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Lei L, Feng S. Immune interplay from circulation to local lesion in pemphigus pathogenesis. J Autoimmun 2024; 147:103261. [PMID: 38797047 DOI: 10.1016/j.jaut.2024.103261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
Pemphigus, a potentially lethal autoimmune skin disease, is mediated by desmoglein-specific antibodies, manifesting cutaneous and mucosal blisters and erosions. The interaction between multiple immune counterparts contributes to the progress of pemphigus. Currently, the emergence of bioinformatic analysis enables investigators to gain a global picture of the pemphigus immune network, based on the exhaustive pedigree annotation of multiple subsets. T helper subsets dominate the landscape as mentioned previously, and innate immune cells have been involved as well. Of particular interests is which phenotype of T cells orchestrates the autoimmune process and chronic inflammation in a certain condition. In this review, the circulatory and peripheral immune cells and cytokine components constituting the immune microenvironment are separately discussed to provide a perspective on pemphigus pathogenesis, with particular reference to insights provided by the bioinformation technique.
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Affiliation(s)
- Li Lei
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - SuYing Feng
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
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Wang X, Huang C, Li W, Hong Y. Focus on pemphigus treatment publications: A bibliometric and visual analysis (1992-2022). Heliyon 2024; 10:e28462. [PMID: 38590872 PMCID: PMC10999929 DOI: 10.1016/j.heliyon.2024.e28462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024] Open
Abstract
Pemphigus is a chronic recurrent disease in dermatology. Although it is not very common, its treatment has been an increasing concern in recent years because it is difficult and long-lasting. At present, there are many papers on pemphigus treatment, and to better understand the research trends and research frontiers of pemphigus treatment, it is necessary to conduct a comprehensive systematic review and analysis. We combined bibliometric and visualization methods to analyze 1365 papers published in the Web of Science database from 1992 to 2022, including basic information about countries, institutions and authors, to gain a general understanding of the treatment of pemphigus. Among them, the United States is the country with the most output, Iran's Tehran University of Medical Sciences is the institution with the most published works, and Ahmed, A. Razzaque of Tufts University is the most influential scholar. In addition, we also learned about the research hotspots and frontiers of pemphigus treatment through a series of analyses on the frequency, clustering, keywords bursts and cited literature, and we briefly reviewed the highly cited literature. We found that the current research focuses in the study of pemphigus treatment are the types, pathogenesis, and treatment of pemphigus, including glucocorticoids, immunosuppressants and many other major treatment methods. Hailey-Hailey disease, genetic susceptibility, and traditional Chinese medicine are potential research hotspots. Rituximab is a research frontier. In conclusion, we hope to provide new research ideas for promoting the development of pemphigus treatment.
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Affiliation(s)
- Xiujing Wang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine. Shanghai University of Traditional Chinese Medicine, China
| | - Chaohong Huang
- Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, China
| | - Wenjie Li
- Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanlong Hong
- Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Combemale L, Bohelay G, Sitbon IY, Ahouach B, Alexandre M, Martin A, Pascal F, Soued I, Doan S, Morin F, Grootenboer-Mignot S, Caux F, Prost-Squarcioni C, Le Roux-Villet C. Lichen planus pemphigoides with predominant mucous membrane involvement: a series of 12 patients and a literature review. Front Immunol 2024; 15:1243566. [PMID: 38686381 PMCID: PMC11057232 DOI: 10.3389/fimmu.2024.1243566] [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: 06/20/2023] [Accepted: 03/12/2024] [Indexed: 05/02/2024] Open
Abstract
Background Lichen planus pemphigoides (LPP), an association between lichen planus and bullous pemphigoid lesions, is a rare subepithelial autoimmune bullous disease. Mucous membrane involvement has been reported previously; however, it has never been specifically studied. Methods We report on 12 cases of LPP with predominant or exclusive mucous membrane involvement. The diagnosis of LPP was based on the presence of lichenoid infiltrates in histology and immune deposits in the basement membrane zone in direct immunofluorescence and/or immunoelectron microscopy. Our systematic review of the literature, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, highlights the clinical and immunological characteristics of LPP, with or without mucous membrane involvement. Results Corticosteroids are the most frequently used treatment, with better outcomes in LPP with skin involvement alone than in that with mucous membrane involvement. Our results suggest that immunomodulators represent an alternative first-line treatment for patients with predominant mucous membrane involvement.
