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Li X, Pas HH, Qian H, Rashid H, Horvath B, Yilmaz K, van Beek N, Schmidt E, Zillikens D, Ishii N, Tsuruta D, Hashimoto T. Potential correlation between anti-laminin 332 autoantibodies and malignant tumours in anti-BP180-type mucous membrane pemphigoid. Clin Exp Dermatol 2024:llae124. [PMID: 38634807 DOI: 10.1093/ced/llae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 04/19/2024]
Abstract
This is the first large cohort study to analyze the potential correlations between anti-laminin (LM) 332 autoantibodies and malignant tumours in 520 anti-BP180-type mucous membrane pemphigoid (BP180-MMP) patients recruited from four countries in two continents, in which anti-LM332 autoantibodies (-) BP180-MMP patients were used as control. The results in this study support that anti-LM332 autoantibodies are positively correlated with malignant tumours in BP180-MMP, particularly in Europe.
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Affiliation(s)
- Xiaoguang Li
- School of Public Health and Laboratory Medicine, Hunan University of Medicine, Huaihua, China
| | - Hendri H Pas
- Center for Blistering Diseases, Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hua Qian
- School of Public Health and Laboratory Medicine, Hunan University of Medicine, Huaihua, China
| | - Hanan Rashid
- Center for Blistering Diseases, Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara Horvath
- Center for Blistering Diseases, Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kaan Yilmaz
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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van Beek N, Eming R, Reuss A, Zillikens D, Sárdy M, Günther C, Kiritsi D, Benoit S, Beissert S, Gläser R, Gollnick H, Horváth ON, Pfeiffer C, Röcken M, Schauer F, Schreml S, Steinbrink K, Zink A, Schade-Brittinger C, Hertl M, Schmidt E. Efficacy and safety of adjuvant immunoadsorption in pemphigus vulgaris and pemphigus foliaceus (IA-Pem Study): a multicentre randomized controlled trial. Br J Dermatol 2024; 190:657-667. [PMID: 38133541 DOI: 10.1093/bjd/ljad489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/23/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are potentially life-threatening autoimmune blistering diseases. Treatment is based on long-term immunosuppression with high doses of glucocorticosteroids in combination with potentially corticosteroid-sparing agents and/or rituximab. Immunoadsorption (IA) has emerged as a fast-acting adjuvant treatment option. OBJECTIVES To assess the clinical efficacy of IA in addition to best medical treatment (BMT). METHODS We conducted a multicentre (26 centres from Germany and Austria) randomized controlled trial in 72 patients with newly diagnosed, relapsed or chronic active PV or PF (34 female patients and 38 male patients, aged 42-72 years) comparing BMT (prednisolone 1.0 mg kg-1 per day plus azathioprine or mycophenolate) with adjuvant IA (BMT + IA). Central 1 : 1 randomization was done at the coordinating centre for clinical trials (KKS Marburg). The primary endpoint was analysed using Kaplan-Meier and Cox regression methods. RESULTS The study was ended prematurely owing to safety concerns after random allocation of 72 patients to BMT + IA (n = 34) or BMT (n = 38). The primary endpoint, time to complete remission on therapy, was not significantly different for the two groups [hazard ratio (HR) 1.35, 95% confidence interval (CI) 0.68-2.69; P = 0.39]. The cumulative dose of prednisolone was significantly lower in the BMT + IA group compared with BMT alone (difference -1214, 95% CI -2225 to -70; P = 0.03). In a post hoc analysis, patients with more extensive PV/PF showed a tendency towards a shorter time to remission in the BMT + IA group compared with the BMT group (HR 1.87, P = 0.17 in patients with baseline Pemphigus Disease Area Index ≥ 15). While more adverse events were observed in patients in the BMT group (29 vs. 25), severe adverse events were more frequent in patients in the BMT + IA group (17 events in 10 patients vs. 11 events in 8 patients). CONCLUSIONS In this study, adjuvant IA did not demonstrate a shorter time to clinical remission, but a corticosteroid-sparing effect was observed. In patients with extensive PV/PF, post hoc analysis suggests that adjuvant IA may lead to earlier remission, but potential adverse events must be carefully weighed against the expected benefits.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, Allergology and Venereology
| | | | - Alexander Reuss
- Coordinating Center for Clinical Trials, Phillips University, Marburg, Germany
| | | | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Dimitra Kiritsi
- Department of Dermatology and Venereology, University Hospital Freiburg, Freiburg, Germany
| | - Sandrine Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Regine Gläser
- Department of Dermatology, Venereology and Allergology, Christian-Albrechts University, Kiel, Germany
| | - Harald Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke University, Magdeburg, Germany
| | - Orsolya N Horváth
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany
| | - Martin Röcken
- Department of Dermatology, Eberhard Karls University, Tübingen, Germany
| | - Franziska Schauer
- Department of Dermatology and Venereology, University Hospital Freiburg, Freiburg, Germany
| | - Stephan Schreml
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - Kerstin Steinbrink
- Department of Dermatology, Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Alexander Zink
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | | | | | - Enno Schmidt
- Department of Dermatology, Allergology and Venereology
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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3
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Emtenani S, Linnemann BE, Recke A, von Georg A, Goletz S, Schmidt E, van Beek N. Anti-BP230 IgE autoantibodies in bullous pemphigoid intraindividually correlate with disease activity. J Dermatol Sci 2024:S0923-1811(24)00055-0. [PMID: 38582700 DOI: 10.1016/j.jdermsci.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Bullous pemphigoid (BP), the most common subepidermal autoimmune blistering disease, is classically defined by the presence of IgG autoantibodies directed against the hemidesmosomal proteins BP180 (type XVII collagen) and BP230 and the predominance of skin lesions. Several studies have addressed the role of anti-BP180 IgE in patients and experimental models, while data on anti-BP230 IgE are scarce. OBJECTIVE To assess anti-BP230 IgE level by ELISA in BP sera and to correlate it with disease severity and clinical characteristics. METHODS BP sera underwent anti-BP230 IgE ELISA and Western blotting against human BP230 fragments. RESULTS We demonstrate that 36/154 (23%) of BP sera were positive for anti-BP230 IgE. Anti-BP230 IgE levels had no correlation with clinical phenotype or disease activity per se. Interestingly, anti-BP230 IgE was significantly associated with disease activity within individuals during the course of the disease. Additionally, anti-BP230 IgE and total IgE levels showed a significant correlation. Notably, anti-BP230 IgG correlated interindividually with disease activity. By Western blotting, the C-terminal domain of BP230 fragments (C2; amino acids 2024-2349 and C3; amino acids 2326-2649), provided the best serological assay for anti-BP230 IgE detection. CONCLUSION As a complementary tool, IgE immunoblotting is recommended to obtain an optimal serological diagnosis, particularly in patients with severe disease without IgG reactivity by BP180- or BP230-specific ELISA. Although the detection of serum anti-BP230 IgE is not of major diagnostic significance, it may be relevant for therapeutic decisions, e.g., for anti-IgE-directed treatment, which has been successfully used in case series of BP.
