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Simionescu O, Tudorache SI. Autoimmune pemphigus: difficulties in diagnosis and the molecular mechanisms underlying the disease. Front Immunol 2025; 16:1481093. [PMID: 40098967 PMCID: PMC11911200 DOI: 10.3389/fimmu.2025.1481093] [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: 08/15/2024] [Accepted: 02/18/2025] [Indexed: 03/19/2025] Open
Abstract
Recently recognised as a desmosomal disorder, autoimmune pemphigus remains severe in some of its forms, such as pemphigus vulgaris. This review is divided into four parts. "Cellular and molecular mechanisms in autoimmune pemphigus" discusses in detail antigenic targets, antibodies, immunological and genetic mechanisms of apoptosis and the involvement of cells and organelles (keratinocytes, lymphocytes, eosinophils and neutrophils) in different forms of pemphigus. These advances have led to today's first-line biologic therapy for pemphigus. The section "Specific features in the diagnosis of immune pemphigus" deals with the clinical diagnostic clues (enanthema, intertrigo, pruritus, distribution of lesions). The third section, "Characteristics and challenges in different types of pemphigus", focuses on the importance of using standardised diagnostic criteria in paraneoplastic pemphigus and pemphigus herpetiformis, the specific and difficult situations of differentiation between bullous lupus and autoimmune Senear-Usher pemphigus, between IgA forms of pemphigus or differentiation with other autoimmune diseases or neutrophilic dermatoses. The possibility of subtype cross-reactivity in pemphigus is also discussed, as is the diagnosis and course of the disease in pregnant women. The final section is an update of the "gold standard for the diagnosis and evaluation of autoimmune pemphigus", the role and place of direct immunofluorescence and additional serological tests. This revision is the first to combine the difficulties in clinical diagnosis with new molecular insights. It provides a comprehensive overview of recent advances in the understanding of autoimmune pemphigus, bridging the clinical challenges and complexities of diagnosing different forms of pemphigus, and is a valuable resource for clinicians caring for patients with pemphigus.
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Affiliation(s)
- Olga Simionescu
- 1stClinic of Dermatology, Carol Davila University of Medicine and Pharmacy, Colentina Hospital, Bucharest, Romania
| | - Sorin Ioan Tudorache
- Department of Preclinical Disciplines, Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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Pacheco-Tovar D, Pacheco-Tovar MG, Saavedra-Alonso S, Zapata-Benavides P, Torres-del-Muro FDJ, Bollain-y-Goytia JJ, Herrera-Esparza R, Rodríguez-Padilla C, Avalos-Díaz E. shRNA-Targeting Caspase-3 Inhibits Cell Detachment Induced by Pemphigus Vulgaris Autoantibodies in HaCaT Cells. Int J Mol Sci 2024; 25:8864. [PMID: 39201550 PMCID: PMC11354573 DOI: 10.3390/ijms25168864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Pemphigus is an autoimmune disease that affects the skin and mucous membranes, induced by the deposition of pemphigus IgG, which mainly targets desmogleins 1 and 3 (Dsg1 and 3). This autoantibody causes steric interference between Dsg1 and 3 and the loss of cell adhesion, producing acantholysis. This molecule and its cellular effects are clinically reflected as intraepidermal blistering. Pemphigus vulgaris-IgG (PV-IgG) binding involves p38MAPK-signaling-dependent caspase-3 activation. The present work assessed the in vitro effect of PV-IgG on the adherence of HaCaT cells dependent on caspase-3. PV-IgG induced cell detachment and apoptotic changes, as demonstrated by annexin fluorescent assays. The effect of caspase-3 induced by PV-IgG was suppressed in cells pre-treated with caspase-3-shRNA, and normal IgG (N-IgG) as a control had no relevant effects on the aforementioned parameters. The results demonstrated that shRNA reduces caspase-3 expression, as measured via qRT-PCR and via Western blot and immunofluorescence, and increases cell adhesion. In conclusion, shRNA prevented in vitro cell detachment and the late effects of apoptosis induced by PV-IgG on HaCaT cells, furthering our understanding of the molecular role of caspase-3 cell adhesion dependence in pemphigus disease.
