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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Desquamative enteropathy and pyloric atresia without skin disease caused by a novel intracellular β24 integrin mutation
Journal of Pediatric Gastroenterology and Nutrition, Volume 47, No. 5, Year 2008
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Description
BACKGROUND:: Mutations in α6 or β24 integrins (ITGA6, ITGB4) are known to cause junctional epidermolysis bullosa with pyloric atresia (JEB-PA), often lethal in infancy through skin desquamation. There is 1 report of pyloric atresia associated with a desquamatory enteropathy but without skin disease, of unknown molecular basis. PATIENTS AND METHODS:: We report 2 Kuwaiti siblings with pyloric atresia and life-threatening intestinal desquamation without significant skin abnormality. The older sibling died of intractable diarrhoea, and the younger sibling suffered episodes of massive protein-losing enteropathy, triggered by viral infections, in addition to obstructive uropathy. Mutation analysis was performed for ITGA6 and ITGB4 and expression of ITGA6 and ITGB4 protein was examined in skin and intestinal biopsies. Her serum also was incubated with normal intestine. RESULTS:: We identified a novel mutation in ITGB4, with homozygous deletion of a single residue (isoleucine 1314) within the intracellular plectin-binding domain. Expression of ITGA6 and ITGB4 within skin, duodenal, and colonic epithelium was normal or minimally reduced, in contrast to previous reports. Biopsies taken during relapse showed accumulation of immunoglobulin G and C1q within intestinal basement membrane, whereas immunoglobulin G from her serum bound to basement membrane of normal small intestine. Immunomodulatory therapy induced significant improvement following relapses. CONCLUSIONS:: ITGB4 mutation may induce a desquamative enteropathy in infancy without significant skin disease. A history of pyloric atresia is important in infants with severe chronic diarrhoeal disease and should prompt investigation for JEB-PA associated mutations. Acquired immune responses may exacerbate primary genetic disorders of epithelial adhesion and immunomodulatory therapy may be beneficial. © 2008 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Salvestrini, Camilla
United Kingdom, London
The Royal Free Hospital
McGrath, J. A.
United Kingdom, London
The Royal Free Hospital
Ozoemena, Linda
United Kingdom, London
St Thomas' Hospital
Husain, Khaled
Kuwait, Safat
Al-amiri Hospital
Buhamrah, Eman
Kuwait, Safat
Al-amiri Hospital
Sabery, Nasim
United States, Boston
Boston Children's Hospital
Leichtner, Alan
United States, Boston
Boston Children's Hospital
Rufo, Paul A.
United States, Boston
Boston Children's Hospital
Pérez-Atayde, Antonio R.
United States, Boston
Boston Children's Hospital
Orteu, Cate H.
United Kingdom, London
The Royal Free Hospital
Torrente, Franco
United Kingdom, London
The Royal Free Hospital
Heuschkel, Robert B.
United Kingdom, London
The Royal Free Hospital
Thomson, Michael A.
United Kingdom, Sheffield
Sheffield Children's Hospital
Murch, Simon H.
United Kingdom, Coventry
Warwick Medical School
Statistics
Citations: 25
Authors: 14
Affiliations: 6
Identifiers
Doi:
10.1097/MPG.0b013e31817af98d
ISSN:
02772116
Research Areas
Cancer
Genetics And Genomics
Infectious Diseases