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Timóteo RP, Pessoa-Gonçalves YM, do Carmo Neto JR, Rodrigues WF, da Silva MV, Oliveira CJF. A Global View of Pemphigus: Geographical Variations. Clin Rev Allergy Immunol 2024; 66:14-29. [PMID: 38289514 DOI: 10.1007/s12016-024-08980-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 03/28/2024]
Abstract
Pemphigus, an autoimmune intraepidermal bullous disease group with roughly eight distinct forms, includes pemphigus vulgaris (PV) and pemphigus foliaceus (PF) as its predominant global forms. Despite the increased utilization of global health records and reporting systems, epidemiological data remain limited and poorly categorized. Therefore, this study aimed to conduct a review to track, identify, and characterize cases of PV and PF published and categorized worldwide. A research question was formulated; studies were selected based on the inclusion criteria; and data from these publications were systematically collected, summarized, and presented using narrative descriptions. The search strategy yielded 3,212 articles, of which 95 underwent critical analysis and data extraction. Studies from 52 countries contributed to the dataset, covering various pemphigus variants. Notably, only two countries, Iran (18.87%) and South Korea (11.43%), accounted for approximately a third of the reported PV cases, while Brazil contributed 40.25% of the foliaceus variants cases documented in the literature. These findings offer valuable insights into the global distribution of pemphigus and inform future research and healthcare efforts.
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Affiliation(s)
- Rodolfo Pessato Timóteo
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - Yago Marcos Pessoa-Gonçalves
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - José Rodrigues do Carmo Neto
- Department of Bioscience and Technology, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania, Goiás, 74690-900, Brazil
| | - Wellington Francisco Rodrigues
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - Marcos Vinícius da Silva
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil
| | - Carlo José Freire Oliveira
- Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, 38025-180, Brazil.
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Starr H, Howerth E, Gogal R, Barber J, Leon R, Blubaugh A, Banovic F. Characterization of the serum and skin inflammatory profile in canine pemphigus foliaceus using multiplex assay and quantitative real-time polymerase chain reaction (qRT-PCR). Vet Immunol Immunopathol 2023; 262:110631. [PMID: 37473673 DOI: 10.1016/j.vetimm.2023.110631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
Canine pemphigus foliaceus (PF) is a common autoimmune skin disease characterized by autoantibodies binding to epithelial adhesion molecules resulting inflammatory response. The immune network of cytokine and chemokine abnormalities that characterize the immune response in canine PF are poorly explored. This study evaluated serum and lesional skin cytokine and chemokine profiles of dogs diagnosed with PF compared to healthy control dogs. Serum samples obtained from 11 PF dogs and 16 healthy control dogs were analyzed using commercially available canine multiplex assay for 13 biomarkers (Canine Milliplex assay). Eight lesional skin samples from seven PF dogs and five healthy site-matched samples from five healthy dogs were evaluated for 20 immune markers using quantitative real-time PCR. Immunomodulating medications were suspended for at least four weeks in all dogs before obtaining serum and skin samples. PF patients showed significantly higher serum concentrations of tumor necrosis factor-α, interleukin (IL)- 6, IL-8, IL-18, CCL2, KC-like, and granulocyte-macrophages colony-stimulating factor when compared to healthy controls (Mann-Whitney U test; p < 0.05 for all). Lesional PF skin exhibited significant expression and upregulation of pro-inflammatory/T helper (Th1) 1 markers IL-1β, MX1, GZMB, OAS1, and IFN-γ as well as Th2 cytokines IL-13, IL-33, TSLP, IL-31 and Th17/22 markers IL-17A and IL-22 (Mann-Whitney U test; p < 0.05 for all). Taken together, the findings from this study describe the role of numerous cytokines and chemokines associated with immune response in the skin and serum of canine PF patients. Further larger-sample proteomics and RNA-sequencing transcriptomics studies are needed to understand the immune pathogenesis of canine PF skin lesions.
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Affiliation(s)
- Haley Starr
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine University of Georgia, Athens, GA 30602, USA
| | - Elizabeth Howerth
- Department of Pathology, College of Veterinary Medicine University of Georgia, Athens, GA 30602, USA
| | - Robert Gogal
- Department of Biosciences and Diagnostic Imaging, University of Georgia, Athens, GA 30602, USA
| | - Jamie Barber
- Department of Infectious Disease, University of Georgia, Athens, GA 30602, USA
| | - Renato Leon
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine University of Georgia, Athens, GA 30602, USA
| | - Amanda Blubaugh
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine University of Georgia, Athens, GA 30602, USA
| | - Frane Banovic
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine University of Georgia, Athens, GA 30602, USA.
