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Baker J, Seiffert-Sinha K, Sinha AA. Patient genetics shape the autoimmune response in the blistering skin disease pemphigus vulgaris. Front Immunol 2023; 13:1064073. [PMID: 36703961 PMCID: PMC9871500 DOI: 10.3389/fimmu.2022.1064073] [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: 10/07/2022] [Accepted: 12/07/2022] [Indexed: 01/11/2023] Open
Abstract
Background and aim Pemphigus vulgaris (PV) is known to have one of the strongest HLA associations among autoimmune diseases. DRB1*0402 and DQB1*0503 in particular are significantly overrepresented in PV patients in certain worldwide populations. Yet, there remain significant gaps in our understanding regarding the precise link between PV-associated HLA molecules, the specificity of the autoimmune response, and clinical expression. In this study we assessed correlations between factors including HLA genotype, ethnicity, autoantibody levels, and lesion distribution in a cohort of 293 patients. Methods and population Participants were recruited from multiple outpatient dermatology clinic settings and patient support meetings in the USA. On intake, patients provided venous blood samples and answered questionnaires regarding their current disease activity. Results Eighty-one percent of patients typed as either DRB1*0402 or DQB1*0503 with a high prevalence of DRB1*0402 in patients of Ashkenazi Jewish or Caucasian (non-Jewish) descent (86% and 42%, respectively) and DQB1*0503 in patients of Southeast Asian descent (78%). Patients typing as HLA DRB1*0402 had higher levels of anti-desmoglein (Dsg)3 antibodies (204.6 +/- 340.5 IU/ml) than patients without DRB1*0402 (138.5 +/- 236.4 IU/ml) (p=0.03) and had mucosal only lesions more often than cutaneous only or mucocutaneous lesions. Patients typing as DQB1*0503 had higher levels of anti-Dsg1 antibodies (47.3 +/- 59.8 IU/ml) compared to other groups (27.8 +/- 43.7 IU/ml) (p=0.06) and higher rates of mucocutaneous disease than other lesion types. We also report an unexpected HLA association of DRB1*0804 in PV patients of African descent. Sixty-four percent of this population carried the DRB1*0804 allele, and presented with highly elevated levels of anti-Dsg3 (p=0.02). However, neither African heritage nor the presence of DRB1*0804 correlated with a predilection to any specific lesion morphology. Patients that carried neither DRB1*0402, nor DQB1*0503 or DRB1*0804 had the lowest levels of anti-Dsg3 antibodies (60.0 +/- 80.0 IU/ml) and the highest rate of solely cutaneous disease compared to carriers of these alleles. Conclusion Our data illuminate the broader impact of genetic factors on disease development by showing that differences in HLA expression among patients and ethnicities play a large role in driving distinct patterns of antibody selection and disease phenotype in PV. These findings provide insights regarding clinical heterogeneity, and are relevant to developing improved, patient tailored management strategies.
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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.
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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,
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Song K, Zheng X, Liu X, Sheng Y, Liu L, Wen L, Shang S, Deng Y, Ouyang Q, Sun X, Li Q, Chen P, Cai G, Chen M, Zhang Y, Liang B, Zhang J, Zhang X, Chen X. Genome-wide association study of SNP- and gene-based approaches to identify susceptibility candidates for lupus nephritis in the Han Chinese population. Front Immunol 2022; 13:908851. [PMID: 36275661 PMCID: PMC9580327 DOI: 10.3389/fimmu.2022.908851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundLupus nephritis (LN) is one of the most common and serious complications of systemic lupus erythaematosus (SLE). Genetic factors play important roles in the pathogenesis of LN and could be used to predict who might develop LN. The purpose of this study was to screen for susceptible candidates of LN across the whole genome in the Han Chinese population.Methods592 LN patients and 453 SLE patients without renal damage were genotyped at 492,970 single nucleotide polymorphisms (SNPs) in the genome-wide association study (GWAS). Fifty-six SNPs were selected for replication in an independent cohort of 188 LN and 171 SLE without LN patients. Further quantitative real-time (qRT) PCR was carried out in 6 LN patients and 6 healthy controls. Gene-based analysis was conducted using the versatile gene-based test for GWAS. Subsequently, enrichment and pathway analyses were performed in the DAVID database.ResultsThe GWAS analysis and the following replication research identified 9 SNPs showing suggestive correlation with LN (P<10-4). The most significant SNP was rs12606116 (18p11.32), at P=8.72×10−6. The qRT-PCR results verified the mRNA levels of LINC00470 and ADCYAP1, the closest genes to rs12606116, were significantly lower in LN patients. From the gene-based analysis, 690 genes had suggestive evidence of association (P<0.05), including LINC00470. The enrichment analysis identified the involvement of transforming growth factor beta (TGF-β) signalings in the development of LN. Lower plasma level of TGF-β1 (P<0.05) in LN patients and lower expression of transforming growth factor beta receptor 2 in lupus mice kidney (P<0.05) futher indicate the involvement of TGF-β in LN.ConclusionsOur analyses identified several promising susceptibility candidates involved in LN, and further verification of these candidates was necessary.
