1
|
Adhikari A, Mikrani JA, Nepal S, Rauniyar A, Chaudhary M, Atreya A. Delayed diagnosis of pemphigus vulgaris in rural Nepal due to healthcare inaccessibility and harmful traditional practices: A case report. Clin Case Rep 2024; 12:e8754. [PMID: 38617063 PMCID: PMC11009452 DOI: 10.1002/ccr3.8754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/11/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Early intervention is imperative for potentially fatal dermatologic diseases such as pemphigus vulgaris. In rural Nepal, limited public awareness, home remedies, and delays in healthcare access lead to poor outcomes. Although biopsy confirms the diagnosis, experienced dermatologists can make an accurate clinical diagnosis when characteristic skin lesions are present.
Collapse
Affiliation(s)
| | | | - Samata Nepal
- Department of Community MedicineLumbini Medical CollegePalpaNepal
| | | | | | - Alok Atreya
- Department of Forensic MedicineLumbini Medical CollegePalpaNepal
| |
Collapse
|
2
|
Barcelos VM, Vale ECSD, Araujo MG, Bittencourt FV. Epidemiological and clinical study of cases of endemic pemphigus foliaceus and pemphigus vulgaris in a reference center in the state of Minas Gerais, Brazil. An Bras Dermatol 2024; 99:43-52. [PMID: 37805349 DOI: 10.1016/j.abd.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/03/2023] [Accepted: 03/12/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Pemphigus constitutes a group of autoimmune bullous diseases. A reduction in the incidence of endemic pemphigus foliaceus and an increase in pemphigus vulgaris has been described, but there are no studies in Minas Gerais that address the subject. OBJECTIVE To describe the epidemiological and clinical profile of patients with pemphigus treated at the Dermatology Service of a public University Hospital in the state of Minas Gerais, Brazil. METHODS An observational, descriptive, and cross-sectional study was carried out of cases of endemic pemphigus foliaceus and pemphigus vulgaris, for a period of six months. A questionnaire was filled out with epidemiological and clinical data on the disease. RESULTS A total of 122 patients were included in the study, 64 with endemic pemphigus foliaceus and 58 with pemphigus vulgaris. When comparing patients with endemic pemphigus foliaceus and those with pemphigus vulgaris, a statistical difference was observed between the median age of initial disease manifestation (p = 0.001), patient occupation (p = 0.010), area of residence (p = 0.000), forests (p = 0.000) and rivers/streams close to the dwelling (p = 0.001) and the number of systemic medications required to control the disease (p = 0.002). When comparing patients with endemic pemphigus foliaceus to those evaluated in a study carried out at the same service in 2008, there was a statistical difference in the area of residence (p = 0.030). STUDY LIMITATIONS The assessed population comes from a tertiary care service that is not a reference for the entire state. CONCLUSIONS Patients with endemic pemphigus foliaceus and pemphigus vulgaris maintain statistically significant differences regarding their main variables in the literature, such as age and area of residence. Historically, there has been a reduction in cases of endemic pemphigus foliaceus and an increase in cases of pemphigus vulgaris in this population.
Collapse
Affiliation(s)
- Vanessa Martins Barcelos
- Service of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | - Marcelo Grossi Araujo
- Service of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Flávia Vasques Bittencourt
- Service of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Postgraduate Programa in Science Applied to Adult Health, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
3
|
Rosi-Schumacher M, Baker J, Waris J, Seiffert-Sinha K, Sinha AA. Worldwide epidemiologic factors in pemphigus vulgaris and bullous pemphigoid. Front Immunol 2023; 14:1159351. [PMID: 37180132 PMCID: PMC10166872 DOI: 10.3389/fimmu.2023.1159351] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023] Open
Abstract
Autoimmune blistering diseases such as bullous pemphigoid (BP) and pemphigus vulgaris (PV) are complex, multifactorial, and polygenic diseases, whose exact pathogenesis is difficult to pinpoint. Research aimed at elucidating the associated epidemiologic risk factors of these two diseases has been hampered by their rare disease status. Further, a lack of centralization and standardization of available data makes the practical application of this information challenging. In order to collate and clarify the available literature we comprehensively reviewed 61 PV articles from 37 different countries and 35 BP articles from 16 different countries addressing a range of disease relevant clinical parameters including age of onset, sex, incidence, prevalence, and HLA allele association. The reported incidence of PV ranged from 0.098 to 5 patients per 100,000 people, while BP ranged from 0.21 to 7.63 patients per 100,000. Prevalence of PV ranged from 0.38 to 30 per 100,000 people and BP ranged from 1.46 to 47.99 per 100,000. The mean age of onset in patients ranged from 36.5 to 71 years for PV and 64 to 82.6 years for BP. Female-to-male ratios ranged from 0.46 to 4.4 in PV and 1.01 to 5.1 in BP. Our analysis provides support for the reported linkage disequilibrium of HLA DRB1*0402 (an allele previously shown to be associated with PV) and DQB1*0302 alleles in Europe, North America, and South America. Our data also highlight that HLA DQB1*0503 (also known to be associated with PV) appears in linkage disequilibrium with DRB1*1404 and DRB1*1401, mainly in Europe, the Middle East, and Asian countries. The HLA DRB1*0804 allele was only associated with PV in patients of Brazilian and Egyptian descent. Only two HLA alleles were reported as associated with BP more than twice in our review, DQB1*0301 and DQA1*0505. Collectively, our findings provide detailed insights into the variation of disease parameters relevant to PV and BP that can be expected to inform future work aimed at unraveling the complex pathogenesis of these conditions across the globe.
Collapse
Affiliation(s)
| | | | | | | | - Animesh A. Sinha
- Department of Dermatology, University at Buffalo, Buffalo, NY, United States
| |
Collapse
|
4
|
Takahashi H, Iriki H, Asahina Y. T cell autoimmunity and immune regulation to desmoglein 3, a pemphigus autoantigen. J Dermatol 2023; 50:112-123. [PMID: 36539957 PMCID: PMC10107879 DOI: 10.1111/1346-8138.16663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
Pemphigus is a life-threatening autoimmune bullous disease mediated by anti-desmoglein IgG autoantibodies. Pemphigus is mainly classified into three subtypes: pemphigus vulgaris, pemphigus foliaceus, and paraneoplastic pemphigus. The pathogenicity of autoantibodies has been extensively studied. Anti-human CD20 antibody therapy targeting B cells emerged as a more effective treatment option compared to conventional therapy for patients with an intractable disease. On the other hand, autoreactive T cells are considered to be involved in the pathogenesis based on the test results of human leukocyte antigen association, autoreactive T cell detection, and cytokine profile analysis. Research on the role of T cells in pemphigus has continued to progress, including that on T follicular helper cells, which initiate molecular mechanisms involved in antibody production in B cells. Autoreactive T cell research in mice has highlighted the crucial roles of cellular autoimmunity and improved the understanding of its pathogenesis, especially in paraneoplastic pemphigus. The mouse research has helped elucidate novel regulatory mechanisms of autoreactive T cells, such as thymic tolerance to desmoglein 3 and the essential roles of regulatory T cells, Langerhans cells, and other molecules in peripheral tissues. This review focuses on the immunological aspects of autoreactive T cells in pemphigus by providing detailed information on various related topics.
Collapse
Affiliation(s)
- Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hisato Iriki
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuhiko Asahina
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Wang Y, Xia X, Zhou X, Zhan T, Dai Q, Zhang Y, Zhang W, Shu Y, Li W, Xu H. Association of gut microbiome and metabolites with onset and treatment response of patients with pemphigus vulgaris. Front Immunol 2023; 14:1114586. [PMID: 37122759 PMCID: PMC10140300 DOI: 10.3389/fimmu.2023.1114586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background Gut dysbiosis and gut microbiome-derived metabolites have been implicated in both disease onset and treatment response, but this has been rarely demonstrated in pemphigus vulgaris (PV). Here, we aim to systematically characterize the gut microbiome to assess the specific microbial species and metabolites associated with PV. Methods We enrolled 60 PV patients and 19 matched healthy family members, and collected 100 fecal samples (60 treatment-naïve, 21 matched post-treatment, and 19 controls). Metagenomic shotgun sequencing and subsequent quality control/alignment/annotation were performed to assess the composition and microbial species, in order to establish the association between gut microbiome with PV onset and treatment response. In addition, we evaluated short-chain fatty acids (SCFAs) in PV patients through targeted metabolomics analysis. Results The diversity of the gut microbiome in PV patients deviates from the healthy family members but not between responder and non-responder, or before and after glucocorticoid treatment. However, the relative abundance of several microbial species, including the pathogenic bacteria (e.g., Escherichia coli) and some SCFA-producing probiotics (e.g., Eubacterium ventriosum), consistently differed between the two groups in each comparison. Escherichia coli was enriched in PV patients and significantly decreased after treatment in responders. In contrast, Eubacterium ventriosum was enriched in healthy family members and significantly increased particularly in responders after treatment. Consistently, several gut microbiome-derived SCFAs were enriched in healthy family members and significantly increased after treatment (e.g., butyric acid and valeric acid). Conclusions This study supports the association between the gut microbiome and PV onset, possibly through disrupting the balance of gut pathogenic bacteria and probiotics and influencing the level of gut microbiome-derived SCFAs. Furthermore, we revealed the potential relationship between specific microbial species and glucocorticoid treatment.
