掌跖角化牙周病综合征一例及组织蛋白酶C基因突变检测

目的 探讨掌跖角化牙周病综合征患者组织蛋白酶C基因（CTSC）突变的特点。 方法 收集1例掌跖角化牙周病综合征患者的临床资料,采集患者及其父母的外周静脉血各2 ml,同时取100例健康人的静脉血2 ml作为对照。以提取的DNA作为模板,用成对的外显子特异性引物对患者的CTSC基因的全部7个外显子进行PCR扩增后直接测序,检测患者CTSC基因的突变情况。 结果 患者的CTSC基因存在复合型杂合突变,外显子6内第824位碱基C被T置换（c.824C > T）,此突变导致CTSC基因第275位氨基酸密码子由ACC替换为ATC,其编码的氨基酸由苏氨酸替换为异亮氨酸（p.T275I）;外显子7内第1040位碱基A被G置换（c.1040A ＞ G）,导致CTSC基因第347位氨基酸密码子由TAT替换为TGT,其编码的氨基酸由酪氨酸变为半胱氨酸（p.Y347C）。其中c.824C > T突变是CTSC基因的新突变位点。患者父亲和母亲分别为c.824C > T和c.1040A ＞ G杂合突变。100例健康对照中未发现CTSC基因c.824C > T和c.1040A ＞ G突变。 结论 CTSC基因突变是导致掌跖角化牙周病综合征临床表型的致病原因,c.824C > T突变扩大了CTSC基因的突变谱,为掌跖角化牙周病综合征的基因诊断提供了依据。     

Netherton综合征一例SPINK5基因突变研究

目的 检测Netherton综合征患者SPINK5基因的突变情况。 方法 收集患者临床资料,提取患者及其相关亲属外周血DNA,用PCR扩增SPINK5基因编码区的全部外显子及其侧翼序列并测序。 结果 直接测序发现患者SPINK5基因的第13号外显子中的第1111位碱基发生C→T杂合突变（c.1111C > T）,导致其编码第371位氨基酸变为终止密码子（p.R371X）;第32号外显子中的第3121位碱基发生C→T杂合突变（c.3121C > T）,导致其编码第1041位氨基酸发生错义突变（p.R1041C）,其健康父母为相应突变的杂合携带者,200例健康对照未见该突变。 结论 SPINK5基因的p.R371X及p.R1041C复合杂合突变可能是引起该患者临床表现的病因之一。     

X连锁鱼鳞病并发Meleda角化病一例临床特征及SLURP-1和STS基因突变分析

目的 报道1例X连锁鱼鳞病并发Meleda角化病,并检测其基因突变.方法 收集临床资料,提取患儿及其父母外周血基因组DNA,PCR扩增SLURP-1和STS基因全部外显子及其侧翼序列,以100例健康人作为对照,对扩增产物行琼脂糖凝胶电泳检测,并对SLURP-1基因扩增产物进行DNA测序.结果 患儿躯干、四肢泛发规则排列的棕褐色或黑色多角形鳞屑,掌跖、肘膝、腹股沟、肛周红斑,过度角化,向背侧延伸,诊断为X连锁鱼鳞病并发Meleda角化病.基因检测提示,STS全基因缺失;SLURP-1基因第3外显子第286位核苷酸发生C→T纯合突变(c.286C＞T),导致其编码蛋白质在第96位氨基酸出现终止改变(p.R96*),其父母均为c.286C＞T杂合突变携带者.健康对照未发现此突变.结论 该患者携带STS全基因缺失和SLURP-1基因纯合无义突变,可能是导致X连锁鱼鳞病并发Meleda角化病的原因.     

