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Lim YL, Bohelay G, Hanakawa S, Musette P, Janela B. Autoimmune Pemphigus: Latest Advances and Emerging Therapies. Front Mol Biosci 2022; 8:808536. [PMID: 35187073 PMCID: PMC8855930 DOI: 10.3389/fmolb.2021.808536] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022] Open
Abstract
Pemphigus represents a group of rare and severe autoimmune intra-epidermal blistering diseases affecting the skin and mucous membranes. These painful and debilitating diseases are driven by the production of autoantibodies that are mainly directed against the desmosomal adhesion proteins, desmoglein 3 (Dsg3) and desmoglein 1 (Dsg1). The search to define underlying triggers for anti-Dsg-antibody production has revealed genetic, environmental, and possible vaccine-driven factors, but our knowledge of the processes underlying disease initiation and pathology remains incomplete. Recent studies point to an important role of T cells in supporting auto-antibody production; yet the involvement of the myeloid compartment remains unexplored. Clinical management of pemphigus is beginning to move away from broad-spectrum immunosuppression and towards B-cell-targeted therapies, which reduce many patients’ symptoms but can have significant side effects. Here, we review the latest developments in our understanding of the predisposing factors/conditions of pemphigus, the underlying pathogenic mechanisms, and new and emerging therapies to treat these devastating diseases.
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Affiliation(s)
- Yen Loo Lim
- Department of Dermatology, National Skin Centre, Singapore
| | - Gerome Bohelay
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Sho Hanakawa
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
| | - Philippe Musette
- Department of Dermatology and INSERM U1125, Avicenne Hospital, Bobigny, France
| | - Baptiste Janela
- A*STAR Skin Research Labs (ASRL), Agency for Science, Technology and Research (A*STAR), Singapore
- Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Singapore
- A*STAR Infectious Diseases Labs, Agency for Science, Technology and Research (A*STAR), Singapore
- Singapore Immunology network, Agency for Science, Technology and Research (A*STAR), Singapore
- *Correspondence: Baptiste Janela,
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Amber KT, Valdebran M, Grando SA. Non-Desmoglein Antibodies in Patients With Pemphigus Vulgaris. Front Immunol 2018; 9:1190. [PMID: 29915578 PMCID: PMC5994403 DOI: 10.3389/fimmu.2018.01190] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 05/14/2018] [Indexed: 12/14/2022] Open
Abstract
Pemphigus vulgaris (PV) is a potentially life-threatening mucocutaneous autoimmune blistering disease. Patients develop non-healing erosions and blisters due to cell–cell detachment of keratinocytes (acantholysis), with subsequent suprabasal intraepidermal splitting. Identified almost 30 years ago, desmoglein-3 (Dsg3), a Ca2+-dependent cell adhesion molecule belonging to the cadherin family, has been considered the “primary” autoantigen in PV. Proteomic studies have identified numerous autoantibodies in patients with PV that have known roles in the physiology and cell adhesion of keratinocytes. Antibodies to these autoantibodies include desmocollins 1 and 3, several muscarinic and nicotinic acetylcholine receptor subtypes, mitochondrial proteins, human leukocyte antigen molecules, thyroid peroxidase, and hSPCA1—the Ca2+/Mn2+-ATPase encoded by ATP2C1, which is mutated in Hailey–Hailey disease. Several studies have identified direct pathogenic roles of these proteins, or synergistic roles when combined with Dsg3. We review the role of these direct and indirect mechanisms of non-desmoglein autoantibodies in the pathogenesis of PV.
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Affiliation(s)
- Kyle T Amber
- Department of Dermatology, University of California Irvine, Irvine, CA, United States
| | - Manuel Valdebran
- Department of Dermatology, University of California Irvine, Irvine, CA, United States
| | - Sergei A Grando
- Department of Dermatology, University of California Irvine, Irvine, CA, United States.,Department of Dermatology, Institute for Immunology, University of California Irvine, Irvine, CA, United States.,Department of Biological Chemistry, Institute for Immunology, University of California Irvine, Irvine, CA, United States
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Lehman VT, Barrick BJ, Pittelkow MR, Peller PJ, Camilleri MJ, Lehman JS. Diagnostic imaging in paraneoplastic autoimmune multiorgan syndrome: retrospective single site study and literature review of 225 patients. Int J Dermatol 2014; 54:424-37. [DOI: 10.1111/ijd.12603] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Koga H, Ohyama B, Tsuruta D, Ishii N, Hamada T, Dainichi T, Natsuaki Y, Sogame R, Fukuda S, Karashima T, Tada J, Yamashiro M, Uezato H, Chan PT, Hashimoto T. Five Japanese cases of antidesmoglein 1 antibody‐positive and antidesmoglein 3 antibody‐negative pemphigus with oral lesions. Br J Dermatol 2012; 166:976-80. [DOI: 10.1111/j.1365-2133.2012.10827.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. Koga
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - B. Ohyama
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - D. Tsuruta
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - N. Ishii
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - T. Hamada
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - T. Dainichi
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - Y. Natsuaki
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - R. Sogame
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - S. Fukuda
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - T. Karashima
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
| | - J. Tada
- Section of Dermatology, Kagawa Prefectural Central Hospital, 5‐4‐16 Bancho, Takamatsu‐shi, Kagawa 760‐8558, Japan
| | - M. Yamashiro
- Department of Dermatology, Ryukyu University School of Medicine, 207 Uehara Nishiharacho, Nakagamigun, Okinawa 903‐0125, Japan
| | - H. Uezato
- Department of Dermatology, Ryukyu University School of Medicine, 207 Uehara Nishiharacho, Nakagamigun, Okinawa 903‐0125, Japan
| | - P. T. Chan
- Social Hygiene Service, Department of Health, Cheung Sha Wan Dermatological Clinic, 3/F West Kowloon Health Centre, 303 Cheung Sha Wan Road, Kowloon, Hong Kong, China
| | - T. Hashimoto
- Department of Dermatology, Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology, 67 Asahimachi, Kurume, Fukuoka 830‐0011, Japan
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Abstract
Paraneoplastic pemphigus (PNP) is a life-threatening autoimmune blistering skin disease. Clinically, it is characterized by severe mucosal erosions and various cutaneous lesions associated with lymphoproliferative neoplasmas. Suprabasal acantholysis and clefts with scattered necrotic keratinocytes are the unique histopathological features. PNP patient sera recognize multiple antigens, which have been identified as the plakin protein family that includes desmoplakin, bullous pemphigoid antigen I (BPAG1), envoplakin and periplakin, and desmogleins 1 and 3. Castleman's tumor, non-Hodgkin's lymphoma, thymoma, follicular dendritic cell sarcoma and chronic lymphocytic leukemia are the commonly associated neoplasmas in PNP. We have also demonstrated that the autoantibodies reacting to epidermal proteins are directly produced by the cells in the associated tumors. Bronchiolitis obliterans is frequently found in PNP and may cause respiratory failure and death. In our experience, the early detection and removal of the tumor and i.v. administration of immunoglobulin are critical for the treatment of PNP.
