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Hong SA, Kim SE, Lee AY, Hwang GH, Kim JH, Iwata H, Kim SC, Bae S, Lee SE. Therapeutic base editing and prime editing of COL7A1 mutations in recessive dystrophic epidermolysis bullosa. Mol Ther 2022; 30:2664-2679. [PMID: 35690907 PMCID: PMC9372317 DOI: 10.1016/j.ymthe.2022.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 12/17/2022] Open
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is a severe skin fragility disorder caused by loss-of-function mutations in the COL7A1 gene, which encodes type VII collagen (C7), a protein that functions in skin adherence. From 36 Korean RDEB patients, we identified a total of 69 pathogenic mutations (40 variants without recurrence), including point mutations (72.5%) and insertion/deletion mutations (27.5%). For fibroblasts from two patients (Pat1 and Pat2), we applied adenine base editors (ABEs) to correct the pathogenic mutation of COL7A1 or to bypass a premature stop codon in Pat1-derived primary fibroblasts. To expand the targeting scope, we also utilized prime editors (PEs) to correct the COL7A1 mutations in Pat1- and Pat2-derived fibroblasts. Ultimately, we found that transfer of edited patient-derived skin equivalents (i.e., RDEB keratinocytes and PE-corrected RDEB fibroblasts from the RDEB patient) into the skin of immunodeficient mice led to C7 deposition and anchoring fibril formation within the dermal-epidermal junction, suggesting that base editing and prime editing could be feasible strategies for ex vivo gene editing to treat RDEB.
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Affiliation(s)
- Sung-Ah Hong
- Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Song-Ee Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - A-Young Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Gue-Ho Hwang
- Department of Chemistry, Hanyang University, Seoul 04763, South Korea
| | - Jong Hoon Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Soo-Chan Kim
- Department of Dermatology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, South Korea
| | - Sangsu Bae
- Genomic Medicine Institute, Medical Research Center, Seoul National University College of Medicine, Seoul 03080, South Korea; Department of Biomedical Sciences, Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul 03080, South Korea.
| | - Sang Eun Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul 06273, South Korea.
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Vicari E, Haeberle S, Bolduan V, Ramcke T, Vorobyev A, Goletz S, Iwata H, Ludwig RJ, Schmidt E, Enk AH, Hadaschik EN. Pathogenic Autoantibody Derived from Regulatory T Cell‒Deficient Scurfy Mice Targets Type VII Collagen and Leads to Epidermolysis Bullosa Acquisita‒Like Blistering Disease. J Invest Dermatol 2021; 142:980-984.e4. [PMID: 34678154 DOI: 10.1016/j.jid.2021.08.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Elisabeth Vicari
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Stefanie Haeberle
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Vanessa Bolduan
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Torben Ramcke
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Artem Vorobyev
- Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany; Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ralf J Ludwig
- Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany; Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University Medical Center Schleswig-Holstein, Lübeck, Germany; Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Alexander H Enk
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva N Hadaschik
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany; Department of Dermatology, Essen University Hospital, Essen, Germany
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Zillikens H, Kasprick A, Osterloh C, Gross N, Radziewitz M, Hass C, Hartmann V, Behnen-Härer M, Ernst N, Boch K, Vidarsson G, Visser R, Laskay T, Yu X, Petersen F, Ludwig RJ, Bieber K. Topical Application of the PI3Kβ-Selective Small Molecule Inhibitor TGX-221 Is an Effective Treatment Option for Experimental Epidermolysis Bullosa Acquisita. Front Med (Lausanne) 2021; 8:713312. [PMID: 34557502 PMCID: PMC8452940 DOI: 10.3389/fmed.2021.713312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Class I phosphoinositide 3-kinases (PI3K) have been implemented in pathogenesis of experimental epidermolysis bullosa acquisita (EBA), an autoimmune skin disease caused by type VII collagen (COL7) autoantibodies. Mechanistically, inhibition of specific PI3K isoforms, namely PI3Kβ or PI3Kδ, impaired immune complex (IC)-induced neutrophil activation, a key prerequisite for EBA pathogenesis. Data unrelated to EBA showed that neutrophil activation is also modulated by PI3Kα and γ, but their impact on the EBA has, so far, remained elusive. To address this and to identify potential therapeutic targets, we evaluated the impact of a panel of PI3K isoform-selective inhibitors (PI3Ki) on neutrophil function in vitro, and in pre-clinical EBA mouse models. We document that distinctive, and EBA pathogenesis-related activation-induced neutrophil in vitro functions depend on distinctive PI3K isoforms. When mice were treated with the different PI3Ki, selective blockade of PI3Kα (alpelisib), PI3Kγ (AS-604850), or PI3Kβ (TGX-221) impaired clinical disease manifestation. When applied topically, only TGX-221 impaired induction of experimental EBA. Ultimately, multiplex kinase activity profiling in the presence of disease-modifying PI3Ki identified unique signatures of different PI3K isoform-selective inhibitors on the kinome of IC-activated human neutrophils. Collectively, we here identify topical PI3Kβ inhibition as a potential therapeutic target for the treatment of EBA.