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Affiliation(s)
- Kangkang Song
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Xiaodong Zheng
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
| | - Xiaomin Liu
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Yujun Sheng
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
| | - Lu Liu
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
| | - Leilei Wen
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
| | - Shunlai Shang
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Yiyao Deng
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Qing Ouyang
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Xuefeng Sun
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Qinggang Li
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Pu Chen
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Guangyan Cai
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
| | - Mengyun Chen
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
| | - Yuanjing Zhang
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
| | - Bo Liang
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
| | - Jianglin Zhang
- Department of Rheumatology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xuejun Zhang
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, China
- Institute of Dermatology and Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Xiangmei Chen, ; Xuejun Zhang,
| | - Xiangmei Chen
- Department of Nephrology, The First Medical Centre, Chinese PLA General Hospital, Medical School of Chinese PLA, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Beijing, China
- Haihe Laboratory of Cell Ecosystem, Tianjin, China
- *Correspondence: Xiangmei Chen, ; Xuejun Zhang,
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Lim YL, Bohelay G, Hanakawa S, Musette P, Janela B. Autoimmune Pemphigus: Latest Advances and Emerging Therapies. Front Mol Biosci 2022; 8:808536. [PMID: 35187073 PMCID: PMC8855930 DOI: 10.3389/fmolb.2021.808536] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022] Open
Abstract
Pemphigus represents a group of rare and severe autoimmune intra-epidermal blistering diseases affecting the skin and mucous membranes. These painful and debilitating diseases are driven by the production of autoantibodies that are mainly directed against the desmosomal adhesion proteins, desmoglein 3 (Dsg3) and desmoglein 1 (Dsg1). The search to define underlying triggers for anti-Dsg-antibody production has revealed genetic, environmental, and possible vaccine-driven factors, but our knowledge of the processes underlying disease initiation and pathology remains incomplete. Recent studies point to an important role of T cells in supporting auto-antibody production; yet the involvement of the myeloid compartment remains unexplored. Clinical management of pemphigus is beginning to move away from broad-spectrum immunosuppression and towards B-cell-targeted therapies, which reduce many patients’ symptoms but can have significant side effects. Here, we review the latest developments in our understanding of the predisposing factors/conditions of pemphigus, the underlying pathogenic mechanisms, and new and emerging therapies to treat these devastating diseases.
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Affiliation(s)
- Yen Loo Lim
- Department of Dermatology, National Skin Centre, Singapore
| | - Gerome Bohelay
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Sho Hanakawa
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Philippe Musette
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Baptiste Janela
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore
- Singapore Immunology network, Agency for Science, Technology and Research (A*STAR), Singapore
- *Correspondence: Baptiste Janela,
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5
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Kridin K, Schmidt E. Epidemiology of Pemphigus. JID INNOVATIONS 2021; 1:100004. [PMID: 34909708 PMCID: PMC8659392 DOI: 10.1016/j.xjidi.2021.100004] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/01/2023] Open
Abstract
Pemphigus is an epidemiologically heterogeneous group of autoimmune bullous diseases comprising pemphigus vulgaris (PV), pemphigus foliaceus, paraneoplastic pemphigus, IgA pemphigus, and pemphigus herpetiformis. Recently, our knowledge about the frequency of pemphigus, which is highly variable between different populations, has considerably expanded, and the first non-HLA genes associated with PV have been identified. In addition, a variety of comorbidities, including other autoimmune diseases, hematological malignancies, and psoriasis, have been described in this variant. Here, initial data about the impact of COVID-19 on this fragile patient population are discussed and perspectives for future epidemiological studies are outlined.