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Affiliation(s)
- Loraine Combemale
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Dermatology Department, Saint Pierre-Brugmann and Queen Fabiola Children’s University Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Gérôme Bohelay
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Ishaï-Yaacov Sitbon
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Btisseme Ahouach
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Marina Alexandre
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Antoine Martin
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Francis Pascal
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Isaac Soued
- Ear, Nose and Throat (ENT) Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Serge Doan
- Ophthalmology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Florence Morin
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Saint-Louis Hospital, Paris University, Paris, France
| | - Sabine Grootenboer-Mignot
- Immunology Department, Assistance Publique des Hôpitaux de Paris (APHP), Bichat Hospital, Paris University, Paris, France
| | - Frédéric Caux
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Pathology Department, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
- Histology Department, Sorbonne Paris Nord University, Bobigny, France
| | - Christelle Le Roux-Villet
- Dermatology Department, Referral Center for Autoimmune Blistering Diseases, Assistance Publique des Hôpitaux de Paris (APHP), Avicenne Hospital and Sorbonne Paris Nord University, Bobigny, France
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Tedbirt B, Maho-Vaillant M, Houivet E, Mignard C, Golinski ML, Calbo S, Prost-Squarcioni C, Labeille B, Picard-Dahan C, Chaby G, Richard MA, Tancrede-Bohin E, Duvert-Lehembre S, Delaporte E, Bernard P, Caux F, Alexandre M, Musette P, Ingen-Housz-Oro S, Vabres P, Quereux G, Dupuy A, Debarbieux S, Avenel-Audran M, D’Incan M, Bédane C, Bénéton N, Jullien D, Dupin N, Misery L, Machet L, Beylot-Barry M, Dereure O, Sassolas B, Benichou J, Joly P, Hébert V. Sustained Remission Without Corticosteroids Among Patients With Pemphigus Who Had Rituximab as First-Line Therapy: Follow-Up of the Ritux 3 Trial. JAMA Dermatol 2024; 160:290-296. [PMID: 38265821 PMCID: PMC10809134 DOI: 10.1001/jamadermatol.2023.5679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
Importance The Ritux 3 trial demonstrated the short-term efficacy and safety of first-line treatment with rituximab compared with a standard corticosteroid regimen in pemphigus. No data on the long-term follow-up of patients who received rituximab as first line are available. Objective To assess the long-term efficacy and safety of the Ritux 3 treatment regimen. Design, Setting, and Participants This 7-year follow-up study of the Ritux 3 trial included patients with pemphigus from 25 dermatology departments in France from January 1, 2010, to December 31, 2015. Exposure Patients were initially randomized in the rituximab plus prednisone group or prednisone-alone group. Main outcomes and measures The primary outcome was the 5- and 7-year disease-free survival (DFS) without corticosteroids, assessed by Kaplan-Meier curves. Secondary outcomes were occurrence of relapse, occurrence of severe adverse events (SAEs), and evolution of antidesmoglein (Dsg) antibody enzyme-linked immunosorbent assay values to predict long-term relapse. Results Of the 90 patients in the Ritux 3 trial, 83 were evaluated at the end of follow-up study visit (44 in the rituximab plus prednisone group; 39 in the prednisone-alone group) with a median (IQR) follow-up of 87.3 (79.1-97.5) months. Forty-three patients (93%) from the rituximab plus prednisone and 17 patients (39%) from the prednisone-alone group had achieved complete remission without corticosteroids at any time during the follow-up. Patients from the rituximab group had much longer 5- and 7-year DFS without corticosteroids than patients from the prednisone-alone group (76.7% and 72.1% vs 35.3% and 35.3%, respectively; P < .001), and had about half the relapses (42.2% vs 83.7%; P < .001). Patients who received rituximab as second-line treatment had shorter DFS than patients treated as first line (P = .007). Fewer SAEs were reported in the rituximab plus prednisone group compared with the prednisone-alone group, 31 vs 58 respectively, corresponding to 0.67 and 1.32 SAEs per patient, respectively (P = .003). The combination of anti-Dsg1 values of 20 or more IU/mL and/or anti-Dsg3 values of 48 or more IU/mL yielded 0.83 positive predictive value and 0.94 negative predictive value to predict long-term relapse. Conclusions and Relevance In this secondary analysis of the Ritux 3 trail, first-line treatment of patients with pemphigus with the Ritux 3 regimen was associated with long-term sustained complete remission without corticosteroid therapy without any additional maintenance infusion of rituximab.