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Affiliation(s)
- Hannah Zillikens
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Anika Kasprick
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Colin Osterloh
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Natalie Gross
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Michael Radziewitz
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Cindy Hass
- Priority Area Asthma and Allergy, Research Center Borstel, Airway Research Center North, German Center for Lung Research, Borstel, Germany
| | - Veronika Hartmann
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Martina Behnen-Härer
- Department for Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Nancy Ernst
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Katharina Boch
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Gestur Vidarsson
- Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Remco Visser
- Sanquin Research and Landsteiner Laboratory, Amsterdam, Netherlands
| | - Tamás Laskay
- Department for Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Xinhua Yu
- Priority Area Asthma and Allergy, Research Center Borstel, Airway Research Center North, German Center for Lung Research, Borstel, Germany
| | - Frank Petersen
- Priority Area Asthma and Allergy, Research Center Borstel, Airway Research Center North, German Center for Lung Research, Borstel, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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Yoshida K, Kobayashi M, Matsunaga Y, Kubo A, Ishiko A. Case of intermediate recessive dystrophic epidermolysis bullosa with negative LH7.2 staining. J Dermatol 2020; 47:e370-e372. [DOI: 10.1111/1346-8138.15498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kenji Yoshida
- Department of Dermatology Toho University School of Medicine TokyoJapan
| | - Mayuko Kobayashi
- Department of Dermatology Toho University School of Medicine TokyoJapan
| | - Yukiko Matsunaga
- Department of Dermatology Toho University School of Medicine TokyoJapan
| | - Akiharu Kubo
- Department of Dermatology Keio University School of Medicine Tokyo Japan
| | - Akira Ishiko
- Department of Dermatology Toho University School of Medicine TokyoJapan
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5
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Autoimmune bullous skin diseases, pemphigus and pemphigoid. J Allergy Clin Immunol 2020; 145:1031-1047. [DOI: 10.1016/j.jaci.2020.02.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
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Takashima S, Shinkuma S, Fujita Y, Nomura T, Ujiie H, Natsuga K, Iwata H, Nakamura H, Vorobyev A, Abe R, Shimizu H. Efficient Gene Reframing Therapy for Recessive Dystrophic Epidermolysis Bullosa with CRISPR/Cas9. J Invest Dermatol 2019; 139:1711-1721.e4. [DOI: 10.1016/j.jid.2019.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 02/01/2019] [Accepted: 02/15/2019] [Indexed: 12/21/2022]
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Abstract
Pemphigoid diseases (PDs) are a group of autoimmune bullous diseases characterized and caused by autoantibodies targeting structural proteins of the skin and mucous membranes. Chronic inflammation, subepidermal blistering, and often scaring are the clinical characteristics of PDs. Itching and, in severe cases, disabilities resulting from scaring (i.e., blindness, esophageal strictures) are the leading subjective symptoms. Treatment of PDs, which is based on nonspecific immunosuppression, is challenging because of frequent relapses, lack of efficacy, and numerous adverse events. In addition, the incidence of PDs is increasing. Given the high morbidity, limited therapeutic options, and increasing incidence, there is a growing urgency for drug discovery to help treat this condition. The recent development of PD model systems has added to the understanding of PD pathogenesis and, based on these insights, new clinical trials will soon be launched. The (auto-)antibody transfer PD models allow for investigations into autoantibody-mediated tissue pathology, while immunization-induced PD models more closely resemble the clinical situation. The latter duplicate all aspects of the human disease and are useful for investigating PD pathogenesis and testing therapeutic interventions. This article describes antibody transfer and immunization-induced PD mouse models currently employed for translational PD research. © 2019 by John Wiley & Sons, Inc.
