1
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McSweeney SM, Saklatvala J, Rispoli R, Ganier C, Woszczek G, Thomas L, Hveem K, Løset M, Dand N, Tziotzios C, Simpson M, McGrath JA. Genome-wide meta-analysis implicates variation affecting mast cell biology in urticaria. J Allergy Clin Immunol 2024; 153:521-526.e11. [PMID: 37690594 DOI: 10.1016/j.jaci.2023.08.033] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/13/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Urticaria is characterized by inappropriate mast cell degranulation leading to the development of wheals and/or angioedema. Twin and family studies indicate that there is a substantial heritable component to urticaria risk. OBJECTIVE Our aim was to identify genomic loci at which common genetic variation influences urticaria susceptibility. METHODS Genome-wide association studies of urticaria (including all subtypes) from 3 European cohorts (UK Biobank, FinnGen, and the Trøndelag Health Study [HUNT]) were combined through statistical meta-analysis (14,306 urticaria cases and 650,664 controls). Cases were identified via electronic health care records from primary and/or secondary care. To identify putative causal variants and genes, statistical fine-mapping, colocalization, and interrogation of publicly available single-cell transcriptome sequencing resources were performed. RESULTS Genome-wide significant associations (P < 5 × 10-8) were identified at 6 independent loci. These included 2 previously reported association signals at 1q44 and the human leucocyte antigen region on chromosome 6. Genes with expected or established roles in mast cell biology were associated with the 4 other genome-wide association signals (GCSAML, FCER1A, TPSAB1, and CBLB). Colocalization of association signals consistent with the presence of shared causal variants was observed between urticaria susceptibility and increased expression of GCSAML (posterior probability of colocalization [PPcoloc] = 0.89) and FCER1A (PPcoloc = 0.91) in skin. CONCLUSION Common genetic variation influencing the risk of developing urticaria was identified at 6 genomic loci. The relationship between genes with roles in mast cell biology and several association signals implicates genetic variability of specific components of mast cell function in the development of urticaria.
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Affiliation(s)
| | - Jake Saklatvala
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Rossella Rispoli
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | - Clarisse Ganier
- Center of Gene Therapy and Regenerative Medicine, King's College London, London, United Kingdom
| | - Grzegorz Woszczek
- School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
| | - Laurent Thomas
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; BioCore - Bioinformatics Core Facility, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Trondheim University Hospital, Trondheim, Norway
| | - Mari Løset
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway; Department of Dermatology, Clinic of Orthopedics, Rheumatology and Dermatology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nick Dand
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
| | | | - Michael Simpson
- Department of Medical and Molecular Genetics, King's College London, London, United Kingdom
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2
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Subramaniam KS, Antoniou MN, McGrath JA, Lwin SM. The potential of gene therapy for recessive dystrophic epidermolysis bullosa. Br J Dermatol 2021; 186:609-619. [PMID: 34862606 DOI: 10.1111/bjd.20910] [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: 07/28/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 11/30/2022]
Abstract
Epidermolysis bullosa (EB) encompasses a heterogeneous group of inherited skin fragility disorders with mutations in genes encoding the basement membrane zone (BMZ) proteins that normally ensure dermal-epidermal integrity. Of the four main EB types, recessive dystrophic EB (RDEB), especially the severe variant, represents one of the most debilitating clinical entities with recurrent mucocutaneous blistering and ulceration leading to chronic wounds, infections, inflammation, scarring and ultimately cutaneous squamous cell carcinoma, which leads to premature death. Improved understanding of the molecular genetics of EB over the past three decades and advances in biotechnology has led to rapid progress in developing gene and cell-based regenerative therapies for EB. In particular, RDEB is at the vanguard of advances in human clinical trials of advanced therapeutics. Furthermore, the past decade has witnessed the emergence of a real collective, global effort involving academia and industry, supported by international EB patient organisations such as the Dystrophic Epidermolysis Bullosa Research Association (DEBRA), amongst others, to develop clinically relevant and marketable targeted therapeutics for EB. Thus, there is an increasing need for the practising dermatologist to become familiar with the concept of gene therapy, fundamental differences between various approaches and their human applications. This review explains the principles of different approaches of gene therapy; summarises its journey and discusses its current and future impact in RDEB.
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Affiliation(s)
- K S Subramaniam
- Genetic Skin Diseases Group, St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
| | - M N Antoniou
- Gene Expression and Therapy Group, Department of Medical & Molecular Genetics, King's College London, Guy's Hospital, London, UK
| | - J A McGrath
- Genetic Skin Diseases Group, St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
| | - S M Lwin
- Genetic Skin Diseases Group, St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
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3
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Wen D, Balacco DL, Bardhan A, Harper N, Walsh D, Ryan G, Liu L, Guy A, McGrath JA, Ogboli M, Heagerty AHM. Localized autosomal recessive epidermolysis bullosa simplex arising from a novel homozygous frameshift mutation in DST (BPAG1). Clin Exp Dermatol 2021; 47:497-502. [PMID: 34806203 DOI: 10.1111/ced.14917] [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] [Accepted: 08/03/2021] [Indexed: 11/26/2022]
Affiliation(s)
- D Wen
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Adult Epidermolysis Bullosa Unit, Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D L Balacco
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Bardhan
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Adult Epidermolysis Bullosa Unit, Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Harper
- Adult Epidermolysis Bullosa Unit, Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Walsh
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - G Ryan
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - L Liu
- National Diagnostic EB Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - A Guy
- National Diagnostic EB Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - J A McGrath
- National Diagnostic EB Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - M Ogboli
- Paediatric Epidermolysis Bullosa Unit, Department of Paediatric Dermatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - A H M Heagerty
- Adult Epidermolysis Bullosa Unit, Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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4
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McSweeney SM, Sarkany R, Fassihi H, Tziotzios C, McGrath JA. Pathogenesis of solar urticaria: Classic perspectives and emerging concepts. Exp Dermatol 2021; 31:586-593. [PMID: 34726314 DOI: 10.1111/exd.14493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/24/2021] [Revised: 10/24/2021] [Accepted: 10/30/2021] [Indexed: 02/05/2023]
Abstract
Solar urticaria is a rare, immunologically mediated photodermatosis in which activation of cutaneous mast cells is triggered by specific wavelengths of solar electromagnetic radiation. This manifests clinically as the rapid development of cutaneous itch, erythema and wheal formation after several minutes of sun exposure. Disease mechanisms in solar urticaria remain incompletely elucidated and there have been few recent investigations of its pathobiology. Historic passive transfer experiments performed during the twentieth century provide support for a 'photoallergy' model of disease pathogenesis, wherein molecular alteration of a putative chromophore by solar electromagnetic radiation produces mast cell activation via an IgE-dependent mechanism. However, this model does not account for several observations made during passive transfer experiments nor does it explain a range of subsequent clinical and photobiological observations made in solar urticaria patients. Furthermore, increased understanding of the molecular dynamics underpinning cutaneous mast cell responses highlights the need to reformulate our understanding of solar urticaria pathogenesis in the context of this contemporary scientific landscape. In this review, we discuss the current understanding of solar urticaria pathogenesis and, by incorporating recent scientific and clinical observations, develop new hypotheses to drive future investigation into this intriguing disorder.
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Affiliation(s)
| | - Robert Sarkany
- St. John's Institute of Dermatology, Guy's Hospital, London, UK
| | - Hiva Fassihi
- St. John's Institute of Dermatology, Guy's Hospital, London, UK
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5
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Rayinda T, McSweeney SM, Dand N, Fenton DA, McGrath JA, Tziotzios C. Clinical characteristics of male frontal fibrosing alopecia: a single-centre case series from London, UK. Br J Dermatol 2021; 186:195-197. [PMID: 34480347 DOI: 10.1111/bjd.20742] [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: 06/21/2021] [Revised: 08/18/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- T Rayinda
- St John's Institute of Dermatology, King's College London, UK.,Department of Dermatology and Venereology, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Indonesia
| | - S M McSweeney
- St John's Institute of Dermatology, King's College London, UK
| | - N Dand
- Department of Medical and Molecular Genetics, King's College London, UK
| | - D A Fenton
- St John's Institute of Dermatology, King's College London, UK
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, UK
| | - C Tziotzios
- St John's Institute of Dermatology, King's College London, UK
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Abstract
WNTs (Wingless-related integration sites) are secreted glycoproteins that are involved in signalling pathways critical to organ development and tissue regeneration. Of the 19 known WNT ligands, one member of this family, WNT10A, appears to have specific relevance to skin, its appendages and teeth. This review focuses on how variants in the WNT10A gene have been associated with various ectodermal disorders and how such changes may have clinical relevance to dermatologists and dentists. Germline mutations in WNT10A underlie several forms of autosomal recessive ectodermal dysplasia in which heterozygous carriers may also display some lesser ectodermal anomalies. Within the general population, multiple heterozygous variants in WNT10A can cause skin, hair, sweat gland or dental alterations, also known as ectodermal derivative impairments. WNT10A variants have also been implicated in hair thickness, male androgenetic alopecia, hair curl, acne vulgaris, lipodystrophy, keloids, wound healing, tooth size, tooth agenesis, hypodontia, taurodontism and oral clefting. Beyond dermatology and dentistry, WNT10A abnormalities have also been identified in kidney fibrosis, keratoconus, certain malignancies (particularly gastrointestinal) and neuropathic pain pathways. In this review, we detail how WNT10A is implicated as a key physiological and pathological contributor to syndromic and nonsyndromic disorders, as well as population variants, affecting the skin and teeth, and document all reported mutations in WNT10A with genotype-phenotype correlation.
