcome. We present a 16-year-old patient previously diagnosed as erythrokeratodermia variabilis and treated with little to no improvement. Systemic therapy with acitretin 10 mg daily, local pimecrolimus 1%, emollients, and bilastine 20 mg once daily was initiated. Due to the limited application of retinoids and the difficulties in achieving permanent remission, modern medicine is faced with the challenge of seeking innovative therapeutic solutions. New hopes are placed on targeted or anti-cytokine therapy, based on inhibiting the inflammatory component of the disease. This article is mainly focused on innovative therapeutic options, including modern medications such as dupilumab, infliximab, secukinumab, anakinra, omalizumab, and others.
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Affiliation(s)
- Simona Atanasova Kordeva
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria.
| | - Ilia Batashki
- Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria
| | - Georgi Tchernev
- Onkoderma-Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606, Sofia, Bulgaria
- Department of Dermatology and Venereology, Medical Institute of Ministry of Interior, General Skobelev 79, 1606, Sofia, Bulgaria
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Nartisa I, Kirsteina R, Neiburga KD, Zigure S, Ozola L, Grantina I, Micule I, Murmane D, Slisere B, Gailite L, Vilne B, Rots D, Taurina G, Kurjane N. Clinical and genetic characterization of Netherton syndrome due to SPINK5 founder variant in Latvian population. Pediatr Allergy Immunol 2023; 34:e13937. [PMID: 37102386 DOI: 10.1111/pai.13937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Netherton syndrome (NS) (OMIM:256500) is a very rare autosomal recessive multisystem disorder mostly affecting ectodermal derivatives (skin and hair) and immune system. It is caused by biallelic loss-of-function variants in the SPINK5 gene, encoding the protease inhibitor lymphoepithelial Kazal-type-related inhibitor (LEKTI). MATERIAL, METHODS AND RESULTS Here, we describe NS clinical and genetic features of homogenous patient group: 9 individuals from 7 families with similar ethnic background and who have the same SPINK5 variant (NM_006846.4: c.1048C > T, p.(Arg350*)) in homozygous or compound heterozygous states, suggesting that it is a common founder variant in Latvian population. Indeed, we were able to show that the variant is common in general Latvian population, and it shares the same haplotype among the NS individual. It is estimated that the variant arose >1000 years ago. Clinically, all nine patients exhibited typical NS skin changes (scaly erythroderma, ichthyosis linearis circumflexa, itchy skin), except for one patient who has a different skin manifestation-epidermodysplasia. Additionally, we show that developmental delay, previously underrecognized in NS, is a common feature among these patients. CONCLUSIONS This study shows that the phenotype of NS individuals with the same genotype is highly homogeneous.
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Affiliation(s)
- Inga Nartisa
- Riga Stradins University, Riga, Latvia
- Children's Clinical University Hospital, Riga, Latvia
| | - Rasa Kirsteina
- Clinic for Medical Genetics and Prenatal Diagnosis, Children's Clinical University Hospital, Riga, Latvia
| | | | - Sanita Zigure
- Riga Stradins University, Riga, Latvia
- Children's Clinical University Hospital, Riga, Latvia
| | - Lota Ozola
- Children's Clinical University Hospital, Riga, Latvia
| | | | - Ieva Micule
- Clinic for Medical Genetics and Prenatal Diagnosis, Children's Clinical University Hospital, Riga, Latvia
| | - Daiga Murmane
- Clinic for Medical Genetics and Prenatal Diagnosis, Children's Clinical University Hospital, Riga, Latvia
| | - Baiba Slisere
- Riga Stradins University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | | | - Dmitrijs Rots
- Riga Stradins University, Riga, Latvia
- Children's Clinical University Hospital, Riga, Latvia
- Radboudumc, Nijmegen, The Netherlands
| | - Gita Taurina
- Clinic for Medical Genetics and Prenatal Diagnosis, Children's Clinical University Hospital, Riga, Latvia
| | - Natalja Kurjane
- Riga Stradins University, Riga, Latvia
- Clinic for Medical Genetics and Prenatal Diagnosis, Children's Clinical University Hospital, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
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7
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Bhat Y, Trumboo T, Krishan K. Hair shaft disorders in children – An update. Indian Dermatol Online J 2023; 14:163-171. [PMID: 37089857 PMCID: PMC10115339 DOI: 10.4103/idoj.idoj_7_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/18/2022] [Accepted: 06/30/2022] [Indexed: 03/12/2023] Open
Abstract
Disorders of hair shaft are a diverse group of congenital and acquired abnormalities of the hair that can pose a diagnostic and therapeutic challenge to the dermatologists. Hair shaft abnormalities can occur as an isolated phenomenon or can be associated with an underlying genetic syndrome. Any change in the texture, appearance, and growth of the hair should prompt evaluation of the patient for the presence of any hair shaft anomaly. The diagnosis can be suggested by a complete history and physical examination of the hair-bearing areas as well as other ectodermal structures (nails and teeth). A key feature in the evaluation of hair shaft defects is to determine the fragility of the hair shaft that can be elucidated by performing the "tug test." Trichoscopy and light microscopy serve as valuable tools in establishing the specific type of hair shaft disorder. An update of the approach for the diagnosis and management is included in this review.
