1
|
Gross N, Marketon J, Mousavi S, Kalies K, Ludwig RJ, Bieber K. Inhibition of interferon gamma impairs induction of experimental epidermolysis bullosa acquisita. Front Immunol 2024; 15:1343299. [PMID: 38799441 PMCID: PMC11116581 DOI: 10.3389/fimmu.2024.1343299] [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: 11/23/2023] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is a muco-cutaneous autoimmune disease characterized and caused by autoantibodies targeting type VII collagen (COL7). The treatment of EBA is notoriously difficult, with a median time to remission of 9 months. In preclinical EBA models, we previously discovered that depletion of regulatory T cells (Treg) enhances autoantibody-induced, neutrophil-mediated inflammation and blistering. Increased EBA severity in Treg-depleted mice was accompanied by an increased cutaneous expression of interferon gamma (IFN-γ). The functional relevance of IFN-γ in EBA pathogenesis had been unknown. Given that emapalumab, an anti-IFN-γ antibody, is approved for primary hemophagocytic lymphohistiocytosis patients, we sought to assess the therapeutic potential of IFN-γ inhibition in EBA. Specifically, we evaluated if IFN-γ inhibition has modulatory effects on skin inflammation in a pre-clinical EBA model, based on the transfer of COL7 antibodies into mice. Compared to isotype control antibody, anti-IFN-γ treatment significantly reduced clinical disease manifestation in experimental EBA. Clinical improvement was associated with a reduced dermal infiltrate, especially Ly6G+ neutrophils. On the molecular level, we noted few changes. Apart from reduced CXCL1 serum concentrations, which has been demonstrated to promote skin inflammation in EBA, the expression of cytokines was unaltered in the serum and skin following IFN-γ blockade. This validates IFN-γ as a potential therapeutic target in EBA, and possibly other diseases with a similar pathogenesis, such as bullous pemphigoid and mucous membrane pemphigoid.
Collapse
Affiliation(s)
- Natalie Gross
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Jana Marketon
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Sadegh Mousavi
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Kathrin Kalies
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University Hospital Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
2
|
Zhang A, Yang Z, Huang T, Wang M. Causal association between psoriasis vulgaris and bullous pemphigoid: a two-sample bidirectional Mendelian randomization study. Front Immunol 2024; 15:1365118. [PMID: 38545121 PMCID: PMC10965669 DOI: 10.3389/fimmu.2024.1365118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/27/2024] [Indexed: 04/17/2024] Open
Abstract
Background The association between psoriasis vulgaris and bullous pemphigoid (BP) remains largely unknown. Objectives To investigate whether there is a causal effect between psoriasis vulgaris and BP. Methods Two-sample bidirectional Mendelian randomization (MR) analyses were conducted using publicly released genome-wide association studies (GWAS) summary statistics. The GWAS summary statistics for BP were downloaded online from FinnGen Biobank Documentation of the R12 release, which includes 219 BP cases and 218,066 controls. The GWAS data for psoriasis vulgaris were extracted from Sakaue et al., which comprises 5072 cases and 478,102 controls. Single-nucleotide polymorphisms (SNPs) associated with exposure were selected as instrumental variables by performing additional quality control steps. The inverse-variance-weighted (IVW) method was used for the primary MR analyses, and the MR-Egger regression, weighted mode method, weighted median method, and simple mode were employed for sensitivity analyses. The MR-Egger intercept test and "leave-one-out" sensitivity analysis were performed to evaluate the horizontal pleiotropy and the potentially influential SNPs, respectively. Results Genetically determined log odds of psoriasis vulgaris were associated with an increased risk of BP (IVW: odds ratio (OR) = 1.263, 95% confidence interval (CI): 1.013-1.575, P=0.038). Sensitivity analyses by the weighted mode (OR=1.255, 95%CI: 0.973-1.618, P=0.106), MR Egger (OR=1.315, 95%CI: 0.951-1.817, P=0.126), simple mode (OR=1.414, 95%CI: 0.823-2.429, P=0.234) and weighted median method (OR=1.177, 95%CI: 0.889-1.559, P=0.254) derived directionally consistent relationship between the genetically predicted log odds of psoriasis vulgaris and risks of developing BP. On the contrary, we found that genetically predicted BP had no significant effect on psoriasis vulgaris (IVW: OR=0.996, P= 0.707), indicating the unidirectionality of the relationship. MR-Egger intercept tests showed no evidence of horizontal pleiotropy. No influential SNP driving the results was detected by the leave-one-out sensitivity analysis. Conclusions Our results suggested that psoriasis vulgaris causally increases the risk of BP, highlighting the need for potential strategies for the prevention and early diagnosis of comorbid BP in patients with psoriasis vulgaris. Further researches into this association and underlying mechanisms are warranted.
Collapse
Affiliation(s)
- Aobei Zhang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, China
| | - Zhihui Yang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, Beijing, China
| | - Mingyue Wang
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China
- Beijing Key Laboratory of Molecular Diagnosis of Dermatoses, Peking University First Hospital, Beijing, China
- National Clinical Research Center for Skin and Immune Diseases, Beijing, China
- National Medical Products Administration (NMPA) Key Laboratory for Quality Control and Evaluation of Cosmetics, Peking University First Hospital, Beijing, China
| |
Collapse
|
3
|
Limberg MM, Weihrauch T, Gray N, Ernst N, Hartmann K, Raap U. Eosinophils, Basophils, and Neutrophils in Bullous Pemphigoid. Biomolecules 2023; 13:1019. [PMID: 37509055 PMCID: PMC10377006 DOI: 10.3390/biom13071019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering skin disease, of which the incidence has increased in recent years. BP is characterized by circulating IgG and IgE autoantibodies against the hemidesmosomal proteins BP180 and BP230. Although autoantibodies trigger inflammatory cascades that lead to blister formation, effector cells and cell-mediated autoimmunity must also be considered as important factors in the pathogenesis of BP. The aim of this review is to outline the current knowledge on the role of eosinophils, basophils, and neutrophils in BP.
Collapse
Affiliation(s)
- Maren M Limberg
- Division of Experimental Allergy and Immunodermatology, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
| | - Tobias Weihrauch
- Division of Experimental Allergy and Immunodermatology, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
| | - Natalie Gray
- Division of Experimental Allergy and Immunodermatology, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
- Division of Anatomy, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
| | - Nancy Ernst
- Department of Dermatology, University of Lübeck, 23562 Lübeck, Germany
| | - Karin Hartmann
- Division of Allergy, Departments of Dermatology and Biomedicine, University Hospital Basel and University of Basel, 4031 Basel, Switzerland
| | - Ulrike Raap
- Division of Experimental Allergy and Immunodermatology, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
- Research Center for Neurosensory Science, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
- University Clinic of Dermatology and Allergy, University of Oldenburg, 26133 Oldenburg, Germany
| |
Collapse
|
4
|
Hiroyasu S, Barit JVJG, Hiroyasu A, Tsuruta D. Pruritogens in pemphigoid diseases: Possible therapeutic targets for a burdensome symptom. J Dermatol 2023; 50:150-161. [PMID: 36477831 PMCID: PMC10108135 DOI: 10.1111/1346-8138.16652] [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: 10/27/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022]
Abstract
Pruritus is a hallmark feature in pemphigoid diseases, where it can be severe and greatly impact the quality of life of affected patients. Despite being a key symptom, the exact pathophysiological mechanisms involved in pruritus in pemphigoid are yet to be fully elucidated and effective therapies addressing them are limited. This review summarizes the present understanding of pruritus specific to pemphigoid diseases, especially the pruritogens that induce it, and the therapeutic options that have been explored so far. The majority of the available evidence is on bullous pemphigoid and epidermolysis bullosa acquisita. Histamine derived from basophils correlates with pruritus severity, with omalizumab demonstrating promising efficacy in pruritus for bullous pemphigoid. IL-4/-13 contribute to itch in bullous pemphigoid with dupilumab being evaluated in clinical trials. Other pruritogens of interest include substance P, tryptase, and thymic stromal lymphopoetin, with therapies targeting them requiring further investigation. Scratching behaviors contribute directly to blister formation through various mechanisms, such as pathological autoantibody recruitment, T helper cell type 1 polarization, and exposure of intracellular autoantigens. Treatments addressing these pathways may contribute to decreasing disease severity. Additional studies are needed to fully characterize how pruritus is regulated in pemphigoid diseases, to help pave the way to develop novel and effective therapeutics that will not only address pruritic symptoms but also decrease disease severity.
Collapse
Affiliation(s)
- Sho Hiroyasu
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Jay-V James G Barit
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Aoi Hiroyasu
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
5
|
Zhang J, Wang SH, Zuo YG. Paradoxical phenomena of bullous pemphigoid induced and treated by identical biologics. Front Immunol 2023; 13:1050373. [PMID: 36685489 PMCID: PMC9849796 DOI: 10.3389/fimmu.2022.1050373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
Objective This study aimed to investigate the clinical features of biologics-induced bullous pemphigoid (BP) and the therapeutic effects of those agents for BP, exploring the underlying pathophysiological mechanisms. Methods We searched PubMed, Web of Science, and Elsevier for studies involving pemphigoid patients treated with or induced by identical biologics published in English from January 2009 to April 2022. Results Seventeen cases of drug-induced BP associated with anti-tumor necrosis factor (aTNF)-α therapies, one with interleukin (IL)-17 inhibitors, and seven with IL-12/IL-23 or IL-23 inhibitors were enrolled. Time to cutaneous toxicity varied among different types of agents, and the characteristics of clinical examinations were similar to idiopathic BP. Discontinuation of the culprit drugs and initiation of topical or systemic corticosteroids were adequate in most cases. Several monoclonal antibodies above have also been reported for the treatment of refractory or recurrent BP, especially concurrent with psoriasis. Conclusion Biologics for immune-related diseases, including TNF-α, IL-17, and IL-12/IL-23 or IL-23 inhibitors, can both induce and treat BP, which might be associated with a helper T cells Th1/Th2 imbalance, complicated inflammatory networks, and a specific individual microenvironment, suggestive of a new perspective on the therapeutic algorithms of BP. There have been numerous reports about biologics inducing or treating BP. We have taken note of this phenomenon and focused on biologics with both pathogenetic and therapeutic effects on BP. Our review summarized the clinical characteristics of associated cases, trying to figure out the underlying mechanisms of this paradoxical phenomenon and to provide an integrated perspective and new therapeutic alternatives for BP.
