1
|
Butt E, Günder T, Stürzebecher P, Kowalski I, Schneider P, Buschmann N, Schäfer S, Bender A, Hermanns HM, Zernecke A. Cholesterol uptake in the intestine is regulated by the LASP1-AKT-NPC1L1 signaling pathway. Am J Physiol Gastrointest Liver Physiol 2024; 327:G25-G35. [PMID: 38713618 DOI: 10.1152/ajpgi.00222.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 05/09/2024]
Abstract
Cholesterol is essential for the stability and architecture of the plasma membrane and a precursor of bile acids and steroid hormones in mammals. Excess dietary cholesterol uptake leads to hypercholesterolemia and atherosclerosis and plays a role in cancer development. The role of actin-binding scaffolding protein LIM and SH3 protein 1 (LASP1) in cholesterol trafficking has not been investigated previously. Cholesterol levels, its uptake, and excretion were studied in mice deficient for low-density lipoprotein receptor and Lasp1 (Ldlr-/-Lasp1-/- mice) upon feeding a high-fat diet, and in LASP1-knockdown, differentiated human intestinal epithelial CaCo-2 cells. When compared with diet-fed Ldlr-/- control mice, Ldlr-/-Lasp1-/- mice displayed a reduction in serum cholesterol levels. Mechanistically, we identified a new role of LASP1 in controlling the translocation of the intestinal cholesterol transporter Niemann-Pick C1-like 1 (NPC1L1) to the apical cell surface, which was limited in LASP1-knockdown human CaCo-2 enterocytes and in the intestine of Ldlr-/- Lasp1-/- compared with Ldlr-/- mice, linked to LASP1-pAKT signaling but not CDC42 activation. In line, a reduction in cholesterol reabsorption was noted in LASP1-knockdown CaCo-2 cells in vitro, and an enhanced cholesterol excretion via the feces was observed in Ldlr-/- Lasp1-/- mice. These data uncover a novel function of Lasp1 in cholesterol trafficking, promoting cholesterol reabsorption in the intestine. Targeting LASP1 locally could thus represent a novel targeting strategy to ameliorate hypercholesterolemia and associated diseases.NEW & NOTEWORTHY We here uncovered LASP1 as a novel regulator of the shuttling of the sterol transporter NPC1L1 to the cell surface in enterocytes to control cholesterol absorption. Accordingly, LASP1-deficient mice displayed lowered serum cholesterol levels under dietary cholesterol supplementation.
Collapse
Affiliation(s)
- Elke Butt
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Thorsten Günder
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Paulina Stürzebecher
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Isabel Kowalski
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Pia Schneider
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Nils Buschmann
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Sarah Schäfer
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Alicia Bender
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| | - Heike M Hermanns
- Division of Hepatology, University Hospital Würzburg, Würzburg, Germany
| | - Alma Zernecke
- Institute of Experimental Biomedicine, University Hospital Würzburg, Würzburg, Germany
| |
Collapse
|
2
|
Rai R, Anand JB, Shanmugasekar C, Arunprasath P, Chaitra V, Zillikens D, Schimdt E. Anti-P 200 pemphigoid - The most common floor binding subepidermal autoimmune bullous disease in a tertiary care center in south India. Indian J Dermatol Venereol Leprol 2021; 87:787-791. [PMID: 34160166 DOI: 10.25259/ijdvl_79_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The pemphigoid group of diseases may present clinically and immunologically in a very similar fashion. Indirect immunofluorescence microscopy with readily available salt-split human skin in a BIOCHIP™ helps to classify these conditions as those with either with roof binding or floor binding of immunoreactants. Epidermolysis bullosa acquisita, anti-laminin 332 pemphigoid and anti-p200 pemphigoid show floor binding, while in the most frequent type of pemphigoid disease, bullous pemphigoid, epidermal side staining pattern is seen on salt-split skin Aims: The aim of the study was to detect the target antigens in sub-epidermal bullous diseases. METHODS Forty patients with bullous pemphigoid diagnosed by lesional histopathology and direct immunofluorescence microscopy were re-evaluated by a BIOCHIP™ mosaic containing both tissue substrates and recombinant target antigens. Sera with floor pattern staining on salt-split skin were further evaluated by immunoblotting with dermal extract. RESULTS Five patients with floor staining had anti-p200 pemphigoid. LIMITATIONS We could not perform serration pattern analysis of direct immunofluorescence in our patients. CONCLUSION Histopathology and direct immunofluorescence microscopy cannot differentiate between various entities of pemphigoid diseases. A multivariant approach using a BIOCHIP™ mosaic including salt-split skin followed by immunoblotting with dermal extract helps to identify the target antigen.
