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A homozygous nonsense mutation within the dystonin gene coding for the coiled-coil domain of the epithelial isoform of BPAG1 underlies a new subtype of autosomal recessive epidermolysis bullosa simplex.
[epidermolysis bullosa simplex]
Epidermolysis
bullosa
(
EB
)
is
a
group
of
autosomal
dominant
and
recessive
blistering
skin
diseases
in
which
pathogenic
mutations
have
been
reported
in
13
different
genes
encoding
structural
proteins
involved
in
keratinocyte
integrity
,
as
well
as
cell-matrix
or
cell-cell
adhesion
.
We
now
report
an
inherited
skin
fragility
disorder
with
a
homozygous
nonsense
mutation
in
the
dystonin
gene
(
DST
)
that
encodes
the
coiled-coil
domain
of
the
epithelial
isoform
of
bullous
pemphigoid
antigen
1
,
BPAG
1
-
e
(
also
known
as
BP
230
)
.
The
mutation
,
p
.
Gln
1124
X
,
leads
to
the
loss
of
hemidesmosomal
inner
plaques
and
a
complete
absence
of
skin
immunostaining
for
BPAG
1
-
e
,
as
well
as
reduced
labeling
for
plectin
,
the
beta
4
integrin
subunit
,
and
for
type
XVII
collagen
.
The
38
-
year
-old
affected
individual
has
lifelong
generalized
trauma-induced
spontaneous
blisters
and
erosions
,
particularly
around
the
ankles
.
In
addition
,
he
experiences
episodic
numbness
in
his
limbs
,
which
started
at
the
age
of
37
years
.
These
neurological
symptoms
may
also
be
due
to
DST
gene
mutation
,
although
he
has
a
concomitant
diagnosis
of
CADASIL
(
cerebral
arteriopathy
,
autosomal
dominant
,
with
subcortical
infarcts
and
leukoencephalopathy
)
,
a
cerebral
small
-vessel
arteriopathy
,
which
thus
complicates
the
genotype-phenotype
interpretation
.
With
regard
to
skin
blistering
,
the
clinicopathological
findings
expand
the
molecular
basis
of
EB
by
identifying
BPAG
1
-
e
pathology
in
a
new
form
of
autosomal
recessive
EB
simplex
.
Diseases
Validation
Diseases presenting
"inherited skin fragility disorder with a homozygous nonsense mutation in the dystonin gene"
symptom
epidermolysis bullosa simplex
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