1
|
Hoftman AC, Hernandez MI, Lee KW, Stiehm ER. Newborn illnesses caused by transplacental antibodies. Adv Pediatr 2008; 55:271-304. [PMID: 19048734 DOI: 10.1016/j.yapd.2008.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Alice Chang Hoftman
- Division of Immunology/Allergy/Rheumatology, Mattel Children's Hospital at UCLA, UCLA Center for Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | | | | | | |
Collapse
|
2
|
Affiliation(s)
- Jien-Wen Chien
- Department of Pediatrics, Changhua Christian Hospital, Changhua 500, Taiwan
| | | |
Collapse
|
3
|
Lawrence S, Luy L, Laxer R, Krafchik B, Silverman E. The health of mothers of children with cutaneous neonatal lupus erythematosus differs from that of mothers of children with congenital heart block. Am J Med 2000; 108:705-9. [PMID: 10924646 DOI: 10.1016/s0002-9343(00)00408-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Neonatal lupus erythematosus is caused by the transplacental passage of maternal autoantibodies. The aim of this study was to determine the risk of connective tissue disorders in mothers of children with cutaneous neonatal lupus erythematosus, as compared with the risk in mothers of children with congenital heart block, which is also often caused by maternal autoantibodies. SUBJECTS AND METHODS We prospectively studied all mothers of children with cutaneous neonatal lupus erythematosus during a 14-year period at the Hospital for Sick Children, Toronto, Ontario, Canada. We identified 28 mothers, of whom 24 were eligible for study. The health and antibody status of the mothers were determined at the birth of the child and at followup. RESULTS All mothers had anti-Ro antibodies at the time of birth. Initially 10 mothers were healthy and 14 mothers had either a defined (n = 9) or an undifferentiated (n = 5) autoimmune disorder. At a mean follow-up of 7 years, 13 (1 of whom had died) had a defined connective tissue disease, and 5 had an undifferentiated autoimmune disorder. Only 6 (25%) remained asymptomatic. By comparison, 36 (56%) of 64 mothers of children with congenital heart block were asymptomatic at follow-up (P <0.005). CONCLUSIONS The majority of mothers of children with cutaneous neonatal lupus erythematosus had a defined or undifferentiated autoimmune disorder at the time of the child's birth, and others developed these conditions during follow-up. The health of these mothers appears to differ from that of mothers of children with congenital heart block.
Collapse
Affiliation(s)
- S Lawrence
- Division of Rheumatology, the Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
4
|
Yukiko N. Immune responses to SS-A 52-kDa and 60-kDa proteins and to SS-B 50-kDa protein in mothers of infants with neonatal lupus erythematosus. Br J Dermatol 2000; 142:908-12. [PMID: 10809847 DOI: 10.1046/j.1365-2133.2000.03470.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Mothers who have anti-SS-A/Ro and anti-SS-B/La antibodies have a greater risk of bearing infants with neonatal lupus erythematosus (NLE). However, most mothers with anti-SS-A/Ro and anti-SS-B/La antibodies give birth to infants with no evidence of NLE. We studied mothers who had the combination of clinical evidence of connective tissue disorder, positive antinuclear antibody and positive anti-SS-A/Ro and/or anti-SS-B/La antibodies. We analysed SS-A/Ro and SS-B/La antibody responses to recombinant 60-, 52- and 50-kDa proteins in eight mothers of NLE infants and 19 mothers whose children did not have NLE. Molecular analysis of the anti-SS-A/Ro and anti-SS-B/La antibodies was carried out by enzyme-linked immunosorbent assay using recombinant 60-, 52- and 50-kDa proteins. The mothers of children with cutaneous NLE were all positive for a high titre of 50-kDa protein. Mothers of children with NLE with complete heart block (CHB) were positive for 52- and 60-kDa proteins. We conjecture that anti-SS-B/La antibody influences the development of cutaneous NLE, and that anti-SS-A/Ro antibody influences the development of NLE with CHB.