Collapse
Affiliation(s)
- Reena Rai
- Department of Dermatology, PSG IMSR, Coimbatore, Tamil Nadu, India
| | - J Bede Anand
- Department of Dermatology, PSG IMSR, Coimbatore, Tamil Nadu, India
| | - C Shanmugasekar
- Department of Dermatology, PSG IMSR, Coimbatore, Tamil Nadu, India
| | - P Arunprasath
- Department of Dermatology, PSG IMSR, Coimbatore, Tamil Nadu, India
| | - V Chaitra
- Department of Pathology, PSG IMSR, Coimbatore, Tamil Nadu, India
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schimdt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
3
|
Koneczny I. Update on IgG4-mediated autoimmune diseases: New insights and new family members. Autoimmun Rev 2020; 19:102646. [PMID: 32801046 DOI: 10.1016/j.autrev.2020.102646] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/08/2020] [Indexed: 12/23/2022]
Abstract
Antibodies of IgG4 subclass are exceptional players of the immune system, as they are considered to be immunologically inert and functionally monovalent, and as such may be part of classical tolerance mechanisms. IgG4 antibodies are found in a range of different diseases, including IgG4-related diseases, allergy, cancer, rheumatoid arthritis, helminth infection and IgG4 autoimmune diseases, where they may be pathogenic or protective. IgG4 autoimmune diseases are an emerging new group of diseases that are characterized by pathogenic, antigen-specific autoantibodies of IgG4 subclass, such as MuSK myasthenia gravis, pemphigus vulgaris and thrombotic thrombocytopenic purpura. The list of IgG4 autoantigens is rapidly growing and to date contains 29 candidate antigens. Interestingly, IgG4 autoimmune diseases are restricted to four distinct organs: 1) the central and peripheral nervous system, 2) the kidney, 3) the skin and mucous membranes and 4) the vascular system and soluble antigens in the blood circulation. The pathogenicity of IgG4 can be validated using our classification system, and is usually excerted by functional blocking of protein-protein interaction.
Collapse
Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Währingergürtel 18-20, 1090 Vienna, Austria.
| |
Collapse
|
4
|
Abstract
Anti-p200 pemphigoid is a rare autoimmune blistering disease. It belongs to the group of pemphigoid diseases and was first described in 1996. The diagnostic gold standard is the combination of (1) linear deposits of immunoreactants at the dermal epidermal junction by direct immunofluorescence microscopy of a perilesional skin biopsy, (2) detection of circulating autoantibodies binding to the dermal side (blister floor) of human salt split skin by indirect immunofluorescence microscopy, and reactivity with a 200 kDa protein (p200) in extract of human dermis by immunoblotting. In 2009, laminin γ1 was described as an additional target antigen in 90% of anti-p200 pemphigoid patients. Since ex vivo and in vivo studies have shown no direct pathogenic relevance for laminin γ1 antibodies and the preadsorption of patient sera against laminin γ1 does not reduce their reactivity with p200, the molecular identity of p200 still remains to be elucidated. The clinical phenotype of the disease is heterogeneous; in most cases, however, it resembles bullous pemphigoid. Anti-p200 patients are younger and skin lesions more often appear on palms of the hands and soles of the feet than in bullous pemphigoid. Therapy consists of topical and systemic corticosteroids. In addition, the use of daspone and immunosuppressants has been reported.
Collapse
|
5
|
Solimani F, Pollmann R, Ishii N, Eming R, Hashimoto T, Schmidt T, Hertl M. Diagnosis of anti-laminin γ-1 pemphigoid by immunoblot analysis. J Eur Acad Dermatol Venereol 2018; 33:735-741. [PMID: 29972879 DOI: 10.1111/jdv.15170] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/01/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Anti-laminin-γ1 (lam-γ1) pemphigoid, a recently described immunobullous disorder sharing immune serological features of bullous pemphigoid and epidermolysis bullosa acquisita (EBA), is characterized by the detection of serum IgG autoantibodies against the lam-γ1 chain, a 200 kDa heterotrimeric component of the dermal-epidermal junction (DEJ). OBJECTIVE The aim of the study was to develop an easy-to-perform and reliable assay for the serological detection of anti-lam-γ1 IgG autoantibodies. The clinical appearance alone is not sufficient to establish diagnosis of anti-lam-γ1 pemphigoid and rather requires immune serological evidence of (i) IgG reactivity against the dermal portion of salt-split human skin; (ii) exclusion of IgG against other components of the DEJ; and (iii) IgG reactivity with a 200 kDa protein of dermal extracts by immunoblot analysis (IB). METHODS The sera of 55 patients with anti-lam-γ1 pemphigoid were tested by IB with two recombinant heterotrimers, laminin 111 (lam-111) and laminin 421 (lam-421), as well as with a recombinant lam-γ1 chain monomer. Additionally, a total of 41 control sera from patients with EBA (n = 15), psoriasis vulgaris (PV; n = 14), and healthy controls (HC; n = 12) were tested. RESULTS Immunoblot analysis revealed a positive reactivity with lam-111 and/or lam-421 in 46/55 (84%) of anti-lam-γ1 pemphigoid sera. Moreover, 8/9 of the initially non-reactive sera were positive with the lam-γ1 monomer, leading to an overall sensitivity of 98.2%. Analyses of 41 control sera with the three lam-γ1 recombinants led to a specificity of 88%. Specifically, 3/15 EBA sera, 1/14 PV serum and 1/12 HC serum reacted with the lam-γ1 monomer while only the 3 EBA sera reacted with lam-421. CONCLUSIONS Here we show a novel two-step IB assay using the two recombinant laminin trimers and lam-γ1 chain monomer for the detection of anti-lam-γ1 serum IgG with high sensitivity and specificity. This assay will facilitate the diagnosis and further characterization of this disease.
