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Reimer-Taschenbrecker A, Hess M, Davidovic M, Hwang A, Hübner S, Hofsaess M, Gewert S, Eyerich K, Has C. IL-6 levels dominate the serum cytokine signature of severe epidermolysis bullosa: A prospective cohort study. J Eur Acad Dermatol Venereol 2024. [PMID: 38376135 DOI: 10.1111/jdv.19898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Systemic inflammation is considered a major player in the pathogenesis of epidermolysis bullosa (EB), but its pattern has only been described in small heterogeneous cohorts. There is controversy if and how systemic inflammation should be therapeutically targeted. METHODS We examined serum proinflammatory, anti-inflammatory, and itch related cytokines in a paediatric cohort of 29 patients with junctional and dystrophic EB. The cytokine that emerged as the most relevant was measured in a validation cohort of 42 patients during follow-up visits over 2 years. RESULTS IL-6 showed the most consistent and highest aberration dominating systemic inflammation. IL-6 correlated with wound body surface area (BSA) in both, finding and validation cohorts. Patients with less than 3% wound BSA had normal IL-6, while IL-6 levels significantly increased at more than 5% and 10% of wound BSA. TGF-β was only marginally elevated in patients with severe recessive dystrophic EB, while TNF-α, IFN-γ and IL-1β varied inconsistently. Patients reporting itch showed elevations in type 2 immunity (IgE, TSLP, IL4 and/or IL-31, respectively). CONCLUSIONS Our data suggest a dominant skin barrier and wound healing inflammatory pattern in junctional and dystrophic EB that depends on the wound area and not on the EB type. In EB, itch mediators may be similar to other pruritic disorders.
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Affiliation(s)
- A Reimer-Taschenbrecker
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - M Hess
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - M Davidovic
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Hwang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - S Hübner
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - M Hofsaess
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - S Gewert
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - K Eyerich
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - C Has
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
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2
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Rietscher K, Jahnke H, Rübsam M, Has C, Omary M, Niessen C, Magin T. 264 PKC412 prevents epithelial sheet damage in epidermolysis bullosa simplex via keratin and cell contact stabilization. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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3
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Frommherz LH, Sayar SB, Wang Y, Trefzer LK, He Y, Leppert J, Eßer P, Has C. Integrin α3 negative podocytes: A gene expression study. Matrix Biol Plus 2022; 16:100119. [PMID: 36060790 PMCID: PMC9429797 DOI: 10.1016/j.mbplus.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 07/30/2022] [Accepted: 08/07/2022] [Indexed: 12/04/2022] Open
Abstract
New cell model to investigate the impact of loss of integrin α3 in podocytes. In this novel model, genes of the extracellular matrix and adhesome are mostly downregulated. Loss of integrin α3 results in changes of cell adhesion and spreading.
Integrin α3β1 is a cell adhesion receptor widely expressed in epithelial cells. Pathogenic variants in the gene encoding the integrin α3 subunit ITGA3 lead to a syndrome including interstitial lung disease, nephrotic syndrome, and epidermolysis bullosa (ILNEB). Renal involvement mainly consists of glomerular disease caused by loss of adhesion between podocytes and the glomerular basement membrane. The aim of this study was to characterize the impact of loss of integrin α3 on human podocytes. ITGA3 was stably knocked-out in the human podocyte cell line AB8/13, designated as PodoA3−, and in human proximal tubule epithelial cell line HK2 using the targeted genome editing technique CRISPR/Cas9. Cell clones were characterized by Sanger sequencing, quantitative PCR, Western Blot and immunofluorescence staining. RNASeq of integrin α3 negative cells and controls was performed to identify differential gene expression patterns. Differentiated PodoA3− did not substantially change morphology and adhesion under standard culture conditions, but displayed significantly reduced spreading and adhesion when seed on laminin 511 in serum free medium. Gene expression studies demonstrated a distinct dysregulation of the adhesion network with downregulation of most integrin α3 interaction partners. In agreement with this, biological processes such as “extracellular matrix organization” and “cell differentiation” as well as KEGG pathways such as “ECM-receptor interaction”, “focal adhesion” and the “PI3K-Akt signaling pathway” were significantly downregulated in human podocytes lacking the integrin α3 subunit.
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Affiliation(s)
- L H Frommherz
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany.,Department of Dermatology and Allergology, University Hospital, LMU Munich, Germany
| | - S B Sayar
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Y Wang
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - L K Trefzer
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Y He
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - J Leppert
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - P Eßer
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - C Has
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
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4
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Cuperus E, Bygum A, Boeckmann L, Bodemer C, Bolling MC, Caproni M, Diociaiuti A, Emmert S, Fischer J, Gostynski A, Guez S, van Gijn ME, Hannulla-Jouppi K, Has C, Hernández-Martín A, Martinez AE, Mazereeuw-Hautier J, Medvecz M, Neri I, Sigurdsson V, Suessmuth K, Traupe H, Oji V, Pasmans SGMA. Proposal for a 6-step-approach for differential diagnosis of neonatal erythroderma. J Eur Acad Dermatol Venereol 2022; 36:973-986. [PMID: 35238435 PMCID: PMC9310754 DOI: 10.1111/jdv.18043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
The broad differential diagnosis of neonatal erythroderma often poses a diagnostic challenge. Mortality of neonatal erythroderma is high due to complications of the erythroderma itself and the occasionally severe and life-threatening underlying disease. Early correct recognition of the underlying cause leads to better treatment and prognosis. Currently, neonatal erythroderma is approached by a case by case basis. The purpose of this scoping review was to develop a diagnostic approach in neonatal erythroderma. After a systematic literature search in Embase (January 1990 - May 2020, 74 cases of neonatal erythroderma were identified, and 50+ diagnoses could be extracted. Main causes were the ichthyoses (40%) and primary immunodeficiencies (35%). Congenital erythroderma was present in 64% (47/74) of the cases, predominantly with congenital ichthyosis (11/11; 100%), Netherton syndrome (12/14, 86%), and Omenn syndrome (11/23, 48%). Time until diagnosis ranged from 102 days to 116 days for cases of non-congenital erythroderma and congenital erythroderma respectively. Among the 74 identified cases a total of 17 patients (23%) died within a mean of 158 days and were related to Omenn syndrome (35%), graft versus host disease (67%), and Netherton syndrome (18%). Disease history and physical examination are summarized in this paper. Age of onset and a collodion membrane can help to narrow the differential diagnoses. Investigations of blood, histology, hair analysis, genetic analysis and clinical imaging are summarized and discussed. A standard blood investigation is proposed and the need for skin biopsies with Lympho-Epithelial Kazal-Type related Inhibitor-staining is highlighted. Overall, this review shows that diagnostic procedures narrow the differential diagnosis in neonatal erythroderma. A 6-step flowchart for the diagnostic approach for neonatal erythroderma during the first month of life is proposed. The approach was made with the support of expert leaders from international multidisciplinary collaborations in the European Reference Network Skin-subthematic group Ichthyosis.
