1
|
Kostova P, Petrova G, Shahid M, Papochieva V, Miteva D, Yordanova I, Drenovska K, Bradinova I, Janniger CK, Schwartz RA, Vassileva S. Netherton syndrome-A therapeutic challenge in childhood. Clin Case Rep 2024; 12:e8770. [PMID: 38634098 PMCID: PMC11021628 DOI: 10.1002/ccr3.8770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Key Clinical Message High-dose intravenous immunoglobulin exhibits great potential in the treatment of Netherton syndrome. Abstract Netherton syndrome (NS) is a rare autosomal recessive genodermatosis (OMIM #256500) characterized by superficial scaling, atopic manifestations, and multisystemic complications. It is caused by loss-of-function mutations in the SPINK5 gene, which encode a key kallikrein protease inhibitor. There are two subtypes of the syndrome that differ in clinical presentation and immune profile: ichthyosiform erythroderma and ichthyosis linearis circumflexa. NS is a multisystemic disease with numerous extracutaneous manifestations. Current therapy for patients with NS is mainly supportive, as there is no curative or specific treatment, especially for children with NS, but targeted therapies are being developed. We describe an 8-year-old boy with genetically proven NS treated with intravenous immunoglobulin for recurrent skin and systemic infections from infancy, growth retardation, and associated erythroderma. Under this therapy, his skin status, infectious exacerbations, and quality of life all improved. Knowledge of the cytokine-mediated pathogenesis of NS and the development of new biologic drugs open new possibilities for NS patients. However, the different therapeutic options have been applied in a limited number of cases, and variable responses have been shown. Randomized controlled trials with a sufficient number of patients stratified and treated according to their specific immune profile and clinical phenotype are needed to evaluate the safety and efficacy of treatment options for patients with NS.
Collapse
Affiliation(s)
- Polina Kostova
- Pediatric DepartmentMedical UniversitySofiaBulgaria
- Pediatric Clinic, UMHAT AlexandrovskaSofiaBulgaria
| | - Guergana Petrova
- Pediatric DepartmentMedical UniversitySofiaBulgaria
- Pediatric Clinic, UMHAT AlexandrovskaSofiaBulgaria
| | - Martin Shahid
- Department of Dermatology and VenereologyMedical UniversitySofiaBulgaria
- Dermatology Clinic UMHAT AlexandrovskaSofiaBulgaria
| | | | - Dimitrinka Miteva
- Pediatric DepartmentMedical UniversitySofiaBulgaria
- Pediatric Clinic, UMHAT AlexandrovskaSofiaBulgaria
| | - Ivelina Yordanova
- Department of Dermatology, Venereology and Allergology, Faculty of MedicineMedical University PlevenPlevenBulgaria
| | - Kossara Drenovska
- Department of Dermatology and VenereologyMedical UniversitySofiaBulgaria
- Dermatology Clinic UMHAT AlexandrovskaSofiaBulgaria
| | - Irena Bradinova
- National Genetic LaboratoryMedical University Sofia, University Hospital of Obstetrics and Gynecology “Maichin dom”SofiaBulgaria
| | - Camila K. Janniger
- Dermatology and PediatricsRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Robert A. Schwartz
- Dermatology, Pediatrics and PathologyRutgers New Jersey Medical SchoolNewarkNew JerseyUSA
| | - Snejina Vassileva
- Department of Dermatology and VenereologyMedical UniversitySofiaBulgaria
- Dermatology Clinic UMHAT AlexandrovskaSofiaBulgaria
| |
Collapse
|
2
|
Gan C, King E, Orchard D. Secukinumab use in the treatment of Netherton's syndrome. Australas J Dermatol 2022; 63:365-367. [PMID: 35622930 DOI: 10.1111/ajd.13880] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 03/11/2022] [Revised: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
Netherton syndrome is a rare, severe genetic disorder of cornification without specific treatment. We describe two cases who demonstrated marked cutaneous improvement with secukinumab and suggest a role for IL-17 therapy in treating this condition.
