A Cross-Sectional Study to Correlate Disease Severity in Bullous Pemphigoid Patients with Serum Levels of Autoantibodies Against BP180 and BP230

Therapeutic potential of recombinant human type XVII collagen in wound healing and bullous pemphigoid: From bench to bedside

OBJECTIVE

To investigate the effects of recombinant human type XVII collagen (RHCXVII) on the proliferation and adhesion of primary human keratinocytes (HPKCs) and to observe its clinical efficacy and safety in bullous pemphigoid (BP).

METHODS

The RHCXVII was produced by genetic recombination technology and characterized by Fourier transform infrared (FTIR) spectroscopy. HPKCs were obtained from human foreskin and seeded onto culture plates coated with RHCXVII at concentrations of 10, 50 and 100μg/ml. The proliferation and relative adhesion of HPKCs were assessed by Cell Counting Kit-8 (CCK-8) and adhesion assays, respectively. Trajectories and velocities of HPKCs were recorded using a living cell imaging platform. To assess the effects of RHCXVII on HPKCs, E-cadherin, integrinα6 and laminin α3 mRNA levels were measured using reverse transcription-polymerase chain reaction (RT-PCR) assays. The patient test sites were treated with RHCXVII, while the contralateral sides served as controls. This was performed in combination with systemic glucocorticoid treatment. Bilateral wound healing was recorded at various time points and the efficacy in BP was assessed.

RESULTS

RHCXVII exhibited the anticipated structural characteristics of recombinant collagen and was deemed suitable for utilization in the present study. HPKCs demonstrated robust growth in culture plates precoated with RHCXVII, expressing keratin 15 (K15). After 3, 5 and 7 days, RHCXVII at a concentration of 10 µg/ml significantly promoted the proliferation of HPKCs (P<0.05). Furthermore, the optimal relative adhesion of HPKCs was observed when cells were cultured on RHCXVII at a concentration of 100 µg/ml (P<0.01). The mRNA levels of E-cadherin, integrinα6 and lamininα3 in HPKCs cultivated in wells coated with RHCXVII were considerably higher compared to the control group (P<0.05). The study encompassed a total of 12 patients. The mean time to resolution of lesions on the treated sides was 11.08 days, significantly shorter than the 13.42 days observed on the control sides. The mean time to blister resolution was 2.3 days shorter on the treated sides than on the controls. By day 7, the percentage improvement in wound healing compared to the baseline was 7.75 % greater on the treated sides than on the control sides. The study noted a high level of patient satisfaction and no occurrence of significant adverse events.

CONCLUSION

RHCXVII has the capacity to promote HPKC growth and adherence. In clinical applications, it has been demonstrated to accelerate wound healing in patients with bullous diseases (BD), thereby reducing the risk of subsequent secondary infection. Its potential as an adjunct treatment for wound repair in diseases such as BD merits further investigation.

Bullous Pemphigoid Severity and Levels of Antibodies to BP180 and BP230: A Systematic Review and Meta-Analysis

Importance

The correlation between serum levels of autoantibodies against bullous pemphigoid (BP) antigens 180 (BP180) and 230 (BP230) with BP disease severity is unclear.

Objective

To investigate the correlation of anti-BP180 and anti-BP230 immunoglobulin G (IgG) antibody levels with BP disease severity.

Data Sources

A search was performed of the Cochrane Central Register of Controlled Trials, Embase, and PubMed databases from their respective inception to April 11, 2024.

Study Selection

Studies evaluating the correlation between serum levels of anti-BP180 or anti-BP230 IgG measured using enzyme-linked immunosorbent assay (ELISA) and disease severity assessed per the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) or BP Disease Area Index (BPDAI) were included. No language or geographic restrictions were imposed. Nearly 0.4% of initially identified studies met the selection criteria.

Data Extraction and Synthesis

One researcher extracted data and another researcher confirmed data. The risk of bias was independently assessed by these researchers using the Quality Assessment of Diagnostic Accuracy Studies 2 tool, with discrepancies resolved by discussion with a third researcher. A random-effects model meta-analysis and a subgroup analysis were conducted based on the ELISA kit manufacturers.

Main Outcomes and Measures

Pooled correlation coefficients of antibody levels with ABSIS and BPDAI.

