RESUMO
BACKGROUND: No efficient treatment has yet been established for epidermolytic ichthyosis (EI), which is caused by pathogenic variants of KRT1 or KRT10. Patients with ichthyosis with confetti (IWC) have multiple normal-appearing spots, caused by the revertant somatic recombination of pathogenic variants that occurs at each spot independently. Additionally, some patients with EI have large areas of normal skin due to revertant postzygotic mosaicism. OBJECTIVES: To assess the feasibility of transplanting cultured epidermal autografts (CEAs) produced from revertant epidermal keratinocytes in patients with EI and IWC. METHODS: We performed a clinical trial of treatment with CEAs produced from each patient's own revertant epidermal keratinocytes as a proof-of-concept study. This was a single-arm, open, unmasked, uncontrolled, single-assignment, treatment-purpose study. The primary outcome was the percentage area that lacked recurrence of ichthyosis lesions 4 weeks after the final transplant. The secondary outcome was the percentage area lacking recurrence of ichthyosis lesions 24 weeks after the initial transplantation. The trial was registered with the Japan Registry of Clinical Trials (jRCTb041190097). RESULTS: We successfully produced CEAs from genetically confirmed revertant skin from two patients with mosaic EI and from one patient with IWC and confirmed by amplicon sequencing and droplet digital polymerase chain reaction analysis that the CEAs mainly consisted of revertant wild-type cells. Single-cell RNA sequencing analysis confirmed the normal proliferation and safety profiling of CEAs. CEAs were transplanted onto desquamated lesional sites in the patients. Four weeks post-transplantation, the percentage area lacking recurrence of ichthyosis lesions in the three patients was 40%, 100% and 100% respectively, although recurrence of ichthyosis lesions was seen at the site of CEA transplantation in all three patients at 24 weeks post-transplantation. CONCLUSIONS: CEAs from normal skin have the potential to be a safe and local treatment option for EI and IWC.
Epidermolytic ichthyosis is a rare skin condition that causes redness, blistering and thickening of the skin. There is currently no effective treatment for the disease, which is caused by mutations in the genes KRT1 or KRT10. People with a type of the disease called 'ichthyosis with confetti' have many normal-appearing spots that are caused by the natural repair of the gene mutations. Some people with epidermolytic ichthyosis have large areas of healthy skin as a result of genetic mutations having been corrected. In this study, we successfully produced skin grafts from the healthy skin of two patients with epidermolytic ichthyosis and one with 'ichthyosis with confetti'. We confirmed that the skin grafts mainly consisted of repaired skin cells. A technique called 'single-cell RNA sequencing' confirmed the skin cells in the skin grafts behaved like healthy skin cells and that the grafts were safe. Overall, our study findings suggest that skin grafts taken from skin consisting of genetically normal keratinocytes that have undergone self-repair have potential to be a safe treatment option for patients with severe epidermolytic ichthyosis and 'ichthyosis with confetti'.