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Affiliation(s)
- E Cuperus
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
| | - A Bygum
- University of Southern Denmark, Clinical Institute, Denmark & Odense University Hospital, Department of Clinical Genetics, Denmark
| | - L Boeckmann
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker-Enfants Malades Hospital (AP-HP5), Paris-Centre University, Imagine Institute, INSERM, Paris, France
| | - M C Bolling
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Groningen, the Netherlands
| | - M Caproni
- Department of Health Sciences, Section of Dermatology, USL Toscana Centro, Rare Diseases Unit, University of Florence, Florence, Italy
| | - A Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Emmert
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Gostynski
- Department of Dermatology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Guez
- Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M E van Gijn
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - K Hannulla-Jouppi
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, HUS, Helsinki, Finland
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - A E Martinez
- Pediatric Dermatology, NHS Foundation Trust, Great Ormond Street, London, UK
| | - J Mazereeuw-Hautier
- Dermatology Department, Reference Center for Rare Skin Diseases, Toulouse, France
| | - M Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - I Neri
- Dermatology - IRCCS Policlinico di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater, Studiorum University of Bologna, Bologna, Italy
| | - V Sigurdsson
- University Medical Center Utrecht and Utrecht University, Department of Dermatology, Utrecht, The Netherlands
| | - K Suessmuth
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - S G M A Pasmans
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
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5
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Schwieger-Briel A, Trefzer L, Schumann H, Reimer-Taschenbrecker A, Rafei-Shamsabadi D, Meiss F, Has C. Esophageal carcinoma in severe recessive dystrophic epidermolysis bullosa-an underestimated complication? J Eur Acad Dermatol Venereol 2021; 36:e293-e295. [PMID: 34807476 DOI: 10.1111/jdv.17826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- A Schwieger-Briel
- Pediatric Skin Center, Division of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - L Trefzer
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Schumann
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | - A Reimer-Taschenbrecker
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D Rafei-Shamsabadi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - F Meiss
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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6
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Has C, El Hachem M, Bučková H, Fischer P, Friedová M, Greco C, Nevoránková P, Salavastru C, Mellerio JE, Zambruno G, Bodemer C. Practical management of epidermolysis bullosa: consensus clinical position statement from the European Reference Network for Rare Skin Diseases. J Eur Acad Dermatol Venereol 2021; 35:2349-2360. [PMID: 34545960 DOI: 10.1111/jdv.17629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/13/2021] [Indexed: 01/13/2023]
Abstract
Inherited epidermolysis bullosa (EB) comprises rare disorders that manifest with fragility and blistering of the skin and mucous membranes, with variable clinical severity. Management of EB is challenging due to disease rarity and complexity, the wide range of extracutaneous manifestations and a profound impact on daily life for the patient and family members. Although reference centres providing multidisciplinary care for EB exist in each European country, it is common for healthcare professionals that are not specialized in this rare disorder to treat EB patients. Here, experts of the European Reference Network for Rare and Undiagnosed Skin Diseases (ERN-Skin, https://ern-skin.eu) propose practical recommendations for the diagnosis and management of the commonest clinical issues, skin blisters and wounds, oral manifestations, pain and itch.
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - H Bučková
- Department of Dermatology, Children's Hospital, University Hospital Brno, Brno, Czech Republic
| | - P Fischer
- Department of Prosthetic Dentistry, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Friedová
- NevDent, Dental Private Clinic, Brno, Czech Republic
| | - C Greco
- Pain and Palliative Care Unit, Hôpital Necker Enfants Malades, Paris, France
| | - P Nevoránková
- NevDent, Dental Private Clinic, Brno, Czech Republic
| | - C Salavastru
- Paediatric Dermatology Department, "Carol Davila" University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - J E Mellerio
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Zambruno
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Bodemer
- Service de Dermatologie, Hôpital Necker Enfants Malades, Paris, France
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7
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Frommherz L, Krause A, Kopp J, Hotz A, Hübner S, Reimer-Taschenbrecker A, Casetti F, Zirn B, Fischer J, Has C. High rate of self-improving phenotypes in children with non-syndromic congenital ichthyosis: case series from south-western Germany. J Eur Acad Dermatol Venereol 2021; 35:2293-2299. [PMID: 34273205 DOI: 10.1111/jdv.17524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Non-syndromic congenital ichthyosis describes a heterogeneous group of hereditary skin disorders associated with erythroderma and scaling at birth. Although both severe and mild courses are known, the prediction of the natural history in clinical practice may be challenging. OBJECTIVES To determine clinical course and genotype-phenotype correlations in children affected by non-syndromic congenital ichthyosis in a case series from south-western Germany. METHODS We performed a retrospective observational study of 32 children affected by non-syndromic congenital ichthyoses seen in our genodermatosis clinic between 2011 and 2020. Follow-ups included assessment of weight and severity of skin involvement utilizing a modified Ichthyosis Area Severity Index (mIASI). mIASI was calculated as a sum comprising the previously published IASI score and an additional novel score to evaluate palmoplantar involvement. Linear regression was assessed using Pearson correlation, and statistical analysis was performed using the Wilcoxon-Mann-Whitney test. RESULTS This study included 23 patients with autosomal recessive congenital ichthyosis, seven with keratinopathic ichthyosis and two with harlequin ichthyosis. Cutaneous manifestations improved in more than 70% of the children during the follow-up. Especially in patients with mutations in ALOXE3 and ALOX12B, mIASI scores dropped significantly. The most common phenotype observed in this study was designated 'mild fine scaling ichthyosis'. Severe palmoplantar involvement occurred in patients with KRT1 and ABCA12 mutations; most patients demonstrated hyperlinearity as a sign of dryness and scaling. Weight was mainly in the normal range and negatively correlated with the severity of skin involvement. CONCLUSIONS Congenital ichthyosis that self-improves and evolves with mild fine scaling ichthyosis was the most common phenotype observed in our patients. This type might be underdiagnosed if the genetic diagnosis is not performed in the first year of life. mIASI is an easy and fast instrument for scoring disease severity and adding additional points for palmoplantar involvement might be valuable.