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8
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Pampalakis G. Αnti-KLK5/KLK7 Antibody-based Strategies for the Treatment of Epidermal Diseases. Curr Pharm Des 2023; 29:2354-2357. [PMID: 37987118 DOI: 10.2174/0113816128258924231011103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/25/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Georgios Pampalakis
- Laboratory of Pharmacology, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
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9
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Yan S, Wu X, Jiang J, Yu S, Fang X, Yang H, Bai X, Wang H, Luo X. Dupilumab improves clinical symptoms in children with Netherton syndrome by suppressing Th2-mediated inflammation. Front Immunol 2022; 13:1054422. [PMID: 36569942 PMCID: PMC9773867 DOI: 10.3389/fimmu.2022.1054422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
Background Netherton syndrome is a rare, life-threatening autosomal recessive genetic disorder with no effective treatment yet. Skin barrier dysfunction caused by SPINK5 gene mutations is a hallmark of the disease. Antigen penetration through the defective skin and nonspecific inflammation provide a pro-T helper 2 (Th2) immune microenvironment in the disease. Therefore, Th2 cytokines are considered to be candidate therapeutic targets. Objective To evaluate the clinical responses of patients with Netherton syndrome to dupilumab, an IL-4Rα antagonist, and identify changes in the Th1/2/17 pathway activity, skin barrier defect protein LEKTI expression after treatment. Methods Four children with severe Netherton syndrome (aged 2 y to 4 y and 6 m) who were treated with dupilumab from January to June 2022 were evaluated at baseline, and at 4, 8, 12, 16, and 20 weeks after the start of dupilumab administration. Treatment response was assessed using the Eczema Area and Severity Index (EASI), the Numerical Rating Scale (NRS), the Dermatology Life Quality Index (CDLQI), and the Dermatitis Family Impact-questionnaire (DFI). Blood eosinophil counts, serum IgE levels and inflammatory cytokines were measured. The immunotyping of Th1/2/17 cells was performed by flow cytometry and cytokine expressions in T cell subsets were analyzed by single-cell RNA sequencing. In addition, expression of the LEKTI in skin lesions was evaluated by immunohistochemical analysis. Results All four patients experienced clinical improvement, with significantly reduced EASI scores (by 75.0-83.9%) and NRS (by 87.5-90.0%) from baseline to 20 weeks of treatment. Improved quality of life scores were also seen for all patients, as measured by CDLQI and DFI. Serum IgE levels also fell by 75.6-86.9%. The serum Th2 cytokines IL-4, IL-5 and IL-13 were found at low level, with no significant changes during the treatment. However, Th2 cytokines expressed by T cells, especially IL-4, decreased at single-cell level after treatment (P = 0.029). The baseline percentage of Th2 cells (among total CD3+CD4+ T cells) was significantly higher in patients than that in healthy controls (HC) (P < 0.0001); this percentage fell from 8.25% ± 0.75% to 4.02% ± 0.62% after 20 weeks dupilumab treatment. There was no noticeable change in LEKTI protein expression in skin lesions pre- and post-treatment. Two patients reported mild ocular adverse effects, but there were no severe adverse events. Conclusion Dupilumab may be an effective and safe treatment option in a subset of pediatric patients with Netherton syndrome, especially in improving itch and the quality of life. These effects were achieved in part by suppression of the Th2-mediated inflammation.