Collapse
|
6
|
Zhang L, Chen Z, Wang L, Luo X. Bullous pemphigoid: The role of type 2 inflammation in its pathogenesis and the prospect of targeted therapy. Front Immunol 2023; 14:1115083. [PMID: 36875098 PMCID: PMC9978795 DOI: 10.3389/fimmu.2023.1115083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune disease that mainly occurs in the elderly, severely affecting their health and life quality. Traditional therapy for BP is mainly based on the systemic use of corticosteroids, but long-term use of corticosteroids results in a series of side effects. Type 2 inflammation is an immune response largely mediated by group 2 innate lymphoid cells, type 2 T helper cells, eosinophils, and inflammatory cytokines, such as interleukin (IL)-4, IL-5 and IL-13. Among patients with BP, the levels of immunoglobulin E and eosinophils are significantly increased in the peripheral blood and skin lesions, suggesting that the pathogenesis is tightly related to type 2 inflammation. To date, various targeted drugs have been developed to treat type 2 inflammatory diseases. In this review, we summarize the general process of type 2 inflammation, its role in the pathogenesis of BP and potential therapeutic targets and medications related to type 2 inflammation. The content of this review may contribute to the development of more effective drugs with fewer side effects for the treatment of BP.
Collapse
Affiliation(s)
- Luyao Zhang
- Department of Allergy and Immunology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zihua Chen
- Department of Allergy and Immunology, Huashan Hospital, Fudan University, Shanghai, China
| | - Lanting Wang
- Department of Allergy and Immunology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoqun Luo
- Department of Allergy and Immunology, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Li HOY, Aw M, Glassman SJ. Imiquimod-induced bullous pemphigoid: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231164222. [PMID: 37025248 PMCID: PMC10071145 DOI: 10.1177/2050313x231164222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
A 72-year-old man treated with 3.5% imiquimod cream for scalp actinic keratoses developed the usual crusted and erosive reaction but developed bullae on the scalp, as well as the limbs and torso after several weeks into treatment. Biopsy confirmed bullous pemphigoid. He was treated with clobetasol ointment, prednisone and methotrexate, with eventual disease control. He had a severe disease course. Bullous pemphigoid is usually idiopathic, but can be induced by skin trauma, as well as by several medications; this is the first report of imiquimod as a trigger. Imiquimod is a toll-like receptor 7 agonist that induces cellular apoptosis and recruits pro-inflammatory cytokines including tumour necrosis factor-alpha and interferon-alpha, which have been implicated in autoimmunity. This case highlights an unusual but severe adverse effect from topical imiquimod.
Collapse
Affiliation(s)
- Heidi Oi-Yee Li
- Division of Dermatology, University of
Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Michael Aw
- Faculty of Medicine, University of
Ottawa, Ottawa, ON, Canada
| | - Steven J Glassman
- Division of Dermatology, University of
Ottawa and The Ottawa Hospital, Ottawa, ON, Canada
- Steven J Glassman, Division of Dermatology,
University of Ottawa and The Ottawa Hospital, Civic Parkdale Clinic, 4th Floor,
737 Parkdale Avenue, Ottawa, ON K1Y 1J8, Canada.
| |
Collapse
|
8
|
Ociepa K, Danilewicz M, Wągrowska-Danilewicz M, Peterson-Jęckowska R, Wójcicka-Rubin A, Lewkowicz N, Zajdel R, Żebrowska A. Expression of the Selected Proteins of JAK/STAT Signaling Pathway in Diseases with Oral Mucosa Involvement. Int J Mol Sci 2022; 24:ijms24010323. [PMID: 36613766 PMCID: PMC9820278 DOI: 10.3390/ijms24010323] [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: 10/30/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
The JAK/STAT signal pathway is a system of intracellular proteins used by many cytokines and growth factors to express genes responsible for the process of cell activation, proliferation and differentiation. There has been numerous inflammatory and autoimmune diseases identified where the JAK/STAT signaling is disrupted; however, there are only a few papers concerning autoimmune bullous diseases published. The aim of this study was to evaluate the expression of proteins: JAK3, STAT2, STAT4 and STAT6 in epithelium lesions in patients with pemphigus vulgaris (PV), bullous pemphigoid (BP), oral lichen planus (LP) and chronic ulcerative stomatitis (CUS), as well as in the control group. Immunohistochemistry and immunoblotting were used to evaluate expression of selected proteins. We found significantly higher expression of selected JAK/STAT proteins in oral mucosa lesions in study groups in comparison to the control group, which indicates participation of JAK/STAT pathway in pathogenesis of these diseases. In BP and PV there were no increased STAT2 expression, whereas in CUS and LP no increased STAT4 expression occurred. The differences in expression of JAK/STAT proteins in selected disorders have been observed. These results create new potential therapeutic targets for the treatment.
Collapse
Affiliation(s)
- Kamila Ociepa
- Department of Dermatology and Venereology, Medical University of Lodz, 90-674 Lodz, Poland
| | - Marian Danilewicz
- Department of Pathomorphology, Medical University of Lodz, 92-213 Lodz, Poland
| | | | - Róża Peterson-Jęckowska
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Lodz, 92-213 Lodz, Poland
| | - Angelika Wójcicka-Rubin
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Lodz, 92-213 Lodz, Poland
| | - Natalia Lewkowicz
- Department of Periodontology and Oral Mucosa Diseases, Medical University of Lodz, 92-213 Lodz, Poland
| | - Radosław Zajdel
- Department of Computer Science in Economics, Faculty of Economics and Sociology, University of Lodz, 90-255 Lodz, Poland
| | - Agnieszka Żebrowska
- Department of Dermatology and Venereology, Medical University of Lodz, 90-674 Lodz, Poland
- Correspondence:
| |
Collapse
|
9
|
Investigation of comorbid autoimmune diseases in women with autoimmune bullous diseases: An interplay of autoimmunity and practical implications. Int J Womens Dermatol 2022; 8:e053. [PMID: 36225612 PMCID: PMC9543088 DOI: 10.1097/jw9.0000000000000053] [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: 04/03/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Autoimmune bullous diseases are a group of skin disorders resulting from an autoimmune reaction against intercellular adhesion molecules or components of the basement membrane of skin and mucosa. Autoimmune disorders often occur in patients with a history of another autoimmune disease and most autoimmune diseases have a striking female predominance. In this review, we aim to analyze the different associations of autoimmune bullous diseases with other autoimmune diseases and highlight the distinctiveness of the female gender in these associations.
Collapse
|
10
|
Management of Coexisting Bullous Pemphigoid and Psoriasis: A Review. Am J Clin Dermatol 2022; 23:869-879. [DOI: 10.1007/s40257-022-00719-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/01/2022]
|
11
|
Wang Y, Mao X, Liu Y, Yang Y, Jin H, Li L. IL-13 Genetic Susceptibility to Bullous Pemphigoid: A Potential Target for Treatment and a Prognostic Marker. Front Immunol 2022; 13:824110. [PMID: 35140724 PMCID: PMC8818855 DOI: 10.3389/fimmu.2022.824110] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/05/2022] [Indexed: 01/07/2023] Open
Abstract
Background Bullous pemphigoid (BP) is a senile chronic autoimmune bullous skin disease with a high relapse rate, which significantly impairs patients’ quality of life and contributes to disease mortality. This observational case-control study explores the gene polymorphisms of cytokines and their clinical significance in Chinese patients with BP. Methods IL-1α (rs1800587), IL-1β (rs16944, rs1143627, rs1143634), IL-4 (rs2243250), IL-6 (rs1800795), IL-10 (rs1800896, rs1800871, rs1800872), IL-13 (rs1800925, rs20541), TNF-α (rs1799964, rs1800630, rs1799724, rs361525), IFN-γ (rs1799964, rs1800630, rs361525, rs1800629, rs4248160, rs1800750), and TGF-β1 (rs2317130, rs1800469, rs4803457) genes were genotyped in the healthy controls and BP patients, respectively. Expression of these cytokines in serum was measured. Medical profiles of patients, including baseline characteristics and prognosis, were statistically analyzed. Results We found that IL-1 β and IL-13 concentrations were higher in the BP patients’ sera compared to those in the controls. For IL-13, significant differences were found in the nucleotide ratio/genotype/haploid frequency/haplotype, respectively. IL-13 (rs20541, rs1800925) is related to gender, and the IL-13 genotype was significantly associated with recurrence. Conclusions BP is associated with IL-13 gene polymorphism and IL-13 concentration is elevated in blood circulation in patients with BP. Our results support that IL-13 is relevant in the pathogenesis of BP, suggesting that IL-13 could potentially represent a promising target for BP therapy and a prognostic marker.
Collapse
Affiliation(s)
- Yiman Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Xuming Mao
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Yangchun Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Yuyan Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Li Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- *Correspondence: Li Li,
| |
Collapse
|
12
|
Kneiber D, Kowalski EH, Amber KT. The Immunogenetics of Autoimmune Blistering Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:173-212. [DOI: 10.1007/978-3-030-92616-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
|
13
|
Messingham KN, Cahill MP, Kilgore SH, Munjal A, Schlievert PM, Fairley JA. TSST-1 +Staphylococcus aureus in Bullous Pemphigoid. J Invest Dermatol 2021; 142:1032-1039.e6. [PMID: 34606884 DOI: 10.1016/j.jid.2021.08.438] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 01/31/2023]
Abstract
A potential role of Staphylococcus aureus in bullous pemphigoid was explored by examining the colonization rate in patients with new-onset disease compared with that in age- and sex-matched controls. S. aureus colonization was observed in 85% of bullous pemphigoid lesions, 3-6-fold higher than the nares or unaffected skin from the same patients (P ≤ 0.003) and 6-fold higher than the nares or skin of controls (P ≤ 0.0015). Furthermore, 96% of the lesional isolates produced the toxic shock syndrome toxin-1 superantigen, and most of these additionally exhibited homogeneous expression of the enterotoxin gene cluster toxins. Toxic shock syndrome toxin-1‒neutralizing antibodies were not protective against colonization. However, S. aureus colonization was not observed in patients who had recently received antibiotics, and the addition of antibiotics with staphylococcal coverage eliminated S. aureus and resulted in clinical improvement. This study shows that toxic shock syndrome toxin-1‒positive S. aureus is prevalent in bullous pemphigoid lesions and suggests that early implementation of antibiotics may be of benefit. Furthermore, our results suggest that S. aureus colonization could provide a source of infection in patients with bullous pemphigoid, particularly in the setting of high-dose immunosuppression.