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Affiliation(s)
- Shirin Emtenani
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Beke E Linnemann
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany; Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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De D, Shilpa S, Kumar S, Drenovska K, Mehta H, van Beek N, Sachdeva N, Fleva A, Shahid M, Handa S, Giannakou A, Naumova E, Mahajan R, Kyriakou A, Lesichkova S, Lazaridou E, Radotra BD, Kishore K, Schmidt E, Vassileva S, Patsatsi A. Differences among Indian and European pemphigus patients based on demographics, clinical parameters and propensity for relapse: results of a prospective bicontinental cohort study. Eur J Dermatol 2023; 33:642-647. [PMID: 38465545 DOI: 10.1684/ejd.2023.4631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Limited studies have explored pemphigus variations among different ethnic groups residing in their respective geographical locations. This bicontinental study aimed to compare clinical and immunological parameters in Indian and European pemphigus patients in complete remission, off therapy, or on minimal therapy. 105 patients (India, n= 75; Bulgaria, n=15; Greece, n=15) with pemphigus vulgaris (PV) or pemphigus foliaceous (PF) in complete remission on minimal therapy (n=64) or complete remission off therapy (n=41) were recruited. Demographic, clinical, and immunological parameters were compared. Indian patients were significantly younger, the maximal disease severity during the preceding active disease phase was significantly lower, and treatment duration until complete remission was significantly shorter, compared to European patients. European patients had significantly higher anti-Dsg3 serum levels and higher IgG positivity rate based on direct immunofluorescence microscopy at baseline. Furthermore, European patients revealed higher CD19, CD19+ CD27+ cell counts, compared with patients from India. Of note, none of the European patients (n=30) relapsed within the study period, in contrast to 29/75 (38.6%) Indian patients. Treatment strategies differed significantly between the two cohorts, with more frequent utilization of rituximab to achieve remission in the Indian cohort, while prednisolone was more widely used for maintaining remission in the European cohort. The observed heterogeneity of pemphigus among patients of different ethnicities in terms of demographics, clinical parameters, and propensity for relapse may be due to genetic background or different treatment strategies.
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Affiliation(s)
- Dipankar De
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shilpa Shilpa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sheetanshu Kumar
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University - Sofia, Bulgaria
| | - Hitaishi Mehta
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Naresh Sachdeva
- Department of Endocrinology (Immunology Division), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alexandra Fleva
- Department of Immunology-Histocompatibility, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Martin Shahid
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University - Sofia, Bulgaria
| | - Sanjeev Handa
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anastasia Giannakou
- Department of Immunology-Histocompatibility, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Elissaveta Naumova
- Department of Clinical Immunology, Faculty of Medicine, Medical University - Sofia, Sofia, Bulgaria
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aikaterini Kyriakou
- 2nd University Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Spaska Lesichkova
- Department of Clinical Immunology, Faculty of Medicine, Medical University - Sofia, Sofia, Bulgaria
| | - Elisabeth Lazaridou
- 2nd University Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
| | - Bishan Dass Radotra
- Department Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kishore
- Department of Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany, Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Faculty of Medicine, Medical University - Sofia, Bulgaria
| | - Aikaterini Patsatsi
- 2nd University Dermatology Department, Aristotle University School of Medicine, Thessaloniki, Greece
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6
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Liu X, van Beek N, Cepic A, Andreani NA, Chung CJ, Hermes BM, Yilmaz K, Benoit S, Drenovska K, Gerdes S, Gläser R, Goebeler M, Günther C, von Georg A, Hammers CM, Holtsche MM, Hübner F, Kiritsi D, Schauer F, Linnenmann B, Huilaja L, Tasanen-Määttä K, Vassileva S, Zillikens D, Sadik CD, Schmidt E, Ibrahim S, Baines JF. The gut microbiome in bullous pemphigoid: implications of the gut-skin axis for disease susceptibility. Front Immunol 2023; 14:1212551. [PMID: 38022583 PMCID: PMC10668026 DOI: 10.3389/fimmu.2023.1212551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering disease that primarily affects the elderly. An altered skin microbiota in BP was recently revealed. Accumulating evidence points toward a link between the gut microbiota and skin diseases; however, the gut microbiota composition of BP patients remains largely underexplored, with only one pilot study to date, with a very limited sample size and no functional profiling of gut microbiota. To thoroughly investigate the composition and function of the gut microbiota in BP patients, and explore possible links between skin conditions and gut microbiota, we here investigated the gut microbiota of 66 patients (81.8% firstly diagnosed) suffering from BP and 66 age-, sex-, and study center-matched controls (CL) with non-inflammatory skin diseases (132 total participants), using 16S rRNA gene and shotgun sequencing data. Decreased alpha-diversity and an overall altered gut microbial community is observed in BP patients. Similar trends are observed in subclassifications of BP patients, including first