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Affiliation(s)
- Shi Yan
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xuege Wu
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jinqiu Jiang
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Shijuan Yu
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Fang
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Huan Yang
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoming Bai
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Xiaoming Bai, ; Hua Wang, ; Xiaoyan Luo,
| | - Hua Wang
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China,Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Xiaoming Bai, ; Hua Wang, ; Xiaoyan Luo,
| | - Xiaoyan Luo
- Department of Dermatology, Children’s Hospital of Chongqing Medical University Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China,Ministry of Education Key Laboratory of Child Development and Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Xiaoming Bai, ; Hua Wang, ; Xiaoyan Luo,
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10
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Identification of novel differentially expressed genes in type 1 diabetes mellitus complications using transcriptomic profiling of UAE patients: a multicenter study. Sci Rep 2022; 12:16316. [PMID: 36175575 PMCID: PMC9523055 DOI: 10.1038/s41598-022-18997-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/23/2022] [Indexed: 12/01/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is a chronic metabolic disorder that mainly affects children and young adults. It is associated with debilitating and long-life complications. Therefore, understanding the factors that lead to the onset and development of these complications is crucial. To our knowledge this is the first study that attempts to identify the common differentially expressed genes (DEGs) in T1DM complications using whole transcriptomic profiling in United Arab Emirates (UAE) patients. The present multicenter study was conducted in different hospitals in UAE including University Hospital Sharjah, Dubai Hospital and Rashid Hospital. A total of fifty-eight Emirati participants aged above 18 years and with a BMI < 25 kg/m2 were recruited and forty-five of these participants had a confirmed diagnosis of T1DM. Five groups of complications associated with the latter were identified including hyperlipidemia, neuropathy, ketoacidosis, hypothyroidism and polycystic ovary syndrome (PCOS). A comprehensive whole transcriptomic analysis using NGS was conducted. The outcomes of the study revealed the common DEGs between T1DM without complications and T1DM with different complications. The results revealed seven common candidate DEGs, SPINK9, TRDN, PVRL4, MYO3A, PDLIM1, KIAA1614 and GRP were upregulated in T1DM complications with significant increase in expression of SPINK9 (Fold change: 5.28, 3.79, 5.20, 3.79, 5.20) and MYO3A (Fold change: 4.14, 6.11, 2.60, 4.33, 4.49) in hyperlipidemia, neuropathy, ketoacidosis, hypothyroidism and PCOS, respectively. In addition, functional pathways of ion transport, mineral absorption and cytosolic calcium concentration were involved in regulation of candidate upregulated genes related to neuropathy, ketoacidosis and PCOS, respectively. The findings of this study represent a novel reference warranting further studies to shed light on the causative genetic factors that are involved in the onset and development of T1DM complications.
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11
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Matus CE, Ehrenfeld P, Figueroa CD. The family of kallikrein-related peptidases and kinin peptides as modulators of epidermal homeostasis. Am J Physiol Cell Physiol 2022; 323:C1070-C1087. [PMID: 35993513 DOI: 10.1152/ajpcell.00012.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The epidermis is the outermost skin layer and is part of one of the largest organs in the body; it is supported by the dermis, a network of fibrils, blood vessels, pilosebaceous units, sweat glands, nerves, and cells. The skin as a whole is a protective shield against numerous noxious agents, including microorganisms and chemical and physical factors. These functions rely on the activity of multiple growth factors, peptide hormones, proteases, and specific signaling pathways that are triggered by the activation of distinct types of receptors sited in the cell membranes of the various cell types present in the skin. The human kallikrein family comprises a large group of 15 serine proteases synthesized and secreted by different types of epithelial cells throughout the body, including the skin. At this site, they initiate a proteolytic cascade that generates the active forms of the proteases, some of which regulate skin desquamation, activation of cytokines, and antimicrobial peptides. Kinin peptides are formed by the action of plasma and tissue kallikreins on kininogens, two plasma proteins produced in the liver and other organs. Although kinins are well known for their proinflammatory abilities, in the skin they are also considered important modulators of keratinocyte differentiation. In this review, we summarize the contributions of the kallikreins and kallikrein-related peptidases family and those of kinins and their receptors in skin homeostasis, with special emphasis on their pathophysiological role.