Collapse
Affiliation(s)
- Kelly N Messingham
- Department of Dermatology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA.
| | - Michael P Cahill
- Department of Microbiology and Immunology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Samuel H Kilgore
- Department of Microbiology and Immunology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Ananya Munjal
- Department of Dermatology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Patrick M Schlievert
- Department of Microbiology and Immunology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Janet A Fairley
- Department of Dermatology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
14
|
Zhou T, Peng B, Geng S. Emerging Biomarkers and Therapeutic Strategies for Refractory Bullous Pemphigoid. Front Immunol 2021; 12:718073. [PMID: 34504496 PMCID: PMC8421646 DOI: 10.3389/fimmu.2021.718073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/04/2021] [Indexed: 12/18/2022] Open
Abstract
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder in the elderly. Systemic and topical use of glucocorticoids and immunosuppressants has been shown to be effective in most patients. However, refractory BP patients are challenged to clinicians with severe clinical symptoms, resistance to treatment, and high relapse rate. How to predict and assess the refractory and severity of bullous pemphigoid is the key issue in clinical practice, and the urgent need for precision medicine in refractory patients is driving the search for biomarkers and biologics. Recently, some biomarkers, such as the level of specific autoantibodies and released cytokines, have been proposed as the potential parameters to reflect the disease severity and predict the treatment response and relapse of refractory BP. Moreover, new biologics targeting pathogenic antibodies, complement, Th2 axis, eosinophils, and Th17 axis have shown potent efficacy on refractory BP. Here, we review the literature and give an overview of emerging biomarkers and therapeutic strategies for refractory bullous pemphigoid to improve the prognosis of the patient.
Collapse
Affiliation(s)
- Tong Zhou
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Bin Peng
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| | - Songmei Geng
- Department of Dermatology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
15
|
Hiroyasu S, Zeglinski MR, Zhao H, Pawluk MA, Turner CT, Kasprick A, Tateishi C, Nishie W, Burleigh A, Lennox PA, Van Laeken N, Carr NJ, Petersen F, Crawford RI, Shimizu H, Tsuruta D, Ludwig RJ, Granville DJ. Granzyme B inhibition reduces disease severity in autoimmune blistering diseases. Nat Commun 2021; 12:302. [PMID: 33436591 PMCID: PMC7804321 DOI: 10.1038/s41467-020-20604-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/07/2020] [Indexed: 02/08/2023] Open
Abstract
Pemphigoid diseases refer to a group of severe autoimmune skin blistering diseases characterized by subepidermal blistering and loss of dermal-epidermal adhesion induced by autoantibody and immune cell infiltrate at the dermal-epidermal junction and upper dermis. Here, we explore the role of the immune cell-secreted serine protease, granzyme B, in pemphigoid disease pathogenesis using three independent murine models. In all models, granzyme B knockout or topical pharmacological inhibition significantly reduces total blistering area compared to controls. In vivo and in vitro studies show that granzyme B contributes to blistering by degrading key anchoring proteins in the dermal-epidermal junction that are necessary for dermal-epidermal adhesion. Further, granzyme B mediates IL-8/macrophage inflammatory protein-2 secretion, lesional neutrophil infiltration, and lesional neutrophil elastase activity. Clinically, granzyme B is elevated and abundant in human pemphigoid disease blister fluids and lesional skin. Collectively, granzyme B is a potential therapeutic target in pemphigoid diseases.
Collapse
Affiliation(s)
- Sho Hiroyasu
- International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Research Laboratory, VCHRI, Vancouver, BC, Canada
| | - Matthew R Zeglinski
- International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Research Laboratory, VCHRI, Vancouver, BC, Canada
| | - Hongyan Zhao
- International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Research Laboratory, VCHRI, Vancouver, BC, Canada
| | - Megan A Pawluk
- International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Research Laboratory, VCHRI, Vancouver, BC, Canada
| | - Christopher T Turner
- International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Research Laboratory, VCHRI, Vancouver, BC, Canada
| | - Anika Kasprick
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Chiharu Tateishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Angela Burleigh
- Department of Dermatology and Skin Science, UBC, Vancouver, BC, Canada
| | | | | | - Nick J Carr
- Department of Surgery, UBC, Vancouver, BC, Canada
| | - Frank Petersen
- Priority Area Asthma and Allergy, Members of the German Center for Lung Research, Research Center Borstel, Borstel, Germany
| | - Richard I Crawford
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- Department of Dermatology and Skin Science, UBC, Vancouver, BC, Canada
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - David J Granville
- International Collaboration On Repair Discoveries (ICORD) Centre, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
- BC Professional Firefighters' Burn and Wound Healing Research Laboratory, VCHRI, Vancouver, BC, Canada.
| |
Collapse
|
16
|
Tabatabaei-Panah PS, Moravvej H, Alirajab M, Etaaty A, Geranmayeh M, Hosseine F, Khansari A, Mahdian M, Mirhashemi M, Parvizi S, Sakhaie F, Ludwig RJ, Akbarzadeh R. Association between TH2 Cytokine Gene Polymorphisms and Risk of Bullous Pemphigoid. Immunol Invest 2020; 51:343-356. [PMID: 33047635 DOI: 10.1080/08820139.2020.1832113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: T-helper 2 (Th2)-associated cytokines are involved in the pathogenesis of bullous pemphigoid (BP), an autoimmune skin disease. Increased expression of Th2 cytokines such as interleukin-4 (IL-4), IL-5, IL-6, IL-10, and IL-13 have been observed in serum, skin biopsies and/or blister fluid. This study aimed to uncover a possible association between Th2 cytokine genetic variations and susceptibility to BP.Methods: In a cohort study, blood samples of BP patients and controls were obtained and variations in IL-4 (rs2243250 and rs2070874), IL-4R (rs1805010), IL-5 (rs2069812), IL-6 (rs1800795), IL-10 (rs1800896, rs1800871, and rs1800872), and IL-13 (rs1800925 and rs20541) were genotyped by PCR-RFLP assays. Furthermore, quantitative expression levels of IL-13 gene were evaluated by real-time RT-PCR analysis.Results: Among the studied variations, a significantly higher frequency of the C-allele was observed in IL-13 gene variation (rs1800925) in the healthy individuals than BP patients. This may indicate a protective effect of C-allele on predisposition to BP. Considering individuals carrying polymorphic genotypes compared to wild genotype, the minor G-allele of IL-4R rs1805010 and A-allele of IL-13 rs20541 had a promotive and protective effect, respectively, on predisposing to the development of BP. No significant difference in IL-13 mRNA expression was detected between BP patients and healthy individuals.Conclusions: Our results indicate that IL-13 rs1800925 variation may be a protective genetic marker for the development of BP. Given this preventive effect against BP, therapeutic strategies could potentially be developed interfering with the functions of IL-13 cytokine, which seems to be integral in the pathogenesis of eosinophilic inflammatory disorders, such as BP.
Collapse
Affiliation(s)
| | - Hamideh Moravvej
- Skin Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Alirajab
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ahmad Etaaty
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Maryam Geranmayeh
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Farzaneh Hosseine
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Atousa Khansari
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mohadeseh Mahdian
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Mahsa Mirhashemi
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Samira Parvizi
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Fatemeh Sakhaie
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Reza Akbarzadeh
- Skin Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Institute of Anatomy, University of Lübeck, Lübeck, Germany
| |
Collapse
|
17
|
The Risk of Systemic Diseases in Those with Psoriasis and Psoriatic Arthritis: From Mechanisms to Clinic. Int J Mol Sci 2020; 21:ijms21197041. [PMID: 32987907 PMCID: PMC7583918 DOI: 10.3390/ijms21197041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 02/08/2023] Open
Abstract
Psoriasis and psoriatic arthritis (PsA) have been recently considered as chronic systemic inflammatory disorders. Over the past decades, enormous evidence indicates that patients with psoriasis and PsA have a higher risk of developing various comorbidities including cardiovascular disease, metabolic disease, cancers, infections, autoimmune disease, and psychiatric diseases. However, reported risks of some comorbidities in those with psoriasis and PsA are somewhat different according to the research design. Moreover, pathomechanisms underlying comorbidities of those with psoriasis and PsA remain poorly elucidated. The purpose of this review is to provide the most updated comprehensive view of the risk of systemic comorbidities in those with psoriasis and PsA. Molecular mechanisms associated with the development of various comorbidities in those with psoriasis and PsA are also reviewed based on recent laboratory and clinical investigations. Identifying the risk of systemic comorbidities and its associated pathomechanisms in those with psoriasis and PsA could provide a sufficient basis to use a multi-disciplinary approach for treating patients with psoriasis and PsA.
Collapse
|
18
|
Kridin K, Ludwig RJ, Schonmann Y, Damiani G, Cohen AD. The Bidirectional Association Between Bullous Pemphigoid and Psoriasis: A Population-Based Cohort Study. Front Med (Lausanne) 2020; 7:511. [PMID: 32984384 PMCID: PMC7489270 DOI: 10.3389/fmed.2020.00511] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022] Open
Abstract
The risk of developing psoriasis during the course of bullous pemphigoid (BP) is yet to be investigated. We aimed to assess the risk of psoriasis among patients with BP and the risk of BP in individuals with a history of psoriasis. A population-based retrospective cohort study was conducted comparing BP patients (n = 3,924) with age-, sex-, and ethnicity-matched control subjects (n = 19,280) with regard to incident cases of psoriasis. A case-control design was additionally followed to estimate the risk of BP in those with a preceding diagnosis of psoriasis. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were estimated by Cox regression and logistic regression, respectively. The incidence of psoriasis was 1.78 (95% CI, 1.25–2.48) and 0.67 (95%CI, 0.53–0.83) per 1,000 person-years among patients with BP and controls, respectively. Patients with BP were 2.6-fold more likely to develop psoriasis (HR, 2.60; 95%CI, 1.59–4.27) compared to controls. Furthermore, the prevalence of preexisting psoriasis was higher in patients with BP than in control subjects (1.7 vs. 1.1%, respectively; P < 0.001). A history of psoriasis was associated with a 50% increase in the risk of BP (OR, 1.53; 95%CI, 1.17–2.02). Patients with a dual diagnosis of BP and psoriasis were younger, had higher prevalence of smoking and hypertension, and were treated more frequently with prolonged systemic and topical corticosteroids when compared to the remaining patients with BP. To conclude, a bidirectional association exists between BP and psoriasis. Awareness of this association may be of great importance for physicians managing patients with BP and psoriasis.