Collapse
Affiliation(s)
- F Solimani
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - R Pollmann
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - N Ishii
- Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - R Eming
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - T Hashimoto
- Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan.,Osaka City University Graduate School of Medicine, Asahimachi, Abeno, Osaka, Japan
| | - T Schmidt
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| | - M Hertl
- Department of Dermatology and Allergology, Philipps-University, Marburg, Germany
| |
Collapse
|
6
|
Li X, Qian H, Takizawa M, Koga H, Tsuchisaka A, Ishii N, Hayakawa T, Ohara K, Sitaru C, Zillikens D, Sekiguchi K, Hirako Y, Hashimoto T. N-linked glycosylation on laminin γ1 influences recognition of anti-laminin γ1 pemphigoid autoantibodies. J Dermatol Sci 2015; 77:125-9. [PMID: 25600662 DOI: 10.1016/j.jdermsci.2014.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Xiaoguang Li
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Hua Qian
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Mamoru Takizawa
- Laboratory of Extracellular Matrix Biochemistry, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Atsunari Tsuchisaka
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Taihei Hayakawa
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Koji Ohara
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan
| | - Cassian Sitaru
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Kiyotoshi Sekiguchi
- Laboratory of Extracellular Matrix Biochemistry, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Yoshiaki Hirako
- Division of Biological Science, Graduate School of Science, Nagoya University, Nagoya, Aichi, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, Kurume, Fukuoka, Japan.
| |
Collapse
|
7
|
Goletz S, Hashimoto T, Zillikens D, Schmidt E. Anti-p200 pemphigoid. J Am Acad Dermatol 2014; 71:185-91. [PMID: 24767733 DOI: 10.1016/j.jaad.2014.02.036] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/17/2014] [Accepted: 02/19/2014] [Indexed: 11/18/2022]
Abstract
Anti-p200 pemphigoid is a rare subepidermal blistering skin disease. Patients' autoantibodies label the dermal side of 1 mol/L NaCl-split human skin by indirect immunofluorescence microscopy and recognize a 200-kd protein by immunoblotting of human dermal extract. Clinically, anti-p200 pemphigoid is characterized by tense blisters and vesicles, erosions, and urticarial plaques, closely resembling bullous pemphigoid and the inflammatory variant of epidermolysis bullosa acquisita. Recently, 90% of anti-p200 pemphigoid sera were shown to recognize laminin γ1. The C-terminus of laminin γ1 was identified as an immunodominant region and in its recombinant form was used by immunoblotting and enzyme-linked immunosorbent assay for the serologic diagnosis of this disease. Subsequent ex vivo and in vivo studies were, however, unable to show pathogenic activity of antilaminin γ1 antibodies. Both patients' sera and sera depleted from antilaminin γ1 antibodies induced subepidermal splitting in an ex vivo model of autoantibody-mediated leukocyte-dependent neutrophil activation. Antilaminin γ1 antibodies appear to be useful biomarkers that will further facilitate the diagnosis of anti-p200 pemphigoid. The true identity of the pathogenetically relevant autoantigen of this disease, which may either be a yet unknown isoform of laminin γ1 or even another 200-kd protein of the dermoepidermal junction, still needs to be elucidated.
Collapse
Affiliation(s)
- Stephanie Goletz
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Luebeck, Luebeck, Germany.
| |
Collapse
|
8
|
Van Lerberghe L, Lasek A, Gosset P, Jouen F, Modiano P. Anti-p200 pemphigoid responding to dapsone. DERMATOL SIN 2014. [DOI: 10.1016/j.dsi.2013.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|
9
|
Les maladies bulleuses auto-immunes. Rev Med Interne 2014; 35:166-73. [DOI: 10.1016/j.revmed.2013.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 04/25/2013] [Indexed: 11/19/2022]
|
10
|
Vafia K, Groth S, Beckmann T, Hirose M, Dworschak J, Recke A, Ludwig RJ, Hashimoto T, Zillikens D, Schmidt E. Pathogenicity of autoantibodies in anti-p200 pemphigoid. PLoS One 2012; 7:e41769. [PMID: 22911854 PMCID: PMC3404064 DOI: 10.1371/journal.pone.0041769] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 06/28/2012] [Indexed: 11/30/2022] Open
Abstract
Recently, the C-terminus of laminin γ1 has been identified as target antigen in anti-p200 pemphigoid and the disease was renamed as anti-laminin γ1 pemphigoid. However, the pathogenic relevance of these autoantibodies has not yet been demonstrated. Therefore, we employed an ex vivo model of autoantibody-mediated leukocyte-dependent neutrophil activation and dermal-epidermal separation (DES) using cryosections of human skin. We showed that anti-p200 pemphigoid sera (n = 7) induced DES in a time-dependent manner, in contrast to sera from healthy controls. Furthermore, laminin γ1-specific IgG and serum depleted from anti-laminin γ1 reactivity were generated using the recombinant C-terminus of laminin γ1 (LAMC1-term; amino acids 1364 to 1609). Interestingly, both fractions labeled the dermal-epidermal-junction (DEJ) by indirect immunofluorescence microscopy on human foreskin and recognized a 200 kDa protein by immunoblotting with dermal extract. Human and rabbit IgG against LAMC1-cterm failed to attract neutrophils at the DEJ and to induce DES. In contrast, patient serum depleted from LAMC1-cterm reactivity led to the same extent of DES as non-depleted IgG. Repeated injection of rabbit anti-murine LAMC1-cterm IgG into both neonatal and adult C57BL/6mice as well as repetitive immunization of various mouse strains with murine LAMC1-cterm failed to induce macro- and microscopic lesions. In all mice, circulating anti-LAMC1-cterm antibodies were present, but only in some mice, IgG deposits were seen at the DEJ. We conclude that autoantibodies in anti-p200 pemphigoid sera are pathogenic while pathogenicity is not mediated by autoantibodies against laminin γ1. Further studies are needed to identify the pathogenically relevant autoantigen in anti-p200 pemphigoid.
