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Jordan TJM, Mamo LB, Olivry T, Liu Z, Bizikova P. Re-evaluating the prevalence of anti-desmocollin-1 IgA autoantibodies in canine pemphigus foliaceus. Vet Immunol Immunopathol 2024; 273:110773. [PMID: 38820947 PMCID: PMC11268094 DOI: 10.1016/j.vetimm.2024.110773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/22/2024] [Accepted: 05/01/2024] [Indexed: 06/02/2024]
Abstract
Pemphigus foliaceus (PF) is an autoimmune skin disease of dogs characterized by intraepidermal pustules containing neutrophils and dissociated keratinocytes that develop in association with circulating and tissue-bound IgG autoantibodies. A subset of IgG autoantibodies in canine PF target desmocollin-1 (DSC1), a component of intercellular adhesion complexes within the epidermis. Passive transfer of IgG autoantibodies from canine PF sera to mice was previously shown to induce skin disease in the absence of infiltrating neutrophils. In attempts to identify a mechanism responsible for neutrophil recruitment, past studies evaluated the prevalence of IgA autoantibodies in canine PF sera where they were found in <20% of affected dogs. We re-evaluated the prevalence of anti-DSC1 IgA in canine PF due to concerns regarding the sensitivity of previously used methods. We hypothesized that anti-DSC1 IgA are present in most dogs with PF but have been under-detected due to competition with concurrent anti-DSC1 IgG for binding to their mutual antigenic target. Despite removing approximately 80% of IgG from patient sera using affinity chromatography, we did not detect an increase in anti-DSC1 IgA by performing indirect immunofluorescence on canine DSC1-transfected HEK293T cells. Taken together, our results do not support a role for pathogenic IgA in canine PF.
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Affiliation(s)
- Tyler J M Jordan
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA; University of North Carolina School of Medicine, Department of Dermatology, 3122 Neuroscience Research Bldg., 115 Mason Farm Road, Chapel Hill, NC 27599, USA
| | - Lisa B Mamo
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Thierry Olivry
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA
| | - Zhi Liu
- University of North Carolina School of Medicine, Department of Dermatology, 3122 Neuroscience Research Bldg., 115 Mason Farm Road, Chapel Hill, NC 27599, USA; University of North Carolina School of Medicine, Department of Microbiology and Immunology, 6th Floor Marsico Hall, 125 Mason Farm Road, Chapel Hill, NC 27599, USA; University of North Carolina School of Medicine, Lineberger Comprehensive Cancer Center, 450 West Drive, Chapel Hill, NC 27514, USA
| | - Petra Bizikova
- North Caroline State University, College of Veterinary Medicine, Department of Clinical Sciences, 1060 William Moore Drive, Raleigh, NC 27607, USA.
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Zhou Y, Zhou X, Feng X, Xia D, Qian H, Liu H, Li X, Li W. Case Report: Prurigo nodularis-like linear IgA/IgG bullous dermatosis: a case report and literature review. Front Immunol 2023; 14:1201163. [PMID: 37325615 PMCID: PMC10265503 DOI: 10.3389/fimmu.2023.1201163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Linear IgA/IgG bullous dermatosis (LAGBD) is a rare autoimmune subepidermal bullous disorder characterized by linear deposition of concurrent IgA and IgG autoantibodies along the basement membrane zone (BMZ). The clinical features of LAGBD can be diverse, including tense blisters, erosions, erythema, crusting and mucosa involvement, while papules or nodules are generally absent. In this study, we present a unique case of LAGBD, which showed prurigo nodularis-like clinical appearance on physical examination, linear deposition of IgG and C3 along the basement membrane zone (BMZ) in direct immunofluorescence (DIF), IgA autoantibodies against the 97-kDa and 120-kDa of BP180 and IgG autoantibodies against the 97-kDa of BP180 by immunoblotting (IB), while BP180 NC16a domain, BP230, and laminin 332 were negative by enzyme-linked immunosorbent assay (ELISA). After administration of minocycline, the skin lesions improved. We performed a literature review of LAGBD cases with heterogeneous autoantibodies and found clinical presentations of most cases resemble bullous pemphigoid (BP) and linear IgA bullous disease (LABD), which is consistent with previous reported findings. We aim to increase our understanding of this disorder and to enhance the importance of applying immunoblot analyses and other serological detection tools in clinic for precise diagnosis as well as accurate treatment strategy of various autoimmune bullous dermatoses.
