Faculty of Health Science Degree of Master of Science in Human Genetics 9809684w / Lipoid proteinosis (LP) (OMIM 247100) is a rare autosomal recessive disorder that is caused by mutations within the extracellular matrix protein 1 gene (ECM1). The ECM1 gene has been shown to play a role in angiogenesis and connective tissue matrix generation, especially in skin and bone. The role of ECM1 in normal skin development and maintenance is further highlighted by its role in LP and in lichen sclerosis where autoantibodies are raised against ECM1. LP usually presents in the first year of life with a faint or hoarse cry and is due to a hyaline-like material deposited in the mucous membranes of the vocal cords. Gradually (over years) there is diffuse skin infiltration and general skin thickening with a yellow, waxy appearance. There is excessive scarring with scars often appearing at sites of minor injury or stress. In many cases, the eyelids show typical beaded papules. In some cases, calcification of certain aspects of the temporal lobes have been observed, and may or may not be associated with variable neurological, psychiatric and neuropsychological sequelae. Although the prevalence of LP in South Africa is unknown, the disproportionately high number of case reports originating from South Africa indicates that LP is unusually common in certain South African populations, most notably the Coloured population of Namaqualand and the Afrikaans-speaking White population. This may be due to a possible LP founder effect that occurred early during the European colonisation of South Africa. The founder effect was investigated in the South African LP patients by conducting ECM1 mutation and linked marker analysis. The data supported a LP founder effect as the Q276X mutation in exon seven of ECM1 was present in the homozygous state in all LP patients investigated. In addition, the Q276X mutation was associated with a single founder haplotype of 19-12-23-22 (ND1-D1S2343-D1S305-D1S2624). These markers were in significant linkage disequilibrium with each other and with the Q276X mutation. VI As variation within ECM1 may alter properties of skin such as healing and scar formation, ECM1 exons two through five and the first part of exon six were investigated for nucleotide variation using denaturing high performance liquid chromatography (dHPLC) and direct DNA sequencing in three different South African populations. Eight nucleotide variants were identified, of which six were cytosine to thymine transitions. Seven of the eight variants identified were either intronic or synonymous, with one variant being a missense variant, changing a methionine residue to a threonine residue (T130M).

Orientador: Heron Fernando de Sousa Gonzaga / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-10T16:40:54Z (GMT). No. of bitstreams: 1 Rodrigues_Marcelo_D.pdf: 760160 bytes, checksum: 48a5a2282ffba53fa69fd0f990fa8ed0 (MD5) Previous issue date: 2008 / Resumo: A hialinose cutâneo-mucosa (HCM) é uma dermatose autossômica recessiva rara, congênita, de aparecimento precoce na infância. Caracteriza-se por deposição de material hialino, que se acumula na pele e mucosas. Foram descritos 258 casos na literatura mundial e no Brasil, doze casos. A HCM apresenta aumento da expressão do colágeno tipo IV e V e redução da expressão do colágeno I e III. Esta doença foi mapeada no locus do cromossomo 1q21. Mutações patogênicas foram identificadas no gene ECM1. A doença é caracterizada por voz rouca, pápulas cutâneas amareladas, cicatrizes atróficas, lesões ulceradas cutâneas, blefarose moniliforme e conjuntivite pseudo-membranosa. Manifesta multiplicidade de sintomas, afetando vários órgãos. A revisão da literatura sobre HLA e HCM não mostrou nenhum trabalho. Realizou-se o estudo clínico e das especificidades HLA na família de uma afetada por HCM. Foram submetidos a exames clínicos e complementares. A tipificação HLA foi realizada através da análise de DNA genômico pela técnica de PCR-SSP. A afetada era branca, com 14 anos. Referia choro rouco desde o nascimento e eritema na região subescapular e cervical há 13 anos, que evoluiu para vesículas e posteriormente, micropápulas, que se rompiam, evoluindo para lesões ulceradas. Nesses locais, apareciam verrucosidades nos ângulos da boca, joelhos, cotovelos e regiões palmares. Concomitantemente, evoluiu para micropápulas hipocrômicas no dorso das mãos e axilas. Referia disfagia. Negava história familiar. Ao exame dermatológico, pápulas amareladas nas pálpebras e linearmente na borda livre; cicatrizes atróficas varioliformes nas regiões antecubitais; placas verrucosas nos cotovelos, regiões palmares, joelhos; pápulas amareladas em dorso das mãos e região cervical posterior. Apresentava alopecia parieto-occipital. Ao exame bucal, abertura limitada, endurecimento labial, lesões vegetantes no ângulo da boca, placas branco-amareladas em regiões de mucosa jugal, vestibular, orofaringe, dorso e ventre da