Collapse
Affiliation(s)
- Katerina Vafia
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Stephanie Groth
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Tina Beckmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Misa Hirose
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Jenny Dworschak
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Andreas Recke
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Ralf J. Ludwig
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Luebeck, Luebeck, Germany
- Comprehensive Center for Inflammation Medicine, University of Luebeck, Luebeck, Germany
- * E-mail:
| |
Collapse
|
11
|
Groth S, Recke A, Vafia K, Ludwig RJ, Hashimoto T, Zillikens D, Schmidt E. Development of a simple enzyme-linked immunosorbent assay for the detection of autoantibodies in anti-p200 pemphigoid. Br J Dermatol 2010; 164:76-82. [PMID: 20854435 DOI: 10.1111/j.1365-2133.2010.10056.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Anti-p200 pemphigoid is a subepidermal blistering skin disease characterized by autoantibodies against a 200-kDa protein (p200) of the dermal-epidermal junction. The laminin γ1 chain has recently been identified as target antigen in this disease and the C-terminus was described as an immunodominant region of laminin γ1. Diagnosis of anti-p200 pemphigoid requires detection of serum IgG at the dermal side of 1 mol L(-1) salt-split skin by indirect immunofluorescence microscopy and labelling of a 200-kDa protein by Western blotting of dermal extract. However, preparation of dermal extract is not widely available, limiting the possibility of diagnosing this disease to a few laboratories. OBJECTIVES To develop a simple, sensitive and specific diagnostic tool for anti-p200 pemphigoid. METHODS Sera from patients with anti-p200 pemphigoid (n = 35), bullous pemphigoid (BP, n = 101), epidermolysis bullosa acquisita (EBA, n = 10), antilaminin 332 mucous membrane pemphigoid (MMP, n = 14), pemphigus vulgaris (PV, n = 51) and healthy volunteers (HV, n = 131) were tested by a novel enzyme-linked immunosorbent assay (ELISA) that employed a recombinant monomeric C-terminal fragment of human laminin γ1 (hLAMC1-cterm) expressed in Escherichia coli. RESULTS Serum reactivity with hLAMC1-cterm was detected in sera from 24 of 35 (69%) patients with anti-p200 pemphigoid, two of 101 (2%) with BP, 0 of 10 with EBA, two of 14 (14%) with anti-laminin 332 MMP, 0 of 51 with PV, and 0 of 131 HV. CONCLUSIONS This novel ELISA will facilitate the diagnosis of anti-p200 pemphigoid.
Collapse
Affiliation(s)
- S Groth
- Department of Dermatology, University of Lübeck, 23538 Lübeck, Germany
| | | | | | | | | | | | | |
Collapse
|
12
|
DAINICHI T, KOGA H, TSUJI T, ISHII N, OHYAMA B, UEDA A, NATSUAKI Y, KARASHIMA T, NAKAMA T, YASUMOTO S, ZILLIKENS D, HASHIMOTO T. From anti-p200 pemphigoid to anti-laminin γ1 pemphigoid. J Dermatol 2010; 37:231-8. [DOI: 10.1111/j.1346-8138.2009.00793.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Schmidt E, Zillikens D. Research in practice: diagnosis of subepidermal autoimmune bullous disorders. J Dtsch Dermatol Ges 2009; 7:296-300. [DOI: 10.1111/j.1610-0387.2008.06974.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
14
|
Abstract
Anti-p200 pemphigoid has been characterized by autoantibodies to an unidentified 200-kDa protein (p200) of the dermal-epidermal junction. The objective of this study was to identify p200. We performed 2D gel electrophoresis of dermal extracts and immunoblotting with patients' sera, followed by MS analysis of a unique protein band. The protein band corresponded to laminin gamma1. Anti-laminin gamma1 mAb reacted with the anti-p200 immunoprecipitates by immunoblotting. Sera from 32 patients with anti-p200 pemphigoid showed 90% reactivity to the recombinant products of laminin gamma1. None of the healthy control sera reacted with laminin gamma1. By immunoblotting, reactivity of a patient's serum with p200 was competitively inhibited by adding anti-laminin gamma1 C-terminus mAb. Purified anti-p200 IgG also inhibited the reactivity of this mAb to dermal laminin gamma1. Most laminin gamma1-positive sera showed reactivity with recombinant laminin gamma1 C-terminal E8 fragment. Reactivity of patients' sera and purified IgG to dermal laminin gamma1 was higher than reactivity to blood vessel laminin gamma1 under reducing conditions. These results suggest that laminin gamma1 is the autoantigen for patients with anti-p200 pemphigoid. The autoantibodies may specifically recognize dermal laminin gamma1 with unique posttranslational modifications. The epitope is localized to the 246 C-terminal amino acids within the coiled-coil domain. The 9 C-terminal residues are known to be critically involved in laminin recognition by integrins.
Collapse
|
15
|
Lally A, Chamberlain A, Allen J, Dean D, Wojnarowska F. Dermal-binding linear IgA disease: an uncommon subset of a rare immunobullous disease. Clin Exp Dermatol 2007; 32:493-8. [PMID: 17459072 DOI: 10.1111/j.1365-2230.2007.02428.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Linear IgA disease (LAD) is an acquired subepidermal blistering disorder, characterized clinically by urticated plaques, papules, vesicles and bullae. Scarring is not usually observed. Direct immunofluorescence on clinically uninvolved skin shows linear deposition of IgA at the basement membrane zone (BMZ). Indirect immunofluorescence on salt-split skin shows dermal binding in a minority of cases. AIM To identify and characterize patients with LAD who have IgA anti-BMZ autoantibodies directed against the dermal side of salt-split human skin (dermal-binding autoantibodies). METHODS This was a retrospective study of patients with a diagnosis of LAD referred to the dermatology department in Oxford between 1986 and 2004, who demonstrated dermal-binding circulating IgA autoantibodies on indirect immunofluorescence. Clinical features were reviewed and target antigens identified by immunoblotting. RESULTS In total, 17 of 101 patients with LAD were found to have dermal-binding autoantibodies. This subset of LAD was relatively more common in adults than in children. There were no other clinical features that distinguished these patients from others with LAD. Collagen VII, the target antigen in epidermolysis bullosa acquisita (EBA), was identified in two of our cohort, but none of the classic clinical features of mechanobullous EBA was observed. CONCLUSION This is the largest cohort of patients with dermal-binding LAD to date. Our patients were clinically indistinguishable from those with non dermal-binding LAD, and showed no evidence of the classic mechanobullous EBA phenotype.
