Morphological alterations in two siblings with autosomal recessive congenital ichthyosis associated with CYP4F22 mutations. (17th January 2017)

• Record Type: Journal Article
• Authors: Gruber, R.; Rainer, G.; Weiss, A.; Udvardi, A.; Thiele, H.; Eckl, K.M.; Schupart, R.; Nürnberg, P.; Zschocke, J.; Schmuth, M.; Volc‐Platzer, B.; Hennies, H.C.
• Is Part Of: British journal of dermatology. Volume 176:Number 4(2017)
• Page Start: 1068
• Page End: 1073
• Publication Date: 2017-01-17
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.14860
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Autosomal recessive congenital ichthyosis (ARCI) caused by mutations in CYP4F22 is very rare. CyP4F22, a protein of the cytochrome‐P450 family 4, encodes an epidermal ω‐hydroxylase decisive in the formation of acylceramides, which is hypothesized to be crucial for skin‐barrier function. We report a girl with consanguineous parents presenting as collodion baby with contractures of the great joints and palmoplantar hyperlinearity. In the course of the disease she developed fine scaling of the skin with erythroderma, the latter disappearing until the age of 6 months. Her sister showed a generalized fine‐scaling phenotype, and, interestingly, was born without a collodion membrane. The analysis of all known candidate genes for ARCI in parallel with a next‐generation sequencing approach using a newly designed dermatogenetics gene panel revealed a previously unknown homozygous splice‐site mutation c.549+5G>C in CYP4F22 in both girls, confirming the diagnosis of ARCI. Ultrastructural analysis by transmission electron microscopy in both patients showed epidermal hyperplasia, orthohyperkeratosis with persistence of corneodesmosomes into the outer stratum corneum layers, fragmented and disorganized lamellar lipid bilayers, which could be ascribed to inhomogeneous lamellar body secretion, as well as lamellar body and lipid entombment in the corneocytes. These findings correlated with increased transepidermal water loss on the functional level. For the first time, we report a collodion baby phenotype and epidermal barrier impairment in CyP4F22‐deficient epidermis at both the ultrastructural and functional level, and corroborate the importance of CyP4F22 for epidermal maturation and barrier function. Abstract : What's already known about this topic? Autosomal recessive congenital ichthyosis (ARCI) caused by CYP4F22 mutations is very rare. There is evidence that CyP4F22 plays a role in the 12(R)‐lipoxygenase pathway and therefore is important for skin‐barrier function. What does this study add? We report a novel homozygous splice‐site mutation c.549+5G>C in CYP4F22 in two sisters with ARCI, presenting with and without a collodion membrane at birth. Transmission electron microscopy reveals epidermal barrier abnormalities in ARCI with CYP4F22 mutations. Respond to this article Linked Comment:Hausser. Br J Dermatol 2017;176 :863–864