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Alami S, Benzekri L, Senouci K, Meziane M. Pemphigus foliaceus triggered after inactivated SARS-CoV-2 vaccine: coincidence or causal link? Dermatol Ther 2022; 35:e15775. [PMID: 35976680 PMCID: PMC9539234 DOI: 10.1111/dth.15775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 08/03/2022] [Accepted: 08/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sofia Alami
- University Hospital Center Ibn Sina, Rabat, Morocco
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Ujiie H, Yamagami J, Takahashi H, Izumi K, Iwata H, Wang G, Sawamura D, Amagai M, Zillikens D. The pathogeneses of pemphigus and pemphigoid diseases. J Dermatol Sci 2021; 104:154-163. [PMID: 34916040 DOI: 10.1016/j.jdermsci.2021.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/22/2021] [Accepted: 11/06/2021] [Indexed: 12/21/2022]
Abstract
Autoimmune bullous diseases (AIBDs) are skin disorders which are mainly induced by autoantibodies against desmosomal or hemidesmosomal structural proteins. Previous studies using patients' samples and animal disease models identified target antigens and elucidated the mechanisms of blister formation. Pemphigus has been the subject of more active clinical and basic research than any other AIBD. These efforts have revealed the pathogenesis of pemphigus, which in turn has led to optimal diagnostic methods and novel therapies, such as rituximab. In bullous pemphigoid (BP), studies with passive-transfer mouse models using rabbit anti-mouse BP180 antibodies and studies with passive-transfer or active mouse models using autoantigen-humanized mice elucidated the immune reactions to BP180 in vivo. Recently, dipeptidyl peptidase-4 inhibitors have attracted attention as a trigger for BP. For epidermolysis bullosa acquisita (EBA), investigations using mouse models are actively under way and several molecules have been identified as targets for novel therapies. In this review, we give an overview and discussion of the recent progress in our understanding of the pathogenesis of pemphigus, BP, and EBA. Further studies on the breakdown of self-tolerance and on the identification of key molecules that are relevant to blister formation may expand our understanding of the etiology of AIBDs and lead to the development of novel therapeutic strategies.
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Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Jun Yamagami
- Department of Dermatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Izumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Daisuke Sawamura
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Detlef Zillikens
- Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, Lübeck, Germany; Department of Dermatology, Allergology, and Venereology, University of Lübeck, Lübeck, Germany, University of Lübeck, Lübeck, Germany
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Kılıç Sayar S, Küçükoğlu R. Evaluation of non-endemic pemphigus foliaceus in a large series of patients: a single-center retrospective study from Turkey focuses on the relapses. An Bras Dermatol 2021; 96:422-8. [PMID: 34059391 DOI: 10.1016/j.abd.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/04/2020] [Accepted: 12/05/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pemphigus foliaceus is exceedingly rare around the world, except within the few regions where it occurs as an endemic variant. Various factors can trigger immune mechanisms that induce pemphigus foliaceus or worsen its course. OBJECTIVE To determine the demographic and clinical characteristics of the patients with pemphigus foliaceus in a large series from a non-endemic country, investigate the triggering factors, and seasonal patterns. METHODS The data of the patients diagnosed with pemphigus foliaceus in the study's center between 1989-2018 were retrospectively analyzed. RESULTS Sixty-eight patients (mean age, 45.7 ± 14.5 years) were included in the study. The number of onsets reached its peak in spring-summer (p = 0.008). A total of 117 relapses occurred in 42 patients and were most common in spring-summer (not significant). Specific trigger factors were detected in 45 relapses. In the other 72 relapses, the peak was observed in spring-summer (p = 0.005). There were no significant differences in the demographic and clinical variables investigated between relapsed and non-relapsed patients. STUDY LIMITATIONS Retrospective design. CONCLUSIONS Triggering factors could not be identified in more than half of the relapses in the study's series. The subgroup of relapses (without identified causes), as well as the onsets of the disease, showed a significant seasonal variation with a peak in spring-summer; however, the seasonal variable did not justify the total group of relapses. Although the seasonal variation may be caused by a combination of factors, UV radiation should be considered a trigger factor for the peaks in spring-summer, particularly in Turkey.
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Luo N, Tan S, Li X, Liu S, Singh S, Chen M, Yang W, He Y, Chen C, Liang M. Pulmonary nocardiosis in a patient with pemphigus foliaceus: case report and literature review. BMC Infect Dis 2021; 21:8. [PMID: 33407179 PMCID: PMC7788831 DOI: 10.1186/s12879-020-05673-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nocardiosis is an uncommon opportunistic infection seen in immunocompromised patients or those with a dysfunctional immune system. Nocardia asteroides infection in patients with Pemphigus foliaceus (PF) has never been reported. CASE PRESENTATION We report an interesting case of nocardiosis-characterized by pulmonary intra-cavitary infection, in a 54-year-old man with PF and diabetes mellitus. The man finally recovered from the infection. CONCLUSIONS This is the first case reporting pulmonary nocardiosis in a patient with PF. We recommend that physicians be aware of nocardiosis in patients with pemphigus as a possible cause of underlying infectious disease to avoid misdiagnoses and mismanagement.
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Affiliation(s)
- Ning Luo
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | - Shifan Tan
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | - Xiaocai Li
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | - Si Liu
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | | | - Mafeng Chen
- Department of Otorhinolaryngology, Maoming People's Hospital, Maoming, China
| | - Weiye Yang
- Department of Laboratory Medicine, Maoming People's Hospital, Maoming, China
| | - Yanhong He
- Department of Scientific Research, Maoming People's Hospital, Maoming, China
| | - Chunna Chen
- Department of Dermatology, Maoming People's Hospital, Maoming, China
| | - Min Liang
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China.