Collapse
Affiliation(s)
- A Lally
- Department of Dermatology, Oxford Radcliffe Hospitals, Oxford, UK.
| | | | | | | | | |
Collapse
|
16
|
Hofmann SC, Voith U, Sasaki T, Trüeb RM, Nischt R, Bruckner-Tuderman L. The autoantigen in anti-p200 pemphigoid is synthesized by keratinocytes and fibroblasts and is distinct from nidogen-2. J Invest Dermatol 2007; 128:87-95. [PMID: 17637825 DOI: 10.1038/sj.jid.5700952] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Anti-p200 pemphigoid is a subepidermal immunobullous disorder associated with tissue-bound and circulating autoantibodies reactive with a 200 kDa protein on the dermal side of salt-split-skin. The autoantigen, named p200, is a non-collagenous glycoprotein located at the lamina lucida-lamina densa border of the epidermal basement membrane. However, its identity and cellular origin remain elusive. Here, we used biochemical and genetic approaches to characterize the autoantibody reactivity in three new patients with anti-p200 pemphigoid. We show that the target antigen p200 is synthesized by both keratinocytes and fibroblasts, is disulfide-bonded, and participates in calcium-dependent molecular interactions. Lack of collagen XVII (BP 180), collagen VII, or laminin 332 (laminin 5) from the dermal-epidermal junction does not destabilize p200. Colocalization within the basement membrane zone and an identical molecular weight suggested nidogen-2 as candidate autoantigen in anti-p200 pemphigoid, but biochemical analysis demonstrated that p200 is distinct from nidogen-2. In conclusion, the results define further the biochemical characteristics of p200 and demonstrate its in vitro-synthesis by keratinocytes and fibroblasts, thus providing a basis for identification and further characterization of this autoantigen.
Collapse
Affiliation(s)
- Silke C Hofmann
- Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany
| | | | | | | | | | | |
Collapse
|
17
|
Mihai S, Sitaru C. Immunopathology and molecular diagnosis of autoimmune bullous diseases. J Cell Mol Med 2007; 11:462-81. [PMID: 17521373 PMCID: PMC3922353 DOI: 10.1111/j.1582-4934.2007.00033.x] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Accepted: 03/05/2007] [Indexed: 11/26/2022] Open
Abstract
Autoimmune bullous diseases are associated with autoimmunity against structural components maintaining cell-cell and cell matrix adhesion in the skin and mucous membranes. Pemphigus diseases are characterized by autoantibodies against the intercellular junctions and intraepithelial blisters. In pemphigoid diseases and epidermolysis bullosa acquisita, sub-epidermal blistering is associated with autoantibodies targeting proteins of the hemidesmosomal anchoring complex. The autoantigens in autoimmune blistering diseases have been extensively characterized over the past three decades. In general, the pathogenicity of autoantibodies, already suggested by clinical observations, has been conclusively demonstrated experimentally. Detection of tissue-bound and circulating serum autoantibodies and characterization of their molecular specificity is mandatory for the diagnosis of autoimmune blistering diseases. For this purpose, various immunofluorescence methods as well as immunoassays, including immunoblotting, enzyme-linked immunosorbent assay and immunoprecipitation have been developed. This review article describes the immunopathological features of autoimmune bullous diseases and the immunological and molecular tests used for their diagnosis and monitoring.
Collapse
Affiliation(s)
- Sidonia Mihai
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Cassian Sitaru
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
18
|
Rose C, Weyers W, Denisjuk N, Hillen U, Zillikens D, Shimanovich I. Histopathology of Anti-p200 Pemphigoid. Am J Dermatopathol 2007; 29:119-24. [PMID: 17414431 DOI: 10.1097/dad.0b013e31803326e6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anti-p200 pemphigoid is an autoimmune subepidermal blistering disease characterized by circulating and tissue-bound antibodies against a 200-kd glycoprotein (p200) of the human dermis. We reviewed 10 lesional biopsies from seven patients with anti-p200 pemphigoid in an attempt to define typical histopathologic features of this disease. All biopsy specimens showed subepidermal blistering and a moderate to dense inflammatory infiltrate in the upper dermis. Immunohistochemical analysis localized type IV collagen to the dermal side of the blister, suggesting that split formation occurred within the lamina lucida of the cutaneous basement membrane. The inflammatory infiltrate was composed almost exclusively of neutrophils in six biopsies and contained a mixture of neutrophils and eosinophils in the remaining four. In three specimens, microabscess formation in the papillary dermis adjacent to the blister cavity was noted. Neutrophilic and eosinophilic spongiosis was found in five and three biopsies, respectively. We conclude that histopathology of anti-p200 pemphigoid is characterized by subepidermal blistering and a superficial inflammatory infiltrate, which is usually dominated by neutrophils but occasionally contains significant numbers of eosinophils. While this microscopic picture mimics that of linear IgA disease, dermatitis herpetiformis, or bullous pemphigoid, it should also alert a histopathologist to the possibility of anti-p200 pemphigoid and prompt immunofluorescence and immunoblotting studies for definite diagnosis or exclusion of this autoimmune subepidermal blistering disease.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Algorithms
- Autoantibodies/blood
- Blotting, Western
- Collagen Type IV/analysis
- Diagnosis, Differential
- Eosinophils/pathology
- Female
- Glycoproteins/chemistry
- Glycoproteins/immunology
- Humans
- Immunohistochemistry
- Male
- Microscopy, Fluorescence
- Middle Aged
- Molecular Weight
- Neutrophil Infiltration
- Neutrophils/pathology
- Pemphigoid, Bullous/immunology
- Pemphigoid, Bullous/metabolism
- Pemphigoid, Bullous/pathology
- Skin/chemistry
- Skin/immunology
- Skin/pathology
- Skin Diseases, Vesiculobullous/diagnosis
- Skin Diseases, Vesiculobullous/immunology
- Skin Diseases, Vesiculobullous/metabolism
- Skin Diseases, Vesiculobullous/pathology
Collapse
Affiliation(s)
- Christian Rose
- Department of Dermatology, University of Lübeck, Germany.
