{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T03:14:23Z","timestamp":1790910863396,"version":"4.1.0"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2008,11,1]],"date-time":"2008-11-01T00:00:00Z","timestamp":1225497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2008,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background:<\/jats:title><jats:p>Mutations in \u03b16 or \u03b24 integrins (ITGA6, ITGB4) are known to cause junctional epidermolysis bullosa with pyloric atresia (JEB\u2010PA), often lethal in infancy through skin desquamation. There is 1 report of pyloric atresia associated with a desquamatory enteropathy but without skin disease, of unknown molecular basis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and Methods:<\/jats:title><jats:p>We report 2 Kuwaiti siblings with pyloric atresia and life\u2010threatening intestinal desquamation without significant skin abnormality. The older sibling died of intractable diarrhoea, and the younger sibling suffered episodes of massive protein\u2010losing enteropathy, triggered by viral infections, in addition to obstructive uropathy. Mutation analysis was performed for ITGA6 and ITGB4 and expression of ITGA6 and ITGB4 protein was examined in skin and intestinal biopsies. Her serum also was incubated with normal intestine.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>We identified a novel mutation in ITGB4, with homozygous deletion of a single residue (isoleucine 1314) within the intracellular plectin\u2010binding domain. Expression of ITGA6 and ITGB4 within skin, duodenal, and colonic epithelium was normal or minimally reduced, in contrast to previous reports. Biopsies taken during relapse showed accumulation of immunoglobulin G and C1q within intestinal basement membrane, whereas immunoglobulin G from her serum bound to basement membrane of normal small intestine. Immunomodulatory therapy induced significant improvement following relapses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>ITGB4 mutation may induce a desquamative enteropathy in infancy without significant skin disease. A history of pyloric atresia is important in infants with severe chronic diarrhoeal disease and should prompt investigation for JEB\u2010PA associated mutations. Acquired immune responses may exacerbate primary genetic disorders of epithelial adhesion and immunomodulatory therapy may be beneficial.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0b013e31817af98d","type":"journal-article","created":{"date-parts":[[2010,2,25]],"date-time":"2010-02-25T06:42:44Z","timestamp":1267080164000},"page":"585-591","source":"Crossref","is-referenced-by-count":25,"title":["Desquamative Enteropathy and Pyloric Atresia Without Skin Disease Caused by a Novel Intracellular \u03b24 Integrin Mutation"],"prefix":"10.1002","volume":"47","author":[{"given":"Camilla","family":"Salvestrini","sequence":"first","affiliation":[{"name":"Centre for Paediatric Gastroenterology UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"McGrath","sequence":"additional","affiliation":[{"name":"National Diagnostic Epidermolysis Bullosa Laboratory St Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Ozoemena","sequence":"additional","affiliation":[{"name":"National Diagnostic Epidermolysis Bullosa Laboratory St Thomas' Hospital London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Husain","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Amiri Hospital Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Buhamrah","sequence":"additional","affiliation":[{"name":"Department of Paediatrics Amiri Hospital Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nasim","family":"Sabery","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nutrition MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Leichtner","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Nutrition MA 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