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Affiliation(s)
- L Frommherz
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany.,Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - A Krause
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - J Kopp
- Institute of Human Genetics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A Hotz
- Institute of Human Genetics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - S Hübner
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - A Reimer-Taschenbrecker
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - F Casetti
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - B Zirn
- Genetikum® Stuttgart, Genetic Counselling and Diagnostics, Stuttgart, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - C Has
- Faculty of Medicine, Department of Dermatology, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
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8
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Kreuter A, Koushk-Jalali B, Akgül B, Silling S, Oellig F, Has C, Wieland U. HPV-5-associated cutaneous squamous cell carcinoma in situ in poikiloderma with neutropenia. Clin Exp Dermatol 2021; 46:1619-1621. [PMID: 34155685 DOI: 10.1111/ced.14811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- A Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Witten, Germany
| | - B Koushk-Jalali
- Department of Dermatology, Venereology and Allergology, HELIOS St Elisabeth Hospital Oberhausen, University Witten/Herdecke, Witten, Germany
| | - B Akgül
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Cologne, Germany
| | - S Silling
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Cologne, Germany
| | - F Oellig
- Institute of Pathology, Mülheim an der Ruhr, Germany
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - U Wieland
- Institute of Virology, National Reference Center for Papilloma- and Polyomaviruses, University of Cologne, Cologne, Germany
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9
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Schreiner D, Uebler A, Ginghina C, Muensterer O, Has C, Mildenberger E. Prognostic assessment and management of a patient with Carmi syndrome. A case report. Int J Surg Case Rep 2021; 84:106070. [PMID: 34182433 PMCID: PMC8250162 DOI: 10.1016/j.ijscr.2021.106070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022] Open
Abstract
Carmi syndrome is a rare and severe disease defined by pyloric atresia and junctional epidermolysis bullosa. There are no clear recommendations when to consider a curative therapy, including surgical repair of pyloric atresia and when to transition to palliative care. We report the case of a female preterm infant suffering from Carmi syndrome. After definitive diagnosis and appropriate ethical counselling, we decided for surgical repair of the pyloric atresia. Nonetheless, there was no clinical improvement and our patient died after 35 days. Reviewing the literature, we found immunofluorescence microscopy to be most decisive examination to determine the prognosis of this severe disease.
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Affiliation(s)
- D Schreiner
- Department of Neonatology, University Medical Center Mainz, Germany.
| | - A Uebler
- Department of Neonatology, University Medical Center Mainz, Germany
| | - C Ginghina
- Department of Pediatrics, Medical Center Idar-Oberstein, Germany
| | - O Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital Munich, Germany
| | - C Has
- Department of Dermatology, University Medical Center Freiburg, Germany
| | - E Mildenberger
- Department of Neonatology, University Medical Center Mainz, Germany
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10
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Reimer-Taschenbrecker A, Hess M, Hotz A, Fischer J, Bruckner-Tuderman L, Has C. Plantar involvement correlates with obesity, pain and impaired mobility in epidermolysis bullosa simplex: a retrospective cohort study. J Eur Acad Dermatol Venereol 2021; 35:2097-2104. [PMID: 33960018 DOI: 10.1111/jdv.17336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Epidermolysis bullosa simplex (EBS) is the most common type of EB, a group of rare genodermatoses. Affected individuals suffer from skin blistering and report a high disease burden. In some EBS subtypes, plantar keratoderma (PK) has been described. OBJECTIVES This study investigated the presence and correlation of PK with body mass index, pain and mobility in EBS. METHODS Individuals (n = 157) with genetically characterized EBS were included in this retrospective cohort study, and clinical data were collected over 16 years (referral patients to the largest German EB centre). Descriptive statistics and mixed linear models were used to assess correlations. RESULTS PK was found in 75.8% of patients beginning at a mean age of 4.3 years. Both focal and diffuse PK were observed, and 60% of adults with localized and severe EBS were preobese or obese, with ~30% of patients reporting severely reduced mobility. The presence of PK, especially diffuse PK, correlated significantly with local infections, obesity, pain and requirement of a wheelchair. CONCLUSION Along with treating skin fragility and blistering, PK should be considered a potential marker of increased morbidity and may represent a target of EBS therapy development.
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Affiliation(s)
- A Reimer-Taschenbrecker
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - M Hess
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Hotz
- Institute of Human Genetics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - L Bruckner-Tuderman
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - C Has
- Department of Dermatology, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
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11
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Zirn B, Bernbeck U, Alt K, Oeffner F, Gerhardinger A, Has C. Rothmund-Thomson syndrome type 1 caused by biallelic ANAPC1 gene mutations. Skin Health Dis 2021; 1:e12. [PMID: 35664819 PMCID: PMC9060067 DOI: 10.1002/ski2.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 01/02/2023]
Abstract
Background Rare syndromic skin disorders may represent a diagnostic challenge. Aims We report a unique case associating cutaneous manifestations and developmental delay. Materials & Methods The affected 14 months old boy had poikiloderma, facial dysmorphism with deep‐set eyes, atrichia, as well as nail dysplasia and non‐descended testes. In addition, his psychomotor development was delayed. Exome sequencing and molecular karyotyping via array‐CGH (oligo‐array, 180k Agilent, design 22060) were performed. Results Mutations in RECQL4 (found in patients with RTS2) were first excluded. In the ANAPC1 gene, a novel combination of a recurrent intronic mutation (c.2705‐198C>T) and a deletion of the second ANAPC1 allele was detected, thus confirming the clinical diagnosis of RTS1. The deletion on chromosome 2q13 comprised further genes and spanned 1,7 megabases. Heterozygous deletions in this region are known as 2q13 microdeletion syndrome and are associated with developmental delay, autism and facial dysmorphism. Discussion The genetic findings most probably explain both, the RTS1 features and the developmental delay. Genetic diagnosis in RTS is indispensable to confirm the specific subtype and its associated risks: juvenile cataracts are features of RTS1 (ANAPC1 gene), whereas a high risk of osteosarcoma is part of RTS2 (RECQL4 gene). Thus, the patient described here is at high risk for the development of juvenile cataracts and requires regular ophthalmologic examination. Conclusion This case report underlines the necessity of thorough clinical diagnosis prior to genetic diagnosis of RTS1, since the recurrent intronic ANAPC1 mutation is otherwise missed.