| | | | | | | | | | | |
Collapse
|
19
|
Yamane N, Sawamura D, Nishie W, Abe M, Kodama K, Adachi K, Nakamura H, Ishii N, Hashimoto T, Shimizu H. Anti-p200 pemphigoid in a 17-year-old girl successfully treated with systemic corticosteroid and dapsone. Br J Dermatol 2007; 156:1075-8. [PMID: 17381449 DOI: 10.1111/j.1365-2133.2007.07810.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
20
|
Dilling A, Rose C, Hashimoto T, Zillikens D, Shimanovich I. Anti-p200 pemphigoid: a novel autoimmune subepidermal blistering disease. J Dermatol 2007; 34:1-8. [PMID: 17204094 DOI: 10.1111/j.1346-8138.2007.00208.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Anti-p200 pemphigoid is a recently defined autoimmune subepidermal blistering disease characterized by circulating and tissue-bound autoantibodies to a 200-kDa protein (p200) of the dermal-epidermal junction (DEJ). This DEJ constituent is thought to be important for adhesion of basal keratinocytes to the underlying dermis. While the exact identity of p200 remains unknown, it has been demonstrated to be immunologically and biochemically distinct from all major autoantigens of the DEJ, including bullous pemphigoid antigens 180 and 230, laminin 1, 5 and 6, alpha6beta4 integrin, and type VII collagen. Clinically, most reported cases present with tense blisters as well as urticarial papules and plaques, closely resembling bullous pemphigoid. Histopathological examination of lesional skin biopsies shows subepidermal split formation and superficial inflammatory infiltrate typically dominated by neutrophils. Immunopathologically, linear deposits of immunoglobulin (Ig)G and C3 are detected along the DEJ by direct immunofluorescence microscopy of perilesional skin. Indirect immunofluorescence microscopy of patients' sera on NaCl-split human skin demonstrates circulating IgG autoantibodies labeling the dermal side of the split. By immunoblotting, these autoantibodies recognize a 200-kDa protein of human dermis. Biochemical characterization of the p200 molecule revealed a noncollagenous N-glycosylated acidic protein with an isoelectric point of approximately 5.5. We present an overview of the pathogenesis, clinical features, diagnosis and treatment of this new disease entity.
Collapse
Affiliation(s)
- Amrei Dilling
- Department of Dermatology, University of Lübeck, Germany
| | | | | | | | | |
Collapse
|
21
|
Ito H, Akiyama M, Nakagawa H, Uematsu R, Deguchi K, McMillan JR, Nishimura SI, Shimizu H. N-linked neutral oligosaccharides in the stratum corneum of normal and ichthyotic skin. Arch Dermatol Res 2006; 298:403-7. [PMID: 17021764 DOI: 10.1007/s00403-006-0702-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Revised: 08/23/2006] [Accepted: 08/28/2006] [Indexed: 10/24/2022]
Abstract
N-Glycan oligosaccharides are thought to play multiple, important roles in a variety of biological events. However, N-glycan profiles in the stratum corneum of human skin have not yet been studied in detail. To clarify the N-glycan profiles in the stratum corneum of normal and ichthyotic epidermis, N-glycan profiles were studied by high-performance liquid chromatography using normal human epidermal samples and scales from hyperkeratotic skin of ichthyosis patients. Chromatograms of patient scale samples showed unique alterations in three peaks eluted at 15.8, 18.8 and 26.9 min. The N-glycan profiles were significantly altered in ichthyotic hyperkeratotic skin compared with normal non-hyperkeratotic controls. These findings indicate the reduction of N-acetylglucosaminyltransferase II and fucosyltransferase 8 activities. Alteration of N-glycan structures in hyperkeratotic skin suggests the biological role of N-glycans in keratinization.
Collapse
Affiliation(s)
- Hiroko Ito
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, 060-8638, Japan
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Campos Domínguez M, Suárez Fernández R, Lázaro Ochaita P. Métodos diagnósticos en las enfermedades ampollosas subepidérmicas autoinmunes. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:485-502. [PMID: 17067526 DOI: 10.1016/s0001-7310(06)73450-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
There is considerable clinical and histological overlap among the subepidermal autoimmune bullous diseases. The knowledge at the molecular level of the dermo-epidermal junction is essential to understand this group of diseases. The immune-based techniques have contributed to increase the knowledge of these entities and have been progressively incorporated into clinical practice. In this review of the diagnostic methods of subepidermal autoimmune bullous diseases we summarize the most recent advances on the molecular biology of the dermo-epidermal junction, focusing on the immune-based diagnostic techniques. We distinguish two main groups of diagnostic methods: those that detect autoimmune deposits in the skin (direct immunofluorescence and its variants including confocal microscopy) and those that detect antibodies in serum or in other fluids (indirect immunofluorescence and its variants, ELISA, immunoblot and immunoprecipitation). We explain the methodology and diagnostic keys of the techniques most widely applied in our milieu.
