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A Incontinência Pigmentar (IP) é uma genodermatose multissistêmica rara caracterizada por diferentes manifestações clínicas que incluem anormalidades de pele, dentes, cabelos, unhas, olhos e sistema nervoso central. A doença tem um padrão de herança ligado ao X dominante, com letalidade no sexo masculino. A IP é causada por mutações no gene IKBKG, que codifica a subunidade regulatória de um complexo necessário para ativação do fator nuclear kB (NF-kB), envolvido em diferentes funções fisiológicas e patológicas essenciais, incluindo a sobrevivência celular. Cerca de 70-80% dos pacientes com IP carregam um rearranjo recorrente no lócus de IKBKG: a deleção dos éxons 4-10 do gene (IKBKGdel). O objetivo do presente estudo é investigar em uma série de casos de IP a prevalência da deleção recorrente, os achados clínicos associados e as histórias genéticas familiares. O estudo molecular incluiu 36 indivíduos, sendo 23 pacientes diagnosticados com IP (11 casos-índice e 12 familiares) e mais 13 familiares não-afetados. A prevalência da deleção IKBKGdel na amostra (73%) está de acordo com o relatado na literatura, indicando que, independente da origem étnica, essa é a principal mutação em IKBKG. As manifestações clínicas dos pacientes estão de acordo ao descrito em estudos prévios e apontam a importância de avaliações específicas que visem aos principais sinais da IP. A alta variabilidade clínica familiar indica uma ausência de correlação genótipo-fenótipo e sugere que outros fatores devem desenvolver um papel importante para a severidade da doença. Nós demonstramos, pela primeira vez, um desvio da proporção esperada pela segregação Mendeliana de meninos:meninas e meninas afetadas:não-afetadas nos casos familiares, indicando uma aparente transmissão preferencial do alelo IKBKG mutado. Estudos adicionais serão importantes para comprovar esse achado. Esse é o primeiro estudo genético em IP realizado no Brasil e contribui para a compreensão das bases genética e clínica envolvidas. / Incontinentia Pigmenti (IP) is a rare multisystem genodermatosis characterized by several clinical manifestations, including abnormalities of skin, teeth, hair, nail, eyes and central nervous system. The disease is X-linked dominant and lethal in males. IP occurs due to mutations in IKBKG gene, which encodes the regulatory subunit of a complex required for nuclear factor kB (NF-kB) activation, involved in many essential physiological and pathologic functions, including cell survival. Around 70-80% of IP patients carry a recurrent rearrangement in IKBKG locus: the exon 4-10 deletion (IKBKGdel). Our aim was to investigate in a case series of IP the recurrent deletion prevalence, the associated clinical findings and the familial genetic histories. The molecular study included 36 individuals, being 23 IP patients (11 index-cases and 12 relatives) and 13 non-affected relatives. The IKBKGdel prevalence in our sample (73%) is in accordance to that reported in literature, indicating that, irrespectively of ethnical origin, this is the major mutation in IKBKG. The clinical manifestations from our IP patients are consistent to those described in previous studies and point out the importance of a specific examination looking for the most prevalent IP signs. The high observed clinical intrafamilial variability indicates a lack of genotype-phenotype correlation and suggests that other factors might play an important role to disease’s severity. We show, in first instance, a deviation in the expected Mendelian proportion of male:female ratio and, among female, the affected:non-affected ratio in familial cases, indicating an apparent preferential transmission of the mutated IKBKG allele. studies are important to verify this finding. This is the first Brazilian genetic study in IP and it contributes to the understanding of the genetic and clinical bases involved.