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Affiliation(s)
- Yuxi Zhou
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingli Zhou
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xun Feng
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dengmei Xia
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua Qian
- Department of Laboratory Medicine, Chronic Disease Research Center, Medical College, Dalian University, Dalian, China
| | - Hongjie Liu
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoguang Li
- Department of Laboratory Medicine, Chronic Disease Research Center, Medical College, Dalian University, Dalian, China
| | - Wei Li
- Department of Dermatology & Venerology, Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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3
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Hashimoto T, Qian H, Ishii N, Nakama T, Tateishi C, Tsuruta D, Li X. Classification and Antigen Molecules of Autoimmune Bullous Diseases. Biomolecules 2023; 13:703. [PMID: 37189450 PMCID: PMC10135556 DOI: 10.3390/biom13040703] [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: 03/30/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Autoimmune bullous diseases (AIBDs), which are a group of tissue-specific autoimmune diseases of the skin, present with various blistering lesions on the skin and mucous membranes, and show autoantibodies of IgG, IgA and IgM against epidermal cell surfaces and basement membrane zone. To date, AIBDs have been classified into a number of distinct subtypes by clinical and histopathological findings, and immunological characteristics. In addition, various biochemical and molecular biological studies have identified various novel autoantigens in AIBDs, which has resulted in proposals of new subtypes of AIBDs. In this article, we summarized various distinct AIBDs, and proposed the latest and most comprehensive classification of AIBDs with their autoantigen molecules.
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Affiliation(s)
- Takashi Hashimoto
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Hua Qian
- Department of Laboratory Medicine, Medical College, Dalian University, Dalian 116622, China
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Takekuni Nakama
- Department of Dermatology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Chiharu Tateishi
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Xiaoguang Li
- Department of Laboratory Medicine, Medical College, Dalian University, Dalian 116622, China
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4
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Calmettes V, Badrignans M, Konstantinou MP, Tancrède-Bohin E, Vignon-Pennamen MD, Castel M, Pham-Ledard A, Le Roux-Villet C, Misery L, Schoenlaub P, Tronquoy AF, Cordel N, Ortonne N, Sohier P, Cellier L, Tournier E, De La Salle EM, Le Flahec G, Plantier F, Grootenboer-Mignot S, Jouen F, Hillion B, Aractingi S, Duvert-Lehembre S, Dupin N, Ingen-Housz-Oro S. IgA and IgG/IgA intercellular dermatosis: a clinicopathological case series of 15 patients. J Eur Acad Dermatol Venereol 2022; 36:e896-e898. [PMID: 35694900 DOI: 10.1111/jdv.18325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/03/2022] [Indexed: 12/16/2022]
Affiliation(s)
- V Calmettes
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - M Badrignans
- Department of Pathology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - M P Konstantinou
- Department of Dermatology, University Hospital of Toulouse, Toulouse, France
| | - E Tancrède-Bohin
- Department of Dermatology, Saint Louis University Hospital, APHP, Paris, France
| | - M D Vignon-Pennamen
- Department of Pathology, Saint Louis University Hospital, APHP, Paris, France
| | - M Castel
- Department of Dermatology, University Hospital of Rouen, Rouen, France
| | - A Pham-Ledard
- Department of Dermatology, CHU Bordeaux and INSERM U1312, Bordeaux, France
| | - C Le Roux-Villet
- Department of Dermatology, University Hospital Avicenne, Bobigny, France
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - P Schoenlaub
- Department of Dermatology, Hopital d'Instruction des Armées, Brest, France
| | - A F Tronquoy
- Department of Dermatology, Hospital of Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - N Cordel
- Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, France
| | - N Ortonne
- Department of Pathology, Henri Mondor University Hospital, AP-HP, Créteil, France
| | - P Sohier
- Department of Pathology, Cochin Hospital, AP-HP, AP-HP, Centre-Université de Paris, Paris, France
| | - L Cellier
- Department of Pathology, University Hospital of Rouen, Rouen, France
| | - E Tournier
- Derpartment of Pathology, University Hospital of Toulouse, Toulouse, France
| | - E M De La Salle
- Department of Pathology, University Hospital of Lille, Lille, France
| | - G Le Flahec
- Department of Pathology, University Hospital of Brest, Brest, France
| | - F Plantier
- Cabinet de Pathologie Mathurin Moreau, Paris, France