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Affiliation(s)
- Carola E Matus
- Departament of Basic Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile.,Center of Molecular Biology and Pharmacogenetics, Universidad de La Frontera, Temuco, Chile.,Center of Biomedical and Morphofunctional Sciences, Universidad de La Frontera, Temuco, Chile
| | - Pamela Ehrenfeld
- Laboratory of Cellular Pathology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile.,Center for Interdisciplinary Studies on Nervous System (CISNe), Universidad Austral de Chile, Valdivia, Chile
| | - Carlos D Figueroa
- Laboratory of Cellular Pathology, Institute of Anatomy, Histology and Pathology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile.,Center for Interdisciplinary Studies on Nervous System (CISNe), Universidad Austral de Chile, Valdivia, Chile
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12
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Joosten MDW, Clabbers JMK, Jonca N, Mazereeuw-Hautier J, Gostyński AH. New developments in the molecular treatment of ichthyosis: review of the literature. Orphanet J Rare Dis 2022; 17:269. [PMID: 35840979 PMCID: PMC9287901 DOI: 10.1186/s13023-022-02430-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Ichthyosis covers a wide spectrum of diseases affecting the cornification of the skin. In recent years, new advances in understanding the pathophysiology of ichthyosis have been made. This knowledge, combined with constant development of pathogenesis-based therapies, such as protein replacement therapy and gene therapy, are rather promising for patients with inherited skin diseases. Several ongoing trials are investigating the potency of these new approaches and various studies have already been published. Furthermore, a lot of case series report that biological therapeutics are effective treatment options, mainly for Netherton syndrome and autosomal recessive congenital ichthyosis. It is expected that some of these new therapies will prove their efficacy and will be incorporated in the treatment of ichthyosis.
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Affiliation(s)
- M D W Joosten
- Department of Dermatology, The Netherlands and European Reference Network - Skin, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands
| | - J M K Clabbers
- Department of Dermatology, The Netherlands and European Reference Network - Skin, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.,Department of Dermatology, Haga Hospital, The Hague, The Netherlands
| | - N Jonca
- Cell Biology and Cytology Laboratory, CNRS, Inserm, UPS, European Reference Network - Skin, University Hospital Center of Toulouse and Infinity, Federal Biology Institute, Toulouse University, Toulouse, France
| | - J Mazereeuw-Hautier
- Department of Dermatology, European Reference Network - Skin, University Hospital Center of Toulouse, Toulouse, France
| | - A H Gostyński
- Department of Dermatology, The Netherlands and European Reference Network - Skin, Maastricht University Medical Center, Maastricht, The Netherlands. .,GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, P. Debyelaan 25, 6229HX, Maastricht, The Netherlands.
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13
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Gonschorek P, Zorzi A, Maric T, Le Jeune M, Schüttel M, Montagnon M, Gómez-Ojea R, Vollmar DP, Whitfield C, Reymond L, Carle V, Verma H, Schilling O, Hovnanian A, Heinis C. Phage Display Selected Cyclic Peptide Inhibitors of Kallikrein-Related Peptidases 5 and 7 and Their In Vivo Delivery to the Skin. J Med Chem 2022; 65:9735-9749. [PMID: 35653695 DOI: 10.1021/acs.jmedchem.2c00306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Kallikrein-related peptidases 5 (KLK5) and 7 (KLK7) are serine proteases with homeostatic functions in the epidermis that play a critical role in Netherton syndrome (NS), a rare yet life-threatening genetic disorder that currently lacks specific treatment. Previous research suggests that controlling KLKs could lead to the development of NS therapies, but existing synthetic inhibitors have limitations. Herein, we used phage display to screen libraries comprising more than 100 billion different cyclic peptides and found selective, high-affinity inhibitors of KLK5 (Ki = 2.2 ± 0.1 nM) and KLK7 (Ki = 16 ± 4 nM). By eliminating protease-prone sites and conjugating the inhibitors to an albumin-binding peptide, we enhanced the inhibitor stability and prolonged the elimination half-life to around 5 h in mice. In tissue sections taken from mice, a fluorescently labeled peptide was detected in the epidermis, suggesting that the inhibitors can reach the KLKs upon systemic delivery and should be suited to control deregulated protease activity in NS.