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Timóteo RP, Sales-Campos H, Silva MV, da Silva DAA, Da Silva Catarino J, de Sousa MAD, Júnior VR, de Andrade E Silva LE, Bittencourt ACS, Carneiro ÉM, Oliveira CJF. Pemphigus foliaceus patients (Fogo Selvagem) treated with kinesiotherapy presented lower levels of proinflammatory cytokines. J Exerc Rehabil 2019; 15:460-467. [PMID: 31316942 PMCID: PMC6614764 DOI: 10.12965/jer.1938146.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/24/2019] [Indexed: 11/27/2022] Open
Abstract
Fogo Selvagem (FS) is a rare autoimmune disease characterized by acantholysis and inflammation of the epidermis. It was evidenced in this disease the increase of proinflammatory cytokines levels which can be influenced by physical activities. Kinesiotherapy, as physiotherapeutic interventions, was associated improvement levels of the quality of live, mainly the pain. Understanding the impact of such methodology in immunology of the FS, may constitute an alternative and effective approach. We compare the levels of serum cytokines and chemokines between nine patients with FS submitted to kinesiotherapy for 12 weeks and ten patients not submitted to kinesiotherapy. The kinesiotherapy was composed by self-stretching followed by a resistance training for upper and lower limbs. The protocol was carried out in three sections of eight to ten repetitions with 70% of the maximum load measured by test maximum of ten repetitions. After strengthening period patients performed a passive stretching. The training sessions lasted 50 min and were performed 3 times a week at least 12 weeks. Cytokines and chemokines were assessed in plasma using enzyme-linked immunosorbent assay and/or cytometric bead array. Patients with FS were being kinesiotherapy presented minors levels of interferon-γ, interleukin (IL)-17, IL-22, and IL-15 when compared to those not submitted to kinesiotherapy. No differences were observed for the detection of the chemokines chemokine ligand (CCL)-2, CCL-3, CCL-5, CCL-11, C-X-C motif chemokine 8 (CXCL-8), and CXCL-10. These results suggest that kinesiotherapy had a positive impact on inflammatory markers that are associated with disease worsening in FS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Élida Mara Carneiro
- Physiotherapy Division (EBSERH/UFTM). Clinical Hospital of Federal University of Triângulo Mineiro, Uberaba, Brazil
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Mitev A, Rencz F, Tamási B, Hajdu K, Péntek M, Gulácsi L, Szegedi A, Bata-Csörgő Z, Kinyó Á, Sárdy M, Brodszky V. Subjective well-being in patients with pemphigus: a path analysis. Eur J Health Econ 2019; 20:101-107. [PMID: 31098885 PMCID: PMC6544602 DOI: 10.1007/s10198-019-01067-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/14/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pemphigus is a chronic autoimmune blistering disease of the skin and mucosa severely impairing patients' health-related quality of life (HRQoL). To date, no studies have measured subjective well-being in terms of life satisfaction in pemphigus. Our main objective was to evaluate satisfaction with life in patients with pemphigus, and to analyse its relationship with clinical severity and HRQoL. METHODS A cross-sectional survey was carried out enrolling 77 patients with pemphigus. Subjective well-being was measured using the Satisfaction with Life Scale (SWLS). HRQoL was assessed by the Dermatology Life Quality Index (DLQI) and EQ-5D-5L. Disease severity was measured by Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). RESULTS Mean ABSIS, DLQI, EQ-5D-5L and SWLS scores of patients were 11.7 (SD 17.3), 5.4 (6.8), 0.84 (0.22) and 4.76 (SD 1.52), respectively. The proportion of patients indicating extreme dissatisfaction, dissatisfaction, slightly below average in life satisfaction, average satisfaction, high satisfaction and very high satisfaction with life was 6 (7.8%), 5 (6.5%), 14 (18.2%), 16 (20.8%), 21 (27.3%) and 15 (19.5%), respectively. Life satisfaction was independent from age, gender, level of education and type of disease. A path analysis revealed that there was no direct relationship between ABSIS and SWLS (beta = - 0.09; p = 0.428); however, the following indirect path was confirmed: ABSIS → DLQI → EQ-5D-5L → SWLS. CONCLUSIONS Disease severity and HRQoL measures regularly used to assess patients' health status may be complemented with a measure of subjective well-being, such as SWLS, to achieve a more holistic assessment of patients' lives and optimise pemphigus care.
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Affiliation(s)
- Ariel Mitev
- Department of Marketing, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
- Hungarian Academy of Sciences, Premium Postdoctoral Research Program, Nádor u. 7, Budapest, 1051, Hungary
| | - Béla Tamási
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, Budapest, 1085, Hungary
| | - Krisztina Hajdu
- Departments of Dermatology, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Department of Dermatological Allergology, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Andrea Szegedi
- Departments of Dermatology, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Department of Dermatological Allergology, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Zsuzsanna Bata-Csörgő
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical Centre, University of Szeged, Korányi fasor 6, Szeged, 6720, Hungary
| | - Ágnes Kinyó
- Department of Dermatology, Venereology and Oncodermatology, University of Pécs Medical School, Akác u. 1, Pécs, 7632, Hungary
| | - Miklós Sárdy
- Department of Dermatology, Venereology and Dermatooncology, Faculty of Medicine, Semmelweis University, Mária u. 41, Budapest, 1085, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
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Abstract
Pemphigus forms a group of rare autoimmune bullous diseases that affect the skin and mucous membranes. This group has a chronic course leading to high morbidity and mortality. It is characterized by the production of pathogenic autoantibodies directed against different proteins of the desmosome, leading histologically to intraepidermal cleavage, and clinically to vesicles and erosions on the epithelium of the mucous membranes and/or the skin. The diagnosis of the subtype of pemphigus is based on clinical features, the level of histologic cleavage, and the identification of the antigens recognized by circulating autoantibodies by immunoserological analyses. The epidemiological features of pemphigus vary considerably in different regions of the world. Observational studies examining comorbidities and associations among patients with pemphigus are scarce and sometimes inconclusive. The prognosis, mortality, and clinical outcomes in pemphigus have undergone dramatic change throughout the years. This review provides a brief overview about the different subtypes of pemphigus: pemphigus vulgaris, pemphigus foliaceus, paraneoplastic pemphigus, pemphigus herpetiformis, and IgA pemphigus. In addition, it summarizes the most recent understanding of the epidemiology, mortality data, and comorbidities of this group of organ-specific autoimmune diseases.