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Affiliation(s)
- Billal Tedbirt
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Maud Maho-Vaillant
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics and Clinical Research, CHU Rouen, Rouen, France
| | - Claire Mignard
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Marie-Laure Golinski
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Sébastien Calbo
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Catherine Prost-Squarcioni
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Bruno Labeille
- Department of Dermatology, University of Saint-Étienne, Saint-Étienne, France
| | | | - Guillaume Chaby
- Department of Dermatology, University of Amiens, Amiens, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Centre in Health Services and Quality of Life Aix Marseille University, Dermatology Department, Universitaire Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, 13385, Marseille, France
| | | | | | | | | | - Frédéric Caux
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Marina Alexandre
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Philippe Musette
- Department of Dermatology, Centre de référence des maladies bulleuses auto-immunes, Avicenne Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris 13, Bobigny, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Univ Paris Est Créteil EpiDermE, Créteil, France
| | - Pierre Vabres
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Gaëlle Quereux
- Department of Dermatology, University of Nantes, Nantes, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | - Sébastien Debarbieux
- Department of Dermatology, Centre Hospitalier Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Michel D’Incan
- Department of Dermatology, University of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Nathalie Bénéton
- Department of Dermatology, Le Mans General Hospital, Le Mans, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Lyon Claude Bernard University, Lyon, France
| | - Nicolas Dupin
- Department of Dermatology, APHP and University of Paris cité, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | | | - Olivier Dereure
- Department of Dermatology, University of Montpellier, Montpellier, France
| | - Bruno Sassolas
- Department of Internal Medicine, Brest University Hospital, Brest, France
| | - Jacques Benichou
- Department of Biostatistics and Clinical Research, CHU Rouen and Inserm U1018, Université Paris-Saclay and Université de Rouen, Rouen, France
| | - Pascal Joly
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
| | - Vivien Hébert
- Department of Dermatology, CHU Rouen and INSERM U1234, Normandie University, Rouen, France
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Spałek MM, Jałowska M, Bowszyc-Dmochowska M, Dmochowski M. Rituximab in the Management of Autoimmune Bullous Diseases: A Treatment-Resistant Case Series from a Single Central European Referral Center. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:270. [PMID: 38399557 PMCID: PMC10890531 DOI: 10.3390/medicina60020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/28/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Rituximab (RTX) has been the predominant treatment for autoimmune bullous diseases (AIBDs). The objective of this research was to assess the advantages and safety characteristics of RTX treatment in individuals with AIBD. This assessment focused on clinical remission and a reduction in glucocorticosteroid usage, its effect on the titers of autoantibodies targeting desmoglein-1 (DSG-1) and desmoglein-3 (DSG-3), and adverse occurrences during a 12-month follow-up period in a dermatology department within a Central European university context. Materials and Methods: Our case series involved eleven patients, including eight patients with pemphigus vulgaris, two with pemphigus foliaceus, and one with epidermolysis bullosa acquisita. They received a 1 g dose of rituximab, repeated over a two-week interval. Results: The reduction in a prednisone-equivalent dosage after 2, 6, and 12 months following the second RTX infusion was 65.05%, 73.99%, and 76.93%, in that order. The titers of antibodies against DSG-1 exhibited reductions of 43.29%, 75.86%, and 54.02% at 2, 6, and 12 months, respectively. By contrast, the antibody concentrations targeting DSG-3 displayed a decrease of 27.88%, 14.48%, and 5.09% at the corresponding time points. Over the course of the 12-month monitoring period, 18.18% of patients experienced disease relapse, while the remaining individuals achieved either complete or partial remission with minimal or no therapy. Adverse effects were noted in 36.36% of the patient population; they were mild, and no serious adverse effects were reported. Conclusions: RTX represents an efficacious and well-tolerated therapeutic option for the management of AIBD and merits consideration in cases of refractory AIBD. However, further research is imperative to delineate the most optimal dosage, dosing frequency, and total quantity of maintenance infusions required. Additionally, there is a compelling need for studies that explore the impact of RTX on individuals with AIBD who do not exhibit a significant reduction in anti-desmoglein autoantibody levels.
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Affiliation(s)
- Maciej Marek Spałek
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (M.M.S.); (M.J.)
| | - Magdalena Jałowska
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (M.M.S.); (M.J.)
| | - Monika Bowszyc-Dmochowska
- Cutaneous Histopathology and Immunopathology Section, Department of Dermatology, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | - Marian Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (M.M.S.); (M.J.)