Collapse
Affiliation(s)
- Yiyi Wang
- Department of Dermatology & Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuyang Xia
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Chengdu, China
| | - Xingli Zhou
- Department of Dermatology & Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tongying Zhan
- Department of Dermatology & Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghong Dai
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, China
| | - Yan Zhang
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Shu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Chengdu, China
| | - Wei Li
- Department of Dermatology & Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Heng Xu, ; Wei Li,
| | - Heng Xu
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Chengdu, China
- Department of Laboratory Medicine, Research Center of Clinical Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Heng Xu, ; Wei Li,
| |
Collapse
|
6
|
Sielski L, Baker J, DePasquale MC, Attwood K, Seiffert-Sinha K, Sinha AA. Desmoglein compensation hypothesis fidelity assessment in Pemphigus. Front Immunol 2022; 13:969278. [PMID: 36211362 PMCID: PMC9537551 DOI: 10.3389/fimmu.2022.969278] [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: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
The pemphigus group of autoimmune blistering diseases encompasses pemphigus vulgaris (PV) and pemphigus foliaceus (PF). Lesion location in pemphigus has been elegantly postulated by the Desmoglein Compensation Hypothesis (DCH), which references the distribution of desmoglein (Dsg) proteins in the epidermis along with a patient’s autoantibody profile to describe three different lesion phenotypes: PF is characterized by subcorneal lesions in the presence of anti-Dsg1 antibodies only, while lesions in PV are suprabasilar and accompanied by anti-Dsg3 antibodies only in mucosal PV, or both anti-Dsg3 and anti-Dsg1 in the case of mucocutaneous PV. While the validity of this hypothesis has been supported by several studies and is prominently featured in textbooks of dermatology, a number of logical inconsistencies have been noted and exceptions have been published in several small-scale studies. We sought to comprehensively assess the extent to which patient clinical and autoantibody profiles contradict the DCH, and characterize these contradictions in a large sample size of 266 pemphigus patients. Remarkably, we find that roughly half of active PV and PF patients surveyed present with a combination of lesion morphology and anti-Dsg3/1 levels that contradict the DCH, including: patients with a cutaneous only PV presentation, mucocutaneous disease in the absence of either Dsg3, Dsg1, or both, and mucosal disease in the absence of Dsg3 or presence of Dsg1. We also find stark differences in fidelity to the DCH based on ethnicity and HLA-association, with the lowest proportion of adherence in previously understudied populations. These findings underscore the need to expand our understanding of pemphigus morphology beyond the DCH, in particular for populations that have not been a focus in previous investigation.
Collapse
Affiliation(s)
- Lauren Sielski
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - John Baker
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Michael C. DePasquale
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - Kristina Seiffert-Sinha
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Animesh A. Sinha
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
- *Correspondence: Animesh A. Sinha,
| |
Collapse
|
7
|
Le TTV, Vuong TTB, Ong TP, Do MD. Allele frequency and the associations of HLA-DRB1 and HLA-DQB1 polymorphisms with pemphigus subtypes and disease severity. Medicine (Baltimore) 2022; 101:e28855. [PMID: 35363186 PMCID: PMC9282124 DOI: 10.1097/md.0000000000028855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/27/2022] [Indexed: 01/04/2023] Open
Abstract
Pemphigus is a rare, devastating, bullous autoimmune disease that damages the skin and mucous membranes, and has high morbidity and mortality. Studies have shown associations of pemphigus vulgaris (PV) and pemphigus foliaceus (PF) with human leukocyte antigen (HLA) class II polymorphisms.This study examined the frequency of Major Histocompatibility Complex, Class II, DR Beta 1, a Protein Coding gene (HLA-DRB1) and Major Histocompatibility Complex, Class II, DQ Beta 1 (HLA-DQB1) alleles in Vietnamese PV and PF patients, and the association of these polymorphisms with pemphigus subtypes and disease severity.The study enrolled 31 unrelated Vietnamese who underwent HLA typing using Sanger sequencing.HLA-DRB1∗14:54 was the most frequent allele in both PV (20.5%) and PF (33.3%) patients. The percentage of HLA-DQB1∗03:02 was significantly higher in PF than PV patients, while the percentage of HLA-DQB1∗05:03 was approximately 10 times higher in PV patients. Pemphigus patients who have the HLA-DRB1∗04 alleles are more likely to have mild or moderate disease.The HLA-DRB1 and DQB1 alleles may influence susceptibility to pemphigus subtypes, with DQB1∗05:03 being specific for PV and DQB1∗03:02 for PF. Our findings suggest that the DRB1∗04 alleles are likely to be associated with mild and moderate disease.
Collapse
Affiliation(s)
- Thanh Thai Van Le
- Department of Dermatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
- Department of Dermatology and Skin Aesthetics, University Medical Center HCMC, Ho Chi Minh City, Viet Nam
| | - Thanh The Bich Vuong
- Department of Dermatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Thinh Phuc Ong
- Mathematical Modelling Group, Centre for Tropical Medicine, Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Minh Duc Do
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| |
Collapse
|
8
|
Hashimoto T. Pathogenic role of ST18 in pemphigus vulgaris. Br J Dermatol 2021; 184:1001-1002. [PMID: 33997950 DOI: 10.1111/bjd.19883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/27/2022]
Affiliation(s)
- T Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
9
|
Castro-Santos P, Olloquequi J, Verdugo RA, Gutiérrez MA, Pinochet C, Quiñones LA, Díaz-Peña R. HLA-DRB1*07:01 and * 08:02 Alleles Confer a Protective Effect Against ACPA-Positive Rheumatoid Arthritis in a Latin American Admixed Population. BIOLOGY 2020; 9:biology9120467. [PMID: 33327594 PMCID: PMC7765073 DOI: 10.3390/biology9120467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 06/12/2023]
Abstract
HLA-DRB1 shared epitope (SE) alleles are important genetic contributors for the risk of developing anti-citrullinated protein antibodies (ACPA)-positive rheumatoid arthritis (RA), particularly in Caucasians. We aimed to analyze the contribution of HLA-DRB1 alleles and single nucleotide polymorphisms (SNPs) within the major histocompatibility complex (MHC) region to the susceptibility to develop ACPA-positive RA in a Latin American (LA) population with admixed ancestry. A total of 289 ACPA-positive RA patients and 510 controls were enrolled in this study. The presence of HLA-DRB1*04:01, *09:01 and *10:01 was increased in ACPA-positive RA patients compared with healthy controls (p < 0.0001, p < 0.001 and p < 0.01, respectively), whereas DRB1*07:01 and *08:02 was associated with a decreased risk of ACPA-positive RA (p < 0.001 and p < 0.01, respectively). These results showed a strong correlation with estimates from studies in Asians but not in Caucasian populations. The present study describes the protective effects of the HLA-DRB1*07:01 and *08:02 alleles in ACPA-positive RA patients in a LA population for the first time. Identifying relationships between HLA-DRB1 alleles and RA is important for identifying disease associations in different ethnic groups in order to reach a better understanding of RA worldwide.
Collapse
Affiliation(s)
- Patricia Castro-Santos
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile; (P.C.-S.); (J.O.)
- Inmunología, Centro de Investigaciones Biomédicas (CINBIO), Universidad de Vigo, 36310 Vigo, Spain
| | - Jordi Olloquequi
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile; (P.C.-S.); (J.O.)
| | - Ricardo A. Verdugo
- Programa de Genética Humana, ICBM, Facultad de Medicina, Universidad de Chile, Santiago 8389100, Chile;
- Departamento de Oncología Básico-Clínico, Facultad de Medicina, Universidad de Chile, Santiago 8389100, Chile
| | - Miguel A. Gutiérrez
- Rheumatology, Almirante Nef Naval Hospital, Viña del Mar, Valparaíso 2340000, Chile;
- School of Medicine, Valparaíso University, Valparaíso 2340000, Chile
| | | | - Luis A. Quiñones
- Laboratory of Chemical Carcinogenesis and Pharmacogenetics, Department of Basic-Clinical Oncology, Faculty of Medicine, University of Chile, Santiago 8320000, Chile
- Latin American Network for Implementation and Validation of Clinical Pharmacogenomics Guidelines (RELIVAF-CYTED), 28015 Madrid, Spain
| | - Roberto Díaz-Peña
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile; (P.C.-S.); (J.O.)
| |
Collapse
|
10
|
Assaf S, Malki L, Mayer T, Mohamad J, Peled A, Pavlovsky M, Malovitski K, Sarig O, Vodo D, Sprecher E. ST18 affects cell-cell adhesion in pemphigus vulgaris in a tumour necrosis factor-α-dependent fashion. Br J Dermatol 2020; 184:1153-1160. [PMID: 33205400 DOI: 10.1111/bjd.19679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is a life-threatening mucocutaneous autoimmune blistering disease. We previously showed that genetic variants within the ST18 gene promoter area confer a sixfold increase in the propensity to develop PV. ST18, a transcription factor, was found to be overexpressed in the epidermis of patients with PV. In addition, it was found to promote autoantibody-mediated abnormal epidermal cell-cell adhesion and secretion of proinflammatory mediators by keratinocytes. OBJECTIVES To delineate the mechanism through which ST18 contributes to destabilization of cell-cell adhesion. METHODS We used quantitative reverse-transcriptase polymerase chain reaction, immunofluorescence microscopy, a luciferase reporter system, site-directed mutagenesis, chromatin immunoprecipitation (ChIP) and the dispase dissociation assay. RESULTS The ChIP and luciferase reporter assays showed that ST18 directly binds and activates the TNF promoter. Accordingly, increased ST18 expression contributes to PV pathogenesis by destabilizing cell-cell adhesion in a tumour necrosis factor (TNF)-α-dependent fashion. In addition, dual immunofluorescence staining showed increased expression of both ST18 and TNF-α in the skin of patients with PV carrying an ST18-associated PV risk variant, which was found to be associated with a more extensive PV phenotype. CONCLUSIONS Our findings suggest a role for TNF-α in mediating the deleterious effect of increased ST18 expression in PV skin.