Results

In all, 14 studies with 1226 participants were analyzed. The risk of bias of included studies was generally low. The meta-analysis found anti-BP180 autoantibody levels showed moderate correlation with objective BPDAI (r = 0.56; 95% CI, 0.46-0.64) at baseline, strong correlation (r = 0.63; 95% CI, 0.39-0.79) at 3-month follow-up, and moderate correlation (r = 0.53; 95% CI, 0.25-0.72) at 6-month follow-up. Anti-BP180 autoantibody levels also showed moderate correlation (r = 0.52; 95% CI, 0.39-0.62) with ABSIS at baseline, strong correlation (r = 0.62; 95% CI, 0.39-0.79) at 3-month follow-up, and moderate correlation (r = 0.53; 95% CI, 0.25-0.72) at 6-month follow-up. By contrast, anti-BP230 autoantibody levels showed no association with objective BPDAI and ABSIS at diagnosis and follow-up. The subgroup analysis found similar results when using different ELISA kits.

Conclusions and Relevance

The findings of this systematic review and meta-analysis indicated that anti-BP180 autoantibody levels may serve as an adjunctive tool for monitoring BP disease severity and guiding clinical care for patients with BP.

Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are positively correlated with disease activity of bullous pemphigoid

Bullous pemphigoid (BP) is a complex inflammatory process with elevated levels of autoantibodies, eosinophils, neutrophils, and various cytokines. Hematological inflammatory biomarkers can reflect inflammatory state in various diseases. Up to now, the correlations of hematological inflammatory biomarkers and disease activity of BP remain unknown. The purpose of this study was to clarify the associations between hematological inflammatory biomarkers and disease activity of BP. The levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR) and mean platelet volume (MPV) of 36 untreated BP patients and 45 age and gender matched healthy controls were detected by routine blood tests. The correlations between hematological inflammatory markers and clinical characteristics of BP were statistically analyzed. The Bullous Pemphigoid Disease Area Index (BPDAI) was used to measure disease activity of BP. The mean levels of NLR, PLR, PNR and MPV in 36 untreated BP patients were 3.9, 157.9, 45.7 and 9.4 fl, respectively. Increased NLR (p < 0.001), PLR (p < 0.01), and MPV (p < 0.001) but decreased PNR (p < 0.001) were observed in BP patients when compared with healthy controls. In BP patients, the levels of NLR were positively correlated to BPDAI Erosion/Blister Scores (p < 0.01); and the levels of NLR and PLR were both positively correlated to BPDAI without Damage Score (both p < 0.05) and BPDAI Total Score (both p < 0.05). No correlation was found in other statistical analyses between hematological inflammatory markers and clinical characteristics in BP patients involved in the present study. Therefore, NLR and PLR are positively correlated with disease activity of BP.

Dupilumab effectively and rapidly treats bullous pemphigoid by inhibiting the activities of multiple cell types

Background

Bullous pemphigoid (BP) is an autoimmune skin-blistering disease. Systemic corticosteroids remain the first line treatment for moderate-to-severe BP with the potential for severe adverse events. Dupilumab has emerged as an alternative option for BP patients.

Objective

We evaluated the efficiency and safety of dupilumab on BP treatment and explored a mode of drug action in depth.

Methods and results

A multicenter retrospective cohort included 20 BP patients who received dupilumab with or without systemic corticosteroid in dupilumab group, and 20 matched BP patients who received corticosteroid alone in conventional group. Serum samples were collected from 20 patients (10 from dupilumab group and 10 from conventional group) at baseline and week 4. Compared to systemic corticosteroid alone, dupilumab with or without systemic corticosteroid was similarly efficacious in clinical remission at week4 (complete remission plus partial remission: 100%) and week24 (complete remission plus partial remission:100%), but allowing significant decreases in the cumulative doses of corticosteroids with reducing the incidence of adverse events. However, dupilumab did not decrease BP180 antibody despite an obvious clinical improvement. Comparative plasma proteomic analysis performed before and after treatment in 3 BP patients from dupilumab group revealed that drug use was associated with 30 differentially expressed proteins, including 26 down-regulated and 4 up-regulated proteins. The former consisted of immune related proteins involved in T/B cell interactions (inducible T-cell co-stimulator ligand, ICOSL) and in the activation of eosinophils (PRG2), mast cells (S100A12), and complement (CR2). TARC and ICOSL levels correlated with BP severity in patients who received either dupilumab or conventional treatment.

Conclusion

Dupilumab has similar efficacy in treating BP as conventional drugs, by inhibiting the activities of many types of immune cells and complement, and regulating the interactions between T and B cells.