diagnoses and relapsed cases. Furthermore, we observe a set of BP disease-associated gut microbial features, including reduced Faecalibacterium prausnitzii and greater abundance of pathways related to gamma-aminobutyric acid (GABA) metabolism in BP patients. Interestingly, F. prausnitzii is a well-known microbiomarker of inflammatory diseases, which has been reported to be reduced in the gut microbiome of atopic dermatitis and psoriasis patients. Moreover, GABA plays multiple roles in maintaining skin health, including the inhibition of itching by acting as a neurotransmitter, attenuating skin lesions by balancing Th1 and Th2 levels, and maintaining skin elasticity by increasing the expression of type I collagen. These findings thus suggest that gut microbiota alterations present in BP may play a role in the disease, and certain key microbes and functions may contribute to the link between gut dysbiosis and BP disease activity. Further studies to investigate the underlying mechanisms of the gut-skin interaction are thus clearly warranted, which could aid in the development of potential therapeutic interventions.
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Affiliation(s)
- Xiaolin Liu
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Biology, Plön, Germany
- Section of Evolutionary Medicine, Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Nina van Beek
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Aleksa Cepic
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Biology, Plön, Germany
- Section of Evolutionary Medicine, Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Nadia A. Andreani
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Biology, Plön, Germany
- Section of Evolutionary Medicine, Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Cecilia J. Chung
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Biology, Plön, Germany
- Section of Evolutionary Medicine, Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Britt M. Hermes
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Biology, Plön, Germany
- Section of Evolutionary Medicine, Institute for Experimental Medicine, Kiel University, Kiel, Germany
| | - Kaan Yilmaz
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Sandrine Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical University-Sofia, Sofia, Bulgaria
| | - Sascha Gerdes
- Department of Dermatology, Venereology and Allergology, University of Kiel, Kiel, Germany
| | - Regine Gläser
- Department of Dermatology, Venereology and Allergology, University of Kiel, Kiel, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Günther
- Department of Dermatology, University Hospital, Technische Universität (TU) Dresden, Dresden, Germany
| | - Anabelle von Georg
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Christoph M. Hammers
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Maike M. Holtsche
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Franziska Hübner
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Dimitra Kiritsi
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Franziska Schauer
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | - Beke Linnenmann
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Laura Huilaja
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Kaisa Tasanen-Määttä
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical University-Sofia, Sofia, Bulgaria
| | - Detlef Zillikens
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, Lübeck, Germany
| | - Christian D. Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
- Center for Research on Inflammation of the Skin (CRIS), University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Saleh Ibrahim
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - John F. Baines
- Department of Evolutionary Genetics, Max Planck Institute for Evolutionary Biology, Plön, Germany
- Section of Evolutionary Medicine, Institute for Experimental Medicine, Kiel University, Kiel, Germany
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7
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Hundt JE, Sadik CD, van Beek N, Busch H, Caux F, Goebeler M, Hammers CM, Hartmann K, Hashimoto T, Ibrahim S, Kasperkiewicz M, Murrell DF, Recke A, Rose C, Schumacher N, Shimanovich I, Sitaru C, Terheyden P, Thaçi D, Ludwig RJ, Schmidt E. A life for autoimmune blistering diseases: in memoriam Detlef Zillikens. Front Immunol 2023; 14:1291590. [PMID: 38175817 PMCID: PMC10621786 DOI: 10.3389/fimmu.2023.1291590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/22/2023] [Indexed: 01/06/2024] Open
Abstract
Detlef Zillikens, MD, director and chair of the Department of Dermatology at the University of Lübeck, Lübeck, Germany, died in September 2022, aged only 64. He dedicated his professional life to autoimmune blistering diseases (AIBDs) and built his department into one of the world's leading centers for these diseases. Herein, his professional life and the impact on the field of AIBDs and the research landscape at the University of Lübeck are addressed. With his warm, integrative, open-minded, ever-optimistic attitude, he was a highly reliable colleague, mentor, and friend to many in the field including each of the authors. Combined with his in-depth knowledge of dermatology, interest in many fields of life science, and hard work, Detlef Zillikens initiated the founding of two independent research institutes, the Lübeck Institute of Experimental Dermatology and the Institute and Comprehensive Center for Inflammation Medicine. He was also instrumental in establishing the Center for Research on Inflammation of the Skin, where in a new research building, over 140 scientists pursue research questions related to skin inflammation. By inviting numerous researchers and clinicians to his department and hosting two large international meetings, he brought the field of AIBDs much closer together and inspired multiple national and international research initiatives. His ideas will live on and grow in many of his colleagues and mentees.
