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Pawlowski J, Pukhalskaya T, Cordoro K, Ibraheim MK, North JP. Interleukin-36 Is Highly Expressed in Skin Biopsies from Two Patients with Netherton Syndrome. Dermatopathology (Basel) 2024; 11:230-237. [PMID: 39189180 PMCID: PMC11348212 DOI: 10.3390/dermatopathology11030024] [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: 07/08/2024] [Revised: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/28/2024] Open
Abstract
Netherton syndrome (NS) is a rare autosomal recessive disorder that occurs due to a loss-of-function mutation in SPINK5; this loss results in significant inflammation, as well as perturbations of the skin barrier's integrity and functionality. While it is unclear which inflammatory pathways contribute to the development of NS, recent studies have demonstrated the expression of interleukin (IL)-17/IL-36, as well as several Th2 cytokines. Consequently, immunohistochemistry (IHC) with IL-36 may serve as a potential tool for aiding the histopathological diagnosis of this condition. In this case series, we present two cases of NS and capture their immunostaining pattern with IL-36. Both cases demonstrated robust expression of IL-36. This finding bolsters the hypothesis that NS is partially driven by Th17 activation and suggests the potential utility of IL-36 IHC as part of the workup for this rare and diagnostically elusive entity. LEKTI IHC was negative in one biopsy, revealing a limitation of this stain in diagnosing NS.
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Affiliation(s)
- Johannes Pawlowski
- Department of Dermatology, University Hospital Mainz, 55131 Mainz, Germany;
| | - Tatsiana Pukhalskaya
- Department of Dermatology and Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Kelly Cordoro
- Department of Dermatology and Pediatrics, University of California San Francisco, San Francisco, CA 94143, USA;
| | | | - Jeffrey P. North
- Department of Dermatology and Pathology, University of California San Francisco, San Francisco, CA 94143, USA
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Salici NS, Ozcanli A, Rasulova G, Basak AN, Tekgul S, Vural S. Successful infliximab treatment in siblings with Netherton syndrome: Unveiling a novel SPINK5 gene variant and literature review. Australas J Dermatol 2024; 65:e45-e49. [PMID: 38419182 DOI: 10.1111/ajd.14234] [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: 12/26/2023] [Revised: 01/15/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
Netherton syndrome (NS) is a rare autosomal recessive genodermatosis. In this article, we present two siblings with NS who harbour a novel variant in the SPINK5 gene and were treated with infliximab infusions. Both patients exhibited the characteristic clinical triad of NS, and their whole exome sequencing analysis revealed a homozygous variant, c.1820+53G>A, in the SPINK5 gene. Notably, this is the first documented instance of homozygosity for this particular variant. Despite the absence of a specific treatment, both patients achieved total clearance of the skin lesions, and a significant decrease in total IgE levels was documented.
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Affiliation(s)
- Nazmiye Selin Salici
- Department of Dermatology and Venereology, Koç University School of Medicine, Zeytinburnu, Turkey
| | - Adil Ozcanli
- Department of Dermatology and Venereology, Koç University School of Medicine, Zeytinburnu, Turkey
| | - Gunel Rasulova
- Department of Dermatology and Venereology, Koç University School of Medicine, Zeytinburnu, Turkey
| | - Ayse Nazli Basak
- Neurodegeneration Research Laboratory, Suna and Inan Kıraç Foundation, KUTTAM, Koç University School of Medicine, Zeytinburnu, Turkey
| | - Seyma Tekgul
- Neurodegeneration Research Laboratory, Suna and Inan Kıraç Foundation, KUTTAM, Koç University School of Medicine, Zeytinburnu, Turkey
| | - Secil Vural
- Department of Dermatology and Venereology, Koç University School of Medicine, Zeytinburnu, Turkey
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Ho M, Nguyen HN, Van Hoang M, Bui TTT, Vu BQ, Dinh THT, Vo HTM, Blaydon DC, Eldirany SA, Bunick CG, Bui CB. Altered skin microbiome, inflammation, and JAK/STAT signaling in Southeast Asian ichthyosis patients. Hum Genomics 2024; 18:38. [PMID: 38627868 PMCID: PMC11022333 DOI: 10.1186/s40246-024-00603-x] [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: 09/14/2023] [Accepted: 04/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Congenital ichthyosis (CI) is a collective group of rare hereditary skin disorders. Patients present with epidermal scaling, fissuring, chronic inflammation, and increased susceptibility to infections. Recently, there is increased interest in the skin microbiome; therefore, we hypothesized that CI patients likely exhibit an abnormal profile of epidermal microbes because of their various underlying skin barrier defects. Among recruited individuals of Southeast Asian ethnicity, we performed skin meta-genomics (i.e., whole-exome sequencing to capture the entire multi-kingdom profile, including fungi, protists, archaea, bacteria, and viruses), comparing 36 CI patients (representing seven subtypes) with that of 15 CI age-and gender-matched controls who had no family history of CI. RESULTS This case-control study revealed 20 novel and 31 recurrent pathogenic variants. Microbiome meta-analysis showed distinct microbial populations, decreases in commensal microbiota, and higher colonization by pathogenic species associated with CI; these were correlated with increased production of inflammatory cytokines and Th17- and JAK/STAT-signaling pathways in peripheral blood mononuclear cells. In the wounds of CI patients, we identified specific changes in microbiota and alterations in inflammatory pathways, which are likely responsible for impaired wound healing. CONCLUSIONS Together, this research enhances our understanding of the microbiological, immunological, and molecular properties of CI and should provide critical information for improving therapeutic management of CI patients.