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Affiliation(s)
- Anika Kasprick
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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8
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Koga H, Prost-Squarcioni C, Iwata H, Jonkman MF, Ludwig RJ, Bieber K. Epidermolysis Bullosa Acquisita: The 2019 Update. Front Med (Lausanne) 2019; 5:362. [PMID: 30687710 PMCID: PMC6335340 DOI: 10.3389/fmed.2018.00362] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/19/2018] [Indexed: 11/13/2022] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is an orphan autoimmune disease. Patients with EBA suffer from chronic inflammation as well as blistering and scarring of the skin and mucous membranes. Current treatment options rely on non-specific immunosuppression, which in many cases, does not lead to a remission of treatment. Hence, novel treatment options are urgently needed for the care of EBA patients. During the past decade, decisive clinical observations, and frequent use of pre-clinical model systems have tremendously increased our understanding of EBA pathogenesis. Herein, we review all of the aspects of EBA, starting with a detailed description of epidemiology, clinical presentation, diagnosis, and current treatment options. Of note, pattern analysis via direct immunofluorescence microscopy of a perilesional skin lesion and novel serological test systems have significantly facilitated diagnosis of the disease. Next, a state-of the art review of the current understanding of EBA pathogenesis, emerging treatments and future perspectives is provided. Based on pre-clinical model systems, cytokines and kinases are among the most promising therapeutic targets, whereas high doses of IgG (IVIG) and the anti-CD20 antibody rituximab are among the most promising "established" EBA therapeutics. We also aim to raise awareness of EBA, as well as initiate basic and clinical research in this field, to further improve the already improved but still unsatisfactory conditions for those diagnosed with this condition.
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Affiliation(s)
- Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Fukuoka, Japan
| | - Catherine Prost-Squarcioni
- Department of Dermatology, APHP, Avicenne Hospital, Referral Center for Autoimmune Bullous Diseases, Bobigny, France
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Marcel F Jonkman
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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9
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Koga H, Kasprick A, López R, Aulí M, Pont M, Godessart N, Zillikens D, Bieber K, Ludwig RJ, Balagué C. Therapeutic Effect of a Novel Phosphatidylinositol-3-Kinase δ Inhibitor in Experimental Epidermolysis Bullosa Acquisita. Front Immunol 2018; 9:1558. [PMID: 30050528 PMCID: PMC6052048 DOI: 10.3389/fimmu.2018.01558] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 06/25/2018] [Indexed: 12/12/2022] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is a rare, but prototypical, organ-specific autoimmune disease, characterized and caused by autoantibodies against type VII collagen (COL7). Mucocutaneous inflammation, blistering, and scarring are the clinical hallmarks of the disease. Treatment of EBA is difficult and mainly relies on general immunosuppression. Hence, novel treatment options are urgently needed. The phosphatidylinositol-3-kinase (PI3K) pathway is a putative target for the treatment of inflammatory diseases, including EBA. We recently discovered LAS191954, an orally available, selective PI3Kδ inhibitor. PI3Kδ has been shown to be involved in B cell and neutrophil cellular functions. Both cell types critically contribute to EBA pathogenesis, rendering LAS191954 a potential drug candidate for EBA treatment. We, here, demonstrate that LAS191954, when administered chronically, dose-dependently improved the clinical phenotype of mice harboring widespread skin lesions secondary to immunization-induced EBA. Direct comparison with high-dose corticosteroid treatment indicated superiority of LAS191954. Interestingly, levels of circulating autoantibodies were unaltered in all groups, indicating a mode of action independent of the inhibition of B cell function. In line with this, LAS191954 also hindered disease progression in antibody transfer-induced EBA, where disease develops dependent on myeloid, but independent of B cells. We further show that, in vitro, LAS191954 dose-dependently impaired activation of human myeloid cells by relevant disease stimuli. Specifically, immune complex-mediated and C5a-mediated ROS release were inhibited in a PI3Kδ-dependent manner. Accordingly, LAS191954 also modulated the dermal–epidermal separation induced in vitro by co-incubation of immune complexes with polymorph nuclear cells, thus pointing to an important role of PI3Kδ in EBA effector functions. Altogether, these results suggest a new potential mechanism for the treatment of EBA and potentially also other autoimmune bullous diseases.