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Huang Y, Liu J, Liang D. Comprehensive analysis reveals key genes and environmental toxin exposures underlying treatment response in ulcerative colitis based on in-silico analysis and Mendelian randomization. Aging (Albany NY) 2023; 15:14141-14171. [PMID: 38059894 PMCID: PMC10756092 DOI: 10.18632/aging.205294] [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: 07/24/2023] [Accepted: 11/03/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND UC is increasingly prevalent worldwide and represents a significant global disease burden. Although medical therapeutics are employed, they often fall short of being optimal, leaving patients struggling with treatment non-responsiveness and many related complications. MATERIALS AND METHODS The study utilized gene microarray data and clinical information from GEO. Gene enrichment and differential expression analyses were conducted using Metascape and Limma, respectively. Lasso Regression Algorithm was constructed using glmnet and heat maps were generated using pheatmap. ROC curves were used to assess diagnostic parameter capability, while XSum was employed to screen for small-molecule drugs exacerbating UC. Molecular docking was carried out using Autodock Vina. The study also performed Mendelian randomization analysis based on TwoSampleMR and used CTD to investigate the relationship between exposure to environmental chemical toxicants and UC therapy responsiveness. RESULTS Six genes (ELL2, DAPP1, SAMD9L, CD38, IGSF6, and LYN) were found to be significantly overexpressed in UC patient samples that did not respond to multiple therapies. Lasso analysis identified ELL2 and DAPP1 as key genes influencing UC treatment response. Both genes accurately predicted intestinal inflammation in UC and impacted the immunological infiltration status. Clofibrate showed therapeutic potential for UC by binding to ELL2 and DAPP1 proteins. The study also reviews environmental toxins and drug exposures that could impact UC progression. CONCLUSIONS We used microarray technology to identify DAPP1 and ELL2 as key genes that impact UC treatment response and inflammatory progression. Clofibrate was identified as a promising UC treatment. Our review also highlights the impact of environmental toxins on UC treatment response, providing valuable insights for personalized clinical management.
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Affiliation(s)
- Yizhou Huang
- Department of Gastroenterology, The PLA Navy Anqing Hospital, Anqing 246000, Anhui Province, China
| | - Jie Liu
- Department of Gastroenterology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, Anhui Province, China
| | - Dingbao Liang
- Department of Gastroenterology, The PLA Navy Anqing Hospital, Anqing 246000, Anhui Province, China
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Iriki H, Takahashi H, Amagai M. Diverse Role of OX40 on T Cells as a Therapeutic Target for Skin Diseases. J Invest Dermatol 2023; 143:545-553. [PMID: 36842860 DOI: 10.1016/j.jid.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 02/26/2023]
Abstract
OX40 is an important costimulatory molecule for T-cell expansion and survival. Because OX40 is expressed on most T-cell subsets, it is an attractive therapeutic target for a variety of T-cell‒mediated diseases. Clinical trials are already underway for some skin inflammatory diseases. In this review, we present various observations that improve our understanding of how OX40-targeted therapy can be applied for skin inflammatory diseases, such as atopic dermatitis and psoriasis, T helper (Th)2- and Th17-mediated diseases, respectively. The important OX40/OX40L-mediated interaction between T cells and other immune cells is also discussed in terms of skin autoimmune diseases, such as alopecia areata and pemphigus. Regulatory T cells (Tregs) highly express OX40, and the skin harbors a large Treg population; thus, understanding how OX40-targeted treatment acts on Tregs is vital for the development of therapeutic strategies for various skin diseases.
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Affiliation(s)
- Hisato Iriki
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan; Laboratory for Skin Homeostasis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.
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Takahashi H, Iriki H, Asahina Y. T cell autoimmunity and immune regulation to desmoglein 3, a pemphigus autoantigen. J Dermatol 2023; 50:112-123. [PMID: 36539957 PMCID: PMC10107879 DOI: 10.1111/1346-8138.16663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
Pemphigus is a life-threatening autoimmune bullous disease mediated by anti-desmoglein IgG autoantibodies. Pemphigus is mainly classified into three subtypes: pemphigus vulgaris, pemphigus foliaceus, and paraneoplastic pemphigus. The pathogenicity of autoantibodies has been extensively studied. Anti-human CD20 antibody therapy targeting B cells emerged as a more effective treatment option compared to conventional therapy for patients with an intractable disease. On the other hand, autoreactive T cells are considered to be involved in the pathogenesis based on the test results of human leukocyte antigen association, autoreactive T cell detection, and cytokine profile analysis. Research on the role of T cells in pemphigus has continued to progress, including that on T follicular helper cells, which initiate molecular mechanisms involved in antibody production in B cells. Autoreactive T cell research in mice has highlighted the crucial roles of cellular autoimmunity and improved the understanding of its pathogenesis, especially in paraneoplastic pemphigus. The mouse research has helped elucidate novel regulatory mechanisms of autoreactive T cells, such as thymic tolerance to desmoglein 3 and the essential roles of regulatory T cells, Langerhans cells, and other molecules in peripheral tissues. This review focuses on the immunological aspects of autoreactive T cells in pemphigus by providing detailed information on various related topics.