língua. Ulcerações linguais e no palato duro e mole. Xerostomia discreta foi observada. Ao exame dentário, placa bacteriana, cálculos e agenesia do dente 22. A gengiva era friável, hipertrófica com bolsas periodontais. Ao exame oftalmológico, obstrução das vias lacrimais, mucosa espessada nos pontos lacrimais e prurido periocular. Diagnóstico psiquiátrico de Distimia foi estabelecido. Na avaliação neurológica, cefaléia. O exame clínico nos outros membros da família não mostrou nenhum traço da doença. Na fibronasofaringolaringoscopia, espessamento epidérmico em epiglote e hipertrofia de falsas cordas, pregueamento mucoso em prega interaritenóidea. O EEG não mostrou anormalidades. A tomografia computadorizada apresentou calcificações parenquimatosas hipocampais bilaterais. O exame histopatológico confirmou o diagnóstico de HCM. Constatou-se que sendo a doença autossômica recessiva, a ausência de manifestações clínicas nos pais da afetada, mostrou serem os mesmos heterozigotos. As manifestações clínicas são importantes para o diagnóstico. A primeira manifestação clínica mais freqüente na literatura, apresentada pela afetada, é a rouquidão. As manifestações clínicas mais exuberantes na doença são as cutâneas e mucosas. O estudo das especificidades HLA determinou os seguintes haplótipos na afetada: A31-B39-Cw7-DR4-DQ8 e A74-B7-Cw7-DR8-DQ-. A paciente era haploidêntica a um dos seus dois meioirmãos. Este foi o primeiro trabalho em que se investigou especificidades HLA em portador de HCM / Abstract: Cutaneous-mucous hyalinosis (CMH) is a rare congenital autosomal recessive dermatose, which is presented precociously in early childhood. It is characterized by disposition of hyaline material that accumulates in the skin and cutaneous mucous. 258 cases were described in the world and 12 cases in Brazil. The CMH presents an increase of the expression of the collagen types IV and V and reduction of the expression of the collagen I and II. The disorder was mapped in a locus on chromosome 1q21 and pathogenic mutations were identified in the ECM1 gene. The disease is characterized by hoarse voice, yellowed cutaneous papules, atrophic scars, ulcerated cutaneous lesions, moniliform blepharosis, and pseudomembranous conjunctivitis. It manifests multiple symptoms affecting several organs. The review of literature about HLA as well as CMH has not presented any work so far. The clinical study as well as of the HLA antigens in the family of an individual affected by CMH was performed. They were submitted to clinical and auxiliary tests. The HLA type was accomplished through the analysis of genome DNA by the technique of PCR-SSP. The proband was a 14 year old white female. It referred hoarse crying from the birth and erythema in the sub-omoplate and cervical area 13 years ago which developed for vesicles and later on, micropapules that broke up, developing for ulcerated lesions, verrucous lesions in the angles of the mouth, knees, elbows and palm areas appeared. Concomitantly it developed for hypochromic micropapules in the back of the hands and armpits. It referred dysphagia. There was no history family. During the dermatological examination she presented yellowed papules in the eyelids and lineally in the free border; atrophic varioliform scars in the ante-cubital areas; verrucous plates in the elbows, palm areas and knees: yellowed papules in the back of the hands and posterior cervical area. She showed Parietal-occipital alopecia. During the oral examination she Presented limited opening, labial hardening, vegetative lesions in the angle of the mouth, white yellowed plaques in the areas of buccal, vestibular, oro-pharynx, dorsal and ventral tongue mucous membranes. Tongue ulcerations and also in the hard and soft palate. Discreet xerostomia was observed. During the dental examination, bacterial plaque, calculous and agenesis of the tooth 22. The gengive was friable, hypertrophic with periodontal depressions. During the ophthalmic examination, obstruction of the lacrimal via, thickened mucous in the lacrimal vias and perio-ocular pruritis. Psychiatric diagnosis of Dysthymia was estableshed. In the neurological evaluation, migraine. The clinical examination in the other members of the family did not show any line of the disease. Epidermal thickening in the epiglottis and hypertrophy of false strings, mucous pleatment in interarytenoide pleat were found. EEG did not show abnormalities. Computed tomography presented bilateral parenchymatosis hippocampus calcifications. The histopathology examination confirmed the diagnosis of CMH. It was verified because of the disease was recessive autosomal, the absence of clinical manifestations in the parents of the affected individual who were heterozygote. The clinical manifestations are important for the diagnosis. The most frequent clinical manifestation in the literature, presented by the affected girl, is the hoarse voice. The most exuberant clinical manifestations in the disease are the cutaneous and the mucous ones. The study of the HLA antigens determined the following haplotypes in the affected girl: A31-B39-Cw7-DR4-DQ8 and A74-B7-Cw7DR8-DQ- . She is haplo-identical to one of two her middle-siblings. This was the first work in which HLA antigens were investigated in carrier of CMH / Doutorado / Estomatologia / Doutor em Estomatopatologia