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Key Words
- ACE, angiotensin-converting enzyme
- AIBD, autoimmune bullous disease
- CAAR, chimeric autoantibody receptor
- CI, confidence interval
- DSG, desmoglein
- EADV, European Academy of Dermatology and Venereology
- EC, extracellular
- EMA, European Medicines Agency
- FS, fogo selvage
- HR, hazard ratio
- ICD, International Classification of Diseases
- PF, pemphigus foliaceus
- PNP, paraneoplastic pemphigus
- PV, pemphigus vulgaris
- SMR, standardized mortality ratio
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Affiliation(s)
- Khalaf Kridin
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Enno Schmidt
- Lűbeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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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.
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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
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Scarsella L, Pollmann R, Amber KT. Autoreactive T cells in pemphigus: perpetrator and target. Ital J Dermatol Venerol 2020; 156:124-133. [PMID: 33179878 DOI: 10.23736/s2784-8671.20.06706-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pemphigus vulgaris (PV) is an autoimmune blistering disease, in which autoantibodies against epidermal cadherins, such as desmoglein (Dsg)1 and Dsg3, lead to the development of blisters and erosions on the skin and mucous membranes. Autoreactive CD4+ T cells are essential for the induction and perpetuation of the disease by interaction with B cells producing autoantibodies. PV has a strong genetic association with certain human leucocyte antigen (HLA) alleles with HLA-DRB1*04:02 and LA-DQB1*05:03 being the most prevalent in patients. Recently, genome-wide association studies have provided a new approach to identify single nucleotide polymorphisms, alongside the known association with HLA alleles. Loss of tolerance against Dsgs and other autoantigens is a critical event in the pathogenesis of PV. Epitope spreading contributes to the progression of PV, leading to an extension of the Dsg-specific autoimmune response to other molecular epitopes of autoantigens, such as desmocollins or muscarinic receptors. Alterations in CD4+CD25+ FoxP3+ regulatory T cells are thought to contribute to the development of PV representing a suitable target for therapeutic interventions. Several CD4+ T-cell subsets and cytokines are involved in the pathogenesis of PV, while Th2 cells are the extensively studied population. Recently, other T cell subsets like T follicular helper cells and Th17 have gained attention as new potential players in PV pathogenesis. The involvement of local autoantibody production in the lesional skin of PV patients in tertiary lymphoid organs is currently discussed but not yet clarified. In this study, we reviewed the current knowledge about the development, characteristics and function of autoreactive T cells in pemphigus and present current new T cell-targeted therapeutic approaches.
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Affiliation(s)
- Luca Scarsella
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany -
| | - Kyle T Amber
- Department of Dermatology, University of Illinois, Chicago, IL, USA
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8
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Petzl-Erler ML. Beyond the HLA polymorphism: A complex pattern of genetic susceptibility to pemphigus. Genet Mol Biol 2020; 43:e20190369. [PMID: 32639508 PMCID: PMC7341728 DOI: 10.1590/1678-4685-gmb-2019-0369] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Pemphigus is a group of autoimmune bullous skin diseases that result in
significant morbidity. As for other multifactorial autoimmune disorders,
environmental factors may trigger the disease in genetically susceptible
individuals. The goals of this review are to summarize the state of knowledge
about the genetic variation that may affect the susceptibility and pathogenesis
of pemphigus vulgaris and pemphigus foliaceus – both the endemic and the
sporadic forms –, to compare and discuss the possible meaning of the
associations reported, and to propose recommendations for new research
initiatives. Understanding how genetic variants translate into pathogenic
mechanisms and phenotypes remains a mystery for most of the polymorphisms that
contribute to disease susceptibility. However, genetic studies provide a strong
foundation for further developments in this field by generating testable
hypotheses. Currently, results still have limited influence on disease
prevention and prognosis, drug development, and clinical practice, although the
perspectives for future applications for the benefit of patients are
encouraging. Recommendations for the continued advancement of our understanding
as to the impact of genetic variation on pemphigus include these partially
overlapping goals: (1) Querying the functional effect of genetic variants on the
regulation of gene expression through their impact on the nucleotide sequence of
cis regulatory DNA elements such as promoters and enhancers, the splicing of
RNA, the structure of regulatory RNAs and proteins, binding of these regulatory
molecules to regulatory DNA elements, and alteration of epigenetic marks; (2)
identifying key cell types and cell states that are implicated in pemphigus
pathogenesis and explore their functional genomes; (3) integrating structural
and functional genomics data; (4) performing disease-progression longitudinal
studies to disclose the causal relationships between genetic and epigenetic
variation and intermediate disease phenotypes; (5) understanding the influence
of genetic and epigenetic variation in the response to treatment and the
severity of the disease; (6) exploring gene-gene and genotype-environment
interactions; (7) developing improved pemphigus-prone and non-prone animal
models that are appropriate for research about the mechanisms that link
genotypes to pemphigus. Achieving these goals will demand larger samples of
patients and controls and multisite collaborations.