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Affiliation(s)
- Jennifer E. Hundt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | | | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Frédéric Caux
- Department of Dermatology, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - Matthias Goebeler
- Department of Dermatology, University of Würzburg, Würzburg, Germany
| | - Christoph M. Hammers
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Kiel, Kiel, Germany
| | | | - Takashi Hashimoto
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Saleh Ibrahim
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Khalifa University, Abu Dhabi, United Arab Emirates
| | - Michael Kasperkiewicz
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Dedee F. Murrell
- Department of Dermatology, St George Hospital, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Andreas Recke
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Christian Rose
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Dermatohistologisches Einsendelabor Lübeck, Lübeck, Germany
| | - Nina Schumacher
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Cassian Sitaru
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
| | | | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine (CCIM), University of Lübeck, Lübeck, Germany
| | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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8
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Kridin K, van Beek N, Bühler E, Kochan AS, Ranjbar M, Beissert S, Zillikens D, Günther C, Schmidt E. Characteristics Associated With Refractory Course, Blindness, and Treatment Strategy-Related Outcomes in Patients With Mucous Membrane Pemphigoid. JAMA Dermatol 2023; 159:198-203. [PMID: 36630148 PMCID: PMC9857489 DOI: 10.1001/jamadermatol.2022.5829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/02/2022] [Indexed: 01/12/2023]
Abstract
Importance Mucous membrane pemphigoid (MMP) is a rare and heterogeneous subepithelial autoimmune bullous disease with predominant mucosal involvement. Characteristics associated with the disease course and complications are yet to be delineated. Objectives To evaluate characteristics associated with refractory disease course and blindness among patients with MMP and to estimate the association of different treatment strategies with the prognostic outcome. Design, Setting, and Participants A retrospective cohort study of consecutive patients diagnosed with MMP and followed up for more than 1 year from 2007 to 2020 in 2 tertiary referral centers. Data were analyzed from January 1, 2009, to June 30, 2020. Main Outcomes and Measures Characteristics associated with refractory disease course and blindness were evaluated using multivariable logistic regression model. Results The study encompassed 121 patients with MMP (mean [SD] age, 66.0 [14.0] years; 78 (64.5%) were women), of whom 56 (46.3%) followed a refractory course and 13 (10.7%) developed blindness. Anti-LAD-1 IgA (odds ratio [OR], 3.42; 95% CI, 1.11-10.52; P = .03) and anti-dermal-epidermal/epithelial junction (DEJ) IgG (by indirect immunofluorescence on human salt-split skin; OR, 2.92; 95% CI, 1.26-6.78; P = .01) were significantly associated with refractory course. Development of blindness was associated with older age (≥68 years; OR, 6.38; 95% CI, 1.35-30.16; P = .009), initial presentation with bilateral ocular involvement (OR, 7.92; 95% CI, 2.04-30.68; P = .001), and scarring ocular lesions (OR, 5.11; 95% CI, 1.47-17.79; P = .006). However, 4 (30.8%) and 2 (15.4%) of those experiencing blindness had no ocular scarring lesions and unilateral ocular involvement at the onset of their disease, respectively. Patients progressing to blindness were more likely to be treated by 3 or more immunosuppressive/immunomodulatory drugs (OR, 4.07; 95% CI, 1.17-14.14; P = .02) and by cyclophosphamide (OR, 7.64; 95% CI, 2.24-26.09; P < .001). Patients developing blindness and refractory course were more frequently managed by intravenous immunoglobulin (OR, 7.64; 95% CI, 2.24-26.09; P < .001 and OR, 3.47; 95% CI, 1.42-8.45; P = .005, respectively). Conclusions and Relevance Findings of this cohort study support that patients with MMP with anti-LAD-1 IgA and anti-DEJ IgG reactivity should be carefully monitored. While initial bilateral ocular disease and scarring ocular lesions were associated with blindness, patients initially presenting with unilateral and nonscarring ocular disease may still develop severe vision impairment.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Medical Center, Poriya, Israel
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Elena Bühler
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Anne S. Kochan
- Department of Dermatology, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Mahdy Ranjbar
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany
| | - Stefan Beissert
- Department of Dermatology, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Claudia Günther
- Department of Dermatology, Carl Gustav Carus University Hospital, TU Dresden, Dresden, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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9
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Hocke J, Krauth J, Krause C, Gerlach S, Warnemünde N, Affeldt K, van Beek N, Schmidt E, Voigt J. Computer-aided classification of indirect immunofluorescence patterns on esophagus and split skin for the detection of autoimmune dermatoses. Front Immunol 2023; 14:1111172. [PMID: 36926325 PMCID: PMC10013071 DOI: 10.3389/fimmu.2023.1111172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Autoimmune bullous dermatoses (AIBD) are rare diseases that affect human skin and mucous membranes. Clinically, they are characterized by blister formation and/or erosions. Depending on the structures involved and the depth of blister formation, they are grouped into pemphigus diseases, pemphigoid diseases, and dermatitis herpetiformis. Classification of AIBD into their sub-entities is crucial to guide treatment decisions. One of the most sensitive screening methods for initial differentiation of AIBD is the indirect immunofluorescence (IIF) microscopy on tissue sections of monkey esophagus and primate salt-split skin, which are used to detect disease-specific autoantibodies. Interpretation of IIF patterns requires a detailed examination of the image by trained professionals automating this process is a challenging task with these highly complex tissue substrates, but offers the great advantage of an objective result. Here, we present computer-aided classification of esophagus and salt-split skin IIF images. We show how deep networks can be adapted to the specifics and challenges of IIF image analysis by incorporating segmentation of relevant regions into the prediction process, and demonstrate their high accuracy. Using this semi-automatic extension can reduce the workload of professionals when reading tissue sections in IIF testing. Furthermore, these results on highly complex tissue sections show that further integration of semi-automated workflows into the daily workflow of diagnostic laboratories is promising.