Carvajal综合征一例伴桥粒斑蛋白基因新突变

【摘要】 目的 对1例临床表现为羊毛状发,膝盖、掌跖角化性皮损,暂无心脏症状的患儿进行基因突变检测。方法 收集患儿及其父母的临床资料。提取患儿、其父母及100例无关健康对照者外周血DNA,采用二代皮肤靶向测序包检测患儿的基因突变,应用Sanger测序法进行验证。结果 患儿女,3岁,出生头发卷曲,8月龄出现掌跖角化并渐累及膝盖,其父母表型正常。测序发现,患儿桥粒斑蛋白（DSP）基因第23号外显子存在移码突变c.5152dupT（p.L1718Ffs*15）,DSP基因第24号外显子检测到无义突变c.C6478T（p.R2160X）。其母亲DSP基因第23号外显子亦存在c.5152dupT移码突变,但第24号外显子未检测到相关突变。其父亲及100例健康对照中均未检测到相关突变。诊断：Carvajal综合征。结论 该例Carvajal综合征患儿存在DSP基因复合杂合突变c.5152dupT（p.L1718Ffs*15）和c.C6478T（p.R2160X）,可能与其发病有关。     

应用全外显子测序技术筛查LEOPARD综合征患者致病基因一例

目的:报道一例LEOPARD综合征(LS)患者并检测其基因突变。方法:收集患者临床资料，提取该患者及父亲外周血DNA,应用全外显子组高通量测序检测技术，筛查患者致病基因。结果:全外显子测序结果发现患者PTPN11基因12号外显子第1415位核苷酸发生c.1415C>T杂合突变，导致第472号氨基酸由Thr变为Met(p.Thr472Met)。结论:PTPN11基因12号外显子c.1415C>T (p.Thr472Met)突变为该例LEOPARD综合征的致病突变位点。     

KRT9基因突变所致表皮松解性掌跖角化病1例

报告KRT9基因突变所致表皮松解性掌跖角化病1例.患者男,中国籍,32岁,手足角化性斑块30余年.皮肤科检查:双侧掌跖面可见对称性弥漫性角化斑块,皮肤粗糙增厚,呈灰黄色.皮损组织病理:表皮明显角化过度,颗粒层棘层增厚,皮突延长,颗粒细胞变性,考虑掌跖角化病.基因全外显子组测序结果:KRT9基因外显子检测出c.487C＞...     

不伴套叠性脆发的2例Netherton综合征致病基因突变检测

目的:通过基因检测的方法,确诊2例不伴有套叠性脆发表现的Netherton综合征患者。方法:采集患者临床资料,进行皮损组织病理检查及毛发镜检,提取患者及其相关亲属外周血DNA,采用PCR扩增相应可疑致病基因编码区的全部外显子及其侧翼序列并测序。结果:2例患者毛发均未见明显形态学异常。基因检测发现例1及其受累的妹妹SPINK5基因发生c.2260AT纯合突变,导致氨基酸出现p.Lys754*改变,未受累的父母及兄长为该突变的杂合携带者;例2的SPINK5基因发生c.1432CT及c.1693-2del A复合杂合突变,导致氨基酸出现p.Gln478*及剪切位点改变,突变分别来自其健康父母。200例健康正常对照者均未见相同突变。患者CDSN、KRT1、KRT10、KRT2及DSG1基因均未见致病性突变。结论:通过基因检测确诊2例Netherton综合征患者,基因检测为确诊临床表现不典型Netherton综合征的重要方法。     

GJB2基因p.N54H突变致经典型Vohwinkel综合征1例

目的检测1例表现为掌跖角化、假性阿洪及耳聋的Vohwinkel综合征患者的基因变异。方法采集先证者临床信息, 并检测分析基因突变位点。结果先证者临床表现符合经典型Vohwinkel综合征, 基因检测发现GJB2基因c.160A>C(p.N54H)杂合突变, 患者父母及健康对照均未发现此位点变异。结论 GJB2基因c.160A>C(p.N54H)突变首次被发现与经典型Vohwinkel综合征相关, 经典型Vohwinkel综合征及掌跖角皮症伴耳聋之间存在变异位点重叠。     