Collapse
Affiliation(s)
- Christian Gan
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma King
- Department of Dermatology, Royal Children's Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Orchard
- Faculty of Medicine, Dentistry and Health Services, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Barbieux C, Bonnet des Claustres M, Fahrner M, Petrova E, Tsoi LC, Gouin O, Leturcq F, Nicaise-Roland P, Bole C, Béziat V, Bourrat E, Schilling O, Gudjonsson JE, Hovnanian A. Netherton syndrome subtypes share IL-17/IL-36 signature with distinct IFN-α and allergic responses. J Allergy Clin Immunol 2022; 149:1358-1372. [PMID: 34543653 DOI: 10.1016/j.jaci.2021.08.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 03/03/2021] [Revised: 08/12/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Netherton syndrome (NS) is a rare recessive skin disorder caused by loss-of-function mutations in SPINK5 encoding the protease inhibitor LEKTI (lymphoepithelial Kazal-type-related inhibitor). NS patients experience severe skin barrier defects, display inflammatory skin lesions, and have superficial scaling with atopic manifestations. They present with typical ichthyosis linearis circumflexa (NS-ILC) or scaly erythroderma (NS-SE). OBJECTIVE We used a combination of several molecular profiling methods to comprehensively characterize the skin, immune cells, and allergic phenotypes of NS-ILC and NS-SE patients. METHODS We studied a cohort of 13 patients comprising 9 NS-ILC and 4 NS-SE. RESULTS Integrated multiomics revealed abnormal epidermal proliferation and differentiation and IL-17/IL-36 signatures in lesion skin and in blood in both NS endotypes. Although the molecular profiles of NS-ILC and NS-SE lesion skin were very similar, nonlesion skin of each disease subtype displayed distinctive molecular features. Nonlesion and lesion NS-SE epidermis showed activation of the type I IFN signaling pathway, while lesion NS-ILC skin differed from nonlesion NS-ILC skin by increased complement activation and neutrophil infiltration. Serum cytokine profiling and immunophenotyping of circulating lymphocytes showed a TH2-driven allergic response in NS-ILC, whereas NS-SE patients displayed mainly a TH9 axis with increased CCL22/MDC and CCL17/TARC serum levels. CONCLUSIONS This study confirms IL-17/IL-36 as the predominant signaling axes in both NS endotypes and unveils molecular features distinguishing NS-ILC and NS-SE. These results identify new therapeutic targets and could pave the way for precision medicine of NS.
Collapse
Affiliation(s)
- Claire Barbieux
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | | | - Matthias Fahrner
- Institute for Surgical Pathology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Spemann Graduate School of Biology and Medicine (SGBM), Albert-Ludwigs-University Freiburg, Freiburg, Germany; Faculty of Biology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Evgeniya Petrova
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - Lam C Tsoi
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - Olivier Gouin
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - Florent Leturcq
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France
| | - Pascale Nicaise-Roland
- Department of Immunology, Bichat Hospital, AP-HP-Nord, Paris, France; INSERM UMR 1152, Paris, France
| | | | - Vivien Béziat
- INSERM UMR 1163, Laboratory of Human Genetics of Infectious Diseases, Imagine Institute, Paris, France
| | | | - Oliver Schilling
- Institute for Surgical Pathology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Alain Hovnanian
- University of Paris, Paris, France; Department of Genetics, Necker Hospital for Sick Children (AP-HP), Paris, France; Department of Dermatology, University of Michigan, Ann Arbor, Mich.
| |
Collapse
|
5
|
Yalcin AD. A case of netherton syndrome: successful treatment with omalizumab and pulse prednisolone and its effects on cytokines and immunoglobulin levels. Immunopharmacol Immunotoxicol 2016; 38:162-6. [PMID: 26592187 DOI: 10.3109/08923973.2015.1115518] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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] [Indexed: 02/05/2023]
Abstract
CONTEXT Netherton syndrome (NS) is associated with the mutation in the SPINK5 gene, which codes LEKTI (lymphoepithelial Kazaltype related inhibitor), a serine protease inhibitor. As a result of aging coupled with immune deficiency, clinical symptoms may vary. METHODS The patient was presented to our clinic with sparse and brittle hair along with pruritic, erythematous and scaling cutaneous lesions. The patient underwent a clinical examination and laboratory analyzes. Based on the clinical and laboratory findings, the patient was diagnosed with NS. Moreover, CRP, Complement-3 (C3), C4 IL-4, IL-5, IL-1β and IL-17A levels of serum were investigated as an apoptotic marker and a negative marker for inflammation. RESULTS Having undergone omalizumab treatment and a short-term (4 months) later, he had a decreased IgE, Ig G, prolactin, CRP, IL-4, IL-5, IL-1β and IL-17A levels. The IgA, IgM and C3, C4 levels were insignificant between before and after Omalizumab treatment. CONCLUSION To the best of our knowledge, this is the first time that an association between omalizumab and NS was documented. In conclusion allergic skin symptoms (pruritus, erythema and desquamation) and mucosal symptoms decreased in the patient.
Collapse
Affiliation(s)
- Arzu Didem Yalcin
- a Department of Internal Medicine , Clinical Immunology and Allergy Unit, Antalya Training and Research Hospital , Antalya , Turkey
| |
Collapse
|