Natural Gene Therapy May Occur in All Patients with Generalized Non-Herlitz Junctional Epidermolysis Bullosa with COL17A1 Mutations Anna M.G. Pasmooij,

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Natural Gene Therapy May Occur in All Patients with Generalized Non-Herlitz Junctional Epidermolysis Bullosa with COL17A1 Mutations Anna M.G. Pasmooij, Miranda Nijenhuis, Renske Brander, Marcel F. Jonkman Journal of Investigative Dermatology Volume 132, Issue 5, Pages 1374-1383 (May 2012) DOI: 10.1038/jid.2011.477 Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Revertant biopsies of patient EB035-01. Absence of blister formation was noted on both the knees. (d) In addition, at least two round patches of clinically healthy skin were present above the right knee. (b) A biopsy taken from affected skin showed lack of Col17 expression (M1) compared with (a) normal human control skin. (e, f, g) Instead, all biopsies taken from unaffected skin (R1, R2, R3) showed reexpression of Col17. (c) A tape strip test showed absence of blister formation in the revertant skin. Journal of Investigative Dermatology 2012 132, 1374-1383DOI: (10.1038/jid.2011.477) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Revertant skin areas in generalized JEB-nH patients. (a, b) The pigmented patches of patient EB035-01 on both his hands resembled the pigmented patches of his brother, i.e., (c) patient EB035-02. In a skin biopsy of patient EB035-02, revertant mosaicism was confirmed (R4). (d, e) The right hand of patient EB208-01 showed two pigmented macular patches (R6 and R5, respectively). The positions of the biopsies are marked with black circles. (f, g) The hands of patients EB011-01 and (h, i) EB117-001 also show similar pigmented areas on both the hands. (j, k) In the 8-year-old patient EB134-01, the pigmented, non-blistering areas are indicated. Clearly visible are the blisters that occur in the surrounding area. Journal of Investigative Dermatology 2012 132, 1374-1383DOI: (10.1038/jid.2011.477) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Revertant skin in patients EB025-01, EB084-01, and EB029-01. Several clinically unaffected areas were present on the (a) back, and (b) lower and (c) upper arms. After sun exposure, the clinically unaffected areas become easily noticeable because of their hyperpigmentation compared with the surrounded skin that is hypopigmented. Note this difference in (a) the neck of the patient and (b) on the lower arm. (d) Occasionally, a hair was present in the healthy skin area. (e) On the back of the 11-year-old boy, EB084-01, hyperpigmented areas were noticed that resembled the revertant skin patches of patient EB025-01 for which in vivo reversion was confirmed on a protein and DNA level. (f) In patient EB029-01 with JEB-nH due to laminin-332 deficiency (Pasmooij et al., 2007a), the revertant skin areas were also pigmented compared with the surrounding affected skin. Journal of Investigative Dermatology 2012 132, 1374-1383DOI: (10.1038/jid.2011.477) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 COL17A1 messenger RNA (mRNA) analysis of revertant and mutant skin biopsies. (a) Schematic depiction of the COL17A1 gene with introns and exons (boxes) with different complementary DNA (cDNA) transcripts of wild-type, Ex30_del, and Ex30+31_del given below. (b) Agarose gel of cDNA amplified with primers F26 and R31. Lane EB098-01 represents cDNA from a patient who is known to have exon 30-skipping (Pasmooij et al., 2004b). Wild-type cDNA resulted in a transcript of 218 bp, whereas the exon 30–deleted transcript was 182bp in size. For the revertant biopsies R1, R2, R3, R4, and R6, almost all cDNA originated from the corrected COL17A1 allele. For revertant biopsy R5 amplified with primers F26 and R31, only cDNA was detected from the mutant COL17A1 allele carrying the c.2237delG mutation. (c) Agarose gel of cDNA amplified with primers F24/25 and R34. Wild-type cDNA resulted in a transcript of 444bp. When cDNA of biopsy R5 was amplified with primers F24/25 and R34, a transcript of 336bp was observed that lacked both exons 30 and 31 that originated from the corrected COL17A1 allele with the large deletion c.2227+153_2336-318del. This transcript lacking exons 30 and 31 could not be amplified with the primers F26 and R31 as used in agarose gel (b), as the sequence to which R31 attaches was missing in the shortened cDNA transcript. MWM, molecular weight marker; NC, negative control; PC, positive control. Journal of Investigative Dermatology 2012 132, 1374-1383DOI: (10.1038/jid.2011.477) Copyright © 2012 The Society for Investigative Dermatology, Inc Terms and Conditions