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Walsh P, Brochado MJF, Vernal S, Machado AR, Turatti A, de Paula NA, Donadi EA, Roselino AM. Relationship between pemphigus and American tegumentary leishmaniasis: insights from serological and genetic profiles. Trans R Soc Trop Med Hyg 2018; 111:345-353. [PMID: 29237064 DOI: 10.1093/trstmh/trx065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/21/2017] [Indexed: 12/29/2022] Open
Abstract
Background Antibodies against Leishmania peptides (Lbr-peps) and desmogleins (Dsgs) have been reported in pemphigus foliaceus (PF) and leishmaniasis patients, respectively. We aimed to compare serological and genetic features in a Brazilian region endemic for American tegumentary leishmaniasis (ATL) and pemphigus. Methods Commercial anti-Dsg ELISA and in-house ELISA with Lbr-peps were used to determine the serological profile, in addition to immunoblotting (IB) and indirect immunofluorescence (IIF) assays. HLA-DRB1 and -DQA1/DQB1 alleles were characterized by PCR combined with sequence-specific oligonucleotide probes (PCR-SSOP). The serological and genetic profiles were compared using 78 PF, 62 pemphigus vulgaris (PV) and 58 ATL patients against 163 and 1592 healthy controls, respectively. Results Some ATL patients showed positive results for anti-Dsg1 and/or anti-Dsg3 antibodies. They also revealed 130, 160 and/or 230 kDa epidermal peptides in IB. Moreover, some ATL samples exhibited pemphigus or a bullous pemphigoid pattern in IIF. ELISA and IB assays showed Lbr-peps in pemphigus patients. HLA-DQA1*01 and -DQA1*01:02 were protective and susceptibility alleles for ATL, respectively, but the opposite for pemphigus. Conclusions Anti-Dsgs in ATL may represent epiphenomena. Anti-Lbr-pep antibodies in pemphigus suggest a previous infection. A differential association of the HLA profile may contribute to the lack of co-association between pemphigus and ATL.
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Affiliation(s)
- Priscilla Walsh
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Maria J F Brochado
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Sebastian Vernal
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Aline R Machado
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Aline Turatti
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Natalia A de Paula
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
| | - Eduardo A Donadi
- Division of Immunology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo, Brazil
| | - Ana Maria Roselino
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, 14049-900, São Paulo
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Vernal S, Pepinelli M, Casanova C, Goulart TM, Kim O, De Paula NA, Pinto MC, Sá-Nunes A, Roselino AM. Insights into the epidemiological link between biting flies and pemphigus foliaceus in southeastern Brazil. Acta Trop 2017; 176:455-462. [PMID: 28941730 DOI: 10.1016/j.actatropica.2017.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/16/2017] [Accepted: 09/17/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Black fly and sandfly bites are related to the endemicity of pemphigus foliaceus (PF); however, an immune reaction against the salivary proteins from these flies still requires confirmation in the case of PF patients living in southeastern Brazil. PURPOSE To georeference the distribution of Simuliidae (Diptera: Simuliidae) and Phlebotominae (Diptera: Psychodidae) and of PF cases in the northeastern region of São Paulo State, and to assess the humoral immune response against salivary gland extracts (SGEs) from biting flies in PF patients, relatives, and neighbours. METHODS PF patients' medical information recorded between 1965 and 2014 were obtained from the database of the University Hospital. Data on the distribution of fly species were collected from scientific reports and epidemiological databases. Spatial maps relating the distribution of biting flies with PF cases were plotted. Serum IgG antibodies against the SGEs from Simulium nigrimanum, Nyssomyia neivai, and Aedes aegypti (as control) were determined by ELISA. RESULTS Two hundred and eighty-five PF cases were distributed in 60 municipalities with a prevalence of 57.5 per million inhabitants, revealing well-defined geographical clusters. S. nigrimanum and N. neivai specimens were registered in eight (13.3%) and 26 (43.3%) of these municipalities, respectively. PF patients, and their relatives presented higher levels of IgG against the SGEs of S. nigrimanum and N. neivai (P<0.001 for both), but not against the SGE from A. aegypti (P=0.115 and P=0.552, respectively), as compared to controls. IgG against the SGEs from S. nigrimanum and N. neivai but not against the SGE from A. aegypti correlated with levels of anti-Desmoglein 1 in PF patients (r=0.3848, P=0.039; and r=0.416, P=0.022, respectively). CONCLUSION An epidemiological link between biting flies and PF in southeastern Brazil is proposed, implying a possible role of the salivary proteins from these flies in PF etiopathogenesis.
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Tavakolpour S. Pemphigus trigger factors: special focus on pemphigus vulgaris and pemphigus foliaceus. Arch Dermatol Res 2018; 310:95-106. [PMID: 29110080 DOI: 10.1007/s00403-017-1790-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 10/07/2017] [Accepted: 10/30/2017] [Indexed: 12/16/2022]
Abstract
Pemphigus is a general term for a rare group of autoimmune diseases which result in the formation of blisters on the skin and oral cavity. Although there is no way to prevent autoimmune diseases, some factors may trigger pemphigus initiation in susceptible individuals or be exacerbated in affected patients. Recognition of these triggers, based on the latest studies and experiences is essential and should be updated every few years. In this study, several triggers, including different drugs and treatments, diseases, vaccines, genetic factors, nutrients, micronutrients, pregnancy, stress, and various other triggers have been discussed. Some possible triggers, such as blood antigens and the effect of seasons have also been discussed briefly. Moreover, some protective factors against pemphigus have been reviewed. Considering the molecular mechanism of pemphigus and immune response alteration during this disease, some possible triggers have been suggested and discussed. Although those triggers may be a real threat, more studies are needed to support these hypotheses.