A Incontinência Pigmentar (IP) é uma genodermatose multissistêmica rara caracterizada por diferentes manifestações clínicas que incluem anormalidades de pele, dentes, cabelos, unhas, olhos e sistema nervoso central. A doença tem um padrão de herança ligado ao X dominante, com letalidade no sexo masculino. A IP é causada por mutações no gene IKBKG, que codifica a subunidade regulatória de um complexo necessário para ativação do fator nuclear kB (NF-kB), envolvido em diferentes funções fisiológicas e patológicas essenciais, incluindo a sobrevivência celular. Cerca de 70-80% dos pacientes com IP carregam um rearranjo recorrente no lócus de IKBKG: a deleção dos éxons 4-10 do gene (IKBKGdel). O objetivo do presente estudo é investigar em uma série de casos de IP a prevalência da deleção recorrente, os achados clínicos associados e as histórias genéticas familiares. O estudo molecular incluiu 36 indivíduos, sendo 23 pacientes diagnosticados com IP (11 casos-índice e 12 familiares) e mais 13 familiares não-afetados. A prevalência da deleção IKBKGdel na amostra (73%) está de acordo com o relatado na literatura, indicando que, independente da origem étnica, essa é a principal mutação em IKBKG. As manifestações clínicas dos pacientes estão de acordo ao descrito em estudos prévios e apontam a importância de avaliações específicas que visem aos principais sinais da IP. A alta variabilidade clínica familiar indica uma ausência de correlação genótipo-fenótipo e sugere que outros fatores devem desenvolver um papel importante para a severidade da doença. Nós demonstramos, pela primeira vez, um desvio da proporção esperada pela segregação Mendeliana de meninos:meninas e meninas afetadas:não-afetadas nos casos familiares, indicando uma aparente transmissão preferencial do alelo IKBKG mutado. Estudos adicionais serão importantes para comprovar esse achado. Esse é o primeiro estudo genético em IP realizado no Brasil e contribui para a compreensão das bases genética e clínica envolvidas. / Incontinentia Pigmenti (IP) is a rare multisystem genodermatosis characterized by several clinical manifestations, including abnormalities of skin, teeth, hair, nail, eyes and central nervous system. The disease is X-linked dominant and lethal in males. IP occurs due to mutations in IKBKG gene, which encodes the regulatory subunit of a complex required for nuclear factor kB (NF-kB) activation, involved in many essential physiological and pathologic functions, including cell survival. Around 70-80% of IP patients carry a recurrent rearrangement in IKBKG locus: the exon 4-10 deletion (IKBKGdel). Our aim was to investigate in a case series of IP the recurrent deletion prevalence, the associated clinical findings and the familial genetic histories. The molecular study included 36 individuals, being 23 IP patients (11 index-cases and 12 relatives) and 13 non-affected relatives. The IKBKGdel prevalence in our sample (73%) is in accordance to that reported in literature, indicating that, irrespectively of ethnical origin, this is the major mutation in IKBKG. The clinical manifestations from our IP patients are consistent to those described in previous studies and point out the importance of a specific examination looking for the most prevalent IP signs. The high observed clinical intrafamilial variability indicates a lack of genotype-phenotype correlation and suggests that other factors might play an important role to disease’s severity. We show, in first instance, a deviation in the expected Mendelian proportion of male:female ratio and, among female, the affected:non-affected ratio in familial cases, indicating an apparent preferential transmission of the mutated IKBKG allele. studies are important to verify this finding. This is the first Brazilian genetic study in IP and it contributes to the understanding of the genetic and clinical bases involved.

A Incontinência Pigmentar (IP) é uma genodermatose multissistêmica rara caracterizada por diferentes manifestações clínicas que incluem anormalidades de pele, dentes, cabelos, unhas, olhos e sistema nervoso central. A doença tem um padrão de herança ligado ao X dominante, com letalidade no sexo masculino. A IP é causada por mutações no gene IKBKG, que codifica a subunidade regulatória de um complexo necessário para ativação do fator nuclear kB (NF-kB), envolvido em diferentes funções fisiológicas e patológicas essenciais, incluindo a sobrevivência celular. Cerca de 70-80% dos pacientes com IP carregam um rearranjo recorrente no lócus de IKBKG: a deleção dos éxons 4-10 do gene (IKBKGdel). O objetivo do presente estudo é investigar em uma série de casos de IP a prevalência da deleção recorrente, os achados clínicos associados e as histórias genéticas familiares. O estudo molecular incluiu 36 indivíduos, sendo 23 pacientes diagnosticados com IP (11 casos-índice e 12 familiares) e mais 13 familiares não-afetados. A prevalência da deleção IKBKGdel na amostra (73%) está de acordo com o relatado na literatura, indicando que, independente da origem étnica, essa é a principal mutação em IKBKG. As manifestações clínicas dos pacientes estão de acordo ao descrito em estudos prévios e apontam a importância de avaliações específicas que visem aos principais sinais da IP. A alta variabilidade clínica familiar indica uma ausência de correlação genótipo-fenótipo e sugere que outros fatores devem desenvolver um papel importante para a severidade da doença. Nós demonstramos, pela primeira vez, um desvio da proporção esperada pela segregação Mendeliana de meninos:meninas e meninas afetadas:não-afetadas nos casos familiares, indicando uma aparente transmissão preferencial do alelo IKBKG mutado. Estudos adicionais serão importantes para comprovar esse achado. Esse é o primeiro estudo genético em IP realizado no Brasil e contribui para a compreensão das bases genética e clínica envolvidas. / Incontinentia Pigmenti (IP) is a rare multisystem genodermatosis characterized by several clinical manifestations, including abnormalities of skin, teeth, hair, nail, eyes and central nervous system. The disease is X-linked dominant and lethal in males. IP occurs due to mutations in IKBKG gene, which encodes the regulatory subunit of a complex required for nuclear factor kB (NF-kB) activation, involved in many essential physiological and pathologic functions, including cell survival. Around 70-80% of IP patients carry a recurrent rearrangement in IKBKG locus: the exon 4-10 deletion (IKBKGdel). Our aim was to investigate in a case series of IP the recurrent deletion prevalence, the associated clinical findings and the familial genetic histories. The molecular study included 36 individuals, being 23 IP patients (11 index-cases and 12 relatives) and 13 non-affected relatives. The IKBKGdel prevalence in our sample (73%) is in accordance to that reported in literature, indicating that, irrespectively of ethnical origin, this is the major mutation in IKBKG. The clinical manifestations from our IP patients are consistent to those described in previous studies and point out the importance of a specific examination looking for the most prevalent IP signs. The high observed clinical intrafamilial variability indicates a lack of genotype-phenotype correlation and suggests that other factors might play an important role to disease’s severity. We show, in first instance, a deviation in the expected Mendelian proportion of male:female ratio and, among female, the affected:non-affected ratio in familial cases, indicating an apparent preferential transmission of the mutated IKBKG allele. studies are important to verify this finding. This is the first Brazilian genetic study in IP and it contributes to the understanding of the genetic and clinical bases involved.

