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Huang J, Zu Y, Zhang L, Cui W. Progress in Procalcitonin Detection Based on Immunoassay. RESEARCH (WASHINGTON, D.C.) 2024; 7:0345. [PMID: 38711476 PMCID: PMC11070848 DOI: 10.34133/research.0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/04/2024] [Indexed: 05/08/2024]
Abstract
Procalcitonin (PCT) serves as a crucial biomarker utilized in diverse clinical contexts, including sepsis diagnosis and emergency departments. Its applications extend to identifying pathogens, assessing infection severity, guiding drug administration, and implementing theranostic strategies. However, current clinical deployed methods cannot meet the needs for accurate or real-time quantitative monitoring of PCT. This review aims to introduce these emerging PCT immunoassay technologies, focusing on analyzing their advantages in improving detection performances, such as easy operation and high precision. The fundamental principles and characteristics of state-of-the-art methods are first introduced, including chemiluminescence, immunofluorescence, latex-enhanced turbidity, enzyme-linked immunosorbent, colloidal gold immunochromatography, and radioimmunoassay. Then, improved methods using new materials and new technologies are briefly described, for instance, the combination with responsive nanomaterials, Raman spectroscopy, and digital microfluidics. Finally, the detection performance parameters of these methods and the clinical importance of PCT detection are also discussed.
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Affiliation(s)
- Jiayue Huang
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-targeting Theranostics, Guangxi Key Laboratory of Bio-targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy,
Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
| | - Yan Zu
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health); Wenzhou Institute,
University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325000, P.R. China
| | - Lexiang Zhang
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health); Wenzhou Institute,
University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325000, P.R. China
- Joint Centre of Translational Medicine,
the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325035, P.R. China
| | - Wenguo Cui
- State Key Laboratory of Targeting Oncology, National Center for International Research of Bio-targeting Theranostics, Guangxi Key Laboratory of Bio-targeting Theranostics, Collaborative Innovation Center for Targeting Tumor Diagnosis and Therapy,
Guangxi Medical University, Nanning, Guangxi 530021, P.R. China
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases,
Shanghai Institute of Traumatology and Orthopedics,Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai 200025, P.R. China
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Alrashdan MS, Andreadis D, Zisis V, Hassona Y. Immune-mediated oral mucosal pathology: a comprehensive review and update for clinicians - part II. Ital J Dermatol Venerol 2024; 159:11-22. [PMID: 38345290 DOI: 10.23736/s2784-8671.23.07690-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The oral mucosa can be involved in a wide variety of mucocutaneous conditions that may present primarily in the mouth or affect other cutaneous or mucosal sites. Many of these conditions are immune mediated and typically present as inflammatory mucosal pathology. Patients experiencing such conditions usually seek medical evaluation and treatment due to the associated pain and discomfort, and occasionally taste disturbance or dysphagia and the overall deterioration in the oral health-related quality of life. These conditions share some common features and there could be some overlap in their clinical presentation, which can lead to delays in diagnosis and proper management of patients. Clinicians dealing with such disorders, including dermatologists, need to be aware of the oral manifestations of mucocutaneous conditions, their clinical features, underlying mechanisms, diagnostic approaches, and treatment options, as well as the recent advances in the research on these conditions. This review provides a comprehensive, evidence-based reference for clinicians, with updated insights into a group of immune mediated conditions known to cause oral mucosal pathology. Part one will cover oral lichen planus, erythema multiforme and systemic lupus erythematosus, while part two will cover recurrent aphthous stomatitis, pemphigus vulgaris and mucous membrane pemphigoid, in addition to the less common disorders linear IgA disease, dermatitis herpetiformis and epidermolysis bullosa.
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Affiliation(s)
- Mohammad S Alrashdan
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates -
- Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan -
| | - Dimitrios Andreadis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Zisis
- Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Yazan Hassona
- Faculty of Dentistry, Al-Ahliyya Amman University, Amman, Jordan
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Mee JB. Diagnostic Techniques in Autoimmune Blistering Diseases. Br J Biomed Sci 2023; 80:11809. [PMID: 38074463 PMCID: PMC10704243 DOI: 10.3389/bjbs.2023.11809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
Autoimmune blistering diseases (AIBD) comprise a heterogeneous group of uncommon disorders of the skin and mucous membranes, characterised by antibodies targeting structural proteins within epithelial tissue and the underlying basement membrane. There can be significant overlap in clinical presentation of these diseases and accurate diagnosis relies on the detection and characterisation of relevant autoantibodies. Immunofluorescence provides the gold-standard diagnostic tool for these diseases, identifying both tissue-bound autoantibodies in biopsy material using direct immunofluorescence and circulating antibodies in serum through indirect immunofluorescence. Following advances in the identification and subsequent characterisation of numerous antigenic targets in these diseases, the development of antigen-specific tests, in particular, enzyme-linked immunosorbent assays on serum specimens, has provided a third key tool to not only identify, but also quantify AIBD autoantibodies. This quantification has proven particularly useful in monitoring disease activity and informing clinical management decisions. Accurate diagnosis of these diseases is important since optimal treatment strategies differ between them and, prognostically, some diagnoses are associated with an increased risk of malignancy. This review outlines the molecular pathology underlying the major AIBD and describes how the three principal techniques can be used in combination, to provide best practice for diagnosis and treatment monitoring.
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Affiliation(s)
- John B. Mee
- Immunodermatology Laboratory, St John’s Institute of Dermatology, Synnovis Analytics, St Thomas’ Hospital, London, United Kingdom
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Opelka B, Schmidt E, Goletz S. Type XVII collagen: Relevance of distinct epitopes, complement-independent effects, and association with neurological disorders in pemphigoid disorders. Front Immunol 2022; 13:948108. [PMID: 36032160 PMCID: PMC9400597 DOI: 10.3389/fimmu.2022.948108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
Pemphigoid diseases (PD) are autoimmune skin blistering diseases characterized by autoantibodies directed against proteins of the cutaneous basement membrane zone (BMZ). One of the major antigens is type XVII collagen (BP180), a transmembrane glycoprotein, which is targeted in four PDs: bullous pemphigoid, mucous membrane pemphigoid, linear IgA dermatosis, and pemphigoid gestationis. To date, different epitopes on BP180 have been described to be recognized by PD disease patients’ autoantibodies. Different BP180 epitopes were associated with distinct clinical phenotypes while the underlying mechanisms are not yet fully understood. So far, the main effects of anti-BP180 reactivity are mediated by Fcγ-receptors on immune cells. More precisely, the autoantibody–antigen interaction leads to activation of complement at the BMZ and infiltration of immune cells into the upper dermis and, by the release of specific enzymes and reactive oxygen species, to the degradation of BP180 and other BMZ components, finally manifesting as blisters and erosions. On the other hand, inflammatory responses independent of Fcγ-receptors have also been reported, including the release of proinflammatory cytokines and internalization and depletion of BP180. Autoantibodies against BP180 can also be found in patients with neurological diseases. The assumption that the clinical expression of PD depends on epitope specificity in addition to target antigens, autoantibody isotypes, and antibody glycosylation is supported by the observation that epitopes of PD patients differ from those of PD patients. The aim of the present review is to describe the fine specificities of anti-BP180 autoantibodies in different PDs and highlight the associated clinical differences. Furthermore, the direct effects after binding of the autoantibodies to their target are summarized.
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Affiliation(s)
- Bianca Opelka
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- *Correspondence: Stephanie Goletz,
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5
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Dikmen HO, Yilmaz K, Benoit S, Bernard P, Drenovska K, Gerdes S, Gläser R, Günther C, Homey B, Horváth ON, Huilaja L, Joly P, Kiritsi D, Meller S, Patsatsi A, Sárdy M, Schauer F, Shahid M, Sticherling M, Tasanen K, Vassileva S, Worm M, Zillikens D, Sadik CD, van Beek N, König IR, Schmidt E. Serum autoantibody reactivity in bullous pemphigoid is associated with neuropsychiatric disorders and the use of antidiabetics and antipsychotics: a large prospective cohort study. J Eur Acad Dermatol Venereol 2022; 36:2181-2189. [PMID: 35796163 DOI: 10.1111/jdv.18414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP), the by far most frequent autoimmune blistering skin disease (AIBD), is immunopathologically characterized by autoantibodies against the two hemidesmosomal proteins BP180 (collagen type XVII) and BP230 (BPAG1 or dystonin). Several comorbidities and potentially disease-inducing medication have been described in BP, yet, a systematic analysis of these clinically relevant findings and autoantibody reactivities has not been performed. OBJECTIVE To determine associations of autoantibody reactivities with comorbidities and concomitant medication. METHODS In this prospective multicenter study, 499 patients diagnosed with BP in sixteen European referral centers were included. The relation between anti-BP180 NC16A and anti-BP230 IgG ELISA values at the time of diagnosis as well as comorbidities and concomitant medication collected by a standardized form were analyzed. RESULTS An association between higher serum anti-BP180 reactivity and neuropsychiatric but not atopic and metabolic disorders was observed as well as with the use of insulin or antipsychotics but not with dipeptidyl peptidase-4 (DPP4) inhibitors, inhibitors of platelet aggregation and L-thyroxine. The use of DPP4 inhibitors was associated with less anti-BP180 and anti-BP230 reactivity compared to BP patients without these drugs. This finding was even more pronounced when compared with diabetic BP patients without DPP4 inhibitors. Associations between anti-BP180 and anti-BP230 reactivities were also found in patients using insulin and antipsychotics, respectively, compared with patients without this medication, but not for the use of inhibitors of platelet aggregation, and L-thyroxine. CONCLUSION Taken together, these data imply a relation between autoantibody reactivities at the time of diagnosis and both neuropsychiatric comorbidities as well as distinct concomitant medication suggesting a link between the pathological immune mechanisms and clinical conditions that precede the clinically overt AIBD.
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Affiliation(s)
| | - Kaan Yilmaz
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Sandrine Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | | | - Kossara Drenovska
- Department of Dermatology, Medical University Sofia, Sofia, Bulgaria
| | - Sascha Gerdes
- Department of Dermatology, Venerology and Allergology, University of Kiel, Kiel, Germany
| | - Regine Gläser
- Department of Dermatology, Venerology and Allergology, University of Kiel, Kiel, Germany
| | - Claudia Günther
- Department of Dermatology, University of Dresden, Dresden, Germany
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Orsolya N Horváth
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Laura Huilaja
- PEDEGO Research Unit, Department of Dermatology, Medical Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pascal Joly
- Department of Dermatology, University of Rouen, Rouen, France
| | - Dimitra Kiritsi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Meller
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Aikaterini Patsatsi
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.,Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Franziska Schauer
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Shahid
- Department of Dermatology, Medical University Sofia, Sofia, Bulgaria
| | | | - Kaisa Tasanen
- PEDEGO Research Unit, Department of Dermatology, Medical Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Snejina Vassileva
- Department of Dermatology, Medical University Sofia, Sofia, Bulgaria
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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Sung YY, Cho YT, Chu CY. Cutaneous-type pemphigus vulgaris might be a transient subtype in pemphigus vulgaris: a case series. J Eur Acad Dermatol Venereol 2022; 36:e903-e905. [PMID: 35734818 DOI: 10.1111/jdv.18348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y-Y Sung
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-T Cho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-Y Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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7
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Endo H. BP180NC16a autoantibody positivity may predict low-risk mucous membrane pemphigoid. Oral Dis 2022. [PMID: 35332632 DOI: 10.1111/odi.14198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 03/12/2022] [Accepted: 03/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of the present study was to explore the clinical characteristics of BP180NC16a autoantibody-positive mucous membrane pemphigoid. SUBJECTS AND METHODS Data from 22 patients were collected by retrospective chart review. For the detection of BP180NC16a autoantibody, a commercially available enzyme-linked immunosorbent assay or chemiluminescent enzyme immunoassay kit was used. The patients were classified into the following clinical phenotypes: low-risk patients who had lesions only in the oral mucosa or in the oral mucosa and skin and high-risk patients who had lesions in the oral mucosa and any of the following sites: the eyes, upper respiratory tract, or esophagus. RESULTS Eleven of the 22 patients (50%) were BP180NC16a-positive at the time of diagnosis. All the positive patients were in the low-risk group. There was a significant difference in the incidence of low-risk mucous membrane pemphigoid between BP180NC16a autoantibody-positive and BP180NC16a autoantibody-negative patients (P = 0.004). Patients' age, disease duration, and oral disease activity scores were not significantly different between the two groups. CONCLUSION BP180NC16a reactivity was associated with the clinical phenotype characterized by only oral mucosal lesions or combined oral mucosal and skin lesions. BP180NC16a autoantibody might be useful as a serum marker to predict low-risk mucous membrane pemphigoid.