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Affiliation(s)
- Patrick Gonschorek
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Alessandro Zorzi
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Tamara Maric
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Mathilde Le Jeune
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Mischa Schüttel
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Mathilde Montagnon
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Rebeca Gómez-Ojea
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Denis Patrick Vollmar
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Chantal Whitfield
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Luc Reymond
- Biomolecular Screening Facility, Swiss Federal Institute of Technology Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Vanessa Carle
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Hitesh Verma
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
| | - Oliver Schilling
- Institute for Surgical Pathology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg 79106, Germany
| | - Alain Hovnanian
- INSERM UMR1163, Imagine Institute, University of Paris, Paris, France; Department of Genetics, Necker Hospital for Sick Children (AP-HP), 75015 Paris, France
| | - Christian Heinis
- Institute of Chemical Sciences and Engineering, School of Basic Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1015, Switzerland
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14
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Nouwen AEM, Schappin R, Nguyen NT, Ragamin A, Bygum A, Bodemer C, Dalm VASH, Pasmans SGMA. Outcomes of Systemic Treatment in Children and Adults With Netherton Syndrome: A Systematic Review. Front Immunol 2022; 13:864449. [PMID: 35464459 PMCID: PMC9022473 DOI: 10.3389/fimmu.2022.864449] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/07/2022] [Indexed: 01/24/2023] Open
Abstract
Background Comèl-Netherton syndrome (NS) is a rare disease caused by pathogenic variants in the SPINK5 gene, leading to severe skin barrier impairment and proinflammatory upregulation. Given the severity of the disease, treatment of NS is challenging. Current treatment regimens are mainly topical and supportive. Although novel systemic treatment options for NS have been suggested in recent literature, little is known about their outcomes. Objective to provide an overview of systemic treatment options and their outcomes in adults and children with NS. Methods Embase, MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to July 22, 2021. Empirical studies published in English language mentioning systemic treatment in NS were enrolled. Studies that did not define a treatment period or report at least one outcome were excluded. Methodological quality was evaluated by the Joanna Briggs Institute critical appraisal checklist for case reports or case series. Overall quality of evidence of the primary outcome, skin, was assessed by the GRADE approach. Results 36 case series and case reports were included. The effects of 15 systemic therapies were described in 48 patients, of which 27 were children. Therapies included retinoids, prednisolone, cyclosporine, immunoglobulins, and biologicals. In retinoids both worsening (4/15 cases) and improvement (6/15 cases) of the skin was observed. Use of prednisolone and cyclosporine was only reported in one patient. Immunoglobulins (13/15 cases) and biologicals (18/21 cases) showed improvement of the skin. Certainty of evidence was rated as very low. Conclusion NS is a rare disease, which is reflected in the scarce literature on systemic treatment outcomes in children and adults with NS. Studies showed large heterogeneity in outcome measures. Adverse events were scarcely reported. Long-term outcomes were reported in a minority of cases. Nonetheless, a general beneficial effect of systemic treatment was found. Immunoglobulins and biologicals showed the most promising results and should be further explored. Future research should focus on determining a core outcome set and measurement instruments for NS to improve quality of research. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=217933, PROSPERO (ID: 217933).