Collapse
Affiliation(s)
- S Assaf
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Malki
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Mayer
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - J Mohamad
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Peled
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Pavlovsky
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - K Malovitski
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - O Sarig
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - D Vodo
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
11
|
Rashid H, Lamberts A, Diercks GFH, Pas HH, Meijer JM, Bolling MC, Horváth B. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol 2019; 20:847-861. [PMID: 31313078 PMCID: PMC6872602 DOI: 10.1007/s40257-019-00461-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Autoimmune bullous diseases are a group of chronic inflammatory disorders caused by autoantibodies targeted against structural proteins of the desmosomal and hemidesmosomal plaques in the skin and mucosa, leading to intra-epithelial or subepithelial blistering. The oral mucosa is frequently affected in these diseases, in particular, in mucous membrane pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus. The clinical symptoms are heterogeneous and may present with erythema, blisters, erosions, and ulcers localized anywhere on the oral mucosa, and lead to severe complaints for the patients including pain, dysphagia, and foetor. Therefore, a quick and proper diagnosis with adequate treatment is needed. Clinical presentations of autoimmune bullous diseases often overlap and diagnosis cannot be made based on clinical features alone. Immunodiagnostic tests are of great importance in differentiating between the different diseases. Direct immunofluorescence microscopy shows depositions of autoantibodies along the epithelial basement membrane zone in mucous membrane pemphigoid subtypes, or depositions on the epithelial cell surface in pemphigus variants. Additional immunoserological tests are useful to discriminate between the different subtypes of pemphigoid, and are essential to differentiate between pemphigus and paraneoplastic pemphigus. This review gives an overview of the clinical characteristics of oral lesions and the diagnostic procedures in autoimmune blistering diseases, and provides a diagnostic algorithm for daily practice.
Collapse
Affiliation(s)
- Hanan Rashid
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Aniek Lamberts
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Gilles F H Diercks
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendri H Pas
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Joost M Meijer
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Maria C Bolling
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| |
Collapse
|
12
|
Abstract
Mucocutaneous diseases affecting the oral cavity are predominantly immune mediated or inflammatory. Three of the most common and clinically significant conditions are reviewed in this article: lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Because oral manifestations may be the first or only manifestation of mucocutaneous diseases, oral health professionals play a critical role in the early diagnosis and multidisciplinary management of these conditions.
Collapse
|
13
|
Kasperkiewicz M, Lai O, Recke A, Betlachin A, Ji L, Groshen S, Woodley D. Clinical outcomes of patients with pemphigus treated by the same physicians in a public safety net healthcare system vs. a private healthcare system. Br J Dermatol 2019; 181:850-852. [DOI: 10.1111/bjd.17983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M. Kasperkiewicz
- Department of Dermatology The Keck School of Medicine University of Southern California, USC/Norris Cancer Center Los Angeles CA U.S.A
- Department of Dermatology University of Lübeck Lübeck Germany
| | - O. Lai
- Department of Dermatology The Keck School of Medicine University of Southern California, USC/Norris Cancer Center Los Angeles CA U.S.A
| | - A. Recke
- Department of Dermatology University of Lübeck Lübeck Germany
| | - A. Betlachin
- Department of Dermatology The Keck School of Medicine University of Southern California, USC/Norris Cancer Center Los Angeles CA U.S.A
| | - L. Ji
- Department of Preventive Medicine University of Southern California, USC/Norris Cancer Center Los Angeles CA U.S.A
| | - S. Groshen
- Department of Preventive Medicine University of Southern California, USC/Norris Cancer Center Los Angeles CA U.S.A
| | - D. Woodley
- Department of Dermatology The Keck School of Medicine University of Southern California, USC/Norris Cancer Center Los Angeles CA U.S.A
| |
Collapse
|
14
|
Radeva MY, Walter E, Stach RA, Yazdi AS, Schlegel N, Sarig O, Sprecher E, Waschke J. ST18 Enhances PV-IgG-Induced Loss of Keratinocyte Cohesion in Parallel to Increased ERK Activation. Front Immunol 2019; 10:770. [PMID: 31057535 PMCID: PMC6478701 DOI: 10.3389/fimmu.2019.00770] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/25/2019] [Indexed: 12/21/2022] Open
Abstract
Pemphigus is an autoimmune blistering disease targeting the desmosomal proteins desmoglein (Dsg) 1 and Dsg3. Recently, a genetic variant of the Suppression of tumorigenicity 18 (ST18) promoter was reported to cause ST18 up-regulation, associated with pemphigus vulgaris (PV)-IgG-mediated increase in cytokine secretion and more prominent loss of keratinocyte cohesion. Here we tested the effects of PV-IgG and the pathogenic pemphigus mouse anti-Dsg3 antibody AK23 on cytokine secretion and ERK activity in human keratinocytes dependent on ST18 expression. Without ST18 overexpression, both PV-IgG and AK23 induced loss of keratinocyte cohesion which was accompanied by prominent fragmentation of Dsg3 immunostaining along cell borders. In contrast, release of pro-inflammatory cytokines such as IL-1α, IL-6, TNFα, and IFN-γ was not altered significantly in both HaCaT and primary NHEK cells. These experiments indicate that cytokine expression is not strictly required for loss of keratinocyte cohesion. Upon ST18 overexpression, fragmentation of cell monolayers increased significantly in response to autoantibody incubation. Furthermore, production of IL-1α and IL-6 was enhanced in some experiments but not in others whereas release of TNF-α dropped significantly upon PV-IgG application in both EV- and ST18-transfected HaCaT cells. Additionally, in NHEK, application of PV-IgG but not of AK23 significantly increased ERK activity. In contrast, ST18 overexpression in HaCaT cells augmented ERK activation in response to both c-IgG and AK23 but not PV-IgG. Because inhibition of ERK by U0126 abolished PV-IgG- and AK23-induced loss of cell cohesion in ST18-expressing cells, we conclude that autoantibody-induced ERK activation was relevant in this scenario. In summary, similar to the situation in PV patients carrying ST18 polymorphism, overexpression of ST18 enhanced keratinocyte susceptibility to autoantibody-induced loss of cell adhesion, which may be caused in part by enhanced ERK signaling.
Collapse
Affiliation(s)
- Mariya Y Radeva
- Department I, Institute of Anatomy and Cell Biology, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Elias Walter
- Department I, Institute of Anatomy and Cell Biology, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Ramona Alexandra Stach
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Amir S Yazdi
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Tübingen, Germany.,Department of Dermatology, RWTH Aachen, Aachen, Germany
| | - Nicolas Schlegel
- Department of General, Visceral, Vascular and Paediatric Surgery, Julius-Maximilians-Universität, Würzburg, Germany
| | - Ofer Sarig
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jens Waschke
- Department I, Institute of Anatomy and Cell Biology, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| |
Collapse
|
15
|
De Bonis M, De Paolis E, Scaglione GL, Fania L, Lavieri MM, Mazzanti C, Di Zenzo G, Minucci A, Capoluongo E. High-resolution melting analysis to screen the ST18 gene functional risk variant for pemphigus vulgaris: The occasion to open a debate on its usefulness in clinical setting. Exp Mol Pathol 2019; 108:57-63. [PMID: 30926339 DOI: 10.1016/j.yexmp.2019.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 01/09/2023]
Abstract
The ST18 -497-65050 T > C polymorphisms (rs17315309) exhibit a very strong association in the pathogenesis of Pemphigus Vulgaris (PV) and could represent a new potential molecular target for the treatment of disease. The present study aimed to establish a low-cost, sensitive and reliable assay using high-resolution melting curve analysis (HRMA) on magnetic induction rotor-based platform, the Magnetic Induction Cycler (MIC) (Bio molecular Systems). HRMA assay was able to identify easily and unambiguously the c.-497-65050 T > C genotypes evaluating melting curve shape and melting temperature (Tm). The results of HRMA were validated by direct DNA sequencing. The HRMA is rapid, sensitive, low-cost and high-throughput assay to screen the rs17315309 variant and could be used in clinical diagnostic laboratories.
Collapse
Affiliation(s)
- Maria De Bonis
- UOC Laboratory Medicine, Genetics and Toxicology, IDI IRCCS, Fondazione Luigi Maria Monti, Via Monti di Creta 104, Rome, Italy; Polo Scienze per Immagini, di Laboratorio e Infettivologiche, "Fondazione Policlinico Agostino Gemelli" - IRCCS, Rome, Italy.
| | - Elisa De Paolis
- UOC Laboratory Medicine, Genetics and Toxicology, IDI IRCCS, Fondazione Luigi Maria Monti, Via Monti di Creta 104, Rome, Italy; Polo Scienze per Immagini, di Laboratorio e Infettivologiche, "Fondazione Policlinico Agostino Gemelli" - IRCCS, Rome, Italy
| | - Giovanni Luca Scaglione
- UOC Laboratory Medicine, Genetics and Toxicology, IDI IRCCS, Fondazione Luigi Maria Monti, Via Monti di Creta 104, Rome, Italy
| | - Luca Fania
- Department of Dermatology - IDI IRCCS, Fondazione Luigi Maria Monti, Via Monti di Creta 104, Rome, Italy
| | | | - Cinzia Mazzanti
- Department of Dermatology - IDI IRCCS, Fondazione Luigi Maria Monti, Via Monti di Creta 104, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory IDI-IRCCS, FLMM, Fondazione Luigi Maria Monti, Via Monti di Creta 104, Rome, Italy
| | - Angelo Minucci
- Polo Scienze per Immagini, di Laboratorio e Infettivologiche, "Fondazione Policlinico Agostino Gemelli" - IRCCS, Rome, Italy
| | - Ettore Capoluongo
- UOC Laboratory Medicine, Genetics and Toxicology, IDI IRCCS, Fondazione Luigi Maria Monti, Via Monti di Creta 104, Rome, Italy; Polo Scienze per Immagini, di Laboratorio e Infettivologiche, "Fondazione Policlinico Agostino Gemelli" - IRCCS, Rome, Italy.
| |
Collapse
|
16
|
Eftekhari H, Rafiei R, Jamshidnoveiry V, Rafiee E, Darjani A, Alizade N, Gharaeinejad K, Rafiee B. Non-specific autoantibodies in pemphigus vulgaris. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2019. [DOI: 10.23736/s0393-3660.18.03763-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
17
|
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.
