title: Pyloric atresia-junctional epidermolysis bullosa syndrome: mutations in the integrin beta4 gene (ITGB4) in two unrelated patients with mild disease.
abstract: Junctional epidermolysis bullosa associated with pyloric atresia (EB-PA; OMIM 226730) is a rare autosomal recessively inherited disease in which mucocutaneous fragility is associated with gastrointestinal atresia. This disease is usually fatal within the first few weeks or months of life even following surgical correction of the intestinal obstruction. Recently, mutations in the genes encoding the epithelial integrin alpha6beta4 (ITGA6 and ITGB4) have been identified in several patients with EB-PA. We report two unrelated patients with this disease who have survived into early childhood with mild cutaneous involvement, in whom we have identified pathogenetic mutations in ITGB4. The first patient was a compound heterozygote for a splice site mutation in exon 30 (3793 + 1G-to-A) and a non-sense mutation in exon 36 (W1478X), and the second was a compound heterozygote for a missense mutation in exon 3 (C38R) and a 1 bp deletion in exon 36 (4776delG). Although the non-sense and deletion mutations are predicted to result in markedly reduced beta4 integrin mRNA levels, the presence of the missense or splice site mutation on the second allele may enable the synthesis of some functional, albeit perturbed, beta4 polypeptide. Determination of the molecular mechanisms in these two cases increases our understanding of EB-PA and may enable correlation between genotype and phenotype.
authors.affiliation: Department of Cell and Molecular Pathology, St John's Institute of Dermatology (GKT), St Thomas' Hospital, London SE1 7EH, U.K.
authors.forename: J E
authors.initials: JE
authors.lastname: Mellerio
authors.forename: L
authors.initials: L
authors.lastname: Pulkkinen
authors.forename: J R
authors.initials: JR
authors.lastname: McMillan
authors.forename: B D
authors.initials: BD
authors.lastname: Lake
authors.forename: H M
authors.initials: HM
authors.lastname: Horn
authors.forename: M J
authors.initials: MJ
authors.lastname: Tidman
authors.forename: J I
authors.initials: JI
authors.lastname: Harper
authors.forename: J A
authors.initials: JA
authors.lastname: McGrath
authors.forename: J
authors.initials: J
authors.lastname: Uitto
authors.forename: R A
authors.initials: RA
authors.lastname: Eady
mesh_terms: D015703:Antigens, CD / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D016109:Epidermolysis Bullosa, Junctional / Q000235:genetics* / Q000473:pathology; D006801:Humans; D039663:Integrin beta4; D016023:Integrins / Q000235:genetics*; D008297:Male; D009154:Mutation; D010375:Pedigree; D011708:Pylorus / Q000002:abnormalities*; D012867:Skin / Q000648:ultrastructure; D013577:Syndrome
chemical_list: D015703:Antigens, CD; D039663:Integrin beta4; D016023:Integrins