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Affiliation(s)
- B Zirn
- Genetikum Stuttgart Genetic Counselling and Diagnostics Stuttgart Germany
| | - U Bernbeck
- Department of Pediatrics Rems-Murr-Klinikum Winnenden Germany
| | - K Alt
- Genetikum Neu-Ulm Genetic Counselling and Diagnostics Neu-Ulm Germany
| | - F Oeffner
- Genetikum Neu-Ulm Genetic Counselling and Diagnostics Neu-Ulm Germany
| | - A Gerhardinger
- Genetikum Neu-Ulm Genetic Counselling and Diagnostics Neu-Ulm Germany
| | - C Has
- Department of Dermatology Faculty of Medicine University of Freiburg Freiburg Germany
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12
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Frommherz LH, Schempp CM, Has C. Secukinumab for the treatment of SAM syndrome associated with desmoglein-1 deficiency. Br J Dermatol 2020; 184:770-772. [PMID: 33205394 DOI: 10.1111/bjd.19684] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/23/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- L H Frommherz
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C M Schempp
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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13
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Saleva-Stateva M, Technau-Hafsi K, Frommherz L, Grüninger G, Jägle S, Dourmishev L, Miteva L, Fischer J, Has C. Recurrent MVD mutation in European patients with disseminated porokeratosis. Br J Dermatol 2020; 184:347-348. [PMID: 32767669 DOI: 10.1111/bjd.19467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Saleva-Stateva
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Dermatology and Venereology, Alexandrovska University Hospital, Sofia, Bulgaria
| | - K Technau-Hafsi
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - L Frommherz
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - G Grüninger
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - S Jägle
- Department of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - L Dourmishev
- Department of Dermatology and Venereology, Alexandrovska University Hospital, Sofia, Bulgaria
| | - L Miteva
- Department of Dermatology and Venereology, Alexandrovska University Hospital, Sofia, Bulgaria
| | - J Fischer
- Department of Human Genetics, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
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14
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Saleva-Stateva M, Weibel L, Theiler M, Balabanova M, Boente MC, Has C. Lack of effect of topical statins in linear porokeratosis. J Eur Acad Dermatol Venereol 2020; 35:e26-e28. [PMID: 32558973 DOI: 10.1111/jdv.16768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/31/2020] [Accepted: 06/08/2020] [Indexed: 12/23/2022]
Affiliation(s)
- M Saleva-Stateva
- Department of Dermatology, Medical Center, University Medical Center Freiburg, Faculty of Medicine, Freiburg, Germany.,Department of Dermatology and Venereology, Alexandrovska University Hospital, Sofia, Bulgaria
| | - L Weibel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Theiler
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Balabanova
- Department of Dermatology and Venereology, Alexandrovska University Hospital, Sofia, Bulgaria
| | - M C Boente
- Hospital del Niño Jesús Tucumán, Tucumán, Argentina
| | - C Has
- Department of Dermatology, Medical Center, University Medical Center Freiburg, Faculty of Medicine, Freiburg, Germany
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15
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Reimer A, Hess M, Schwieger‐Brie A, Kiritsi D, Schauer F, Schumann H, Bruckner‐Tuderman L, Has C. A study into growth and anaemia in children with epidermolysis bullosa. Br J Dermatol 2020. [DOI: 10.1111/bjd.19068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Reimer A, Hess M, Schwieger‐Brie A, Kiritsi D, Schauer F, Schumann H, Bruckner‐Tuderman L, Has C. 大疱性表皮松解症患儿生长发育及贫血的研究. Br J Dermatol 2020. [DOI: 10.1111/bjd.19080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Mittwollen R, Wohlfart S, Park J, Grosch E, Has C, Hohenester E, Schneider H, Hammersen J. Aberrant splicing as potential modifier of the phenotype of junctional epidermolysis bullosa. J Eur Acad Dermatol Venereol 2020; 34:2127-2134. [PMID: 32124492 DOI: 10.1111/jdv.16332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND A lack or dysfunction of the anchoring protein laminin-332 in the basement membrane leads to the skin blistering disorder junctional epidermolysis bullosa (JEB). The mutation c.628G>A in the gene LAMB3 encoding the laminin β3-chain is associated with generalized intermediate JEB; it may introduce an amino acid substitution (p.Glu210Lys) or disrupt splicing. OBJECTIVE This retrospective study aimed at determining the effects of aberrant splicing on the JEB phenotype. METHODS LAMB3 transcription was analysed in two siblings compound heterozygous for the LAMB3 mutations p.Glu210Lys and p.Arg635* with a diverging JEB phenotype from late childhood on. Laminin-332 levels in skin sections and in cultured keratinocytes were investigated by immunofluorescence staining. Real-time PCR was used to quantify LAMB3 expression in keratinocytes. RNA splice variants were identified by subcloning of a LAMB3 cDNA fraction and subsequent DNA sequencing. Structural models of laminin-332 helped to assess the impact of certain mutations on laminin-332 folding. RESULTS Both siblings showed diminished LAMB3 expression. Laminin-332 was equally reduced in skin sections obtained during infancy but differed in keratinocytes isolated during adolescence. Although aberrant LAMB3 splicing with 26 variants was detected in both patients, splicing differed significantly: the full-length LAMB3 transcript harbouring the p.Glu210Lys mutation was found more often in the patient affected less severely (14/108 vs. 5/106 clones; P = 0.03). Structural modelling predicted that several deletions in LAMB3, but not the point mutation p.Glu210Lys, have an effect on laminin-332 folding and secretion. CONCLUSIONS Differential LAMB3 mRNA splicing in the patients may explain the disparate JEB phenotype. By elucidating the regulation of laminin-332 gene expression, these findings may contribute to the development of therapeutic strategies for JEB and might help to understand phenotype modification by splice-site mutations in other hereditary diseases.