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Affiliation(s)
- Jens Hocke
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Jens Krauth
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Christopher Krause
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Stefan Gerlach
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Nicole Warnemünde
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Kai Affeldt
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, Allergology and Venerology, University Hospital Schleswig-Holstein/University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, Allergology and Venerology, University Hospital Schleswig-Holstein/University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Jörn Voigt
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
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10
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Lütgerath C, Sadik CD, van Beek N. [Trigger factors associated with bullous autoimmune dermatoses]. Dermatologie (Heidelb) 2022; 74:948-954. [PMID: 37943295 DOI: 10.1007/s00105-023-05249-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Blistering autoimmune dermatoses are a heterogeneous group of rare diseases. Pemphigus diseases are distinguished from pemphigoid diseases as well as dermatitis herpetiformis. In pemphigus diseases, cutaneous blistering is caused by an intraepidermal loss of adhesion between keratinocytes. In pemphigoid diseases, blister formation is due to a subepidermal loss of adhesion of keratinocytes from the basement membrane. OBJECTIVES This article reviews the most important trigger factors associated with bullous autoimmune dermatoses and discusses their role in their initial manifestation as well as exacerbation. MATERIALS AND METHODS A focused review of the literature including original articles, guidelines, reference works and previously published review articles was performed. RESULTS Vaccinations, viral infections, ultraviolet light (UV) exposure and radiation therapies are possible triggers of pemphigus vulgaris in predisposed patients. For the much rarer pemphigus foliaceus, UV exposure is of particular importance. Thiols and phenols are drugs that can induce pemphigus usually resembling pemphigus foliaceus clinically. Age is the most important risk factor of bullous pemphigoid. In addition, in bullous pemphigoid associations with dipeptidyl peptidase 4 inhibitors, programmed cell death protein‑1 or programmed death-ligand‑1 inhibitors as well as neurological diseases are particularly relevant. Severe mucosal damage, certain drugs and in particular cases neoplasms might play a role in mucous membrane pemphigoid. CONCLUSION Knowing possible trigger factors facilitates a timely diagnosis upon initial manifestation and supports the prevention of relapse of bullous autoimmune dermatoses.
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Affiliation(s)
- Constantin Lütgerath
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - Christian D Sadik
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
- Center for Research on Inflammation of the Skin, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Nina van Beek
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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11
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Emtenani S, Holtsche MM, Stahlkopf R, Seiler DL, Burn T, Liu H, Parker M, Yilmaz K, Dikmen HO, Lang MH, Sadik CD, Karsten CM, van Beek N, Ludwig RJ, Köhl J, Schmidt E. Differential expression of C5aR1 and C5aR2 in innate and adaptive immune cells located in early skin lesions of bullous pemphigoid patients. Front Immunol 2022; 13:942493. [PMID: 36466856 PMCID: PMC9716273 DOI: 10.3389/fimmu.2022.942493] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/05/2022] [Indexed: 10/20/2023] Open
Abstract
Bullous pemphigoid (BP), the by far most frequent autoimmune subepidermal blistering disorder (AIBD), is characterized by the deposition of autoantibodies against BP180 (type XVII collagen; Col17) and BP230 as well as complement components at the dermal-epidermal junction (DEJ). The mechanisms of complement activation in BP patients, including the generation of C5a and regulation of its two cognate C5aRs, i.e., C5aR1 and C5aR2, are incompletely understood. In this study, transcriptome analysis of perilesional and non-lesional skin biopsies of BP patients compared to site-, age-, and sex-matched controls showed an upregulated expression of C5AR1, C5AR2, CR1, and C3AR1 and other complement-associated genes in perilesional BP skin. Of note, increased expressions of C5AR2 and C3AR1 were also observed in non-lesional BP skin. Subsequently, double immunofluorescence (IF) staining revealed T cells and macrophages as the dominant cellular sources of C5aR1 in early lesions of BP patients, while C5aR2 mainly expressed on mast cells and eosinophils. In addition, systemic levels of various complement factors and associated molecules were measured in BP patients and controls. Significantly higher plasma levels of C3a, CD55, and mannose-binding lectin-pathway activity were found in BP patients compared to controls. Finally, the functional relevance of C5aR1 and C5aR2 in BP was explored by two in vitro assays. Specific inhibition of C5aR1, resulted in significantly reduced migration of human neutrophils toward the chemoattractant C5a, whereas stimulation of C5aR2 showed no effect. In contrast, the selective targeting of C5aR1 and/or C5aR2 had no effect on the release of reactive oxygen species (ROS) from Col17-anti-Col17 IgG immune complex-stimulated human leukocytes. Collectively, this study delineates a complex landscape of activated complement receptors, complement factors, and related molecules in early BP skin lesions. Our results corroborate findings in mouse models of pemphigoid diseases that the C5a/C5aR1 axis is pivotal for attracting inflammatory cells to the skin and substantiate our understanding of the C5a/C5aR1 axis in human BP. The broad expression of C5aRs on multiple cell types critical for BP pathogenesis call for clinical studies targeting this axis in BP and other complement-mediated AIBDs.