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Affiliation(s)
- Anouk E M Nouwen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Renske Schappin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - N Tan Nguyen
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Aviël Ragamin
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Anette Bygum
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Christine Bodemer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Diseases (MAGEC), Necker-Enfants Malades Hospital (AP-HP), Paris Centre University, Paris, France
| | - Virgil A S H Dalm
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology-Center of Pediatric Dermatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
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15
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Srinivasan S, Kryza T, Batra J, Clements J. Remodelling of the tumour microenvironment by the kallikrein-related peptidases. Nat Rev Cancer 2022; 22:223-238. [PMID: 35102281 DOI: 10.1038/s41568-021-00436-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 02/07/2023]
Abstract
Kallikrein-related peptidases (KLKs) are critical regulators of the tumour microenvironment. KLKs are proteolytic enzymes regulating multiple functions of bioactive molecules including hormones and growth factors, membrane receptors and the extracellular matrix architecture involved in cancer progression and metastasis. Perturbations of the proteolytic cascade generated by these peptidases, and their downstream signalling actions, underlie tumour emergence or blockade of tumour growth. Recent studies have also revealed their role in tumour immune suppression and resistance to cancer therapy. Here, we present an overview of the complex biology of the KLK family and its context-dependent nature in cancer, and discuss the different therapeutic strategies available to potentially target these proteases.
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Affiliation(s)
- Srilakshmi Srinivasan
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Australian Prostate Cancer Research Centre-Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Thomas Kryza
- Australian Prostate Cancer Research Centre-Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
- Mater Research Institute, The University of Queensland, Woolloongabba, Brisbane, Queensland, Australia
| | - Jyotsna Batra
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Australian Prostate Cancer Research Centre-Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia
- Centre for Genomics and Personalised Medicine, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Judith Clements
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.
- Australian Prostate Cancer Research Centre-Queensland, Translational Research Institute, Woolloongabba, Queensland, Australia.
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16
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Hegazy M, Perl AL, Svoboda SA, Green KJ. Desmosomal Cadherins in Health and Disease. ANNUAL REVIEW OF PATHOLOGY 2022; 17:47-72. [PMID: 34425055 PMCID: PMC8792335 DOI: 10.1146/annurev-pathol-042320-092912] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Desmosomal cadherins are a recent evolutionary innovation that make up the adhesive core of highly specialized intercellular junctions called desmosomes. Desmosomal cadherins, which are grouped into desmogleins and desmocollins, are related to the classical cadherins, but their cytoplasmic domains are tailored for anchoring intermediate filaments instead of actin to sites of cell-cell adhesion. The resulting junctions are critical for resisting mechanical stress in tissues such as the skin and heart. Desmosomal cadherins also act as signaling hubs that promote differentiation and facilitate morphogenesis, creating more complex and effective tissue barriers in vertebrate tissues. Interference with desmosomal cadherin adhesive and supra-adhesive functions leads to a variety of autoimmune, hereditary, toxin-mediated, and malignant diseases. We review our current understanding of how desmosomal cadherins contribute to human health and disease, highlight gaps in our knowledge about their regulation and function, and introduce promising new directions toward combatting desmosome-related diseases.
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Affiliation(s)
- Marihan Hegazy
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Abbey L. Perl
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Sophia A. Svoboda
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
| | - Kathleen J. Green
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA,Department of Dermatology, Feinberg School of Medicine, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois 60611, USA
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17
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Cocktails of KLK5 Protease Inhibitors and Anti-TNFα Therapeutics: an Effective Treatment for Netherton Syndrome. J Clin Immunol 2022; 42:597-605. [PMID: 35040012 DOI: 10.1007/s10875-021-01195-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
Netherton syndrome (NS) is a rare, severe type of ichthyosis, often lethal in neonates, for which there is no therapy. Spink5-/- mice recapitulate major NS hallmarks and die homogeneously within 5 h from birth due to severe epidermal barrier defect leading to dehydration. Spink5-/-Klk5-/- mice survive neonatal lethality, indicating that KLK5 could be a drug target for NS. Nevertheless, after a week, these mice developed epidermal inflammation and signs of barrier defect leading to lethality. Here we tested whether anti-TNFα strategy in combination with anti-KLK5 could provide a long-term effective therapy for NS. Deletion of Tnfa in Spink5-/- suppressed the inflammatory phenotype but did not rescue neonatal lethality of Spink5-/- indicating that anti-TNFα therapy alone would not be sufficient to treat NS. Interestingly, in Spink5-/-Klk5-/-Tnfa-/- mice, NS features were rescued, and mice lived normally for 16-18 months. For the first time, evidence is provided that a combination of anti-TNFα and anti-KLK5 therapeutics represents an effective therapeutic strategy for NS. Notably, anti-TNFα factors are marketed and used widely, while LMW KLK5 inhibitors are being developed.