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Affiliation(s)
- Hiroshi Koga
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Anika Kasprick
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Rosa López
- Skin Biology and Pharmacology, Almirall R&D, Barcelona, Spain
| | - Mariona Aulí
- Preclinical Safety and Toxicology, Almirall R&D, Barcelona, Spain
| | - Mercè Pont
- Skin Biology and Pharmacology, Almirall R&D, Barcelona, Spain
| | - Núria Godessart
- Skin Biology and Pharmacology, Almirall R&D, Barcelona, Spain
| | | | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology University of Lübeck, Lübeck, Germany
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Goletz S, Zillikens D, Schmidt E. Structural proteins of the dermal-epidermal junction targeted by autoantibodies in pemphigoid diseases. Exp Dermatol 2017; 26:1154-1162. [PMID: 28887824 DOI: 10.1111/exd.13446] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 12/12/2022]
Abstract
The dermal-epidermal junction consists of a network of several interacting structural proteins that strengthen adhesion and mediate signalling events. This structural network consists of hemidesmosomal-anchoring filament complexes connecting the basal keratinocytes to the basement membrane. The anchoring filaments in turn interact with the anchoring fibrils to attach the basement membrane to the underlying dermis. Several of these structural proteins are recognized by autoantibodies in pemphigoid diseases, a heterogeneous group of clinically and immunopathologically diverse entities. Targeted proteins include the two intracellular plakins, plectin isoform 1a and BP230 (also called bullous pemphigoid antigen (BPAG) 1 isoform e (BPAG1e)). Plectin 1a and BP230 are connected to the intermediate filaments and to the cell surface receptor α6β4 integrin, which in turn is connected to laminin 332, a component of the anchoring filaments. Further essential adhesion proteins are BP180, a transmembrane protein, laminin γ1 and type VII collagen. Latter protein is the major constituent of the anchoring fibrils. Mutations in the corresponding genes of these adhesion molecules lead to inherited epidermolysis bullosa emphasizing the importance of these proteins for the integrity of the dermal-epidermal junction. This review will provide an overview on the structure and function of the proteins situated in the dermal-epidermal junction targeted by autoantibodies.