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Affiliation(s)
- Hiroyasu Endo
- Department of Oral Diagnostics, Nihon University, School of Dentistry at Matsudo, Japan
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Costan VV, Popa C, Hâncu MF, Porumb-Andrese E, Toader MP. Comprehensive review on the pathophysiology, clinical variants and management of pemphigus (Review). Exp Ther Med 2021; 22:1335. [PMID: 34630689 PMCID: PMC8495539 DOI: 10.3892/etm.2021.10770] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022] Open
Abstract
Pemphigus represents a group of chronic inflammatory disorders characterized by autoantibodies that target components of desmosomes, leading to the loss of intercellular adhesion between keratinocytes and causing intraepithelial blistering. The pemphigus group consists of four main clinical types with several variants: pemphigus vulgaris (with pemphigus vegetans and pemphigus herpetiformis as variants), pemphigus foliaceus, paraneoplastic pemphigus and IgA pemphigus (with two clinical variants: intraepidermal neutrophilic IgA dermatosis and subcorneal pustular dermatosis). Genetic factors are involved in the pathogenesis, with HLA-DR4 (DRB1*0402) and HLA-DRw6 (DQB1*0503) allele more common in patients with pemphigus vulgaris, HLA class II DRB1*0344 and HLA Cw*1445 correlated with paraneoplastic pemphigus, and HLA-DRB1*04:01, HLA-DRB1*04:06, HLA-DRB1*01:01, HLA-DRB1*14, associated with a higher risk of developing pemphigus foliaceus. Autoantibodies are conducted against structural desmosomal proteins in the skin and mucous membranes, mainly desmogleins, desmocollins and plakins. Cell-mediated immunity may also play a role, especially in paraneoplastic pemphigus. Patients may present erythema, blisters, erosions, and ulcers that may affect the skin, as well as mucosal surfaces of the oral cavity, eyes, nose, leading to severe complaints including pain, dysphagia, and fetor. Oral mucosal postbullous erosive lesions are frequently the first sign of disease in pemphigus vulgaris and in paraneoplastic pemphigus, without skin involvement, making the diagnosis difficult. Treatment options classically include immunosuppressive agents, such as corticosteroids and corticosteroid-sparing agents such as azathioprine, mycophenolate mofetil, cyclophosphamide, methotrexate or dapsone. Newer therapies focus on blocking cell signaling events induced by pathogenic autoantibodies and/or targeting specific autoantibodies. The disease evolution is conditioned by the treatment with maximum doses of corticosteroids and the side effects associated with long-term immunosuppressive therapy, which is why patients need a multidisciplinary approach in following the treatment. In this review, we provide a comprehensive overview of the epidemiology, pathophysiology, clinical aspect, diagnosis and management of the main intraepidermal blistering diseases from the pemphigus group.
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Affiliation(s)
- Victor-Vlad Costan
- Department of Oral and Maxillofacial Surgery, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Cristina Popa
- Department of Oral Medicine and Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Mădălina Florina Hâncu
- Department of Dermatology, 'Sf. Spiridon' Clinical Emergency County Hospital, 700111 Iași, Romania
| | - Elena Porumb-Andrese
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Mihaela Paula Toader
- Department of Oral Medicine and Oral Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iași, Romania
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Jerbi A, Hachicha H, Feki S, Abida O, Bahloul E, Sellami K, Bouzid A, Turki H, Masmoudi A, Masmoudi H. Autoantibodies against Desmoglein 1 and 3 in South Tunisian pemphigus. LA TUNISIE MEDICALE 2021; 99:992-999. [PMID: 35288901 PMCID: PMC8972175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Desmoglein (Dsg) 1 and 3 are the 2 major autoantigens in pemphigus foliaceus (PF) and pemphigus vulgaris (PV). AIM We aimed to determine anti-Dsg1 and 3 Abs'usefulness in the diagnosis of pemphigus and to assess the correlation of these antibodies (Abs) with clinical phenotype and disease activity in south Tunisian patients. METHODS We retrospectively analyzed 131 samples from 82 patients (52 with PF and 30 with PV) during follow-up. Anti-Dsg1 and 3 Abs were measured by ELISA. Consecutive anti-Dsg1 and 3 Abs were correlated with disease activity. Receiver operating characteristics (ROC) curve were calculated to determine anti-Dsg1 and 3 Abs'cut-offs with optimal sensitivity and specificity for disease activity. RESULTS Anti-Dsg1 and 3 levels were associated to in PF and PV patients respectively (p<0,001). Anti-Dsg1 and 3 Ab were associated with skin (95%) and mucosal (60%) lesions, respectively. A significant decrease of anti-Dsg1 Abs was observed in patients with PF in clinical remission (36 ± 62 U/mL; (p=0,04). No correlation was found between anti-Dsg3 Abs and the course of mucosal lesions in PV (p=0,3). During follow-up, anti-Dsg1 Abs correlated with relapses (177 ±60 U/mL ; p=0,04). The 161,5 U/mL cut-off for anti-Dsg1 Abs provided 100% specificity and 86,4% sensitivity in PF disease activity. The 30,7U/mL cut-off for anti-Dsg3 provided 89,5% sensitivity and 100% specificity in PV. CONCLUSIONS High anti-Dsg3 Abs values are not always associated with PV disease activity. Anti-Dsg1 Abs showed a closer relationship with skin activity in PS and should be therefore taken into account in management of pemphigus patients.
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Affiliation(s)
- Ameni Jerbi
- 1-Laboratoire d’Immunologie, CHU Habib Bourguiba Sfax, Tunisie / Faculté de médecine de Sfax
| | - Hend Hachicha
- 1-Laboratoire d’Immunologie, CHU Habib Bourguiba Sfax, Tunisie / Faculté de médecine de Sfax
| | - Sawsan Feki
- 1-Laboratoire d’Immunologie, CHU Habib Bourguiba Sfax, Tunisie / Faculté de médecine de Sfax
| | - Olfa Abida
- 1-Laboratoire d’Immunologie, CHU Habib Bourguiba Sfax, Tunisie / Faculté de médecine de Sfax
| | - Emna Bahloul
- 2-Service de Dermatologie, CHU Hedi CHAKER Sfax, Tunisie / Faculté de médecine de Sfax
| | - Khadija Sellami
- 2-Service de Dermatologie, CHU Hedi CHAKER Sfax, Tunisie / Faculté de médecine de Sfax
| | - Amina Bouzid
- 1-Laboratoire d’Immunologie, CHU Habib Bourguiba Sfax, Tunisie / Faculté de médecine de Sfax
| | - Hamida Turki
- 2-Service de Dermatologie, CHU Hedi CHAKER Sfax, Tunisie / Faculté de médecine de Sfax
| | - Abderrahmen Masmoudi
- 2-Service de Dermatologie, CHU Hedi CHAKER Sfax, Tunisie / Faculté de médecine de Sfax
| | - Hatem Masmoudi
- 1-Laboratoire d’Immunologie, CHU Habib Bourguiba Sfax, Tunisie / Faculté de médecine de Sfax
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10
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Jindal A, Rao C, Pai SB, Rao R. Utility of oral mucosa as a substrate for the serodiagnosis of pemphigus: A descriptive analysis. Indian J Dermatol Venereol Leprol 2021; 88:156-161. [PMID: 34491669 DOI: 10.25259/ijdvl_469_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The indirect immunofluorescence test is useful in the serodiagnosis of pemphigus. As indirect immunofluorescence titers correlate with disease activity in pemphigus, it is often used as a monitoring tool. The sensitivity of indirect immunofluorescence depends on the substrate used, and the preferred substrates are monkey esophagus for pemphigus vulgaris and normal human skin for pemphigus foliaceus. AIMS We evaluated oral mucosa as a substrate for indirect immunofluorescence in pemphigus. METHODS Fifty patients with pemphigus (40 with pemphigus vulgaris and ten with pemphigus foliaceus) and 50 controls were enrolled for study. Demographic and clinical details were recorded and indirect immunofluorescence using two substrates (oral mucosa and normal human skin) was carried out in serial dilution. Desmoglein (Dsg) 1 and 3 enzyme-linked immunosorbent assay was also evaluated simultaneously. RESULTS Indirect immunofluorescence was positive in 40 patients (80%) with oral mucosa substrate and 34 patients (68%) with normal human skin substrate. Circulating antibodies were detected with oral mucosa in 33 (82.5%) of the 40 pemphigus vulgaris patients and in 26 (65%) patients using normal human skin. Antibodies were detected in eight of the ten pemphigus foliaceus patients (80%) with normal human skin and in seven (70%) patients with oral mucosa. Dsg enzyme-linked immunosorbent assay was positive in 45 (90%) patients, and 37 of these were also indirect immunofluorescence positive with oral mucosa. In the five Dsg enzyme-linked immunosorbent assay-negative patients, indirect immunofluorescence with oral mucosa was positive in three. LIMITATIONS A comparison of oral mucosa with monkey esophagus could not be performed. CONCLUSION Oral mucosa is a suitable and sensitive substrate for indirect immunofluorescence in pemphigus. Further studies comparing the sensitivity of indirect immunofluorescence using oral mucosa with monkey esophagus are recommended.
