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Ringer A, Smichowski AM, Gómez R, Virasoro B, Martínez L, Bertiller E, Siegrist C, Abdala B, Chulibert S, Grossi G, Rubín E, Kostianovsky A, Muñoz SA, Lutgen S, Gandino IJ. Ocular cicatricial pemphigoid: is there an association with autoimmune diseases? Int Ophthalmol 2024; 44:99. [PMID: 38376602 DOI: 10.1007/s10792-024-02939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 12/17/2023] [Indexed: 02/21/2024]
Abstract
PURPOSE To assess the prevalence of autoimmune diseases (ADs) associated with ocular cicatricial pemphigoid (OCP) and analyze clinical, laboratory, and treatment associations between these entities. METHODS A multicentre cross-sectional study of patients with an OCP diagnosis. The population was divided into two groups according to their association with other ADs or not. Clinical, laboratory and treatment variables were described and compared between groups. A multivariable logistic regression analysis was performed to identify variables that could suggest the association between OCP and ADs. RESULTS Eighty-eight patients were recruited, with a mean age at diagnosis of 64.3 years (SD 11.9). Biopsy was performed in 86.8% of the patients. There was a median delay of 2 years from the onset of symptoms to diagnosis. Extraocular involvement was evidenced in 11.5%. The group associated with ADs included 24 patients (27.3%). The most prevalent diagnosis was Sjögren´s syndrome. Hypergammaglobulinemia was associated with ADs and OCP, adjusted for age, sex, smoking, skin and mucosal involvement, and erythrocyte sedimentation rate (OR 8.7; 95%CI 1.6-46.8; p = 0.012). CONCLUSIONS Due to OCP's autoimmune nature, it could coexist with other ADs. This study observed that more than a quarter of the population presented with this association, and hypergammaglobulinemia could suggest it.
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Affiliation(s)
- Ariana Ringer
- Rheumatology Unit, National University of Rosario, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina.
- Rheumatology and Internal Medicine Unit, Consultorios Médicos y Laboratorio de Análisis Bioquímicos e Inmunológicos (CM/LABI), Rosario, Santa Fe, Argentina.
| | - Andrea María Smichowski
- Rheumatology Unit, Hospital Militar Central, 601 Cirujano Mayor Doctor Cosme Argerich, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ramiro Gómez
- Rheumatology Unit, Hospital Nacional Alejandro Posadas, El Palomar, Provincia de Buenos Aires, Argentina
| | - Belén Virasoro
- Consultorio de Enfermedades Autoinmunes (CEA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Liliana Martínez
- Internal Medicine Unit, Hospital General de Agudos Juan Antonio Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Emmanuel Bertiller
- Internal Medicine Unit, Hospital General de Agudos Juan Antonio Fernández, Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos Siegrist
- Rheumatology and Internal Medicine Unit, Consultorios Médicos y Laboratorio de Análisis Bioquímicos e Inmunológicos (CM/LABI), Rosario, Santa Fe, Argentina
| | - Brian Abdala
- Rheumatology Unit, National University of Rosario, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - Serenela Chulibert
- Rheumatology Unit, National University of Rosario, Hospital Provincial del Centenario, Rosario, Santa Fe, Argentina
| | - German Grossi
- Ophtalmology Unit, Hospital Provincial del Centenario, Rosario, Provincia de Santa Fe, Argentina
| | - Eduardo Rubín
- Ophtalmology Unit, Hospital Provincial del Centenario, Rosario, Provincia de Santa Fe, Argentina
| | - Alex Kostianovsky
- Consultorio de Enfermedades Autoinmunes (CEA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sebastián Andrés Muñoz
- Consultorio de Enfermedades Autoinmunes (CEA), Ciudad Autónoma de Buenos Aires, Argentina
| | - Sophia Lutgen
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ignacio Javier Gandino
- Internal Medicine Unit, Hospital General de Agudos Juan Antonio Fernández, Ciudad Autónoma de Buenos Aires, Argentina
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Kokubu H, Takahashi T, Tateishi C, Hashimoto T, Tsuruta D, Fujimoto N. Associations of autoimmune bullous diseases and autoantibodies against epidermal autoantigens in patients with inflammatory myopathy. Mod Rheumatol 2023; 33:1207-1208. [PMID: 36527416 DOI: 10.1093/mr/roac159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/16/2022] [Indexed: 11/08/2023]
Affiliation(s)
- Hiraku Kokubu
- Department of Dermatology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Toshifumi Takahashi
- Department of Dermatology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Chiharu Tateishi
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Noriki Fujimoto
- Department of Dermatology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Avalos-Díaz E, Pérez-Pérez E, Granados J, Pacheco-Tovar D, Bollain-Y-Goytia-de-la-Rosa JJ, Herrera-Esparza R. Multiple autoimmunity and epitope spreading in monozygotic twins. J Transl Autoimmun 2021; 4:100132. [PMID: 34816112 PMCID: PMC8593657 DOI: 10.1016/j.jtauto.2021.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/25/2023] Open
Abstract
We report clinical, serologic, and immunogenetic studies of a set of monozygotic male twin patients who develop autoimmune thyroiditis and vitiligo associated with the HLA-DRB1*04-DQB1*03:02 and HLA-DRB1*03-DQB1*0201 haplotypes. The patients had detectable anti-thyroid and anti-melanocyte autoantibodies. A critical review is presented regarding the role of MHC II molecules linked to clinical manifestations of various autoimmune diseases displayed in a single patient, as is the case in the twin patients reported here. Multiple autoimmunity is a clinicopathological issue that is not well understood. Monozygotic twins with thyroiditis, vitiligo, HLA-DRB1*04-DQB1*03:02 and HLA-DRB1*03-DQBI*0201 haplotypes. Multiple autoantibodies related with intermolecular epitope spreading. Epitope handling by MHC proteins probably related with multiple autoimmunity.