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Affiliation(s)
- B J Doolan
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - P Kantaputra
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.,Center of Excellence in Medical Genetics Research, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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7
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McFadden JP, Cunningham LS, Ferguson FJ, Tziotzios C, McGrath JA. Synergistic multiple early therapy (SMET) for inflammatory diseases with pathogenic autoinflammatory feedback circuits. Br J Dermatol 2021; 185:469-470. [PMID: 33797104 DOI: 10.1111/bjd.20077] [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: 02/05/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- J P McFadden
- Department of Cutaneous Allergy, St John's Institute of Dermatology, King's College London, London, UK
| | - L S Cunningham
- Department of Cutaneous Allergy, St John's Institute of Dermatology, King's College London, London, UK
| | - F J Ferguson
- Department of Cutaneous Allergy, St John's Institute of Dermatology, King's College London, London, UK
| | - C Tziotzios
- Department of Cutaneous Allergy, St John's Institute of Dermatology, King's College London, London, UK
| | - J A McGrath
- Department of Cutaneous Allergy, St John's Institute of Dermatology, King's College London, London, UK
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8
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Dayal JHS, Mason SM, Salas-Alanis JC, McGrath JA, Taylor RG, Mellerio JE, Blyth K, South AP, Inman GJ. Heterogeneous addiction to transforming growth factor-beta signalling in recessive dystrophic epidermolysis bullosa-associated cutaneous squamous cell carcinoma. Br J Dermatol 2021; 184:697-708. [PMID: 32726455 DOI: 10.1111/bjd.19421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recessive dystrophic epidermolysis bullosa (RDEB) is associated with a high mortality rate due to the development of life-threatening, metastatic cutaneous squamous cell carcinoma (cSCC). Elevated transforming growth factor-beta (TGF-β) signalling is implicated in cSCC development and progression in patients with RDEB. OBJECTIVES To determine the effect of exogenous and endogenous TGF-β signalling in RDEB cSCC with a view to assessing the potential of targeting TGF-β signalling for RDEB cSCC therapy. METHODS A panel of 11 patient-derived RDEB cSCC primary tumour keratinocyte cell lines (SCCRDEBs) were tested for their signalling and proliferation responses to exogenous TGF-β. Their responses to TGF-β receptor type-1 (TGFBR1) kinase inhibitors [SB-431542 and AZ12601011 (AZA01)] were tested using in vitro proliferation, clonogenicity, migration and three-dimensional invasion assays, and in vivo tumour xenograft assays. RESULTS All SCCRDEBs responded to exogenous TGF-β by activation of canonical SMAD signalling and proliferative arrest. Blocking endogenous signalling by treatment with SB-431542 and AZ12601011 significantly inhibited proliferation (seven of 11), clonogenicity (six of 11), migration (eight of 11) and invasion (six of 11) of SCCRDEBs. However, these TGFBR1 kinase inhibitors also promoted proliferation and clonogenicity in two of 11 SCCRDEB cell lines. Pretreatment of in vitro TGFBR1-addicted SCCRDEB70 cells with SB-431542 enhanced overall survival and reduced tumour volume in subcutaneous xenografts but had no effect on nonaddicted SCCRDEB2 cells in these assays. CONCLUSIONS Targeting TGFBR1 kinase activity may have therapeutic benefit in the majority of RDEB cSCCs. However, the potential tumour suppressive role of TGF-β signalling in a subset of RDEB cSCCs necessitates biomarker identification to enable patient stratification before clinical intervention.
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Affiliation(s)
- J H S Dayal
- Cancer Research UK Beatson Institute, Glasgow, UK
- Division of Cancer Research, Ninewells Hospital and Medical School, Jacqui Wood Cancer Centre, University of Dundee, Dundee, UK
| | - S M Mason
- Cancer Research UK Beatson Institute, Glasgow, UK
| | - J C Salas-Alanis
- Department of Basic Sciences, Health Sciences Division, Universidad de Monterrey, Guadalupe, Nuevo León, México
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R G Taylor
- Division of Cancer Research, Ninewells Hospital and Medical School, Jacqui Wood Cancer Centre, University of Dundee, Dundee, UK
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - K Blyth
- Cancer Research UK Beatson Institute, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - A P South
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - G J Inman
- Cancer Research UK Beatson Institute, Glasgow, UK
- Division of Cancer Research, Ninewells Hospital and Medical School, Jacqui Wood Cancer Centre, University of Dundee, Dundee, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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9
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Onoufriadis A, Boulouadnine B, Dachy G, Higashino T, Huang HY, Hsu CK, Simpson MA, Bork K, Demoulin JB, McGrath JA. A germline mutation in the platelet-derived growth factor receptor beta gene may be implicated in hereditary progressive mucinous histiocytosis. Br J Dermatol 2021; 184:967-970. [PMID: 33301597 DOI: 10.1111/bjd.19717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/06/2020] [Accepted: 12/07/2020] [Indexed: 01/29/2023]
Affiliation(s)
- A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | | | - G Dachy
- De Duve Institute, UCLouvain, Brussels, Belgium
| | - T Higashino
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - H Y Huang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C K Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - M A Simpson
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - K Bork
- Department of Dermatology, Johannes Gutenberg University, Mainz, Germany
| | | | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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10
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Ebens CL, McGrath JA, Riedl JA, Keith AR, Lilja G, Rusch S, Keene DR, Tufa SF, Riddle MJ, Shanley R, Van Heest AE, Tolar J. Immune tolerance of allogeneic haematopoietic cell transplantation supports donor epidermal grafting of recessive dystrophic epidermolysis bullosa chronic wounds. Br J Dermatol 2020; 184:1161-1169. [PMID: 32866988 DOI: 10.1111/bjd.19503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chronic wounds, a common morbidity in recessive dystrophic epidermolysis bullosa (RDEB), lack definitive therapies. OBJECTIVES To assess allogeneic epidermal skin grafts in terms of wound healing and durability over time. METHODS In a prospective, open-label clinical trial for postallogeneic haematopoietic cell transplantation (post-alloHCT) patients with RDEB, up to nine chronic wounds per patient were grafted over 1 year. Epidermal grafts measuring 5 cm2 were obtained from related alloHCT donors in the outpatient setting using the CELLUTOMETM Epidermal Harvesting System. Wounds were photographed and symptom inventories completed at baseline and 6, 12 and 52 weeks after grafting. The trial was registered at ClinicalTrials.gov (NCT02670837). RESULTS Between August 2016 and January 2019, eight patients with RDEB received a total of 35 epidermal allografts at a median of 1157 days (range 548-2884) post-alloHCT. The median (interquartile range) percentage reductions in wound surface area were 75% (52-94), 95% (72-100) and 100% (97-100) at 6, 12 and 52 weeks postgraft, respectively, each significantly reduced from baseline (P < 0·001). Donor harvest sites healed quickly without scarring. Biopsy evaluation at 1 year of an epidermal allograft site revealed wildtype type VII collagen (immunofluorescence), anchoring fibrils (electron microscopy), and full-thickness skin whole-DNA donor chimerism of 42% (compared with 16% in concurrently biopsied native skin). This strategy subsequently supported release of RDEB pseudosyndactyly. CONCLUSIONS The immune tolerance established by alloHCT supports successful adoptive transfer of donor epidermal grafts. Persistence of donor grafts in a single patient beyond 1 year and observed migration of donor-grafted cells into adjacent wound suggest that epidermal allografts include nonterminally differentiated cells and/or trigger recruitment of donor bone-marrow-derived cells to mediate wound healing.
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Affiliation(s)
- C L Ebens
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, London, England
| | - J A Riedl
- Department of Microbiology, Immunology, and Cancer Biology, University of Minnesota, Minneapolis, MN, USA
| | - A R Keith
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN, USA
| | - G Lilja
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - S Rusch
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - D R Keene
- Microimaging Center, Shriners Hospital for Children, Portland, OR, USA
| | - S F Tufa
- Microimaging Center, Shriners Hospital for Children, Portland, OR, USA
| | - M J Riddle
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - R Shanley
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - A E Van Heest
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - J Tolar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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11
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Mac Giolla Eain M, Joyce M, O'Sullivan A, McGrath JA, MacLoughlin R. An in vitro investigation into the release of fugitive medical aerosols into the environment during manual ventilation. J Hosp Infect 2020; 108:135-141. [PMID: 33296706 DOI: 10.1016/j.jhin.2020.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 10/20/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND During manual resuscitation, nebulizer therapy may be used to deliver therapeutics to patients in respiratory distress. However, the devices used to generate and deliver these medical aerosols have the potential to release these therapeutics into the local environment and expose caregivers to unwanted medical aerosols. AIM To quantify the levels of fugitive medical aerosol released into the environment during aerosol drug delivery using a manual resuscitation bag with and without filtration. METHODS Time-varying fugitive aerosol concentrations were measured using an aerodynamic particle sizer placed at a position designed to mimic a caregiver. Two nebulizer types were assessed, a vibrating mesh nebulizer and a jet nebulizer. The aerosol dose delivered to the simulated patient lung was also quantified. FINDINGS Filtration of the exhalation port of the manual resuscitation bag was seen to reduce fugitive medical aerosols to ambient levels for both nebulizer types. The vibrating mesh nebulizer delivered the greatest quantity of aerosol to the simulated adult patient (18.44 ± 1.03% versus 3.64 ± 0.26% with a jet nebulizer). CONCLUSIONS The results highlight the potential for exposure to fugitive medical aerosols released during the delivery of aerosol therapy with a manual resuscitation bag and also the potential for significant variation in patient lung dose depending on nebulizer type.