Assuntos
Hiperceratose Epidermolítica , Queratinócitos , Humanos , Hiperceratose Epidermolítica/genética , Hiperceratose Epidermolítica/patologia , Masculino , Feminino , Queratinócitos/transplante , Criança , Adulto , Transplante de Pele/métodos , Autoenxertos , Epiderme/transplante , Epiderme/patologia , Queratina-10/genética , Adolescente , Estudos de Viabilidade , Queratina-1/genética , Adulto Jovem , Estudo de Prova de Conceito , Transplante Autólogo , Resultado do Tratamento , Pré-Escolar , Mosaicismo , Ictiose/genética , Ictiose/cirurgia , Ictiose/patologiaRESUMO
Autosomal recessive congenital ichthyoses (ARCI) is a genetically heterogeneous condition that can be caused by pathogenic variants in at least 12 genes, including ABCA12. ARCI mainly consists of congenital ichthyosiform erythroderma (CIE), lamellar ichthyosis (LI) and harlequin ichthyosis (HI). The objective was to determine previously unreported pathogenic variants in ABCA12 and to update genotype-phenotype correlations for patients with pathogenic ABCA12 variants. Pathogenic variants in ABCA12 were detected using Sanger sequencing or a combination of Sanger sequencing and whole-exome sequencing. To verify the pathogenicity of a previously unreported large deletion and intron variant, cDNA analysis was performed using total RNA extracted from hair roots. Genetic analyses were performed on the patients with CIE, LI, HI and non-congenital ichthyosis with unusual phenotypes (NIUP), and 11 previously unreported ABCA12 variants were identified. Sequencing of cDNA confirmed the aberrant splicing of the variant ABCA12 in the patients with the previously unreported large deletion and intron variant. Our findings expand the phenotype spectrum of ichthyosis patients with ABCA12 pathogenic variants. The present missense variants in ABCA12 are considered to be heterogenous in pathogenicity, and they lead to varying disease severities in patients with ARCI and non-congenital ichthyosis with unusual phenotypes (NIUP).
Assuntos
Eritrodermia Ictiosiforme Congênita , Ictiose Lamelar , Ictiose , Humanos , Ictiose Lamelar/genética , Ictiose Lamelar/patologia , DNA Complementar , Genes Recessivos , Mutação , Ictiose/genética , Eritrodermia Ictiosiforme Congênita/genética , Estudos de Associação Genética , Transportadores de Cassetes de Ligação de ATP/genéticaRESUMO
Pathogenic variants in ABCA12 are important causative genetic defects for autosomal recessive congenital ichthyoses (ARCI), which include congenital ichthyosiform erythroderma (CIE), harlequin ichthyosis, and lamellar ichthyosis. In addition, pathogenic variants in ABCA12 are known to cause a localized nevoid form of CIE due to recessive mosaicism. We previously reported siblings who carried an ABCA12 variant but did not show a "congenital" phenotype. They were considered to have pityriasis rubra pilaris (PRP). Here, we present a further patient with ABCA12 variants whose phenotype was not congenital ichthyosis, in an independent family. Notably, these three patients had geographic unaffected areas. Such areas are not usually found in patients with ARCI who have ABCA12 variants, suggesting mild phenotypes for these patients. Interestingly, the histological features of the ichthyotic lesions in these patients resembled those of PRP. All three patients had homozygous pathogenic missense variants in ABCA12. Our findings expand the phenotypic spectrum of patients with ABCA12 variants.
Assuntos
Eritrodermia Ictiosiforme Congênita , Ictiose Lamelar , Ictiose , Pitiríase Rubra Pilar , Humanos , Pitiríase Rubra Pilar/genética , Ictiose Lamelar/genética , Eritrodermia Ictiosiforme Congênita/genética , Eritrodermia Ictiosiforme Congênita/patologia , Fenótipo , Mutação , Transportadores de Cassetes de Ligação de ATP/genéticaAssuntos
Dermatite Atópica , Ictiose Vulgar , Ictiose Ligada ao Cromossomo X , Ictiose , Humanos , Dermatite Atópica/complicações , Dermatite Atópica/diagnóstico , Ictiose Vulgar/complicações , Ictiose Vulgar/diagnóstico , Ictiose Vulgar/genética , Ictiose Ligada ao Cromossomo X/complicações , Ictiose Ligada ao Cromossomo X/diagnóstico , Ictiose Ligada ao Cromossomo X/genética , Ictiose/diagnóstico , Ictiose/genéticaAssuntos