Collapse
Affiliation(s)
- Khalaf Kridin
- Department of Experimental Dermatology, Lubeck Institute, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Department of Experimental Dermatology, Lubeck Institute, University of Lübeck, Lübeck, Germany
| | - Yochai Schonmann
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel
| | - Giovanni Damiani
- Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Clalit Health Services, Tel Aviv, Israel.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| |
Collapse
|
19
|
Liu Y, Li L. Commentary: Proinflammatory role of blister fluid-derived exosomes in bullous pemphigoid. Front Immunol 2020; 11:1506. [PMID: 32765519 PMCID: PMC7378439 DOI: 10.3389/fimmu.2020.01506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yangchun Liu
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
20
|
Garrido PM, Queirós CS, Travassos AR, Borges-Costa J, Filipe P. Emerging treatments for bullous pemphigoid. J DERMATOL TREAT 2020; 33:649-661. [DOI: 10.1080/09546634.2020.1782325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Pedro Miguel Garrido
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Catarina Soares Queirós
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - Ana Rita Travassos
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
| | - João Borges-Costa
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
- Dermatology Universitary Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Dermatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Paulo Filipe
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal
- Dermatology Universitary Clinic, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Dermatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
21
|
Liu Y, Wang Y, Chen X, Jin H, Li L. Factors associated with the activity and severity of bullous pemphigoid: a review. Ann Med 2020; 52:55-62. [PMID: 32163298 PMCID: PMC7877946 DOI: 10.1080/07853890.2020.1742367] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 01/01/2023] Open
Abstract
Bullous pemphigoid (BP) is the most common subepidermal autoimmune blistering disease. It usually affects people older than 70 years of age. The two main autoantigens are BP180 and BP230, both of which are components of hemidesmosomes. Immunoglobulin (Ig)G and IgE autoantibodies to BP180 detected by the enzyme-linked immunoassay (ELISA) show close associations with the activity and severity of BP. In addition, inflammatory cells (eosinophils, neutrophils and mast cells) and cytokines (e.g. interleukins and CC chemokine ligands) play an important part in the pathogenesis, activity and severity of BP. We summarized the potential contribution of each factor postulated to be associated with the activity and severity of BP, and provide guidance for clinicians to pay timely and close attention to such parameters. This review may also promote the development of novel therapies for BP.Key MessagesBullous Pemphigoid Disease Area Index (BPDAI) is a scoring system which can reflect the extent of clinical involvement of BP patients.The titres of IgE autoantibodies and IgG autoantibodies against the NC16A domain of BP180 are closely correlated with the activity and severity of BP.Many inflammatory cells and molecules, such as eosinophils and interleukins, can also reflect the activity and severity of BP.
Collapse
Affiliation(s)
- Yangchun Liu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Yiman Wang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Xinyi Chen
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, PR China
| |
Collapse
|
22
|
Niebuhr M, Bieber K, Banczyk D, Maass S, Klein S, Becker M, Ludwig R, Zillikens D, Westermann J, Kalies K. Epidermal Damage Induces Th1 Polarization and Defines the Site of Inflammation in Murine Epidermolysis Bullosa Acquisita. J Invest Dermatol 2020; 140:1713-1722.e9. [PMID: 32057838 DOI: 10.1016/j.jid.2020.01.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 12/15/2022]
Abstract
Epidermolysis bullosa acquisita is an autoimmune skin disease characterized by subepidermal blisters. The pathogenesis is mediated by deposits of autoantibodies directed against type VII collagen in the skin, but the sequence of events regulating the localization of skin blisters is not fully understood. In this study, using the immunization-induced mouse model of epidermolysis bullosa acquisita, we demonstrate that epidermal disruption induces not only an infiltration of CD4+ T cells but also a T helper type 1 phenotype as it has been described for delayed-type hypersensitivity reactions. This T helper type 1 reaction was not found when different antigens were applied. Deep T-cell receptor β profiling revealed shifts in the V/J gene usage only in epidermolysis bullosa acquisita, suggesting an infiltration of autoantigen-specific T cells. To target these autoantigen-specific T cells, we established an approach with which skin inflammation could be prevented without impairing the functionality of autoantibodies. We conclude that T-cell involvement in skin blistering diseases such as epidermolysis bullosa acquisita relates not only to T-cell help for B cells that produce pathogenic autoantibodies but also to autoreactive T helper type 1 effector cells that migrate into injured skin sites, exacerbate inflammation through production of inflammatory cytokines such as IFNγ, and prevent wound healing.
Collapse
Affiliation(s)
- Markus Niebuhr
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Katja Bieber
- Institute of Anatomy, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - David Banczyk
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | | | | | - Mareike Becker
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University Medical Center of Schleswig-Holstein, Lübeck, Germany
| | | | - Kathrin Kalies
- Institute of Anatomy, University of Lübeck, Lübeck, Germany.
| |
Collapse
|
23
|
Yang M, Wu H, Zhao M, Chang C, Lu Q. The pathogenesis of bullous skin diseases. J Transl Autoimmun 2019; 2:100014. [PMID: 32743502 PMCID: PMC7388362 DOI: 10.1016/j.jtauto.2019.100014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 01/13/2023] Open
Abstract
Bullous skin diseases are a group of dermatoses characterized by blisters and bullae in the skin and mucous membranes. The etiology and pathogenesis of bullous skin diseases are not completely clear. The most common are pemphigus and bullous pemphigoid (BP). Autoantibodies play critical roles in their pathogenesis. Abnormalities in the adhesion between keratinocytes in patients with pemphigus leads to acantholysis and formation of intra-epidermal blisters. Anti-desmoglein autoantibodies are present both in the circulation and skin lesions of patients with pemphigus. The deficient adhesion of keratinocytes to the basement membrane in BP patients gives rise to subepidermal blisters. Autoantibodies against the components of hemidesmosome can be detected in BP patients. Many novel therapeutics based on knowledge of the pathogenesis have emerged in recent years.
Collapse
Affiliation(s)
- Miao Yang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
| | - Haijing Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
| | - Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
| | - Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, CA, 95616, USA
- Division of Pediatric Immunology and Allergy, Joe DiMaggio Children’s Hospital, Hollywood, FL, 33021, USA
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, PR China
| |
Collapse
|
24
|
Kridin K, Kowalski EH, Kneiber D, Laufer-Britva R, Amber KT. From bench to bedside: evolving therapeutic targets in autoimmune blistering disease. J Eur Acad Dermatol Venereol 2019; 33:2239-2252. [PMID: 31314932 DOI: 10.1111/jdv.15816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/08/2019] [Indexed: 12/17/2022]
Abstract
Autoimmune blistering diseases comprise a group of heterogenous conditions characterized by the loss of tolerance and subsequent development of autoantibodies targeting epidermal and subepidermal adhesion proteins. Blisters and erosions form on the skin and mucous membranes leading to significant morbidity and mortality. Traditional therapies rely on systemic immunosuppression. Advancements in our understanding of the pathophysiology of pemphigus and pemphigoid have led to the development of molecules which target specific pathways involved in induction and perpetuation of disease. In this review, we outline the novel therapeutic strategies including B-cell depletion, T-regulatory cell repletion, cell signalling inhibitors and small molecular inhibitors, inhibitory monoclonal antibodies, as well as complement inhibition. We additionally review their current level of clinical evidence. We lastly review therapeutics targets gleaned from the experimental epidermolysis bullosa acquisita mouse model. These emerging treatments offer an exciting progression from basic science discoveries that have the potential to transform the treatment paradigm in autoimmune blistering diseases.
Collapse
Affiliation(s)
- K Kridin
- Department of Dermatology, Rambam Healthcare Campus, Haifa, Israel
| | - E H Kowalski
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - D Kneiber
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| | - R Laufer-Britva
- Department of Dermatology, Rambam Healthcare Campus, Haifa, Israel
| | - K T Amber
- Department of Dermatology, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
25
|
Le Jan S, Muller C, Plee J, Durlach A, Bernard P, Antonicelli F. IL-23/IL-17 Axis Activates IL-1β-Associated Inflammasome in Macrophages and Generates an Auto-Inflammatory Response in a Subgroup of Patients With Bullous Pemphigoid. Front Immunol 2019; 10:1972. [PMID: 31507596 PMCID: PMC6718471 DOI: 10.3389/fimmu.2019.01972] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022] Open
Abstract
Bullous Pemphigoid (BP) is a skin autoimmune blistering disease characterized by immune-mediated degradation of the dermo-epidermal junction and release of a large number of inflammatory cytokines. Interleukin-1β (IL-1β) is a pleiotropic pro-inflammatory cytokine associated with inflammasome activation and known to be pivotal in several auto-immune and auto-inflammatory diseases. We sought to clarify the presence of inflammasome-dependent IL-1β and to investigate its role in BP. Skin biopsy specimens (n = 13), serum (n = 60), blister fluid (n = 26), and primary inflammatory cells from patients with BP were used to investigate inflammasome activation and function. We here highlighted a differential occurrence of a functional in situ inflammasome in patients with BP, biologically distinguished by IL-1β and NLRP3 expression. Clinically, elevated IL-1β levels were associated with the presence of erythema and urticarial plaques reflecting the inflammatory phase preceding blister formation. We further identified IL-17 and IL-23 as important molecules favoring IL-1β expression in monocyte-derived macrophages from BP patients. Finally, we demonstrated the ability of IL-1β to stimulate the release of the matrix metalloproteinase-9 in those macrophages, reinforcing the role of IL-1β in the auto-amplification loop of the inflammatory response associated to BP. However, whether this inflammasome is an epiphenomenon associated with BP disease or constitutes an amplification inflammatory step in certain patients still need to be determined. In the context of a precision medicine approach, our findings allowed us to delineate a subgroup of patients with BP that showed similarities with auto-inflammatory diseases. Subsequently, this opens up alternative therapeutic strategies targeting IL-1β pathway in the aim to control the early, pre-blistering inflammatory phase. Ultimately, this could also help in reducing the detrimental effects associated with high doses of corticosteroids treatment.
Collapse
Affiliation(s)
- Sébastien Le Jan
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| | - Céline Muller
- Department of Dermatology, University Hospital, University of Reims-Champagne-Ardenne, Reims, France
| | - Julie Plee
- Department of Dermatology, University Hospital, University of Reims-Champagne-Ardenne, Reims, France
| | - Anne Durlach
- Laboratory Pol Bouin, Hospital Maison Blanche, University Hospital, University of Reims-Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims-Champagne-Ardenne, Reims, France
| |
Collapse
|
26
|
Riani M, Muller C, Bour C, Bernard P, Antonicelli F, Le Jan S. Blister Fluid Induces MMP-9-Associated M2-Type Macrophages in Bullous Pemphigoid. Front Immunol 2019; 10:1858. [PMID: 31440247 PMCID: PMC6692716 DOI: 10.3389/fimmu.2019.01858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/23/2019] [Indexed: 12/17/2022] Open
Abstract
Bullous pemphigoid (BP) is a cutaneous autoimmune disease, characterized by an inflammatory cascade leading to blister formation. Although macrophages were shown to participate in BP pathophysiology, their role in the blister formation process still needs to be investigated. We here addressed the influence of serum and blister fluid (BF) from patients with BP on the polarization status of macrophages with regards to the metalloproteinase-9 (MMP-9) expression. We demonstrated that several markers related to the alternatively activated macrophage phenotype (M2) including IL-10, TARC, arginase, TNFα, and IL-1RA were meaningfully increased in BF of patients with BP. We further showed that BF, but not serum from patients with BP, significantly induced the expression of CD163, CD206, and IL-10 in BP monocyte-derived macrophages (MDMs). Notably IL-10 was the only cytokine to be correlated to the reference clinical score, BP disease activity index (BPDAI), especially to the inflammatory BPDAI subscore evaluating urticarial and erythematous skin lesions (r = 0.57, p = 0.0004). We also found elevated levels of MMP-9 to M2-type macrophages ex vivo and highlighted the presence of CD163+ MMP-9+ macrophages histologically, at skin lesional site. Finally, we showed that methylprednisolone reduced MMP-9 levels in MDMs without modifying the other M2 markers. All together these results strongly support the presence of M2-phenotype macrophages with pro-inflammatory properties susceptible to favor blister formation in BP.