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Affiliation(s)
| | - M Joyce
- Aerogen, IDA Business Park, Dangan, Galway, Ireland
| | - A O'Sullivan
- Aerogen, IDA Business Park, Dangan, Galway, Ireland
| | - J A McGrath
- School of Physics & Ryan Institute's Centre for Climate and Air Pollution Studies, National University of Ireland Galway, Galway, Ireland
| | - R MacLoughlin
- Aerogen, IDA Business Park, Dangan, Galway, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland; School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland.
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12
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Papanikolaou M, Onoufriadis A, Mellerio JE, Nattkemper LA, Yosipovitch G, Steinhoff M, McGrath JA. Prevalence, pathophysiology and management of itch in epidermolysis bullosa. Br J Dermatol 2020; 184:816-825. [PMID: 32810291 DOI: 10.1111/bjd.19496] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 12/18/2022]
Abstract
Epidermolysis bullosa (EB) is a highly diverse group of inherited skin disorders, resulting from mutations in genes encoding proteins of the dermoepidermal junction. Itch (pruritus) is one of the most common symptoms across all EB subtypes. It occurs in blistered or wounded sites, or manifests as a generalized phenomenon, thereby affecting both intact skin and healing wounds. The mechanism of pruritus in EB is unclear. It is likely that skin inflammation secondary to barrier disruption, wound healing cascades and dysregulated activation of epidermal sensory nerve endings are all involved in its pathophysiology on the molecular and cellular level. Understanding these mechanisms in depth is crucial in developing optimized treatments for people with EB and improving quality of life. This review summarizes current evidence on the prevalence, mechanisms and management of itch in EB.
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Affiliation(s)
- M Papanikolaou
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - J E Mellerio
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - L A Nattkemper
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery and Miami Itch Centre, University of Miami Miller School of Medicine, Miami, FL, USA
| | - G Yosipovitch
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery and Miami Itch Centre, University of Miami Miller School of Medicine, Miami, FL, USA
| | - M Steinhoff
- Department of Dermatology, Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Weill Cornell Medicine-Qatar, Doha, Qatar.,Weill Cornell Medicine, New York, NY, USA
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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13
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Onoufriadis A, Cabezas A, Ng JCF, Canales J, Costas MJ, Ribeiro JM, Rodrigues JR, McAleer MA, Castelo-Soccio L, Simpson MA, Fraternali F, Irvine AD, Cameselle JC, McGrath JA. Autosomal recessive hypotrichosis with loose anagen hairs associated with TKFC mutations. Br J Dermatol 2020; 184:935-943. [PMID: 32790068 DOI: 10.1111/bjd.19481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Loose anagen hair is a rare form of impaired hair anchorage in which anagen hairs that lack inner and outer root sheaths can be gently and painlessly plucked from the scalp. This condition usually occurs in children and is often self-limiting. A genetic basis for the disorder has been suggested but not proven. A better understanding the aetiology of loose anagen hair may improve prevention and treatment strategies. OBJECTIVES To identify a possible genetic basis of loose anagen hair using next-generation DNA sequencing and functional analysis of variants identified. METHODS In this case study, whole-exome sequencing analysis of a pedigree with one affected individual with features of loose anagen hair was performed. RESULTS The patient was found to be compound heterozygous for two single-nucleotide substitutions in TKFC resulting in the following missense mutations: c.574G> C (p.Gly192Arg) and c.682C> T (p.Arg228Trp). Structural analysis of human TKFC showed that both mutations are located near the active site cavity. Kinetic assays of recombinant proteins bearing either of these amino acid substitutions showed almost no dihydroxyacetone kinase or D-glyceraldehyde kinase activity, and FMN cyclase activity reduced to just 10% of wildtype catalytic activity. CONCLUSIONS TKFC missense mutations may predispose to the development of loose anagen hairs. Identification of this new biochemical pathobiology expands the metabolic and genetic basis of hypotrichosis.
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Affiliation(s)
- A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Guy's Hospital, King's College London, London, UK
| | - A Cabezas
- Grupo de Enzimología, Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - J C F Ng
- Randall Centre for Cell and Molecular Biophysics, Guy's Hospital, King's College London, London, UK
| | - J Canales
- Grupo de Enzimología, Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - M J Costas
- Grupo de Enzimología, Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - J M Ribeiro
- Grupo de Enzimología, Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - J R Rodrigues
- Laboratório Associado LSRE-LCM, Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Leiria, Leiria, Portugal
| | - M A McAleer
- Paediatric Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - L Castelo-Soccio
- Pediatric Dermatology, Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - M A Simpson
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Guy's Hospital, King's College London, London, UK
| | - F Fraternali
- Randall Centre for Cell and Molecular Biophysics, Guy's Hospital, King's College London, London, UK
| | - A D Irvine
- Paediatric Dermatology, Children's Health Ireland at Crumlin, Dublin, Ireland.,Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - J C Cameselle
- Grupo de Enzimología, Departamento de Bioquímica y Biología Molecular y Genética, Facultad de Medicina, Universidad de Extremadura, Badajoz, Spain
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, Guy's Hospital, King's College London, London, UK
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14
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O'Sullivan S, Ozoemena L, Liu L, McGrath JA, Mellerio JE, Martinez AE. PLACK syndrome: the penny dropped. Clin Exp Dermatol 2020; 45:1091-1092. [PMID: 32918489 DOI: 10.1111/ced.14417] [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: 07/15/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- S O'Sullivan
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
| | - L Ozoemena
- National Diagnostic EB Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - L Liu
- National Diagnostic EB Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
| | - A E Martinez
- Dermatology Department, Great Ormond Street Hospital, NHS Foundation Trust, London, UK
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15
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McSweeney SM, Christou EAA, Dand N, Boalch A, Holmes S, Harries M, Palamaras I, Cunningham F, Parkins G, Kaur M, Farrant P, McDonagh A, Messenger A, Jones J, Jolliffe V, Ali I, Ardern-Jones M, Mitchell C, Burrows N, Atkar R, Banfield C, Alexandroff A, Champagne C, Cooper HL, Patel GK, Macbeth A, Page M, Bryden A, Mowbray M, Wahie S, Armstrong K, Cooke N, Goodfield M, Man I, de Berker D, Dunnil G, Takwale A, Rao A, Siah TW, Sinclair R, Wade MS, Bhargava K, Fenton DA, McGrath JA, Tziotzios C. Frontal fibrosing alopecia: a descriptive cross-sectional study of 711 cases in female patients from the UK. Br J Dermatol 2020; 183:1136-1138. [PMID: 32652611 DOI: 10.1111/bjd.19399] [Citation(s) in RCA: 5] [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: 12/21/2022]
Affiliation(s)
- S M McSweeney
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - E A A Christou
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - N Dand
- Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - A Boalch
- Greenwich and Lewisham NHS Foundation Trust, London, SE13 6LH, UK
| | - S Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | - F Cunningham
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | - G Parkins
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - K Bhargava
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - D A Fenton
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - J A McGrath
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - C Tziotzios
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
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16
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Lee JYW, McGrath JA. Mutations in genes encoding desmosomal proteins: spectrum of cutaneous and extracutaneous abnormalities. Br J Dermatol 2020; 184:596-605. [PMID: 32593191 DOI: 10.1111/bjd.19342] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2020] [Indexed: 12/27/2022]
Abstract
The desmosome is a type of intercellular junction found in epithelial cells, cardiomyocytes and other specialized cell types. Composed of a network of transmembranous cadherins and intracellular armadillo, plakin and other proteins, desmosomes contribute to cell-cell adhesion, signalling, development and differentiation. Mutations in genes encoding desmosomal proteins result in a spectrum of erosive skin and mucosal phenotypes that also may affect hair or heart. This review summarizes the molecular pathology and phenotypes associated with desmosomal dysfunction with a focus on inherited disorders that involve the skin/hair, as well as associated extracutaneous pathologies. We reviewed the relevant literature to collate studies of pathogenic human mutations in desmosomes that have been reported over the last 25 years. Mutations in 12 different desmosome genes have been documented, with mutations in nine genes affecting the skin/mucous membranes (DSG1, DSG3, DSC2, DSC3, JUP, PKP1, DSP, CDSN, PERP) and eight resulting in hair abnormalities (DSG4, DSC2, DSC3, JUP, PKP1, DSP, CDSN, PERP). Mutations in three genes can result in cardiocutaneous syndromes (DSC2, JUP, DSP), although mutations have been described in five genes in inherited heart disorders that may lack any dermatological manifestations (DSG2, DSC2, JUP, PKP2, DSP). Understanding the diverse nature of these clinical phenotypes, as well as the desmosome gene mutation(s), has clinical value in managing and counselling patients, as well as demonstrating the biological role and activity of specific components of desmosomes in skin and other tissues.
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Affiliation(s)
- J Y W Lee
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, UK
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17
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Chiu FPC, Doolan BJ, McGrath JA, Onoufriadis A. A decade of next-generation sequencing in genodermatoses: the impact on gene discovery and clinical diagnostics. Br J Dermatol 2020; 184:606-616. [PMID: 32628274 DOI: 10.1111/bjd.19384] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Discovering the genetic basis of inherited skin diseases is fundamental to improving diagnostic accuracy and genetic counselling. In the 1990s and 2000s, genetic linkage and candidate gene approaches led to the molecular characterization of several dozen genodermatoses, but over the past decade the advent of next-generation sequencing (NGS) technologies has accelerated diagnostic discovery and precision. OBJECTIVES This review examines the application of NGS technologies from 2009 to 2019 that have (i) led to the initial discovery of gene mutations in known or new genodermatoses and (ii) identified involvement of more than one contributing pathogenic gene in individuals with complex Mendelian skin disorder phenotypes. METHODS A comprehensive review of the PubMed database and dermatology conference abstracts was undertaken between January 2009 and December 2019. The results were collated and cross-referenced with OMIM. RESULTS We identified 166 new disease-gene associations in inherited skin diseases discovered by NGS. Of these, 131 were previously recognized, while 35 were brand new disorders. Eighty-five were autosomal dominant (with 43 of 85 mutations occurring de novo), 78 were autosomal recessive and three were X-linked. We also identified 63 cases harbouring multiple pathogenic mutations, either involving two coexisting genodermatoses (n = 13) or an inherited skin disorder in conjunction with other organ system phenotypes (n = 50). CONCLUSIONS NGS technologies have accelerated disease-gene discoveries in dermatology over the last decade. Moreover, the era of NGS has enabled clinicians to split complex Mendelian phenotypes into separate diseases. These genetic data improve diagnostic precision and make feasible accurate prenatal testing and better-targeted translational research.