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Affiliation(s)
- R Mittwollen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - S Wohlfart
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - J Park
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - E Grosch
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - C Has
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - E Hohenester
- Department of Life Sciences, Imperial College London, London, UK
| | - H Schneider
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - J Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
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18
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Frommherz L, Has C. Successful treatment of Pachyonychia congenita with Rosuvastatin. J Eur Acad Dermatol Venereol 2020; 34:e480-e482. [PMID: 32236980 DOI: 10.1111/jdv.16393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Affiliation(s)
- L Frommherz
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C Has
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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19
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Has C, Bauer JW, Bodemer C, Bolling MC, Bruckner-Tuderman L, Diem A, Fine JD, Heagerty A, Hovnanian A, Marinkovich MP, Martinez AE, McGrath JA, Moss C, Murrell DF, Palisson F, Schwieger-Briel A, Sprecher E, Tamai K, Uitto J, Woodley DT, Zambruno G, Mellerio JE. Consensus reclassification of inherited epidermolysis bullosa and other disorders with skin fragility. Br J Dermatol 2020; 183:614-627. [PMID: 32017015 DOI: 10.1111/bjd.18921] [Citation(s) in RCA: 344] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several new genes and clinical subtypes have been identified since the publication in 2014 of the report of the last International Consensus Meeting on Epidermolysis Bullosa (EB). OBJECTIVES We sought to reclassify disorders with skin fragility, with a focus on EB, based on new clinical and molecular data. METHODS This was a consensus expert review. RESULTS In this latest consensus report, we introduce the concept of genetic disorders with skin fragility, of which classical EB represents the prototype. Other disorders with skin fragility, where blisters are a minor part of the clinical picture or are not seen because skin cleavage is very superficial, are classified as separate categories. These include peeling skin disorders, erosive disorders, hyperkeratotic disorders, and connective tissue disorders with skin fragility. Because of the common manifestation of skin fragility, these 'EB-related' disorders should be considered under the EB umbrella in terms of medical and socioeconomic provision of care. CONCLUSIONS The proposed classification scheme should be of value both to clinicians and researchers, emphasizing both clinical and genetic features of EB. What is already known about this topic? Epidermolysis bullosa (EB) is a group of genetic disorders with skin blistering. The last updated recommendations on diagnosis and classification were published in 2014. What does this study add? We introduce the concept of genetic disorders with skin fragility, of which classical EB represents the prototype. Clinical and genetic aspects, genotype-phenotype correlations, disease-modifying factors and natural history of EB are reviewed. Other disorders with skin fragility, e.g. peeling skin disorders, erosive disorders, hyperkeratotic disorders, and connective tissue disorders with skin fragility are classified as separate categories; these 'EB-related' disorders should be considered under the EB umbrella in terms of medical and socioeconomic provision of care. Linked Comment: Pope. Br J Dermatol 2020; 183:603.
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - J W Bauer
- Department of Dermatology and Allergology and EB Haus Austria University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - C Bodemer
- Department of Dermatology, Necker Hospital des Enfants Malades, University Paris-Centre APHP 5, Paris, France
| | - M C Bolling
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - L Bruckner-Tuderman
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - A Diem
- Department of Dermatology and Allergology and EB Haus Austria University Hospital of the Paracelsus Medical University Salzburg, Austria
| | - J-D Fine
- Vanderbilt University School of Medicine, Nashville, TN, USA; National Epidermolysis Bullosa Registry, Nashville, TN, USA
| | - A Heagerty
- Heart of England Foundation Trust, Birmingham, UK
| | - A Hovnanian
- INSERM UMR1163, Imagine Institute, Department of Genetics, Necker hospital for sick children, Paris University, Paris, France
| | - M P Marinkovich
- Stanford University School of Medicine, Stanford, Palo Alto Veterans Affairs Medical Center CA, USA
| | - A E Martinez
- Dermatology Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - C Moss
- Birmingham Children's Hospital and University of Birmingham, UK
| | - D F Murrell
- St George Hospital and University of New South Wales, Sydney, Australia
| | - F Palisson
- DEBRA Chile, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - A Schwieger-Briel
- Department of Pediatric Dermatology, University Children's Hospital Zürich, Zürich, Switzerland
| | - E Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Tamai
- Dermatology Department, University of Osaka, Osaka, Japan
| | - J Uitto
- Thomas Jefferson University, Philadelphia, PA, USA
| | - D T Woodley
- University of Southern California, Los Angeles, CA, USA
| | - G Zambruno
- Dermatology Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK
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20
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Has C, Liu L, Bolling M, Charlesworth A, El Hachem M, Escámez M, Fuentes I, Büchel S, Hiremagalore R, Pohla‐Gubo G, Akker P, Wertheim‐Tysarowska K, Zambruno G. 大疱性表皮松解症诊断的新指南. Br J Dermatol 2020. [DOI: 10.1111/bjd.18842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Has C, Liu L, Bolling M, Charlesworth A, El Hachem M, Escámez M, Fuentes I, Büchel S, Hiremagalore R, Pohla‐Gubo G, Akker P, Wertheim‐Tysarowska K, Zambruno G. New guidelines for the diagnosis of epidermolysis bullosa. Br J Dermatol 2020. [DOI: 10.1111/bjd.18829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Happle R, van Gysel D, Fölster-Holst R, Jordaan HF, Claasens S, Has C. An unusual type of telangiectatic naevus with underlying and surrounding dilated veins: report of four cases. J Eur Acad Dermatol Venereol 2019; 34:e169-e171. [PMID: 31777114 DOI: 10.1111/jdv.16116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Happle
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - D van Gysel
- Department of Pediatrics, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - R Fölster-Holst
- Department of Dermatology, Venereology and Allergology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - H F Jordaan
- Department of Internal Medicine, Divison of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - S Claasens
- Department of Internal Medicine, Divison of Dermatology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C Has
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
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23
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Reimer A, Hess M, Schwieger-Briel A, Kiritsi D, Schauer F, Schumann H, Bruckner-Tuderman L, Has C. Natural history of growth and anaemia in children with epidermolysis bullosa: a retrospective cohort study. Br J Dermatol 2019; 182:1437-1448. [PMID: 31487386 DOI: 10.1111/bjd.18475] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Impaired growth and anaemia are major extracutaneous complications of epidermolysis bullosa (EB), but data on their development are lacking. OBJECTIVES To determine the clinical course of growth and anaemia in children with EB and clarify the impact of nutritional compromise, inflammation and genetic factors. METHODS A retrospective study was conducted of 200 children, 157 with recessive dystrophic EB (RDEB) and 43 with junctional EB (JEB)-generalized intermediate, followed at the main referral centre in Germany. Growth charts were calculated using the modified LMS method and were correlated with parameters of anaemia, nutrition, inflammation and the molecular defect in a linear model. RESULTS In our cohort of patients with RDEB, weight impairment started at 12-18 months old; by the age of 10 years, 50% showed wasting. The predicted median weight at age 20 years was 35·2 kg for men and 40·1 kg for women. In JEB, growth resembled that of healthy children. Anaemia was present from the second year of life onwards in RDEB and JEB. Low levels of haemoglobin, iron, vitamin D, zinc and albumin, high levels of C-reactive protein, and absence of collagen VII correlated significantly with low weight in RDEB. No correlation was observed in JEB. CONCLUSIONS The results highlight that nutritional compromise occurs early in children with RDEB and therefore may require interventions as of the first year or two of life. What's already known about this topic? Children with epidermolysis bullosa (EB) suffer from failure to thrive and anaemia as major extracutaneous complications. The course of growth and the development of anaemia in EB are poorly characterized. What does this study add? A molecularly well characterized cohort of 200 children with EB was followed with regard to anthropometrics, anaemia and inflammation. We demonstrate early onset of growth failure and anaemia, most pronounced in the subset of recessive dystrophic EB. Awareness of early growth delay and nutritional deficiencies will improve EB care in daily practice.