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Affiliation(s)
- Anuradha Jindal
- Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chythra Rao
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Satish B Pai
- Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Raghavendra Rao
- Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Van de Gaer O, de Haes P, Bossuyt X. Detection of circulating anti-skin antibodies by indirect immunofluorescence and by ELISA: a comparative systematic review and meta-analysis. Clin Chem Lab Med 2021; 58:1623-1633. [PMID: 32335537 DOI: 10.1515/cclm-2019-1031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 03/03/2020] [Indexed: 12/24/2022]
Abstract
Background Both enzyme-linked immunosorbent assays (ELISAs) and indirect immunofluorescence (IIF) are available for the diagnosis of autoimmune bullous diseases (AIBD). Many studies have reported on the performance of ELISAs and concluded that ELISAs could replace IIF. This study compares the diagnostic accuracy of ELISA and IIF for the detection of autoantibodies to desmoglein 1 (DSG1), desmoglein 3 (DSG3), bullous pemphigoid antigen 2 (BP180) and bullous pemphigoid antigen 1 (BP230) to support the diagnosis of pemphigus vulgaris (PV), pemphigus foliaceus (PF) and bullous pemphigoid (BP). Methods A literature search was performed in the PubMed database. The meta-analysis was performed using summary values and a bivariate random effect model. Results The five included studies on PV did not demonstrate significant differences between IIF and DSG3-ELISA (sensitivity 82.3% vs. 81.6%, p = 0.9284; specificity 95.6% vs. 93.9%, p = 0.5318; diagnostic odds ratio [DOR] 101.60 vs. 67.760, p = 0.6206). The three included studies on PF did not demonstrate significant differences between IIF and DSG1-ELISA (sensitivity 80.6% vs. 83.1%, p = 0.8501; specificity 97.5% vs. 93.9%, p = 0.3614; DOR 160.72 vs. 75.615, p = 0.5381). The eight included studies on BP showed that BP230-ELISA differed significantly from both IIF on monkey esophagus (MO) and BP180-ELISA with regard to DOR (11.384 vs. 68.349, p = 0.0008; 11.384 vs. 41.699, p = 0.0125, respectively) Conclusions Our meta-analysis shows that ELISA performs as well as IIF for diagnosing PV, PF and BP.
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Affiliation(s)
- Otto Van de Gaer
- Department of Microbiology and Immunology, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, Immunology Service, University Hospitals Leuven, Leuven, Belgium
| | - Petra de Haes
- Department of Microbiology and Immunology, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, Immunology Service, University Hospitals Leuven, Leuven, Belgium.,Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Xavier Bossuyt
- Department of Microbiology and Immunology, Clinical and Diagnostic Immunology, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, Immunology Service, University Hospitals Leuven, Leuven, Belgium
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12
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Heydari P, Kharaziha M, Varshosaz J, Javanmard SH. Current knowledge of immunomodulation strategies for chronic skin wound repair. J Biomed Mater Res B Appl Biomater 2021; 110:265-288. [PMID: 34318595 DOI: 10.1002/jbm.b.34921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/11/2022]
Abstract
In orchestrating the wound healing process, the immune system plays a critical role. Hence, controlling the immune system to repair skin defects is an attractive approach. The highly complex immune system includes the coordinated actions of several immune cells, which can produce various inflammatory and antiinflammatory cytokines and affect the healing of skin wounds. This process can be optimized using biomaterials, bioactive molecules, and cell delivery. The present review discusses various immunomodulation strategies for supporting the healing of chronic wounds. In this regard, following the evolution of the immune system and its role in the wound healing mechanism, the interaction between the extracellular mechanism and immune cells for acceleration wound healing will be firstly investigated. Consequently, the immune-based chronic wounds will be briefly examined and the mechanism of progression, and conventional methods of their treatment are evaluated. In the following, various biomaterials-based immunomodulation strategies are introduced to stimulate and control the immune system to treat and regenerate skin defects. Other effective methods of controlling the immune system in wound healing which is the release of bioactive agents (such as antiinflammatory, antigens, and immunomodulators) and stem cell therapy at the site of injury are reviewed.
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Affiliation(s)
- Parisa Heydari
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Mahshid Kharaziha
- Department of Materials Engineering, Isfahan University of Technology, Isfahan, Iran
| | - Jaleh Varshosaz
- School of Pharmacy and Pharmaceutical Science, Isfahan University of Medical Science, Isfahan, Iran
| | - Shaghayegh Haghjooy Javanmard
- Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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13
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Fagundes PPS, Santi CG, Maruta CW, Miyamoto D, Aoki V. Autoimmune bullous diseases in pregnancy: clinical and epidemiological characteristics and therapeutic approach. An Bras Dermatol 2021; 96:581-590. [PMID: 34304937 PMCID: PMC8441454 DOI: 10.1016/j.abd.2020.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/09/2020] [Accepted: 10/17/2020] [Indexed: 01/11/2023] Open
Abstract
Autoimmune bullous dermatoses are a heterogeneous group of diseases with autoantibodies against structural skin proteins. Although the occurrence of autoimmune bullous dermatoses during pregnancy is low, this topic deserves attention, since the immunological and hormonal alterations that occur during this period can produce alterations during the expected course of these dermatoses. The authors review the several aspects of autoimmune bullous dermatoses that affect pregnant women, including the therapeutic approach during pregnancy and breastfeeding. Gestational pemphigoid, a pregnancy-specific bullous disease, was not studied in this review.
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Affiliation(s)
| | - Claudia Giuli Santi
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Celina Wakisaka Maruta
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Denise Miyamoto
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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14
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Liu YK, Gao H, Jin SB, Tu WJ, Chen YJ. Association of neonatal blood levels of brain-derived neurotrophic factor with development of autism spectrum disorder: a systematic review and meta-analysis. World J Pediatr 2021; 17:164-170. [PMID: 33650030 DOI: 10.1007/s12519-021-00415-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/07/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Our goal was to evaluate the association between neonatal blood brain-derived neurotrophic factor (BDNF) level and autism spectrum disorder (ASD) diagnosis later in life. METHODS MEDLINE and Web of Science databases were searched from inception until September 16, 2020. Reference lists of all relevant articles also were reviewed. Mean blood BDNF concentrations, standard deviations, sample sizes, and other data needed for calculation of effect sizes were extracted by two independent investigators. The quality of the included studies was appraised using the Newcastle-Ottawa Scale for case-control studies. Data were pooled using the random-effects model. RESULTS Five case-control studies involving 1341 cases and 3395 controls were included in the meta-analysis. The meta-analysis of all included studies showed no significant difference in blood BDNF levels between neonates diagnosed with ASD later in life and healthy controls [standardized mean difference (SMD) = 0.261; 95% confidence interval (CI) - 0.052 to 0.573; P = 0.102], with high level of heterogeneity (Q = 64.346; I2 = 93.784; P < 0.001). A subgroup analysis by assay type showed decreased blood BDNF levels in ASDs compared to controls (SMD = - 0.070; 95% CI - 0.114 to - 0.026; P = 0.002), with high level of homogeneity (Q = 0.894; I2 = 0.000; P = 0.827). No evidence of publication bias was observed. CONCLUSIONS Neonates diagnosed with ASD later in life have decreased blood levels of BDNF measured by double-antibody immunoassay. More studies are warranted to facilitate a more robust conclusion.
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Affiliation(s)
- Ya-Kun Liu
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, No.56 Nanlishi St, Beijing, 100045, China
| | - Hua Gao
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua St, Jinan, 250000, China
| | - Shao-Bin Jin
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, No. 107 West Wenhua St, Jinan, 250000, China
| | - Wen-Jun Tu
- Institute of Radiation Medicine, Chinese Academy of Medical Science, Peking Union Medical College, No. 238 Baidi St, Tianjin, 300192, China.,Key Lab of Cerebral Microcirculation in Universities of Shandong, Shandong First Medical University, Shandong Academy of Medical Sciences, No. 619 Changcheng St, Taian, 271000, China
| | - Ya-Jun Chen
- Department of General Surgery, Beijing Children's Hospital, Capital Medical University, No.56 Nanlishi St, Beijing, 100045, China.
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15
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Petruzzi M, Lucchese A, Contaldo M, Tampoia M, Frassanito MA, Lauritano D, Della Vella F. ELISA detection of anti-desmoglein 1 and anti-desmoglein 3 and indirect immunofluorescence in oral pemphigus: A retrospective study. Oral Dis 2021; 28:1149-1156. [PMID: 33721369 DOI: 10.1111/odi.13849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/03/2021] [Accepted: 03/07/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to test the efficacy of autoantibodies to desmoglein 1 and desmoglein 3 detected by ELISA and indirect immunofluorescence in the diagnosis of oral pemphigus and to correlate the antibody titres with the severity of the disease. MATERIALS AND METHODS We report a retrospective cohort study of 22 patients with oral pemphigus and 64 controls from a single tertiary centre. Data about histopathological examination, direct immunofluorescence, indirect immunofluorescence and ELISA were analysed. Global validation of ELISA and IIF both alone and combined was established by calculating sensitivity, specificity, accuracy and both positive predictive value and negative predictive value. The relationship between Oral Disease Severity Score values and ELISA titres was analysed using Pearson's coefficient. RESULTS The best diagnostic performance was observed for anti-desmoglein 3 ELISA. The sensitivity was 75% and specificity 100% and positive predictive value and negative predictive value were 92.5% and accuracy 93.9%. The level of agreement with histopathology + direct immunofluorescence was substantial (k = .758). Anti-desmoglein 3 titres showed a significant correlation with Oral Disease Severity Score (p < .05). CONCLUSIONS Serological tests are commonly employed during clinical practice as adjunctive tools. Anti-desmoglein 3 ELISA should be considered as a first-instance diagnostic test for oral pemphigus early detection.
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Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical, Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Maria Contaldo
- Multidisciplinary Department of Medical, Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Marilina Tampoia
- Section of Clinical Pathology, Policlinico Hospital, Bari, Italy
| | | | - Dorina Lauritano
- Department of Medicine and Surgery, Center of Neuroscience Milan, University of "Milan Bicocca", Monza, Italy
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
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Ma L, Jiang F, Fan X, Wang L, He C, Zhou M, Li S, Luo H, Cheng C, Qiu L. Metal-Organic-Framework-Engineered Enzyme-Mimetic Catalysts. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e2003065. [PMID: 33124725 DOI: 10.1002/adma.202003065] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/26/2020] [Indexed: 02/05/2023]
Abstract
Nanomaterial-based enzyme-mimetic catalysts (Enz-Cats) have received considerable attention because of their optimized and enhanced catalytic performances and selectivities in diverse physiological environments compared with natural enzymes. Recently, owing to their molecular/atomic-level catalytic centers, high porosity, large surface area, high loading capacity, and homogeneous structure, metal-organic frameworks (MOFs) have emerged as one of the most promising materials in engineering Enz-Cats. Here, the recent advances in the design of MOF-engineered Enz-Cats, including their preparation methods, composite constructions, structural characterizations, and biomedical applications, are highlighted and commented upon. In particular, the performance, selectivities, essential mechanisms, and potential structure-property relations of these MOF-engineered Enz-Cats in accelerating catalytic reactions are discussed. Some potential biomedical applications of these MOF-engineered Enz-Cats are also breifly proposed. These applications include, for example, tumor therapies, bacterial disinfection, tissue regeneration, and biosensors. Finally, the future opportunities and challenges in emerging research frontiers are thoroughly discussed. Thereby, potential pathways and perspectives for designing future state-of-the-art Enz-Cats in biomedical sciences are offered.
