ABSTRACT
Monogenic inherited skin diseases are a group of clinically rare diseases that include nearly 1000 phenotypically distinct disorders. Through the concerted efforts of researchers in dermatological sciences and related disciplines worldwide, many advances have been made in the etiology and pathogenesis of these diseases in the last 30 years. However, it is important to note that the treatment of the majority of monogenic inherited skin diseases remains a challenge for clinicians. Dupilumab is a fully human monoclonal IgG4 antibody that specifically binds to the α subunit of the IL-4 receptor, thereby inhibiting the IL-4 and IL-13 signaling pathway. It was first approved for the treatment of moderate-to-severe atopic dermatitis (AD) and has been used worldwide. In recent years, the drug has been successfully used to treat some monogenic inherited skin diseases with AD-like clinical manifestations, such as hyper-IgE syndrome and Netherton syndrome, with good efficacy. The drug was later tried for the treatment of other monogenic inherited skin diseases, such as Hailey-Hailey syndrome and epidermolysis bullosa pruriginosa, where it was also proven to be effective. In this paper, we review literature reports related to dupilumab for the treatment of monogenic inherited skin diseases in recent years, focusing on its efficacy, safety and possible therapeutic mechanisms. We aim to provide a possible scientific basis for the future application of this drug in the field of rare monogenic inherited skin diseases.
ABSTRACT
Objective:To construct a serine protease inhibitor Kazal type-5 (Spink5) conditional knockout mouse model, and to identify its phenotype.Methods:B cell-specific Spink5 conditional knockout mice of genotype Mb1 cre/+Spink5 floxp/floxp were constructed by using clustered regularly interspaced short palindromic repeats (CRISPR) /CRISPR-associated protein 9 (Cas9) technology, and served as the knockout group. Mice of genotype Mb1 +/+Spink5 floxp/floxp served as the control group. The mice of genotype Mb1 cre/+Spink5 floxp/floxp or Mb1 +/+Spink5 floxp/floxp were sacrificed when they were 4 to 6 weeks old, splenic mononuclear cells were isolated, and B lymphocytes and non-B lymphocytes were sorted by flow cytometry and fluorescence-activated cell sorting. Genotype identification was performed by PCR, and protein expression of lymphoepithelial Kazal-type-related inhibitor (LEKTI) was determined by Western blot analysis. Skin tissues were resected from the mice, and subjected to hematoxylin-eosin staining for measuring the epidermal thickness. Immunofluorescence staining was performed to determine fluorescence intensity of LEKTI protein in the mouse skin tissues. Paired t test or two-independent-sample t test was used for comparisons between groups. Results:Genotype identification results demonstrated that the stable B lymphocyte-specific Spink5 conditional knockout mouse model was successfully constructed. Western blot analysis revealed that the relative protein expression of LEKTI in the B lymphocytes in the knockout group was 0.01 ± 0.02, which was significantly lower than that in the non-B lymphocytes in the knockout group (0.66 ± 0.11, t = 9.99, P < 0.001) , and that in the B lymphocytes in the control group (1.08 ± 0.13, t = 13.78, P < 0.001) . Among 39 mice in the knockout group, 4 presented with dry skin and scattered scaly hypertrophic maculopapules. The epidermal thickness of the lesional skin tissues in the knockout group was 90.42 ± 21.31 μm, significantly higher than that of the non-lesional skin tissues in the knockout group (29.71 ± 3.63 μm, t = 5.05, P = 0.002) and that of normal skin tissues in the control group (12.42 ± 2.21 μm, t = 6.74, P < 0.001) . Immunofluorescence staining showed no significant difference in the fluorescence intensity of LEKTI protein among the lesional skin tissues (46.21 ± 1.21) , non-lesional skin tissues (46.62 ± 2.13) in the knockout group and normal skin tissues in the control group (47.69 ± 1.71, P > 0.05) . Conclusion:The B lymphocyte-specific Spink5 conditional knockout mouse model was successfully constructed, which provides a basis for further exploring mechanisms underlying skin barrier defects and immune dysfunction in Netherton syndrome.
ABSTRACT
Thymic stromal lymphopoietin (TSLP) , a cytokine similar to interleukin-7 (IL-7) , can promote the differentiation and proliferation of a variety of cells, promote the secretion of Th2 cytokines by these cells, and plays an important role in the immune system. In recent years, abnormal expression of TSLP has been found in many skin diseases, and its level is also related to the severity of some skin diseases, suggesting that TSLP may be a potential target for the treatment of various skin diseases. This review summarizes recent research progress in the role of TSLP in the occurrence and development of various skin diseases, including inflammatory diseases, immune diseases, genetic diseases and tumors, and provides a basis and some ideas for the diagnosis and treatment of related diseases.
ABSTRACT
A 24-year-old female patient presented with recurrent itchy annular erythema and scales on the trunk and extremities for 9 years. Histopathological study revealed hyperkeratosis with focal parakeratosis, neutrophil aggregation in the stratum corneum, blisters below the stratum corneum, and perivascular infiltration with lymphocytes, a small number of eosinophils and neutrophils in the superficial and middle dermis. Direct immunofluorescence assay showed negative staining for IgG, IgM, IgA and C3. Whole-exome sequencing of the SPINK5 gene showed a missense mutation c.2423C>T (p.T808I) in exon 25, and a splicing site mutation c.2965-1G>A in exon 31. The compound heterozygosity for the two mutations may be the cause of Netherton syndrome in the patient. Based on the clinical manifestations and genetic testing results, the patient was diagnosed with Netherton syndrome.