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Affiliation(s)
- Deyanira Pacheco-Tovar
- Department of Immunology, School of Biological Sciences, UACB, Universidad Autónoma de Zacatecas, Av. de la Revolución Mexicana s/n, Colonia Tierra y Libertad, Guadalupe CP 98615, Zacatecas, Mexico; (D.P.-T.); (M.-G.P.-T.); (F.-d.-J.T.-d.-M.); (J.-J.B.-y.-G.)
- School of Chemistry Sciences, Universidad Autónoma de Zacatecas, Campus Universitario Siglo XXI, Carretera Zacatecas-Guadalajara, Ejido “La Escondida”, Zacatecas CP 98160, Zacatecas, Mexico
- Department of Immunology and Virology, Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, Av. Pedro de Alba s/n, Ciudad Universitaria, San Nicolás de los Garza CP 64450, Nuevo León, Mexico; (S.S.-A.); (C.R.-P.)
| | - María-Guadalupe Pacheco-Tovar
- Department of Immunology, School of Biological Sciences, UACB, Universidad Autónoma de Zacatecas, Av. de la Revolución Mexicana s/n, Colonia Tierra y Libertad, Guadalupe CP 98615, Zacatecas, Mexico; (D.P.-T.); (M.-G.P.-T.); (F.-d.-J.T.-d.-M.); (J.-J.B.-y.-G.)
- School of Chemistry Sciences, Universidad Autónoma de Zacatecas, Campus Universitario Siglo XXI, Carretera Zacatecas-Guadalajara, Ejido “La Escondida”, Zacatecas CP 98160, Zacatecas, Mexico
- Department of Immunology and Virology, Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, Av. Pedro de Alba s/n, Ciudad Universitaria, San Nicolás de los Garza CP 64450, Nuevo León, Mexico; (S.S.-A.); (C.R.-P.)
| | - Santiago Saavedra-Alonso
- Department of Immunology and Virology, Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, Av. Pedro de Alba s/n, Ciudad Universitaria, San Nicolás de los Garza CP 64450, Nuevo León, Mexico; (S.S.-A.); (C.R.-P.)
| | - Pablo Zapata-Benavides
- Department of Immunology and Virology, Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, Av. Pedro de Alba s/n, Ciudad Universitaria, San Nicolás de los Garza CP 64450, Nuevo León, Mexico; (S.S.-A.); (C.R.-P.)
| | - Felipe-de-Jesús Torres-del-Muro
- Department of Immunology, School of Biological Sciences, UACB, Universidad Autónoma de Zacatecas, Av. de la Revolución Mexicana s/n, Colonia Tierra y Libertad, Guadalupe CP 98615, Zacatecas, Mexico; (D.P.-T.); (M.-G.P.-T.); (F.-d.-J.T.-d.-M.); (J.-J.B.-y.-G.)
- School of Chemistry Sciences, Universidad Autónoma de Zacatecas, Campus Universitario Siglo XXI, Carretera Zacatecas-Guadalajara, Ejido “La Escondida”, Zacatecas CP 98160, Zacatecas, Mexico
- Department of Immunology and Virology, Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, Av. Pedro de Alba s/n, Ciudad Universitaria, San Nicolás de los Garza CP 64450, Nuevo León, Mexico; (S.S.-A.); (C.R.-P.)
| | - Juan-José Bollain-y-Goytia
- Department of Immunology, School of Biological Sciences, UACB, Universidad Autónoma de Zacatecas, Av. de la Revolución Mexicana s/n, Colonia Tierra y Libertad, Guadalupe CP 98615, Zacatecas, Mexico; (D.P.-T.); (M.-G.P.-T.); (F.-d.-J.T.-d.-M.); (J.-J.B.-y.-G.)
| | - Rafael Herrera-Esparza
- Department of Immunology, School of Biological Sciences, UACB, Universidad Autónoma de Zacatecas, Av. de la Revolución Mexicana s/n, Colonia Tierra y Libertad, Guadalupe CP 98615, Zacatecas, Mexico; (D.P.-T.); (M.-G.P.-T.); (F.-d.-J.T.-d.-M.); (J.-J.B.-y.-G.)
| | - Cristina Rodríguez-Padilla
- Department of Immunology and Virology, Faculty of Biological Sciences, Universidad Autónoma de Nuevo León, Av. Pedro de Alba s/n, Ciudad Universitaria, San Nicolás de los Garza CP 64450, Nuevo León, Mexico; (S.S.-A.); (C.R.-P.)
| | - Esperanza Avalos-Díaz
- Department of Immunology, School of Biological Sciences, UACB, Universidad Autónoma de Zacatecas, Av. de la Revolución Mexicana s/n, Colonia Tierra y Libertad, Guadalupe CP 98615, Zacatecas, Mexico; (D.P.-T.); (M.-G.P.-T.); (F.-d.-J.T.-d.-M.); (J.-J.B.-y.-G.)