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Ben Jmaa M, Abida O, Bahloul E, Toumi A, Khlif S, Fakhfakh R, Elloumi N, Sellami K, Masmoudi A, Turki H, Masmoudi H. Role of FOXP3 gene polymorphism in the susceptibility to Tunisian endemic Pemphigus Foliaceus. Immunol Lett 2017; 184:105-111. [PMID: 28216259 DOI: 10.1016/j.imlet.2017.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/25/2017] [Accepted: 02/10/2017] [Indexed: 12/07/2022]
Abstract
OBJECTIVE Forkhead box P3 (FOXP3) is an essential and crucial transcription factor of regulatory T-cells. Genetic polymorphisms in the promoter region of FOXP3 gene may alter the gene expression level and, therefore, contribute to several autoimmune diseases susceptibility. We aimed to investigate the possible role of genetic variants of four SNPs (rs3761547, rs3761548, rs3761549 and rs2294021) and a (GT)n microsatellite located in FOXP3 gene in the susceptibility to Tunisian Pemphigus Foliaceus (PF). METHOD A case-control study was conducted on 98 patients with different clinical features of PF and 182 matched healthy controls using PCR-RFLP method. RESULTS According to the epidemio-demographic features of the disease, patients were classified into two groups: an endemic group (n=33, mean age=31 [18-48]) versus a sporadic one (n=65, mean age=36 [19-84]). In the whole population, rs3761548, rs3761549 and rs2294021 were associated with the susceptibility to PF. Interestingly, significant differences of gene distributions between the two sub-groups of patients were observed. In the endemic group, all associations observed in the whole population were maintained and reinforced and a new association was revealed with rs3761547; while in the sporadic group, only the association with rs3761549 was conserved. Further, the haplotype analysis showed that the G-A-C-15-C risk haplotype was significantly much more expressed in PF patients and specially in the endemic group. The phenotype-genotype correlation revealed that the rs3761548>AA genotype was significantly correlated with the severity of the disease including Nickolsky sign, generalized form of the disease and the earliest age onset. CONCLUSION These results underline the particular genetic background of the Tunisian endemic PF and suggest the implication of FOXP3 gene in the susceptibility and the clinical course of the disease.
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Affiliation(s)
- Mariem Ben Jmaa
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia.
| | - Olfa Abida
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia.
| | - Emna Bahloul
- Dermatology Department, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.
| | - Amina Toumi
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia; Emirates College of Technology, Abu Dhabi, United Arab Emirates.
| | - Sana Khlif
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia.
| | - Raouia Fakhfakh
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia.
| | - Nesrine Elloumi
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia.
| | - Khadija Sellami
- Dermatology Department, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.
| | - Abderrahmen Masmoudi
- Dermatology Department, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.
| | - Hamida Turki
- Dermatology Department, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.
| | - Hatem Masmoudi
- Immunology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia.
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Yoshida K, Ishii K, Shimizu A, Yokouchi M, Amagai M, Shiraishi K, Shirakata Y, Stanley JR, Ishiko A. Non-pathogenic pemphigus foliaceus (PF) IgG acts synergistically with a directly pathogenic PF IgG to increase blistering by p38MAPK-dependent desmoglein 1 clustering. J Dermatol Sci 2017; 85:197-207. [PMID: 28024684 DOI: 10.1016/j.jdermsci.2016.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/13/2016] [Accepted: 12/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pemphigus foliaceus (PF) is an autoimmune blistering disease caused by autoantibodies (Abs) against desmoglein 1 (Dsg1). PF sera contain polyclonal Abs which are heterogeneous mixture of both pathogenic and non-pathogenic Abs, as shown by isolation of monoclonal Abs (mAbs). OBJECTIVE To investigate how pathogenic and non-pathogenic anti-Dsg1 Abs contribute to blister formation in PF. METHODS Using organ-cultured human skin, we compared the effect of a single pathogenic anti-Dsg1 IgG mAb, a single non-pathogenic anti-Dsg1 IgG mAb, and their mixture on blister formation as analyzed by histology, subcellular localization of IgG deposits and desmosomal proteins by confocal microscopy, and desmosomal structure by electron microscopy. In addition, we measured keratinocyte adhesion by an in vitro dissociation assay. RESULTS 24h after injection, a single pathogenic anti-Dsg1 IgG caused a subcorneal blister with IgG and Dsg1 localized linearly on the cell surface of keratinocytes. A single non-pathogenic anti-Dsg1 IgG bound linearly on the keratinocytes but did not induce blisters. A pathogenic and a non-pathogenic IgG mAb injected together caused an aberrant granular pattern of IgG and Dsg1 in the lower epidermis with blister formation in the superficial epidermis. Electron microscopy demonstrated that the mixture of mAbs shortened desmosomal lengths more than a single mAb in the basal and spinous layers. Furthermore, although Dsg1 clustering required both cross-linking of Dsg1 molecules by the non-pathogenic IgG plus a pathogenic antibody, the latter could be in the form of a monovalent single chain variable fragment, suggesting that loss of trans-interaction of Dsg1 is required for clustering. Finally, a p38MAPK inhibitor blocked Dsg1 clustering. When pathogenic strength was measured by the dissociation assay, a mixture of pathogenic and non-pathogenic IgG mAbs disrupted keratinocyte adhesion more than a single pathogenic mAb. This pathogenic effect was only partially suppressed by the p38MAPK inhibitor. CONCLUSION These findings indicate that a polyclonal mixture of anti-Dsg1 IgG antibodies enhances pathogenic activity for blister formation associated with p38MAPK-dependent Dsg1 clustering and that not only pathogenic antibodies but also non-pathogenic antibodies coordinately contribute to blister formation in PF.
