Morphological characteristics of fatal pediatric hand, foot and mouth disease: A clinicopathological study with related receptors of EV71
PATHOLOGY RESEARCH AND PRACTICE
Authors: Gu, Yong-yao; Shi, Ke; Yao, Sha; Yang, Xia; Liu, Yu-hui; Tang, Lan; Dang, Yi-wu; Chen, Gang; Feng, Zhen-bo; Pan, Hong-bo
Abstract
Objective: To investigate the pathological features of fatal pediatric hand foot and mouth disease (HFMD). Methods: The histopathological features of HFMD were first summarized from literature, and then confirmed by in-house autopsies. Furthermore, immunohistochemistry was conducted to detect the distribution and expression level of two enterovirus 71 (EV71) receptors scavenger receptor class B, member 2 (SCARB2), and P-selectin glycoprotein ligand-1 (PSGL1) in the samples of autopsies. Results: The main symptoms of HFMD included hand and foot rashes, as well as oral herpes. The fatal HFMD patients had typical histopathological change in the central nervous system, such as encephaledema and encephalitis. As for respiratory system, the fatal HFMD patients suffered acute pulmonary edema and congestion. SCARB2 positive signaling was distributed equally in bronchial and bronchiolar epithelial cells, alveolar epithelial cells and inflammatory cells of all HFMD patients, healthy children and adults without significant difference. PSGL-1 dispersed in bronchial and bronchiolar epithelial cells of healthy adults, but no PSGL-1 expression was detected in HFMD patients and healthy children. Conclusions: Both of the central nervous and respiratory systems may be involved in the fatal HFMD patients. The EV71 receptor PSGL-1 might play essential parts in the pathogenesis of fatal HFMD, however, the hypothesis needs to be further investigated. (C) 2017 Elsevier GmbH. All rights reserved.
SCARB2 Mutations in Progressive Myoclonus Epilepsy (PME) Without Renal Failure
ANNALS OF NEUROLOGY
Authors: Dibbens, L. M.; Michelucci, R.; Gambardella, A.; Andermann, F.; Rubboli, G.; Bayly, M. A.; Joensuu, T.; Vears, D. F.; Franceschetti, S.; Canafoglia, L.; Wallace, R.; Bassuk, A. G.; Power, D. A.; Tassinari, C. A.; Andermann, E.; Lehesjoki, A. E.; Berkovic, S. F.
Abstract
Objective: Mutations in SCARB2 were recently described as causing action myoclonus renal failure syndrome (AMRF). We hypothesized that mutations in SCARB2 might account for unsolved cases of progressive myoclonus epilepsy (PME) without renal impairment, especially those resembling Unverricht-Lundborg disease (ULD). Additionally, we searched for mutations in the PRICKLE1 gene, newly recognized as a cause of PME mimicking ULD. Methods: We reviewed cases of PME referred for diagnosis over two decades in which a molecular diagnosis had not been reached. Patients were classified according to age of onset, clinical pattern, and associated neurological signs into "ULD-like" and "not ULD-like." After exclusion of mutations in cystatin B (CSTB), DNA was examined for sequence variation in SCARB2 and PRICKLE1. Results: Of 71 cases evaluated, 41 were "ULD-like" and five had SCARB2 mutations. None of 30 "not ULD-like" cases were positive. The five patients with SCARB2 mutations had onset between 14 and 26 years of age, with no evidence of renal failure during 5.5 to 15 years of follow-up; four were followed until death. One living patient had slight proteinuria. A subset of 25 cases were sequenced for PRICKLE1 and no mutations were found. Interpretation: Mutations in SCARB2 are an important cause of hither-to unsolved cases of PME resembling ULD at onset. SCARB2 should be evaluated even in the absence of renal involvement. Onset is in teenage or young adult life. Molecular diagnosis is important for counseling the patient and family, particularly as the prognosis is worse than classical ULD.