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Affiliation(s)
- Hayato Takahashi
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Hisato Iriki
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuhiko Asahina
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Font G, Walet-Balieu ML, Petit M, Burel C, Maho-Vaillant M, Hébert V, Chan P, Fréret M, Boyer O, Joly P, Calbo S, Bardor M, Golinski ML. IgG N-Glycosylation from Patients with Pemphigus Treated with Rituximab. Biomedicines 2022; 10:biomedicines10081774. [PMID: 35892674 PMCID: PMC9330150 DOI: 10.3390/biomedicines10081774] [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: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
Pemphigus is a life-threatening auto-immune blistering disease of the skin and mucous membrane that is caused by the production of auto-antibodies (auto-Abs) directed against adhesion proteins: desmoglein 1 and 3. We demonstrated in the “Ritux3” trial, the high efficacy of rituximab, an anti-CD20 recombinant monoclonal antibody, as the first-line treatment for pemphigus. However, 25% of patients relapsed during the six-month period after rituximab treatment. These early relapses were associated with a lower decrease in anti-desmoglein auto-Abs after the initial cycle of rituximab. The N-glycosylation of immunoglobulin-G (IgG) can affect their affinity for Fc receptors and their serum half-life. We hypothesized that the extended half-life of Abs could be related to modifications of IgG N-glycans. The IgG N-glycome from pemphigus patients and its evolution under rituximab treatment were analyzed. Pemphigus patients presented a different IgG N-glycome than healthy donors, with less galactosylated, sialylated N-glycans, as well as a lower level of N-glycans bearing an additional N-acetylglucosamine. IgG N-glycome from patients who achieved clinical remission was not different to the one observed at baseline. Moreover, our study did not identify the N-glycans profile as discriminating between relapsing and non-relapsing patients. We report that pemphigus patients present a specific IgG N-glycome. The changes observed in these patients could be a biomarker of autoimmunity susceptibility rather than a sign of inflammation.
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Affiliation(s)
- Guillaume Font
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Marie-Laure Walet-Balieu
- Université de Rouen Normandie, Laboratoire Glyco-MEV UR 4358, SFR Normandie Végétal FED 4277, Innovation Chimie Carnot, F-76000 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
| | - Marie Petit
- Université de Rouen Normandie, Inserm U1234, F-76000 Rouen, France; (M.P.); (S.C.)
| | - Carole Burel
- Université de Rouen Normandie, Laboratoire Glyco-MEV UR 4358, SFR Normandie Végétal FED 4277, Innovation Chimie Carnot, F-76000 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
| | - Maud Maho-Vaillant
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Vivien Hébert
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Philippe Chan
- Université de Rouen Normandie, INSERM US 51, CNRS UAR 2026, HeRacLeS-PISSARO, Normandie Université, F-76000 Rouen, France;
| | - Manuel Fréret
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Rhumatology, F-76000 Rouen, France;
| | - Olivier Boyer
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Immunology and Biotherapy, F-76000 Rouen, France;
| | - Pascal Joly
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
| | - Sébastien Calbo
- Université de Rouen Normandie, Inserm U1234, F-76000 Rouen, France; (M.P.); (S.C.)
| | - Muriel Bardor
- Université de Rouen Normandie, Laboratoire Glyco-MEV UR 4358, SFR Normandie Végétal FED 4277, Innovation Chimie Carnot, F-76000 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
- Université de Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, F-59000 Lille, France
| | - Marie-Laure Golinski
- Université de Rouen Normandie, Inserm U1234, CHU Rouen, Department of Dermatology, F-76000 Rouen, France; (G.F.); (M.M.-V.); (V.H.); (P.J.)
- Correspondence: ; Tel.: +33-2-35-14-83-49
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10
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Maho-Vaillant M, Sips M, Golinski ML, Vidarsson G, Goebeler M, Stoevesandt J, Bata-Csörgő Z, Balbino B, Verheesen P, Joly P, Hertl M, Calbo S. FcRn Antagonism Leads to a Decrease of Desmoglein-Specific B Cells: Secondary Analysis of a Phase 2 Study of Efgartigimod in Pemphigus Vulgaris and Pemphigus Foliaceus. Front Immunol 2022; 13:863095. [PMID: 35663943 PMCID: PMC9157593 DOI: 10.3389/fimmu.2022.863095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Background Immunoglobulin G (IgG) levels are maintained by the IgG-recycling neonatal Fc-receptor (FcRn). Pemphigus vulgaris and pemphigus foliaceus are debilitating autoimmune disorders triggered by IgG autoantibodies against mucosal and epidermal desmogleins. Recently, a phase 2 clinical trial (NCT03334058; https://clinicaltrials.gov/NCT03334058) was completed in participants with pemphigus using efgartigimod, an FcRn inhibitor, in combination with prednisone. Efgartigimod demonstrated an early effect on diease activity and was well tolerated. In addition to the safety and efficacy assessment, clinical trials present an opportunity to gain more insights into the mechanism of disease, the mode of action of treatment, and potential for corticosteroid-sparing activity. Objective The aim of our study was to assess the impact of FcRn antagonism by efgartigimod on immunological parameters known to be directly involved in pemphigus pathology, such as cellular and serological responses. Methods We investigated total and antigen-specific IgG subclass level kinetics during and after treatment, assessed antigen-specific B-cell responses, followed T- and B-cell immunophenotypes, and analyzed how different immunophenotypes link to clinical response. Results Treatment resulted in reduction of total IgG as well as autoreactive IgG antibody levels. Surprisingly, unlike total IgG and vaccine- or natural-infection-elicited IgG, which returned to baseline levels after stopping efgartigimod treatment, autoreactive antibody levels remained low in several study participants. Efgartigimod showed no effect on total leukocytes, neutrophils, monocytes, or lymphocytes in patients treated with extended efgartigimod therapy. Intriguingly, antigen-specific analyses revealed a loss of desmoglein-specific B cells in several participants responding to efgartigimod, in line with prolonged reduction of pathogenic IgG levels. Conclusions Efgartigimod treatment of participants with pemphigus improved their conditions and exerted an immunomodulatory effect beyond the blockade of IgG recycling. Further studies in larger populations with an appropriate placebo control are needed to confirm these potentially important observations to establish long-term clinical responses in autoimmune diseases.