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Key Words
- AMA, anti-mitochondrial antibodies
- ANA, antinuclear antibodies
- ANCA, antineutrophil cytoplasmic antibodies
- ASMA, anti-smooth muscle antibodies
- Anti-CCP, anti-cyclic citrullinated peptide antibodies
- Anti-GBM, anti-glomerular basement membrane antibodies
- Autoimmune diseases
- Autoimmunity
- BP, bullous pemphigoid
- Dsg, desmoglein
- Epitope spreading
- FITC, fluorescein isothiocyanate
- HLA, Human Leucocyte Antigen
- HRP, horseradish peroxidase
- IgG, immunoglobulin G
- MHC, major histocompatibility complex
- Multiple autoimmunity
- PBS, phosphate buffered saline
- SSP, sequence specific priming
- TMB, tetramethylbenzidine/H2O2
- Thyroiditis
- Vitiligo
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Affiliation(s)
- Esperanza Avalos-Díaz
- Universidad Autónoma de Zacatecas, Department of Immunology, UACB. Guadalupe, Zac, Mexico
| | - Elena Pérez-Pérez
- Universidad Autónoma de Zacatecas, Department of Immunology, UACB. Guadalupe, Zac, Mexico
| | - Julio Granados
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Transplantation, Mexico City, Mexico
| | - Deyanira Pacheco-Tovar
- Universidad Autónoma de Zacatecas, Department of Immunology, UACB. Guadalupe, Zac, Mexico
| | | | - Rafael Herrera-Esparza
- Universidad Autónoma de Zacatecas, Department of Immunology, UACB. Guadalupe, Zac, Mexico
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Didona D, Di Zenzo G. Humoral Epitope Spreading in Autoimmune Bullous Diseases. Front Immunol 2018; 9:779. [PMID: 29719538 PMCID: PMC5913575 DOI: 10.3389/fimmu.2018.00779] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/28/2018] [Indexed: 12/15/2022] Open
Abstract
Autoimmune blistering diseases are characterized by autoantibodies against structural adhesion proteins of the skin and mucous membranes. Extensive characterization of their autoantibody targets has improved understanding of pathogenesis and laid the basis for the study of antigens/epitopes diversification, a process termed epitope spreading (ES). In this review, we have reported and discussed ES phenomena in autoimmune bullous diseases and underlined their functional role in disease pathogenesis. A functional ES has been proposed: (1) in bullous pemphigoid patients and correlates with the initial phase of the disease, (2) in pemphigus vulgaris patients with mucosal involvement during the clinical transition to a mucocutaneous form, (3) in endemic pemphigus foliaceus, underlining its role in disease pathogenesis, and (4) in numerous cases of disease transition associated with an intermolecular diversification of immune response. All these findings could give useful information to better understand autoimmune disease pathogenesis and to design antigen/epitope specific therapeutic approaches.