Collapse
Affiliation(s)
- Minia Campos Domínguez
- Unidad de Enfermedades Ampollosas, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | | | | |
Collapse
|
23
|
Sitaru C, Chiriac MT, Mihai S, Büning J, Gebert A, Ishiko A, Zillikens D. Induction of Complement-Fixing Autoantibodies against Type VII Collagen Results in Subepidermal Blistering in Mice. THE JOURNAL OF IMMUNOLOGY 2006; 177:3461-8. [PMID: 16920988 DOI: 10.4049/jimmunol.177.5.3461] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Experimental models reproducing an autoimmune response resulting in skin blistering in immunocompetent animals are lacking. Epidermolysis bullosa acquisita (EBA) is a bullous skin disease caused by autoantibodies to type VII collagen. In this study, we describe an active disease model of EBA by immunizing mice of different strains with murine type VII collagen. All mice developed circulating IgG autoantibodies that recognized type VII collagen and bound to the lamina densa of the dermal-epidermal junction. Importantly, subepidermal blisters developed in 82% of SJL-1, 56% of BALB/c mice, and 45% of Fc gammaRIIb-deficient mice, but not in SKH-1 mice. In susceptible animals, deposits of IgG1, IgG2, and complement C3 were detected at the dermal-epidermal junction. In contrast, in the nondiseased mice, tissue-bound autoantibodies were predominantly of the IgG1 subclass and complement activation was weak or absent. This active disease model reproduces in mice the clinical, histopathological, and immunopathological findings in EBA patients. This robust experimental system should greatly facilitate further studies on the pathogenesis of EBA and the development of novel immunomodulatory therapies for this and other autoimmune diseases.
Collapse
Affiliation(s)
- Cassian Sitaru
- Department of Dermatology, University of Lübeck, Lübeck, Germany.
| | | | | | | | | | | | | |
Collapse
|
24
|
Yamada T, Suzuki M, Koike Y, Kida K, Murata S, Ishii N, Hashimoto T, Ohtsuki M. A Case of Epidermolysis Bullosa Acquisita with Autoantibody to Anti-p200 Pemphigoid Antigen and Exfoliative Esophagitis. Dermatology 2006; 212:381-4. [PMID: 16707891 DOI: 10.1159/000092292] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Accepted: 11/05/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Some cases of a subepidermal blistering disease associated with autoantibodies to more than two antigens have been reported. OBSERVATION A 52-year-old Japanese woman had pruritic blisters on almost the whole body as well as erosive lesions in the oral cavity and esophagus. A histological finding was subepidermal bullae. Direct immunofluorescence (IF) revealed a linear deposition of IgG, IgM and C3 at the epidermal basement membrane zone (BMZ). Indirect IF using human skin split by 1 M NaCl as a substrate showed IgG antibody reactive with the dermal side. By immunoblot analysis using normal human dermal extract, the 200-kDa and 290-kDa bands were detected. Indirect IF did not show any anti-BMZ antibody activity, when using the skin of the patient with recessive dystrophic epidermolysis bullosa as a substrate. CONCLUSION We regarded our case as epidermolysis bullosa acquisita with autoantibody to anti-p200 pemphigoid antigen. This is the second case in the literature associated with autoantibodies to these two antigens.
Collapse
Affiliation(s)
- Tomoko Yamada
- Department of Dermatology, Jichi Medical School, Tochigi, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Rose C, Bröcker EB, Zillikens D. [Relevance of histological examination in the diagnosis of autoimmune bullous dermatoses]. J Dtsch Dermatol Ges 2006; 2:96-104. [PMID: 16279243 DOI: 10.1046/j.1439-0353.2004.04003.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The histopathological picture of many autoimmune bullous dermatoses is considered to be relatively characteristic. However, different entities may show similar histological findings. In addition, the picture depends on both the stage of the disease and prior treatment. Autoimmune bullous dermatoses are characterized by the production of autoantibodies to structural proteins of the skin. In most instances, the autoantigens have been identified and are available as recombinant proteins. Utilizing these recombinant forms, specific and sensitive assays have been developed for the detection of circulating autoantibodies in the serum. The detection of autoantibodies in skin or mucous membranes and/or serum is required for the diagnosis of autoimmune bullous dermatoses. The task of the dermatopathologist in the diagnostic process of autoimmune bullous dermatoses is to describe precisely the histopathological findings, to mention differential diagnoses and to recommend how these can be confirmed or excluded by immunopathological and immunoserological studies.
Collapse
|
26
|
Abstract
Mucous membrane pemphigoid (MMP) is a sub-epithelial vesiculobullous disorder. It is now quite evident that a number of sub-epithelial vesiculobullous disorders may produce similar clinical pictures, and also that a range of variants of MMP exist, with antibodies directed against various hemidesmosomal components or components of the epithelial basement membrane. The term immune-mediated sub-epithelial blistering diseases (IMSEBD) has therefore been used. Immunological differences may account for the significant differences in their clinical presentation and responses to therapy, but unfortunately data on this are few. The diagnosis and management of IMSEBD on clinical grounds alone is impossible and a full history, general, and oral examination, and biopsy with immunostaining are now invariably required, sometimes supplemented with other investigations. No single treatment regimen reliably controls all these disorders, and it is not known if the specific subsets of MMP will respond to different drugs. Currently, apart from improving oral hygiene, immunomodulatory-especially immunosuppressive-therapy is typically used to control oral lesions. The present paper reviews pemphigoid, describing the present understanding of this fascinating clinical phenotype, summarising the increasing number of subsets with sometimes-different natural histories and immunological features, and outlining current clinical practice.