Collapse
Affiliation(s)
- Meriem Riani
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| | - Céline Muller
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| | - Camille Bour
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France.,Department of Dermatology, University Hospital, University of Reims-Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France.,Department of Dermatology, University Hospital, University of Reims-Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims-Champagne-Ardenne, Reims, France
| | - Sébastien Le Jan
- Laboratory of Dermatology, EA7509 IRMAIC, University of Reims-Champagne-Ardenne, Reims, France
| |
Collapse
|
27
|
Amber KT, Maglie R, Solimani F, Eming R, Hertl M. Targeted Therapies for Autoimmune Bullous Diseases: Current Status. Drugs 2019; 78:1527-1548. [PMID: 30238396 DOI: 10.1007/s40265-018-0976-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Autoimmune bullous skin disorders are rare but meaningful chronic inflammatory diseases, many of which had a poor or devastating prognosis prior to the advent of immunosuppressive drugs such as systemic corticosteroids, which down-regulate the immune pathogenesis in these disorders. Glucocorticoids and adjuvant immunosuppressive drugs have been of major benefit for the fast control of most of these disorders, but their long-term use is limited by major side effects such as blood cytopenia, osteoporosis, diabetes mellitus, hypertension, and gastrointestinal ulcers. In recent years, major efforts were made to identify key elements in the pathogenesis of autoimmune bullous disorders, leading to the identification of their autoantigens, which are mainly located in desmosomes (pemphigus) and the basement membrane zone (pemphigoids). In the majority of cases, immunoglobulin G, and to a lesser extent, immunoglobulin A autoantibodies directed against distinct cutaneous adhesion molecules are directly responsible for the loss of cell-cell and cell-basement membrane adhesion, which is clinically related to the formation of blisters and/or erosions of the skin and mucous membranes. We describe and discuss novel therapeutic strategies that directly interfere with the production and regulation of pathogenic autoantibodies (rituximab), their catabolism (intravenous immunoglobulins), and their presence in the circulation and extravascular tissues such as the skin (immunoadsorption), leading to a significant amelioration of disease. Moreover, we show that these novel therapies have pleiotropic effects on various proinflammatory cells and cytokines. Recent studies in bullous pemphigoid suggest that targeting of immunoglobulin E autoantibodies (omalizumab) may be also beneficial. In summary, the introduction of targeted therapies in pemphigus and pemphigoid holds major promise because of the high efficacy and fewer side effects compared with conventional global immunosuppressive therapy.
Collapse
Affiliation(s)
- Kyle T Amber
- Department of Dermatology, University of Illinois at Chicago, 808 Wood St. Room 377, Chicago, IL, 60612, USA.
| | - Roberto Maglie
- Department of Dermatology, Philipps University, Baldingerstr., 35043, Marburg, Germany.,Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - Farzan Solimani
- Department of Dermatology, Philipps University, Baldingerstr., 35043, Marburg, Germany
| | - Rüdiger Eming
- Department of Dermatology, Philipps University, Baldingerstr., 35043, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology, Philipps University, Baldingerstr., 35043, Marburg, Germany.
| |
Collapse
|
28
|
Hiroyasu S, Turner CT, Richardson KC, Granville DJ. Proteases in Pemphigoid Diseases. Front Immunol 2019; 10:1454. [PMID: 31297118 PMCID: PMC6607946 DOI: 10.3389/fimmu.2019.01454] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/10/2019] [Indexed: 12/28/2022] Open
Abstract
Pemphigoid diseases are a subgroup of autoimmune skin diseases characterized by widespread tense blisters. Standard of care typically involves immunosuppressive treatments, which may be insufficient and are often associated with significant adverse events. As such, a deeper understanding of the pathomechanism(s) of pemphigoid diseases is necessary in order to identify improved therapeutic approaches. A major initiator of pemphigoid diseases is the accumulation of autoantibodies against proteins at the dermal-epidermal junction (DEJ), followed by protease activation at the lesion. The contribution of proteases to pemphigoid disease pathogenesis has been investigated using a combination of in vitro and in vivo models. These studies suggest proteolytic degradation of anchoring proteins proximal to the DEJ is crucial for dermal-epidermal separation and blister formation. In addition, proteases can also augment inflammation, expose autoantigenic cryptic epitopes, and/or provoke autoantigen spreading, which are all important in pemphigoid disease pathology. The present review summarizes and critically evaluates the current understanding with respect to the role of proteases in pemphigoid diseases.
Collapse
Affiliation(s)
- Sho Hiroyasu
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
| | - Christopher T. Turner
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
| | - Katlyn C. Richardson
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
| | - David J. Granville
- International Collaboration On Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute (VCHRI), Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia (UBC), Vancouver, BC, Canada
- BC Professional Firefighters' Burn and Wound Healing Group, Vancouver Coastal Health Research Institute (VCHRI), University of British Columbia (UBC), Vancouver, BC, Canada
| |
Collapse
|
29
|
Kowalski EH, Kneibner D, Kridin K, Amber KT. Serum and blister fluid levels of cytokines and chemokines in pemphigus and bullous pemphigoid. Autoimmun Rev 2019; 18:526-534. [DOI: 10.1016/j.autrev.2019.03.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 12/24/2022]
|
30
|
Giusti D, Bini E, Terryn C, Didier K, Le Jan S, Gatouillat G, Durlach A, Nesmond S, Muller C, Bernard P, Antonicelli F, Pham BN. NET Formation in Bullous Pemphigoid Patients With Relapse Is Modulated by IL-17 and IL-23 Interplay. Front Immunol 2019; 10:701. [PMID: 31019514 PMCID: PMC6458298 DOI: 10.3389/fimmu.2019.00701] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 03/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background: DNA extracellular traps (ETs), released by neutrophils (NETs), or eosinophils (EETs), play a pathogenic role in several autoimmune disorders. However, to date, NETs have never been investigated in bullous pemphigoid (BP) with respect to clinical and immunological activities, both at baseline and at time of relapse which have been characterized with specific IL-17 and IL-23 patterns. Objective: We sought to assess whether ETs were associated with BP as well as the relative contribution of IL-17 axis cytokines to NET induction. Methods: Skin biopsy specimens were obtained from 11 patients with BP. Immuno-detection of neutrophils and eosinophils combined to DNA staining allowed us to investigate the in-situ presence of NETs and EETs using confocal scanning microscopy. NETs release was evaluated ex vivo by stimulating polymorphonuclear cells from BP patients with BP biological fluids in presence of IL-17A and IL-23 or of glucocorticoids. Results: At baseline, ETs were observed in BP lesions at the site of dermal-epidermal cleavage. Despite an important infiltrate of eosinophils, ETs were essentially associated with neutrophils in situ and were not related to BP clinical activity at diagnosis. In situ observation of NETs was associated in 6 among 8 patients with serum capacity of NET induction. Notably both blister fluid and sera from BP patients at diagnosis and at time of relapse could induce NET formation ex vivo. In contrast, a longitudinal investigation showed a decrease of NET formation with time of treatment in patients undergoing remission. Mimicking relapse, complementation of sera from BP patients with ongoing remission with either IL-17A or IL-23 increased NET formation. Conversely, IL-17A inhibited NET formation induced by serum from BP patients with relapse supplemented or not with IL-23. Finally, glucocorticoids also inhibited NET formation ex vivo in BP. Conclusion: NET formation is an associated phenomenon with BP. Furthermore, we showed that IL-23 favored NET formation, whereas the effects of IL-17A are environment dependent. Indeed, IL-17A displayed a protective effect on NET formation when associated with IL-23, showing for the first-time differential effects of these two cytokines in BP.
Collapse
Affiliation(s)
- Delphine Giusti
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Champagne-Ardenne, Reims, France
| | - Estela Bini
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France
| | - Christine Terryn
- PICT Platform, University of Reims Champagne-Ardenne, Reims, France
| | - Kevin Didier
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France
| | - Sébastien Le Jan
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France
| | - Grégory Gatouillat
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Champagne-Ardenne, Reims, France
| | - Anne Durlach
- Laboratory of Pathology, Reims University Hospital, Reims, France
| | - Stéphane Nesmond
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France
| | - Celine Muller
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims Champagne-Ardenne, Reims, France
| | - Bach Nga Pham
- Laboratory of Dermatology, Faculty of Medicine of Reims, University of Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Champagne-Ardenne, Reims, France
| |
Collapse
|
31
|
Tabatabaei-Panah PS, Moravvej H, Sadaf Z, Babaei H, Geranmayeh M, Hajmanouchehri S, Karimi A, Sajjadi F, Arghand F, Ludwig RJ, Witte M, Akbarzadeh R. Proinflammatory Cytokine Gene Polymorphisms in Bullous Pemphigoid. Front Immunol 2019; 10:636. [PMID: 31001258 PMCID: PMC6455081 DOI: 10.3389/fimmu.2019.00636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/08/2019] [Indexed: 12/13/2022] Open
Abstract
Bullous pemphigoid (BP) is a rare autoimmune skin blistering disease, characterized by the presence of autoantibodies against hemidesmosomal autoantigens. Cytokine expression is altered in BP patients, and several of these differently expressed cytokines, including IL-1α, IL-1β, IL-8, and TNF-α, contribute to disease pathogenesis. Since genetic polymorphisms in the genes of these cytokines might be implicated in susceptibility to BP disease, we aimed at testing this implication in susceptibility to BP in an Iranian cohort. Blood samples were collected from the subjects and genomic DNA was extracted. To detect the single nucleotide polymorphisms (SNPs), IL-1α (rs1800587), IL-1β (rs1143627, rs16944, rs1143634), IL-8 (rs4073), and TNF-α (rs1799964, rs1800630, rs1799724, and rs361525) genes were genotyped in BP patients and healthy controls as well as IL-8 (rs4073) in pemphigus vulgaris (PV) patients. Quantitative gene expression was evaluated by RT-PCR analysis. A significant difference was observed in the distribution of genotypes or alleles of IL-8 SNP between the BP patients and controls. The A-allele of IL-8 SNP is significantly more prevalent in the control individuals compared to the BP patient. To further validate this observation, we included PV patients as an additional control. Again, the A-allele of IL-8 SNP is significantly more prevalent in the PV compared to the BP patients. While we observed a trend toward significant differences regarding alleles of TNF-α rs1799724 as well as alleles of TNF-α rs1799964, this difference was, however, not evident after correction for multiple analysis. There was no significant difference in all other studied SNPs. In contrast to IL-1α, IL-1β, and TNF-α, IL-8 gene expression levels were significantly higher in the patients than that of controls. The minor allele in IL-8 SNP might play a protective role in susceptibility to BP in Iranian patients. Although higher expression levels of IL-8 gene was found in the patients compared with healthy controls, these levels, however, suggest no association with the examined polymorphism. Moreover, further investigation revealed an elevation in gene expression between wild and polymorphic genotypes of IL-1α rs1800587 and TNF-α rs361525 in the patient group and these SNPs are therefore associated with altering the levels of gene expression.