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Affiliation(s)
- Stephanie Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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Bieber K, Koga H, Nishie W. In vitro and in vivo models to investigate the pathomechanisms and novel treatments for pemphigoid diseases. Exp Dermatol 2017; 26:1163-1170. [DOI: 10.1111/exd.13415] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Katja Bieber
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
| | - Hiroshi Koga
- Department of Dermatology; Kurume University School of Medicine; Fukuoka Japan
| | - Wataru Nishie
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
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12
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Tukaj S, Bieber K, Witte M, Ghorbanalipoor S, Schmidt E, Zillikens D, Ludwig RJ, Kasperkiewicz M. Calcitriol Treatment Ameliorates Inflammation and Blistering in Mouse Models of Epidermolysis Bullosa Acquisita. J Invest Dermatol 2017; 138:301-309. [PMID: 28942362 DOI: 10.1016/j.jid.2017.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 12/30/2022]
Abstract
A link between hypovitaminosis D and development of autoimmune bullous disorders has been suggested recently, but this association has not been elaborated experimentally. Here, the role of vitamin D was investigated in epidermolysis bullosa acquisita (EBA), an anti-type VII collagen autoantibody-induced blistering skin disease. Oral administration of the hormonally active vitamin D metabolite calcitriol ameliorated clinical disease severity and dermal neutrophil infiltration in both an antibody transfer- and immunization-induced EBA mouse model. Mechanistically, calcitriol hindered immune effector cell activation as evidenced by increased L-selectin expression on Gr-1+ cells in calcitriol-treated mice with antibody transfer-induced EBA, as well as suppressed in vitro immune complex-induced reactive oxygen species production in calcitriol-treated murine neutrophils. Additionally, calcitriol administration was associated with an increase of regulatory T (CD4+FoxP3+) and B (CD19+IL10+) cells as well as reduction of pro-inflammatory T helper 17 (CD4+IL-17+) cells in mice with immunization-induced EBA. In line, levels of circulating anti-type VII collagen autoantibodies were lower in mice that received calcitriol compared to solvent-treated animals. Together with the observed state of hypovitaminosis D in most cases of an analyzed EBA patient cohort, the results of this study support the use of vitamin D derivatives or analogs for patients with EBA and related diseases.
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Affiliation(s)
- Stefan Tukaj
- Department of Molecular Biology, Faculty of Biology, University of Gdańsk, Poland.
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Mareike Witte
- Department of Dermatology, University of Lübeck, Germany
| | | | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany; Department of Dermatology, University of Lübeck, Germany
| | - Detlef Zillikens
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany; Department of Dermatology, University of Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany; Department of Dermatology, University of Lübeck, Germany
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Hashimoto T, Tsuruta D, Koga H, Fukuda S, Ohyama B, Komai A, Karashima T, Ohata C, Teye K, Ishii N. Summary of results of serological tests and diagnoses for 4774 cases of various autoimmune bullous diseases consulted to Kurume University. Br J Dermatol 2016; 175:953-965. [DOI: 10.1111/bjd.14692] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/12/2022]
Affiliation(s)
- T. Hashimoto
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - D. Tsuruta
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - H. Koga
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - S. Fukuda
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - B. Ohyama
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - A. Komai
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - T. Karashima
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - C. Ohata
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - K. Teye
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
| | - N. Ishii
- Department of Dermatology; Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology; Kurume Fukuoka 830-0011 Japan
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14
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Vorobyev A, Ludwig RJ, Schmidt E. Clinical features and diagnosis of epidermolysis bullosa acquisita. Expert Rev Clin Immunol 2016; 13:157-169. [PMID: 27580464 DOI: 10.1080/1744666x.2016.1221343] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Epidermolysis bullosa acquisita (EBA) is a rare autoimmune blistering disease of skin and mucous membranes. EBA is caused by autoantibodies against type VII collagen, which is a major component of anchoring fibrils, attaching epidermis to dermis. Binding of autoantibodies to type VII collagen leads to skin fragility and, finally, blister formation. The clinical picture of EBA is polymorphic, with several distinct phenotypes being described. Despite recent progress in understanding the pathophysiology of EBA, its diagnosis is still challenging. Areas covered: This review provides an update on the clinical manifestations and diagnostic methods of EBA. We searched PubMed using the terms 'epidermolysis bullosa acquisita' covering articles in English between 1 January 2005 and 31 May 2016. Relevant older publications were retrieved form cited literature. Expert commentary: While the clinical picture is highly variable, diagnosis relies on direct immunofluorescence (IF) microscopy of a perilesional skin biopsy. Linear deposits of IgG, IgA and/or C3 along the dermal-epidermal junction with an u-serrated pattern are diagnostic for EBA alike the detection of serum autoantibodies against type VII collagen. Several test systems for the serological diagnosis of EBA have recently become widely available. In some patients, sophisticated diagnostic approaches only available in specialized centers are required.