Urbach-Wiethe Sindroom (beter bekend as lipo"ied prote"inose of hyalinosis cutis et mucosae) is 'n seldsame, outosomaal-oorerflike siekte. Die kenmerkendste simptome van die siekte is vel- en slymvliesveranderinge wat deur 'n neerslag van ekstrasellulere hialienagtige materiaal van onbekende oorsprong veroorsaak word. Die vel word maklik beseer, genees stadig en lelike, pokagtige letsels ontstaan. 'n Fyn, korrelagtige neerslag op die ooglede, die sogenaamde "kralestringvoorkoms" kenmerk die siekte, sowel as heesheid, die prominentste en lastigste simptoom, wat sedert geboorte teenwoordig kan wees. Radiografie en tomografie toon bilaterale,boontjievormige verkalking op die temporale lobbe van die brein, wat tot epileptiese aanvalle en ander neuropsigiese simptome soos geremde geheue en aggressie lei. Heesheid veroorsaak kommunikatiewe beperkinge vir die lyer,terwyldie opsigtelike velletsels aversiewe- en die verkalkings onsigbare beperkinge meebring. Die lyer aan Urbach-Wiethe Sindroom kan volgens die beginsels en kriteria van die medies-kliniese, die persoonsgeorienteerde en die sosio-omgewingsperspektiewe gestremdheid ondervind. Teoreties kan die lyer se belewinge van sy andersheid en die nie-aanvaardingdeurdie gemeenskap, soos by gestremdes,die handhawing van sy selfagting rem, sodat 'n negatiewe selfkonsep tot skuldgevoelens, angsbelewinge en depressie kan lei. 'n Betekenisvolle verband is in die empiriese ondersoek tussen die graad van aantasting en wanaanpassing in die lyer se leefwereld gevind. Die lyers wat ernstig aangetas is, identifiseer moeilik met hulle fisieke voorkoms. ldentiteitsvorming word gerem en die selfagting is negatief. Hulle openbaar 'n negatiewe selfkonsep en depressiewe gevoelens met selfmoordgedagtes. Hulle relasies en sosialisering is problematies en hulle voel hulle word nie deur die gemeenskap aanvaar nie. Die lyers ondervind 'n algemene wanaanpassing in hulle leefwereld. 'n Geval van paranoia is ook gevind. Alhoewel die ouers vrae oor die toestand het en sekere emosies beleef, kan die meeste van hulle die situasie hanteer. Riglyne vir 'n terapeutiese begeleidingsprogram vir lyers aan Urbach-Wiethe Sindroom, wat op die verbetering van die selfkonsep; die hantering van depressie, aggressie en woedebuie, asook die verbetering van relasies en sosialisering gerig is, is saamgestel. 'n Ondersteuningsgroep waarby lyers en hulle ouers kan inskakel, is gestig. / Urbach-Wiethe Syndrome, also known as lipoid proteinosis or hyalinosis cutis et mucosae, is a rare, recessively inherited, autosomal disorder characterized by lesions of the skin and mucosae, caused by widespread deposition of hyaline material of unknown etiology. The skin injures easily and heals slowly with "pock­ like" lesions. Bead-like deposits on the eyelids, called "string of pearls",are often found. Present since early infancy, hoarseness is the first, and most striking, irritating symptom. Bean-shaped intracranial calcification within the temporallobes of the brain in the area of the hippocampus, shown up by radiography and tomography, may cause epileptic seizures and other neuropsychological complications like impaired memory and aggression. The sufferer experiences communicative impairment through hoarseness, aversive impairment because of the conspicuous lesions, and concealed impairment as a result of the calcifications. According to the medical-clinical,person-orientated and socio-environmental perspectives on disability, a sufferer of Urbach-Wiethe Syndrome may experience disability. Like disabled persons, the sufferer finds it difficult to identify with his physical appearance. Impaired identity formation and low self-esteem cause a negative self­ concept. Feelings of guilt,anxiety and depression result from perceived dissimilarity, social rejection and low self-esteem. Socialising is adversely affected. A significant relationship was found in the empirical study between the extent to which the sufferer is affected and the degree of maladjustment in his life-world. Seriously affected sufferers display a negative self-concept and feelings of depression with suicidal thoughts. Socialisation and relationships are problematic and sufferers feel unaccepted by the community. General maladjustment in the life-world is experienced. A case of paranoia was reported. Except for some questions and unresolved feelings about the disease,most parents are able to cope with the situation. Guidelines have been set for a therapeutic programme for sufferers from Urbach­ Wiethe Syndrome aimed at enhancing self-concept, coping with depression and aggression, and improving relationships and socialising. A support group has been ounded for sufferers and their parents. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)