Collapse
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.
| |
Collapse
|
18
|
Walsh P, Brochado MJF, Vernal S, Machado AR, Turatti A, de Paula NA, Donadi EA, Roselino AM. Relationship between pemphigus and American tegumentary leishmaniasis: insights from serological and genetic profiles. Trans R Soc Trop Med Hyg 2018; 111:345-353. [PMID: 29237064 DOI: 10.1093/trstmh/trx065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/21/2017] [Indexed: 12/29/2022] Open
Abstract
Background Antibodies against Leishmania peptides (Lbr-peps) and desmogleins (Dsgs) have been reported in pemphigus foliaceus (PF) and leishmaniasis patients, respectively. We aimed to compare serological and genetic features in a Brazilian region endemic for American tegumentary leishmaniasis (ATL) and pemphigus. Methods Commercial anti-Dsg ELISA and in-house ELISA with Lbr-peps were used to determine the serological profile, in addition to immunoblotting (IB) and indirect immunofluorescence (IIF) assays. HLA-DRB1 and -DQA1/DQB1 alleles were characterized by PCR combined with sequence-specific oligonucleotide probes (PCR-SSOP). The serological and genetic profiles were compared using 78 PF, 62 pemphigus vulgaris (PV) and 58 ATL patients against 163 and 1592 healthy controls, respectively. Results Some ATL patients showed positive results for anti-Dsg1 and/or anti-Dsg3 antibodies. They also revealed 130, 160 and/or 230 kDa epidermal peptides in IB. Moreover, some ATL samples exhibited pemphigus or a bullous pemphigoid pattern in IIF. ELISA and IB assays showed Lbr-peps in pemphigus patients. HLA-DQA1*01 and -DQA1*01:02 were protective and susceptibility alleles for ATL, respectively, but the opposite for pemphigus. Conclusions Anti-Dsgs in ATL may represent epiphenomena. Anti-Lbr-pep antibodies in pemphigus suggest a previous infection. A differential association of the HLA profile may contribute to the lack of co-association between pemphigus and ATL.
Collapse
Affiliation(s)
- Priscilla Walsh
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Maria J F Brochado
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Sebastian Vernal
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Aline R Machado
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Aline Turatti
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Natalia A de Paula
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Eduardo A Donadi
- Division of Immunology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo, Brazil
| | - Ana Maria Roselino
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| |
Collapse
|
19
|
Zhang S, Zhou X, Zhou X, Zhang Y, Deng Y, Liao F, Yang M, Xia X, Zhou Y, Yin D, Ojaswi P, Hou Q, Wang L, Zhang D, Xia D, Deng Y, Ding L, Liu H, Yan W, Li M, Ma W, Ma J, Yu Q, Liu B, Yang L, Zhang W, Shu Y, Xu H, Li W. Subtype‐specific inherited predisposition to pemphigus in the Chinese population. Br J Dermatol 2018; 180:828-835. [PMID: 30230522 DOI: 10.1111/bjd.17191] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 02/06/2023]
Affiliation(s)
- S.Y. Zhang
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - X.Y. Zhou
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - X.L. Zhou
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - Y. Zhang
- Department of Thoracic Oncology Cancer Center State Key Laboratory of Biotherapy West China Hospital Sichuan University Chengdu Sichuan China
| | - Y. Deng
- National Office for Maternal and Child Health Surveillance of China Department of Pediatrics West China Second University Hospital Sichuan University Chengdu Sichuan China
| | - F. Liao
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - M. Yang
- Department of Pathology West China Hospital Sichuan University Chengdu Sichuan China
| | - X.Y. Xia
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - Y.H. Zhou
- Department of Laboratory Medicine Research Center of Clinical Laboratory Medicine West China Hospital Sichuan University Chengdu Sichuan China
| | - D.D. Yin
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - P. Ojaswi
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - Q.Q. Hou
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - L. Wang
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - D.Y. Zhang
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - D.M. Xia
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - Y.Q. Deng
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - L. Ding
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - H.J. Liu
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - W. Yan
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - M.M. Li
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - W.T. Ma
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - J.J. Ma
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - Q. Yu
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| | - B. Liu
- State Key Laboratory of Biotherapy West China Hospital Sichuan University and Collaborative Innovation Center Chengdu Sichuan China
| | - L. Yang
- State Key Laboratory of Biotherapy West China Hospital Sichuan University and Collaborative Innovation Center Chengdu Sichuan China
| | - W. Zhang
- Department of Clinical Pharmacology Hunan Key Laboratory of Pharmacogenetics Xiangya Hospital Central South University Changsha China
| | - Y. Shu
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
| | - H. Xu
- Precision Medicine Center State Key Laboratory of Biotherapy Precision Medicine Key Laboratory of Sichuan Province West China Hospital Sichuan University and Collaborative Innovation Center No. 17, Section 3, South Renmin Road Chengdu Sichuan China 610041
- Department of Laboratory Medicine Research Center of Clinical Laboratory Medicine West China Hospital Sichuan University Chengdu Sichuan China
| | - W. Li
- Department of Dermatovenereology Rare Disease Center West China Hospital Sichuan University No. 37 Guo Xue Xiang Street Chengdu Sichuan China 610041
| |
Collapse
|
20
|
Abstract
Pemphigus and pemphigoid are characterized as autoimmune blistering diseases in which immunoglobulin G autoantibodies cause blisters and erosions of the skin or mucosa or both. Recently, understanding of the pathophysiology of pemphigus and pemphigoid has been furthered by genetic analyses, characterization of autoantibodies and autoreactive B cells, and elucidation of cell–cell adhesion between keratinocytes. For the management of pemphigus and pemphigoid, the administration of systemic corticosteroids still represents the standard treatment strategy; however, evidence of the efficacy of therapies not involving corticosteroids, such as those employing anti-CD20 antibodies, is increasing. The goal should be to develop antigen-specific immune suppression-based treatments.
Collapse
Affiliation(s)
- Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
21
|
Vodo D, Sarig O, Sprecher E. The Genetics of Pemphigus Vulgaris. Front Med (Lausanne) 2018; 5:226. [PMID: 30155467 PMCID: PMC6102399 DOI: 10.3389/fmed.2018.00226] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/25/2018] [Indexed: 12/15/2022] Open
Abstract
Pemphigus vulgaris (PV) is a severe autoimmune blistering disease caused by auto-antibodies (auto-Abs) directed against epithelial desmosomal components and leading to disruption of cell-cell adhesion. The exact mechanisms underlying the disease pathogenesis remain unknown and treatment is still based on immunosuppressive drugs, such as corticosteroids, which are associated with potentially significant side effects. Ethnic susceptibility, familial occurrence, and autoimmune comorbidity, suggest a genetic component to the pathogenesis of the disease, which, if discovered, could advance our understanding of PV pathogenesis and thereby point to novel therapeutic targets for this life-threatening disorder. In this article, we review the evidence for a genetic basis of PV, summarize the different approaches used to investigate susceptibility traits for the disease and describe past and recent discoveries regarding genes associated with PV, most of which belong to the human leukocyte antigen (HLA) locus with limited data regarding association of non-HLA genes with the disease.
Collapse
Affiliation(s)
- Dan Vodo
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Sarig
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
22
|
Amber KT, Valdebran M, Grando SA. Non-Desmoglein Antibodies in Patients With Pemphigus Vulgaris. Front Immunol 2018; 9:1190. [PMID: 29915578 PMCID: PMC5994403 DOI: 10.3389/fimmu.2018.01190] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/14/2018] [Indexed: 12/14/2022] Open
Abstract
Pemphigus vulgaris (PV) is a potentially life-threatening mucocutaneous autoimmune blistering disease. Patients develop non-healing erosions and blisters due to cell–cell detachment of keratinocytes (acantholysis), with subsequent suprabasal intraepidermal splitting. Identified almost 30 years ago, desmoglein-3 (Dsg3), a Ca2+-dependent cell adhesion molecule belonging to the cadherin family, has been considered the “primary” autoantigen in PV. Proteomic studies have identified numerous autoantibodies in patients with PV that have known roles in the physiology and cell adhesion of keratinocytes. Antibodies to these autoantibodies include desmocollins 1 and 3, several muscarinic and nicotinic acetylcholine receptor subtypes, mitochondrial proteins, human leukocyte antigen molecules, thyroid peroxidase, and hSPCA1—the Ca2+/Mn2+-ATPase encoded by ATP2C1, which is mutated in Hailey–Hailey disease. Several studies have identified direct pathogenic roles of these proteins, or synergistic roles when combined with Dsg3. We review the role of these direct and indirect mechanisms of non-desmoglein autoantibodies in the pathogenesis of PV.
Collapse
Affiliation(s)
- Kyle T Amber
- Department of Dermatology, University of California Irvine, Irvine, CA, United States
| | - Manuel Valdebran
- Department of Dermatology, University of California Irvine, Irvine, CA, United States
| | - Sergei A Grando
- Department of Dermatology, University of California Irvine, Irvine, CA, United States.,Department of Dermatology, Institute for Immunology, University of California Irvine, Irvine, CA, United States.,Department of Biological Chemistry, Institute for Immunology, University of California Irvine, Irvine, CA, United States
| |
Collapse
|
23
|
Association Study and Fine-Mapping Major Histocompatibility Complex Analysis of Pemphigus Vulgaris in a Han Chinese Population. J Invest Dermatol 2018; 138:2307-2314. [PMID: 29857070 DOI: 10.1016/j.jid.2018.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 05/08/2018] [Accepted: 05/13/2018] [Indexed: 12/15/2022]
Abstract
To identify possible additional genetic susceptibility loci for pemphigus vulgaris (PV), we performed a genome-wide association study of 240 PV patients and 1,031 control individuals, and we selected the top single nucleotide polymorphisms for replication in independent samples, with 252 patient samples and 1,852 control samples. We identified rs11218708 (P = 3.1 × 10-8, odds ratio = 1.54) at chromosome locus 11q24.1 as significantly associated with PV. A fine-mapping analysis of PV risk in the major histocompatibility complex region showed three independent variants predisposed to PV using stepwise analysis: HLA-DRB1*14:04 (P = 2.47 × 10-38, odds ratio = 6.28), rs7454108 at the TAP2 gene (P = 2.78 × 10-12, odds ratio = 3.25), and rs1051336 at the HLA-DRA gene (P = 3.06 × 10-6, odds ratio = 0.33). A systematic evaluation using gene- and pathway-based analyses showed a high tendency for PV susceptibility genes to be associated with autoimmunity. Our study highlights the involvement of immune-mediated processes in the pathophysiology of PV and illustrates the value of imputation to identify variants in the major histocompatibility complex region.
