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潜在的双基因贡献导致点滴状白癫风成为单纯型大疱性表皮松解症的主要特征。

Potential di-genic contribution to guttate leukoderma as the predominant feature of epidermolysis bullosa simplex.

机构信息

Department of Dermatology, "Emek" Medical Center, Afula, Israel.

The Genetic Institute, "Emek" Medical Center, Afula, Israel.

出版信息

Exp Dermatol. 2022 Dec;31(12):1927-1931. doi: 10.1111/exd.14661. Epub 2022 Aug 23.

Abstract

Inherited epidermolysis bullosa (EB) simplex is a heterogeneous group of skin fragility disorders caused by mutations in genes encoding cell-cell or cell-matrix adhesion proteins. A recently identified, rare subtype of EB simplex is due to bi-allelic mutations in the EXPH5 gene, which encodes exophilin5, an effector protein of the Rab27B GTPase involved in intracellular vesicle trafficking and exosome secretion. The EXPH5 EB subtype is characterized by early-onset skin blisters and scars, mainly on extremities, and varying degrees of pigmentary alterations. Here, we present a 31-year-old female with diffuse guttate hypopigmentation on the trunk and extremities since early childhood, with no apparent blisters or scars. We employed whole exome sequencing of germline DNA extracted from the patient's leukocytes to determine the genetic aetiology of the phenotype. A novel homozygous variant in EXPH5, c.1153C>T causing a premature stop codon at amino acid Glutamine 385, was identified. Histologic examination after skin pricking disclosed focal keratinocyte detachment typical to EB. Additionally, we identified a deleterious-predicted variant in ENPP1, a gene associated with disturbed transfer of melanosomes to keratinocytes in Cole disease. Our report expands the clinical spectrum of inherited EB simplex with a possible di-genic synergism contributing to co-presentation with guttate leukoderma.

摘要

遗传性表皮松解症(EB)单纯型是一组由编码细胞-细胞或细胞-基质黏附蛋白的基因突变引起的皮肤脆弱性疾病的异质性群体。最近发现的一种罕见的 EB 单纯型亚型是由于 EXPH5 基因的双等位基因突变引起的,该基因编码外泌素 5,是 Rab27B GTPase 的效应蛋白,参与细胞内囊泡运输和外泌体分泌。EXPH5 EB 亚型的特征是早期出现皮肤水疱和疤痕,主要在四肢,并有不同程度的色素改变。在这里,我们介绍了一位 31 岁的女性,她从儿童早期开始在躯干和四肢上出现弥漫性滴状色素减退,没有明显的水疱或疤痕。我们采用从患者白细胞中提取的种系 DNA 的全外显子组测序来确定表型的遗传病因。在 EXPH5 中发现了一个新的纯合变异 c.1153C>T,导致氨基酸 Glutamine 385 提前出现终止密码子。皮肤划痕后的组织学检查显示出典型的 EB 局灶性角朊细胞脱落。此外,我们还在 ENPP1 中发现了一个有害预测的变异,该基因与 Cole 病中黑色素体向角朊细胞转移障碍有关。我们的报告扩展了遗传性 EB 单纯型的临床谱,可能存在双基因协同作用,导致与滴状白化病同时出现。

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