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Affiliation(s)
- Maud Maho-Vaillant
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM U1234, Normandie University, Rouen, France
| | | | - Marie-Laure Golinski
- Department of Dermatology, Rouen University Hospital, Rouen, France
- INSERM U1234, Normandie University, Rouen, France
| | - Gestur Vidarsson
- Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Johanna Stoevesandt
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Pascal Joly
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps-Universität Marburg, Marburg, Germany
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11
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Huang ZX, Qu P, Wang KK, Zheng J, Pan M, Zhu HQ. Transcriptomic profiling of pemphigus lesion infiltrating mononuclear cells reveals a distinct local immune microenvironment and novel lncRNA regulators. J Transl Med 2022; 20:182. [PMID: 35449056 PMCID: PMC9027862 DOI: 10.1186/s12967-022-03387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/09/2022] [Indexed: 12/07/2022] Open
Abstract
Pemphigus is an autoimmune skin disease. Ectopic lymphoid-like structures (ELSs) were found to be commonly present in the pemphigus lesions, presumably supporting in situ desmoglein (Dsg)-specific antibody production. Yet functional phenotypes and the regulators of Lymphoid aggregates in pemphigus lesions remain largely unknown. Herein, we used microarray technology to profile the gene expression in skin lesion infiltrating mononuclear cells (SIMC) from pemphigus patients. On top of that, we compared SIMC dataset to peripheral blood mononuclear cells (PBMC) dataset to characterize the unique role of SIMC. Functional enrichment results showed that mononuclear cells in skin lesions and peripheral blood both had over-represented IL-17 signaling pathways while neither was characterized by an activation of type I Interferon signaling pathways. Cell-type identification with relative subsets of known RNA transcripts (CIBERSORT) results showed that naïve natural killer cells (NK cells) were significantly more abundant in pemphigus lesions, and their relative abundance positively correlated with B cells abundance. Meanwhile, plasma cells population highly correlated with type 1 macrophages (M1) abundance. In addition, we also identified a lncRNA LINC01588 which might epigenetically regulate T helper 17 cells (Th17)/regulatory T cells (Treg) balance via the peroxisome proliferator-activated receptor (PPAR) signaling pathway. Here, we provide the first transcriptomic characterization of lesion infiltrating immune cells which illustrates a distinct interplay network between adaptive and innate immune cells. It helps discover new regulators of local immune response, which potentially will provide a novel path forward to further uncover pemphigus pathological mechanisms and develop targeted therapy.
