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Lehr S, Felber F, Tantcheva-Poór I, Keßler C, Eming R, Nyström A, Rizzi M, Kiritsi D. Occurrence of autoantibodies against skin proteins in patients with hereditary epidermolysis bullosa predisposes to development of autoimmune blistering disease. Front Immunol 2022; 13:945176. [PMID: 35958577 PMCID: PMC9358991 DOI: 10.3389/fimmu.2022.945176] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Skin blistering disorders are associated with inherited defects in proteins involved in the dermal-epidermal adhesion or autoantibodies targeting those proteins. Although blistering in hereditary epidermolysis bullosa (EB) is pathogenetically linked to genetic deficiency of distinct proteins of the epidermis or the dermal-epidermal junction, circulating autoantibodies against these proteins have also been identified in EB patients. So far, autoantibodies have been considered bystanders in EB and active pathogenicity of them in EB has not been disclosed. In sera of a cohort of 258 EB patients, we found by ELISA in 22% of the patients autoantibodies against the bullous pemphigoid antigen BP180. The titers correlated negatively with collagen VII skin expression and positively with disease severity. Among those patients, we identified six (2.33%) with clinical features of an autoimmune bullous disorder (AIBD) and positive indirect immunofluorescence (IIF) staining. In literature, we found four more cases of EB patients developing disease-aggravating AIBD. Co-existence of these two rare skin disorders suggests that EB patients have a predisposition for the development of AIBD. Our work highlights that EB patients with increased itch or blister formation should be evaluated for additional AIBD and repeated screening for changes in autoantibody titers and skin-binding specificities is advised.
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Affiliation(s)
- Saskia Lehr
- Department of Dermatology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Felicitas Felber
- Department of Dermatology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Christina Keßler
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
| | - Alexander Nyström
- Department of Dermatology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany
| | - Marta Rizzi
- Department of Rheumatology and Clinical Immunology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Chronic Immunodeficiency, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dimitra Kiritsi
- Department of Dermatology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- *Correspondence: Dimitra Kiritsi,
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Fania L, Provini A, Salemme A, Sinagra JL, Guerra L, Mazzanti C, Didona B, Castiglia D, Di Zenzo G. Development of bullous pemphigoid in junctional epidermolysis bullosa. J Eur Acad Dermatol Venereol 2020; 34:e146-e148. [PMID: 31709656 DOI: 10.1111/jdv.16057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- L Fania
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - A Provini
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - A Salemme
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - J L Sinagra
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - L Guerra
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - C Mazzanti
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - B Didona
- First Dermatologic Division, IDI-IRCCS, Rome, Italy
| | - D Castiglia
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
| | - G Di Zenzo
- Laboratory of Molecular and Cell Biology, IDI-IRCCS, Rome, Italy
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Saraiya A, Yang CS, Kim J, Bercovitch L, Robinson-Bostom L, Telang G. Dermal eosinophilic infiltrate in junctional epidermolysis bullosa. J Cutan Pathol 2015; 42:559-63. [PMID: 25950805 DOI: 10.1111/cup.12521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/27/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
Junctional epidermolysis bullosa (JEB) is a rare genodermatosis characterized by a split in the lamina lucida usually because of mutations in LAMA3, LAMB3 and LAMC2 resulting in absence or reduction of laminin-332. Rare subtypes of JEB have mutations in COL17A1, ITGB4, ITGA6 and ITGA3 leading to reduction or dysfunction of collagen XVII, integrin α6β4 and integrin α3. The classic finding under light microscopy is a paucicellular, subepidermal split. We describe the unusual presence of an eosinophilic infiltrate in the bullae and subjacent dermis in a neonate with JEB, generalized intermediate (formerly known as non-Herlitz-type JEB), discuss the histologic differential diagnosis for a subepidermal blister in a neonate, review the literature regarding cases of epidermolysis bullosa (EB) presenting with inflammatory infiltrates, and discuss mechanisms to explain these findings. This case highlights that eosinophils can rarely be seen in EB and should not mislead the dermatopathologist into diagnosing an autoimmune blistering disorder.
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Affiliation(s)
- Ami Saraiya
- Tufts Dermatology Research Department, Tufts Medical Center, Boston, MA, USA
| | - Catherine S Yang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Jinah Kim
- Department of Pathology, Division of Dermatopathology, Stanford University, Palo Alto, CA, USA
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Gladys Telang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
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