Collapse
Affiliation(s)
| | - Hamideh Moravvej
- Skin Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Sadaf
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Hadis Babaei
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Maryam Geranmayeh
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | | | - Ahmad Karimi
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Fatemeh Sajjadi
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Fereshteh Arghand
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Mareike Witte
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Reza Akbarzadeh
- Skin Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Institute of Anatomy, University of Lübeck, Lübeck, Germany
| |
Collapse
|
32
|
Sernicola A, Russo I, Saponeri A, Alaibac M. Biochip detection of BP180 autoantibodies in blister fluid for the serodiagnosis of bullous pemphigoid: A pilot study. Medicine (Baltimore) 2019; 98:e14514. [PMID: 30762788 PMCID: PMC6408141 DOI: 10.1097/md.0000000000014514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Bullous pemphigoid is an autoimmune subepidermal blistering skin disease immunologically defined by autoantibodies directed against basement membrane zone antigens, the main of which is BP180. Laboratory tests are essential for diagnosis and include direct immunofluorescence and serologic assessments with indirect immunofluorescence and ELISA. Serology may be performed on blister fluid, in alternative to blood serum. This study investigated the use of a Biochip-based indirect immunofluorescence approach for the serum diagnosis of bullous pemphigoid on blister fluid. We compared the results using the Biochip-method with the ELISA detection of bullous pemphigoid-180 autoantibodies in blister fluid and observed a perfect correlation between these 2 methods in our group of 13 patients with clinical and direct immunofluorescence diagnosis of bullous pemphigoid. The Biochip is a simple, standardized and inexpensive diagnostic tool and its use on blister fluid may facilitate the diagnosis of this and other autoimmune bullous disorders. Our results suggest that the Biochip assay on serum of bullae is a non-invasive screening technique for the early diagnosis of bullous pemphigoid that is practical for fragile elderly patients and achievable even in small laboratory settings.
Collapse
|
33
|
Giusti D, Le Jan S, Gatouillat G, Bernard P, Pham BN, Antonicelli F. Biomarkers related to bullous pemphigoid activity and outcome. Exp Dermatol 2018; 26:1240-1247. [PMID: 29105148 DOI: 10.1111/exd.13459] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2017] [Indexed: 12/11/2022]
Abstract
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease of the skin. Investigation of the BP-associated pathophysiological processes during the last decades showed that the generation of autoantibodies directed against the hemidesmosome proteins BP180 and BP230, a hallmark of the BP-associated autoimmune response, leads to the recruitment of inflammatory immune cells at the dermal-epidermal junction, and subsequently to the release of a large amount of inflammatory molecules involved in blister formation. Analysis in transversal and longitudinal studies of autoantibodies and inflammatory molecules production both at the time of diagnosis and under treatment was mainly performed within the serum but also in the blister fluid. Some autoimmune or inflammatory molecules expression was related to the presence of clinical signs, while others were mere bystanders. In this review, we focused on the autoimmune and inflammatory molecules that have been identified as potential biomarkers of BP development and outcome.
Collapse
Affiliation(s)
- Delphine Giusti
- Laboratory of Dermatology, Faculty of Medicine of Reims, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Sébastien Le Jan
- Laboratory of Dermatology, Faculty of Medicine of Reims, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France
| | - Gregory Gatouillat
- Laboratory of Dermatology, Faculty of Medicine of Reims, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Laboratory of Dermatology, Faculty of Medicine of Reims, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Bach Nga Pham
- Laboratory of Dermatology, Faculty of Medicine of Reims, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Faculty of Medicine of Reims, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
34
|
Moravvej H, Tabatabaei-Panah PS, Ebrahimi E, Esmaeili N, Ghaderian SMH, Ludwig RJ, Akbarzadeh R. TNF-α -308G/A gene polymorphism in bullous pemphigoid and alopecia areata. Hum Antibodies 2018; 26:201-207. [PMID: 29843231 DOI: 10.3233/hab-180339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND TNF-α -308G/A polymorphism has been investigated in few studies for an association with susceptibility to bullous pemphigoid (BP) and alopecia areata (AA). Yet, these findings had so far not been independently replicated, and no data on a possible association of TNFα -308G/A polymorphism with these diseases in Iranian population were available. OBJECTIVES In the present study, a possible effect of TNF-α -308G/A variation on susceptibility to BP or AA disease was evaluated. METHODS Genomic DNA was extracted from the blood of the patients with BP and AA as well as control subjects which genotyped for the TNF-α -308 G/A polymorphism. TNF-α gene expression levels were analyzed by real-time RT-PCR. RESULTS No association was observed between the TNF-α -308 G/A variation and susceptibility to BP or AA diseases in our Iranian cohort. In contrast to AA patients, expression of TNF-α gene was significantly higher in BP patients compared to control group. TNF-α gene was found to be similarly expressed in mutant and wild-type genotypes. CONCLUSIONS TNF-α -308G/A polymorphism is not associated with the risk to develop of BP and AA in our Iranian cohort. Furthermore, this polymorphism is contributed to altering the levels of gene expression in BP disease.
Collapse
Affiliation(s)
- Hamideh Moravvej
- Skin Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Skin Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis-Sadat Tabatabaei-Panah
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran.,Skin Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elaheh Ebrahimi
- Biology Department, East Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Nafiseh Esmaeili
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Reza Akbarzadeh
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Institute of Anatomy, University of Lübeck, Lübeck, Germany
| |
Collapse
|
35
|
Fang H, Shao S, Jiang M, Dang E, Shen S, Zhang J, Qiao P, Li C, Wang G. Proinflammatory role of blister fluid-derived exosomes in bullous pemphigoid. J Pathol 2018; 245:114-125. [PMID: 29468680 DOI: 10.1002/path.5061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/24/2018] [Accepted: 02/16/2018] [Indexed: 02/02/2023]
Abstract
Bullous pemphigoid is an autoimmune inflammatory disorder characterized by the presence of autoantibodies against bullous pemphigoid autoantigens, leading to dermal-epidermal separation with consequent blister formation. However, whether and how the components of blister fluid exacerbate the progression of bullous pemphigoid is unclear. Exosomes are nanometre-sized vesicles released from cells into the body fluid, where they can transmit signals throughout the body. In the present study, we isolated and characterized exosomes from blister fluids of patients with bullous pemphigoid, evaluated their proinflammatory role, and identified the underlying molecular mechanisms. We found that exosomes isolated from blister fluids of patients with bullous pemphigoid showed the expected size and expressed the marker proteins CD63, CD81, and CD9. Additionally, blister fluid-derived exosomes were internalized by human primary keratinocytes, inducing the production of critical inflammatory cytokines and chemokines. Western blotting analysis showed robust and rapid activation of the extracellular signal-regulated kinase 1/2 and signal transducer and activator of transcription 3 signalling pathways in human primary keratinocytes after stimulation with blister fluid-derived exosomes. We also found that blister fluid-derived exosomes indirectly induced neutrophil trafficking by upregulating C-X-C motif chemokine ligand 8 in vitro. Furthermore, CD63 was localized mostly to keratinocytes and infiltrative granulocytes in skin lesions, suggesting that these cells were the possible sources of exosomes in blister fluid. Using mass spectrometry, we analysed the proteomes of blister fluid-derived exosomes and identified a variety of proteins implicated in inflammatory and immune responses. Together, our findings provide strong evidence that blister fluid-derived exosomes are involved in the local autoinflammatory responses of the skin associated with bullous pemphigoid. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Hui Fang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Man Jiang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Shengxian Shen
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Jieyu Zhang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Pei Qiao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Caixia Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, PR China
| |
Collapse
|
36
|
Giusti D, Gatouillat G, Le Jan S, Plée J, Bernard P, Antonicelli F, Pham BN. Anti-Type VII Collagen Antibodies Are Identified in a Subpopulation of Bullous Pemphigoid Patients With Relapse. Front Immunol 2018; 9:570. [PMID: 29619029 PMCID: PMC5871753 DOI: 10.3389/fimmu.2018.00570] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/06/2018] [Indexed: 11/19/2022] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune bullous skin disease characterized by anti-BP180 and anti-BP230 autoantibodies (AAbs). Mucous membrane involvement is an uncommon clinical feature of BP which may evoke epidermolysis bullosa acquisita, another skin autoimmune disease characterized by anti-type VII collagen AAbs. We therefore evaluated the presence of anti-type VII collagen AAbs in the serum of BP patients with and without mucosal lesions at time of diagnosis and under therapy. Anti-BP180, anti-BP230, and anti-type VII collagen AAbs were measured by ELISA in the serum of unselected patients fulfilling clinical and histo/immunopathological BP criteria at baseline (n = 71) and at time of relapse (n = 24). At baseline, anti-type VII collagen AAbs were detected in 2 out of 24 patients with BP presenting with mucosal involvement, but not in patients without mucosal lesions (n = 47). At the time of relapse, 10 out of 24 BP patients either displayed a significant induction or increase of concentrations of anti-type VII collagen AAbs (P < 0.01), independently of mucosal involvement. Those 10 relapsing BP patients were also characterized by a sustained high concentration of anti-BP180 AAb, whereas the serum anti-BP230 AAb concentrations did not vary in BP patients with relapse according to the presence of anti-type VII collagen AAbs. Thus, our study showed that anti-type VII collagen along with anti-BP180 AAbs detection stratified BP patients at time of relapse, illustrating a still dysregulated immune response that could reflect a potential epitope spreading mechanism in those BP patients.