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Affiliation(s)
- Zi-Xuan Huang
- Department of Dermatology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Peng Qu
- Department of Dermatology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Kan-Kan Wang
- Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jie Zheng
- Department of Dermatology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Meng Pan
- Department of Dermatology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Hai-Qin Zhu
- Department of Dermatology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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12
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Golinski ML, Lemieux A, Maho-Vaillant M, Barray M, Drouot L, Schapman D, Petit M, Hertl M, Boyer O, Calbo S, Joly P, Hébert V. The Diversity of Serum Anti-DSG3 IgG Subclasses Has a Major Impact on Pemphigus Activity and Is Predictive of Relapses After Treatment With Rituximab. Front Immunol 2022; 13:849790. [PMID: 35371083 PMCID: PMC8965561 DOI: 10.3389/fimmu.2022.849790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction We studied the distribution and in vitro pathogenicity of anti-DSG3 IgG subclasses during the course of pemphigus vulgaris (PV). Methods We longitudinally studied the distribution of anti-DSG3 IgG subclasses (before versus after treatment) in sera from PV patients, using an addressable-laser bead immunoassay (ALBIA). The in vitro pathogenicity of corresponding sera was tested using keratinocyte dissociation and immunofluorescence assays. Results Sixty-five sera were assessed at baseline (33 from patients treated with rituximab and 32 with corticosteroids). Sixty-three percent of these baseline sera contained 2 or more anti-DSG3 IgG subclasses versus 35.7% of sera from patients in complete remission (CR) and 75.0% of sera from patients with persistent disease activity after treatment. IgG4 was the most frequently detected anti-DSG3 IgG subclass, both in patients with disease activity and in those in CR. The presence of three or more anti-DSG3 IgG subclasses was predictive of relapse, in particular when it included IgG3, with a positive predictive value of 62.5% and a negative predictive value of 92%. While anti-DSG3 IgG4 Abs from sera collected before treatment were most often pathogenic, anti-DSG3 IgG4 from sera collected after treatment were pathogenic only after adjusting their titer to the one measured before treatment. The IgG3 fraction containing anti-DSG3 Abs also had an in vitro pathogenic effect. The disappearance of the pathogenic effect of some sera after removal of anti-DSG3 IgG3 suggested an additional effect of this IgG subclass. Conclusion The serum levels and number of anti-DSG3 IgG subclasses drive the pathogenic effect of pemphigus sera and may predict the occurrence of relapses.
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Affiliation(s)
- Marie-Laure Golinski
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Alexandre Lemieux
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Maud Maho-Vaillant
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Marion Barray
- Normandie Univ, UNIROUEN, Inserm U1234, Rouen, France
| | | | | | - Marie Petit
- Normandie Univ, UNIROUEN, Inserm U1234, Rouen, France
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Olivier Boyer
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Immunology, Rouen, France
| | | | - Pascal Joly
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
| | - Vivien Hébert
- Normandie Univ, UNIROUEN, Inserm U1234, CHU Rouen, Department of Dermatology, Rouen, France
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13
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Lim YL, Bohelay G, Hanakawa S, Musette P, Janela B. Autoimmune Pemphigus: Latest Advances and Emerging Therapies. Front Mol Biosci 2022; 8:808536. [PMID: 35187073 PMCID: PMC8855930 DOI: 10.3389/fmolb.2021.808536] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022] Open
Abstract
Pemphigus represents a group of rare and severe autoimmune intra-epidermal blistering diseases affecting the skin and mucous membranes. These painful and debilitating diseases are driven by the production of autoantibodies that are mainly directed against the desmosomal adhesion proteins, desmoglein 3 (Dsg3) and desmoglein 1 (Dsg1). The search to define underlying triggers for anti-Dsg-antibody production has revealed genetic, environmental, and possible vaccine-driven factors, but our knowledge of the processes underlying disease initiation and pathology remains incomplete. Recent studies point to an important role of T cells in supporting auto-antibody production; yet the involvement of the myeloid compartment remains unexplored. Clinical management of pemphigus is beginning to move away from broad-spectrum immunosuppression and towards B-cell-targeted therapies, which reduce many patients’ symptoms but can have significant side effects. Here, we review the latest developments in our understanding of the predisposing factors/conditions of pemphigus, the underlying pathogenic mechanisms, and new and emerging therapies to treat these devastating diseases.
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Affiliation(s)
- Yen Loo Lim
- Department of Dermatology, National Skin Centre, Singapore
| | - Gerome Bohelay
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Sho Hanakawa
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Philippe Musette
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Baptiste Janela
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore
- Singapore Immunology network, Agency for Science, Technology and Research (A*STAR), Singapore
- *Correspondence: Baptiste Janela,
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14
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Petit M, Walet-Balieu ML, Schapman D, Golinski ML, Burel C, Barray M, Drouot L, Maho-Vaillant M, Hébert V, Boyer O, Bardor M, Joly P, Calbo S. Longitudinal Pathogenic Properties and N-Glycosylation Profile of Antibodies from Patients with Pemphigus after Corticosteroid Treatment. Biomedicines 2021; 9:biomedicines9101411. [PMID: 34680528 PMCID: PMC8533488 DOI: 10.3390/biomedicines9101411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Pemphigus vulgaris is an autoimmune disease that occurs due to pathogenic autoantibodies that recognize the following epidermal adhesion proteins: desmogleins. Systemic corticosteroids usually decrease the titers of anti-desmoglein autoantibodies and improve patients’ conditions. Since modifications of IgG N-glycosylation have been described in some autoimmune diseases, we hypothesized that changes in the pathogenic activity of pemphigus IgG could be related to changes in their N-glycosylation profile. The purpose of this study was to assess, longitudinally, the pathogenicity of pemphigus serum IgG and their N-glycosylation profile during phases of disease activity and clinical remission. The pathogenic activity of serum IgG was measured in vitro on immortalized keratinocytes, by immunofluorescence and dissociation assays, and IgG N-glycans were analyzed by mass spectrometry. We showed (i) a correlation between pemphigus clinical activity and the pathogenicity of serum IgG at baseline and at month 6, while the persistence of the in vitro pathogenic activity of IgG during its evolution, even in patients in clinical remission, seemed to be predictive of relapse; (ii) that modifications of the N-glycan structure were altered the in vitro pathogenicity of patients’ autoantibodies; (iii) that the pathogenic properties of pemphigus IgG did not appear to be related to the disparity in IgG N-glycans during the course of pemphigus.