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Affiliation(s)
- Lang Ma
- Department of Ultrasound West China Hospital College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu 610065 China
| | - Fuben Jiang
- Department of Ultrasound West China Hospital College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu 610065 China
| | - Xin Fan
- Department of Chemistry and Biochemistry Freie Universität Berlin Takustraße 3 Berlin 14195 Germany
| | - Liyun Wang
- Department of Ultrasound West China Hospital College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu 610065 China
| | - Chao He
- Department of Ultrasound West China Hospital College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu 610065 China
| | - Mi Zhou
- College of Biomass Science and Engineering Sichuan University Chengdu 610065 China
| | - Shuang Li
- Functional Materials Department of Chemistry Technische Universität Berlin Hardenbergstraße 40 Berlin 10623 Germany
| | - Hongrong Luo
- National Engineering Research Center for Biomaterials Sichuan University Chengdu 610064 China
| | - Chong Cheng
- Department of Ultrasound West China Hospital College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu 610065 China
- Department of Chemistry and Biochemistry Freie Universität Berlin Takustraße 3 Berlin 14195 Germany
| | - Li Qiu
- Department of Ultrasound West China Hospital College of Polymer Science and Engineering State Key Laboratory of Polymer Materials Engineering Sichuan University Chengdu 610065 China
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17
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Petruzzi M, Tampoia M, Serpico R, Lauritano D, Lajolo C, Lucchese A, Della Vella F. Evaluation of BP180-NC16A ELISA in exclusive oral pemphigoid diagnosis. A comparative study. Oral Dis 2020; 27:525-531. [PMID: 32726466 DOI: 10.1111/odi.13574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/04/2020] [Accepted: 07/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Aims of this study were to test the efficacy of anti-BP180-NC160 ELISA in the diagnosis of oral pemphigoid compared to the gold standard, represented by direct immunofluorescence and pathological examination, to correlate the antibody titers with the severity of the disease and the demographical data. MATERIALS AND METHODS Patients with a suspect of oral pemphigoid were enrolled and underwent biopsy and sera collection both, in order to perform histopathological examination, direct immunofluorescence and ELISA. The test outcomes were compared, and ELISA sensitivity, specificity, accuracy, and negative and positive predictive values were calculated. RESULTS ELISA showed good specificity (83.3%), while sensitivity was only 50%. A moderate correlation between antibody titers and disease severity was recorded. CONCLUSIONS Mucomembranous Pemphigoid is an autoimmune autoantibody-mediated blistering disease, often affecting exclusively the oral mucosa. Currently, the biopsy is required to diagnose this disease, but serological tests are also commonly employed during clinical practice as adjunctive tools. BP180-NC160 ELISA should be considered an ancillary diagnostic test in course of oral pemphigoid; direct immunofluorescence + histologic examination remains the diagnostic gold standard.
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Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Marilina Tampoia
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Rosario Serpico
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dorina Lauritano
- Department of Medicine and Surgery, Centre of Neuroscience Milan, University of Milan-Bicocca, Monza, Italy
| | - Carlo Lajolo
- Head and Neck Department, School of Dentistry, Fondazione Policlinico Universitario A. Gemelli - IRCCS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
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18
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Cole EF, Sami N, Feldman RJ. Updates on diagnosis and management of autoimmune blistering diseases. GIORN ITAL DERMAT V 2019; 155:46-64. [PMID: 31804056 DOI: 10.23736/s0392-0488.19.06517-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last several decades, advances in the understanding of the pathogenesis of autoimmune blistering diseases has resulted in significant improvements in diagnosis and management. These improvements include new diagnostic assays and therapies targeted at specific disease mediators. Furthermore, the abundance of new therapies in clinic trials for autoimmune blistering diseases will translate to an enhanced therapeutic armamentarium for clinicians. The aim of this article is to review new developments in the understanding of autoimmune blistering diseases and to summarize advancements in their diagnosis and management.
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Affiliation(s)
- Emily F Cole
- Emory Autoimmune Blistering Disease Clinic, Emory Department of Dermatology, Atlanta, GA, USA
| | - Naveed Sami
- Department of Dermatology, University of Central Florida, Orlando, FL, USA -
| | - Ron J Feldman
- Emory Autoimmune Blistering Disease Clinic, Emory Department of Dermatology, Atlanta, GA, USA
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19
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Qian L, Li Q, Baryeh K, Qiu W, Li K, Zhang J, Yu Q, Xu D, Liu W, Brand RE, Zhang X, Chen W, Liu G. Biosensors for early diagnosis of pancreatic cancer: a review. Transl Res 2019; 213:67-89. [PMID: 31442419 DOI: 10.1016/j.trsl.2019.08.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 12/21/2022]
Abstract
Pancreatic cancer is characterized by extremely high mortality and poor prognosis and is projected to be the leading cause of cancer deaths by 2030. Due to the lack of early symptoms and appropriate methods to detect pancreatic carcinoma at an early stage as well as its aggressive progression, the disease is often quite advanced by the time a definite diagnosis is established. The 5-year relative survival rate for all stages is approximately 8%. Therefore, detection of pancreatic cancer at an early surgically resectable stage is the key to decrease mortality and to improve survival. The traditional methods for diagnosing pancreatic cancer involve an imaging test, such as ultrasound or magnetic resonance imaging, paired with a biopsy of the mass in question. These methods are often expensive, time consuming, and require trained professionals to use the instruments and analyze the imaging. To overcome these issues, biosensors have been proposed as a promising tool for the early diagnosis of pancreatic cancer. The present review critically discusses the latest developments in biosensors for the early diagnosis of pancreatic cancer. Protein and microRNA biomarkers of pancreatic cancer and corresponding biosensors for pancreatic cancer diagnosis have been reviewed, and all these cases demonstrate that the emerging biosensors are becoming an increasingly relevant alternative to traditional techniques. In addition, we discuss the existing problems in biosensors and future challenges.
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Affiliation(s)
- Lisheng Qian
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China
| | - Qiaobin Li
- Department of Chemistry & Biochemistry, North Dakota State University, Fargo, North Dakota
| | - Kwaku Baryeh
- Department of Chemistry & Biochemistry, North Dakota State University, Fargo, North Dakota
| | - Wanwei Qiu
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China
| | - Kun Li
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China
| | - Jing Zhang
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China
| | - Qingcai Yu
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China
| | - Dongqin Xu
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China
| | - Wenju Liu
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China
| | - Randall E Brand
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Xueji Zhang
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China; School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, Guangdong, PR China.
| | - Wei Chen
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China; School of Food Science & Engineering, Hefei University of Technology, Hefei, Anhui, PR China.
| | - Guodong Liu
- Institute of Biomedical and Health, School of Life and Health Science, Anhui Science and Technology University, Fengyang, Anhui, PR China; Department of Chemistry & Biochemistry, North Dakota State University, Fargo, North Dakota.
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20
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van Beek N, Zillikens D, Schmidt E. Diagnosis of autoimmune bullous diseases. J Dtsch Dermatol Ges 2019; 16:1077-1091. [PMID: 30179336 DOI: 10.1111/ddg.13637] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/28/2018] [Indexed: 12/25/2022]
Abstract
Autoimmune bullous disorders (AIBDs) are a heterogeneous group of rare diseases clinically characterized by erosions and/or blisters on the skin and mucous membranes. AIBDs can be categorized into two groups: pemphigus diseases, characterized by intraepidermal blistering and autoantibodies against desmosomal proteins such as desmoglein (Dsg) 1, Dsg3, members of the plakin family, and subepidermal AIBDs, comprised of pemphigoid diseases and dermatitis herpetiformis. Autoantibodies in dermatitis herpetiformis target transglutaminases 2 and 3, while in pemphigoid disease, autoantibodies are directed against structural proteins of the dermal-epidermal junction. Although analysis of a perilesional biopsy with direct immunofluorescence (IF) microscopy is still the diagnostic gold standard, several assays have become widely available that allow serological diagnosis in the majority of patients. Standard serological diagnosis includes indirect IF on monkey esophagus and salt-split human skin. Assays to further characterize autoantibody specificity include ELISA systems based on recombinant forms of the immunodominant regions of the target antigens as well as multivariant indirect IF microscopy tests with several miniature substrates. These serological assays are complemented by various in-house assays using immunoblotting and ELISA, which are only available in specialized laboratories. Here we review new developments in the diagnosis of AIBDs and describe state-of-the-art diagnostic procedures for this group of diseases.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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21
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Meijer JM, Diercks GFH, de Lang EWG, Pas HH, Jonkman MF. Assessment of Diagnostic Strategy for Early Recognition of Bullous and Nonbullous Variants of Pemphigoid. JAMA Dermatol 2019; 155:158-165. [PMID: 30624575 DOI: 10.1001/jamadermatol.2018.4390] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A substantial number of patients with bullous pemphigoid do not develop skin blisters and may not have received the correct diagnosis. Diagnostic criteria and an optimal diagnostic strategy are needed for early recognition and trials. Objectives To assess the minimal requirements for diagnosis of bullous and nonbullous forms of pemphigoid and to evaluate the optimal diagnostic strategy. Design, Setting, and Participants This paired, multivariable, diagnostic accuracy study analyzed data from 1125 consecutive patients with suspected pemphigoid who were referred to the Groningen Center for Blistering Diseases from secondary and tertiary care hospitals throughout the Netherlands. Eligible participants were patients with paired data on at least (1) a skin biopsy specimen for the direct immunofluorescence (DIF) microscopy test; (2) indirect immunofluorescence on a human salt-split skin substrate (IIF SSS) test; and (3) 1 or more routine immunoserologic tests administered between January 1, 2002, and May 1, 2015. Samples were taken from patients at the time of first diagnosis, before introduction of immunosuppressive therapy, and within an inclusion window of a maximum of 4 weeks. Data analysis was conducted from October 1, 2015, to December 1, 2017. Main Outcomes and Measures Pairwise DIF, IIF SSS, IIF on monkey esophagus, BP180 and BP230 enzyme-linked immunosorbent assays, and immunoblot for BP180 and BP230 tests were performed. The results were reported in accordance with 2015 version of the Standards for Reporting Diagnostic Accuracy. Results Of the 1125 patients analyzed, 653 (58.0%) were women and 472 (42.0%) were men, with a mean (SD) age of 63.2 (19.9) years. In total, 343 participants received a pemphigoid diagnosis, with 782 controls. Of the 343 patients, 74 (21.6%, or 1 in 5) presented with nonbullous pemphigoid. The DIF microscopy was the most sensitive diagnostic test (88.3% [n = 303]; 95% CI, 84.5%-91.3%), whereas IIF SSS was less sensitive (77.0% [n = 263]; 95% CI, 72.2%-81.1%) but was highly specific (99.9%; 95% CI, 99.3%-100%) and complemented most cases with negative DIF findings. Results of the BP180 NC16A enzyme-linked immunosorbent assay did not add diagnostic value for initial diagnosis in multivariable logistic regression analysis of combined tests. These findings lead to the proposed minimal criteria for diagnosing pemphigoid: (1) pruritus and/or predominant cutaneous blisters, (2) linear IgG and/or C3c deposits (in an n-serrated pattern) by DIF on a skin biopsy specimen, and (3) positive epidermal side staining of IgG by IIF SSS on a serum sample; this proposal extends bullous pemphigoid with the unrecognized nonbullous form. Conclusions and Relevance Both DIF and IIF SSS tests should be performed for diagnosis of the bullous and nonbullous variants of pemphigoid, and the BP180 NC16A enzyme-linked immunosorbent assay is recommended as an add-on test for disease activity monitoring.