Collapse
Affiliation(s)
- Delphine Giusti
- Laboratory of Dermatology, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Grégory Gatouillat
- Laboratory of Dermatology, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Sébastien Le Jan
- Laboratory of Dermatology, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France
| | - Julie Plée
- Laboratory of Dermatology, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Philippe Bernard
- Laboratory of Dermatology, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, Faculty of Odontology, University of Reims Champagne-Ardenne, Reims, France
| | - Bach-Nga Pham
- Laboratory of Dermatology, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France.,Laboratory of Immunology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
37
|
Surya R, Tejasvi B, Shenoi SD, Pai S, Rao C, Rao R. Detection of Anti-basement Membrane Zone Antibodies in the Blister Fluid in Subepidermal Autoimmune Bullous Diseases. Indian J Dermatol 2017; 62:649-653. [PMID: 29263541 PMCID: PMC5724315 DOI: 10.4103/ijd.ijd_403_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Subepidermal autoimmune bullous diseases (sAIBD) are diverse of conditions with clinicopathological overlap. Circulating autoantibodies in the serum can be demonstrated using indirect immunofluorescence (IIF) microscopy. Artificially split normal human skin is considered as an optimum substrate for the demonstration of anti-basement membrane zone (BMZ) antibodies using IIF in sAIBD; it not only helps to detect the presence of circulating antibodies in the serum but also helps to subclassify these conditions into “roof” and “floor” binding disorders. Aim: In this study, we evaluated the utility of IIF to detect anti-BMZ antibodies in the blister fluid of patients with sAIBD. Materials and Methods: Twenty-two patients with a clinical diagnosis of sAIBD were enrolled in the study. IIF of serum and blister fluid were done simultaneously using salt-split skin as a substrate. Results: Anti-BMZ antibodies could be detected in the blister fluid using IIF in all patients in the study group. Limitation: We could not do enzyme-linked immunosorbent assay of blister fluid. This would have given us the quantitative data of circulating antibodies in the blister fluid. Conclusion: Blister fluid offers an alternate source for the detection of autoantibodies in patients with sAIBD. It may be of particular help in children and in elderly with poor venous access.
Collapse
Affiliation(s)
- Ravindran Surya
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Bobbili Tejasvi
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Shrutakirthi D Shenoi
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Sathish Pai
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Chythra Rao
- Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Raghavendra Rao
- Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| |
Collapse
|
38
|
Freire P, Muñoz C, Stingl G. IgE autoreactivity in bullous pemphigoid: eosinophils and mast cells as major targets of pathogenic immune reactants. Br J Dermatol 2017; 177:1644-1653. [PMID: 28868796 PMCID: PMC5814899 DOI: 10.1111/bjd.15924] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune disease characterized by tense blisters that are usually preceded by urticarial eruptions. Affected patients exhibit IgG and/or IgE autoantibodies against BP180 and/or BP230. Their relative importance in disease pathogenesis has not been fully elucidated. OBJECTIVES The aim of this study was to provide a better characterization of the circulating and tissue-resident IgE in patients with BP at the serological, structural and functional levels. METHODS Sera (n = 19) and skin (n = 33) from patients with BP were analysed via enzyme-linked immunosorbent assay (ELISA) and immunofluorescence, respectively. RESULTS The results obtained show that many patients with BP exhibit elevated IgE levels in the serum and in the skin. In the skin, it is very rarely and only sparsely found along the basement membrane zone, but is prominently present on mast cells and eosinophils. At least a portion of these IgE antibodies are BP-specific, as evidenced by serum ELISA and by the colocalization of BP180 and FcεRI-bound IgE on mast cells and/or eosinophils. An important role of these immune reactants can be inferred from our additional finding that cross-linking of IgE, derived from BP sera, on FcεRI-expressing rat basophils with BP180 results in robust degranulation of these cells. CONCLUSIONS We propose the existence of a disease pathway alternative to IgG and complement that may well be responsible for some of the clinical features of this autoimmune disease.
Collapse
Affiliation(s)
- P.C. Freire
- Department of DermatologyDivision of Immunology, Allergy and Infectious DiseasesMedical University of ViennaVienna1090Austria
| | - C.H. Muñoz
- Department of DermatologyDivision of Immunology, Allergy and Infectious DiseasesMedical University of ViennaVienna1090Austria
| | - G. Stingl
- Department of DermatologyDivision of Immunology, Allergy and Infectious DiseasesMedical University of ViennaVienna1090Austria
| |
Collapse
|
39
|
Brulefert A, Le Jan S, Plée J, Durlach A, Bernard P, Antonicelli F, Trussardi-Régnier A. Variation of the epidermal expression of glucocorticoid receptor-beta as potential predictive marker of bullous pemphigoid outcome. Exp Dermatol 2017; 26:1261-1266. [PMID: 28887823 DOI: 10.1111/exd.13444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2017] [Indexed: 11/29/2022]
Abstract
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease in Western countries. Although topical and/or systemic glucocorticoids treatment efficacy is widely recognized, up to 30% of patients with BP may undergo a relapse during the first year of treatment. We investigated the protein expression of the total glucocorticoid receptor and GRβ isoform in the skin biopsy specimens from patients with BP and wondered whether such investigation at baseline provided a tool to predict disease outcome. Total GR and GRβ protein expressions were detected by immunohistochemistry at baseline on 12 patients who later relapse and 11 patients who remained on remission in comparison with 14 control patients. The expression of GRβ in the epidermis of patients with BP who later relapse was significantly higher than that in the epidermis of patients with BP controlled upon corticosteroid treatment, which was also higher than control patients. Thus, our results suggest that increased protein expression of GRβ in skin epithelial cells is predictive of reduced steroid treatment efficacy, and therefore of increased risk of disease relapse in patients with BP.
Collapse
Affiliation(s)
- Adrien Brulefert
- Laboratory of Dermatology, Faculty of Medicine of Reims, EA 7319, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France
| | - Sébastien Le Jan
- Laboratory of Dermatology, Faculty of Medicine of Reims, EA 7319, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France
| | - Julie Plée
- Laboratory of Dermatology, Faculty of Medicine of Reims, EA 7319, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Anne Durlach
- Laboratory of Dermatology, Faculty of Medicine of Reims, EA 7319, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Laboratory Pol Bouin, Hospital Maison Blanche, University Hospital, Reims Cedex, France
| | - Philippe Bernard
- Laboratory of Dermatology, Faculty of Medicine of Reims, EA 7319, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Department of Dermatology, Reims University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Frank Antonicelli
- Laboratory of Dermatology, Faculty of Medicine of Reims, EA 7319, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France.,Department of Biological Sciences, Immunology, UFR Odontology, University of Reims Champagne-Ardenne, Reims, France
| | - Aurélie Trussardi-Régnier
- Laboratory of Dermatology, Faculty of Medicine of Reims, EA 7319, IFR CAP Santé, University of Reims Champagne-Ardenne, Reims, France
| |
Collapse
|
40
|
Kubin ME, Hellberg L, Palatsi R. Glucocorticoids: The mode of action in bullous pemphigoid. Exp Dermatol 2017; 26:1253-1260. [PMID: 28771827 DOI: 10.1111/exd.13408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 12/16/2022]
Abstract
Bullous pemphigoid (BP) is the most common of pemphigoid diseases caused by autoantibodies against the structures of dermoepidermal junction followed by complement activation, innate immune cell infiltration, neutrophil proteinase secretion and subepidermal blister formation. The first-line treatment of BP is topical and systemic glucocorticoids (GC). Regulation of the immune system and inflammatory cells is the main target of GC actions. GCs act through genomic and non-genomic mechanisms. The human glucocorticoid receptor (GR) mediates most of the biologic effects of GC: cytosolic GR binds GCs and is capable to bind to glucocorticoid response elements in DNA and either transactivate or transrepress genes depending on the tissue and cell type. In addition, GR exerts rapid, non-genomic effects possibly mediated by membrane-localized receptors or by translocation to mitochondria. GCs can also interact directly with several enzymes and cytokines. As a target treatment for BP, the production of autoantibodies should be discontinued. GCs, in spite of their wide immunosuppressive actions, are weak to stop immunoglobulin G (IgG) autoantibody formation. However, both systemic and topical GCs are able to reduce the clinical symptoms of BP. GCs are used to inhibit the secondary inflammation and symptoms, such as blistering and pruritus, and it is shown that GC treatment will gradually decrease also the autoantibody formation. Our review article analyses the mode of action of GC treatment in BP, as far it is possible due to paucity of modern immunological studies.
Collapse
Affiliation(s)
- Minna E Kubin
- PEDEGO Research Unit, Oulu Center for Cell-Matrix Research, Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Lars Hellberg
- Institute for Medical Microbiology and Hygiene, University of Lübeck, Lübeck, Germany
| | - Riitta Palatsi
- PEDEGO Research Unit, Oulu Center for Cell-Matrix Research, Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| |
Collapse
|
41
|
Simon D, Borradori L, Simon HU. Eosinophils as putative therapeutic targets in bullous pemphigoid. Exp Dermatol 2017; 26:1187-1192. [PMID: 28833620 DOI: 10.1111/exd.13416] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 12/14/2022]
Abstract
Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering skin disease and is characterized by the presence of autoantibodies directed against the hemidesmosomal proteins BP180 and BP230 that can be detected in the skin and serum of BP patients. Histologically, the dermal infiltration of eosinophils is obvious. The objective of this review was to present evidence that eosinophils play a key role in the pathogenesis of BP. Eosinophils, together with cytokines and chemokines regulating their production, recruitment and activation, are abundantly present in lesional skin, in blisters and in peripheral blood of patients with BP. Recently, using a cryosection model, eosinophils were demonstrated to induce dermal-epidermal separation in the presence of BP antibodies. Thus, eosinophils and their products, as well as mediators regulating their function, present promising targets for the treatment of BP.
Collapse
Affiliation(s)
- Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| |
Collapse
|
42
|
Expression of the JAK/STAT Signaling Pathway in Bullous Pemphigoid and Dermatitis Herpetiformis. Mediators Inflamm 2017; 2017:6716419. [PMID: 29203970 PMCID: PMC5674508 DOI: 10.1155/2017/6716419] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/22/2017] [Accepted: 09/07/2017] [Indexed: 12/20/2022] Open
Abstract
A family of eleven proteins comprises the Janus kinases (JAK) and signal transducers and activators of transcription (STAT) signaling pathway, which enables transduction of signal from cytokine receptor to the nucleus and activation of transcription of target genes. Irregular functioning of the cascade may contribute to pathogenesis of autoimmune diseases; however, there are no reports concerning autoimmune bullous diseases yet to be published. The aim of this study was to evaluate the expression of proteins constituting the JAK/STAT signaling pathway in skin lesions and perilesional area in dermatitis herpetiformis (DH) and bullous pemphigoid (BP), as well as in the control group. Skin biopsies were collected from 21 DH patients, from 20 BP patients, and from 10 healthy volunteers. The localization and expression of selected STAT and JAK proteins were examined by immunohistochemistry and immunoblotting. We found significantly higher expression of JAK/STAT proteins in skin lesions in patients with BP and DH, in comparison to perilesional skin and the control group, which may be related to proinflammatory cytokine network and induction of inflammatory infiltrate in tissues. Our findings suggest that differences in the JAK and STAT expression may be related to distinct cytokines activating them and mediating neutrophilic and/or eosinophilic infiltrate.