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Affiliation(s)
- Shirin Emtenani
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Maike M. Holtsche
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Richard Stahlkopf
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Daniel L. Seiler
- Institute for Systemic Inflammation Research (ISEF), University of Lübeck, Lübeck, Germany
| | - Timothy Burn
- Incyte Research Institute, Wilmington, DE, United States
| | - Huiqing Liu
- Incyte Research Institute, Wilmington, DE, United States
| | - Melissa Parker
- Incyte Research Institute, Wilmington, DE, United States
| | - Kaan Yilmaz
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Hasan O. Dikmen
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Markus Huber Lang
- Institute of Experimental Trauma-Immunology, University Hospital of Ulm, Ulm, Germany
| | - Christian D. Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Christian M. Karsten
- Institute for Systemic Inflammation Research (ISEF), University of Lübeck, Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
| | - Jörg Köhl
- Institute for Systemic Inflammation Research (ISEF), University of Lübeck, Lübeck, Germany
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Centre, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, Lübeck, Germany
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12
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Dikmen HO, Yilmaz K, Benoit S, Bernard P, Drenovska K, Gerdes S, Gläser R, Günther C, Homey B, Horváth ON, Huilaja L, Joly P, Kiritsi D, Meller S, Patsatsi A, Sárdy M, Schauer F, Shahid M, Sticherling M, Tasanen K, Vassileva S, Worm M, Zillikens D, Sadik CD, van Beek N, König IR, Schmidt E. Serum autoantibody reactivity in bullous pemphigoid is associated with neuropsychiatric disorders and the use of antidiabetics and antipsychotics: a large prospective cohort study. J Eur Acad Dermatol Venereol 2022; 36:2181-2189. [PMID: 35796163 DOI: 10.1111/jdv.18414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP), the by far most frequent autoimmune blistering skin disease (AIBD), is immunopathologically characterized by autoantibodies against the two hemidesmosomal proteins BP180 (collagen type XVII) and BP230 (BPAG1 or dystonin). Several comorbidities and potentially disease-inducing medication have been described in BP, yet, a systematic analysis of these clinically relevant findings and autoantibody reactivities has not been performed. OBJECTIVE To determine associations of autoantibody reactivities with comorbidities and concomitant medication. METHODS In this prospective multicenter study, 499 patients diagnosed with BP in sixteen European referral centers were included. The relation between anti-BP180 NC16A and anti-BP230 IgG ELISA values at the time of diagnosis as well as comorbidities and concomitant medication collected by a standardized form were analyzed. RESULTS An association between higher serum anti-BP180 reactivity and neuropsychiatric but not atopic and metabolic disorders was observed as well as with the use of insulin or antipsychotics but not with dipeptidyl peptidase-4 (DPP4) inhibitors, inhibitors of platelet aggregation and L-thyroxine. The use of DPP4 inhibitors was associated with less anti-BP180 and anti-BP230 reactivity compared to BP patients without these drugs. This finding was even more pronounced when compared with diabetic BP patients without DPP4 inhibitors. Associations between anti-BP180 and anti-BP230 reactivities were also found in patients using insulin and antipsychotics, respectively, compared with patients without this medication, but not for the use of inhibitors of platelet aggregation, and L-thyroxine. CONCLUSION Taken together, these data imply a relation between autoantibody reactivities at the time of diagnosis and both neuropsychiatric comorbidities as well as distinct concomitant medication suggesting a link between the pathological immune mechanisms and clinical conditions that precede the clinically overt AIBD.
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Affiliation(s)
| | - Kaan Yilmaz
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Sandrine Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | | | - Kossara Drenovska
- Department of Dermatology, Medical University Sofia, Sofia, Bulgaria
| | - Sascha Gerdes
- Department of Dermatology, Venerology and Allergology, University of Kiel, Kiel, Germany
| | - Regine Gläser
- Department of Dermatology, Venerology and Allergology, University of Kiel, Kiel, Germany
| | - Claudia Günther
- Department of Dermatology, University of Dresden, Dresden, Germany
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Orsolya N Horváth
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Laura Huilaja
- PEDEGO Research Unit, Department of Dermatology, Medical Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pascal Joly
- Department of Dermatology, University of Rouen, Rouen, France
| | - Dimitra Kiritsi
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stephan Meller
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Aikaterini Patsatsi
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Miklós Sárdy
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany.,Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Franziska Schauer
- Department of Dermatology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Shahid
- Department of Dermatology, Medical University Sofia, Sofia, Bulgaria
| | | | - Kaisa Tasanen
- PEDEGO Research Unit, Department of Dermatology, Medical Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Snejina Vassileva
- Department of Dermatology, Medical University Sofia, Sofia, Bulgaria
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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13
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Abstract
Mucous membrane pemphigoid (MMP) is a clinically and immunopathologically heterogenous disease with an incidence of about 2/million inhabitants/year in central Europe. Pemphigoid diseases are characterized by autoantibodies against structural proteins of the epidermis and/or surface-close epithelia. MMP has been defined as pemphigoid disease with predominant mucosal lesions. Most frequently, the oral cavity and the conjunctivae are affected. Lesions outside the mouth tend to heal with scarring leading to visual impairment and finally blindness, as well as, more rarely, impairment of breathing and food intake. Autoantibodies target BP180 (collagen type XVII), laminin 332, BP230 (nearly always in conjunction with other antigens), and type VII collagen in about 75%, 10-20%, 10-30%, and <5% of MMP patients, respectively. While the main autoantibody isotype is IgG, additional, and less frequently, exclusive IgA autoantibodies can be detected in the majority of patients. Assaying for anti-laminin 332 reactivity is pivotal, since in about a quarter of patients with anti-laminin 332 MMP, a malignancy, mainly solid cancers, is associated. The pathophysiology of MMP is yet incompletely understood. A recent mouse model of anti-laminin 332 MMP replicating characteristic clinical and immunopathological findings of the human disease may be helpful to close this knowledge gap. Diagnosis is established by the clinical picture with predominant mucosal lesions and visualization of tissue-bound anti-basement membrane zone antibodies by direct immunofluorescence microscopy. In recent S3 guidelines initiated by the European Academy of Dermatology and Venereology, the clinical spectrum and diagnostic strategies are detailed. In addition, treatment regimens for different clinical situations including patients with exclusive oral or ocular involvement are outlined. Future studies are needed to better understand the clinal complexity and associations as well as to establish widely available diagnostic assays and evidence-based therapeutic strategies.