TP63基因突变导致的不伴指（趾）畸形的ADULT综合征1例

【摘要】 目的 检测1例以外胚层发育不良为主要临床表现的ADULT综合征患者的致病基因。方法 收集先证者临床资料,采集先证者及其父母的外周血,提取基因组DNA,对先证者行遗传性皮肤病目标基因外显子测序,确定候选突变位点,在家系中对该位点行Sanger测序验证。结果 先证者男,22岁,表现为毛发稀疏、变细,颜面部散在雀斑,恒牙缺失,角膜混浊,掌跖红斑、角化,指（趾）甲营养不良,乳头发育不良等。基因检测显示,先证者外周血基因组DNA中TP63基因第8号外显子中存在杂合突变（c.1040G＞T）,导致氨基酸序列发生改变（p.C347F）,其父母表型正常且未检测到该突变位点,突变与疾病表型符合共分离。结论 TP63基因的新发杂合错义突变是先证者的可能致病突变,结合先证者临床表现,诊断为不伴指（趾）畸形的ADULT综合征。     

双下肢浅表播散型汗孔角化症一例基因突变检测

目的：检测一例局限于双下肢的散发浅表播散型汗孔角化症患者致病基因突变。方法：提取患者外周血DNA,在Illumina HiSeq测序平台进行全基因组外显子测序,将测序结果与既往报道的汗孔角化症致病基因比对,采用Sanger测序对发现的突变位点在100例患者中进行验证。结果：最终将DSP的致病基因锁定为位于12号染色体的MVK基因,检测到10号内含子c.1040-2A>C突变位点,在全部正常对照中未检测到该位点。经检索,该突变为浅表播散型和播散性浅表性光线型汗孔角化症的共同突变位点。结论：本家系中MVK基因突变位点(c.1040-2A>C)与浅表播散型汗孔角化症发病相关。     

A new SPINK5 mutation in a patient with Netherton syndrome: a case report

We report on a case of Netherton syndrome showing a new SPINK5 mutation (c.957_960dupTGGT duplication in exon 11), associated with partial defect of biotinidase.     

A Japanese infant with localized ichthyosis linearis circumflexa on the palms and soles harbouring a compound heterozygous mutation in the SPINK5 gene

We report a 6-month-old Japanese boy showing ichthyosis linearis circumflexa localized on the palms and soles. He showed bamboo hairs and aminoaciduria, and was positive for cow's milk and egg IgE antibodies by radioallergosorbent tests. Trypsin-like hydrolytic activity in the patient's lesional stratum corneum showed an activity seven times higher than that in age-matched controls. DNA analysis showed that the patient harboured the compound heterozygous mutations R790X and 1220+1 G-->C in the SPINK5 gene, compatible with the diagnosis of Netherton syndrome (NS). As the genotype/phenotype correlations in NS have not yet been fully clarified, the position of the premature termination codon in the SPINK5 gene may contribute to explain such a mild form of NS in our patient.     

Order and disorder in corneocyte adhesion

Epidermal cornified cells are attached to each other with modified desmosomes, namely corneodesmosomes. Changes in the corneodesmosome degradation process influence the total thickness of the stratum corneum and surface appearance of the skin. The major extracellular constituents of corneodesmosomes are desmoglein 1, desmocollin 1 and corneodesmosin. The intracellular part of corneodesmosomes is cross-linked into cornified cell envelopes. Corneodesmosomes are degraded from the central surface area of each cell. Peripheral corneodesmosomes retain structural integrity up to the skin surface. A hypothesis where tight junctions in the stratum corneum play a role in this spatial difference in corneodesmosome degradation has recently been proposed. Genetic defects in corneodesmosin and inhibitors for proteases involved in corneodesmosome degradation result in accelerated desquamation and severe barrier impairment, presenting as the inflammatory type of peeling skin syndrome and Netherton syndrome, respectively. Abnormal corneodesmosome degradation is also found in more common skin diseases including ichthyosis vulgaris, atopic dermatitis, psoriasis vulgaris, lichen planus and soap-induced xerosis.     