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Affiliation(s)
- Dario Didona
- Clinic for Dermatology and Allergology, University Hospital Marburg, University of Marburg, Marburg, Germany
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell’Immacolata (IDI)-IRCCS, Rome, Italy
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Arakelyan A, Nersisyan L, Poghosyan D, Khondkaryan L, Hakobyan A, Löffler-Wirth H, Melanitou E, Binder H. Autoimmunity and autoinflammation: A systems view on signaling pathway dysregulation profiles. PLoS One 2017; 12:e0187572. [PMID: 29099860 PMCID: PMC5669448 DOI: 10.1371/journal.pone.0187572] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/23/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Autoinflammatory and autoimmune disorders are characterized by aberrant changes in innate and adaptive immunity that may lead from an initial inflammatory state to an organ specific damage. These disorders possess heterogeneity in terms of affected organs and clinical phenotypes. However, despite the differences in etiology and phenotypic variations, they share genetic associations, treatment responses and clinical manifestations. The mechanisms involved in their initiation and development remain poorly understood, however the existence of some clear similarities between autoimmune and autoinflammatory disorders indicates variable degrees of interaction between immune-related mechanisms. METHODS Our study aims at contributing to a holistic, pathway-centered view on the inflammatory condition of autoimmune and autoinflammatory diseases. We have evaluated similarities and specificities of pathway activity changes in twelve autoimmune and autoinflammatory disorders by performing meta-analysis of publicly available gene expression datasets generated from peripheral blood mononuclear cells, using a bioinformatics pipeline that integrates Self Organizing Maps and Pathway Signal Flow algorithms along with KEGG pathway topologies. RESULTS AND CONCLUSIONS The results reveal that clinically divergent disease groups share common pathway perturbation profiles. We identified pathways, similarly perturbed in all the studied diseases, such as PI3K-Akt, Toll-like receptor, and NF-kappa B signaling, that serve as integrators of signals guiding immune cell polarization, migration, growth, survival and differentiation. Further, two clusters of diseases were identified based on specifically dysregulated pathways: one gathering mostly autoimmune and the other mainly autoinflammatory diseases. Cluster separation was driven not only by apparent involvement of pathways implicated in adaptive immunity in one case, and inflammation in the other, but also by processes not explicitly related to immune response, but rather representing various events related to the formation of specific pathophysiological environment. Thus, our data suggest that while all of the studied diseases are affected by activation of common inflammatory processes, disease-specific variations in their relative balance are also identified.
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Affiliation(s)
- Arsen Arakelyan
- Bioinformatics Group, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
- Department of Bioinformatics and Bioengineering, Russian-Armenian University, Yerevan, Armenia
| | - Lilit Nersisyan
- Bioinformatics Group, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
- Zaven and Sonia Akian College of Science and Engineering, American University of Armenia, Yerevan, Armenia
| | - David Poghosyan
- Group of Immune Response Regulation, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
| | - Lusine Khondkaryan
- Group of Immune Response Regulation, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
| | - Anna Hakobyan
- Bioinformatics Group, Institute of Molecular Biology, National Academy of Sciences RA, Yerevan, Armenia
| | - Henry Löffler-Wirth
- Interdisciplinary Centre for Bioinformatics, University of Leipzig, Leipzig, Germany
| | - Evie Melanitou
- Department of Parasitology and Insect Vectors, Institut Pasteur, Paris, France
| | - Hans Binder
- Interdisciplinary Centre for Bioinformatics, University of Leipzig, Leipzig, Germany
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Amber KT, Zikry J, Hertl M. A multi-hit hypothesis of bullous pemphigoid and associated neurological disease: Is HLA-DQB1*03:01, a potential link between immune privileged antigen exposure and epitope spreading? HLA 2017; 89:127-134. [PMID: 28101965 DOI: 10.1111/tan.12960] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/13/2016] [Accepted: 12/22/2016] [Indexed: 12/14/2022]
Abstract
Bullous pemphigoid (BP) is the most common autoimmune blistering disease and is linked to IgG recognition of 2 hemidesmosomal antigens, that is, BP230 (BP antigen 1) and BP180 (BP antigen 2, collagen XVII). The association of BP with other systemic diseases, particularly neurocognitive diseases, provides a potential clue in the underlying pathogenesis of BP. The role of HLA-DQB1*03:01 binding to the immunogenic portion of BP180 provides a potential mechanism by which exposure to neuronal collagen BP180 may lead to cutaneous disease. In our proposed multi-hit hypothesis, patients with underlying neuronal disease are exposed to previously sequestered self-antigen, most importantly BP180. Patients with the HLA-DQB1*03:01 allele show an increased T-cell avidity to several epitopes of BP180, particularly the BP180-NC16a domain. Thus, they have a genetic susceptibility to developing BP upon exposure to the target antigen. In a patient with dysregulation of Th1/Th2 balance, anergy is lost and T-cells are subsequently primed resulting in the development of functional autoimmunity against the BP180-NC16a domain leading to clinically overt disease.