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Affiliation(s)
- A Reimer
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - M Hess
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Schwieger-Briel
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany.,University Children's Hospital Zurich, Zurich, Switzerland
| | - D Kiritsi
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - F Schauer
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - H Schumann
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - L Bruckner-Tuderman
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
| | - C Has
- Department of Dermatology, University Clinic for Dermatology and Venereology, Faculty of Medicine, University of Freiburg, Hauptstraβe 7, 79104, Freiburg, Germany
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Affiliation(s)
- C. Has
- Department of Chemical Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | - P. Sunthar
- Department of Chemical Engineering, Indian Institute of Technology Bombay, Mumbai, India
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25
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Frommherz L, Küsel J, Zimmer A, Fischer J, Has C. Withdrawn:
Skin fragility caused by biallelic
KRT10
mutations: an intriguing form of self‐improving epidermolytic ichthyosis. Br J Dermatol 2019; 182:780-785. [DOI: 10.1111/bjd.18325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- L. Frommherz
- Department of Dermatology Medical Center – University of Freiburg Faculty of Medicine Hauptstraße 7 79104 Freiburg Germany
| | - J. Küsel
- Institute of Human Genetics Medical Center – University of Freiburg Faculty of Medicine Hauptstraße 7 79104 Freiburg Germany
| | - A. Zimmer
- Institute of Human Genetics Medical Center – University of Freiburg Faculty of Medicine Hauptstraße 7 79104 Freiburg Germany
| | - J. Fischer
- Institute of Human Genetics Medical Center – University of Freiburg Faculty of Medicine Hauptstraße 7 79104 Freiburg Germany
| | - C. Has
- Department of Dermatology Medical Center – University of Freiburg Faculty of Medicine Hauptstraße 7 79104 Freiburg Germany
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26
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Reimer A, Lu S, He Y, Bruckner-Tuderman L, Technau-Hafsi K, Meiss F, Has C, von Bubnoff D. Combined anti-inflammatory and low-dose antiproliferative therapy for squamous cell carcinomas in recessive dystrophic epidermolysis bullosa. J Eur Acad Dermatol Venereol 2019; 34:e1-e3. [PMID: 31374134 DOI: 10.1111/jdv.15835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/26/2022]
Affiliation(s)
- A Reimer
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - S Lu
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany.,Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Y He
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - L Bruckner-Tuderman
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - K Technau-Hafsi
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - F Meiss
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - C Has
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - D von Bubnoff
- Department of Dermatology, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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27
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Vahidnezhad H, Youssefian L, Daneshpazhooh M, Mahmoudi H, Kariminejad A, Fischer J, Christiansen J, Schneider H, Guy A, Liu L, McGrath J, Has C, Uitto J. 307 Homozygous Biallelic KRT5 Mutations in Epidermolysis Bullosa Simplex, Including a Complete Human Keratin 5 “Knock-Out”, in Families with Extensive Consanguinity. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lu S, Hess M, Reimer A, Castiglia D, He Y, Rafei-Shamsabadi D, Bubnoff D, Meiss F, Boerries M, Has C. 302 Molecular and mutational signatures of squamous cell carcinomas in epidermolysis bullosa. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Has C, Liu L, Bolling MC, Charlesworth AV, El Hachem M, Escámez MJ, Fuentes I, Büchel S, Hiremagalore R, Pohla-Gubo G, van den Akker PC, Wertheim-Tysarowska K, Zambruno G. Clinical practice guidelines for laboratory diagnosis of epidermolysis bullosa. Br J Dermatol 2019; 182:574-592. [PMID: 31090061 PMCID: PMC7064925 DOI: 10.1111/bjd.18128] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
Linked Comment: https://doi.org/10.1111/bjd.18377. https://doi.org/10.1111/bjd.18829 available online
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - L Liu
- Viapath, St Thomas' Hospital, London, U.K
| | - M C Bolling
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A V Charlesworth
- Centre de Reference des Maladies Rares de la Peau et des Muqueuses d'Origine Génétique, L'Archet Hôpital, Nice, France
| | - M El Hachem
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M J Escámez
- Bioengineering Department at Universidad Carlos III de Madrid (UC3M), Regenerative Medicine Unit at CIEMAT - U714 CIBER on Rare Diseases (ISCIII), Instituto de Investigación Sanitaria Fundación Jiménez Diaz (IISFJD), Madrid, Spain
| | - I Fuentes
- Fundación DEBRA Chile, Santiago, Chile.,Centro de Genética y Genómica, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - S Büchel
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Hiremagalore
- Adjunct Faculty, Centre for Human Genetics and Department of Dermatology and Pediatrics, Manipal Hospital, Bengaluru, India
| | - G Pohla-Gubo
- EB House Austria, Department of Dermatology, University Hospital of the Paracelsus Medical University, Salzburg, Austria
| | - P C van den Akker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - G Zambruno
- Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Affiliation(s)
- C. Has
- Faculty of Medicine Medical Center‐University of Freiburg Freiburg Germany
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He Y, Frommherz L, Leppert J, Esser P, Huber T, Has C. 402 Variable effects of the ITGA3 on epithelial keratinocytes and kidney epithelial cells, insights into genotype-phenotype correlations in ILNEB. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Has C, Happle R, Fischer J, Grüninger G, Technau-Hafsi K. Postzygotic HRAS mutation in heterochromia of straight scalp hair. Br J Dermatol 2019; 181:1074-1076. [PMID: 31021405 DOI: 10.1111/bjd.18045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - R Happle
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - J Fischer
- Institute for Human Genetics, Medical Center - University of Freiburg, Freiburg, Germany
| | - G Grüninger
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - K Technau-Hafsi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