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Affiliation(s)
- Xuejun Zhu
- Department of Dermatology, Peking University First Hospital, Beijing, China.
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Uemura M, Nouso K, Kobayashi Y, Tanaka H, Nakamura SI, Higashi T, Ono T, Nakayama E, Hanafusa T, Shiratori Y. Identification of the antigens predominantly reacted with serum from patients with hepatocellular carcinoma. Cancer 2003; 97:2474-9. [PMID: 12733146 DOI: 10.1002/cncr.11374] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND To identify antigens specifically recognized by the immune surveillance system in patients with hepatocellular carcinoma (HCC), the authors examined two complementary DNA (cDNA) libraries of moderately differentiated HCC by serologic analysis of recombinant cDNA expression libraries (SEREX). METHODS The libraries were screened with autologous patients' sera, and sequences of the reacted clones were determined. To study the immunoreactivity of the antigens, sera from 20 patients with HCC, from 20 healthy volunteers, and from 16 patients with chronic viral hepatitis were examined. RESULTS Twenty-seven antigens were identified. They included SART1, p57Kip2, ROCK-1, gamma-catenin, and heat shock proteins, which are classified as tumor-associated genes. Three of 27 antigens-Tat-binding protein-1 (TBP-1), beta4 integrin-binding protein (p27[BBP]), and ribosomal protein L30 (rpL30)-were reacted predominantly with sera from patients with HCC (55% of patients, 45% of patients, and 20% of patients, respectively). Patients in the control group had no antibodies against these three antigens. Seventy percent of patients with HCC had the antibody against at least one of these antigens. CONCLUSIONS Disease specific humoral immune response against TBP-1, p27(BBP), and rpL30 was induced in patients with HCC, and the antibodies against these antigens also may be used as tumor markers.
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MESH Headings
- Aged
- Antigens, Neoplasm/genetics
- Antigens, Neoplasm/immunology
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/immunology
- Carcinoma, Hepatocellular/genetics
- Carcinoma, Hepatocellular/immunology
- Case-Control Studies
- Cell Transformation, Neoplastic
- DNA Primers
- DNA, Complementary/genetics
- Female
- Gene Library
- Hepatitis B/genetics
- Hepatitis B/immunology
- Hepatitis C/genetics
- Hepatitis C/immunology
- Hepatitis, Alcoholic/genetics
- Hepatitis, Alcoholic/immunology
- Humans
- Liver Neoplasms/genetics
- Liver Neoplasms/immunology
- Male
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Affiliation(s)
- Masayuki Uemura
- Department of Medicine and Medical Science, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
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Kimyai-Asadi A, Kotcher LB, Jih MH. The molecular basis of hereditary palmoplantar keratodermas. J Am Acad Dermatol 2002; 47:327-43; quiz 344-6. [PMID: 12196741 DOI: 10.1067/mjd.2002.124814] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In recent years, the gene defects causing many types of hereditary palmoplantar keratoderma have been discovered. These genes encode a variety of proteins involved in the terminal differentiation of keratinocytes and the formation of the cornified cell envelope. In this article, we review the molecular defects underlying various palmoplantar keratodermas with particular attention to the role of these molecules in the terminal differentiation of palmoplantar epidermis. Of the proteins involved in keratodermas, loricrin, keratins, and desmosomal proteins provide the protein structure of the cornified cell envelope. Connexins form intercellular gap junctions, which regulate ionic calcium signals necessary for the expression of the proteins that form the cornified cell envelope. Cathepsins likely mediate enzymatic processes necessary for the formation and dissolution of the cornified cell envelope. The clinical phenotypes produced by various mutations affecting these proteins are discussed vis-à-vis data from genetic, cellular, and molecular experiments.
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Affiliation(s)
- Arash Kimyai-Asadi
- Ronald O. Perelman Department of Dermatology, The New York University School of Medicine, New York, USA
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