Collapse
|
24
|
Priyadarshini A, George R, Daniel D, Varughese S, Jayaseelan V. Association between human leukocyte antigen-DRB1 and human leukocyte antigen-DQB1 alleles and pemphigus vulgaris in Indian patients: A case-control study. Indian J Dermatol Venereol Leprol 2018; 84:280-284. [PMID: 29582787 DOI: 10.4103/ijdvl.ijdvl_1014_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND HLA-DRB1*04, -DRB1*08, -DRB1*14, -DQB1*03 and -DQB1*05 are reported to have significant association with pemphigus vulgaris; however, this is partially dependent on ethnicity. This study was done to determine the HLA-DR and -DQ types prevalent in Indian patients with pemphigus vulgaris. METHODS A prospective case-control study was done for a period of 9 months in Christian Medical College Vellore, India. HLA typing was done by PCR-SSOP method in 50 cases and 50 healthy controls. Allele frequencies in cases and controls were compared and odds ratios with 95% confidence interval were calculated. RESULTS The mean age of the patients (29 females, 21 males) and that of controls (36 males, 14 females) were 41.3 ± 13.65 and 35.42 ± 11.09 years, respectively. HLA-DRB1*14 was present in 47 patients and 18 controls (OR, 27.85; 95% CI, 7.57-102.42) and HLA-DQB1*05 was seen in 47 patients and 24 controls (OR, 16.97; 95% CI, 4.66-61.80). The haplotype DRB1*14, DQB1*05 was present in 44 patients and 14 controls (OR, 18.86; 95% CI, 6.58-54.05). DRB1*15 was present in 7 cases and 16 controls (OR, 0.35; 95% CI, 0.13-0.94) and DQB1*06 was present in 8 cases and 19 controls (OR, 0.31; 95% CI, 0.12-0.80). HLA-DQB1*03 was associated with significantly higher pemphigus disease area index scores. LIMITATIONS The main limitations were that the numbers studied were small as the study was conducted at a single center, and the haplotype analysis was limited only to the proband. PDAI scores could have been influenced by prior treatment. CONCLUSION There was a significant association between HLA-DRB1*14 and HLA-DQB1*05 and pemphigus vulgaris in our patients. A negative association was seen with DRB1*15 and DQB1*06.
Collapse
Affiliation(s)
- Anuradha Priyadarshini
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Renu George
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dolly Daniel
- Department of Transfusion Medicine and Immunohematology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | | |
Collapse
|
25
|
Seiffert-Sinha K, Khan S, Attwood K, Gerlach JA, Sinha AA. Anti-Thyroid Peroxidase Reactivity Is Heightened in Pemphigus Vulgaris and Is Driven by Human Leukocyte Antigen Status and the Absence of Desmoglein Reactivity. Front Immunol 2018; 9:625. [PMID: 29675021 PMCID: PMC5896579 DOI: 10.3389/fimmu.2018.00625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/13/2018] [Indexed: 12/17/2022] Open
Abstract
Pemphigus vulgaris (PV) belongs to an autoimmune disease cluster that includes autoimmune thyroid disease (AITD), suggesting common mechanisms driving autoimmune susceptibility. Our group has shown that PV patients exhibit significant reactivity to AITD-related anti-thyroid peroxidase (anti-TPO), and anti-TPO antibodies affect signaling pathways in keratinocytes similar to anti-desmoglein (Dsg) 3 antibodies. To further assess the relevance of anti-TPO reactivity in PV, we analyzed anti-TPO levels in 280 PV and 167 healthy control serum samples across a comprehensive set of variable and static parameters of disease activity and etiopathogenesis. PV patients have significantly higher activity rates (A.R.s) for anti-TPO than healthy controls, but levels do not differ between phases of clinical activity and remission. Patients that carry both the PV-associated human leukocyte antigen (HLA) alleles DRB1*0402 and DQB1*0503, or DQB1*0503 alone show a low prevalence of anti-TPO (A.R. 9.5 and 4.8%, respectively), while patients that lack expression of these alleles or carry DRB1*0402 alone have a much higher prevalence of anti-TPO (A.R. 23.1 and 15.8%, respectively), suggesting that the absence of DQB1*0503 may predispose patients to the development of anti-TPO antibodies. Similarly, anti-Dsg1−/3− patients have a higher anti-TPO A.R. (26.9%) than anti-Dsg1−/3+ (18.8%), anti-Dsg1+/3− (14.3%), and anti-Dsg1+/3+ (3.9%) patients. Our data suggest that anti-TPO reactivity in PV is driven by genetic markers that may be in linkage disequilibrium with the established PV-susceptibility alleles and that this association drives the selection of a combination of anti-Dsg and anti-TPO antibodies, with anti-TPO filling the gap in active patients that do not carry the established PV-associated autoantibodies and/or are lacking the established PV-HLA-susceptibility alleles.
Collapse
Affiliation(s)
- Kristina Seiffert-Sinha
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Shahzaib Khan
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - Kristopher Attwood
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, Buffalo, NY, United States
| | - John A Gerlach
- Biomedical Laboratory Diagnostics Program, Tissue Typing Laboratory, Michigan State University, East Lansing, MI, United States
| | - Animesh A Sinha
- Department of Dermatology, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| |
Collapse
|
26
|
de Sena Nogueira Maehara L, De-Souza-Santana F, Porro A, Marcos E, Ura S, Nolte I, Pas H, Jonkman M, Tomimori J. HLA
class II alleles of susceptibility and protection in Brazilian and Dutch pemphigus foliaceus. Br J Dermatol 2018; 178:e212-e214. [DOI: 10.1111/bjd.16022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- L. de Sena Nogueira Maehara
- Department of Dermatology; Federal University of São Paulo; São Paulo Brazil
- Center for Blistering Diseases; Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | | | - A.M. Porro
- Department of Dermatology; Federal University of São Paulo; São Paulo Brazil
| | - E.V.C. Marcos
- Immunogenetics Laboratory; Lauro de Souza Lima Institute; Bauru São Paulo Brazil
| | - S. Ura
- Department of Clinical and Therapeutic; Lauro de Souza Lima Institute; Bauru São Paulo Brazil
| | - I.M. Nolte
- Department of Epidemiology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - H.H. Pas
- Center for Blistering Diseases; Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - M.F. Jonkman
- Center for Blistering Diseases; Department of Dermatology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - J. Tomimori
- Department of Dermatology; Federal University of São Paulo; São Paulo Brazil
| |
Collapse
|
27
|
Li S, Zhang Q, Wang P, Li J, Ni J, Wu J, Liang Y, Leng RX, Pan HF, Ye DQ. Association between HLA-DQB1 polymorphisms and pemphigus vulgaris: A meta-analysis. Immunol Invest 2017; 47:101-112. [PMID: 29182409 DOI: 10.1080/08820139.2017.1385622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study was performed to systematically summarize the results on the association of HLA-DQB1 polymorphisms with pemphigus vulgaris (PV) and other related factors. METHODS A comprehensive literature search of PubMed, The Cochrane Library, Embase, and Google Scholar database was conducted to identify relevant articles in English, with the last report up to November 1, 2016. Heterogeneity test was performed, and publication bias was evaluated. Stata software 12.0 was used to perform the meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CI) were used to describe the correlation by random-effects model. RESULTS 18 studies were obtained after searching databases: 10 studies were about Caucasian, and 8 articles were about non-Caucasian. Meta-analysis revealed that the allele and phenotype frequencies of DQB1*05 were markedly higher in PV patients than in controls [P < 0.001, OR: 2.640, 95%CI: 1.570-4.441; P = 0.030, OR 3.688, 95%CI: 1.138-11.946]. In addition, DQB1*03 was significantly increased at the allele level [P < 0.001, OR: 2.080, 95%CI: 1.507-2.869], and DQB1*02 was significantly decreased in PV at the allele and phenotype levels [P = 0.002, OR: 0.450, 95%CI: 0.289-0.702; P = 0.001, OR: 0.293, 95%CI: 0.146-0.587]. When based on each subtype of HLA-DQB1, DQB1*05:03 and DQB1*03:02 may play susceptibility roles in PV, and DQB1*03:03, DQB1*05:01 and DQB1*06:01 are negatively associated with PV. CONCLUSION In summary, our study suggests that alleles from the groups DQB1*05 and DQB1*03, concretely DQB1*05:03 and DQB1*03:02, respectively, may be the susceptibility factors for PV at allele and phenotype levels, whereas DQB1*05:01, DQB1*02, DQB1*06:01, and DQB1*03:03 are negatively associated with PV.