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Has C, Küsel J, Happle R, Steinke H, Technau-Hafsi K, Fischer J. Extending the phenotypic spectrum associated with mosaicism for GJB2 mutations. Br J Dermatol 2019; 181:623-624. [PMID: 30816995 DOI: 10.1111/bjd.17838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - J Küsel
- Institute for Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - R Happle
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - H Steinke
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - K Technau-Hafsi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - J Fischer
- Institute for Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
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Affiliation(s)
- P. Yilmaz
- Department of Dermatology University of Freiburg Freiburg Germany
| | - M. Medvecz
- Department of Dermatology, Venerology and Dermato‐oncology Semmelweis University Budapest Hungary
| | - J. Kohlhase
- Institute for Human Genetics, Faculty of Medicine, Medical Center University of Freiburg Freiburg Germany
| | - J. Küsel
- Institute for Human Genetics, Faculty of Medicine, Medical Center University of Freiburg Freiburg Germany
| | - J. Fischer
- Institute for Human Genetics, Faculty of Medicine, Medical Center University of Freiburg Freiburg Germany
| | - C. Has
- Department of Dermatology University of Freiburg Freiburg Germany
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Affiliation(s)
- C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstrasse 7, 79104, Freiburg, Germany
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He Y, Thriene K, Boerries M, Busch H, Dengjel J, Has C. 872 Epithelial integrin α3 impacts the composition of the cellular microenvironment. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Higgins R, Jensen A, Wachstein J, Has C, Bruckner-Tuderman L, Spiegel R, Traber H, Achermann J, Schaller M, Röcken M, Ignatova D, Chang Y, Fischer T, French L, Hötzenecker W, Hornung R, Malzacher A, Cozzio A, Navarini A, Guenova E. 814 Uniparental inheritance of junctional epidermolysis bullosa (JEB) through mutation of ITGA6 and trisomic rescue. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Reimer A, Schwieger-Briel A, He Y, Leppert J, Schauer F, Kiritsi D, Schneider H, Ott H, Bruckner-Tuderman L, Has C. Natural history and clinical outcome of junctional epidermolysis bullosa generalized intermediate due to a LAMA3 mutation. Br J Dermatol 2018; 178:973-975. [PMID: 29077994 DOI: 10.1111/bjd.16088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Reimer
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Schwieger-Briel
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
- Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Y He
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - J Leppert
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - F Schauer
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - D Kiritsi
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - H Schneider
- Department of Pediatrics, University of Erlangen-Nürnberg, Loschgestraße 15, 91054, Erlangen, Germany
| | - H Ott
- Department of Pediatric Dermatology, Children's Hospital Auf Der Bult, Janusz-Korczak-Allee 12, 30173, Hannover, Germany
| | - L Bruckner-Tuderman
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
| | - C Has
- Department of Dermatology and Venerology, Medical Center - University of Freiburg, Faculty of Medicine, Hauptstraße 7, 79104, Freiburg, Germany
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de Almeida H, Has C, Fischer J, Hausser I. Acral lamellar Ichthyosis - expanding the phenotype of temperature-sensitive keratinization disorders. J Eur Acad Dermatol Venereol 2017; 32:e206-e207. [PMID: 29194782 DOI: 10.1111/jdv.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H de Almeida
- Dermatology, Federal and Catholic University of Pelotas, Pelotas, Brazil
| | - C Has
- Dermatology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - J Fischer
- Institute for Human Genetics, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - I Hausser
- Institute of Pathology Heidelberg IPH, University Hospital, Heidelberg University, Heidelberg, Germany
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Alkhalifah A, Chiaverini C, Charlesworth A, Has C, Lacour JP. Fragilité cutanée et cicatrices réticulées, penser à l’épidermolyse bulleuse simple liée au gène KLHL24. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schauer F, Hoffmann J, Fischer J, Has C. Oral manifestations as the main feature of late-onset recessive dystrophic epidermolysis bullosa. J Eur Acad Dermatol Venereol 2017; 32:e161-e163. [PMID: 29080321 DOI: 10.1111/jdv.14663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Schauer
- Faculty of Medicine, Department of Dermatology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - J Hoffmann
- Faculty of Medicine, Department of Dermatology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - J Fischer
- Faculty of Medicine, Department of Human Genetics, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - C Has
- Faculty of Medicine, Department of Dermatology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
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Conti C, Guerrero-Aspizua S, Escamez M, Garcia-Martín A, Castiglia D, Itin P, Tadini G, Martin L, Has C, del Río M. 582 A study of non-melanoma skin cancer in a series of well-characterized patients with Kindler Syndrome (KS). J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kroeger J, Hofmann S, Leppert J, Has C, Franzke C. 098 Novel amino acid duplication in collagen XVII causes mild junctional epidermolysis bullosa by altering the coiled-coil structure and impairing collagen XVII trimerization and maturation. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Vázquez-Osorio I, Chmel N, Rodríguez-Díaz E, Gonzalvo-Rodríguez P, Happle R, Bueno E, Has C, Torrelo A. A case of mosaicism in ectodermal dysplasia-skin fragility syndrome. Br J Dermatol 2017; 177:e101-e102. [DOI: 10.1111/bjd.15374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- I. Vázquez-Osorio
- Department of Dermatology; Hospital Universitario de Cabueñes; Gijón Spain
| | - N. Chmel
- Department of Dermatology; Freiburg University Medical Center; Freiburg Germany
| | - E. Rodríguez-Díaz
- Department of Dermatology; Hospital Universitario de Cabueñes; Gijón Spain
| | | | - R. Happle
- Department of Dermatology; Freiburg University Medical Center; Freiburg Germany
| | - E. Bueno
- Molecular Medicine Unit; Department of Medicine; Facultad de Medicina de Salamanca; Salamanca Spain
| | - C. Has
- Department of Dermatology; Freiburg University Medical Center; Freiburg Germany
| | - A. Torrelo
- Department of Dermatology; Hospital Infantil del Niño Jesús; Madrid Spain