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Affiliation(s)
- F P-C Chiu
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - B J Doolan
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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18
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McSweeney SM, Stefanato CM, Fenton DA, McGrath JA, Tziotzios C. Alopecia areata and frontal fibrosing alopecia: dimorphism by concurrence. Clin Exp Dermatol 2020; 45:734-737. [PMID: 32198940 DOI: 10.1111/ced.14224] [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] [Accepted: 03/18/2020] [Indexed: 11/27/2022]
Affiliation(s)
- S M McSweeney
- St John's Institute of Dermatology, Guys and St Thomas' NHS Trust, London, UK
| | - C M Stefanato
- Department of Dermatopathology, St John's Institute of Dermatology, Guys and St Thomas' NHS Trust, London, UK
| | - D A Fenton
- St John's Institute of Dermatology, Guys and St Thomas' NHS Trust, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, Guys and St Thomas' NHS Trust, London, UK
| | - C Tziotzios
- St John's Institute of Dermatology, Guys and St Thomas' NHS Trust, London, UK
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19
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Chiu FPC, Salas-Alanis JC, Amaya-Guerra M, Cepeda-Valdes R, McGrath JA, Hsu CK. Novel p.Ala675Thr missense mutation in TRPV3 in Olmsted syndrome. Clin Exp Dermatol 2020; 45:796-798. [PMID: 32410213 DOI: 10.1111/ced.14228] [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] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- F P-C Chiu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan.,St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - J C Salas-Alanis
- Department of Dermatology, Dystrophic Epidermolysis Bullosa Research Association Mexico Foundation, Monterrey, Nuevo Leon, Mexico
| | | | - R Cepeda-Valdes
- Department of Dermatology, Dystrophic Epidermolysis Bullosa Research Association Mexico Foundation, Monterrey, Nuevo Leon, Mexico
| | - J A McGrath
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - C-K Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan.,St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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20
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Abd Elmaksoud MS, Gomaa NS, Azouz HG, On CNV, Ho CT, Omar TE, McGrath JA, Onoufriadis A. Genetic analysis in three Egyptian patients with Griscelli syndrome Type 1 reveals new nonsense mutations in MYO5A. Clin Exp Dermatol 2020; 45:789-792. [PMID: 32275080 DOI: 10.1111/ced.14220] [Citation(s) in RCA: 5] [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] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Affiliation(s)
- M S Abd Elmaksoud
- Department of Pediatrics, Pediatric Neurology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - N S Gomaa
- Dermatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - H G Azouz
- Department of Pediatrics, Pediatric Neurology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - C N V On
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - C T Ho
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - T E Omar
- Department of Pediatrics, Pediatric Neurology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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21
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Oktem A, Doolan BJ, Akay BN, Onoufriadis A, Okcu Heper A, Kocak O, Ersoy-Evans S, McGrath JA. Autosomal recessive mutations in plakoglobin and risk of cardiac abnormalities. Clin Exp Dermatol 2020; 45:654-657. [PMID: 32212272 DOI: 10.1111/ced.14201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 11/28/2022]
Affiliation(s)
- A Oktem
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - B J Doolan
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - B N Akay
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A Okcu Heper
- Department of Pathology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - O Kocak
- Department of Dermatology, Kutahya Evliya Celebi Education and Research Hospital, Dumlupinar University, Kutahya, Turkey
| | - S Ersoy-Evans
- Department of Dermatology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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22
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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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23
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Chiu FPC, Wessagowit V, Cakmak MF, Doolan BJ, Kootiratrakarn T, Chaowalit P, Bunnag T, Simpson MA, McGrath JA, Onoufriadis A. Molecular basis and inheritance patterns of amyloidosis cutis dyschromica. Clin Exp Dermatol 2020; 45:650-653. [PMID: 32097499 DOI: 10.1111/ced.14183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2019] [Indexed: 01/10/2023]
Affiliation(s)
- F P C Chiu
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - V Wessagowit
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - M F Cakmak
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - B J Doolan
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - T Kootiratrakarn
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - P Chaowalit
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - T Bunnag
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - M A Simpson
- The Institute of Dermatology, Department of Medical Services, Ministry of Public Health, Thailand
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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24
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Gaucher S, Lwin SM, Titeux M, Abdul-Wahab A, Pironon N, Izmiryan A, Miskinyte S, Ganier C, Duchatelet S, Mellerio JE, Bourrat E, McGrath JA, Hovnanian A. EBGene trial: patient preselection outcomes for the European GENEGRAFT ex vivo phase I/II gene therapy trial for recessive dystrophic epidermolysis bullosa. Br J Dermatol 2019; 182:794-797. [PMID: 31557321 DOI: 10.1111/bjd.18559] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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)
- S Gaucher
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France.,Service de Chirurgie Générale, Plastique et Ambulatoire, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - S M Lwin
- St John's Institute of Dermatology, King's College London, London, U.K
| | - M Titeux
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - A Abdul-Wahab
- St John's Institute of Dermatology, King's College London, London, U.K
| | - N Pironon
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - A Izmiryan
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - S Miskinyte
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - C Ganier
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - S Duchatelet
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London, London, U.K
| | - E Bourrat
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, London, U.K
| | - A Hovnanian
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes-Sorbonne Paris Cité, Paris, France.,Department of Genetics, Assistance Publique-Hôpitaux de Paris, Necker Hospital for Sick Children, Paris, France
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Onoufriadis A, Simpson JK, McDonald C, Nguyen TTM, Campeau PM, Simpson MA, Martinez AE, McGrath JA. Nonsyndromic erythrodermic ichthyosis resulting from a homozygous mutation in PIGL. Clin Exp Dermatol 2019; 45:391-394. [PMID: 31535386 DOI: 10.1111/ced.14077] [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] [Accepted: 07/29/2019] [Indexed: 12/01/2022]
Affiliation(s)
- A Onoufriadis
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - J K Simpson
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - C McDonald
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - T T M Nguyen
- Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, Canada
| | - P M Campeau
- Centre Hospitalier Universitaire Sainte-Justine Research Center, University of Montreal, Montreal, Canada
| | - M A Simpson
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, UK
| | - A E Martinez
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
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26
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Twaroski K, Eide C, Riddle MJ, Xia L, Lees CJ, Chen W, Mathews W, Keene DR, McGrath JA, Tolar J. Revertant mosaic fibroblasts in recessive dystrophic epidermolysis bullosa. Br J Dermatol 2019; 181:1247-1253. [PMID: 30924923 DOI: 10.1111/bjd.17943] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Revertant mosaicism has been described previously in recessive dystrophic epidermolysis bullosa (RDEB), manifesting as regions of skin with normal mechanical and biological characteristics. Here we report the discovery of revertant dermal fibroblasts, unique in that all other documented cases of revertant mosaicism occur in epidermal keratinocytes. OBJECTIVES To determine the cause of revertant mosaicism found in a patient with RDEB from isolated epidermal keratinocytes and dermal fibroblasts in blister and mosaic skin regions. METHODS Skin biopsies were taken from blister and mosaic skin regions of a patient with RDEB. Allele identification was confirmed and the type VII collagen (C7) content and COL7A1 expression profile of isolated keratinocytes and fibroblasts was determined. RESULTS Keratinocytes isolated from the mosaic area had a slight increase in C7, although overall expression of COL7A1 was unchanged between blister and mosaic fibroblasts. Differential allele expression was identified in blister and mosaic fibroblasts using targeted RNA sequencing (TREx), where the allele harbouring a point mutation was preferentially expressed over that containing a frameshift mutation. A crossing over event was identified in mosaic fibroblasts that was not present in blister fibroblasts, yielding a functional COL7A1 allele in a subset of cells. CONCLUSIONS In documenting a novel case of revertant mosaicism in RDEB, we have identified dermal fibroblasts as having the capacity to correct blistering functionally. We have also pioneered the use of TREx in quantifying allele-specific expression. Using fibroblasts instead of keratinocytes for RDEB therapies offers advantages in the local and systemic therapy of RDEB. What's already known about this topic? Revertant mosaicism has been previously documented in patients with recessive dystrophic epidermolysis bullosa (RDEB), however, it has only been found in epidermal keratinocytes. What does this study add? We have demonstrated that COL7A1 gene reversion in dermal fibroblasts occurs and is able to form functional skin in a patient with RDEB. Additionally, we have pioneered a new application for targeted RNA sequencing in quantifying allele-specific expression in fibroblasts and keratinocytes. What is the translational message? This opens up possibilities for using fibroblasts as local and systemic therapy for patients with RDEB.