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Affiliation(s)
- Maria Luiza Petzl-Erler
- Laboratório de Genética Molecular Humana, Departamento de Genética, Universidade Federal do Paraná, Curitiba, PR, Brazil
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9
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Hammers CM, Stanley JR. Recent Advances in Understanding Pemphigus and Bullous Pemphigoid. J Invest Dermatol 2020; 140:733-741. [DOI: 10.1016/j.jid.2019.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 12/11/2022]
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10
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Uitto J, Lu Q, Wang G. Meeting Report of the 4th Annual Meeting of the Chinese Society for Investigative Dermatology: Reflections on the Rise of Cutaneous Biology Research in China. J Invest Dermatol 2019; 140:729-732.e4. [PMID: 31862384 DOI: 10.1016/j.jid.2019.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Jouni Uitto
- Department of Dermatology and Cutaneous Biology and the Jefferson Institute of Molecular Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Qianjin Lu
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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11
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Olbrich M, Künstner A, Witte M, Busch H, Fähnrich A. Genetics and Omics Analysis of Autoimmune Skin Blistering Diseases. Front Immunol 2019; 10:2327. [PMID: 31749790 PMCID: PMC6843061 DOI: 10.3389/fimmu.2019.02327] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
Autoimmune blistering diseases (AIBDs) of the skin are characterized by autoantibodies against different intra-/extracellular structures within the epidermis and at the basement membrane zone (BMZ). Binding of the antibodies to their target antigen leads to inflammation at the respective binding site and degradation of these structures, resulting in the separation of the affected skin layers. Clinically, blistering, erythema and lesions of the skin and/or mucous membranes can be observed. Based on the localization of the autoantigen, AIBDs can be divided into pemphigus (intra-epidermal blistering diseases) and pemphigoid diseases (sub-epidermal blistering diseases), respectively. Although autoantigens have been extensively characterized, the underlying causes that trigger the diseases are still poorly understood. Besides the environment, genetic factors seem to play an important role in a predisposition to AIBDs. Here, we review currently known genetic and immunological mechanisms that contribute to the pathogenesis of AIBDs. Among the most commonly encountered genetic predispositions for AIBDs are the HLA gene region, and deleterious mutations of key genes for the immune system. Particularly, HLA class II genes such as the HLA-DR and HLA-DQ alleles have been shown to be prevalent in patients. This has prompted further epidemiological studies as well as unbiased Omics approaches on the transcriptome, microbiome, and proteome level to elucidate common and individual genetic risk factors as well as the molecular pathways that lead to the pathogenesis of AIBDs.