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18
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Fölster-Holst R, Naß C, Dähnhardt-Pfeiffer S, Freitag-Wolf S. Analysis of the structure and function of the epidermal barrier in patients with ichthyoses - clinical and electron microscopical investigations. J Eur Acad Dermatol Venereol 2022; 36:726-738. [PMID: 35015925 DOI: 10.1111/jdv.17914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ichthyoses are pathogenetically characterised by a pronounced disorder of the epidermal barrier. Clinically, hyperkeratosis, severe scaling and erythroderma are present on the entire integument. The time-consuming therapy includes daily baths and the application of skin care products to restore the epidermal barrier. OBJECTIVES AND METHODS To enhance the knowledge about the structure and function of the epidermal barrier in ichthyoses, we conducted clinical, biophysical and electron microscopical measurements on 46 patients with ichthyoses, including autosomal recessive ichthyoses, keratinopathic ichthyoses, X-chromosomal recessive ichthyosis and Netherton syndrome. RESULTS The patients displayed a significantly decreased skin hydration along with unexpectedly low transepidermal waterloss values. Electron microscopical examinations demonstrated a severe occlusion of the epidermis by lipid remnants of skin care products in the stratum corneum. We found decreased intercellular lipid lamellae and an increased undulation of the corneocyte membrane of all ichthyoses, mostly pronounced in Netherton syndrome. The lipid profiles of ichthyoses showed decreased esterified Ω-hydroxy-sphingosine (EOS) ceramide levels. CONCLUSIONS The results demonstrate the extent of the epidermal barrier disruption in ichthyoses. In combination with the knowledge about pathogenetic causes, individually improved therapeutic options can be derived from our results. In the future, the analyses of the organisation of intercellular lipid lamellae and corneocyte membrane undulation will enable improved investigations of the epidermal barrier in ichthyoses and may be used to study and evaluate possible effects of topical skin preparations.
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Affiliation(s)
- R Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - C Naß
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - S Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
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19
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Pontone M, Giovannini M, Filippeschi C, Oranges T, Pedaci FA, Mori F, Barni S, Barbati F, Consonni F, Indolfi G, Lodi L, Azzari C, Ricci S, Hovnanian A. Biological treatments for pediatric Netherton syndrome. Front Pediatr 2022; 10:1074243. [PMID: 36619513 PMCID: PMC9822572 DOI: 10.3389/fped.2022.1074243] [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: 10/24/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Netherton syndrome (NS) is a rare and potentially life-threatening genetic skin disease responsible for skin inflammation and scaling, hair abnormalities and severe allergic manifestations. NS is caused by loss-of-function variants in Serine Peptidase Inhibitor Kazal-Type 5 (SPINK5), encoding the serine protease inhibitor LEKTI. NS patients have a profound skin barrier defect caused by unopposed kallikrein-related proteases activity (KLKs). They develop severe skin inflammation with eczematous-like lesions and high serum IgE levels. Multiomics studies have revealed that the IL-17/IL-36 pathway is the most predominant upregulated pathway in NS. It is associated with a Th2 signature with complement activation in the ichthyosis linearis circumflexa subtype, and with interferon and Th9 activation in the scaly erythrodermic form. Several case reports proved the efficacy of different biotherapies targeting IL-17A, IL-12/IL-23, IL-4R and IL-13R, TNF-a and IL-1β in pediatric NS patients. Intravenous immunoglobulins (IVIG) have also shown efficacy. These studies showed no severe side effects. At present, IL-17 blockade seems to be the most efficient treatment, but case reports remain limited with small numbers of patients and no placebo-control. Additional pathways must also be explored, and more efficient strategies could be used to block IL-17 and IL-23 pathways. In the future, the combination of specific strategies aiming at repairing the initial skin barrier defect could potentiate the efficacy of biologics. The current reports suggest that biological therapy is safe and often effective at pediatric age. However, controlled clinical trials that include a larger number of patients need to be conducted to reach more reliable conclusions.