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Affiliation(s)
| | - C Eide
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - M J Riddle
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - L Xia
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - C J Lees
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | | | - W Mathews
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - D R Keene
- Shriners Hospital for Children, Medical Genetics and Biochemistry & Molecular Biology, Oregon Health & Science University, Portland, OR, U.S.A
| | - J A McGrath
- St. John's Institute of Dermatology, King's College London, London, U.K
| | - J Tolar
- Stem Cell Institute and.,Department of Pediatrics, Division of Blood and Marrow Transplantation, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
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27
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Ebens CL, McGrath JA, Tamai K, Hovnanian A, Wagner JE, Riddle MJ, Keene DR, DeFor TE, Tryon R, Chen M, Woodley DT, Hook K, Tolar J. Bone marrow transplant with post-transplant cyclophosphamide for recessive dystrophic epidermolysis bullosa expands the related donor pool and permits tolerance of nonhaematopoietic cellular grafts. Br J Dermatol 2019; 181:1238-1246. [PMID: 30843184 DOI: 10.1111/bjd.17858] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recessive dystrophic epidermolysis bullosa (RDEB) is a severe systemic genodermatosis lacking therapies beyond supportive care for its extensive, life-limiting manifestations. OBJECTIVES To report the safety and preliminary responses of 10 patients with RDEB to bone marrow transplant (BMT) with post-transplant cyclophosphamide (PTCy BMT) after reduced-intensity conditioning with infusions of immunomodulatory donor-derived mesenchymal stromal cells (median follow-up 16 months). METHODS BMT toxicities, donor blood and skin engraftment, skin biopsies, photographic and dynamic assessments of RDEB disease activity were obtained at intervals from pre-BMT to 1 year post-BMT. RESULTS Related donors varied from haploidentical (n = 6) to human leucocyte antigen (HLA)-matched (n = 3), with one HLA-matched unrelated donor. Transplant complications included graft failure (n = 3; two pursued a second PTCy BMT), veno-occlusive disease (n = 2), posterior reversible encephalopathy (n = 1) and chronic graft-versus-host disease (n = 1; this patient died). In the nine ultimately engrafted patients, median donor chimerism at 180 days after transplant was 100% in peripheral blood and 27% in skin. Skin biopsies showed stable (n = 7) to improved (n = 2) type VII collagen protein expression by immunofluorescence and gain of anchoring fibril components (n = 3) by transmission electron microscopy. Early signs of clinical response include trends toward reduced body surface area of blisters/erosions from a median of 49·5% to 27·5% at 100 days after BMT (P = 0·05), with parental measures indicating stable quality of life. CONCLUSIONS PTCy BMT in RDEB provides a means of attaining immunotolerance for future donor-derived cellular grafts (ClinicalTrials.gov identifier NCT02582775). What's already known about this topic? Severe, generalized recessive dystrophic epidermolysis bullosa (RDEB) is marked by great morbidity and early death. No cure currently exists for RDEB. Bone marrow transplant (BMT) is the only described systemic therapy for RDEB. What does this study add? The first description of post-transplant cyclophosphamide (PTCy) BMT for RDEB. PTCy was well tolerated and provided excellent graft-versus-host disease prophylaxis, replacing long courses of calcineurin inhibitors in patients receiving human leucocyte antigen-matched sibling BMT. What is the translational message? The PTCy BMT platform permits identification of a suitable related donor for most patients and for subsequent adoptive transfer of donor nonhaematopoietic cells after establishment of immunological tolerance.
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Affiliation(s)
- C L Ebens
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, London, U.K
| | - K Tamai
- Department of Stem Cell Therapy Science, Graduate School of Medicine, University of Osaka, Osaka, Japan
| | - A Hovnanian
- INSERM UMR1163, Imagine Institute, Department of Genetics, University Paris Descartes, Necker Hospital, Paris, France
| | - J E Wagner
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - M J Riddle
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - D R Keene
- Microimaging Center, Shriners Hospital for Children, Portland, OR, U.S.A
| | - T E DeFor
- Biostatistic Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, U.S.A
| | - R Tryon
- Genetics Division, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - M Chen
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - D T Woodley
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - K Hook
- Department of Dermatology, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
| | - J Tolar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, U.S.A
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Affiliation(s)
- J A McGrath
- St John's Institute of Dermatology, King's College London, London, U.K
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29
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Thomas LJ, Freeman A, O'Toole EA, McGrath JA, Perrett CM. Inherited palmoplantar keratodermas: the heart of the matter. Clin Exp Dermatol 2017; 43:228-230. [PMID: 28940524 DOI: 10.1111/ced.13240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- L J Thomas
- Department of Dermatology, Chelsea and Westminster Hospital, London, UK
| | - A Freeman
- Department of Pathology, University College Hospital, London, UK
| | - E A O'Toole
- Department of Dermatology, The Royal London Hospital, London, UK
| | - J A McGrath
- Department of Dermatology, Guy's Hospital, London, UK.,King's College London, London, UK
| | - C M Perrett
- Department of Dermatology, University College Hospital, London, UK
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30
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Takeichi T, Nomura T, Takama H, Kono M, Sugiura K, Watanabe D, Shimizu H, Simpson MA, McGrath JA, Akiyama M. Deficient stratum corneum intercellular lipid in a Japanese patient with lamellar ichthyosis with a homozygous deletion mutation in SDR9C7. Br J Dermatol 2017; 177:e62-e64. [PMID: 28112794 DOI: 10.1111/bjd.15315] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- T Takeichi
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - T Nomura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Takama
- Department of Dermatology, Aichi Medical University, Nagakute, Japan
| | - M Kono
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - D Watanabe
- Department of Dermatology, Aichi Medical University, Nagakute, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - M A Simpson
- Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, U.K
| | - J A McGrath
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K
| | - M Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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31
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McGrath JA. A new clinical diagnostic matrix for epidermolysis bullosa. Br J Dermatol 2017; 176:1442-1443. [PMID: 28581214 DOI: 10.1111/bjd.15583] [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: 11/30/2022]
Affiliation(s)
- J A McGrath
- St John's Institute of Dermatology (King's College London), Dermatology Research Labs, Floor 9 Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, U.K
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32
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Takeichi T, Nanda A, Yang HS, Hsu CK, Lee JYY, Al-Ajmi H, Akiyama M, Simpson MA, McGrath JA. Syndromic inherited poikiloderma due to a de novo mutation in FAM111B. Br J Dermatol 2016; 176:534-536. [PMID: 27406236 DOI: 10.1111/bjd.14845] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T Takeichi
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, U.K.,Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - A Nanda
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait
| | - H-S Yang
- Department of Dermatology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - C-K Hsu
- Department of Dermatology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - J Y-Y Lee
- Department of Dermatology, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - H Al-Ajmi
- As'ad Al-Hamad Dermatology Center, Al-Sabah Hospital, Kuwait
| | - M Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M A Simpson
- Department of Genetics and Molecular Medicine, King's College London, Guy's Hospital, London, U.K
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, Guy's Hospital, London, U.K
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33
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Seegobin SD, Tziotzios C, Stefanato CM, Bhargava K, Fenton DA, McGrath JA. Frontal fibrosing alopecia: there is no statistically significant association with leave-on facial skin care products and sunscreens. Br J Dermatol 2016; 175:1407-1408. [PMID: 27614082 DOI: 10.1111/bjd.15054] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- S D Seegobin
- King's College London, St John's Institute of Dermatology, London, U.K
| | - C Tziotzios
- King's College London, St John's Institute of Dermatology, London, U.K
| | - C M Stefanato
- King's College London, St John's Institute of Dermatology, London, U.K
| | - K Bhargava
- King's College London, St John's Institute of Dermatology, London, U.K
| | - D A Fenton
- King's College London, St John's Institute of Dermatology, London, U.K
| | - J A McGrath
- King's College London, St John's Institute of Dermatology, London, U.K
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34
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Boente MDC, Nanda A, Baselaga PA, Kelsell DP, McGrath JA, South AP. Cardiomyopathy diagnosed in the eldest child harbouring p.S24X mutation in JUP. Br J Dermatol 2016; 175:644-6. [PMID: 27037756 DOI: 10.1111/bjd.14617] [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: 11/30/2022]
Affiliation(s)
- M Del C Boente
- Department of Dermatology, Hospital del Niño Jesús, Tucumán, Argentina
| | - A Nanda
- Asad Al-Hamad Dermatology Center, Kuwait
| | - P A Baselaga
- Department of Cardiology, Hospital del Niño Jesús, Tucumán, Argentina
| | - D P Kelsell
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, U.K
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, London, U.K
| | - A P South
- Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, U.S.A.
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35
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Pourreyron C, Chen M, McGrath JA, Salas-Alanis JC, South AP, Leigh IM. High levels of type VII collagen expression in recessive dystrophic epidermolysis bullosa cutaneous squamous cell carcinoma keratinocytes increases PI3K and MAPK signalling, cell migration and invasion. Br J Dermatol 2016; 170:1256-65. [PMID: 24641191 DOI: 10.1111/bjd.12715] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidermolysis bullosa is a group of inherited skin fragility diseases varying in severity from mild scarring to infant mortality. Great efforts are being undertaken to develop therapeutic strategies to treat the more pernicious forms of this disease, particularly those associated with recessive, loss-of-function mutations. In such cases significant effort is directed toward delivering recombinant protein at levels sufficient to demonstrate clinical benefit. Recessive dystrophic epidermolysis bullosa (RDEB) predisposes patients to a high incidence of life-threatening cutaneous squamous cell carcinoma (cSCC). Mutations in the gene encoding type VII collagen, COL7A1, are the sole cause of this disease and conflicting reports concerning type VII collagen and COL7A1 in carcinogenesis exist. OBJECTIVES To investigate potential oncogenic effects of expressing recombinant type VII collagen in patient cells. METHODS We used retroviral transduction to introduce type VII collagen into keratinocytes derived from patients with and without RDEB. RESULTS Retroviral expression of type VII collagen in cSCC keratinocytes established from patients with RDEB resulted in increased cell adhesion, migration and invasion coupled with a concurrent increase in PI3K and MAPK signalling. CONCLUSIONS Our data suggest caution when formulating strategies where delivery of type VII collagen is likely to exceed levels seen under normal physiological conditions in a patient group with a higher inherent risk of developing skin cancer.