Collapse
Affiliation(s)
- J Bagan
- University of Valencia, Spain
| | | | | | | |
Collapse
|
27
|
Sitaru C, Mihai S, Otto C, Chiriac MT, Hausser I, Dotterweich B, Saito H, Rose C, Ishiko A, Zillikens D. Induction of dermal-epidermal separation in mice by passive transfer of antibodies specific to type VII collagen. J Clin Invest 2005; 115:870-8. [PMID: 15841176 PMCID: PMC1070403 DOI: 10.1172/jci21386] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Accepted: 12/21/2004] [Indexed: 11/17/2022] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is a subepidermal blistering disorder associated with tissue-bound and circulating autoantibodies specific to type VII collagen, a major constituent of the dermal-epidermal junction. Previous attempts to transfer the disease by injection of patient autoantibodies into mice have been unsuccessful. To study the pathogenic relevance of antibodies specific to type VII collagen in vivo, we generated and characterized rabbit antibodies specific to a murine form of this antigen and passively transferred them into adult nude, BALB/c, and C57BL/6 mice. Immune rabbit IgG bound to the lamina densa of murine skin and immunoblotted type VII collagen. Mice injected with purified IgG specific to type VII collagen, in contrast to control mice, developed subepidermal skin blisters, reproducing the human disease at the clinical, histological, electron microscopical, and immunopathological levels. Titers of rabbit IgG in the serum of mice correlated with the extent of the disease. F(ab')(2) fragments of rabbit IgG specific to type VII collagen were not pathogenic. When injected into C5-deficient mice, antibodies specific to type VII collagen failed to induce the disease, whereas C5-sufficient mice were susceptible to blister induction. This animal model for EBA should facilitate further dissection of the pathogenesis of this disease and development of new therapeutic strategies.
Collapse
Affiliation(s)
- Cassian Sitaru
- Department of Dermatology, University of Lübeck, Lübeck, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Shimanovich I, Petersen EE, Weyers W, Sitaru C, Zillikens D. Subepidermal blistering disease with autoantibodies to both the p200 autoantigen and the α3 chain of laminin 5. J Am Acad Dermatol 2005; 52:S90-2. [PMID: 15858518 DOI: 10.1016/j.jaad.2004.07.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anti-p200 pemphigoid and anti-laminin 5 mucous membrane pemphigoid are two distinct autoimmune blistering skin diseases. Patients with anti-p200 pemphigoid demonstrate circulating autoantibodies to an unknown 200-kd acidic noncollagenous glycoprotein of the lower lamina lucida, whereas anti-laminin 5 mucous membrane pemphigoid is characterized by an autoimmune response against the major basement membrane adhesion molecule laminin 5. In this report, we describe a patient who developed a recurrent nonscarring blistering eruption, affecting both skin and mucous membranes. Immunoblotting of dermal extracts and extracellular matrix of cultured keratinocytes revealed circulating autoantibodies directed to the p200 antigen and the alpha3 chain of laminin 5, respectively. The unusual clinical and immunologic profile of this case suggests that molecular specificity of circulating autoantibodies affects the clinical presentation of autoimmune subepidermal blistering skin diseases.
Collapse
|
29
|
Sitaru C, Mihai S, Otto C, Chiriac MT, Hausser I, Dotterweich B, Saito H, Rose C, Ishiko A, Zillikens D. Induction of dermal-epidermal separation in mice by passive transfer of antibodies specific to type VII collagen. J Clin Invest 2005. [DOI: 10.1172/jci200521386] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
30
|
Shimanovich I, Rose C, Hirako Y, Butt-Dörje E, Zillikens D. Anti-p200-Pemphigoid - Eine neue blasenbildende Autoimmundermatose. Anti-p200 pemphigoid - a new bullous autoimmune dermatosis. J Dtsch Dermatol Ges 2004; 2:7-14. [PMID: 16281877 DOI: 10.1046/j.1439-0353.2004.03047.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anti-p200 pemphigoid is an autoimmune skin disease characterized by tense blisters, subepidermal split formation, and mainly neutrophilic inflammatory infiltration of the dermal-epidermal junction (DEJ). Direct immunofluorescence microscopy of perilesional skin biopsies demonstrates linear deposits of IgG and C3 along the DEJ, while by indirect immunofluorescence microscopy on NaCI-split human skin, patients' IgG labels the dermal side. The antigenic target of the autoantibodies is a 200 kD protein (p200) of the lower lamina lucida that can be detected in human dermal extracts by immunoblotting. While p200 is thought to be important for cell-matrix adhesion, its exact identity is unknown. To date, the p200 autoantigen has been demonstrated to be distinct from bullous pemphigoid antigens 180 und 230, laminin 1, 5, and 6, alpha6beta4 integrin, and type VII collagen. Biochemical characterization of the p200 molecule revealed a noncollagenous N-glycosylated acidic protein with an isoelectric point of approximately 5.5. We provide an overview on pathogenesis, clinical features, diagnosis, and treatment of this unique autoimmune dermatosis.
Collapse
|