ATPases Transportadoras de Cálcio , Pênfigo Familiar Benigno , Humanos , Pênfigo Familiar Benigno/genética , Pênfigo Familiar Benigno/patologia , Pênfigo Familiar Benigno/diagnóstico , ATPases Transportadoras de Cálcio/genética , Feminino , Masculino , Estudos de Associação Genética , Pessoa de Meia-Idade , Adulto , MutaçãoAssuntos
Psoríase , Humanos , Doença Aguda , Causalidade , Doença Crônica , Psoríase/epidemiologia , Psoríase/genética , Pirina/genéticaRESUMO
Pathogenic variants in MPO, which encodes the myeloperoxidase, were reported as causative genetic defects in several cases of generalised pustular psoriasis (GPP) in addition to patients with myeloperoxidase deficiency in 2020. However, which clinical subtypes of GPP patients have pathogenic variants in MPO remains largely undetermined, and elucidating this is clinically important. The present report outlines a mild case of GPP with a rare missense heterozygous variant, c.1810C>T p.(Arg604Cys), in MPO. Our structural analysis and functional assays to measure myeloperoxidase activity suggest that the present MPO substitution is a hypomorphic variant in MPO. Thus, the mild phenotype of the present GPP patient might be associated with an incomplete hypomorphic loss-of-function variant in MPO. Additionally, the severe intractable edematous pustules and erythema improved dramatically after five rounds of granulocyte and monocyte adsorption apheresis (GMA) therapy. This is the first report of GMA treatment for GPP associated with a pathogenic variant in MPO, as far as we know. Our findings suggest that GMA might be a useful and powerful tool for controlling GPP in patients with myeloperoxidase deficiency.
Assuntos
Remoção de Componentes Sanguíneos , Psoríase , Dermatopatias Vesiculobolhosas , Humanos , Adsorção , Doença Crônica , Granulócitos/patologia , Interleucinas/genética , Monócitos , Peroxidase/genética , Psoríase/genética , Psoríase/terapia , Psoríase/patologia , Dermatopatias Vesiculobolhosas/terapiaAssuntos
Ceratodermia Palmar e Plantar/genética , Serpinas/genética , Adolescente , Adulto , Idoso , Povo Asiático/genética , Criança , Pré-Escolar , Feminino , Efeito Fundador , Frequência do Gene , Humanos , Lactente , Recém-Nascido , Masculino , Mutação , Adulto JovemAssuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Ictiose/tratamento farmacológico , Síndrome de Netherton/tratamento farmacológico , Adolescente , Adulto , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Feminino , Humanos , Ictiose/diagnóstico , Ictiose/imunologia , Síndrome de Netherton/complicações , Síndrome de Netherton/diagnóstico , Síndrome de Netherton/imunologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Heterozygous mutations in JAK1 which result in JAK-STAT hyperactivity have been implicated in an autosomal dominant disorder that features multi-organ immune dysregulation. This study identifies another previously unreported heterozygous missense JAK1 mutation, H596D, in an individual with a unique autoinflammatory keratinization disease associated with early-onset liver dysfunction and autism. Using CRISPR-Cas9 gene targeting, we generated mice with an identical Jak1 knock-in missense mutation (Jak1H595D/+;I596I/+;Y597Y/+ mice) that recapitulated key aspects of the human phenotype. RNA sequencing of samples isolated from the Jak1H595D/+;I596I/+;Y597Y/+ mice revealed the upregulation of genes associated with the hyperactivation of tyrosine kinases and NF-κB signaling. Interestingly, there was a strong correlation between genes downregulated in Jak1H595D/+;I596I/+;Y597Y/+ mice and those downregulated in the brain of model mice with 22q11.2 deletion syndrome that showed cognitive and behavioral deficits, such as autism spectrum disorders. Our findings expand the phenotypic spectrum of JAK1-associated disease and underscore how JAK1 dysfunction contributes to this autoinflammatory disorder.