Urbach-Wiethe Sindroom (beter bekend as lipo"ied prote"inose of hyalinosis cutis et mucosae) is 'n seldsame, outosomaal-oorerflike siekte. Die kenmerkendste simptome van die siekte is vel- en slymvliesveranderinge wat deur 'n neerslag van ekstrasellulere hialienagtige materiaal van onbekende oorsprong veroorsaak word. Die vel word maklik beseer, genees stadig en lelike, pokagtige letsels ontstaan. 'n Fyn, korrelagtige neerslag op die ooglede, die sogenaamde "kralestringvoorkoms" kenmerk die siekte, sowel as heesheid, die prominentste en lastigste simptoom, wat sedert geboorte teenwoordig kan wees. Radiografie en tomografie toon bilaterale,boontjievormige verkalking op die temporale lobbe van die brein, wat tot epileptiese aanvalle en ander neuropsigiese simptome soos geremde geheue en aggressie lei. Heesheid veroorsaak kommunikatiewe beperkinge vir die lyer,terwyldie opsigtelike velletsels aversiewe- en die verkalkings onsigbare beperkinge meebring. Die lyer aan Urbach-Wiethe Sindroom kan volgens die beginsels en kriteria van die medies-kliniese, die persoonsgeorienteerde en die sosio-omgewingsperspektiewe gestremdheid ondervind. Teoreties kan die lyer se belewinge van sy andersheid en die nie-aanvaardingdeurdie gemeenskap, soos by gestremdes,die handhawing van sy selfagting rem, sodat 'n negatiewe selfkonsep tot skuldgevoelens, angsbelewinge en depressie kan lei. 'n Betekenisvolle verband is in die empiriese ondersoek tussen die graad van aantasting en wanaanpassing in die lyer se leefwereld gevind. Die lyers wat ernstig aangetas is, identifiseer moeilik met hulle fisieke voorkoms. ldentiteitsvorming word gerem en die selfagting is negatief. Hulle openbaar 'n negatiewe selfkonsep en depressiewe gevoelens met selfmoordgedagtes. Hulle relasies en sosialisering is problematies en hulle voel hulle word nie deur die gemeenskap aanvaar nie. Die lyers ondervind 'n algemene wanaanpassing in hulle leefwereld. 'n Geval van paranoia is ook gevind. Alhoewel die ouers vrae oor die toestand het en sekere emosies beleef, kan die meeste van hulle die situasie hanteer. Riglyne vir 'n terapeutiese begeleidingsprogram vir lyers aan Urbach-Wiethe Sindroom, wat op die verbetering van die selfkonsep; die hantering van depressie, aggressie en woedebuie, asook die verbetering van relasies en sosialisering gerig is, is saamgestel. 'n Ondersteuningsgroep waarby lyers en hulle ouers kan inskakel, is gestig. / Urbach-Wiethe Syndrome, also known as lipoid proteinosis or hyalinosis cutis et mucosae, is a rare, recessively inherited, autosomal disorder characterized by lesions of the skin and mucosae, caused by widespread deposition of hyaline material of unknown etiology. The skin injures easily and heals slowly with "pock­ like" lesions. Bead-like deposits on the eyelids, called "string of pearls",are often found. Present since early infancy, hoarseness is the first, and most striking, irritating symptom. Bean-shaped intracranial calcification within the temporallobes of the brain in the area of the hippocampus, shown up by radiography and tomography, may cause epileptic seizures and other neuropsychological complications like impaired memory and aggression. The sufferer experiences communicative impairment through hoarseness, aversive impairment because of the conspicuous lesions, and concealed impairment as a result of the calcifications. According to the medical-clinical,person-orientated and socio-environmental perspectives on disability, a sufferer of Urbach-Wiethe Syndrome may experience disability. Like disabled persons, the sufferer finds it difficult to identify with his physical appearance. Impaired identity formation and low self-esteem cause a negative self­ concept. Feelings of guilt,anxiety and depression result from perceived dissimilarity, social rejection and low self-esteem. Socialising is adversely affected. A significant relationship was found in the empirical study between the extent to which the sufferer is affected and the degree of maladjustment in his life-world. Seriously affected sufferers display a negative self-concept and feelings of depression with suicidal thoughts. Socialisation and relationships are problematic and sufferers feel unaccepted by the community. General maladjustment in the life-world is experienced. A case of paranoia was reported. Except for some questions and unresolved feelings about the disease,most parents are able to cope with the situation. Guidelines have been set for a therapeutic programme for sufferers from Urbach­ Wiethe Syndrome aimed at enhancing self-concept, coping with depression and aggression, and improving relationships and socialising. A support group has been ounded for sufferers and their parents. / Psychology of Education / D. Ed. (Sielkundige Opvoedkunde)