Collapse
Affiliation(s)
- Si Li
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Qin Zhang
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Peng Wang
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Jun Li
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Jing Ni
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Jun Wu
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Yan Liang
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Rui-Xue Leng
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Hai-Feng Pan
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| | - Dong-Qing Ye
- a Department of Epidemiology and Biostatistics , School of Public Health, Anhui Medical University , Hefei , Anhui , China.,b The Key Laboratory of Major Autoimmune Disease, Anhui Province , Anhui Medical University , Hefei , Anhui , China
| |
Collapse
|
28
|
Pemphigus trigger factors: special focus on pemphigus vulgaris and pemphigus foliaceus. Arch Dermatol Res 2017; 310:95-106. [PMID: 29110080 DOI: 10.1007/s00403-017-1790-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 10/07/2017] [Accepted: 10/30/2017] [Indexed: 12/16/2022]
Abstract
Pemphigus is a general term for a rare group of autoimmune diseases which result in the formation of blisters on the skin and oral cavity. Although there is no way to prevent autoimmune diseases, some factors may trigger pemphigus initiation in susceptible individuals or be exacerbated in affected patients. Recognition of these triggers, based on the latest studies and experiences is essential and should be updated every few years. In this study, several triggers, including different drugs and treatments, diseases, vaccines, genetic factors, nutrients, micronutrients, pregnancy, stress, and various other triggers have been discussed. Some possible triggers, such as blood antigens and the effect of seasons have also been discussed briefly. Moreover, some protective factors against pemphigus have been reviewed. Considering the molecular mechanism of pemphigus and immune response alteration during this disease, some possible triggers have been suggested and discussed. Although those triggers may be a real threat, more studies are needed to support these hypotheses.
Collapse
|
29
|
Celere BS, Vernal S, La Serra L, Franco Brochado MJ, Moschini LE, Roselino AM, Segura-Muñoz SI. Spatial Distribution of Pemphigus Occurrence over Five Decades in Southeastern Brazil. Am J Trop Med Hyg 2017; 97:1737-1745. [PMID: 29016334 DOI: 10.4269/ajtmh.17-0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Well-defined locations of pemphigus cases support the hypothesis of environmental factors' involvement in its etiopathogenesis; however, these foci have never been described using specialized geographical tools. This is the first report to geo-reference pemphigus cases in a high-prevalence Brazilian region using geographic information systems. We aimed to report the spatio-temporal behavior of pemphigus foliaceus (PF) and vulgaris (PV) in southeastern Brazil, over the last five decades to describe geographical clusters, as well as to characterize the land use in the city with the highest number of cases. Patients were identified from 1965 to 2014. Maps were developed using ArcGIS software and organized into decades from 1965 to 2014. Ribeirão Preto was identified as the city with the greatest number of cases. Land use was analyzed within a 2 km-buffer surrounding the residence of each patient. A total of 426 cases of pemphigus were identified. PF was the predominant form (285 cases); notwithstanding, the number of new cases of PV rose, overtaking the number of new cases of PF in the last decade studied. Agricultural area (42%) and exposed soil (33.2%) are the most predominant land uses in Ribeirão Preto surrounding patients' residences. This study shows high-confidence geographical foci of PF and PV, as well as provides evidence of an increase of both clinical forms over the last five decades. All cases of PV and PF are in proximity to rivers and agricultural areas which reinforce the hypothesis that environmental factors play a role in pemphigus etiopathogenesis.
Collapse
Affiliation(s)
- Beatriz Smidt Celere
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sebastian Vernal
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Leonardo La Serra
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria José Franco Brochado
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luiz Eduardo Moschini
- Department of Environmental Sciences, Center for Biological and Health Sciences, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Ana Maria Roselino
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Susana Inés Segura-Muñoz
- Department of Maternal-Infant Nursing and Public Health, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
30
|
Abstract
Pemphigus is a group of IgG-mediated autoimmune diseases of stratified squamous epithelia, such as the skin and oral mucosa, in which acantholysis (the loss of cell adhesion) causes blisters and erosions. Pemphigus has three major subtypes: pemphigus vulgaris, pemphigus foliaceus and paraneoplastic pemphigus. IgG autoantibodies are characteristically raised against desmoglein 1 and desmoglein 3, which are cell-cell adhesion molecules found in desmosomes. The sites of blister formation can be physiologically explained by the anti-desmoglein autoantibody profile and tissue-specific expression pattern of desmoglein isoforms. The pathophysiological roles of T cells and B cells have been characterized in mouse models of pemphigus and patients, revealing insights into the mechanisms of autoimmunity. Diagnosis is based on clinical manifestations and confirmed with histological and immunochemical testing. The current first-line treatment is systemic corticosteroids and adjuvant therapies, including immunosuppressive agents, intravenous immunoglobulin and plasmapheresis. Rituximab, a monoclonal antibody against CD20+ B cells, is a promising therapeutic option that may soon become first-line therapy. Pemphigus is one of the best-characterized human autoimmune diseases and provides an ideal paradigm for both basic and clinical research, especially towards the development of antigen-specific immune suppression treatments for autoimmune diseases.
Collapse
|
31
|
Mangold AR, Costello CM, Pittelkow MR, DiCaudo DJ. Concomitant pemphigus herpetiformis and sarcoidosis. JAAD Case Rep 2016; 2:436-438. [PMID: 27981211 PMCID: PMC5144745 DOI: 10.1016/j.jdcr.2016.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Collin M Costello
- Department of Medical Education, University of Arizona, Scottsdale, Arizona
| | | | | |
Collapse
|
32
|
Tanasilovic S, Popadic S, Medenica L, Popadic D. Pemphigus vulgaris and pemphigus foliaceus determined by CD86 and CTLA4 polymorphisms. Clin Dermatol 2016; 35:236-241. [PMID: 28274366 DOI: 10.1016/j.clindermatol.2016.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are rare autoimmune blistering diseases with presumed T-cell-dependent pathology. Activation of naïve T cells is dependent on antigen recognition, subsequent signaling through the T-cell receptor complex (signal 1), and various other interactions of T cells with antigen presenting cells that may be collectively designated as signal 2, which is unconditionally required for T-cell activation both in response to infection and to autoantigens. Among the best described interactions contributing to signal 2 are those mediated by B7 family molecules, such as CD80 and CD86 with their ligands; CD28, providing activation signals; and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), conferring inhibition. Single nucleotide polymorphisms (SNPs) within genes encoding those molecules may alter the signaling process. It is not known whether functional genetic polymorphisms within genes encoding the aforementioned proteins may increase risk for developing PV and PF and, if so, whether they might serve as biomarkers for susceptibility to these diseases. To address those questions, we examined functional single nucleotide polymorphisms within CD86 (rs1129055) and CTLA4 (rs733618 and rs5742909) genes in 61 pemphigus patients and 486 healthy controls. We found statistically significant differences in allele and genotype frequencies between PV patients and controls for rs1129055, as well as for rs5742909 among PV and PF patients. Namely, the rs1129055 A allele was significantly more common in PV patients compared with controls (35.4% versus 25.7%, respectively; P = .040), whereas the rs5742909 T allele was significantly more common in PF compared with PV patients (19.2% versus 5.2%, respectively; P = .035). The frequency of the rs5742909 T allele did not, however, differ significantly in PF or in PV compared with controls (10.5%; P = .187 and P = .100, respectively). We report a novel association of SNPs within CD86 and CTLA4 genes with pemphigus. The CD86 rs1129055 A allele appears to confer susceptibility to PV but not to PF. © 2016 Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
- Srdjan Tanasilovic
- Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetlana Popadic
- Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Ljiljana Medenica
- Department of Dermatovenereology, School of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Dermatovenereology, Clinical Center of Serbia, Belgrade, Serbia
| | - Dusan Popadic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
33
|
Vodo D, Sarig O, Geller S, Ben-Asher E, Olender T, Bochner R, Goldberg I, Nosgorodsky J, Alkelai A, Tatarskyy P, Peled A, Baum S, Barzilai A, Ibrahim SM, Zillikens D, Lancet D, Sprecher E. Identification of a Functional Risk Variant for Pemphigus Vulgaris in the ST18 Gene. PLoS Genet 2016; 12:e1006008. [PMID: 27148741 PMCID: PMC4858139 DOI: 10.1371/journal.pgen.1006008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 04/05/2016] [Indexed: 12/13/2022] Open
Abstract
Pemphigus vulgaris (PV) is a life-threatening autoimmune mucocutaneous blistering disease caused by disruption of intercellular adhesion due to auto-antibodies directed against epithelial components. Treatment is limited to immunosuppressive agents, which are associated with serious adverse effects. The propensity to develop the disease is in part genetically determined. We therefore reasoned that the delineation of PV genetic basis may point to novel therapeutic strategies. Using a genome-wide association approach, we recently found that genetic variants in the vicinity of the ST18 gene confer a significant risk for the disease. Here, using targeted deep sequencing, we identified a PV-associated variant residing within the ST18 promoter region (p<0.0002; odds ratio = 2.03). This variant was found to drive increased gene transcription in a p53/p63-dependent manner, which may explain the fact that ST18 is up-regulated in the skin of PV patients. We then discovered that when overexpressed, ST18 stimulates PV serum-induced secretion of key inflammatory molecules and contributes to PV serum-induced disruption of keratinocyte cell-cell adhesion, two processes previously implicated in the pathogenesis of PV. Thus, the present findings indicate that ST18 may play a direct role in PV and consequently represents a potential target for the treatment of this disease.