Bjornstad综合征致病BCS1L基因的新发突变位点研究

【摘要】 目的 检测1例以先天性头发扭曲和感音性听力丧失为主要表现的Bj-rnstad综合征（扭曲发综合征）患者的致病基因BCS1L的突变情况。方法 收集患者临床资料,提取患者及其父母的外周血DNA,PCR扩增BCS1L基因全部外显子及侧翼序列并进行Sanger测序,测序结果与正常序列进行比对;取患者头发进行扫描电镜检查。结果 患者BCS1L基因存在2处突变：①第4号外显子上存在杂合无义突变,即第144位密码子CGA→TGA,导致其编码氨基酸序列由精氨酸变为终止密码子（p.R144*）,此为BCS1L基因突变导致Bj-rnstad综合征新发现的致病突变位点,属国际首例;②第8号外显子上存在杂合错义突变,即第306位密码子CGC→CAC,导致其编码氨基酸序列由精氨酸变为组氨酸（p.R306H）。患者母亲仅在BCS1L基因第4号外显子发生c.430 C>T杂合突变（p.R144*）,患者父亲仅在BCS1L基因第8号外显子发生c.917 G>A杂合突变（p.R306H）。扫描电镜显示,患者发干以不规则的间隔出现扁平、沟槽和沿长轴的扭曲。结论 首次报道BCS1L基因第144位密码子CGA→TGA导致的编码终止为该基因突变导致Bj-rnstad综合征的新发突变位点,BCS1L基因复合杂合突变与患者的临床表现相关,基因检测有助于Bj-rnstad综合征的诊断。     

A heterozygous null mutation combined with the G1258A polymorphism of SPINK5 causes impaired LEKTI function and abnormal expression of skin barrier proteins

Background  Loss-of-function mutations in the Kazal-type serine protease inhibitor, LEKTI, encoded by the SPINK5 gene cause the rare autosomal recessive skin disease Netherton syndrome (NS). G1258A polymorphism in SPINK5 may be associated with atopic dermatitis, which shares several clinical features with NS.
Objectives  To determine if the phenotype of NS can be caused by a single null mutation in SPINK5 combined with the homozygous G1258A polymorphism.
Methods  We screened mutations in the gene SPINK5 by direct DNA sequencing and position cloning and examined the expressions of the SPINK5 -encoded protein LEKTI and other relevant proteins by immunostaining and immunoblot.
Results  We describe here a patient who was clinically diagnosed with NS and carried a single null mutation in SPINK5 combined with the homozygous G1258A polymorphism. SPINK5 mRNA was present at normal levels and LEKTI was expressed in the epidermis. Nonetheless, the putative downstream LEKTI substrates stratum corneum trypsin-like enzyme (SCTE), desmoglein 1 and protein markers of keratinocyte differentiation were expressed abnormally, similar to that seen in NS if two null mutant alleles are present.
Conclusion  This finding indicates that haploinsufficiency of SPINK5 can cause the NS phenotype in the presence of one null mutation with homozygous G1258A polymorphisms in SPINK5 , and this could impair the function of LEKTI and therefore acts as a true mutation.     

A novel SPINK5 mutation and successful subcutaneous immunoglobulin replacement therapy in a child with Netherton syndrome

We report a 2-year-old patient with Netherton syndrome presenting with generalized exfoliative erythroderma, ichthyosiform dermatitis, trichorrhexis invaginata, hypernatremic dehydration, failure to thrive, and recurrent respiratory infections. Molecular analysis of SPINK5 identified a novel mutation (c.1530CA). Our case report also verifies and supports the safety and efficacy of subcutaneous immunoglobulin substitution in chronic generalized skin disorders associated with primary immunodeficiencies such as Netherton syndrome.     

A case of a Japanese neonate with congenital ichthyosiform erythroderma diagnosed as Netherton syndrome

We report a 6-day-old Japanese girl showing generalized erythroderma accompanied by yellowish, exfoliative scaling that was accentuated on the face and scalp. Histological analysis showed psoriasiform dermatitis with acanthotic epidermis and premature shedding of the stratum corneum. Measurement of trypsin-like hydrolytic activity in SC showed six-fold greater activity compared with age-matched controls. DNA analysis revealed two mutations, 375delAT and 966insC, in exons 5 and 11, respectively, of the SPINK5 gene. Although at 4 weeks the child was still too young to display characteristic hair abnormalities or atopic diathesis, we diagnosed Netherton syndrome based on enzyme assay and DNA analysis.