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Affiliation(s)
- Minh Ho
- Department of Dermatology and Program in Translational Biomedicine, Yale University, New Haven, CT, USA
| | - Huynh-Nga Nguyen
- Microbial Genomics DNA Medical Technology, Ho Chi Minh, Vietnam
- Department of Biology, Dalat University, Da Lat, Lam Dong, Vietnam
| | - Minh Van Hoang
- Vietnam Vascular Anomalies Center, University Medical Center 3, Ho Chi Minh, Vietnam
| | | | - Bao-Quoc Vu
- Microbial Genomics DNA Medical Technology, Ho Chi Minh, Vietnam
- Department of Biology, Dalat University, Da Lat, Lam Dong, Vietnam
| | - Truc Huong Thi Dinh
- Department of Pathophysiology and Immunology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Hoa Thi My Vo
- Oxford University Clinical Research Unit, Ho Chi Minh, Vietnam
| | - Diana C Blaydon
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Sherif A Eldirany
- Department of Dermatology and Program in Translational Biomedicine, Yale University, New Haven, CT, USA
| | - Christopher G Bunick
- Department of Dermatology and Program in Translational Biomedicine, Yale University, New Haven, CT, USA.
| | - Chi-Bao Bui
- Microbial Genomics DNA Medical Technology, Ho Chi Minh, Vietnam.
- Department of Microbiology, City Children's Hospital, Ho Chi Minh, Vietnam.
- School of Medicine, Vietnam National University, Ho Chi Minh, Vietnam.
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Chen MKY, Flanagan AL, Sebaratnam DF, Gu Y. Biologics for inherited disorders of keratinisation: A systematic review. Australas J Dermatol 2024; 65:185-214. [PMID: 38126177 DOI: 10.1111/ajd.14197] [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: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND/OBJECTIVES Recent literature highlights the potential of biologics in the management of inherited disorders of keratinisation. In this study, we conducted a systematic review of existing literature on treatment outcomes of inherited keratinisation disorders treated with biologics. METHODS Eligible records were retrieved through searches of the electronic databases MEDLINE, Embase, PubMed and Scopus. Databases were searched from inception to July 2023 for eligible records. A snowballing method was employed to search the references of the retrieved records for the identification of potentially relevant articles. RESULTS One hundred and four eligible studies consisting of a total of 166 patients with an inherited disorder of keratinisation were included. Patients had a median age of 19 years (range: 0.5 to 70 years). The most common disorders were Netherton syndrome (n = 63; 38%), autosomal recessive congenital ichthyoses (n = 27; 16%), CARD14-associated papulosquamous eruptions (n = 17; 10%) and familial pityriasis rubra pilaris (PRP) (n = 15; 9%).Of the 207 times biologics were employed, the three most frequently employed biologics were secukinumab (n = 47; 23%), dupilumab (n = 44; 21%) and ustekinumab (n = 37; 18%). Complete remission was observed in 10 (5%) instances, partial remission in 129 (62%), no or limited response to biologic therapy in 68 (32%) cases, and results are still pending in one case. A total of 33 adverse events were reported. CONCLUSIONS Whilst biologics may be considered in cases of inherited keratinisation disorders recalcitrant to standard therapy, definitive conclusions are prohibited by the low-level of evidence and substantial heterogeneity in methodology across the included studies. Establishment of consensus definitions, and randomised clinical trials may help ascertain the efficacy and safety of biologic therapy in this context and establish the best agent and dosing protocol for each disorder.