Collapse
Affiliation(s)
- Dan Vodo
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofer Sarig
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shamir Geller
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Edna Ben-Asher
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Tsviya Olender
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Ron Bochner
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ilan Goldberg
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Judith Nosgorodsky
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Anna Alkelai
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Pavel Tatarskyy
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Alon Peled
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Saleh M. Ibrahim
- Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Doron Lancet
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- * E-mail:
| |
Collapse
|
34
|
|
35
|
Shah AA, Dey-Rao R, Seiffert-Sinha K, Sinha AA. Increased oxidative stress in pemphigus vulgaris is related to disease activity and HLA-association. Autoimmunity 2016; 49:248-57. [PMID: 26911801 DOI: 10.3109/08916934.2016.1145675] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pemphigus vulgaris (PV) is a rare blistering skin disorder characterized by the disadhesion of keratinocytes due to autoantibody attack against epidermal targets including desmoglein (Dsg) 3, Dsg 1 and possibly other adhesion and non-adhesion molecules. The mechanisms leading to immune-mediated pathology in PV are multifactorial and not fully understood. Recently, oxidative stress (antioxidant/oxidant disequilibrium) has been proposed as a contributory mechanism of autoimmune skin diseases, including PV. In this study, we directly assessed oxidative stress via measurement of total antioxidant capacity (TAC) using ELISA in 47 PV patients, 25 healthy controls and 18 bullous pemphigoid (BP) patients. We also performed microarray gene expression analysis on a separate set of 21 PV patients and 10 healthy controls to evaluate transcriptional dysregulation in oxidative stress-related pathways. Our data indicate that there is a significant reduction in TAC levels in PV patients compared with healthy controls, as well as BP patients. Furthermore, PV patients with active disease have significantly lower TAC levels than PV patients in remission. We also find that HLA allele status has a significant influence on oxidative stress. These findings are corroborated by microarray analysis showing differentially expressed genes involved in oxidative stress between the aforementioned groups. Collectively, our findings provide support for a role of oxidative stress in PV. Whether increased oxidative stress leads to disease manifestation and/or activity, or if disease activity leads to increased oxidative stress remains unknown. Future longitudinal studies may help to further elucidate the relationship between PV and oxidative stress.
Collapse
Affiliation(s)
- Amit Aakash Shah
- a Department of Dermatology , Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo , NY , USA
| | - Rama Dey-Rao
- a Department of Dermatology , Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo , NY , USA
| | - Kristina Seiffert-Sinha
- a Department of Dermatology , Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo , NY , USA
| | - Animesh A Sinha
- a Department of Dermatology , Jacobs School of Medicine and Biomedical Sciences, University at Buffalo , Buffalo , NY , USA
| |
Collapse
|
36
|
Dar SA, Akhter N, Haque S, Singh T, Mandal RK, Ramachandran VG, Bhattacharya SN, Banerjee BD, Das S. Tumor necrosis factor (TNF)-α -308G/A (rs1800629) polymorphism distribution in North India and its association with pemphigus: Case-control study and meta-analysis. Autoimmunity 2016; 49:179-87. [PMID: 26761187 DOI: 10.3109/08916934.2015.1134512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pemphigus is an autoimmune blistering disorder of skin and/or mucosal surfaces characterized by intraepithelial lesions and immunoglobulin-G autoantibodies against desmogleins (proteins critical in cell-to-cell adhesion). Genetic, immunological, hormonal, and environmental factors are known to contribute to its etiology. Tumor necrosis factor-alpha (TNF-α) which plays a key role in pathogenesis of many infectious and inflammatory diseases has been found in high levels in lesional skin and sera of pemphigus patients. However, studies on association of single nucleotide polymorphism (SNP) in promoter region of TNF-α at position -308 affecting G to A transition with pemphigus has been scarce. This study was conducted to evaluate the TNF-α -308G/A SNP distribution in North Indian cohort, and to define the association between the TNF-α -308G/A SNP distribution and pemphigus, globally, by means of meta-analysis. TNF-α -308G/A SNP in pemphigus patients was investigated by cytokine genotyping using genomic DNA by PCR with sequence-specific primers. Meta-analysis of the data, including four previously published studies from other populations, was performed to generate a meaningful relationship. The results of our case-control study indicate non-significant differences between patients and controls in TNF-α -308G/A SNP. The meta-analysis also revealed that TNF-α -308G/A SNP is not associated with pemphigus risk in population at large; however, it may be contributing towards autoimmune phenomenon in pemphigus by being a part of its multi-factorial etiology. This study provides evidence that the TNF-α -308G/A polymorphism is not associated with overall pemphigus susceptibility. Nevertheless, further studies on specific ethnicity and pemphigus variants are necessary to validate the findings.
Collapse
Affiliation(s)
- Sajad Ahmad Dar
- a Department of Microbiology , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India .,b Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, University of Jazan , Jazan , Kingdom of Saudi Arabia
| | - Naseem Akhter
- c Department of Laboratory Medicine, Faculty of Applied Medical Sciences , Albaha University , Albaha , Kingdom of Saudi Arabia
| | - Shafiul Haque
- b Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, University of Jazan , Jazan , Kingdom of Saudi Arabia .,d Centre for Drug Research, Faculty of Pharmacy, University of Helsinki , Helsinki , Finland
| | - Taru Singh
- a Department of Microbiology , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India
| | - Raju Kumar Mandal
- b Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, University of Jazan , Jazan , Kingdom of Saudi Arabia
| | | | | | - Basu Dev Banerjee
- f Department of Biochemistry , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India
| | - Shukla Das
- a Department of Microbiology , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India
| |
Collapse
|
37
|
Mustafa MB, Porter SR, Smoller BR, Sitaru C. Oral mucosal manifestations of autoimmune skin diseases. Autoimmun Rev 2015; 14:930-51. [PMID: 26117595 DOI: 10.1016/j.autrev.2015.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 06/16/2015] [Indexed: 02/06/2023]
Abstract
A group of autoimmune diseases is characterised by autoantibodies against epithelial adhesion structures and/or tissue-tropic lymphocytes driving inflammatory processes resulting in specific pathology at the mucosal surfaces and the skin. The most frequent site of mucosal involvement in autoimmune diseases is the oral cavity. Broadly, these diseases include conditions affecting the cell-cell adhesion causing intra-epithelial blistering and those where autoantibodies or infiltration lymphocytes cause a loss of cell-matrix adhesion or interface inflammation. Clinically, patients present with blistering, erosions and ulcers that may affect the skin as well as further mucosal surfaces of the eyes, nose and genitalia. While the autoimmune disease may be suspected based on clinical manifestations, demonstration of tissue-bound and circulating autoantibodies, or lymphocytic infiltrates, by various methods including histological examination, direct and indirect immunofluorescence microscopy, immunoblotting and quantitative immunoassay is a prerequisite for definitive diagnosis. Given the frequency of oral involvement and the fact that oral mucosa is the initially affected site in many cases, the informed practitioner should be well acquainted with diagnostic and therapeutic aspects of autoimmune dermatosis with oral involvement. This paper reviews the pathogenesis and clinical presentation of these conditions in the oral cavity with a specific emphasis on their differential diagnosis and current management approaches.
Collapse
Affiliation(s)
- Mayson B Mustafa
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; Oral medicine section, Department of Oral and Maxillofacial Surgery, University of Khartoum, Faculty of Dentistry, Khartoum, Sudan
| | | | - Bruce R Smoller
- Department of Pathology, University of Rochester, School of Medicine and Dentistry, USA
| | - Cassian Sitaru
- Department of Dermatology, University of Freiburg, Hauptstrasse 7, 79104 Freiburg, Germany; BIOSS Centre for Biological Signalling Studies, Signalhaus Freiburg, Schänzlestr. 18, 79104 Freiburg, Germany.
| |
Collapse
|
38
|
Patel F, Wilken R, Patel FB, Sultani H, Bustos I, Duong C, Zone JJ, Raychaudhuri SP, Maverakis E. Pathophysiology of Autoimmune Bullous Diseases: Nature Versus Nurture. Indian J Dermatol 2015; 62:262-267. [PMID: 28584368 PMCID: PMC5448260 DOI: 10.4103/0019-5154.159620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pemphigus and pemphigoid are the prototypical immunobullous diseases. Although it has been well established that they are caused by deposition of autoreactive antibodies directed against adherence proteins within the skin, the specific genetic and environmental factors leading to development of these diseases continue to be an area of investigation. Herein, we discuss several of the potential environmental triggers that may induce patients to develop immunobullous diseases including medications, viral infections, UV exposure or other radiation injury and dietary factors. In addition, the potential genetic and immunologic mechanisms contributing to the pathogenesis of pemphigus and pemphigoid will be reviewed. The multifactorial nature of these diseases contributes to their complexity and highlights the importance of a detailed personal and family history when caring for these patients.
Collapse
Affiliation(s)
- Forum Patel
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Reason Wilken
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Falin B Patel
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Hawa Sultani
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Itzel Bustos
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Christopher Duong
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - John J Zone
- Department of Dermatology, University of Utah, Salt Lake City, UT
| | - Siba P Raychaudhuri
- Department of Rheumatology, VA Northern California Medical Center, Mather, CA, USA.,Division of Rheumatology, Allergy and Clinical Immunology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| |
Collapse
|
39
|
Barone A, Toti P, Giuca MR, Derchi G, Covani U. A gene network bioinformatics analysis for pemphigoid autoimmune blistering diseases. Clin Oral Investig 2014; 19:1207-22. [PMID: 25378027 DOI: 10.1007/s00784-014-1349-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 10/27/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this theoretical study, a text mining search and clustering analysis of data related to genes potentially involved in human pemphigoid autoimmune blistering diseases (PAIBD) was performed using web tools to create a gene/protein interaction network. METHODS The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database was employed to identify a final set of PAIBD-involved genes and to calculate the overall significant interactions among genes: for each gene, the weighted number of links, or WNL, was registered and a clustering procedure was performed using the WNL analysis. Genes were ranked in class (leader, B, C, D and so on, up to orphans). An ontological analysis was performed for the set of 'leader' genes. RESULTS Using the above-mentioned data network, 115 genes represented the final set; leader genes numbered 7 (intercellular adhesion molecule 1 (ICAM-1), interferon gamma (IFNG), interleukin (IL)-2, IL-4, IL-6, IL-8 and tumour necrosis factor (TNF)), class B genes were 13, whereas the orphans were 24. The ontological analysis attested that the molecular action was focused on extracellular space and cell surface, whereas the activation and regulation of the immunity system was widely involved. CONCLUSIONS Despite the limited knowledge of the present pathologic phenomenon, attested by the presence of 24 genes revealing no protein-protein direct or indirect interactions, the network showed significant pathways gathered in several subgroups: cellular components, molecular functions, biological processes and the pathologic phenomenon obtained from the Kyoto Encyclopaedia of Genes and Genomes (KEGG) database. CLINICAL RELEVANCE The molecular basis for PAIBD was summarised and expanded, which will perhaps give researchers promising directions for the identification of new therapeutic targets.
