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Modeling dilated cardiomyopathies in epidermolysis bullosa simplex patients using induced pluripotent stem cells with KLHL24 mutations (Raymond 1)

Project lead Dr Karine Raymond
Organisation Leiden University Medical Center, Leiden, THE NETHERLANDS
Project budget EUR 258,000.00
Start date / Duration 01. Jul 2020 / 36 months
Funder(s) / Co-Funder(s) DEBRA Austria, MSAP/EBEP Recommended
Research area EB genetics, epigenetics & biology

Project details

Short lay summary

Mutations in KLHL24 genes cause a new form of epidermolysis bullosa simplex (EBS) associated with high risk of developing dilated cardiomyopathies (DCM). Clinical symptoms include denuded skin areas that heal quickly after birth, the presence of burn-like scars, skin atrophy, hair loss and nail defects. These patients also develop heart defects with ventricular dilation and impaired contraction that strongly affect their quality of life and are a potential source of mortality. The underlying mechanisms responsible for these heart anomalies are unknown and there is no treatment with proven efficacy to prevent these symptoms. Here, we wish to generate from skin tissue of patients with KLHL24 gene mutations, an in vitro human model of EBS-DCM by using the induced pluripotent stem cell (hiPSC) technology. By differentiating hiPSCs into heart cells, we will decipher in depth the heart phenotype and the mechanisms by which altered activity of KLHL24 contributes to the development of DCM.

Scientific summary

Mutations in KLHL24 genes cause a new form of EBS associated with high risk of developing dilated cardiomyopathies (DCM). KLHL24 is a component of the ubiquitin-proteasome system that regulates protein turnover. Mutated KLHL24 proteins are more stable suggesting that excessive degradation of targeted substrates underlies disease development, although the mechanism is not resolved. Here, we aim to model DCM using hiPSCs harboring KLHL24 mutations and isogenic controls that will be differentiated into cardiomyocytes and supporting cells. By identifying KLHL24-substrates and by testing drugs, we expect to gain insights into KLHL24 functions in heart opening new avenues for treatments.

Strategic relevance

If validated, the hiPSC model of the combined EBS-DCM syndrome would be suitable for drug testing and could open new avenues for treatments in a group of patients that has no therapeutic option.

What did this project achieve?

To understand the mechanisms underlying dilated cardiomyopathy (DCM) of epidermolysis bullosa (EB) patients carrying KLHL24 mutation, we developed an in vitro human model of EB-DCM using induced pluripotent stem cell (hiPSC) technology. We combined this approach with the investigation of the heart explants that we obtained after KLHL24 patients underwent heart transplantation. Our study shows that mutation in KLHL24 leads to reduced levels of several proteins in multiple types of cells, demonstrating the need for holistic approach when designing diagnosis, treatment and research models tackling this EB type.


EB Simplex
KLHL24 mutations
Human induced
pluripotent stem cells (hiPSC)
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