Epidermolysis Bullosa (EB) is a rare genetic disorder that causes extreme skin fragility and blistering in patients, significantly impacting their quality of life. EB can be classified into various subtypes, each with a unique genetic profile and diverse physical symptoms. Due to the heterogeneous inheritance patterns of EB, a cure remains yet to be found. However, various symptomatic treatments have been developed and continue to be developed to relieve pain and itching for patients and improve their quality of life. These treatments can be divided into topical treatments, some of which have undergone clinical trials, and systemic treatments, which target the upregulation of inflammatory pathways. Potential curative treatments in development for EB include gene replacement therapy, gene editing therapy, RNA-based therapy, revertant mosaicism, cell-based therapy, protein therapy, and protein codon read-through. Recent advancements in gene therapy and stem cell therapy show promise for a cure for EB in the future. Stem cell therapies utilizing umbilical cord blood-derived mesenchymal stem cells or dermal mesenchymal stromal cells, among others, have shown potential in clinical trials, but further research is required before they can be implemented in a clinical setting. On the other hand, B-VEC, a topical gene therapy, and EB-101, an autologous ex-vivo gene therapy, have undergone more extensive research and are awaiting FDA approval. The ongoing research and development of these therapeutic modalities provide hope that a cure will soon be found for this devastating disease.

The skin is the largest organ in the body. Its function is to protect the body from potential harm and to maintain homeostasis. The epidermis is the outermost layer of the skin. Stratum corneum is the outermost layer of the epidermis, composed of corneocytes and surrounding lipids. The lipids are produced by different enzymes that all play a role in the formation and function of the skin permeability barrier. Mutations in genes coding for these enzymes can lead to barrier dysfunction and could cause autosomal recessive congenital ichthyosis (ARCI). Nine genes have been identified as ARCI-causative and two of them are CYP4F22 and CERS3.   The purpose of this project was to study co-localization of CYP4F22 with CERS3 and also mutated CYP4F22 enzymes, by transfecting plasmids into HeLa and HaCaT cells and performing PLA on HEKn cells. Co-localization could indicate potential interactions and by studying these more in the future, novel treatment strategies can be developed for ARCI patients.   Transfection attempts showed a low transfection grade of wild type genes in both HeLa and HaCaT cells. Tendencies towards co-localization was seen in both cell types and some HeLa cells showed strong correlation after image analysis. Transfection of mutated genes failed, unfortunately. PLA showed co-localization in normal keratinocytes. The obtained results indicated a co-localization, but results need to be confirmed by immunoprecipitation and immunoblotting in the future.

<p>Hereditary ichthyosis is a collective name for many dry and scaly skin disorders ranging in frequency from common to very rare. The main groups are autosomal recessive lamellar ichthyosis, autosomal dominant epidermolytic hyperkeratosis and ichthyosis vulgaris, and x-linked recessive ichthyosis. Anhidrosis, ectropion and keratodermia are common symptoms, especially in lamellar ichthyosis, which is often caused by mutations in the transglutaminase 1 (TGM1) gene. The aim of this work was to study patients with different types of ichthyosis regarding (i) the patho-aetiology (TGM1 and electron microscopy [EM] analysis), (ii) skin signs and symptoms (clinical score and subjective measure of disease activity), (iii) quality of life (questionnaires DLQI, SF-36 and NHP and face-to-face interviews) and (iv) a search for new ways of topical treatment. Patients from Sweden and Estonia with autosomal recessive congenital ichthyosis (n=83) had a broader clinical spectrum than anticipated, but a majority carried TGM1 mutations. Based on DNA analysis and clinical examinations the patients were classified into three groups, which could be further subdivided after EM analysis. Our studies indicate that patients with ichthyosis have reduced quality of life as reflected by DLQI and by some domains of SF-36, by NHP and the interviews. All the interviewees reported that their skin disease had affected them negatively to varying degrees during their entire lives and that the most problematic period was childhood. All patients with ichthyosis use topical therapy. In a double-blind study creams containing either 5% urea or 20% propylene glycol were found inferior to a cream formulation containing lactic acid 5% and propylene glycol 20% both regarding clinical improvement and thinning of the skin barrier. Improved topical therapy may reduce the need of more toxic, oral drugs. Future studies should elucidate whether this increases the quality of life of ichthyosis patients, especially if combined with more detailed information about the aetiology and inheritance of the diseases.</p>