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Affiliation(s)
- Joost M Meijer
- Center for Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gilles F H Diercks
- Center for Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Emma W G de Lang
- Center for Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hendri H Pas
- Center for Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel F Jonkman
- Center for Blistering Diseases, Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Harrell J, Rubio XB, Nielson C, Hsu S, Motaparthi K. Advances in the diagnosis of autoimmune bullous dermatoses. Clin Dermatol 2019; 37:692-712. [PMID: 31864451 DOI: 10.1016/j.clindermatol.2019.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Autoimmune bullous dermatoses are defined by autoantibodies directed against adhesion proteins in the epidermis or basement membrane zone, resulting in blister formation on the skin and mucosa. Diagnosis depends on lesional biopsy for histopathology and perilesional biopsy for direct immunofluorescence. Additional diagnostic methods include indirect immunofluorescence, enzyme-linked immunosorbent assay, and immunoblot (Western blot), which may be selected in specific clinical scenarios due to improved sensitivity and/or specificity. This contribution reviews the available evidence supporting the use of each method to provide a practical reference for clinicians when diagnosing autoimmune bullous disorders. Techniques and cost are reviewed, and newer diagnostic techniques with potential for clinical application are.
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Affiliation(s)
- Jane Harrell
- University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Colton Nielson
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sylvia Hsu
- Department of Dermatology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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23
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van Beek N, Zillikens D, Schmidt E. Diagnostik blasenbildender Autoimmundermatosen. J Dtsch Dermatol Ges 2019; 16:1077-1092. [PMID: 30179341 DOI: 10.1111/ddg.13637_g] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/28/2018] [Indexed: 01/07/2023]
Abstract
Blasenbildende Autoimmundermatosen (BAIDs) sind eine heterogene Gruppe seltener Erkrankungen, die klinisch durch Erosionen und/oder Blasen an Haut und Schleimhäuten charakterisiert sind. BAIDs können in zwei Gruppen eingeteilt werden: Pemphigus-Erkrankungen, die durch intraepidermale Blasenbildung und Autoantikörper gegen desmosomale Proteine wie Desmoglein (Dsg) 1, Dsg3 und Mitglieder der Plakin-Familie charakterisiert sind, sowie subepidermale BAIDs, die Pemphigoid-Erkrankungen und die Dermatitis herpetiformis umfassen. Bei der Dermatitis herpetiformis greifen die Autoantikörper die Transglutaminasen 2 und 3 an, während sie bei Pemphigoid-Erkrankungen gegen Strukturproteine der dermoepidermalen Junktionszone gerichtet sind. Die Analyse einer periläsionalen Biopsie mittels direkter Immunfluoreszenzmikroskopie (IF-Mikroskopie) stellt zwar nach wie vor den diagnostischen Goldstandard dar, mittlerweile sind jedoch verschiedene Tests allgemein verfügbar, die eine serologische Diagnosefindung für den Großteil der Patienten ermöglichen. Zur serologischen Standarddiagnostik gehört die indirekte IF auf Affenösophagus und NaCl-separierter Spalthaut. Die Spezifität der Autoantikörper kann mit ELISA-Systemen, die auf rekombinanten Formen der immundominanten Regionen der Zielantigene basieren, sowie indirekter IF-Mikroskopie anhand multivarianter Tests mit mehreren multivariate näher charakterisiert werden. Diese serologischen Tests werden durch verschiedene hauseigene Immunoblotting- und ELISA-Systeme ergänzt, die nur in spezialisierten Laboratorien verfügbar sind. In diesem Review geben wir einen Überblick über neue Entwicklungen bei der Diagnose von BAIDs und beschreiben moderne Diagnoseverfahren für diese Krankheitsgruppe.
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Affiliation(s)
- Nina van Beek
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck
| | - Detlef Zillikens
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck
| | - Enno Schmidt
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck.,Lübecker Institut für Experimentelle Dermatologie (LIED), Universität zu Lübeck
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Saschenbrecker S, Karl I, Komorowski L, Probst C, Dähnrich C, Fechner K, Stöcker W, Schlumberger W. Serological Diagnosis of Autoimmune Bullous Skin Diseases. Front Immunol 2019; 10:1974. [PMID: 31552014 PMCID: PMC6736620 DOI: 10.3389/fimmu.2019.01974] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
Autoimmune bullous dermatoses (AIBD) encompass a variety of organ-specific autoimmune diseases that manifest with cutaneous and/or mucosal blisters and erosions. They are characterized by autoantibodies targeting structural proteins of the skin, which are responsible for the intercellular contact between epidermal keratinocytes and for adhesion of the basal keratinocytes to the dermis. The autoantibodies disrupt the adhesive functions, leading to splitting and blister formation. In pemphigus diseases, blisters form intraepidermally, whereas in all other disease types they occur subepidermally. Early identification of autoimmune bullous dermatoses is crucial for both treatment and prognosis, particularly as regards tumor-associated disease entities. The diagnosis is based on clinical symptoms, histopathology, direct immunofluorescence to detect antibody/complement deposits, and the determination of circulating autoantibodies. The identification of various target antigens has paved the way for the recent development of numerous specific autoantibody tests. In particular, optimized designer antigens and multiplex test formats for indirect immunofluorescence and ELISA have enhanced and refined the laboratory analysis, enabling highly efficient serodiagnosis and follow-up. This review elaborates on the current standards in the serological diagnostics for autoimmune bullous dermatoses.
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Affiliation(s)
| | - Ingolf Karl
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Lars Komorowski
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Christian Probst
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Cornelia Dähnrich
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Kai Fechner
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Winfried Stöcker
- Institute for Experimental Immunology, Euroimmun AG, Lübeck, Germany
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25
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Yang A, Xuan R, Murrell DF. A new indirect immunofluorescence
BIOCHIP
method for the serological diagnosis of bullous pemphigoid: A review of literature. Australas J Dermatol 2019; 60:e173-e177. [DOI: 10.1111/ajd.13034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/20/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anes Yang
- Department of Dermatology St George Hospital Sydney New South Wales Australia
- Faculty of Medicine University of New South Wales Sydney New South Wales Australia
| | - Rachel Xuan
- Department of Dermatology St George Hospital Sydney New South Wales Australia
- Faculty of Medicine University of New South Wales Sydney New South Wales Australia
| | - Dedee F Murrell
- Department of Dermatology St George Hospital Sydney New South Wales Australia
- Faculty of Medicine University of New South Wales Sydney New South Wales Australia
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26
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Sun S, Zhong B, Li W, Jin X, Yao Y, Wang J, Liu J, Dan H, Chen Q, Zeng X. Immunological methods for the diagnosis of oral mucosal diseases. Br J Dermatol 2019; 181:23-36. [PMID: 30585301 DOI: 10.1111/bjd.17589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 02/05/2023]
Abstract
Immunological methods, which have been widely used in autoimmune blistering diseases (AIBDs) of the oral mucosa, can also be adopted as auxiliary diagnostic tools in oral lichen planus (OLP) and discoid lupus erythematosus (DLE). AIBDs, characterized by autoantibodies against structural proteins of keratinocytes or the basement membrane zone, clinically present as blisters and erosions of the oral mucosa. When atypical lesions occur, OLP or DLE may be confused with AIBDs. The improvement of diagnostic accuracy is necessary due to the significant differences in treatment and prognosis among these diseases. A variety of immunological methods are used for qualitative and quantitative detection of target antigens and autoantibodies. These methods can evaluate efficacy of treatment, monitor diseases and guide treatment decisions. In this review, we discuss the application of immunofluorescence, biochemical tests, and protein microarrays for AIBDs, OLP and DLE, as well as the differential diagnostic methods using immunological tests.
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Affiliation(s)
- S Sun
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - B Zhong
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - W Li
- Department of Dermatovenereology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - X Jin
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences and College of Stomatology, Chongqing Medical University, Chongqing, China
| | - Y Yao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China.,Department of Oral Medicine, Affiliated Hospital of Stomatology, Zunyi Medical University, Zunyi, China
| | - J Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - J Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - H Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Q Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
| | - X Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, 610041, China
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27
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Liu Z, Chen L, Zhang C, Xiang LF. Circulating bullous pemphigoid 180 autoantibody can be detected in a wide spectrum of patients with other dermatologic conditions: A cross-sectional study. J Am Acad Dermatol 2019; 80:774-775. [PMID: 29906544 DOI: 10.1016/j.jaad.2018.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/26/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Ziqi Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China.
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28
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Buonavoglia A, Leone P, Dammacco R, Di Lernia G, Petruzzi M, Bonamonte D, Vacca A, Racanelli V, Dammacco F. Pemphigus and mucous membrane pemphigoid: An update from diagnosis to therapy. Autoimmun Rev 2019; 18:349-358. [PMID: 30738958 DOI: 10.1016/j.autrev.2019.02.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 11/02/2018] [Indexed: 12/23/2022]
Abstract
Pemphigus diseases (PDs) and mucous membrane pemphigoid (MMP) are a group of immune-mediated mucocutaneous disorders clinically characterized by the formation of blisters, erosions and ulcers. The skin and mucous membranes are predominantly affected, with the oropharyngeal mucosa as the initially involved site. Ocular involvement is also a frequent feature of these diseases. Because of the considerable overlap in their clinical presentations, the diagnosis of PDs vs. MMP can be challenging. A recognition of their specific immunological and histopathologic features is crucial in the differential diagnosis. Treatment modalities include systemically administered corticosteroids, steroid-sparing immunosuppressive agents, and biologic therapies (rituximab, intravenous immunoglobulins, and anti-tumor necrosis factor agents). Topical, oral, conjunctival, or intralesional corticosteroids as well as anti-inflammatory drugs and antibiotics are prescribed as needed.
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Affiliation(s)
- Alessio Buonavoglia
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Bari, Italy
| | - Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Bari, Italy
| | - Rosanna Dammacco
- Department of Ophthalmology and Neuroscience, University of Bari Medical School, Bari, Italy
| | - Giuseppe Di Lernia
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Bari, Italy
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, Section of Dentistry, University of Bari Medical School, Bari, Italy
| | - Domenico Bonamonte
- Department of Biomedical Sciences and Human Oncology, Dermatology Unit, University of Bari Medical School, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Bari, Italy
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Bari, Italy.
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Bari, Italy.
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29
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Sernicola A, Russo I, Saponeri A, Alaibac M. Biochip detection of BP180 autoantibodies in blister fluid for the serodiagnosis of bullous pemphigoid: A pilot study. Medicine (Baltimore) 2019; 98:e14514. [PMID: 30762788 PMCID: PMC6408141 DOI: 10.1097/md.0000000000014514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Bullous pemphigoid is an autoimmune subepidermal blistering skin disease immunologically defined by autoantibodies directed against basement membrane zone antigens, the main of which is BP180. Laboratory tests are essential for diagnosis and include direct immunofluorescence and serologic assessments with indirect immunofluorescence and ELISA. Serology may be performed on blister fluid, in alternative to blood serum. This study investigated the use of a Biochip-based indirect immunofluorescence approach for the serum diagnosis of bullous pemphigoid on blister fluid. We compared the results using the Biochip-method with the ELISA detection of bullous pemphigoid-180 autoantibodies in blister fluid and observed a perfect correlation between these 2 methods in our group of 13 patients with clinical and direct immunofluorescence diagnosis of bullous pemphigoid. The Biochip is a simple, standardized and inexpensive diagnostic tool and its use on blister fluid may facilitate the diagnosis of this and other autoimmune bullous disorders. Our results suggest that the Biochip assay on serum of bullae is a non-invasive screening technique for the early diagnosis of bullous pemphigoid that is practical for fragile elderly patients and achievable even in small laboratory settings.