| | | | - F Jouen
- Department of Immunology, University Hospital of Rouen, Rouen, France
| | - B Hillion
- Department of Dermatology, Hospital of Marne la Vallée, Jossigny, France
| | - S Aractingi
- Department of Dermatology, Cochin Hospital, AP-HP, AP-HP, Centre-Université de Paris, Paris, France
| | - S Duvert-Lehembre
- Department of Dermatology, Hospital of Dunkerque, Dunkerque, France.,Department of Dermatology, University Hospital of Lille, Lille, France
| | - N Dupin
- Department of Dermatology, Cochin Hospital, AP-HP, AP-HP, Centre-Université de Paris, Paris, France
| | - S Ingen-Housz-Oro
- Department of Dermatology, Henri Mondor University Hospital, AP-HP, Créteil, France.,Univ Paris Est Créteil EpidermE, Créteil, France
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- French Bullous Diseases Study Group Paris, Paris, France
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5
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Cho YT, Fu KT, Chen KL, Chang YL, Chu CY. Clinical, Histopathologic, and Immunohistochemical Features of Patients with IgG/IgA Pemphigus. Biomedicines 2022; 10:1197. [PMID: 35625932 PMCID: PMC9138426 DOI: 10.3390/biomedicines10051197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
Pemphigus is an autoantibody-mediated blistering disease. In addition to conventional pemphigus vulgaris and pemphigus foliaceus, several other types have been reported. Among them, IgG/IgA pemphigus is less well defined and seldom reported. To characterize the clinical, histopathologic, and immunohistochemical presentation of IgG/IgA pemphigus, we retrospectively identified 22 patients with the disease at a referral center in Taiwan. These patients showed two types of skin lesion: annular or arciform erythemas with blisters or erosions (45.5%) and discrete erosions or blisters such as those in conventional pemphigus (54.5%). Mucosal involvement was found in 40.9%. Histopathologic analysis identified acantholysis (77.3%) and intra-epidermal aggregates of neutrophils (40.9%) and eosinophils (31.8%). Direct immunofluorescence studies showed IgG/IgA (100%) and C3 (81.8%) depositions in the intercellular space of the epidermis. In immunohistochemical staining, patients with IgG/IgA pemphigus demonstrated significantly higher levels of epidermal expression of interleukin-8 and matrix metalloproteinase-9 than those with conventional pemphigus (p < 0.05). In conclusion, although IgG/IgA pemphigus is heterogeneous in presentation, it shows characteristic features that are different from other forms of pemphigus and should be considered a distinct type of pemphigus.
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Affiliation(s)
- Yung-Tsu Cho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Y.-T.C.); (K.-T.F.); (K.-L.C.)
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Dermatology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 243, Taiwan
| | - Ko-Ting Fu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Y.-T.C.); (K.-T.F.); (K.-L.C.)
| | - Kai-Lung Chen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Y.-T.C.); (K.-T.F.); (K.-L.C.)
| | - Yih-Leong Chang
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei 100, Taiwan
- Department of Pathology, National Taiwan University Cancer Center, Taipei 106, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (Y.-T.C.); (K.-T.F.); (K.-L.C.)
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6
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Cheng HF, Tsoi WK, Ng MMT, Ip WK, Ho KM. IgG/IgA pemphigus with differing regional presentations. JAAD Case Rep 2022; 28:119-122. [PMID: 36147207 PMCID: PMC9486352 DOI: 10.1016/j.jdcr.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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7
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Leiferman KM, Snook JP, Khalighi MA, Kuechle MK, Zone JJ. Diagnostics for Dermatologic Diseases with Autoantibodies. J Appl Lab Med 2022; 7:165-196. [DOI: 10.1093/jalm/jfab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Dermatologic diseases with autoantibodies were recognized early as autoimmunity became accepted as a pathogenic immunologic concept. Laboratory testing to identify disease-defining autoantibodies and investigate their role in pathophysiology has evolved since.
Content
Blistering dermatologic diseases, profiled by autoantibody production, target epithelial components critical in cell–cell and cell–matrix adhesion, resulting in epithelial separation and other characteristic features of the disorders. This review covers the clinical indications for dermatologic disease-related autoantibody testing, the specifics of procuring specimens to test, the available diagnostic tests, and information provided by the testing. Atypical, uncharacteristic, and less well-known clinical and autoantibody profiles as well as several of the many future prospects for expansion of the testing applications are elaborated on in the online Data Supplement.