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Sulzbach Denardin M, Bumiller-Bini Hoch V, Salviano-Silva A, Lobo-Alves SC, Adelman Cipolla G, Malheiros D, Augusto DG, Wittig M, Franke A, Pföhler C, Worm M, van Beek N, Goebeler M, Sárdy M, Ibrahim S, Busch H, Schmidt E, Hundt JE, Petzl-Erler ML, Beate Winter Boldt A. Genetic Association and Differential RNA Expression of Histone (De)Acetylation-Related Genes in Pemphigus Foliaceus-A Possible Epigenetic Effect in the Autoimmune Response. Life (Basel) 2023; 14:60. [PMID: 38255677 PMCID: PMC10821360 DOI: 10.3390/life14010060] [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: 11/28/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Pemphigus foliaceus (PF) is an autoimmune skin blistering disease characterized by antidesmoglein-1 IgG production, with an endemic form (EPF) in Brazil. Genetic and epigenetic factors have been associated with EPF, but its etiology is still not fully understood. To evaluate the genetic association of histone (de)acetylation-related genes with EPF susceptibility, we evaluated 785 polymorphisms from 144 genes, for 227 EPF patients and 194 controls. Carriers of HDAC4_rs4852054*A were more susceptible (OR = 1.79, p = 0.0038), whereas those with GSE1_rs13339618*A (OR = 0.57, p = 0.0011) and homozygotes for PHF21A_rs4756055*A (OR = 0.39, p = 0.0006) were less susceptible to EPF. These variants were not associated with sporadic PF (SPF) in German samples of 75 SPF patients and 150 controls, possibly reflecting differences in SPF and EPF pathophysiology. We further evaluated the expression of histone (de)acetylation-related genes in CD4+ T lymphocytes, using RNAseq. In these cells, we found a higher expression of KAT2B, PHF20, and ZEB2 and lower expression of KAT14 and JAD1 in patients with active EPF without treatment compared to controls from endemic regions. The encoded proteins cause epigenetic modifications related to immune cell differentiation and cell death, possibly affecting the immune response in patients with PF.
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Affiliation(s)
- Maiara Sulzbach Denardin
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
| | - Valéria Bumiller-Bini Hoch
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil
| | - Amanda Salviano-Silva
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Sara Cristina Lobo-Alves
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
- Research Institut Pelé Pequeno Príncipe, Curitiba 80250-060, Brazil
| | - Gabriel Adelman Cipolla
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
| | - Danielle Malheiros
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil
| | - Danillo G. Augusto
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
- Department of Biological Sciences, The University of North Carolina at Charlotte, Charlotte, NC 28223, USA
| | - Michael Wittig
- Institute of Clinical Molecular Biology (IKMB), Christian-Albrechts-University of Kiel, 24105 Kiel, Germany; (M.W.); (A.F.)
| | - Andre Franke
- Institute of Clinical Molecular Biology (IKMB), Christian-Albrechts-University of Kiel, 24105 Kiel, Germany; (M.W.); (A.F.)
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, 66421 Homburg, Germany;
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, 23562 Lübeck, Germany; (N.v.B.); (E.S.)
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, 97080 Würzburg, Germany;
| | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80539 Munich, Germany;
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary
| | - Saleh Ibrahim
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 127788, United Arab Emirates;
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, 23562 Lübeck, Germany; (H.B.); (J.E.H.)
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, 23562 Lübeck, Germany; (H.B.); (J.E.H.)
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, 23562 Lübeck, Germany; (N.v.B.); (E.S.)
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, 23562 Lübeck, Germany; (H.B.); (J.E.H.)
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, 23562 Lübeck, Germany; (H.B.); (J.E.H.)
| | - Maria Luiza Petzl-Erler
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil
| | - Angelica Beate Winter Boldt
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil; (M.S.D.); (V.B.-B.H.); (S.C.L.-A.); (G.A.C.); (D.M.); (D.G.A.); (M.L.P.-E.)
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil
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