Hereditary ichthyosis is a collective name for many dry and scaly skin disorders ranging in frequency from common to very rare. The main groups are autosomal recessive lamellar ichthyosis, autosomal dominant epidermolytic hyperkeratosis and ichthyosis vulgaris, and x-linked recessive ichthyosis. Anhidrosis, ectropion and keratodermia are common symptoms, especially in lamellar ichthyosis, which is often caused by mutations in the transglutaminase 1 (TGM1) gene. The aim of this work was to study patients with different types of ichthyosis regarding (i) the patho-aetiology (TGM1 and electron microscopy [EM] analysis), (ii) skin signs and symptoms (clinical score and subjective measure of disease activity), (iii) quality of life (questionnaires DLQI, SF-36 and NHP and face-to-face interviews) and (iv) a search for new ways of topical treatment. Patients from Sweden and Estonia with autosomal recessive congenital ichthyosis (n=83) had a broader clinical spectrum than anticipated, but a majority carried TGM1 mutations. Based on DNA analysis and clinical examinations the patients were classified into three groups, which could be further subdivided after EM analysis. Our studies indicate that patients with ichthyosis have reduced quality of life as reflected by DLQI and by some domains of SF-36, by NHP and the interviews. All the interviewees reported that their skin disease had affected them negatively to varying degrees during their entire lives and that the most problematic period was childhood. All patients with ichthyosis use topical therapy. In a double-blind study creams containing either 5% urea or 20% propylene glycol were found inferior to a cream formulation containing lactic acid 5% and propylene glycol 20% both regarding clinical improvement and thinning of the skin barrier. Improved topical therapy may reduce the need of more toxic, oral drugs. Future studies should elucidate whether this increases the quality of life of ichthyosis patients, especially if combined with more detailed information about the aetiology and inheritance of the diseases.

Epidermolysis bullosa simplex (EBS) and epidermolytic ichthyosis (EI) are rare skin fragility diseases characterized by intra-epidermal blistering due to autosomal dominant-negative mutations in basal (KRT5 or KRT14) and suprabasal (KRT1 or KRT10) keratin genes,  respectively. Despite vast knowledge in the disease pathogenesis, the pathomechanisms are not fully understood, and no effective remedies exist. The purpose of this work was to search for keratin gene mutations in EBS patients, to develop in vitro models for studying EBS and EI, and to investigate novel pharmacological approaches for both diseases. We identified both novel and recurrent KRT5 mutations in all studied EBS patients but one which did not show any pathogenic keratin mutations. Using cultured primary keratinocytes from EBS patients, we reproduced a correlation between clinical severity and cytoskeletal instability in vitro. Immortalized keratinocyte cell lines were established from three EBS and three EI patients with different phenotypes using HPV16-E6E7. Only cell lines derived from severely affected patients exhibited spontaneous keratin aggregates under normal culture conditions. However, heat stress significantly induced keratin aggregates in all patient cell lines. This effect was more dramatic in cells from patients with a severe phenotype. In organotypic cultures, the immortalized cells were able to differentiate and form a multilayered epidermis reminiscent of those observed in vivo. Addition of two molecular chaperones, trimethylamine N-oxide dihydrate (TMAO) and sodium 4-phenylbutyrate (4-PBA), reduced the keratin aggregates in both stressed and unstressed EBS and EI keratinocytes, respectively. The mechanism of action of TMAO and 4-PBA was shown to involve the endogenous chaperone system (Heat shock proteins e.g. Hsp70). Besides, MAPK signaling pathways also seemed to be incriminated in the pathogenesis of EBS. Furthermore, depending on which type of keratin is mutated, 4-PBA up-regulated Hsp70 and KRT4 (possibly compensating for mutated KRT1/5), and down-regulated KRT1 and KRT10, which could further assist in protecting EBS and EI cells against stress. In conclusion, novel and recurrent pathogenic keratin mutations have been identified in EBS. Immortalized EBS and EI cell lines that functionally reflect the disease phenotype were established. Two pharmacologic agents, TMAO and 4-PBA, were shown to be promising candidates as novel treatment of heritable keratinopathies in this in vitro model.