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Affiliation(s)
- Gefei Du
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany; Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Sabrina Patzelt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany; Department of Dermatology, University of Lübeck, Lübeck, Germany.
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14
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van Beek N, Kridin K, Bühler E, Kochan AS, Ständer S, Ludwig RJ, Zillikens D, Schmidt E, Günther C. Evaluation of Site- and Autoantigen-Specific Characteristics of Mucous Membrane Pemphigoid. JAMA Dermatol 2021; 158:84-89. [PMID: 34817539 DOI: 10.1001/jamadermatol.2021.4773] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Mucous membrane pemphigoid (MMP) is a rare, heterogeneous subepithelial autoimmune bullous disease. The association between its clinical and immunological features is yet to be fully evaluated. Objectives To characterize the clinical, immunoserological, and immunopathological characteristics of patients with MMP and to identify site- and autoantigen-specific characteristics. Design, Setting, and Participants A retrospective cohort study encompassing all consecutive patients diagnosed with MMP from January 2007 through February 2020 in 2 tertiary referral centers in Germany. Main Outcomes and Measures The clinical, immunoserological, and immunopathological features of eligible patients were evaluated. Associations of different anatomical sites and autoantigens were assessed using a multivariable logistic regression model. Results The study encompassed 154 patients (96 [62.3%] women and 58 [37.7%] men; mean [SD] age at diagnosis, 66.2 [13.8] years) with MMP, of whom 125 (81.2%), 61 (39.6%), 34 (22.1%), and 16 (10.4%) presented with lesions involving the oral, ocular, nasal, and genital mucosae, respectively, and 35 (22.7%) presented with cutaneous involvement. Among the 154 patients, the most frequently targeted antigen was BP180 (90 patients [58.4%]), followed by laminin 332 (13 patients [8.4%]) and BP230 (3 patients [1.9%]). Ocular disease was inversely associated with oral (adjusted odds ratio [aOR], 0.02; 95% CI, 0.01-0.13) and nasal (aOR, 0.20; 95% CI, 0.04-0.91) involvement and was associated with a 13-fold increased risk of malignant neoplasm (aOR, 13.07; 95% CI, 1.56-109.36). Anti-laminin 332 reactivity was associated with malignant neoplasm (aOR, 23.27; 95% CI, 1.83-296.68), whereas anti-BP180 NC16A immunoglobulin G seropositivity was associated with absence of ocular lesions (aOR, 0.09; 95% CI, 0.01-0.99). Conclusions and Relevance In this cohort study of patients with MMP, malignant neoplasms were associated with ocular disease and anti-laminin 332 reactivity, suggesting potential benefit of malignant neoplasm screening in these patients.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Elena Bühler
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Anne S Kochan
- Department of Dermatology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Sascha Ständer
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Claudia Günther
- Department of Dermatology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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15
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Beek NV, Zillikens D, Schmidt E. Bullous Autoimmune Dermatoses. Dtsch Arztebl Int 2021; 118:413-420. [PMID: 34369370 DOI: 10.3238/arztebl.m2021.0136] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/03/2020] [Accepted: 01/27/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bullous autoimmune dermatoses are a clinically and immunopatho - logically heterogeneous group of diseases, characterized clinically by blisters or erosions of the skin and/or mucous membranes. In Germany, their prevalence is approximately 40 000 cases nationwide, and their incidence approximately 20 new cases per million people per year. METHODS This review is based on publications that were retrieved by a selective search of the literature focusing on the current German and European guidelines. RESULTS Recent years have seen the publication of guidelines, controlled prospective clinical trials, and multicenter diagnostic studies improving both diagnosis and therapy. Specific monovalent and multivariate serological test systems and pattern analysis of tissue-bound autoantibodies allow identification of the target antigens in 80-90% of patients. This enables the precise classification of disease entities, with implications for treatment selection and disease outcome. In 2019, the anti-CD20 antibody rituximab was approved by the European Medicines Agency for the treatment of moderate and severe pemphigus vulgaris, with an ensuing marked improvement in the care of the affected patients. To treat mild and moderate bullous pemphigoid, topical clobetasol proprionate is recommended, in severe disease, combined with systemic treatment, i.e. usually (a) prednisolone p.o. at an initial dose of 0.5mg/kg/d , (b) an immunomodulant, e.g. dapsone or doxycycline, or (c) prednisolone plus an immunomodulant. CONCLUSION The early recognition and precise diagnostic evaluation of bullous autoimmune dermatoses now enables improved, often interdisciplinary treatment, in accordance with the available guidelines. Current research projects are focused on new treatment approaches, an improved understanding of the underlying pathophysiology, and further refinements of diagnostic techniques.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, Venereology, and Allergology, University of Lübeck, Lübeck, Germany; Lubeck Institute of Experimental Dermatology (LIED), University of Lubeck, Lubeck, Germany
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16
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Holtsche MM, van Beek N, Hashimoto T, Di Zenzo G, Zillikens D, Prost-Squarcioni C, Titeux M, Hovnanian A, Schmidt E, Goletz S. Diagnosis of Epidermolysis Bullosa Acquisita: Multicentre Comparison of Different Assays for Serum Anti-type VII Collagen Reactivity. Acta Derm Venereol 2021; 101:adv00420. [PMID: 33686442 PMCID: PMC9366678 DOI: 10.2340/00015555-3774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Epidermolysis bullosa acquisita is a pemphigoid disease characterized by autoantibodies against type VII collagen. This study compared the sensitivity and specificity of 6 diagnostic assays: type VII collagen non-collagenous domains enzyme-linked immunoassay (NC1/2 ELISA) (MBL, Nagoya, Japan); type VII collagen NC1 ELISA (Euroimmun, Lübeck, Germany); indirect immunofluorescence (IF) microscopy test based on the expression of recombinant NC1 in a human cell line (NC1 BIOCHIP®; Euroimmun); full-length recombinant type VII collagen ELISA; immunoblotting with full-length type VII collagen in the extract of human dermis; and immunoblotting with recombinant NC1. Immunoblotting with recombinant NC1 showed a sensitivity of 93.1% and specificity of 100%, followed by NC1 BIOCHIP® (sensitivity, 89.1%; specificity, 100%), immunoblotting with human dermis (sensitivity, 87.1%; specificity 100%), NC1-ELISA (sensitivity 82.2%; specificity 98.6%), NC1/NC2 ELISA (sensitivity 88.1%; specificity 93.3%), and full-length type VII collagen ELISA (sensitivity 80.2%; specificity 93.8%).