Summary
Autoantibody-associated dermatologic diseases are acquired immunologic disorders that have considerable clinical implications affecting essential barrier functions of skin and mucous membranes and causing discomfort, including pain and pruritus. Certain of the diseases can have life-threatening manifestations, and treatments can have significant side-effects. The skin diseases may presage other clinical associations that are important to recognize and treat. Laboratory testing aids in the diagnosis of these diseases through identification of the autoantibodies and is essential for prompt and precise knowledge of the disease type for prognosis, further clinical evaluations, and treatment decisions.
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Affiliation(s)
- Kristin M Leiferman
- Immunodermatology Laboratory, Department of Dermatology, University of Utah, UT, USA
| | - Jeremy P Snook
- Immunodermatology Laboratory, Department of Dermatology, University of Utah, UT, USA
| | - Mazdak A Khalighi
- Immunodermatology Laboratory, Department of Dermatology, University of Utah, UT, USA
| | - Melanie K Kuechle
- Immunodermatology Laboratory, Department of Dermatology, University of Utah, UT, USA
- Puget Sound Dermatology, Edmonds, WA. USA
| | - John J Zone
- Immunodermatology Laboratory, Department of Dermatology, University of Utah, UT, USA
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8
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Ninković-Baroš Đ, Balaban J, Umićević-Šipka S, Gajanin V. Relationship between the age and sex of the patient with the results of the indirect immunofluorescence test in patients with bullous dermatoses. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-37483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background/Aim: Autoimmune bullous diseases are characterised by the production of autoantibodies to epidermal or subepidermal adhesive proteins. The aim of this study was to determine the relationship between age and sex of patients with the results of indirect immunofluorescence test in patients with newly diagnosed bullous dermatoses. Methods: The investigation presents a retrospective study of newly diagnosed patients with autoimmune bullous diseases at the Clinic for Skin and Venereal Diseases of the University Clinical Centre in Banja Luka in the period 2016-2021. In addition to demographic data, the results of an indirect immunofluorescence test in two titres (≥ 1:10 and ≥ 1:100) were analysed. Results: In this study, almost the same number of patients with pemphigus (45.2 %) and pemphigoid (54.8 %) was found. There were more women than men in the total sample (p = 0.049). The average age of subjects with pemphigoid was higher than that of patients with pemphigus (p = 0.001). 48.2 % of patients with pemphigus and 51.8 % of patients with pemphigoid had a positive indirect immunofluorescence test. A positive test for epidermal intercellular substance in both sexes at a titre ≥ 1:100 is higher than a titre ≥ 1:10 (p = 0.029). Patients with autoantibody titres ≥ 1:100 to desmoglein-1 were statistically significantly older than patients with titres ≥ 1:10 (p = 0.047). Conclusion: Number of patients with pemphigus and pemphigoid were similar, with no difference in sex distribution between the two groups of patients, but patients with pemphigoid were older than patients with pemphigus. The difference between high and low autoantibody titres in both sexes was found only in the group of pemphigus on epidermal intercellular substance and desmoglein-1.
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Bosch-Amate X, Iranzo P, Ivars M, Mascaró Galy JM, España A. Anti-Desmocollin Autoantibodies in Autoimmune Blistering Diseases. Front Immunol 2021; 12:740820. [PMID: 34567003 PMCID: PMC8462461 DOI: 10.3389/fimmu.2021.740820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
The presence of anti-desmocollin (Dsc) antibodies is rarely described in autoimmune blistering diseases patients. Moreover, several clinical phenotypes of pemphigus may be associated with these antibodies. In this review we analyze clinicopathological, immunologic and outcome features of anti-Dsc autoimmune blistering diseases patients, to improve their diagnosis and management. We conducted a systematic search of PubMed and Embase (1990-present) for studies reporting cases of autoimmune blistering diseases with anti-Dsc antibodies. We classified the selected patients as patients with exclusively anti-Dsc autoantibodies, and patients with anti-Dsc and other autoantibodies. Of 93 cases with anti-Dsc autoantibodies included, 38 (41%) had exclusively these antibodies. Only 18% of patients presented with the typical clinicopathological phenotype of pemphigus vulgaris or pemphigus foliaceous. Mucosal involvement was seen in approximately half of the patients. Up to 18% of cases were associated with neoplasms. Acantholysis was described in 54% of cases with histopathological information. Treatments and outcomes vary in the different clinical phenotypes. The presence of anti-Dsc antibodies must be suspected mainly in those patients with either atypical pemphigus, in special with clinical pustules, or in cases showing intraepithelial or dermal neutrophilic/eosinophilic infiltrate on histological examination and dual pattern by direct immunofluorescence examination.