Associations between bullous pemphigoid and hematological diseases: Literature review on mechanistic connections and possible treatments

Bullous pemphigoid is an autoimmune blistering disorder that primarily occurs in elderly patients. Reports indicate that BP coexists with various hematological diseases, including acquired hemophilia A, hypereosinophilic syndrome, aplastic anemia, autoimmune thrombocytopenia, and hematological malignancies. Early identification of these comorbidities contributes to a better control and reduced mortality. This article details the atypical clinical manifestations of BP when associated with hematological diseases, specific diagnostic strategies, underlying mechanistic connections, and possible treatments. Cross-reactivity between autoantibodies and exposed abnormal epitopes, shared cytokines and immune cells, together with genetic susceptibility are the most common connections between BP and hematological diseases. Patients were most often successfully treated with oral steroids combined with medications specifically targeting the hematological disorders. However, the individual comorbidities require specific considerations.

Case Report: Variety of Target Antigens During 1 Year Follow-Up of a Patient Initially Diagnosed With Bullous Pemphigoid

Autoimmune bullous diseases (AIBDs), presenting cutaneous and/or mucosal bullous lesions, are classified into pemphigus and pemphigoid diseases. A longtime observation for complicated AIBD cases is rarely reported. In this study, serum samples of one AIBD patient were collected at seven different time points during the disease course including a relapse, which were examined by our conventional and newly developed methods for the detection of autoantibodies. Interestingly, we found changes of both the presence and the titers of various autoantibodies in accordance with the changes of clinical features during the whole disease course, which indicated that the patient started as bullous pemphigoid and relapsed as concurrence of bullous pemphigoid and mucosal-dominant-type pemphigus vulgaris.

Gliptin-associated bullous pemphigoid shows peculiar features of anti-BP180 and -BP230 humoral response: results from a multicenter study

BACKGROUND

Recently, several case-control studies demonstrated an association between gliptins and bullous pemphigoid (BP) occurrence. Data on clinical and immunological features of gliptin-associated bullous pemphigoid (GABP) are controversial.

OBJECTIVE

This study aims to clinically and immunologically characterize a large cohort of GABP patients to get insight into the pathophysiology of this emerging drug-induced variant of BP.

METHODS

Seventy-four GABP patients were prospectively enrolled and characterized from nine different Italian Dermatology Units between 2013 and 2020.

RESULTS

Our findings demonstrate that in GABP patients: i) the non-inflammatory phenotype which is characterized by low amounts of circulating and skin infiltrating eosinophils is frequently found; ii) IgG, IgE and IgA humoral response to BP180 and BP230 antigens is reduced in frequency and titers when compared with idiopathic BP; iii) IgG reactivity targets multiple BP180 epitopes other than NC16A.

LIMITATIONS

A limitation of the study is the control group that did not comprise only type 2 diabetes mellitus BP patients.

CONCLUSIONS

GABP patients show peculiar features of anti-BP180 and -BP230 humoral response laying the foundations for diagnostic improvements and to get novel insights into understanding the mechanism of BP onset.

Relationship between the age and sex of the patient with the results of the indirect immunofluorescence test in patients with bullous dermatoses

Background/Aim: Autoimmune bullous diseases are characterised by the production of autoantibodies to epidermal or subepidermal adhesive proteins. The aim of this study was to determine the relationship between age and sex of patients with the results of indirect immunofluorescence test in patients with newly diagnosed bullous dermatoses. Methods: The investigation presents a retrospective study of newly diagnosed patients with autoimmune bullous diseases at the Clinic for Skin and Venereal Diseases of the University Clinical Centre in Banja Luka in the period 2016-2021. In addition to demographic data, the results of an indirect immunofluorescence test in two titres (≥ 1:10 and ≥ 1:100) were analysed. Results: In this study, almost the same number of patients with pemphigus (45.2 %) and pemphigoid (54.8 %) was found. There were more women than men in the total sample (p = 0.049). The average age of subjects with pemphigoid was higher than that of patients with pemphigus (p = 0.001). 48.2 % of patients with pemphigus and 51.8 % of patients with pemphigoid had a positive indirect immunofluorescence test. A positive test for epidermal intercellular substance in both sexes at a titre ≥ 1:100 is higher than a titre ≥ 1:10 (p = 0.029). Patients with autoantibody titres ≥ 1:100 to desmoglein-1 were statistically significantly older than patients with titres ≥ 1:10 (p = 0.047). Conclusion: Number of patients with pemphigus and pemphigoid were similar, with no difference in sex distribution between the two groups of patients, but patients with pemphigoid were older than patients with pemphigus. The difference between high and low autoantibody titres in both sexes was found only in the group of pemphigus on epidermal intercellular substance and desmoglein-1.