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Qian Y, Culton DA, Jeong JS, Trupiano N, Valenzuela JG, Diaz LA. Non-infectious environmental antigens as a trigger for the initiation of an autoimmune skin disease. Autoimmun Rev 2016; 15:923-30. [PMID: 27396816 DOI: 10.1016/j.autrev.2016.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022]
Abstract
Pemphigus represents a group of organ specific autoimmune blistering disorders of the skin mediated by pathogenic autoantibodies with well-defined antigenic targets. While most of these diseases are sporadic, endemic forms of disease do exist. The endemic form of pemphigus foliaceus (also known as fogo selvagem, FS) exhibits epidemiological features that suggest exposure to hematophagous insect bites are a possible precipitating factor of this autoimmune disease, and provides a unique opportunity to study how environmental factors contribute to autoimmune disease development. FS patients and healthy individuals from endemic regions show an autoreactive IgM response that starts in early childhood and becomes restricted to IgG4 autoantibodies in FS patients. In searching for triggering environmental antigens, we have found that IgG4 and IgE autoantibodies from FS patients cross-react with a salivary antigen from sand flies. The presence of these cross-reactive antibodies and antibody genetic analysis confirming that these antibodies evolve from the same naïve B cells provides compelling evidence that this non-infectious environmental antigen could be the initial target of the autoantibody response in FS. Consequently, FS serves as an ideal model to study the impact of environmental antigens in the development of autoimmune disease.
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Affiliation(s)
- Ye Qian
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Donna A Culton
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Joseph S Jeong
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nicole Trupiano
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jesus G Valenzuela
- Vector Molecular Biology Section, LMVR, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20852, USA
| | - Luis A Diaz
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Brochado MJF, Nascimento DF, Campos W, Deghaide NHS, Donadi EA, Roselino AM. Differential HLA class I and class II associations in pemphigus foliaceus and pemphigus vulgaris patients from a prevalent Southeastern Brazilian region. J Autoimmun 2016; 72:19-24. [PMID: 27178774 DOI: 10.1016/j.jaut.2016.04.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 04/23/2016] [Accepted: 04/24/2016] [Indexed: 12/22/2022]
Abstract
Genetic factors, particularly those concerning HLA class II, have been associated with the pathogenesis of pemphigus. Taking advantage of an area where pemphigus foliaceus (PF) and pemphigus vulgaris (PV) are prevalent in the northeastern region of the state of São Paulo, Southeastern Brazil, we have studied the HLA class I (A, B and C) and class II (DRB1 and DQA1/DQB1) profiles in 86 and 83 patients with PF and PV, respectively, as compared with 1592 controls from the same region. Among all the HLA alleles described herein, the more prevalent susceptibility alleles for PF were HLA-A*11, 33, -B*14; -DRB1*01:01, *01:02; -DQA1*01:02; and -DQB1*05:01. In PV patients, the HLA-B*38; -C*12; -DRB1*04:02, *08:04, *14:01, *14:04; -DQA1*03:01; and -DQB1*03:02 and *05:03 alleles were associated with susceptibility. The HLA-DRB1*01:02 allele and the HLA-DRB1*01-DQA1*01-DQB1*05 haplotype in PF patients and the HLA-DRB1*04:02 and *14:01 alleles and the HLA-DRB1*14-DQA1*01-DQB1*05 haplotype in PV patients were related with the highest etiologic fraction values. Distinct genetic patterns and not yet described HLA susceptibility/protection alleles/haplotypes profiles have been observed in this series. Our findings corroborate the differential genetic markers in PF and PV in an area where pemphigus is prevalent but not yet reported.
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Affiliation(s)
- Maria José Franco Brochado
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Daniela Francisca Nascimento
- Post-Graduate Clinical Medical Area, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Wagner Campos
- Laboratory of Biochemistry and Phytopathology, Biological Institute, São Paulo, São Paulo, Brazil
| | - Neifi Hassan Saloum Deghaide
- Division of Clinical Immunology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eduardo Antonio Donadi
- Division of Clinical Immunology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | - Ana Maria Roselino
- Division of Dermatology, Department of Clinical Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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Salathiel AM, Brochado MJF, Kim O, Deghaide NHS, Donadi EA, Roselino AM. Family study of monozygotic twins affected by pemphigus vulgaris. Hum Immunol 2016; 77:600-4. [PMID: 27177496 DOI: 10.1016/j.humimm.2016.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 12/21/2015] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
Rare are the family studies that include siblings affected by pemphigus vulgaris (PV) and in whom HLA class II alleles are related. HLA-DR and -DQ genotyping and profiling of antibodies against desmogleins (Dsg) 1 and Dsg3 were performed in ten members of a family including monozygotic twins affected by PV. The twin sisters were heterozygotes; they presented the haplotypes most commonly associated with increased susceptibility to PV (DRB1∗04:02-DQA1∗03:01-DQB1∗03:02 and DRB1∗14:04-DQA1∗01:01-DQB1∗05:03). Their parents and five siblings had only one or none of these two haplotypes in combination with the alleles or haplotypes associated with resistance to PV (DRB1∗07:01-DQA1∗02:01-DQB1∗02:02 and DRB1∗13:01-DQA1∗01:03-DQB1∗06:03). Only the monozygotic twins presented IgG antibodies against both Dsg1 and Dsg3. According to our knowledge based on a review of published literature on the topic, this is the first report of PV affecting monozygotic twins.