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Affiliation(s)
- Matteo Pontone
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy.,Allergy Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Cesare Filippeschi
- Dermatology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Teresa Oranges
- Dermatology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | | | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Simona Barni
- Allergy Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Federica Barbati
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Filippo Consonni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Giuseppe Indolfi
- Pediatric and Liver Unit, Meyer Children's University Hospital, Florence, Italy
| | - Lorenzo Lodi
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Chiara Azzari
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Silvia Ricci
- Department of Health Sciences, University of Florence, Florence, Italy.,Immunology Unit, Department of Pediatrics, Meyer Children's Hospital, Florence, Italy
| | - Alain Hovnanian
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute and University of Paris, Paris, France.,Department of Genetics, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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20
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Liddle J, Beneton V, Benson M, Bingham R, Bouillot A, Boullay AB, Brook E, Cryan J, Denis A, Edgar E, Ferrie A, Fouchet MH, Grillot D, Holmes DS, Howes A, Krysa G, Laroze A, Lennon M, McClure F, Moquette A, Nicodeme E, Santiago B, Santos L, Smith KJ, Thorpe JH, Thripp G, Trottet L, Walker AL, Ward SA, Wang Y, Wilson S, Pearce AC, Hovnanian A. A Potent and Selective Kallikrein-5 Inhibitor Delivers High Pharmacological Activity in Skin from Patients with Netherton Syndrome. J Invest Dermatol 2021; 141:2272-2279. [PMID: 33744298 DOI: 10.1016/j.jid.2021.01.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/10/2020] [Accepted: 01/06/2021] [Indexed: 12/01/2022]
Abstract
Regulation of proteolytic activity in the skin plays a pivotal role in epidermal homeostasis. This is best exemplified in Netherton syndrome, a severe genetic skin condition caused by loss-of-function mutations in the gene serine protease inhibitor Kazal-type 5 encoding lympho-epithelial Kazal-type-related inhibitor, a serine protease inhibitor that regulates kallikrein (KLK)-related peptidase 5, 7, and 14 activities. KLK5 plays a central role in stratum corneum shedding and inflammatory cell signaling, activates KLK7 and KLK14, and is therefore an optimal therapeutic target. We aimed to identify a potent and selective small-molecule inhibitor of KLK5 amenable to epidermal delivery. GSK951 was identified using a structure-based design strategy and showed a half maximal inhibitory concentration of 250 pM for KLK5 and greater than 100-fold selectivity over KLK7 and KLK14. Cocrystal structure analysis identified the critical catalytic site interactions to a surrogate for KLK5. Topical application of GSK951-containing cream inhibited KLK5 activity in TgKLK5 mouse skin, reduced transepidermal water loss, and decreased proinflammatory cytokine expression. GSK951 achieved high concentrations in healthy human epidermis following topical application in a cream formulation. Finally, KLK5 protease activity was increased in stratum corneum of patients with Netherton syndrome and significantly inhibited by GSK951. These findings unveil a KLK5-specific small-molecule inhibitor with a high therapeutic potential for patients with Netherton syndrome.
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Affiliation(s)
- John Liddle
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | | | - Matthew Benson
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Ryan Bingham
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | | | | | - Eloisa Brook
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Jenni Cryan
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | | | - Emma Edgar
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Alan Ferrie
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | | | | | - Duncan S Holmes
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Ashleigh Howes
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | | | | | - Mark Lennon
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Fiona McClure
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | | | | | - Brandon Santiago
- Discovery and Preclinical Development, GSK Dermatology Unit, Collegeville, Pennsylvania, USA
| | - Leandro Santos
- Discovery and Preclinical Development, GSK Dermatology Unit, Collegeville, Pennsylvania, USA
| | - Kathrine J Smith
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - James H Thorpe
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Gary Thripp
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | | | - Ann L Walker
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Simon A Ward
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Yichen Wang
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - Steve Wilson
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Andrew C Pearce
- Medicines Research Centre, GlaxoSmithKline R&D, Stevenage, United Kingdom
| | - Alain Hovnanian
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France; University of Paris, Paris, France; Department of Genetics, Necker hospital for sick children, Assistance Publique-Hôpitaux de Paris, Paris, France.
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