Immunologic markers of systemic scleroderma in children

Stefania Jabłońska (1920-2017): A giant in 20th century dermatology

Stefania Jabłońska (1920-2017) is remembered as a physician extraordinaire, outstanding medical scientist, and superb professor of dermatology. She served as Professor and Chairman of Dermatology at the Warsaw Medical School. Not only is she one of the most cited of Polish physicians, she also was world renowned, being elected to honorary membership in innumerable dermatology societies. Jabłońska in 1972 was the first to describe the relationship between the human papillomavirus and skin cancer in epidermodysplasia verruciformis. She collaborated with Professor Gérard Charles Jacques Orth (1936-), with whom she characterized the molecular structure of the oncogenic virus to be the first to be discovered in dermatologic diseases. They also showed that a viral infection could not spread to people with different genetic patterns. For this discovery, Jabłońska and Orth in 1985 were awarded the Robert Koch Medal, which was presented to them by the President of the Federal Republic of Germany, Richard Karl Freiherr von Weizsäcker (1920-2015). Jabłońska is the only Polish scientist to be so honored.

Clinical, serologic, and immunogenetic features in Polish patients with idiopathic inflammatory myopathies

OBJECTIVE

To determine the clinical, serologic, and immunogenetic correlations in patients with idiopathic inflammatory myopathies (IIM), and to evaluate the useful grouping of some diseases for practical clinical purposes.

METHODS

Patients with IIM were categorized according to clinical presentation as compared with autoantibody specificity. Serum samples from 84 patients were screened for myositis-specific autoantibodies (MSAs) by indirect immunofluorescence and double immunodiffusion. All sera were also studied by protein A-assisted immunoprecipitation. Genomic DNA was isolated from peripheral blood mononuclear cells, and HLA-DQA1 and DRB1 alleles were determined. The patients were seen and followed up for many years in the same center.

RESULTS

MSAs were present in 19% of patients. The most common MSAs were antisynthetases in 13% of patients (Jo-1 10.7%, PL-12 1.2%, and EJ 1.2%), associated with the antisynthetase syndrome. Anti-SRP was found in 1.2% of patients, associated with polymyositis, and anti-Mi-2 in 4.9%, found exclusively in patients with dermatomyositis. The most frequent MSA was PM-Scl in 23.8% of patients, associated with scleromyositis, and Ku was present in 9.6% of patients with overlap syndromes. The alleles that were found at a significantly increased frequency were HLA-DRB1*0301 (59.4%) and DQA1*0501 (71.6%), which are in linkage disequilibrium. DQA1*0501 was present in 85.7% of patients with antisynthetases, and in 100% of patients with PM-Scl and Ku.

CONCLUSION

The HLA-DRB1*0301; DQA1*0501 haplotype was found to be significantly increased in this population overall and in those myositis patients with antisynthetase, anti-PM-Scl, and anti-Ku antibodies. The results of this study confirm that IIM are heterogeneous syndromes, but can be divided into more useful groups on the basis of clinical, serologic, and immunogenetic features.

Analysis of the specificity of anti-PM-Scl autoantibodies

OBJECTIVE

To compare the specificity of anti-PM-Scl autoantibodies in serum samples from 43 patients with myositis, scleroderma, or both.

METHODS

Anti-PM-Scl immunoprecipitates from HeLa cell extract were used as antigen for immunoblot analyses to determine the antigenic components. A series of complementary DNA fragments was expressed in Escherichia coli for immunoblot examination of the reaction with the 100-kd protein.

RESULTS

The immunoblot against immunoprecipitates was sensitive and specific for detecting reactions with components of the PM-Scl antigen: 42 of 43 sera (97.7%) reacted with the 100-kd, 27 of 43 (62.8%) with the 70-kd, and 5 of 43 (11.6%) with the 37-kd protein (not previously recognized as antigenic). Forty-one sera reacted with N-terminal protein S1 (amino acids 11-437), 39 with central protein S2 (amino acids 439-749), and 24 with C-terminal protein S3 (amino acids 750-882). Of 42 sera tested, 28 (66.7%) reacted most strongly with S1, and 6 (14.3%) reacted most strongly with S2. Absorption studies implied additional, conformational epitopes not present on the bacterially expressed antigen.

CONCLUSION

There was an overall similarity in reactivity to the PM-Scl antigen, but there were differences in the reactivity to the 70-kd and 37-kd proteins, as well as in the relative strength of the reactivity to the S2 protein.

Antinuclear antibodies are not induced by PUVA treatment in patients with uncomplicated psoriasis

BACKGROUND

Previous investigations of antinuclear antibody (ANA) prevalence in patients undergoing PUVA therapy reported contrasting results. However, ANA tests were performed on low-sensitivity substrates that do not allow investigation of anti-Ro (SS-A) antibodies.

OBJECTIVE

We assessed ANAs on a highly sensitive substrate.

METHODS

ANAs were assayed on HEp-2 cells at regular intervals in 238 patients with psoriasis who were treated with PUVA therapy for 1 to 5 years and in 118 untreated control subjects with psoriasis. In addition, radioimmunoassay and counterimmunoelectrophoresis studies of anti-DNA and anti-extractable nuclear antigen antibodies were performed.

RESULTS

Low titers of ANA developed in three patients in at least two consecutive determinations and in 10 patients in a single determination despite continuing treatments. The positive conversion rate was not statistically significant. Radioimmunoassay counterimmunoelectrophoresis studies of anti-DNA and anti-extractable nuclear antigen antibodies were never positive.

CONCLUSION

In our experience PUVA therapy does not represent a risk factor for the induction of anti-Ro antibodies and other ANAs.