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Affiliation(s)
- Michelle K Y Chen
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Alice L Flanagan
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Deshan F Sebaratnam
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Yaron Gu
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
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Ting IPL, Lee TS, Teo HG, Albela H, Tang MM, Leong KF. Secukinumab for Netherton syndrome: a Malaysian experience. Clin Exp Dermatol 2023; 48:1366-1369. [PMID: 37503742 DOI: 10.1093/ced/llad253] [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: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 07/29/2023]
Abstract
We described three patients with Netherton syndrome in Malaysia treated with secukinumab with variable outcomes. To date, there have only been reports of about eight patients being treated with secukinumab globally with this condition, with good outcomes. We hope our observation will add to the existing global pool of information about Netherton syndrome treated with secukinumab.
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Affiliation(s)
| | - Tyan Shin Lee
- Pediatric Dermatology Unit, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | | | | | - Kin Fon Leong
- Pediatric Dermatology Unit, Hospital Kuala Lumpur, Kuala Lumpur, Wilayah Persekutuan, Malaysia
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Özkaya E, Günay MB, Babuna Kobaner G, Keskinkaya Z, Gökalp MO. Long-term dupilumab therapy in Netherton syndrome with severe atopic manifestations: Case report and review of the literature. Australas J Dermatol 2023; 64:272-277. [PMID: 36745433 DOI: 10.1111/ajd.13986] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/05/2023] [Accepted: 01/18/2023] [Indexed: 02/07/2023]
Abstract
We herein present a unique patient of Netherton syndrome (NS) with ichthyosis linearis circumflexa (ILC) lesions associated with severe atopic manifestations since infancy, showing different responses of atopic and ILC lesions to a 2-year dupilumab therapy. The atopic eczematous lesions and pruritus healed remarkably, dramatically improving the patient's quality of life, whilst the scalp hair showed a clinical and light microscopic improvement. The additional recovery in axillary/pubic/extremity hair growth, sweating and nail growth in the presented case was not previously reported in NS patients treated with dupilumab. However, dupilumab had no therapeutic effect on ILC lesions which were not pruritic and showed a treatment-independent wax and waned course.
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Affiliation(s)
- Esen Özkaya
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Muhammed Burak Günay
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Goncagül Babuna Kobaner
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
| | - Zeynep Keskinkaya
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey.,Department of Dermatology and Venereology, Faculty of Medicine, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Mehmet Onur Gökalp
- Department of Dermatology and Venereology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkey
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Samuelov L, Shehadeh W, Sarig O, Gat A, Matz H, Sprecher E. Ustekinumab therapy for Netherton syndrome. J Dermatol 2022; 50:494-499. [PMID: 36419401 DOI: 10.1111/1346-8138.16645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/14/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022]
Abstract
Netherton syndrome (NS) is a rare disorder of cornification associated with high morbidity. It is caused by bi-allelic mutations in SPINK5 encoding the serine protease inhibitor LEKTI. Previous studies have shown Th17 skewing with IL-23 upregulation in NS, raising the possibility that targeting these inflammatory pathways may alleviate disease manifestations. We ascertained the therapeutic efficacy of six doses of ustekinumab administered to three patients with NS over a period of 13 months using the Ichthyosis Area and Severity Index (IASI), the Dermatology Life Quality Index (DLQI), a visual analogue scale (VAS) for itch and the peak-pruritus numeric rating scale (PP-NRS). Histopathology analysis including CD3, CD4, CD8 and interleukin 17 (IL-17) immunostaining, was performed at baseline and 4 weeks following the last ustekinumab dose. Total IASI scores were reduced by 28% in two patients at week 16 with sustained response by week 56. No consistent improvement in DLQI, VAS for itch and PP-NRS scores was observed. The inflammatory infiltrate and the degree of acanthosis were slightly reduced at week 56 as compared to baseline. No significant change in immunostaining of the various inflammatory markers was observed at week 56. In conclusion, this case series did not demonstrate a significant therapeutic effect of ustekinumab in NS.
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Affiliation(s)
- Liat Samuelov
- Division of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Waseem Shehadeh
- Division of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Ofer Sarig
- Division of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Andrea Gat
- Department of Pathology Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Hagit Matz
- Division of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
| | - Eli Sprecher
- Division of Dermatology Tel Aviv Sourasky Medical Center Tel Aviv Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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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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