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30
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Witte M, Zillikens D, Schmidt E. Diagnosis of Autoimmune Blistering Diseases. Front Med (Lausanne) 2018; 5:296. [PMID: 30450358 PMCID: PMC6224342 DOI: 10.3389/fmed.2018.00296] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/05/2018] [Indexed: 12/11/2022] Open
Abstract
Autoimmune skin blistering diseases (AIBD) are characterized by autoantibodies that are directed against structural proteins in the skin and adjacent mucous membranes. Some clinical signs are typical for a specific AIBD, however, correct diagnosis requires the detection of tissue-bound or circulating autoantibodies. The gold standard for diagnosis of AIBD is the detection of autoantibodies or complement component 3 by direct immunofluorescence (DIF) microscopy of a perilesional biopsy. Circulating antibodies can be detected via indirect immunofluorescence (IIF) microscopy of different tissue substrates including human skin, monkey esophagus, and more recently, recombinant forms of the different target antigens. Latter are also employed in various commercial ELISA systems and by immunoblotting in in-house assays available in specialized laboratories. ELISA systems are also particularly valuable for monitoring of the disease activity during the disease course which can be helpful for treatment decisions. Exact diagnosis is essential for both treatment and prognosis, since some AIBD are associated with malign tumors such as paraneoplastic pemphigus and anti-laminin 332 mucous membrane pemphigoid. This review presents clinical and immunopathological features of AIBD for the state-of the art diagnosis of these disorders.
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Affiliation(s)
- Mareike Witte
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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31
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Holtsche MM, Goletz S, van Beek N, Zillikens D, Benoit S, Harman K, Walton S, English J, Sticherling M, Chapman A, Levell NJ, Groves R, Williams HC, König IR, Schmidt E. Prospective study in bullous pemphigoid: association of high serum anti-BP180 IgG levels with increased mortality and reduced Karnofsky score. Br J Dermatol 2018; 179:918-924. [PMID: 29607480 DOI: 10.1111/bjd.16553] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is a subepidermal blistering disease characterized by autoantibodies against the two hemidesmosomal proteins, BP180 (type XVII collagen) and BP230. The multicentre prospective BLISTER (Bullous Pemphigoid Steroids and Tetracyclines) trial randomized 253 patients with BP to compare the benefits and harms between initial treatment with doxycycline or prednisolone. OBJECTIVES To analyse distinct autoantibody profiles for the prediction of the disease course in a well-characterized cohort of BP sera. METHODS One hundred and forty-three patients of the BLISTER trial consented to participate in this serological study. Sera taken at baseline were analysed by (i) indirect immunofluorescence, (ii) anti-BP180 NC16A (16th noncollagenous domain) and anti-BP230 enzyme-linked immunosorbent assay and (iii) immunoblotting with various substrates. Results were then linked with clinical parameters including age, Karnofsky score, number of blisters, related adverse events and mortality. RESULTS Disease activity correlated with immunoglobulin (Ig)G anti-BP180 levels but not with levels of anti-BP230 IgG and anti-BP180 IgE. High levels of both anti-BP180 IgG and anti-BP230 IgG were associated with a low Karnofsky score. The presence of anti-BP230 IgG was more frequent in older patients. Those with higher total IgE serum levels suffered from fewer adverse events. Higher IgG anti-BP180 levels were associated with an increased 1-year mortality rate. CONCLUSIONS Analysis of the autoantibody profile is not only of diagnostic relevance but may also be helpful in predicting the course of the disease.
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Affiliation(s)
- M M Holtsche
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - N van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - S Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - K Harman
- Department of Dermatology, University Hospitals Leicester, Leicester Royal Infirmary, Leicester, U.K
| | - S Walton
- Castle Hill Hospital, Cottingham, U.K
| | - J English
- Queen's Medical Centre, University Hospital, Nottingham, U.K
| | - M Sticherling
- Department of Dermatology, University of Erlangen, Erlangen, Germany
| | - A Chapman
- Queen Elizabeth Hospital, Greenwich, London, U.K
| | - N J Levell
- Norfolk and Norwich University Hospital, Norwich, U.K
| | - R Groves
- Department of Immunodermatology, St John's Institute of Dermatology, St Thomas' Hospital, London, U.K
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - I R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - E Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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32
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Amber KT, Murrell DF, Schmidt E, Joly P, Borradori L. Autoimmune Subepidermal Bullous Diseases of the Skin and Mucosae: Clinical Features, Diagnosis, and Management. Clin Rev Allergy Immunol 2018; 54:26-51. [PMID: 28779299 DOI: 10.1007/s12016-017-8633-4] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Autoimmune subepidermal blistering diseases of the skin and mucosae constitute a large group of sometimes devastating diseases, encompassing bullous pemphigoid, gestational pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, and anti-p200 pemphigoid. Their clinical presentation is polymorphic. These autoimmune blistering diseases are associated with autoantibodies that target distinct components of the basement membrane zone of stratified epithelia. These autoantigens represent structural proteins important for maintenance of dermo-epidermal integrity. Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering disease of the skin and mucosae. Although the disease typically presents with a generalized blistering eruption associated with itch, atypical variants with either localized bullous lesions or "non-bullous" presentations are observed in approximately 20% of patients. A peculiar form of BP typically associated with pregnancy is pemphigoid gestationis. In anti-p200 pemphigoid, patients present with tense blisters on erythematosus or normal skin resembling BP, with a predilection for acral surfaces. These patients have antibodies targeting the 200-kDa basement membrane protein. Epidermolysis bullosa is a rare autoimmune blistering disease associated with autoantibodies against type VII collagen that can have several phenotypes including a classical form mimicking dystrophic epidermolysis bullosa, an inflammatory presentation mimicking BP, or mucous membrane pemphigoid-like lesions. Mucous membrane pemphigoid (MMP) is the term agreed upon by international consensus for an autoimmune blistering disorder, which affects one or more mucous membrane and may involve the skin. The condition involves a number of different autoantigens in the basement membrane zone. It may result in severe complications from scarring, such as blindness and strictures. Diagnosis of these diseases relies on direct immunofluorescence microscopy studies and immunoserological assays. Management of affected patients is often challenging. We will here review the clinical and immunopathological features as well as the pathophysiology of this group of organ-specific autoimmune diseases. Finally, we will discuss the diagnostic approach and the principles of management in clinical practice.
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Affiliation(s)
- Kyle T Amber
- Department of Dermatology, University of California Irvine Health, 118 Med Surg 1, Irvine, CA, 92697, USA.
| | - Dedee F Murrell
- Department of Dermatology, St. George Hospital, Gray Street, Kogarah, Sydney, NSW, Australia
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Pascal Joly
- Department of Dermatology, INSERM U901, University of Rouen, Rouen, France
| | - Luca Borradori
- Department of Dermatology, University of Bern, Bern, Switzerland
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33
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Clinical, histological, immunological presentations and outcomes of bullous systemic lupus erythematosus: 10 New cases and a literature review of 118 cases. Semin Arthritis Rheum 2018; 48:83-89. [DOI: 10.1016/j.semarthrit.2017.11.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/15/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022]
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34
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Eckardt J, Eberle FC, Ghoreschi K. Diagnostic value of autoantibody titres in patients with bullous pemphigoid. Eur J Dermatol 2018; 28:3-12. [PMID: 29336324 DOI: 10.1684/ejd.2017.3166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is the most common autoimmune blistering disease of the skin requiring skin and serum tests for a precise diagnosis. OBJECTIVES We analysed the sensitivity and specificity of BP-relevant parameters and the value of autoantibody titres during follow-up of BP patients. MATERIALS & METHODS In a retrospective single-centre study, we included 200 consecutive patients with BP and 400 non-BP patients, and evaluated the test results of patients' serum and skin. In addition, we followed patients' autoantibody titres and clinical characteristics. RESULTS BP180-ELISA revealed the highest sensitivity (85.0%; specificity: 93.9%), while BP230-ELISA demonstrated the lowest sensitivity (55.5%; specificity: 92.9%). Direct and indirect immunofluorescence showed comparable results for sensitivity (77.2%/72.7%) and specificity (94.9%/93.7%). The sensitivity for skin histology was 76.3% (specificity: 81.3%). Longitudinal analysis showed significant changes in autoantibody titres. CONCLUSIONS BP diagnostics should include serum tests for BP autoantibodies and skin immunofluorescence. Skin histology is supportive for diagnosis. Autoantibody titres are markers for disease activity.
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Affiliation(s)
- Julia Eckardt
- Department of Dermatology, University Medical Centre, Eberhard Karls University Tübingen, Germany
| | - Franziska C Eberle
- Department of Dermatology, University Medical Centre, Eberhard Karls University Tübingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, University Medical Centre, Eberhard Karls University Tübingen, Germany
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35
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Katisko K, Kokkonen N, Krüger J, Hartikainen P, Koivisto AM, Helisalmi S, Korhonen VE, Kokki M, Tuusa J, Herukka SK, Solje E, Haapasalo A, Tasanen K, Remes AM. The Association Between Frontotemporal Lobar Degeneration and Bullous Pemphigoid. J Alzheimers Dis 2018; 66:743-750. [PMID: 30320585 DOI: 10.3233/jad-180624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recent studies have shown an epidemiological and immunological association between bullous pemphigoid (BP) and several neurological or psychiatric diseases. Here, our aim was for the first time to specify whether an association exists between BP and frontotemporal lobar degeneration (FTLD). Medical histories of FTLD patients (N = 196) were screened for clinical comorbidity, and BP180 and BP230 autoantibodies were analyzed in the sera of FTLD patients (N = 70, including 24 C9orf72 repeat expansion carriers) by BP180-NC16A-ELISA and BP230-ELISA. One FTLD patient (C9orf72 repeat expansion carrier) had a comorbid diagnosis of BP. Increased levels of serum BP180 autoantibodies (cutoff value >9 U/ml) were detected more often in FTLD patients (10.0%) than in controls (4.9%). Moreover, elevated levels of both BP180 and BP230 autoantibodies were found more often in C9orf72 repeat expansion-carrying FTLD than non-carrying patients or controls. However, none of these differences reached a statistical significance likely due to our limited cohort size. In conclusion, our findings suggest that subset of FTLD patients especially with the C9orf72 repeat expansion may have an immunological association with BP.
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Liu Y, Li L, Xia Y. BP180 Is Critical in the Autoimmunity of Bullous Pemphigoid. Front Immunol 2017; 8:1752. [PMID: 29276517 PMCID: PMC5727044 DOI: 10.3389/fimmu.2017.01752] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022] Open
Abstract
Bullous pemphigoid (BP) is by far the most common autoimmune blistering dermatosis that mainly occurs in the elderly. The BP180 is a transmembrane glycoprotein, which is highly immunodominant in BP. The structure and location of BP180 indicate that it is a significant autoantigen and plays a key role in blister formation. Autoantibodies from BP patients react with BP180, which leads to its degradation and this has been regarded as the central event in BP pathogenesis. The consequent blister formation involves the activation of complement-dependent or -independent signals, as well as inflammatory pathways induced by BP180/anti-BP180 autoantibody interaction. As a multi-epitope molecule, BP180 can cause dermal-epidermal separation via combining each epitope with specific immunoglobulin, which also facilitates blister formation. In addition, some inflammatory factors can directly deplete BP180, thereby leading to fragility of the dermal-epidermal junction and blister formation. This review summarizes recent investigations on the role of BP180 in BP pathogenesis to determine the potential targets for the treatment of patients with BP.