ABSTRACT
El síndrome de Netherton (SN) es una enfermedad autosómica recesiva, muy poco frecuente, que se caracteriza por la presencia de eritrodermia ictiosiforme congènita, anomalías capilares y manifestaciones atópicas. Este síndrome es consecuencia de una mutación recesiva en el gen SPINK5. Las manifestaciones del síndrome de SN varían considerablemente entre las personas que lo padecen. Aquí informamos el caso de un recién nacido que presentaba insuficiencia respiratoria grave, hipotermia y eritrodermia, al que se le diagnosticó SN, confirmado mediante pruebas genéticas moleculares.
Netherton syndrome (NS) is a rare, autosomal recessive disease characterized with congenital ichthyosiform erythroderma, hair abnormality and atopic manifestations. This syndrome is caused by recessive mutation in the SPINK5 gene. Disease manifestations vary considerably among NS individuals. We report a newborn presented with severe respiratory insufficiency, hypothermia and erythroderma, was diagnosed as having NS and confirmed with molecular genetic testing.
Subject(s)
Humans , Male , Infant, Newborn , Respiratory Insufficiency/etiology , Ichthyosiform Erythroderma, Congenital/etiology , Netherton Syndrome/diagnosis , Respiratory Insufficiency/genetics , Ichthyosiform Erythroderma, Congenital/genetics , Netherton Syndrome/genetics , Serine Peptidase Inhibitor Kazal-Type 5/genetics , Hypothermia/etiology , Hypothermia/genetics , MutationABSTRACT
Netherton syndrome is a rare autosomal recessive disease characterized by erythroderma, ichthyosis linearis circumflexa, atopy, failure to thrive and a specific hair shaft abnormality called trichorrhexis invaginata or bamboo hair, considered pathognomonic. We report the case of a 4-year-old boy with erythroderma since birth, growth deficit and chronic diarrhea. Trichoscopy was used to visualize typical bamboo and "golf tee" hair and of key importance to diagnose Netherton syndrome. We suggest the use of this procedure in all children diagnosed with erythroderma.
Subject(s)
Child, Preschool , Humans , Male , Dermatitis, Exfoliative/pathology , Dermoscopy/methods , Hair Diseases/pathology , Netherton Syndrome/pathology , Scalp/pathology , Diagnosis, Differential , Reproducibility of ResultsABSTRACT
The family of Kazal-type serine protease inhibitor(SPINK)correlates with chronic pancreatitis,Netherton syndrome,esophageal carcinoma,and other humane diseases.The functions of SPINK1,SPINK5 and SPINK7 have been identified.However,other members remain to be explored.In this review,we summarized locations of SPINK genes,protein structures,functions of SPINK proteins,and the relationship between SPINK family and humane diseases.
ABSTRACT
Netherton Syndrome is a rare autosomal recessive inherited disorder, characterized by triad of congenital ichthyosiform dermatosis, trichorrhexis invaginata and atopy diathesis. It has been found to be due to mutations in SPINK5, a gene encoding LEKTI (lympho-epithelial Kazal-type related inhibitor). LEKTI is a serine proteinase inhibitor that is expressed in epithelial and lymphoid tissues, and may be important in the keratinocyte terminal differentiation and T and B cell maturation. We herein report two cases of Netherton Syndrome in sisters who had ichthyosis linearis circumflexa, trichorrhexis invaginata and atropic dermatitis.
Subject(s)
Humans , Dermatitis , Disease Susceptibility , Genes, vif , Ichthyosis , Keratinocytes , Lymphoid Tissue , Netherton Syndrome , Serine Proteases , Siblings , Skin DiseasesABSTRACT
Netherton's syndrome is an unusual disorder which consists of triad of ichtyosiform dermatosis, multiple defects of hair shaft and an atopic diathesis. The finding of bamboo hair is pathognomic in Netherton's syndrome and the ichthyosiform dermatosis may consist of either ichtyosis linearis circumflexa or congenital ichthyosiform erythroderma. Often, variability in the clinical features leads to a delay in diagnosis in many cases. We report a case of Netherton's syndrome diagnosed in the neonatal period. The patient presented with severe ichthyosis and confirmed microscopically distinctive bamboo hair.
Subject(s)
Humans , Infant, Newborn , Diagnosis , Disease Susceptibility , Hair , Ichthyosiform Erythroderma, Congenital , Ichthyosis , Skin DiseasesABSTRACT
Netherton's syndrome is a rare autosomal recessive disorder characterized by the concurrence of ichthyosis, structural hair shaft abnormality, and atopy. The pathognomonic finding is that of trichorrhexis invaginata identified by light and scanning electron microscopic examination of hair shaft. We herein report a case of Netherton's syndrome in a 51-year-old woman who had polycyclic, serpiginous and erythematous patches with a characteristic, migratory, double-edged scale at the margins as a skin manifestation and trichorrhexis invaginata as a hair defect.
Subject(s)
Female , Humans , Middle Aged , Hair , Ichthyosis , Skin ManifestationsABSTRACT
Netherton's syndrome is a rare autosomal recessive disorder characterized by the concurrence of ichthyosis, structural hair shaft abnormality, and atopy. The pathognomonic finding is that of trichorrhexis invaginata identified by light and scanning electron microscopic examination of hair shaft. We herein report a case of Netherton's syndrome in a 51-year-old woman who had polycyclic, serpiginous and erythematous patches with a characteristic, migratory, double-edged scale at the margins as a skin manifestation and trichorrhexis invaginata as a hair defect.