Morice-Picard F
Service de dermatologie pédiatrique et dermatologie, Centre de référence des maladies rares de la peau, Hôpital pédiatrique, Groupe hospitalier Pellegrin, Centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
Ann Dermatol Venereol. 2019 Apr;146(4):326-339. doi: 10.1016/j.annder.2019.02.009. Epub 2019 Apr 18.
Many types of genodermatosis exist, with numerous modes of transmission. The development of molecular genetic methods, in particular the most recent sequencing techniques, can be used to identify an increasing number of genes involved in these forms of genodermatosis while providing confirmation or more details regarding clinical diagnosis. Thanks to this approach, it is possible to determine risk of recurrence and to formulate an antenatal strategy. These technologies have led to improved molecular definition and to a better understanding of the physiopathological mechanisms involved in different genodermatoses such as bullous epidermolysis, keratinisation disorders, pigmentation disorders, potentially tumoral conditions, and epidermal and pilar dysplasia. The large amount of information provided by high-throughput sequencing makes it possible to study modifying genes as well as genotype-phenotype correlations. However, this genetic information in its turn poses problems of interpretation and of control of the resulting data. The use of genetics in dermatology for the purposes of diagnosis or research requires a consultation to provide patients with information regarding the genetic tests involved and the potential consequences thereof for them and their families. Furthermore, with pangenomic approaches there is a higher probability of fortuitous discovery of abnormalities such as variants associated with risks predisposing to cancer or neurodegenerative disease. Collaboration between dermatologists and geneticists enables optimisation of patient management in terms of diagnosis and genetic counselling in the event of such rare diseases. Therapeutic applications are beginning to be developed. The scope of therapeutic application includes gene therapy, replacement therapy (enzyme therapy) and targeted therapy.
存在多种类型的遗传性皮肤病,其传播方式众多。分子遗传学方法的发展,尤其是最新的测序技术,可用于识别越来越多与这些遗传性皮肤病相关的基因,同时为临床诊断提供确认或更多细节。借助这种方法,可以确定复发风险并制定产前策略。这些技术已导致分子定义得到改善,并能更好地理解不同遗传性皮肤病(如大疱性表皮松解症、角化障碍、色素沉着障碍、潜在肿瘤性疾病以及表皮和毛囊发育异常)所涉及的生理病理机制。高通量测序提供的大量信息使得研究修饰基因以及基因型 - 表型相关性成为可能。然而,这些遗传信息反过来又带来了解释和控制所得数据的问题。在皮肤科将遗传学用于诊断或研究目的时,需要进行咨询,以便为患者提供有关所涉及的基因检测及其对患者及其家人潜在后果的信息。此外,通过泛基因组方法,偶然发现异常(如与癌症或神经退行性疾病易患风险相关的变异)的可能性更高。皮肤科医生和遗传学家之间的合作能够在诊断和针对此类罕见疾病的遗传咨询方面优化患者管理。治疗应用也开始得到发展。治疗应用的范围包括基因治疗、替代疗法(酶疗法)和靶向治疗。