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Zimmer AD, Kim GJ, Hotz A, Bourrat E, Hausser I, Has C, Oji V, Stieler K, Vahlquist A, Kunde V, Weber B, Radner FPW, Leclerc-Mercier S, Schlipf N, Demmer P, Küsel J, Fischer J. 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. Br J Dermatol 2017; 177:445-455. [PMID: 28093717 DOI: 10.1111/bjd.15308] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- A D Zimmer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - G-J Kim
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - A Hotz
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - E Bourrat
- Department of Dermatology, Reference Center for Rare Skin Diseases MAGEC, Saint Louis Hospital AP-HP, Paris, France
| | - I Hausser
- Institute of Pathology IPH, University Clinic Heidelberg, Heidelberg, Germany
| | - C Has
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - V Oji
- Department of Dermatology, University Hospital Münster, Münster, Germany
| | - K Stieler
- Department of Dermatology, Charité Universitätsmedizin Berlin, Child Dermatology and Hair Competence Centre, Berlin, Germany
| | - A Vahlquist
- Department of Medical Sciences, Section of Dermatology, University Hospital, Uppsala, Sweden
| | - V Kunde
- Department of Neonatology, Christian Children's Hospital, Osnabrück, Switzerland
| | - B Weber
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - F P W Radner
- Institute of Molecular Biosciences, University of Graz, Graz, Austria
| | - S Leclerc-Mercier
- Department of Dermatology and Pathology, Reference Center for Rare Skin Diseases MAGEC, Hôpital Necker Enfants Malades, Paris, France
| | - N Schlipf
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - P Demmer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Küsel
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Affiliation(s)
- C. Has
- Department of Dermatology Medical Center – University of Freiburg Freiburg Germany
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Roser A, Avenel-Audran M, Has C, Martin L. Traitement par phénylbutyrate d’un patient porteur d’un syndrome de Kindler dû à une mutation hypomorphe du gène FERMT1. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dănescu S, Leppert J, Cosgarea R, Zurac S, Pop S, Baican A, Has C. Compound heterozygosity for dominant and recessive DSG1 mutations in a patient with atypical SAM syndrome (severe dermatitis, multiple allergies, metabolic wasting). J Eur Acad Dermatol Venereol 2016; 31:e144-e146. [PMID: 27632246 DOI: 10.1111/jdv.13967] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- S Dănescu
- Department of Dermatology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - J Leppert
- Department of Dermatology, Medical Center - University Freiburg, Freiburg, Germany
| | - R Cosgarea
- Department of Dermatology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - S Zurac
- Department of Pathology, Colentina University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - S Pop
- Department of Dermatology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - A Baican
- Department of Dermatology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - C Has
- Department of Dermatology, Medical Center - University Freiburg, Freiburg, Germany
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Mayer B, Silló P, Mazán M, Pintér D, Medvecz M, Has C, Castiglia D, Petit F, Charlesworth A, Hatvani Z, Pamjav H, Kárpáti S. A unique LAMB3 splice-site mutation with founder effect from the Balkans causes lethal epidermolysis bullosa in several European countries. Br J Dermatol 2016; 175:721-7. [PMID: 27062385 DOI: 10.1111/bjd.14646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have encountered repeated cases of recessive lethal generalized severe (Herlitz-type) junctional epidermolysis bullosa (JEB gen sev) in infants born to Hungarian Roma parents residing in a small region of Hungary. OBJECTIVES To identify the disease-causing mutation and to investigate the genetic background of its unique carrier group. METHODS The LAMB3 gene was analysed in peripheral-blood genomic DNA samples, and the pathological consequences of the lethal defect were confirmed by cutaneous LAMB3cDNA sequencing. A median joining haplotype network within the Y chromosome H1a-M82 haplogroup of individuals from the community was constructed, and LAMB3 single-nucleotide polymorphism (SNP) patterns were also determined. RESULTS An unconventional intronic splice-site mutation (LAMB3, c.1133-22G>A) was identified. Thirty of 64 voluntarily screened Roma from the closed community carried the mutation, but none of the 306 Roma from other regions of the country did. The age of the mutation was estimated to be 548 ± 222 years. Within the last year, more patients with JEB gen sev carrying the same unusual mutation have been identified in three unrelated families, all immigrants from the Balkans. Two were compound heterozygous newborns, in Germany and Italy, and one homozygous newborn died in France. Only the French family recognized their Roma background. LAMB3SNP haplotyping confirmed the link between the apparently unrelated Hungarian, German and Italian male cases, but could not verify the same background in the female newborn from France. CONCLUSIONS The estimated age of the mutation corresponds to the time period when Roma were wandering in the Balkans.
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Affiliation(s)
- B Mayer
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, 1085, Budapest, Hungary
| | - P Silló
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, 1085, Budapest, Hungary
| | - M Mazán
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, 1085, Budapest, Hungary
| | - D Pintér
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, 1085, Budapest, Hungary
| | - M Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, 1085, Budapest, Hungary
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - D Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - F Petit
- Clinical Genetics Department, Jeanne de Flandre Hospital, Lille, France
| | - A Charlesworth
- French Centre for Hereditary Epidermolysis Bullosa, Archet 2 Hospital, Nice, France
| | - Zs Hatvani
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, 1085, Budapest, Hungary
| | - H Pamjav
- Institute of Forensic Medicine, Network of Forensic Science Institutes, Ministry of Justice, Budapest, Hungary
| | - S Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, 1085, Budapest, Hungary.
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Maier K, He Y, Wölfle U, Schempp C, Bruckner-Tuderman L, Has C. 166 Kindlin-1 protects keratinocytes against UV-B: Prospects for antioxidant treatment in Kindler syndrome. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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