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Affiliation(s)
- Adriana Martinelli Salathiel
- Laboratory of Dermatology, University Hospital, Division of Dermatology, Department of Medical Clinics, Ribeirao Preto Medical School - University of Sao Paulo, Brazil
| | - Maria José Franco Brochado
- Laboratory of Dermatology, University Hospital, Division of Dermatology, Department of Medical Clinics, Ribeirao Preto Medical School - University of Sao Paulo, Brazil
| | - Olivia Kim
- Laboratory of Dermatology, University Hospital, Division of Dermatology, Department of Medical Clinics, Ribeirao Preto Medical School - University of Sao Paulo, Brazil
| | - Neifi Hassan Saloum Deghaide
- Laboratory of Immunogenetics of Blood Donor Center, Division of Immunology, Department of Medical Clinics, Ribeirao Preto Medical School - University of Sao Paulo, Brazil
| | - Eduardo Antonio Donadi
- Laboratory of Immunogenetics of Blood Donor Center, Division of Immunology, Department of Medical Clinics, Ribeirao Preto Medical School - University of Sao Paulo, Brazil
| | - Ana Maria Roselino
- Laboratory of Dermatology, University Hospital, Division of Dermatology, Department of Medical Clinics, Ribeirao Preto Medical School - University of Sao Paulo, Brazil.
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18
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Maderal AD, Miner A, Nousari C, Alonso-Llamazares J. Localized pemphigus foliaceus with unilateral facial involvement. Actas Dermosifiliogr 2014; 105:413-7. [PMID: 24784930 DOI: 10.1016/j.adengl.2013.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/10/2013] [Indexed: 11/22/2022] Open
Abstract
Pemphigus foliaceus is a superficial vesiculobullous disease that typically presents with widespread lesions. Localized presentations are less frequent, and they typically occur in middle-aged patients, following exposure to topical medications, and later on, become more disseminated. We present a case of a 19-year-old female with a localized presentation of pemphigus foliaceus unrelated to previous topical medications, that was a diagnostic and therapeutically challenging case. We also discuss the literature on localized cases, differences in presentations and responses to various treatment modalities.
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19
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Augusto DG, O'Connor GM, Lobo-Alves SC, Bass S, Martin MP, Carrington M, McVicar DW, Petzl-Erler ML. Pemphigus is associated with KIR3DL2 expression levels and provides evidence that KIR3DL2 may bind HLA-A3 and A11 in vivo. Eur J Immunol 2015; 45:2052-60. [PMID: 25867094 DOI: 10.1002/eji.201445324] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/03/2015] [Accepted: 04/09/2015] [Indexed: 12/18/2022]
Abstract
Although HLA-A3 and A11 have been reported to be ligands for KIR3DL2, evidence for any in vivo relevance of this interaction is still missing. To explore the functional importance of KIR3DL2 allelic variation, we analyzed the autoimmune disease pemphigus foliaceus, previously associated (lower risk) with activating KIR genes. KIR3DL2*001 was increased in patients (odds ratio (OR) = 2.04; p = 0.007). The risk was higher for the presence of both KIR3DL2*001 and HLA-A3 or A11 (OR = 3.76, p = 0.013), providing the first evidence that HLA-A3 and A11 may interact with KIR3DL2 in vivo. The nonsynonymous single nucleotide polymorphism 1190T (rs3745902) was associated with protection (OR = 0.52, p = 0.018). This SNP results in a threonine-to-methionine substitution. Individuals who have methionine in this position exhibit a lower percentage of KIR3DL2-positive natural killer (NK) cells and also lower intensity of KIR3DL2 on expressing natural killer cells; additionally, we show that the expression of KIR3DL2 is independent of other killer cell immunoglobulin-like receptors. Pemphigus foliaceus is a very unique complex disease strongly associated with immune-related genes. It is the only autoimmune disease known to be endemic, showing a strong correlation with environmental factors. Our data demonstrate that this relatively unknown autoimmune disease may facilitate understanding of the molecular mechanisms of KIR3DL2 ligand recognition.
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Affiliation(s)
- Danillo G Augusto
- Departamento de Genética, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA.,Leidos Biomedical Research, Cancer and Inflammation Program, Laboratory for Experimental Immunology, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Geraldine M O'Connor
- Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA
| | - Sara C Lobo-Alves
- Departamento de Genética, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Sara Bass
- Leidos Biomedical Research, Cancer and Inflammation Program, Laboratory for Experimental Immunology, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Maureen P Martin
- Leidos Biomedical Research, Cancer and Inflammation Program, Laboratory for Experimental Immunology, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Mary Carrington
- Ragon Institute of MGH, MIT and Harvard, Boston, MA, USA.,Leidos Biomedical Research, Cancer and Inflammation Program, Laboratory for Experimental Immunology, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Daniel W McVicar
- Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute, Frederick, MD, USA
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Lévy-Sitbon C, Reguiaï Z, Durlach A, Goeldel AL, Grange F, Bernard P. [Transition from pemphigus vulgaris to pemphigus foliaceus: a case report]. Ann Dermatol Venereol 2013; 140:788-92. [PMID: 24315225 DOI: 10.1016/j.annder.2013.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 05/28/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are the two main subtypes of auto-immune pemphigus, each having different clinical, histological and immunopathological features. We report the case of a patient initially with typical PV who relapsed within 2years, presenting clinically, histologically and immunologically typical PF. PATIENTS AND METHODS A 47-year old man presented in March 2008 with clinically, histologically and serologically typical PV and treated with systemic corticosteroids alone (prednisone: 1mg/kg per day) then combined with a cycle of rituximab, which resulted in complete remission. After discontinuation of therapy (duration: 26months), he relapsed 6 months later with PF presenting clinical, histological and serological characteristics typical of this condition. DISCUSSION This is a rare case of complete transition from PV to PF in clinical, histological and serological terms, and the first case occurring after initial treatment with rituximab.