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Affiliation(s)
- Yale Liu
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Liang Li
- National-Local Joint Engineering Research Center of Biodiagnostics and Biotherapy, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Yumin Xia
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
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Gornowicz-Porowska J, Seraszek-Jaros A, Bowszyc-Dmochowska M, Bartkiewicz P, Kaczmarek E, Dmochowski M. Clinical evaluation of a multiparametric ELISA as a rapid tool for routinely diagnosing IgG-mediated autoimmune blistering dermatoses in ethnic Slavs. J Clin Lab Anal 2017; 32:e22336. [PMID: 28948640 DOI: 10.1002/jcla.22336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Technical innovation of autoimmune blistering dermatoses (ABDs) diagnosis aimed at multiplex approach. Two multiparametric ELISA tests are commercially available for ABDs serology. The aim was to compare diagnostic accuracy of multiparametric and monospecific ELISAs and to examine the diagnostic value/agreement of multivariant ELISA in compliance with traditional diagnostic setup for ABDs. METHODS In total, 128 sera from suspected ABDs patients were studied (27 sera in order to compare ELISAs). Multivariant ELISA (detection of IgG against desmoglein 1 and 3 - DSG1/3; BP180, BP230, envoplakin, type VII collagen), monovariant ELISA, and statistical analysis were performed. RESULTS With the use of sera from patients with suspected ABDs, the multiparametric ELISA yield an agreement of 84% with traditional stepwise diagnostics. Multivariant ELISA with BP180 and BP230 showed 87.5% and 80% sensitivity, 87.5% and 91% specificity, 87.5% reliability as well as 87.5% and 80% positive predictive value, 87.5% and 91% negative predictive value, respectively, in relation to monospecific ELISA. Multivariant ELISA with DSG1 and DSG3 showed 50% and 80% sensitivity, 100% and 80% specificity, 85% and 80% reliability as well as 100% and 57% positive predictive value, 82% and 92% negative predictive value, respectively, in relation to monospecific ELISA. A better rate of agreement was observed among ELISA systems with BP180 and BP230, than with ELISA systems with DSG1 and DSG3. CONCLUSION Multivariant ELISA test combined with clinical examinations and DIF is recommended as a minimal approach to diagnosing ABDs in ethnic Slavs.
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Affiliation(s)
- Justyna Gornowicz-Porowska
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Seraszek-Jaros
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Bowszyc-Dmochowska
- Cutaneous Histopathology and Immunopathology Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Bartkiewicz
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Elżbieta Kaczmarek
- Department of Bioinformatics and Computational Biology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marian Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
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38
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van Beek N, Dähnrich C, Johannsen N, Lemcke S, Goletz S, Hübner F, Di Zenzo G, Dmochowski M, Drenovska K, Geller S, Horn M, Kowalewski C, Medenica L, Murrell DF, Patsatsi A, Uzun S, Vassileva S, Zillikens D, Schlumberger W, Schmidt E. Prospective studies on the routine use of a novel multivariant enzyme-linked immunosorbent assay for the diagnosis of autoimmune bullous diseases. J Am Acad Dermatol 2017; 76:889-894.e5. [PMID: 28038887 DOI: 10.1016/j.jaad.2016.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Serologic diagnosis of autoimmune blistering disease (AIBD) usually follows a sophisticated multistep algorithm. OBJECTIVE We sought validation of a multivariant enzyme-linked immunosorbent assay (ELISA) in the routine diagnosis of AIBD. METHODS The multivariant ELISA comprising 6 recombinant immunodominant forms of major AIBD target antigens, ie, desmoglein 1, desmoglein 3, envoplakin, BP180, BP230, and type VII collagen was applied in: (1) a cohort of well-characterized AIBD (n = 173) and control sera (n = 130), (2) a prospective multicenter study with 204 sera from patients with newly diagnosed AIBD with positive direct immunofluorescence microscopy, and (3) a prospective monocenter study with 292 consecutive sera from patients with clinical suspicion of AIBD in comparison with the conventional multistep diagnostic algorithm. RESULTS Concordant results in the multivariant ELISA compared with direct immunofluorescence microscopy were seen in 94% of patients with pemphigus and 71% of patients with pemphigoid (Cohen κ value, 0.95 and 0.66) and with the conventional multistep diagnostic approach in 91% of patients with pemphigus and 88% of patients with bullous pemphigoid and 93% of autoantibody-negative sera (Cohen κ, 0.95, 0.84, and 0.78). LIMITATIONS IgA autoantibodies and less common target antigens were not analyzed. CONCLUSIONS The multivariant ELISA is a practical, highly standardized, and widely available novel diagnostic tool for the routine diagnosis of AIBD.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Nora Johannsen
- Institute of Experimental Immunology, Euroimmun, Lübeck, Germany
| | - Susanne Lemcke
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Franziska Hübner
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Marian Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical Faculty of Medicine, Sofia, Bulgaria
| | - Shamir Geller
- Dermatology Department Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Horn
- University Institute of Clinical Chemistry and Center of Laboratory Medicine, Inselspital, Bern, Switzerland
| | - Cezary Kowalewski
- Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Ljiljana Medenica
- Department of Dermatology, University of Belgrade, School of Medicine Pasterova 2, Belgrade, Serbia
| | - Dedee F Murrell
- Department of Dermatology St George Hospital, University of New South Wales School of Medicine, Sydney, Australia
| | - Aikaterini Patsatsi
- Second University Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Soner Uzun
- Akdeniz University Faculty of Medicine Department of Dermatology, Antalya, Turkey
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical Faculty of Medicine, Sofia, Bulgaria
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany
| | | | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
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39
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Kokkonen N, Herukka SK, Huilaja L, Kokki M, Koivisto AM, Hartikainen P, Remes AM, Tasanen K. Increased Levels of the Bullous Pemphigoid BP180 Autoantibody Are Associated with More Severe Dementia in Alzheimer's Disease. J Invest Dermatol 2017; 137:71-76. [PMID: 27650606 DOI: 10.1016/j.jid.2016.09.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/12/2016] [Accepted: 09/02/2016] [Indexed: 02/08/2023]
Abstract
Bullous pemphigoid (BP) is a subepidermal blistering skin disease, which has shown a strong association with neurological diseases in epidemiological studies. The BP autoantigens BP180 and BP230 are expressed in the cutaneous basement membrane and the central nervous system. Using BP180 and BP230 ELISA assays and immunoblotting against BP180, we analyzed the IgG reactivity in the sera of 115 patients with Alzheimer's disease (AD) and 40 neurologically healthy controls. BP180 autoantibodies were found in 18% of patients with AD, whereas only 3% of controls had positive results (P = 0.019). BP230 values were higher and more often elevated in patients with AD than controls, but not significantly. None of the positive AD sera that recognized the full-length human BP180 in immunoblotting reacted with the cutaneous basement membrane in indirect immunofluorescence analysis. Moreover, a retrospective evaluation of the hospital records of the patients with AD revealed neither BP diagnosis nor BP-like symptoms. Interestingly, increased BP180-NC16A autoantibody values correlated with cognitive decline measured by mini-mental state examination scores, but not with the concentration of AD biomarkers in cerebrospinal fluid. Our findings further the understanding of the role of BP180 as a shared autoantigen in neurodermatological interactions and the association between BP and neurodegenerative diseases.
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Affiliation(s)
- Nina Kokkonen
- Department of Dermatology, PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sanna-Kaisa Herukka
- Institute of Clinical Medicine-Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Laura Huilaja
- Department of Dermatology, PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Merja Kokki
- Department of Anesthesia and Operative Service, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Koivisto
- Institute of Clinical Medicine-Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Hartikainen
- Institute of Clinical Medicine-Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anne M Remes
- Institute of Clinical Medicine-Neurology, University of Eastern Finland and Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Kaisa Tasanen
- Department of Dermatology, PEDEGO Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
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40
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Recke A, Oei A, Hübner F, Fechner K, Graf J, Hagenah J, May C, Woitalla D, Salmen A, Zillikens D, Gold R, Schlumberger W, Schmidt E. Parkinson disease and multiple sclerosis are not associated with autoantibodies against structural proteins of the dermal-epidermal junction. Br J Dermatol 2016; 175:407-9. [PMID: 26972435 DOI: 10.1111/bjd.14538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Recke
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - A Oei
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - F Hübner
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - K Fechner
- Institute of Experimental Immunology, Euroimmun Inc., Lübeck, Germany
| | - J Graf
- Departments of Neurology, University of Lübeck, Lübeck, Germany
| | - J Hagenah
- Departments of Neurology, University of Lübeck, Lübeck, Germany
| | - C May
- Medizinisches Proteom-Center, Ruhr-Universität Bochum, Bochum, Germany
| | - D Woitalla
- Department of Neurology, Katholische Kliniken Ruhrhalbinsel GmbH, Essen, Germany
| | - A Salmen
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - R Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - W Schlumberger
- Institute of Experimental Immunology, Euroimmun Inc., Lübeck, Germany
| | - E Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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41
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Keller JJ, Kittridge AL, Debanne SM, Korman NJ. Evaluation of ELISA testing for BP180 and BP230 as a diagnostic modality for bullous pemphigoid: a clinical experience. Arch Dermatol Res 2016; 308:269-72. [PMID: 26895534 DOI: 10.1007/s00403-016-1631-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 10/17/2015] [Accepted: 02/09/2016] [Indexed: 11/26/2022]
Abstract
Bullous pemphigoid (BP) is a common autoimmune blistering disorder of the elderly. Several diagnostic modalities are available, including clinical impression, histopathology, direct and indirect immunofluorescence, and enzyme-linked immunosorbent assay (ELISA) detection of pathogenic antibodies. In this study, we aim to examine the utility of the newest test, ELISA, in comparison to the constellation of other tests. We describe our clinical experience in which 170 patients diagnosed with bullous pemphigoid had multiple tests performed. BP180 alone showed a sensitivity of 54 % and specificity of 94 %. The positive predictive value (PPV) is 95 % while the negative predictive value (NPV) is 52 %. BP230 alone yielded a sensitivity of 48 % and specificity of 94 %. The PPV is 94 % and the NPV is 49 %. Using both tests in combination yielded a sensitivity of 66 % and specificity of 89 %. The PPV of at least one of two tests returning positive is 92 % while the NPV of dual negative tests is 58 %. Use of ELISAs for suspected cases of BP are an inadequate standalone test, and are only helpful in making the diagnosis should they return positive. However, they would appear to miss about one-third of cases.