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Affiliation(s)
- C Pourreyron
- Division of Cancer Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, U.K
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36
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Martins VL, Caley MP, Moore K, Szentpetery Z, Marsh ST, Murrell DF, Kim MH, Avari M, McGrath JA, Cerio R, Kivisaari A, Kähäri VM, Hodivala-Dilke K, Brennan CH, Chen M, Marshall JF, O'Toole EA. Suppression of TGFβ and Angiogenesis by Type VII Collagen in Cutaneous SCC. J Natl Cancer Inst 2016; 108:djv293. [PMID: 26476432 DOI: 10.1093/jnci/djv293] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/22/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Individuals with severe generalized recessive dystrophic epidermolysis bullosa (RDEB), an inherited blistering disorder caused by mutations in the COL7A1 gene, develop unexplained aggressive squamous cell carcinomas (SCC). Here we report that loss of type VII collagen (Col7) in SCC results in increased TGFβ signaling and angiogenesis in vitro and in vivo. METHODS Stable knockdown (KD) of Col7 was established using shRNA, and cells were used in a mouse xenograft model. Angiogenesis was assessed by immunohistochemistry, endothelial tube-forming assays, and proteome arrays. Mouse and zebrafish models were used to examine the effect of recombinant Col7 on angiogenesis. Findings were confirmed in anonymized, archival human tissue: RDEB SCC tumors, non-EB SCC tumors, RDEB skin, normal skin; and two human RDEB SCC cell lines. The TGFβ pathway was examined using immunoblotting, immunohistochemistry, biochemical inhibition, and siRNA. All statistical tests were two-sided. RESULTS Increased numbers of cross-cut blood vessels were observed in Col7 KD compared with control xenografts (n = 4 to 7 per group) and in RDEB tumors (n = 21) compared with sporadic SCC (n = 24, P < .001). Recombinant human Col7 reversed the increased SCC angiogenesis in Col7 KD xenografts in vivo (n = 7 per group, P = .04). Blocking the interaction between α2β1 integrin and Col7 increased TGFB1 mRNA expression 1.8-fold and p-Smad2 levels two-fold. Increased TGFβ signaling and VEGF expression were observed in Col7 KD xenografts (n = 4) compared with control (n = 4) and RDEB tumors (TGFβ markers, n = 6; VEGF, n = 17) compared with sporadic SCC (TGFβ markers, n = 6; VEGF, n = 21). Inhibition of TGFβ receptor signaling using siRNA resulted in decreased endothelial cell tube formation (n = 9 per group, mean tubes per well siC = 63.6, SD = 17.1; mean tubes per well siTβRII = 29.7, SD = 6.1, P = .02). CONCLUSIONS Type VII collagen suppresses TGFβ signaling and angiogenesis in cutaneous SCC. Patients with RDEB SCC may benefit from anti-angiogenic therapy.
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Affiliation(s)
- V L Martins
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - M P Caley
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - K Moore
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - Z Szentpetery
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - S T Marsh
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - D F Murrell
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - M H Kim
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - M Avari
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - J A McGrath
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - R Cerio
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - A Kivisaari
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - V M Kähäri
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - K Hodivala-Dilke
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - C H Brennan
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - M Chen
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - J F Marshall
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC)
| | - E A O'Toole
- Centre for Cell Biology and Cutaneous Research, Blizard Institute (VLM, MPC, ZS, STM, MA, RC, EOT), Barts Cancer Institute (KM, KHD, JFM), Barts and the London School of Medicine and Dentistry and School of Biological and Chemical Sciences (CHB), Queen Mary University of London, London, UK; Department of Dermatology, St George Hospital, University of NSW, Sydney, NSW, Australia (DFM, MHK); St John's Institute of Dermatology, Kings College London (Guys Campus), London, UK (JAM); Department of Dermatology and MediCity Research Laboratory, University of Turku, and Turku University Hospital, Turku, Finland (AK, VMK); Department of Dermatology, University of Southern California, Los Angeles, CA (MC).
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Rashidghamat E, Ozoemena L, Liu L, McGrath JA, Martinez AE, Mellerio JE. Mutations in EXPH5 underlie a rare subtype of autosomal recessive epidermolysis bullosa simplex. Br J Dermatol 2015. [PMID: 26211931 DOI: 10.1111/bjd.14047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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)
- E Rashidghamat
- St John's Institute of Dermatology, King's College London, London, U.K
| | - L Ozoemena
- Viapath, St Thomas' Hospital, London, U.K
| | - L Liu
- Viapath, St Thomas' Hospital, London, U.K
| | - J A McGrath
- St John's Institute of Dermatology, King's College London, London, U.K
| | - A E Martinez
- Department of Dermatology, Great Ormond Street for Children NHS Foundation Trust, London, U.K
| | - J E Mellerio
- St John's Institute of Dermatology, King's College London, London, U.K.,Department of Dermatology, Great Ormond Street for Children NHS Foundation Trust, London, U.K
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38
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Mellerio JE, Robertson SJ, Bernardis C, Diem A, Fine JD, George R, Goldberg D, Halmos GB, Harries M, Jonkman MF, Lucky A, Martinez AE, Maubec E, Morris S, Murrell DF, Palisson F, Pillay EI, Robson A, Salas-Alanis JC, McGrath JA. Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines. Br J Dermatol 2015; 174:56-67. [PMID: 26302137 DOI: 10.1111/bjd.14104] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/24/2022]
Abstract
This article summarizes recommendations reached following a systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa. The guidelines are intended to help inform decision making by clinicians dealing with this complex complication of a devastating disease.
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Affiliation(s)
- J E Mellerio
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K.,Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - S J Robertson
- Department of Dermatology, The Royal Melbourne Hospital, The Royal Children's Hospital and Monash Medical Centre, Melbourne, Australia
| | - C Bernardis
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A Diem
- Department of Dermatology, Paracelsus Medical University, Salzburg, Austria
| | - J D Fine
- Division of Dermatology, Vanderbilt University School of Medicine, Nashville, TN, U.S.A
| | - R George
- Department of Palliative Care, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - D Goldberg
- Division of Dermatology, University of Massachusetts, Worcester, MA, U.S.A
| | - G B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - M Harries
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - M F Jonkman
- Department of Dermatology, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Lucky
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, U.S.A
| | - A E Martinez
- Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - E Maubec
- Department of Dermatology, APHP, Avicenne Hospital, Bobigny, France
| | - S Morris
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - D F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, Australia
| | - F Palisson
- Facultad de Medicina, Clínica Alemana, Santiago, Chile
| | - E I Pillay
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A Robson
- Department of Dermatopathology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - J C Salas-Alanis
- Basic Sciences Department, Universidad de Monterrey, Monterrey, Mexico
| | - J A McGrath
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, U.K
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39
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Pohler E, Cunningham F, Sandilands A, Cole C, Digby S, McMillan JR, Aristodemou S, McGrath JA, Smith FJD, McLean WHI, Munro CS, Zamiri M. Novel autosomal dominant mutation in loricrin presenting as prominent ichthyosis. Br J Dermatol 2015; 173:1291-4. [PMID: 25965869 PMCID: PMC4832349 DOI: 10.1111/bjd.13895] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Pohler
- Centre for Dermatology and Genetic Medicine, Colleges of Life Sciences and Medicine, Dentistry and Nursing, University of Dundee, U.K
| | - F Cunningham
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, U.K
| | - A Sandilands
- Centre for Dermatology and Genetic Medicine, Colleges of Life Sciences and Medicine, Dentistry and Nursing, University of Dundee, U.K
| | - C Cole
- Division of Computational Biology, College of Life Sciences, University of Dundee, U.K
| | - S Digby
- Department of Pathology, Southern General Hospital, Glasgow, U.K
| | - J R McMillan
- EB Laboratory, Viapath LLP, St Thomas' Hospital, London Group, King's College London (Guy's Campus), London, U.K
| | - S Aristodemou
- EB Laboratory, Viapath LLP, St Thomas' Hospital, London Group, King's College London (Guy's Campus), London, U.K
| | - J A McGrath
- Department of Cell Pathology, St John's Institute of Dermatology, St. Thomas' Hospital, London, U.K
| | - F J D Smith
- Centre for Dermatology and Genetic Medicine, Colleges of Life Sciences and Medicine, Dentistry and Nursing, University of Dundee, U.K
| | - W H I McLean
- Centre for Dermatology and Genetic Medicine, Colleges of Life Sciences and Medicine, Dentistry and Nursing, University of Dundee, U.K
| | - C S Munro
- Alan Lyell Centre for Dermatology, Southern General Hospital, Glasgow, U.K
| | - M Zamiri
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, U.K.,Alan Lyell Centre for Dermatology, Southern General Hospital, Glasgow, U.K
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40
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Cuell A, Bansal N, Cole T, Kaur MR, Lee J, Loffeld A, Moss C, O'Donnell M, Takeichi T, Thind CK, McGrath JA. Familial progressive hyper- and hypopigmentation and malignancy in two families with new mutations in KITLG. Clin Exp Dermatol 2015; 40:860-4. [PMID: 26179221 DOI: 10.1111/ced.12702] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Familial progressive hyper- and hypopigmentation (FPHH) is an autosomal dominant skin condition presenting in childhood with generalized macular dyspigmentation, usually reported in patients of East Asian origin. It overlaps phenotypically with other dyschromatoses, but can now be distinguished by mutations in the KIT ligand gene (KITLG). AIM We report two unrelated white families with similar phenotypic presentations of FPHH developing in early childhood in several generations. METHODS Sanger sequencing of the exons and flanking introns of KITLG was performed. RESULTS This identified a new heterozygous missense mutation in each family (p.Thr34Asn and p.Val37Gly, respectively). Of the six affected individuals examined by us, two had cancer: a 62-year-old man in family 1 had developed two primary melanomas and a pharyngeal carcinoma, and a 42-year-old woman in family 2 had developed thyroid carcinoma. All had unusually sparse lateral eyebrows, a finding not previously reported in this condition. CONCLUSIONS We summarize the genetic spectrum of the dyschromatoses and discuss a possible increased risk of malignancy in FPHH.
