Mutations in the Desmoglein 4 Gene Underlie Localized Autosomal Recessive Hypotrichosis with Monilethrix Hairs and Congenital Scalp Erosions Julie V.

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Date of download: 6/2/2016 Copyright © 2016 American Medical Association. All rights reserved. From: Is the Loose Anagen Hair Syndrome a Keratin Disorder?

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Mutations in the Desmoglein 4 Gene Underlie Localized Autosomal Recessive Hypotrichosis with Monilethrix Hairs and Congenital Scalp Erosions Julie V. Schaffer, Hisham Bazzi, Anna Vitebsky, Agnieszka Witkiewicz, Olympia I. Kovich, Hideko Kamino, Lawrence S. Shapiro, Snehal P. Amin, Seth J. Orlow, Angela M. Christiano Journal of Investigative Dermatology Volume 126, Issue 6, Pages 1286-1291 (June 2006) DOI: 10.1038/sj.jid.5700237 Copyright © 2006 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Clinical presentation and family pedigree of the new LAH case. (a) Patchy stubble and (b) irregularly shaped erosions on the older sibling's (II-1) scalp during the first few days of life. (c, d) Short, sparse hairs and follicular papules on the scalp of individual II-1 at age 2 years. (e, f) Trichogram showing elliptical nodes, an irregular diameter and bending, and trichoschisis. (g) The three affected siblings belong to a nonconsanguineous pedigree, with a mother (I-1) of Iranian and a father (I-2) of Iraqi descent. Journal of Investigative Dermatology 2006 126, 1286-1291DOI: (10.1038/sj.jid.5700237) Copyright © 2006 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Histologic findings of scalp biopsies from affected individual II-1 and normal expression of DSG4 in human skin. (a) A biopsy from a noneroded area of the scalp performed on day of life 3 (II-1), demonstrating a thin epidermis, slight fibrosis of the upper dermis, and a hair shaft of uneven diameter within one short, thin anagen follicle. (b–f) A scalp biopsy performed at age 18 months (II-1), showing terminal anagen hairs of normal density with distorted shafts. (b) Up to three hair follicles converge in a single ostium. (c) Slightly hyperplastic epidermis with focal parakeratosis (inset, e) and abnormal stratum corneum. (d) Broken lance head-like hair shaft in an irregular follicle with abnormally keratinizing trichocytes (inset). (f) Irregular hair shafts with an abnormal cortex (arrows). (g) DSG4 expression (green) in normal epidermis is confined to the high spinous and granular layers. (h) The hair cortex is the main expression domain of DSG4 in the hair follicle, consistent with the sites of phenotypic manifestation. (a) Bar=100μm; (b) Bar=200μm; (c, g) Bar=40μm; (d, f) Bar=70μm; (e) Bar=15μm; (h) Bar=85μm. Journal of Investigative Dermatology 2006 126, 1286-1291DOI: (10.1038/sj.jid.5700237) Copyright © 2006 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Molecular analysis of the DSG4 gene in the family. (a) Sequence analysis of the PCR products revealed a mutation in the 5′ donor splice site of intron 3 in all affected individuals. This mutation is designated 216+1G>T. The second mutation is a C-to-G transversion resulting in the substitution of a highly conserved proline at amino acid 267 by arginine (P267R), identified in all affected individuals. The mother and father are heterozygous carriers of the splice site (216+1G>T) and missense mutation (P267R), respectively. (b) Amino-acid sequence of the region surrounding the mutation, showing the highly conserved residues in and around the calcium-binding pocket, as well as the mutated proline 267, highlighted in red, and conserved in both classical and desmosomal cadherins (Patel et al., 2003). (c) Worm diagrams of the calcium-binding sites from the crystal structure of C-cadherin (Boggon et al., 2002) for each calcium-binding region, EC1–EC2, EC2–EC3, EC3–EC4, and EC4–EC5. The DSG4 P267R mutation corresponds to C-cadherin P219. However, all cadherin calcium-binding sites contain analogous proline residues. Each of these is circled in red for all four such residues in the crystal structure of C-cadherin. The affected interface, EC2–EC3, is boxed in red. (d, e) Immunohistochemistry of patient's versus control scalp reveals a decrease in the intensity of DSG4 staining, reflecting the loss of functional mRNA from the maternal mutant allele. (d, e) Bar=40μm. Journal of Investigative Dermatology 2006 126, 1286-1291DOI: (10.1038/sj.jid.5700237) Copyright © 2006 The Society for Investigative Dermatology, Inc Terms and Conditions