Gene-Targeted Next Generation Sequencing Identifies PNPLA1 Mutations in Patients with a Phenotypic Spectrum of Autosomal Recessive Congenital Ichthyosis:

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Gene-Targeted Next Generation Sequencing Identifies PNPLA1 Mutations in Patients with a Phenotypic Spectrum of Autosomal Recessive Congenital Ichthyosis: The Impact of Consanguinity  Hassan Vahidnezhad, Leila Youssefian, Amir Hossein Saeidian, Sirous Zeinali, Parvin Mansouri, Soheila Sotoudeh, Mohammadreza Barzegar, Javad Mohammadi-asl, Razieh Karamzadeh, Maryam Abiri, Kevin McCormick, Paolo Fortina, Jouni Uitto  Journal of Investigative Dermatology  Volume 137, Issue 3, Pages 678-685 (March 2017) DOI: 10.1016/j.jid.2016.11.012 Copyright © 2016 The Authors Terms and Conditions

Figure 1 Clinical features and histopathology of patients with PNPLA1 mutations. (a–f, k, o) Note hyperkeratotic scaly lesions with ectropion, as well as (h) hyperlinearity of the palms, and (i, j) acrogeric features on the backs of the hands in a 7-year-old patient, and (l) of a 32-year old patient. Also note (d, g) erythroderma, (f, g) malformation of the outer ears, and (m, n) nail dystrophy. (p) Characteristic histopathological findings include lamellar orthokeratosis, focal parakeratosis, and mild psoriasiform acanthosis; granular layer appears normal in epidermis. In the upper dermis, there is vascular proliferation, ectasia, and sparse perivascular inflammatory cell infiltrate. Scale bar = 50 μm). (q–t) Illustration of the evolvement of the clinical phenotype of the 8-year-old patient shown in d and g, showing (q, r) collodion membrane at birth, (s, t) which resolved 1 year later. All subjects and parents of underaged patients gave written informed consent to publish their images. Journal of Investigative Dermatology 2017 137, 678-685DOI: (10.1016/j.jid.2016.11.012) Copyright © 2016 The Authors Terms and Conditions

Figure 2 Family pedigrees and identification of mutations in PNPLA1 in nine families with ichthyosis. (a–i) The probands are indicated by arrowheads, and the affected individuals tested for mutations are identified by a number (family-patient) to allow reference to Supplementary Table S1. The parents of the probands in whom the mutations were verified in the heterozygous state are indicated by red asterisks. Note the consanguinity in all families; the parents of the probands are in most cases first cousins (Table 1). The positions of the homozygous nucleotide substitutions resulting in missense mutations are indicated by red arrows. Journal of Investigative Dermatology 2017 137, 678-685DOI: (10.1016/j.jid.2016.11.012) Copyright © 2016 The Authors Terms and Conditions

Figure 3 Gene and protein structures of PNPLA1 and the positions of pathogenic mutations. (a) The PNPLA1 gene consists of eight exons with their sizes (bp) indicated in parenthesis. (The introns are not drawn to scale). The genomic sequences encoding patatin-like and proline-rich domains are indicated. Amino acid residues essential for enzymatic activity are indicated by yellow triangles. The positions of mutations identified in this study that were, to our knowledge, previously unreported are indicated in red above the gene structure, and those previously reported are in black below. Note that all mutations reside within the gene segment encoding the patatin-like protein domain. (b) Structural representation of patatin-like domain of PNPLA1 (residues Ile16-Thr185) with the catalytic center adjacent to residue Ser53 being shown by dashed circle with yellow overlay. Mutations that are likely to interfere with catalytic activity are colored in pink. Mutations that are located at the protein interface are indicated in green. Oxygen, hydrogen, nitrogen, and carbon atoms are in red, white, blue, and cyan, respectively (stick-and-ball structures). Aa, amino acids; bp, base pairs; Ex, exon; TGA, stop codon; UTR, translated region. Journal of Investigative Dermatology 2017 137, 678-685DOI: (10.1016/j.jid.2016.11.012) Copyright © 2016 The Authors Terms and Conditions