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Affiliation(s)
- A Cuell
- Department of Dermatology, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - N Bansal
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's Hospital, NHS Foundation Trust, Birmingham, UK
| | - M R Kaur
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - J Lee
- Genetic Skin Disease Group, St John's Institute of Dermatology, King's College London, London, UK
| | - A Loffeld
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - C Moss
- Department of Dermatology, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - M O'Donnell
- Department of Clinical Genetics, Birmingham Women's Hospital, NHS Foundation Trust, Birmingham, UK
| | - T Takeichi
- Genetic Skin Disease Group, St John's Institute of Dermatology, King's College London, London, UK
| | - C K Thind
- Department of Dermatology, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - J A McGrath
- Genetic Skin Disease Group, St John's Institute of Dermatology, King's College London, London, UK
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41
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Depp CA, Bowie CR, Mausbach BT, Wolyniec P, Thornquist MH, Luke JR, McGrath JA, Pulver AE, Patterson TL, Harvey PD. Current smoking is associated with worse cognitive and adaptive functioning in serious mental illness. Acta Psychiatr Scand 2015; 131:333-41. [PMID: 25559296 PMCID: PMC4400207 DOI: 10.1111/acps.12380] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Cigarette smoking is highly prevalent among people with bipolar disorder or schizophrenia. Few studies have examined whether smoking history is associated with adaptive functioning among individuals diagnosed with these serious mental illnesses. METHOD In a large relatively homogenous cohort of patients with either bipolar disorder (n=363) or schizophrenia (n=400), we investigated the association between cigarette smoking status, intensity, and cumulative exposure and performance on a comprehensive battery of neurocognitive, functional capacity, and informant-rated functional measures. The associations were adjusted for variation in sociodemographic indicators, psychopathologic symptoms, and substance use. RESULTS There was an average of 12 pack years of smoking across the sample. People with schizophrenia reported double the rate of current smoking compared to patients with bipolar disorder. Adjusting for demographic covariates, current smokers had worse composite cognitive functioning and poorer functional outcome than past or never smokers. There were no significant differences between never and past smokers, and these effects were evident in both bipolar disorder and schizophrenia. CONCLUSION Current smokers with either schizophrenia or bipolar disorder evidence worse cognitive and adaptive functioning functional outcome, even when demographic covariates are considered.
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Affiliation(s)
- C A Depp
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; VA San Diego Healthcare System, San Diego, CA, USA
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Takeichi T, Hsu CK, Yang HS, Chen HY, Wong TW, Tsai WL, Chao SC, Lee JYY, Akiyama M, Simpson MA, McGrath JA. Progressive hyperpigmentation in a Taiwanese child due to an inborn error of vitamin B12 metabolism (cblJ). Br J Dermatol 2015; 172:1111-5. [PMID: 25234635 DOI: 10.1111/bjd.13413] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
The physiology of human skin pigmentation is varied and complex, with an extensive melanogenic paracrine network involving mesenchymal and epithelial cells, contributing to the regulation of melanocyte survival and proliferation and melanogenesis. Mutations in several genes, involving predominantly the KIT ligand/c-Kit and Ras/mitogen-activated protein kinase signalling pathways, have been implicated in a spectrum of diseases in which there is hyperpigmentation, hypopigmentation or both. Here, we report on a 12-year-old girl from Taiwan with a 6-year history of diffuse progressive skin hyperpigmentation resulting from a different aetiology: an inborn metabolic disorder of vitamin B12 (cobalamin), designated cblJ. Using whole-exome sequencing we identified a homozygous mutation in ABCD4 (c.423C>G; p.Asn141Lys), which encodes an ATP-binding cassette transporter with a role in the intracellular processing of cobalamin. The patient had biochemical and haematological evidence of cobalamin deficiency but no other clinical abnormalities apart from a slight lightening of her previously black hair. Of note, she had no neurological symptoms or signs. Treatment with oral cobalamin (3 mg daily) led to metabolic correction and some reduction in the skin hyperpigmentation at the 3-month follow-up. This case demonstrates that defects or deficiencies of cobalamin should be remembered in the differential diagnosis of diffuse hyperpigmentary skin disorders.
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Affiliation(s)
- T Takeichi
- St John's Institute of Dermatology, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, U.K; Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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43
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Liu L, Mellerio JE, Martinez AE, McMillan JR, Aristodemou S, Parsons M, McGrath JA. Mutations in EXPH5 result in autosomal recessive inherited skin fragility. Br J Dermatol 2015; 170:196-9. [PMID: 24443915 DOI: 10.1111/bjd.12723] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2013] [Indexed: 12/15/2022]
Abstract
Several different genes have been implicated in the pathophysiology of inherited blistering skin diseases. Recently, autosomal recessive loss-of-function mutations in EXPH5 (encoding exophilin-5, also known as Slac2-b, a protein involved in intracellular vesicle transport) were identified in a new mechanobullous disease resembling a form of epidermolysis bullosa simplex (EBS). Here, we searched for mutations in EXPH5 in a 4-year-old white boy with EBS in whom initial Sanger sequencing of known genes implicated in intraepidermal skin fragility failed to identify pathogenic mutations. Transmission electron microscopy of rubbed nonlesional patient skin revealed disruption of keratinocytes in the lower epidermis with cytolysis and acantholysis, keratin filament clumping and prominent perinuclear cytoplasmic vesicles, and provided the clue to the candidate gene pathology. Sanger sequencing of genomic DNA showed compound heterozygosity for two new mutations in EXPH5, c.1947dupC (p.Pro649fsPro*11) and c.2249C>A (p.Ser750*). Immunofluorescence microscopy of patient skin showed a complete absence of exophilin-5 labelling. This case represents the third pedigree with EXPH5 mutations resulting in inherited skin fragility. The clinical and molecular data expand genotype-phenotype correlation in this new form of EBS and demonstrate the important role of exophilin-5 in keratinocyte cell biology.
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Affiliation(s)
- L Liu
- The Robin Eady National Diagnostic Epidermolysis Bullosa Laboratory, GSTS Pathology, St Thomas' Hospital, London, U.K
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44
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Fuchs-Telem D, Nousbeck J, Singer A, McGrath JA, Sarig O, Sprecher E. New intragenic and promoter region deletion mutations in FERMT1 underscore genetic homogeneity in Kindler syndrome. Clin Exp Dermatol 2015; 39:361-7. [PMID: 24635080 DOI: 10.1111/ced.12222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Kindler syndrome (KS) is a rare autosomal recessive skin disorder, which was recently reclassified as a subtype of epidermolysis bullosa. Despite the fact that loss-of-function mutations in the FERMT1 gene, encoding kindlin-1, have been shown to cause the syndrome in numerous patients, a small number of typical cases of KS in which FERMT1 mutations could not be identified has raised the possibility that the disorder may be genetically heterogeneous. AIM To assess two highly consanguineous families with clinical characteristics of KS. RESULTS In the first family, a hitherto unreported deletion (c.137-140delTAGT) in FERMT1 was detected, which is predicted to lead to premature termination of translation. However, direct sequencing of the coding region of FERMT1 failed to disclose any pathogenic change in the second family. To confirm the possibility that the disease in this family may be due to a mutation in another gene, we used homozygosity mapping, and found that all affected family members share a segment of homozygosity on 20p12.3, spanning the FERMT1 gene. Accordingly, a large and highly unusual deletion (g.-711-1241del) spanning the putative FERMT1 promoter sequence and the first noncoding exon of the gene was found to cosegregate with the disease phenotype in this family, and to prevent transcription of the gene, as attested by the lack of FERMT1 message in the skin of a patient. CONCLUSION The present data provide evidence in support of genetic homogeneity in KS.