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Affiliation(s)
- Artem Vorobyev
- a Department of Dermatology , University of Lübeck , Lübeck , Germany.,b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
| | - Ralf J Ludwig
- a Department of Dermatology , University of Lübeck , Lübeck , Germany.,b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
| | - Enno Schmidt
- a Department of Dermatology , University of Lübeck , Lübeck , Germany.,b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
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Kasperkiewicz M, Sadik CD, Bieber K, Ibrahim SM, Manz RA, Schmidt E, Zillikens D, Ludwig RJ. Epidermolysis Bullosa Acquisita: From Pathophysiology to Novel Therapeutic Options. J Invest Dermatol 2016; 136:24-33. [DOI: 10.1038/jid.2015.356] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/29/2015] [Accepted: 08/20/2015] [Indexed: 12/26/2022]
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Iwata H, Witte M, Samavedam UKSRL, Gupta Y, Shimizu A, Ishiko A, Schröder T, Seeger K, Dahlke M, Rades D, Zillikens D, Ludwig RJ. Radiosensitive Hematopoietic Cells Determine the Extent of Skin Inflammation in Experimental Epidermolysis Bullosa Acquisita. THE JOURNAL OF IMMUNOLOGY 2015. [PMID: 26202985 DOI: 10.4049/jimmunol.1501003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Animal models have enhanced our understanding of the pathogenesis of autoimmune diseases. For these models, genetically identical, inbred mice have commonly been used. Different inbred mouse strains, however, show a high variability in disease manifestation. Identifying the factors that influence this disease variability could provide unrecognized insights into pathogenesis. We established a novel Ab transfer-induced model of epidermolysis bullosa acquisita (EBA), an autoimmune disease characterized by (muco)-cutaneous blistering caused by anti-type VII collagen (COL7) autoantibodies. Blistering after anti-COL7 IgG (directed against the von Willebrand factor A-like domain 2) transfer showed clear variability among inbred mouse strains, that is, severe cutaneous blistering and inflammation in C57BL/6J and absence of skin lesions in MRL/MpJ mice. The transfer of anti-COL7 IgG into irradiated, EBA-resistant MRL/MpJ mice, rescued by transplantation with bone marrow from EBA-susceptible B6.AK-H2k mice, induced blistering. To the contrary, irradiated EBA-susceptible B6.AK-H2k mice that were rescued using MRL/MpJ bone marrow were devoid of blistering. In vitro, immune complex activation of neutrophils from C57BL/6J or MRL/MpJ mice showed an impaired reactive oxygen species release from the latter, whereas no differences were observed after PMA activation. This finding was paralleled by divergent expression profiles of immune complex-activated neutrophils from either C57BL/6J or MRL/MpJ mice. Collectively, we demonstrate that radiosensitive cells determine the varying extent of skin inflammation and blistering in the end-stage effector phase of EBA.
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Affiliation(s)
- Hiroaki Iwata
- Department of Dermatology, University of Lübeck, D-23538 Lübeck, Germany
| | - Mareike Witte
- Lübeck Institute of Experimental Dermatology, University of Lübeck, D-23538 Lübeck, Germany
| | | | - Yask Gupta
- Lübeck Institute of Experimental Dermatology, University of Lübeck, D-23538 Lübeck, Germany
| | - Atsushi Shimizu
- First Department of Dermatology, School of Medicine, Faculty of Medicine Toho University, Tokyo 143-8540, Japan
| | - Akira Ishiko
- First Department of Dermatology, School of Medicine, Faculty of Medicine Toho University, Tokyo 143-8540, Japan
| | - Tobias Schröder
- Lübeck Institute of Experimental Dermatology, University of Lübeck, D-23538 Lübeck, Germany
| | - Karsten Seeger
- Department of Chemistry, University of Lübeck, D-23538 Lübeck, Germany; and
| | - Markus Dahlke
- Department of Radiation Oncology, University of Lübeck, D-23538 Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, D-23538 Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, D-23538 Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, D-23538 Lübeck, Germany
| | - Ralf J Ludwig
- Department of Dermatology, University of Lübeck, D-23538 Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, D-23538 Lübeck, Germany;
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