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Affiliation(s)
- K T Amber
- Department of Dermatology, University of California Irvine, Irvine, California
| | - J Zikry
- Department of Dermatology, University of California Irvine, Irvine, California
| | - M Hertl
- Department of Dermatology and Allergology, Philipps University of Marburg, Germany
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Avalos-Díaz E, Pérez-Pérez E, Rodríguez-Rodríguez M, Pacheco-Tovar MG, Herrera-Esparza R. Autoimmune vitiligo in rheumatic disease in the mestizo Mexican population. Biomed Rep 2016; 5:176-180. [PMID: 27446537 PMCID: PMC4950649 DOI: 10.3892/br.2016.700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/01/2016] [Indexed: 12/27/2022] Open
Abstract
Vitiligo is a chronic disease characterized by the dysfunction or destruction of melanocytes with secondary depigmentation. The aim of the present study was to determine the prevalence of vitiligo associated with autoimmune rheumatic diseases. The clinical records from a 10-year database of patients with rheumatic diseases and associated vitiligo was analysed, with one group of patients having autoimmune rheumatic disease and another non-autoimmune rheumatic disease. Available serum samples were used to assess the anti-melanocyte antibodies. A total of 5,251 individual clinical files were archived in the last 10 years, and these patients underwent multiple rheumatology consultations, with 0.3% of the group presenting with vitiligo. The prevalence of vitiligo in the autoimmune rheumatic disease group was 0.672%, which was mainly associated with lupus and arthritis. However, patients with more than one autoimmune disease had an increased relative risk to develop vitiligo, and anti-melanocyte antibodies were positive in 92% of these patients. By contrast, the prevalence was 0.082% in the group that lacked autoimmune rheumatic disease and had negative autoantibodies. In conclusion, the association between vitiligo and autoimmune rheumatic diseases was relatively low. However, the relative risk increased when there were other autoimmune comorbidities, such as thyroiditis or celiac disease. Therefore, the presence of multiple autoimmune syndromes should be suspected.
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Affiliation(s)
- Esperanza Avalos-Díaz
- Department of Immunology, UACB, Universidad Autónoma de Zacatecas, Zacatecas 98040, Mexico
| | - Elena Pérez-Pérez
- Department of Immunology, UACB, Universidad Autónoma de Zacatecas, Zacatecas 98040, Mexico
| | | | | | - Rafael Herrera-Esparza
- Department of Immunology, UACB, Universidad Autónoma de Zacatecas, Zacatecas 98040, Mexico
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Abstract
The initiation and perpetuation of autoimmunity recognize numerous checkpoints, from the genomic susceptibility to the breakdown of tolerance. This latter phenomenon includes the loss of B cell anergy and T regulatory cell failure, as well as the production of autoantibodies and autoreactive T cells. These mechanisms ultimately lead to tissue injury via different mechanisms that span from the production of proinflammatory cytokines to the chemotaxis of immune cells to the target sites. The pathways to autoimmunity have been widely investigated over the past year and resulted in a number of articles in peer-reviewed journals that has increased by nearly 10 % compared to 2011. We herein follow on the attempt to provide a brief discussion of the majority of articles on autoimmune diseases that were published in the major immunology journals in the previous solar year. The selection is necessarily arbitrary and may thus not be seen as comprehensive but reflects current research trends. Indeed, 2012 articles were mostly dedicated to define new and old mechanisms with potential therapeutic implications in autoimmunity in general, though based on specific clinical conditions or animal models. As paradigmatic examples, the environmental influence on autoimmunity, Th17 changes modulating the autoimmune response, serum autoantibodies and B cell changes as biomarkers and therapeutic targets were major issues addressed by experimental articles in 2012. Further, a growing number of studies investigated the sex bias of autoimmunity and supported different working hypotheses to explain the female predominance, including sex chromosome changes and reproductive life factors. In conclusion, the resulting scenario illustrates that common factors may underlie different autoimmune diseases and this is well represented by the observed alterations in interferon-α and TGFβ or by the shared signaling pathways.
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Affiliation(s)
- Carlo Selmi
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy,
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Autoantibodies in senear-usher syndrome: cross-reactivity or multiple autoimmunity? Autoimmune Dis 2012; 2012:296214. [PMID: 23320149 PMCID: PMC3539423 DOI: 10.1155/2012/296214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 11/23/2012] [Indexed: 11/18/2022] Open
Abstract
Senear-Usher syndrome or pemphigus erythematosus is a pathology that overlaps clinically and serologically with pemphigus foliaceus and lupus erythematosus. Skin biopsies of patients with pemphigus erythematosus reveal acantholysis and deposits of immunoglobulins in desmosomes, and they are positive in the lupus band test. In the present paper, we determined whether the autoantibodies associated with pemphigus erythematosus targeted a single antigen or multiple antigens as a result of the stimulation of independent B cell clones. Our present paper demonstrates that patients with pemphigus erythematosus produce both antiepithelial antibodies specific for desmoglein 1 and 3 and antinuclear antibodies specific for Ro, La, Sm, and double-stranded DNA antigens. After eluting specific anti-epithelial or anti-nuclear antibodies, which were recovered and tested using double-fluorescence assays, a lack of cross-reactivity was demonstrated between desmosomes and nuclear and cytoplasmic lupus antigens. This result suggests that autoantibodies in pemphigus erythematosus are directed against different antigens and that these autoantibodies are produced by independent clones. Given these clinical and serological data, we suggest that pemphigus erythematosus behaves as a multiple autoimmune disease.
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