Collapse
Affiliation(s)
- N Yukiko
- Department of Dermatology, Aichi Medical University, 21 Yasago-Karimata, Nagakute-cho, Aichi-gun, Aichi-ken 480-1195, Japan
| |
Collapse
|
5
|
Jaovisidha P, Crawford SE, Yu BH, Gewurz AT. A six-month-old boy with neonatal lupus and cardiac enlargement. Ann Allergy Asthma Immunol 1999; 83:293-8. [PMID: 10541420 DOI: 10.1016/s1081-1206(10)62668-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Jaovisidha
- Department of Immunology/Microbiology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Cook County Hospital, Chicago, Illinois, USA
| | | | | | | |
Collapse
|
6
|
Chung JH, Kwon OS, Eun HC, Youn JI, Song YW, Kim JG, Cho KH. Apoptosis in the pathogenesis of cutaneous lupus erythematosus. Am J Dermatopathol 1998; 20:233-41. [PMID: 9650694 DOI: 10.1097/00000372-199806000-00002] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Defective regulation of apoptosis may play a role in the development of autoimmune diseases such as systemic lupus erythematosus, in which the skin is a prominent target. To our knowledge, however, the nature of epidermal changes in cutaneous lupus erythematosus (LE) has not previously been investigated. We investigated the involvement of apoptosis in cutaneous LE. A total of 44 lesional skin samples from patients with cutaneous LE, 44 skin samples from patients with scleroderma, five skin specimens from patients suffering from dermatomyositis, and 13 normal skin samples were stained immunohistochemically with monoclonal antibodies to Ki-67, p53 (DO-7), and bcl-2. The lesional skin from cutaneous LE, except LE profundus, showed a marked increase in Ki-67- and p53-positive keratinocytes, which were predominantly located in the basal layer of the epidermis and follicle, and a drastic reduction in the number of bcl-2-positive cells localized in the basal cell compartment. With TdT-mediated dUTP-biotin nick end-labeling staining, we demonstrated that extensive apoptosis occurred in almost the whole epidermis of cutaneous LE, except in cases of LE profundus. This abnormal expression of Ki-67, p53, and bcl-2 and the occurrence of apoptosis in the epidermis was also observed in epidermis from patients with dermatomyositis, but not in that from patients with scleroderma.
Collapse
Affiliation(s)
- J H Chung
- Department of Dermatology, College of Medicine, Seoul National University, South Korea
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
This article discusses neonatal lupus erythematosus, which is a disease of the newborn defined by the presence of maternal autoantibodies and characteristic clinical features in the neonatal period. Although the autoantibodies often are not associated with clinical disease in the mother, neonatal lupus erythematosus is likely the result of fetal or neonatal tissue damage caused by maternally transmitted IgG autoantibodies.
Collapse
Affiliation(s)
- E D Silverman
- Division of Rheumatology, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | | |
Collapse
|
8
|
Silverman ED, Buyon J, Laxer RM, Hamilton R, Bini P, Chu JL, Elkon KB. Autoantibody response to the Ro/La particle may predict outcome in neonatal lupus erythematosus. Clin Exp Immunol 1995; 100:499-505. [PMID: 7774062 PMCID: PMC1534456 DOI: 10.1111/j.1365-2249.1995.tb03729.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This study was undertaken to determine the role of antibodies against both recombinant Ro (r-Ro) and La (r-La) proteins and polypeptides derived from the recombinant La protein in predicting fetal and neonatal outcome in children at risk to develop neonatal lupus erythematosus (NLE). All sera were obtained in the perinatal period and quantitative ELISA assays were used. We collected 41 maternal sera within 2 months of delivery of a child with NLE (21 with congenital heart disease block (CHB) and 20 with dermatologic NLE) and 19 sera from anti-Ro and/or anti-La antibody-positive mothers with systemic lupus erythematosus (SLE) who delivered a child without NLE. All sera were tested for anti-r-La and anti-r-Ro antibodies by ELISA, and most sera were tested for antibodies directed against La polypeptides by immunoblot. We found significantly higher anti-r-La antibody levels in the sera from mothers of children with NLE compared with sera from mothers of unaffected children (0.67 +/- 0.43 versus 0.14 +/- 0.30; P < 0.0001). There was a statistically significant difference in the mean anti-r-La levels between the sera of mothers of children with CHB compared with dermatologic NLE (0.51 +/- 0.45 versus 0.83 +/- 0.37 respectively; P = 0.0091). When we examined antibodies directed against the recombinant 52-kD Ro protein, there was a statistically significant elevation of titres in the sera of mothers of NLE children (0.77 +/- 0.35) compared with non-NLE mothers (0.29 +/- 0.39; P < 0.0001). There was no difference in the r-Ro levels between mothers of children with dermatologic NLE compared with CHB (0.82 +/- 0.37 versus 0.71 +/- 0.74; P = 0.32). When we examined polypeptides derived from the recombinant La protein, the mean number of polypeptides recognized by sera from mothers of children with NLE was significantly higher than the mean number of polypeptides recognized by sera from mothers of unaffected children (5.1 +/- 0.54 versus 2.3 +/- 0.54 respectively; P < 0.001). More importantly, when we examined the individual polypeptides, we found that only sera from mothers of children with NLE and not from mothers of unaffected children recognized a polypeptide designated DD (30% versus 0%, respectively). These studies indicate that the autoantibody response to the Ro/La particle can differentiate sera from mothers of children with NLE and sera from mothers of unaffected children. Furthermore, there was a difference in the anti-La autoantibody response between mothers of children with CHB and dermatologic NLE.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- E D Silverman
- Department of Paediatrics and Immunology, University of Toronto Hospital for Sick Children, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
9
|
Nitta Y, Ohashi M, Morikawa M, Ueki H. Significance of tubuloreticular structures forming in Daudi cells cultured with sera from mothers bearing infants with neonatal lupus erythematosus. Br J Dermatol 1994; 131:525-31. [PMID: 7947204 DOI: 10.1111/j.1365-2133.1994.tb08554.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is known that infants with neonatal lupus erythematosus (NLE) may be born to mothers whose sera are positive for the anti-Ro/SSA antibody. However, women who have this antibody do not always give birth to children with NLE. We have demonstrated tubuloreticular structures in vascular endothelial cells in the skin lesions of infants with NLE. Tubuloreticular structures could no longer be detected at the site of the lesions once the annular erythema had resolved, and the anti-Ro/SSA antibody test had become negative. The probability of a child being born with NLE was assessed by observing whether tubuloreticular structures were formed in Daudi cells cultured with sera from eight mothers who were anti-Ro/SSA antibody positive. Tubuloreticular structures formed in Daudi cells cultured with sera from four mothers who bore infants with NLE, but not in Daudi cells cultured with sera from four other mothers who bore normal infants. These results suggest that women who are positive for the anti-Ro/SSA antibody have a higher risk of bearing infants with NLE if tubuloreticular structures are formed in Daudi cells cultured with sera from these women, whereas this risk is lower if tubuloreticular structures do not develop in Daudi cells.