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Affiliation(s)
- Xavier Bosch-Amate
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Iranzo
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marta Ivars
- Dermatology Department, University Clinic of Navarra, University of Navarra, Madrid, Spain
| | - José Manuel Mascaró Galy
- Dermatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Agustín España
- Dermatology Department, University Clinic of Navarra, University of Navarra, Pamplona, Spain
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10
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Nili A, Salehi Farid A, Asgari M, Tavakolpour S, Mahmoudi H, Daneshpazhooh M. Current status and prospects for the diagnosis of pemphigus vulgaris. Expert Rev Clin Immunol 2021; 17:819-834. [PMID: 34162306 DOI: 10.1080/1744666x.2021.1945925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Pemphigus vulgaris (PV) is an intraepidermal autoimmune bullous disease (AIBD) characterized by autoantibodies against desmosomal adhesion proteins, most commonly desmoglein (Dsg)3, leading to the suprabasal cleft formation and acantholysis.Areas covered: Direct immunofluorescence (DIF) and indirect immunofluorescence (IIF) studies display the intercellular deposition of IgG/C3 throughout the epidermis and presence of circulating autoantibodies respectively, as a net-like pattern. However, the target antigen remains unknown using immunofluorescence techniques. Thanks to the development of Dsg ELISA, using recombinant technology, circulating antibodies against Dsg1 and 3 could be detected sensitively. It is possible to differentiate PV from pemphigus foliaceus (PF) using this assay. BIOCHIP mosaic and multivariant ELISA are two novel serologic methods with the added value of the ability to screen several AIBDs simultaneously.Non-Dsg1/3 antigens are also involved in the pathogenesis of PV and investigated more deeply thanks to the protein microarrays technique. Additionally, patients with high values of anti-Dsg1/3 may be lesion-free, suggesting the presence of nonpathogenic autoantibodies.Expert opinion: Newer diagnostic methods to replace traditional techniques should possess high sensitivity and specificity and be widely available, noninvasive, and relatively cheap. The newly developed methods need to be further evaluated before being recommended for routine use.
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Affiliation(s)
- Ali Nili
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Salehi Farid
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Asgari
- Department of Pathology and Laboratory Medicine, Yosemite Pathology Medical Group, San Ramon Regional Medical Center, San Ramon, CA, USA
| | - Soheil Tavakolpour
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Hamidreza Mahmoudi
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Department of Dermatology, Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
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11
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Karacheva YV, Ruksha TG, Naumova AS, Motorina AV. Linear IGA-dependent bullous dermatosis in a 2-year-old child. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Linear IgA-dependent bullous dermatosis is a rare subepidermal bladderworm disease that occurs in both adults and children. The pathogenesis of the disease, regardless of age, is the same, where the basis is the autoimmune response to antigens of the basal membrane zones of the skin, the clinical picture in childhood differs from the manifestations at an older age, having a clear picture and localization of manifestations. The causes of the onset of the disease in older people are most often associated with taking medications, manifested as a side effect of the therapy being taken, cancer, and in children, both an acquired character and a genetic predisposition are responsible for the manifestation of linear IgA-dependent bullous dermatosis. The diagnosis can be confirmed by histological and immunofluorescence analysis.
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12
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Solimani F, Meier K, Zimmer CL, Hashimoto T. Immune serological diagnosis of pemphigus. Ital J Dermatol Venerol 2020; 156:151-160. [PMID: 33228340 DOI: 10.23736/s2784-8671.20.06788-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pemphigus is a rare autoimmune blistering disease which manifests with painful erosions and blisters of the skin and mucosa. This disorder is caused by autoantibodies attacking desmosomal proteins, necessary for cell-cell contact stability and epidermal integrity. Desmoglein (Dsg) 1 and Dsg3 are the two major target antigens in pemphigus. Yet, many other target proteins, which have been described over the years, seem to be involved in the loss of epidermal integrity. Clinical examination, combined to serological advances and detection of targeted antigens, permitted to differentiate among several pemphigus subtypes, in which pemphigus vulgaris and pemphigus foliaceus are the most common. Nowadays, serological analysis in pemphigus is a fundamental step of the diagnostic algorithm. This is based on analysis of clinical symptoms, histopathological examination of lesional skin, detection of tissue bound and circulating antibodies by direct and indirect immunofluorescence, and determination of target antigens either by enzyme-linked immunosorbent essay (ELISA) or by western blot analysis. A correct and exhaustive diagnostic algorithm is fundamental to characterize pemphigus subtypes, which lastly permits to adopt a correct treatment approach. Moreover, quality and quantity of circulating antibodies in patient's sera deliver important information regarding clinical course, disease severity and treatment response; thus, relevantly affecting physician's decision. To facilitate this process, "easy-to-perform" diagnostic kits with high sensitivity and specificity are being commercialized. In this review, we focus on available methods and established assays to correctly detect circulating autoantibodies in pemphigus. Moreover, we discuss subtype specific serological peculiarities in the five most relevant subtypes (pemphigus vulgaris, pemphigus foliaceus, pemphigus vegetans, paraneoplastic pemphigus and intercellular IgA dermatosis (also called as IgA pemphigus).