Assuntos
Transtorno Autístico/genética , Doenças Autoimunes/genética , Hepatite Autoimune/genética , Janus Quinase 1/genética , Dermatopatias/genética , Animais , Doenças Autoimunes/patologia , Modelos Animais de Doenças , Feminino , Técnicas de Introdução de Genes , Hepatite Autoimune/patologia , Humanos , Camundongos , Mutação de Sentido Incorreto , Dermatopatias/patologia , Adulto JovemAssuntos
Ceratodermia Palmar e Plantar Epidermolítica/genética , Serpinas/genética , Adulto , Análise Mutacional de DNA , Feminino , Heterozigoto , Humanos , Queratina-9/genética , Ceratodermia Palmar e Plantar Epidermolítica/patologia , Masculino , Mutação , Linhagem , Pele/patologia , Adulto JovemAssuntos
Cabelo/anormalidades , Hipotricose/tratamento farmacológico , Minoxidil/administração & dosagem , Administração Tópica , Adolescente , Criança , Pré-Escolar , Feminino , Cabelo/efeitos dos fármacos , Doenças do Cabelo/diagnóstico , Doenças do Cabelo/genética , Folículo Piloso/diagnóstico por imagem , Folículo Piloso/efeitos dos fármacos , Folículo Piloso/crescimento & desenvolvimento , Humanos , Hipotricose/diagnóstico , Hipotricose/genética , Lipase/genética , Masculino , Mutação , Fotografação , Estudos Prospectivos , Couro Cabeludo , Soluções , Resultado do Tratamento , Adulto JovemAssuntos
Antígenos Virais/sangue , Antivirais/administração & dosagem , Infecções por Citomegalovirus/prevenção & controle , Ganciclovir/administração & dosagem , Pênfigo/terapia , Idoso , Antibioticoprofilaxia/métodos , Antígenos Virais/imunologia , Citomegalovirus/imunologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , Relação Dose-Resposta a Droga , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Imunoterapia/efeitos adversos , Imunoterapia/métodos , Masculino , Pênfigo/sangue , Pênfigo/imunologia , Plasmaferese/efeitos adversos , Resultado do TratamentoAssuntos
Nervo Glossofaríngeo , Herpes Zoster/complicações , Herpesvirus Humano 3/isolamento & purificação , Nervo Laríngeo Recorrente , Paralisia das Pregas Vocais/etiologia , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Pavilhão Auricular , Feminino , Herpes Zoster/diagnóstico , Herpes Zoster/tratamento farmacológico , Herpes Zoster/virologia , Humanos , Músculos Laríngeos/inervação , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/prevenção & controle , Pulsoterapia , Pele/virologia , Resultado do TratamentoAssuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Mucopolissacaridose II/terapia , Urticária/patologia , Vasculite/patologia , Biópsia , Criança , Extremidades , Glicosaminoglicanos/metabolismo , Humanos , Masculino , Microscopia Eletrônica , Remissão Espontânea , Pele/patologia , Tela Subcutânea/patologia , Tela Subcutânea/ultraestrutura , Urticária/diagnóstico , Urticária/etiologia , Vasculite/diagnóstico , Vasculite/etiologiaRESUMO
A 47-year-old man with acute myeloid leukemia and myelodysplastic-related changes relapsed after an allogenic bone marrow transplant and received a cord blood transplant as salvage therapy. The patient developed febrile neutropenia that was resistant to broad-spectrum antibiotics and multiple, painful, nodular skin lesions on his trunk and extremities before engraftment. A skin biopsy and blood culture found mold, and the subsequent microscopic examination, mass spectrometry, and DNA sequencing of the fungal colonies identified Fusarium solani. The patient's fever and skin lesions began to improve with the administration of liposomal amphotericin B at 5 mg/kg/day. Neutrophilic engraftment occurred on day 19. Stage 3 acute skin graft-versus-host disease was cured by the application of topical steroid. Unexpectedly, a change from liposomal amphotericin B to voriconazole on day 38 exacerbated the Fusarium infection. The Fusarium infection was finally cured by the administration of liposomal amphotericin B for a total of 19 weeks. Neutrophilic engraftment, an immediate definitive diagnosis, the sufficient and long-term administration of appropriate antifungal medication, and avoidance of the systemic administration of steroids might have contributed to the successful outcome of this patient.