Collapse
Affiliation(s)
- Y Nitta
- Department of Dermatology, Aichi Medical University, Japan
| | | | | | | |
Collapse
|
10
|
Neidenbach PJ, Sahn EE. La (SS-B)-positive neonatal lupus erythematosus: report of a case with unusual features. J Am Acad Dermatol 1993; 29:848-52. [PMID: 8408825 DOI: 10.1016/0190-9622(93)70253-p] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Neonatal lupus erythematosus is most often associated with autoantibodies against Ro and La antigens. Rarely, neonatal lupus erythematosus occurs in the absence of Ro antibody. We present a case of La antibody-positive neonatal lupus erythematosus with unusual features.
Collapse
Affiliation(s)
- P J Neidenbach
- Department of Dermatology, Medical University of South Carolina, Charleston 29425-2215
| | | |
Collapse
|
11
|
Tope WD, Kamino H, Briggaman RA, Rico MJ, Prose NS. Neonatal pemphigus vulgaris in a child born to a woman in remission. J Am Acad Dermatol 1993; 29:480-5. [PMID: 8349868 DOI: 10.1016/0190-9622(93)70216-g] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We describe the tenth reported case of neonatal pemphigus that mimicked Bart's syndrome and review previously published cases. Unlike previous cases, the child was born with significant blistering to a mother who was in complete remission throughout the pregnancy. High antepartum maternal titers of anti-intercellular space antibodies, increased maternal disease activity, and maternal disease that requires high doses of corticosteroids or use of combined therapy correlate with poor fetal outcome, including intrauterine death.
Collapse
Affiliation(s)
- W D Tope
- Division of Dermatology, Duke University Medical Center, Chapel Hill, North Carolina
| | | | | | | | | |
Collapse
|
12
|
|
13
|
Abstract
This review discusses the mechanisms involved in different photosensitive lupus syndromes: acute cutaneous lupus erythematosus, chronic cutaneous (discoid) lupus erythematosus, subacute cutaneous lupus erythematosus, and neonatal lupus erythematosus. It is proposed that there are three principal determinants of photosensitivity in lupus: 1) susceptibility to UVR-induced release of epidermal and dermal cytokines; 2) susceptibility to UVR-induced release or translocation of sequestered antigens in the epidermis or dermis; and 3) different specific immunologic effector mechanisms, activated by cytokines and directed against discrete epidermal targets. Several characteristics of photosensitive lupus are discussed in detail: autoantibody specificities, autoantigen translocation, induction of epidermal intercellular adhesion molecule-a (ICAM-1), vascular activation, cytokine release and T-cell activation, and clinical phototesting. The role of antibodies to the extractable nuclear antigens Ro and La and the relationship to subacute cutaneous lupus erythematosus (SCLE) and neonatal lupus erythematosus is discussed in detail, and a model of SCLE is proposed.
Collapse
Affiliation(s)
- D A Norris
- Department of Dermatology, University of Colorado School of Medicine, Denver 80262
| |
Collapse
|
14
|
|
15
|
Abstract
Transplacentally transferred dermatoses (TTDs) are cutaneous diseases that are transmitted from mother to fetus through the placental circulation. The uniqueness of the maternal-placental-fetal interaction provides many helpful opportunities to enhance our understanding of the pathogenesis and course of these diseases.
Collapse
Affiliation(s)
- P A Krusinski
- Division of Dermatology, University of Vermont College of Medicine, Burlington
| | | |
Collapse
|