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Affiliation(s)
- C Lévy-Sitbon
- Service de dermatologie, hôpital Robert-Debré, CHU, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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Kwon HH, Kwon IH, Chung JH, Youn JI. Pemphigus Foliaceus Associated with Psoriasis during the Course of Narrow-Band UVB Therapy: A Simple Coincidence? Ann Dermatol 2011; 23:S281-4. [PMID: 22346257 PMCID: PMC3276776 DOI: 10.5021/ad.2011.23.s3.s281] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 08/18/2010] [Accepted: 08/18/2010] [Indexed: 12/25/2022] Open
Abstract
Although psoriasis and bullous diseases are considered to be completely different disease entities, the literature has reported a few cases of psoriasis associated with bullous diseases, most of which are bullous pemphigoid. In limited cases, pemphigus foliaceus has also been reported in association with psoriasis. In most of them, pemphigus lesions usually developed on an untreated patient with a chronic history of psoriasis. Herein, we report a case of 53-year-old male with a chronic history of psoriasis who first developed generalized erosive lesions after 26 cycles of narrow-band ultraviolet B (NBUVB) therapy. A diagnosis of pemphigus foliaceus was made based on skin biopsy and direct immunofluorescence assay. Pemphigus lesions were well controlled with combination therapy of oral steroid and azathioprine. This is the first case where pemphigus foliaceus co-occurred with psoriasis during NBUVB therapy.
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Affiliation(s)
- Hyuck Hoon Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Abréu-Vélez AM, Roselino AM, Howard MS, Reason IJDM. Endemic pemphigus over a century: Part II. N Am J Med Sci 2010; 2:114-25. [PMID: 22624125 PMCID: PMC3354423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Endemic pemphigus foliaceus (EPF) is an autoimmune disease, classically occurring in a restricted geographic area. Foci of EPF have been described in several Central and South American countries, often affecting young people and Amerindians, with some female predilection. Although most American EPF cases have been documented in Brazil, cases have been reported in Peru, Paraguay, El Salvador and Venezuela. An additional variant of EPF has been described in El Bagre, Colombia, (El Bagre-EPF) affecting older men and a few post-menopausal females. Finally, one additional type of EPF has been described in nomadic tribes affecting females of child bearing age in Tunisia, Africa. AIMS The main aim of this review is to summarize current knowledge about autoantigens, and immunologic and genetic studies in EPF. MATERIAL AND METHODS We utilized a retrospective review of the literature, aiming to compile and compare the multiple geographic foci of EPF. RESULTS The primary autoantigens in EPF are still considered to be desmogleins in the case of the Tunisian and all American cases, in contradistinction to plakins and desmogleins in El Bagre-EPF. Although several autoantigens are been suggested, their biochemical nature needs further elucidation. Current knowledge still supports the concept that an antibody mediated immune response represents the principal pathophysiology in all variants of EPF. CONCLUSION A strong genetic susceptibility appears to contribute to disease development in several people affected by these diseases; however, no specific genes have been confirmed at present. We conclude that further investigation is necessary to define these disorders immunologically and genetically.
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Affiliation(s)
| | - Ana Maria Roselino
- Molecular Biology Laboratory, Division of Dermatology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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Abréu-Vélez AM, Reason IJDM, Howard MS, Roselino AM. Endemic pemphigus foliaceus over a century: Part I. N Am J Med Sci 2010; 2:51-9. [PMID: 22624115 PMCID: PMC3354435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endemic pemphigus foliaceus (EPF) is the only known autoimmune disease presenting in circumscribed geographic areas. AIM We aim to provide information concerning the natural course of EPF, including systemic compromise in the presteroid era, which has been largely unavailable in the current medical literature. MATERIAL #ENTITYSTARTX00026; METHODS By a retrospective review of the literature we aim to compile and compare the focus of EPF and the current knowledge about them. The main aim of this review is to summarize our current knowledge of EPF, including data described almost one century ago; and, to include several unindexed reports, which may have not been available to many current scientists and health care personnel. RESULTS Foci of EPF have been described in several Central American and South American countries, affecting predominately young people and Amerindians, with an additional female predilection. Although most cases have occurred in Brazil, some cases have been reported in Peru, Paraguay, El Salvador, and Venezuela. Another variant of EPF has been described in El Bagre, Colombia, affecting older men and a few post-menopausal females. Finally, another type of EPF was described in nomadic tribes affecting females of child bearing age in Tunisia, Africa. CONCLUSION Our understanding of EPF has been hampered by a lack of government attention to these diseases, especially in some South and Central American countries. Other factors that have made past studies of EPF difficult include 1) that the disease foci are often located in rural areas bordering the rain forest of underdeveloped countries; and 2) military conflicts in some of these areas.
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Affiliation(s)
| | | | | | - Ana Maria Roselino
- Georgia Dermatopathology Associates, Atlanta, Georgia, USA
- Molecular Biology Laboratory, Division of Dermatology, School of Medicine of Ribeirão Preto, University of São Paulo, Brazil
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