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Affiliation(s)
- Jesse J Keller
- Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA.
| | | | - Sara M Debanne
- Department of Epidemiology, Case Western Reserve University, 10900 Euclid Ave, Wood Building WG51, Cleveland, OH, 44106, USA
| | - Neil J Korman
- Department of Dermatology, UH Case Medical Center, 11100 Euclid Ave, Lakeside Building 3500, Cleveland, OH, 44106, USA
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42
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Giurdanella F, Diercks G, Jonkman M, Pas H. Laboratory diagnosis of pemphigus: direct immunofluorescence remains the gold standard. Br J Dermatol 2016; 175:185-6. [DOI: 10.1111/bjd.14408] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- F. Giurdanella
- Center for Blistering Diseases Department of Dermatology University Medical Center Groningen University of Groningen P.O. Box 30 001 9700 RB Groningen the Netherlands
| | - G.F.H. Diercks
- Center for Blistering Diseases Department of Dermatology University Medical Center Groningen University of Groningen P.O. Box 30 001 9700 RB Groningen the Netherlands
| | - M.F. Jonkman
- Center for Blistering Diseases Department of Dermatology University Medical Center Groningen University of Groningen P.O. Box 30 001 9700 RB Groningen the Netherlands
| | - H.H. Pas
- Center for Blistering Diseases Department of Dermatology University Medical Center Groningen University of Groningen P.O. Box 30 001 9700 RB Groningen the Netherlands
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43
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Schmidt E, Goebeler M, Hertl M, Sárdy M, Sitaru C, Eming R, Hofmann SC, Hunzelmann N, Kern JS, Kramer H, Orzechowski HD, Pfeiffer C, Schuster V, Sporbeck B, Sticherling M, Worm M, Zillikens D, Nast A. S2k guideline for the diagnosis of pemphigus vulgaris/foliaceus and bullous pemphigoid. J Dtsch Dermatol Ges 2016; 13:713-27. [PMID: 26110729 DOI: 10.1111/ddg.12612] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Enno Schmidt
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology, and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Miklós Sárdy
- Department of Dermatology, Venereology, and Allergology, University Hospital Munich (LMU), Munich, Germany
| | - Cassian Sitaru
- Department of Dermatology and Venereology, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, University Hospital Marburg, Marburg, Germany
| | - Silke C Hofmann
- Center for Dermatology, Allergology, and Dermatosurgery, Helios Hospital Wuppertal, Wuppertal, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Johannes S Kern
- Department of Dermatology and Venereology, Albert-Ludwigs University Freiburg, Freiburg, Germany
| | | | - Hans-Dieter Orzechowski
- Institute of Clinical Pharmacology and Toxicology, Charité - University Hospital Berlin, Berlin, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany
| | - Volker Schuster
- Pediatric Immunology and Rheumatology, University Hospital and Outpatient Clinical for Children and Adolescents, Leipzig, Germany
| | - Birte Sporbeck
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - University Hospital Berlin, Berlin, Germany
| | | | - Margitta Worm
- Center for Allergy, Department of Dermatology, Charité - University Hospital Berlin, Berlin, Germany
| | - Detlef Zillikens
- Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany
| | - Alexander Nast
- Division of Evidence Based Medicine (dEBM), Department of Dermatology, Charité - University Hospital Berlin, Berlin, Germany
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44
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Abstract
Convergence of localized surface plasmon resonance of metal nanoparticles with classical ELISA has emerged as a new class of immunoassays, i.e. plasmonic ELISA, enabling biocatalysis mediated ultrasensitive naked-eye detection of disease biomarkers.
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Affiliation(s)
- Jitendra Satija
- School of BioSciences and Technology (SBST)
- VIT University
- Vellore
- India
| | - Nirmal Punjabi
- Department of Biosciences and Bioengineering
- IIT Bombay
- Mumbai 400 076
- India
| | - Debasish Mishra
- School of BioSciences and Technology (SBST)
- VIT University
- Vellore
- India
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT)
| | - Soumyo Mukherji
- Department of Biosciences and Bioengineering
- IIT Bombay
- Mumbai 400 076
- India
- Centre of Excellence for Nanoelectronics
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45
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Amber K, Bloom R, Hertl M. A systematic review with pooled analysis of clinical presentation and immunodiagnostic testing in mucous membrane pemphigoid: association of anti-laminin-332 IgG with oropharyngeal involvement and the usefulness of ELISA. J Eur Acad Dermatol Venereol 2015; 30:72-7. [DOI: 10.1111/jdv.13397] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- K.T. Amber
- Department of Dermatology; University of California Irvine Health Center; Irvine CA USA
| | - R. Bloom
- Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL USA
| | - M. Hertl
- Department of Dermatology and Allergology; Phillipps University; Marburg Germany
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46
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Schmidt E, Goebeler M, Hertl M, Sárdy M, Sitaru C, Eming R, Hofmann SC, Hunzelmann N, Kern JS, Kramer H, Orzechowski HD, Pfeiffer C, Schuster V, Sporbeck B, Sticherling M, Worm M, Zillikens D, Nast A. S2k-Leitlinie zur Diagnostik des Pemphigus vulgaris/foliaceus und des bullösen Pemphigoids. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.40_12612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Enno Schmidt
- Klinik für Dermatologie; Allergologie und Venerologie, Universität Lübeck; Lübeck
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie; Universitätsklinikum Würzburg; Würzburg
| | - Michael Hertl
- Klinik für Dermatologie und Allergology Universitätsklinikum Marburg
| | - Miklós Sárdy
- Klinik und Poliklinik für Dermatologie und Allergologie; Klinikum der Universität München (LMU); München
| | - Cassian Sitaru
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg; Albert-Ludwigs-Universität Freiburg; Freiburg
| | - Rüdiger Eming
- Klinik für Dermatologie und Allergology Universitätsklinikum Marburg
| | - Silke C. Hofmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie; Helios Klinikum Wuppertal
| | - Nicolas Hunzelmann
- Klinik und Poliklinik für Dermatologie und Venerologie; Universität zu Köln
| | - Johannes S. Kern
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg; Albert-Ludwigs-Universität Freiburg; Freiburg
| | | | | | | | - Volker Schuster
- Pädiatrische Immunologie und Rheumatologie; Universitätsklinik und Poliklinik für Kinder und Jugendliche; Leipzig
| | - Birte Sporbeck
- Division of Evidence Based Medicine (dEBM); Klinik für Dermatologie; Charité - Universitätsmedizin Berlin
| | | | - Margitta Worm
- Allergie-Centrum, Klinik für Dermatologie; Charité - Universitätsmedizin Berlin
| | - Detlef Zillikens
- Klinik für Dermatologie; Allergologie und Venerologie, Universität Lübeck; Lübeck
| | - Alexander Nast
- Division of Evidence Based Medicine (dEBM); Klinik für Dermatologie; Charité - Universitätsmedizin Berlin
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47
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Atypical presentations of bullous pemphigoid: Clinical and immunopathological aspects. Autoimmun Rev 2015; 14:438-45. [DOI: 10.1016/j.autrev.2015.01.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 01/14/2015] [Indexed: 11/19/2022]
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48
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Autoimmune blistering diseases in females: a review. Int J Womens Dermatol 2015; 1:4-12. [PMID: 28491949 PMCID: PMC5418673 DOI: 10.1016/j.ijwd.2015.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/23/2014] [Accepted: 01/13/2015] [Indexed: 12/31/2022] Open
Abstract
The autoimmune blistering diseases (AIBDs) are a group of heterogeneous skin diseases with autoantibodies directed against structural proteins in the skin. A new interest in the female bias towards autoimmune diseases in general has led to our attention to focus on how and why this female bias manifests in AIBD. The authors aim to review and explore the various aspects of AIBD affecting females more than males, including the higher prevalence, worse quality of life, and complex management issues such as pregnancy and lactation. What is already known on this topic? Echoing autoimmune diseases in general, most autoimmune blistering diseases (AIBDs) have a female predominance, but the exact level of predominance is unknown. Pregnancy raises several complicated management issues for females with an AIBD.
What does this article add to our knowledge? Review of sex-specific epidemiology and etiology of each AIBD. Exploration and explanation of the key factors underlying the detrimental impacts of AIBD on women’s quality of life (QOL). Discussion of management issues in pregnancy and lactation for females with an AIBD.
How does this information impact clinical practice and/or change patient care? An awareness and understanding of the female predominance in AIBDs will ensure more appropriate diagnosis, evaluation, and future research. Emphasizing holistic care targeting the debilitating effects of AIBDs on women’s QOL. Informing the reader of optimal, yet safe interventions for pregnant women with an AIBD.
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Salivary desmoglein enzyme-linked immunosorbent assay for diagnosis of pemphigus vulgaris: a noninvasive alternative test to serum assessment. BIOMED RESEARCH INTERNATIONAL 2015; 2015:698310. [PMID: 25688364 PMCID: PMC4320921 DOI: 10.1155/2015/698310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/19/2014] [Indexed: 12/02/2022]
Abstract
Background. Serum desmoglein enzyme-linked immunosorbent assay (ELISA) is used for the diagnosis and monitoring of pemphigus diseases. Objectives. To compare the diagnostic accuracy of salivary antidesmoglein (Dsg) 1 and 3 ELISA in the diagnosis of pemphigus vulgaris (PV) patients with that of serum desmogleins ELISA. Methods. Eighty-six untreated PV patients and 180 age- and sex-matched PV-free controls were recruited in this case-control study. PV was diagnosed based on clinical, histopathological, and direct immunofluorescence findings. After processing, serum and salivary anti-Dsg 1 and 3 were measured by the ELISA method using Euroimmun kit (Lübeck, Germany). Results. Using the cut-off point of 20 relative units (RU)/mL, the serum anti-Dsg 1 and 3 ELISA were positive in 62 (72.1%) and 83 (96.5%) patients, respectively, and the salivary anti-Dsg 1 and 3 ELISA were positive in 31 (36.1%) and 63 (73.3%) patients, respectively. The specificity of salivary anti-Dsg 1 and anti-Dsg 3 were both 98.9%. Optimal cut-off values of 7.7 and 13.4 RU/mL were determined for the salivary anti-Dsg 1 and anti-Dsg 3 ELISA, respectively. Conclusion. Salivary anti-Dsg 1 and 3 ELISA with high specificities (98.9%) could be suggested as safe and noninvasive methods for the diagnosis of PV when obtaining a blood sample is difficult.
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Reis-Filho EGDM, Silva TDA, Aguirre LHDL, Reis CMS. Bullous pemphigoid in a 3-month-old infant: case report and literature review of this dermatosis in childhood. An Bras Dermatol 2014; 88:961-5. [PMID: 24474106 PMCID: PMC3900348 DOI: 10.1590/abd1806-4841.20132378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 01/04/2013] [Indexed: 11/22/2022] Open
Abstract
Bullous pemphigoid is an autoimmune subepidermal blistering dermatosis that is
uncommon in childhood. We report a case of a female infant, 3 months old, which
presented clinical and laboratory data for the confirmatory diagnosis of bullous
pemphigoid. The authors used immunohistochemical staining for collagen type IV that
allowed the differentiation of bullous pemphigoid from other subepidermal bullous
diseases. Opportunely we review the clinical, immunological, therapeutic and
prognostic features of this pathology in children.
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Affiliation(s)
- Eugenio Galdino de Mendonça Reis-Filho
- Brasilia Catholic University, MD, Board certified dermatologist - Professor of dermatology at Brasilia Catholic University (UCB). Dermatologist at the Distrito Federal Health State Secretariat (SES-DF) - Brasília (DF), Brazil
| | - Tainah de Almeida Silva
- Asa Norte Regional Hospital, BrasíliaDF, Brazil, MD - Resident in Dermatology at Asa Norte Regional Hospital (HRAN) - Brasília (DF), Brazil
| | - Luiza Helena de Lima Aguirre
- Asa Norte Regional Hospital, Preceptor of the Dermatology Residency Program, BrasíliaDF, Brazil, MD, Board certified dermatologist. Preceptor of the Dermatology Residency Program at Asa Norte Regional Hospital (HRAN) - Brasília (DF), Brazil
| | - Carmelia Matos Santiago Reis
- Brasilia Catholic University, MD, Board certified dermatologist - Professor of dermatology at Brasilia Catholic University (UCB). Dermatologist at the Distrito Federal Health State Secretariat (SES-DF) - Brasília (DF), Brazil
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