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Affiliation(s)
- Farzan Solimani
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany -
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christine L Zimmer
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Abstract
Direct immunofluorescence (DIF) remains a valuable tool that may be underused because of perceived challenges in the interpretation, limitations, and processing of DIF specimens. The aim of this review is to provide a practical guide for appropriately incorporating DIF in a variety of clinical diseases, such as autoimmune blistering disorders. In vasculitis, the role of DIF continues to evolve, particularly in the setting of IgA vasculitis. Although typically not indicated for the workup of connective tissue disease, DIF may be helpful in cases with negative serologies, nondiagnostic histologic findings, or scarring alopecia. Practical pearls for biopsy technique, specimen handling, and storage are also discussed.
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14
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Burmester IAK, Emtenani S, Johns JG, Ludwig RJ, Hammers CM, Hundt JE. Translational Use of a Standardized Full Human Skin Organ Culture Model in Autoimmune Blistering Diseases. ACTA ACUST UNITED AC 2019; 85:e56. [DOI: 10.1002/cpph.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Shirin Emtenani
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
| | | | - Ralf J. Ludwig
- Department of Dermatology; University of Lübeck; Lübeck Germany
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
| | - Christoph M. Hammers
- Department of Dermatology; University of Lübeck; Lübeck Germany
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
| | - Jennifer E. Hundt
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
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15
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Chapman CM, Kwock J, Cresce N, Privette E, Cropley T, Gru AA. IgG/IgA pemphigus in a patient with a history of pemphigus vulgaris: An example of epitope spreading? J Cutan Pathol 2019; 46:380-382. [PMID: 30681733 DOI: 10.1111/cup.13433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/02/2019] [Accepted: 01/14/2019] [Indexed: 11/29/2022]
Abstract
We report a case of IgG/IgA pemphigus presenting as pemphigus foliaceus following diagnosis and treatment of classic IgG-mediated pemphigus vulgaris. The dual presentation of IgG and IgA positivity on direct immunofluorescence (DIF) constitutes a rare form of pemphigus with a wide variety of clinicopathologic manifestations. The progression of pemphigus vulgaris is commonly because of epitope spreading. However, the patient's disease was partially refractory to rituximab and showed a change in the DIF with dual staining for IgG and IgA. This indicates that class-switching may have occurred with epitope spreading or that there was autoreactive IgA at the onset of disease below the threshold of detection by DIF. Our case indicates that in progressive autoimmune disease refractory to treatment, re-evaluation of the patient for antibody isotypes absent on initial diagnosis may offer key information in better identifying the cause of progression as well as in directing the necessary treatment.
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Affiliation(s)
- Courtney M Chapman
- Division of Pathology, George Washington, University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Jessica Kwock
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia.,Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Nicole Cresce
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Emily Privette
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Thomas Cropley
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia
| | - Alejandro A Gru
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, Virginia.,Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia
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16
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Iranzo P, Ishii N, Hashimoto T, Alsina‐Gibert M. Nonclassical pemphigus with exclusively IgG anti‐desmocollin 3‐specific antibodies. Australas J Dermatol 2019; 60:e217-e219. [DOI: 10.1111/ajd.12991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Pilar Iranzo
- Department of Dermatology Hospital Clínic de Barcelona Barcelona Spain
| | - Norito Ishii
- Department of Dermatology Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology Kurume, Fukuoka Japan
| | - Takashi Hashimoto
- Department of Dermatology Osaka City University Graduate School of Medicine Osaka Japan
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