Collapse
Affiliation(s)
- Antonio Barone
- Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy,
| | | | | | | | | |
Collapse
|
40
|
|
41
|
Yue Z, Fu X, Chen M, Wang Z, Wang C, Yang B, Zhou G, Liu H, Zhang F. Lack of association between the single nucleotide polymorphism of ST18 and pemphigus in Chinese population. J Dermatol 2014; 41:353-4. [PMID: 24612320 DOI: 10.1111/1346-8138.12363] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zhenhua Yue
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Jinan, China; Shandong Provincial Key Lab for Dermatovenereology, Jinan, China; School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, China
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Zhu X, Pan J, Yu Z, Wang Y, Cai L, Zheng S. Epidemiology of pemphigus vulgaris in the Northeast China: a 10-year retrospective study. J Dermatol 2013; 41:70-5. [PMID: 24354355 DOI: 10.1111/1346-8138.12286] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 08/18/2013] [Indexed: 01/13/2023]
Abstract
The aim of the present study was to evaluate the incidence, epidemiological, clinical and therapeutic features of patients with pemphigus vulgaris in China. We retrospectively investigated a total of 221 patients with pemphigus vulgaris. The parameters including age at diagnosis/onset, sex, diagnostic methods, hospitalizations, side-effects with different treatments, pemphigus vulgaris-associated diseases, the therapeutic features and duration of follow up were evaluated. The male : female ratio was 1:1.40. The incidence rate was obviously higher in two age groups, 31-40 years and 41-50 years. The mean age at onset was 44.19 ± 21.45 years. The majority of patients (56.56%) presented the mucocutaneous type. In addition, we found that various doses of corticosteroids (including the mean initial dose, maximum control dose, total dose before reducing and hospitalized total dose) exhibited statistical differences between only corticosteroids and corticosteroids-immunosuppressant groups in mild, moderate and severe pemphigus vulgaris (P < 0.05). Our survey suggested that pemphigus vulgaris most frequently occurred in the 41-50-year age group in China and the majority of patients manifested mucocutaneous lesions. Importantly, the incidence rate in females was higher than in males. The patients who needed combined immunosuppressant treatment, usually needed higher doses of corticosteroids initially, to control the disease and over the total course of treatment.
Collapse
Affiliation(s)
- Xiaoling Zhu
- Department of Pathology, Basic Medical Science College, Harbin Medical University, Harbin, China
| | | | | | | | | | | |
Collapse
|
43
|
Genome-wide expression analysis suggests unique disease-promoting and disease-preventing signatures in Pemphigus vulgaris. Genes Immun 2013; 14:487-99. [PMID: 23985570 DOI: 10.1038/gene.2013.44] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/02/2013] [Accepted: 07/19/2013] [Indexed: 01/17/2023]
Abstract
To evaluate pathogenetic mechanisms underlying disease development and progression in the autoimmune skin disease Pemphigus vulgaris (PV), we examined global peripheral blood gene expression in patients and healthy controls. Our goals were to: (1) assign blood gene expression signatures to patients and controls; (2) identify differentially expressed genes (DEGs) and investigate functional pathways associated with these signatures; and (3) evaluate the distribution of DEGs across the genome to identify transcriptional 'hot spots'. Unbiased hierarchical clustering clearly separated patients from human leukocyte antigen (HLA)-matched controls (MCRs; 'disease' signature), and active from remittent patients ('activity' signature). DEGs associated with these signatures are involved in immune response, cytoskeletal reorganization, mitogen-activated protein kinase (MAPK) signaling, oxidation-reduction and apoptosis. We further found that MCRs carrying the PV-associated HLA risk alleles cluster distinctly from unmatched controls (UMCR) revealing an HLA-associated 'control' signature. A subset of DEGs within the 'control' signature overlap with the 'disease' signature, but are inversely regulated in MCR when compared with either PV patients or UMCR, suggesting the existence of a 'protection' signature in healthy individuals carrying the PV HLA genetic risk elements. Finally, we identified 19 transcriptional 'hot spots' across the signatures, which may guide future studies aimed at pinpointing disease risk genes.
Collapse
|
44
|
Ruocco V, Ruocco E, Lo Schiavo A, Brunetti G, Guerrera LP, Wolf R. Pemphigus: Etiology, pathogenesis, and inducing or triggering factors: Facts and controversies. Clin Dermatol 2013; 31:374-381. [DOI: 10.1016/j.clindermatol.2013.01.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
Mortazavi H, Amirzargar AA, Esmaili N, Toofan H, Ehsani AH, Hosseini SH, Rezaei N. Association of human leukocyte antigen class I antigens in Iranian patients with pemphigus vulgaris. J Dermatol 2013; 40:244-8. [DOI: 10.1111/1346-8138.12071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 11/19/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ali Akbar Amirzargar
- Molecular Immunology Research Center and Department of Immunology; School of Medicine; Tehran University of Medical Sciences; Tehran; Iran
| | | | - Hesam Toofan
- Department of Dermatology; Razi Hospital; Tehran University of Medical Sciences; Tehran University of Medical Sciences; Tehran; Iran
| | - Amir Hooshang Ehsani
- Department of Dermatology; Razi Hospital; Tehran University of Medical Sciences; Tehran University of Medical Sciences; Tehran; Iran
| | - Seyed Hamed Hosseini
- Knowledge Utilization Research Center; School of Public Health; Tehran University of Medical Sciences; Tehran; Iran
| | | |
Collapse
|
46
|
Zhao M, Huang W, Zhang Q, Gao F, Wang L, Zhang G, Su Y, Xiao R, Zhang J, Tang M, Cheng W, Tan Y, Lu Q. Aberrant epigenetic modifications in peripheral blood mononuclear cells from patients with pemphigus vulgaris. Br J Dermatol 2012; 167:523-31. [DOI: 10.1111/j.1365-2133.2012.11007.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Mosaad YM, Fathy H, Fawzy Z, El-Saied MA. Tumor necrosis factor-α -308 G>A and interleukin-6 -174 G>C promoter polymorphisms and pemphigus. Hum Immunol 2012; 73:560-5. [PMID: 22365967 DOI: 10.1016/j.humimm.2012.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/26/2012] [Accepted: 02/01/2012] [Indexed: 01/09/2023]
Abstract
The objective of this study was to analyze the possible involvement of the tumor necrosis factor (TNF)-α -308 G>A and interleukin-6 (IL-6) -174 G>C polymorphisms in the susceptibility and/or disease profile of pemphigus in Egyptian patients. Detection of TNF-α -308 G>A by amplification refractory mutation system and IL-6 -174 G>C by restriction fragment length polymorphism was performed for 70 patients and 203 controls. No significant differences were observed in the distribution of TNF-α -308 in pemphigus patients and controls. However, GA+AA genotypes were more frequent in pemphigus vulgaris (PV) patients only versus controls (p(c) = 0.046). The frequency of the C allele and CC/GC genotypes of IL-6 -174 was significantly higher in pemphigus patients and those with the 2 major clinical forms (PV and pemphigus foliaceus [PF]) compared with controls (p < 0.05). Comparison of the distribution of TNF-α -308 and IL-6 -174 variants in relation to clinical type of pemphigus (PV versus PF), activity score, recurrence, and demographic data of patients revealed no significant associations. The IL-6 -174 CC genotype represents a marker of increased susceptibility to pemphigus in Egyptian patients and GG genotype can be considered a low-risk genotype; TNF-α -308 A-containing genotypes contribute to the susceptibility to PV only.
Collapse
Affiliation(s)
- Youssef M Mosaad
- Clinical Immunology Unit, Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura 35111, Egypt.
| | | | | | | |
Collapse
|
48
|
Yesilova Y, Ucmak D, Selek S, Dertlioğlu SB, Sula B, Bozkus F, Turan E. Oxidative stress index may play a key role in patients with pemphigus vulgaris. J Eur Acad Dermatol Venereol 2012; 27:465-7. [PMID: 22324759 DOI: 10.1111/j.1468-3083.2012.04463.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Increased reactive oxygen species (ROS) and lipid peroxidation are seen in many dermatologic disorders, including atopic dermatitis, psoriasis, vitiligo, acne vulgaris, pemphigus vulgaris (PV), lichen planus and alopecia areata. In PV, the increased production of ROS from activated neutrophils reduces the concentrations of antioxidant vitamins and enzymes. OBJECTIVE The present study aims to determine the oxidative stress index (OSI) by studying serum total oxidant capacity (TOC), lipid hydroperoxide (LOOH) and total antioxidant capacity (TAC) in PV patients. METHODS The study included 27 PV patients and a control group consisting of 24 healthy volunteers. Serum TOC, LOOH and TAC levels were examined and OSI was measured in the PV patients and the control group. RESULTS TOC (P = 0.001) and LOOH (P = 0.001) levels as well as OSI (P = 0.001) were found higher in the PV patients, relative to the control group. Serum TAS (P = 0.221) did not differ between groups. Serum TOC, LOOH and TAC levels and OSI in PV patients with mucosal involvement were not different than those in mucocutaneous PV patients. CONCLUSION Serum TOC and LOOH levels and OSI were higher in the PV patients, in comparison with the control group. Serum TAC level was not different.
Collapse
Affiliation(s)
- Y Yesilova
- Department of Dermatology, Harran University School of Medicine, Sanliurfa, Turkey.
| | | | | | | | | | | | | |
Collapse
|