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Affiliation(s)
- Marie Petit
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
| | - Marie-Laure Walet-Balieu
- EA4358, Laboratoire Glycobiologie et Matrice Extracellulaire Végétale (Glyco-MEV), Normandie University, 76821 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
| | | | - Marie-Laure Golinski
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
- Dermatology Department, Rouen University Hospital, Normandie University, 76000 Rouen, France
| | - Carole Burel
- EA4358, Laboratoire Glycobiologie et Matrice Extracellulaire Végétale (Glyco-MEV), Normandie University, 76821 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
| | - Marion Barray
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
| | - Laurent Drouot
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
| | - Maud Maho-Vaillant
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
- Dermatology Department, Rouen University Hospital, Normandie University, 76000 Rouen, France
| | - Vivien Hébert
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
- Dermatology Department, Rouen University Hospital, Normandie University, 76000 Rouen, France
| | - Olivier Boyer
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
| | - Muriel Bardor
- EA4358, Laboratoire Glycobiologie et Matrice Extracellulaire Végétale (Glyco-MEV), Normandie University, 76821 Rouen, France; (M.-L.W.-B.); (C.B.); (M.B.)
- CNRS UMR 8576, Unité de Glycobiologie Structurale et Fonctionnelle, University of Lille, 59000 Lille, France
| | - Pascal Joly
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
- Dermatology Department, Rouen University Hospital, Normandie University, 76000 Rouen, France
| | - Sébastien Calbo
- INSERM U1234, Normandie University, 76000 Rouen, France; (M.P.); (M.-L.G.); (M.B.); (L.D.); (M.M.-V.); (V.H.); (O.B.); (P.J.)
- Correspondence: ; Tel.: +33-2-3514-8557
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15
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Schmitt T, Waschke J. Autoantibody-Specific Signalling in Pemphigus. Front Med (Lausanne) 2021; 8:701809. [PMID: 34434944 PMCID: PMC8381052 DOI: 10.3389/fmed.2021.701809] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/08/2021] [Indexed: 12/11/2022] Open
Abstract
Pemphigus is a severe autoimmune disease impairing barrier functions of epidermis and mucosa. Autoantibodies primarily target the desmosomal adhesion molecules desmoglein (Dsg) 1 and Dsg 3 and induce loss of desmosomal adhesion. Strikingly, autoantibody profiles in pemphigus correlate with clinical phenotypes. Mucosal-dominant pemphigus vulgaris (PV) is characterised by autoantibodies (PV-IgG) against Dsg3 whereas epidermal blistering in PV and pemphigus foliaceus (PF) is associated with autoantibodies against Dsg1. Therapy in pemphigus is evolving towards specific suppression of autoantibody formation and autoantibody depletion. Nevertheless, during the acute phase and relapses of the disease additional treatment options to stabilise desmosomes and thereby rescue keratinocyte adhesion would be beneficial. Therefore, the mechanisms by which autoantibodies interfere with adhesion of desmosomes need to be characterised in detail. Besides direct inhibition of Dsg adhesion, autoantibodies engage signalling pathways interfering with different steps of desmosome turn-over. With this respect, recent data indicate that autoantibodies induce separate signalling responses in keratinocytes via specific signalling complexes organised by Dsg1 and Dsg3 which transfer the signal of autoantibody binding into the cell. This hypothesis may also explain the different clinical pemphigus phenotypes.
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Affiliation(s)
- Thomas Schmitt
- Ludwig-Maximilian-Universität München, Anatomische Anstalt, Lehrstuhl Anatomie I - Vegetative Anatomie, Munich, Germany
| | - Jens Waschke
- Ludwig-Maximilian-Universität München, Anatomische Anstalt, Lehrstuhl Anatomie I - Vegetative Anatomie, Munich, Germany
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