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Affiliation(s)
- Michael Olbrich
- Medical Systems Biology, Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute of Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Axel Künstner
- Medical Systems Biology, Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute of Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Mareike Witte
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hauke Busch
- Medical Systems Biology, Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute of Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Anke Fähnrich
- Medical Systems Biology, Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute of Cardiogenetics, University of Lübeck, Lübeck, Germany
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Abstract
Pemphigus consists of a group of rare and severe autoimmune blistering diseases mediated by pathogenic autoantibodies mainly directed against two desmosomal adhesion proteins, desmoglein (Dsg)1 and Dsg3 (also known as DG1 and DG3), which are present in the skin and surface-close mucosae. The binding of autoantibodies to Dsg proteins induces a separation of neighbouring keratinocytes, in a process known as acantholysis. The two main pemphigus variants are pemphigus vulgaris, which often originates with painful oral erosions, and pemphigus foliaceus, which is characterised by exclusive skin lesions. Pemphigus is diagnosed on the basis of either IgG or complement component 3 deposits (or both) at the keratinocyte cell membrane, detected by direct immunofluorescence microscopy of a perilesional biopsy, with serum anti-Dsg1 or anti-Dsg3 antibodies (or both) detected by ELISA. Corticosteroids are the therapeutic mainstay, which have recently been complemented by the anti-CD20 antibody rituximab in moderate and severe disease. Rituximab induces complete remission off therapy in 90% of patients, despite rapid tapering of corticosteroids, thus allowing for a major corticosteroid-sparing effect and a halved number of adverse events related to corticosteroids.
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Affiliation(s)
- Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute for Experimental Dermatology, University of Lübeck, Lübeck, Germany.
| | - Michael Kasperkiewicz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France; INSERM Unit 2345, French Reference Center for Autoimmune Bullous Diseases, Normandy University, Rouen, France
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13
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Mahmoudi H, Ebrahimi E, Daneshpazhooh M, Balighi K, Mirzazadeh A, Elikaei Behjati S, Tavakolpour S. Single-nucleotide polymorphisms associated with pemphigus vulgaris: Potent markers for better treatment and personalized medicine. Int J Immunogenet 2019; 47:41-49. [PMID: 31342641 DOI: 10.1111/iji.12451] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/27/2019] [Accepted: 06/30/2019] [Indexed: 12/22/2022]
Abstract
Pemphigus vulgaris (PV) is a rare autoimmune blistering disorder, which could affect both skin and mucosal surfaces. There is increasing evidence that genetics plays a critical role in PV development, severity and prognosis. Single-nucleotide polymorphisms (SNPs) are the most common type of genetic variation among people and have been widely evaluated in most diseases. However, there are few studies regarding the roles of SNPs in the PV. Here, we reviewed both pathogenic and protective roles of the SNPs in non-HLA genes regarding the PV. Among the large number of studied SNPs, it was found that several SNPs in different genes might control the susceptibility of PV, including TNFA (rs361525, rs1800629, rs1800629), IL10 (rs1800871, rs1800896, rs1800871, and rs1800872), IL6 (rs1800795), CTLA4 (rs231775), ICOS (rs10932029), CD86 (rs1129055), DSG3 (rs8085532, rs3911655, rs3848485, rs3794925, rs1466379), ST18 (rs2304365, rs17315309) and TAP2 (rs7454108), probably in a population-specific manner. Moreover, SNPs in glucocorticoid receptor, also known as nuclear receptor subfamily 3 group C member 1 (NR3C1) gene, including rs11745958, rs17209237, rs33388, rs7701443 as well as rs116855232 at NUDT15, seem to be associated with therapeutic outcomes in PV patients. Additionally, variations in the other genes involved in the drugs' metabolisms, pharmacokinetics and pharmacodynamics such as rs396991 in FCGR3A gene could be used for the prediction of clinical response to drugs and side effects. Taken together, SNPs seem to be valuable tools for better management of PV patients. Further studies need to be conducted to evaluate SNPs in genes that control immune responses and apoptosis.
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Affiliation(s)
- HamidReza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Ebrahimi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Balighi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Mirzazadeh
- Joint Bioinformatics graduate Program, University of Arkansas Little Rock and University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Somayeh Elikaei Behjati
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Tavakolpour
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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14
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Has C, Amber KT, Murrell DF, Musette P, Ludwig RJ. Editorial: Skin Blistering Diseases. Front Med (Lausanne) 2019; 6:60. [PMID: 31001533 PMCID: PMC6454141 DOI: 10.3389/fmed.2019.00060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/07/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Cristina Has
- Department of Dermatology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kyle T Amber
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, United States
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Philippe Musette
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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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
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