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Affiliation(s)
- D Fuchs-Telem
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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45
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Takeichi T, Liu L, Fong K, Ozoemena L, McMillan JR, Salam A, Campbell P, Akiyama M, Mellerio JE, McLean WHI, Simpson MA, McGrath JA. Whole-exome sequencing improves mutation detection in a diagnostic epidermolysis bullosa laboratory. Br J Dermatol 2015; 172:94-100. [PMID: 24947307 DOI: 10.1111/bjd.13190] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Subtypes of inherited epidermolysis bullosa (EB) vary significantly in their clinical presentation and prognosis. Establishing an accurate diagnosis is important for genetic counselling and patient management. Current approaches in EB diagnostics involve skin biopsy for immunohistochemistry and transmission electron microscopy, and Sanger sequencing of candidate genes. Although informative in most cases, this approach can be expensive and laborious and may fail to identify pathogenic mutations in ~15% of cases. OBJECTIVES Next-generation DNA sequencing (NGS) technologies offer a fast and efficient complementary diagnostic strategy, but the value of NGS in EB diagnostics has yet to be explored. The aim of this study was to undertake whole-exome sequencing (WES) in nine cases of EB in which established diagnostic methods failed to make a genetic diagnosis. METHODS Whole-exome capture was performed using genomic DNA from each case of EB, followed by massively parallel sequencing. Resulting reads were mapped to the human genome reference hg19. Potentially pathogenic mutations were subsequently confirmed by Sanger sequencing. RESULTS Analysis of WES data disclosed biallelic pathogenic mutations in each case, with all mutations occurring in known EB genes (LAMB3, PLEC, FERMT1 and COL7A1). This study demonstrates that NGS can improve diagnostic sensitivity in EB compared with current laboratory practice. CONCLUSIONS With appropriate diagnostic platforms and bioinformatics support, WES is likely to increase mutation detection in cases of EB and improve EB diagnostic services, although skin biopsy remains an important diagnostic investigation in current clinical practice.
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Affiliation(s)
- T Takeichi
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, U.K; Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Takeichi T, Nanda A, Liu L, Aristodemou S, McMillan JR, Sugiura K, Akiyama M, Al-Ajmi H, Simpson MA, McGrath JA. Founder mutation in dystonin-e underlying autosomal recessive epidermolysis bullosa simplex in Kuwait. Br J Dermatol 2014; 172:527-31. [PMID: 25059916 DOI: 10.1111/bjd.13294] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2014] [Indexed: 01/30/2023]
Abstract
Only two homozygous nonsense mutations in the epidermal isoform of the dystonin gene, DST-e, have been reported previously in autosomal recessive epidermolysis bullosa simplex (EBS); the affected pedigrees were Kuwaiti and Iranian. This subtype of EBS is therefore considered to be a rare clinicopathological entity. In this study, we identified four seemingly unrelated Kuwaiti families in which a total of seven individuals had predominantly acral trauma-induced blistering since infancy. All affected individuals were homozygous for the mutation p.Gln1124* in DST-e, the same mutation that was identified in the originally reported family from Kuwait. Haplotype analysis in the five pedigrees (including the previous case) revealed a shared block of ~60 kb of genomic DNA across the site of the mutation, consistent with a founder effect. Most heterozygotes had no clinical abnormalities although one subject had mild transient skin fragility during childhood, an observation noted in the previously reported Iranian pedigree, suggesting that the condition may also be semidominant in some pedigrees rather than purely autosomal recessive. Our study reveals propagation of a mutant ancestral allele in DST-e throughout Kuwait, indicating that this subtype of EBS may be more common in Kuwait, and perhaps other Middle Eastern countries, than is currently appreciated.
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Affiliation(s)
- T Takeichi
- St John's Institute of Dermatology, King's College London, Guy's Hospital, Great Maze Pond, London, SE1 9RT, U.K; Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Anbar TS, El-Badry MM, McGrath JA, Abdel-Azim ES. Most individuals with either segmental or non-segmental vitiligo display evidence of bilateral cochlear dysfunction. Br J Dermatol 2014; 172:406-11. [PMID: 25041189 DOI: 10.1111/bjd.13276] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vitiligo has been classified clinically into segmental vitiligo (SV) and nonsegmental vitiligo (NSV) and may also be associated with audiological abnormalities. OBJECTIVES We examined cochlear function in ears of individuals with SV and NSV, including subjects with facial and nonfacial lesions, and in patients who have SV with unilateral facial involvement. METHODS This study included 25 patients with SV and 28 patients with NSV. Fifteen age- and sex-matched healthy individuals served as controls. Cochlear function was studied using the distortion product otoacoustic emissions (DPOAEs). Data were analysed using SPSS. RESULTS Sixty-four ears (60%) of patients with vitiligo had cochlear dysfunction while the control group exhibited no abnormalities. On comparing the cochlear dysfunction of patients with SV with patients with NSV, no statistically significant difference was found. The ears on both sides, affected and unaffected by vitiligo, in patients with SV showed cochlear dysfunction with no statistically significant difference in DPOAE. To determine the effect of the lesion side on cochlear function, we compared DPOAE amplitude using Student's t-test. The comparisons included NSV of the face vs. NSV on other areas, NSV of the face vs. SV of the face and SV of the face vs. SV of other areas. No statistically significant difference was found in these comparisons. CONCLUSIONS Bilateral cochlear dysfunction is common in both NSV and SV and does not reflect the appearance of vitiligo in the skin. Our results underscore the important role of melanocytes and melanin in cochlear function, and suggest that the cochlear abnormalities in SV point to the presence of additional nonsegmental pathophysiological events underlying all forms of vitiligo.
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Affiliation(s)
- T S Anbar
- Dermatology Department, Al-Minya University, 129 El-Hosany street, Al-Minya, 61111, Egypt
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Szczecinska W, Nesteruk D, Wertheim-Tysarowska K, Greenblatt DT, Baty D, Browne F, Liu L, Ozoemena L, Terron-Kwiatkowski A, McGrath JA, Mellerio JE, Morton J, Woźniak K, Kowalewski C, Has C, Moss C. Under-recognition of acral peeling skin syndrome: 59 new cases with 15 novel mutations. Br J Dermatol 2014; 171:1206-10. [PMID: 24628291 DOI: 10.1111/bjd.12964] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acral peeling skin syndrome (APSS) is a rare skin fragility disorder usually caused by mutations in the transglutaminase 5 gene (TGM5). METHODS We investigated the mutation spectrum of APSS in the U.K., Germany and Poland. RESULTS We identified 59 children with APSS from 52 families. The phenotype was readily recognizable, with some variation in severity both within and between families. Most cases had been misdiagnosed as the localized form of epidermolysis bullosa simplex (EBS-loc). Eighteen different TGM5 mutations were identified, 15 of which were novel. Eight mutations were unique to a single family, nine each occurred in two families, while the common p.Gly113Cys mutation linked to a second missense variant p.Thr109Met occurred in 47 of the 52 families and was homozygous in 28. Most patients were of nonconsanguineous white European origin. CONCLUSIONS We propose that APSS is under-reported and widely misdiagnosed as EBS-loc, with significant counselling implications as APSS is autosomal recessive while EBS-loc is dominant. We recommend screening for TGM5 mutations when EBS-loc is suspected but not confirmed by mutations in KRT5 or KRT14. Our report trebles the number of known TGM5 mutations. It provides further evidence that p.Gly113Cys is a founder mutation in the European population. This is consistent with the striking ethnic distribution of APSS in U.K., where the majority of patients are of nonconsanguineous white European origin, in contrast to the pattern of other recessive skin disorders.
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Affiliation(s)
- W Szczecinska
- Department of Dermatology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, U.K
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Tziotzios C, Petrof G, Liu L, Verma A, Wedgeworth EK, Mellerio JE, McGrath JA. Clinical features and WNT10A mutations in seven unrelated cases of Schöpf-Schulz-Passarge syndrome. Br J Dermatol 2014; 171:1211-4. [PMID: 24902757 DOI: 10.1111/bjd.13158] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Schöpf-Schulz-Passarge syndrome (SSPS) is an autosomal recessive form of ectodermal dysplasia resulting from mutations in WNT10A. OBJECTIVES To document the spectrum of clinical features and search for pathogenic mutations in seven unrelated cases of SSPS. METHODS Clinical examination of patients and Sanger sequencing of genomic DNA spanning the coding exons and flanking spice sites of WNT10A. RESULTS Most subjects had bilateral eyelid cysts and some degree of palmoplantar keratoderma, although nail, hair, and teeth abnormalities were variably present. Bi-allelic pathogenic mutations in WNT10A were found in all seven subjects. New mutations comprised p.Glu390*, p.Ser270Arg, and p.Cys362Arg; the recurrent mutations were p.Cys107* and p.Ala131Thr. CONCLUSIONS This study reveals the range of ectodermal pathology in cases of SSPS that result from WNT10A mutations. Eyelid cysts provide a useful clinical clue to diagnosing SSPS which may be less rare than is currently appreciated.
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Affiliation(s)
- C Tziotzios
- St. John's Institute of Dermatology, King's College London (Guy's Campus), London, SE1 9RT, U.K
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Vahlquist A, Virtanen M, Hellström-Pigg M, Dragomir A, Ryberg K, Wilson NJ, Östman--Smith I, Lu L, McGrath JA, Smith FJD. A Scandinavian case of skin fragility, alopecia and cardiomyopathy caused by DSP mutations. Clin Exp Dermatol 2014; 39:30-4. [PMID: 24341478 DOI: 10.1111/ced.12226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2013] [Indexed: 11/27/2022]
Abstract
Congenital skin fragility is a heterogeneous disorder with epidermolysis bullosa and various skin infections as the leading causes. However, even rare diseases must be considered in the differential diagnosis of neonatal skin blistering, including some genetic syndromes with extracutaneous involvement. One such syndrome is ectodermal dysplasia due to deficiency of desmoplakin, a desmosomal protein essential for cellular cohesion in both epithelia and cardiac tissues. Desmoplakin is encoded by the DSP gene, which is localized on chromosome 6p24. Both dominant and recessive mutations in this gene have been reported to cause skin fragility and keratinization defects. We report a child born with a fragile epidermis, alopecia, thick nails, and focal hyperkeratoses on the digits and knees. She was found to have a deficiency of desmoplakin caused by compound heterozygous DSP mutations. She has gradually developed signs of a left ventricular cardiomyopathy.
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Affiliation(s)
- A Vahlquist
- Department of Medical Sciences (Dermatology), Uppsala University, Uppsala, Sweden
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