Collapse
|
43
|
de Graauw E, Sitaru C, Horn M, Borradori L, Yousefi S, Simon HU, Simon D. Evidence for a role of eosinophils in blister formation in bullous pemphigoid. Allergy 2017; 72:1105-1113. [PMID: 28135772 DOI: 10.1111/all.13131] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune bullous disease of the skin characterized by subepidermal blister formation due to tissue-bound and circulating autoantibodies to the hemidesmosomal antigens BP180 and BP230. Although eosinophils and their toxic mediators are found abundantly in BP lesions, their role in blister formation has remained unclear. OBJECTIVE To investigate the role of eosinophils in the pathogenesis of BP with a specific focus on blister formation and to define conditions inducing dermal-epidermal separation (DES). METHODS In an ex vivo human model of BP, normal human skin cryosections were incubated with purified human peripheral blood eosinophils with or without activation in the presence or absence of BP autoantibodies, brefeldin A, diphenyleneiodonium, DNase or blocking F(ab')2 fragments to CD16, CD18, CD32 and CD64. Dermal-epidermal separation was assessed by light microscopy studies and quantified using Fiji software. RESULTS Following activation with IL-5 and in the presence of BP autoantibodies, eosinophils induced separation along the dermal-epidermal junction of ex vivo skin. Dermal-epidermal separation was significantly reduced by blocking any of the following: Fcγ receptor binding (P = 0.048), eosinophil adhesion (P = 0.046), reactive oxygen species (ROS) production (P = 0.002), degranulation (P < 0.0001) or eosinophil extracellular trap (EET) formation (P = 0.048). CONCLUSIONS Our results provide evidence that IL-5-activated eosinophils directly contribute to BP blister formation in the presence of BP autoantibodies. Dermal-epidermal separation by IL-5-activated eosinophils depends on adhesion and Fcγ receptor activation, requires elevated ROS production and degranulation and involves EET formation. Thus, targeting eosinophils may be a promising therapeutic approach for BP.
Collapse
Affiliation(s)
- E. de Graauw
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - C. Sitaru
- Department of Dermatology and Centre for Biological Signaling Studies (BIOSS); University Medical Center Freiburg; Freiburg Germany
| | - M. Horn
- Centre of Laboratory Medicine; Inselspital; Bern University Hospital; Bern Switzerland
| | - L. Borradori
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - S. Yousefi
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - D. Simon
- Department of Dermatology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| |
Collapse
|
44
|
Bağcı IS, Horváth ON, Ruzicka T, Sárdy M. Bullous pemphigoid. Autoimmun Rev 2017; 16:445-455. [DOI: 10.1016/j.autrev.2017.03.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
|
45
|
Fang H, Shao S, Cao T, Lei J, Dang E, Zhang J, Wang G. Increased expression of NLRP3 inflammasome components and interleukin-18 in patients with bullous pemphigoid. J Dermatol Sci 2016; 83:116-23. [PMID: 27174093 DOI: 10.1016/j.jdermsci.2016.04.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) is the most common blistering autoimmune disease severely affecting older people. The complex interplay between innate and adaptive immunity is critical in the development of BP. Inflammasomes, which lead to cleavage-induced maturation of pro-inflammatory cytokines, have been shown to participate in a variety of autoimmune diseases. However, the role of inflammasomes in BP has not been delineated. OBJECTIVE The present work aimed to investigate whether inflammasomes are involved in the pathogenesis and progression of BP. METHODS Expressions of inflammasome components at the messenger RNA (mRNA) and protein levels in peripheral blood mononuclear cells (PBMCs) from patients with BP and from healthy controls were investigated by quantitative real-time PCR (qRT-PCR) and western blot, respectively. ELISA was employed to evaluate interleukin (IL)-1β, IL-18, lactate dehydrogenase (LDH), and high-mobility group-1 (HMGB1) levels in the serum and blister fluid of patients with BP. Immunohistochemical staining was used to detect IL-18 expression in the skin lesion of patients with BP. RESULTS The mRNA levels of NLRP3 inflammasome components (NLRP3, pro-caspase-1, and pro-IL-18) in PBMCs were significantly up-regulated in BP patients compared with those in healthy controls, and were positively correlated with the autoantibody titers for BP180-NC16A. Western Blot analysis showed that the baseline expressions of NLRP3 inflammasome components were increased in PBMCs of BP patients compared with healthy controls, and we failed to observe the mature IL-1β and IL-18. Further analysis showed that IL-18 was elevated in serum, blister fluid and lesional skin from patients with BP, and the serum IL-18 level was positively correlated with the titers of anti-BP180-NC16A autoantibody in BP patient. Most importantly, we found that mRNA expressions of the NLRP3-caspase-1-IL-18 axis components and the serum IL-18 level in BP patients decreased dramatically after effective treatment, which indicated that the up-regulation of NLRP3 inflammasome was responsible, at least to a great degree, for the enhanced IL-18 level in BP patients. CONCLUSIONS This study demonstrates that the expression of the NLRP3-caspase-1-IL-18 axis is highly expressed in the PBMCs of patients with BP, and correlated with disease activity, suggesting its involvement in the pathogenesis and progression of BP.
Collapse
Affiliation(s)
- Hui Fang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an 710032, China
| | - Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an 710032, China
| | - Tianyu Cao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an 710032, China
| | - Jie Lei
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an 710032, China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an 710032, China
| | - Jieyu Zhang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an 710032, China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Road, Xi'an 710032, China.
| |
Collapse
|
46
|
Ludwig R. Immune mechanism-targeted treatment of experimental epidermolysis bullosa acquisita. Expert Rev Clin Immunol 2015; 11:1365-78. [PMID: 26471717 DOI: 10.1586/1744666x.2015.1085801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Epidermolysis bullosa acquisita (EBA) is an autoimmune bullous dermatosis characterized by chronic mucocutaneous blistering caused by autoantibodies directed against type VII collagen. EBA causes a high morbidity and is difficult to treat. Model systems have significantly broadened our understanding of EBA pathogenesis, leading to the identification of numerous therapeutic targets. Of these, so far, a few have been evaluated for their therapeutic potential in preclinical models. In mice, EBA can be induced by transfer of anti-type VII collagen antibodies or by immunization with the protein. The latter model, immunization-induced EBA, is ideal to test drugs for their therapeutic efficacy. Here, mice with already established disease can be treated for prolonged periods. Albeit time consuming, results from immunization-induced EBA will pave the way for clinical application in patients. As the key pathogenic principle, that is, autoantibody-induced, leukocyte-mediated tissue injury and inflammation, is shared by other diseases, these findings may have translational applications beyond EBA.
Collapse
Affiliation(s)
- Ralf Ludwig
- a University of Luebeck, Luebeck Institute of Experimental Dermatology, Ratzeburger Allee 160, Luebeck, Germany
| |
Collapse
|
47
|
Namazi MR, Parhizkar AR, Jowkar F. Serum levels of hypersensitive-C-reactive protein in moderate and severe acne. Indian Dermatol Online J 2015. [PMID: 26225329 PMCID: PMC4513404 DOI: 10.4103/2229-5178.160256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Elevation of C-reactive protein (CRP) has been reported to occur in psoriasis, urticaria, acne, rosacea and many other dermatological and nondermatological conditions. Chronic systemic inflammation has been implicated in the development of neuropsychiatric/degenerative disorders, atherosclerosis, coronary artery disease, diabetes mellitus and even carcinogenesis. The present study is designed to determine whether the level of inflammation created by acne vulgaris could be high enough to raise the serum levels of high-sensitive CRP. MATERIALS AND METHODS Forty-two patients with moderate and severe acne vulgaris were enrolled, along with 44 age and sex matched healthy blood donors as controls. Hypersensitive-CRP (Hs-CRP) was measured in both groups. RESULTS Hypersensitive-C-reactive protein levels in the case group varied between 0 and 28.1 μg/ml with an average of 2.24 ± 4.87 μg/ml (mean ± standard deviation) and a median of 0.6 μg/ml (interquartile range [IQR] =0.3, 1.4 μg/ml). Hs-CRP levels of the control group varied between 0 and 14 μg/ml with an average of 3.12 ± 3.67 μg/ml and a median of 1.5 μg/ml (IQR = 0.55, 5.0 μg/ml). No significant difference of Hs-CRP level between the two groups was seen (t = -0.961, 95% confidence interval: Lower = -2.6942, upper = 0.9377; P = 0.339). Additionally, no significant difference in the level of Hs-CRP was noted between the moderate and severe acne groups (95% confidence interval: Lower = -5.2495, upper = 1.6711; P = 0.165). CONCLUSION Acne vulgaris, even in its severe grades (excluding acne fulminans and acne conglobata), does not induce significant inflammation at the systemic level.
Collapse
Affiliation(s)
- M R Namazi
- Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Department of Liverpool Hospital Dermatology, Conjoint Faculty Member, University of New South Wales, Sydney, Australia
| | - A R Parhizkar
- Department of Dermatology, Fasa University of Medical Sciences, Fasa, Iran
| | - F Jowkar
- Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
48
|
Coexistence of autoimmune bullous diseases (AIBDs) and psoriasis: A series of 145 cases. J Am Acad Dermatol 2015; 73:50-5. [DOI: 10.1016/j.jaad.2015.03.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/02/2015] [Accepted: 03/06/2015] [Indexed: 11/18/2022]
|
49
|
Nakayama C, Fujita Y, Watanabe M, Shimizu H. Development of bullous pemphigoid during treatment of psoriatic onycho-pachydermo periostitis with ustekinumab. J Dermatol 2015; 42:996-8. [DOI: 10.1111/1346-8138.12943] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Chihiro Nakayama
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Yasuyuki Fujita
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Mika Watanabe
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - Hiroshi Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| |
Collapse
|
50
|
Ujiie H. IgE autoantibodies in bullous pemphigoid: supporting role, or leading player? J Dermatol Sci 2015; 78:5-10. [PMID: 25797172 DOI: 10.1016/j.jdermsci.2015.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 11/16/2022]
Abstract
Bullous pemphigoid (BP) is a common autoimmune blistering skin disease in which two hemidesmosomal components--the transmembrane collagen XVII (BP180 or BPAG2) and the plakin family protein BP230 (BPAG1)--are targeted by autoimmunity. Of these, collagen XVII (COL17) is thought to be a major autoantigen, and vital roles of IgG autoantibodies in blister formation have been elucidated. However, BP shows distinct features, including pruritic urticarial erythema and eosinophilic infiltration, which may be independent of IgG-mediated autoimmunity. Recently, it has been revealed that sera from certain patients with BP contain IgE autoantibodies to COL17 and that IgE autoantibodies bind to peri-lesional dermal-epidermal junctions. Mouse models have demonstrated that IgE antibodies to COL17 induce erythema and eosinophilic infiltration in skin. In addition, the successful treatment of severe BP with omalizumab, a humanized monoclonal antibody targeting IgE, has been reported. These findings suggest that both IgG and IgE autoantibodies to COL17 may be involved in the BP pathogenesis. This article summarizes IgE-mediated autoimmunity to COL17 in BP.
Collapse
Affiliation(s)
- Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, N15W7, Kita-Ku, Sapporo 060-8638, Japan.
| |
Collapse
|