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Affiliation(s)
- Maike M Holtsche
- Department of Dermatology, University of Lubeck, DE-23522 Lubeck, Germany
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17
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Pruessmann J, Pruessmann W, Holtsche MM, Linnemann B, Hammers CM, van Beek N, Zillikens D, Schmidt E, Sadik CD. Immunomodulator Galectin-9 is Increased in Blood and Skin of Patients with Bullous Pemphigoid. Acta Derm Venereol 2021; 101:adv00419. [PMID: 33606034 PMCID: PMC9366699 DOI: 10.2340/00015555-3771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Massive recruitment of eosinophils into the dermis is a hallmark of bullous pemphigoid pathogenesis. Identifying the chemoattractant(s) guiding eosinophils into the skin in bullous pemphigoid is a prerequisite to thera-peutic targeting of eosinophil recruitment. Galectin -9 is a potent chemoattractant for eosinophils, but its potential role in bullous pemphigoid is unknown. The aim of this study was to determine the expression levels of galectin-9 in serum and skin of patients with bullous pemphigoid. Galectin-9 levels were significantly elevated in serum of patients with bullous pemphigoid compared with age- and sex-matched controls, but did not correlate with disease activity assessed with the Bullous Pemphigoid Disease Area Index. Galectin-9 expression was also increased in lesional skin of patients with bullous pemphigoid, and was expressed predominantly in eosinophils, neutrophils and keratinocytes. In conclusion, these results support the notion that galectin-9 may play a role in the patho-genesis of bullous pemphigoid.
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Affiliation(s)
- Jasper Pruessmann
- Department of Dermatology, Allergology, and Venerology, University of Lübeck, Lübeck, Germany
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18
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Holtsche MM, van Beek N, Künstner A, Busch H, Zillikens D, Schmidt E. Diagnostic Value and Practicability of Serration Pattern Analysis by Direct Immunofluorescence Microscopy in Pemphigoid Diseases. Acta Derm Venereol 2021; 101:adv00410. [PMID: 33491096 PMCID: PMC9366507 DOI: 10.2340/00015555-3748] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In pemphigoid diseases, direct immunofluorescence can be used to differentiate 2 patterns of antibody deposition at the dermal–epidermal junction; u- and n-serrated pattern. The u-serrated pattern is found in epidermolysis bullosa acquisita, and n-serrated pattern in all other pemphigoid diseases. To determine the detection frequency of these serrated patterns and the optimal thickness of biopsy cryosections, 2 patient cohorts obtained form our routine autoimmune laboratory were analysed; a retrospective cohort (n = 226) and a prospective cohort (n = 156). In 76% (291/382) of biopsies, a pattern was recognized, of which 96% (278/291) and 4% (13/291) had an n- or u-serrated pattern, respectively. A u-serrated pattern was seen in all epidermolysis bullosa acquisita biopsies confirmed by serology. No antibodies against type VII collagen were detected in any of the sera from biopsies with n-serrated pattern. No differences between the detection frequencies of serrated pattern were seen with respect to age, sex, biopsy site, or section thickness, while the detection frequency was higher in patients with serum anti-BP180 reactivity compared with those without. In conclusion, serrated pattern analysis using direct immunofluorescence has a high detection frequency and specificity for epidermolysis bullosa acquisita and will further facilitate the diagnosis of latter disorder.
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Affiliation(s)
- Maike M Holtsche
- Department of Dermatology, University of Lubeck, DE-23522 Lubeck, Germany
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19
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Salviano-Silva A, Farias TDJ, Bumiller-Bini V, Castro MDS, Lobo-Alves SC, Busch H, Pföhler C, Worm M, Goebeler M, van Beek N, Franke A, Wittig M, Zillikens D, de Almeida RC, Hundt JE, Boldt ABW, Ibrahim S, Augusto DG, Petzl-Erler ML, Schmidt E, Malheiros D. Genetic variability of immune-related lncRNAs: polymorphisms in LINC-PINT and LY86-AS1 are associated with pemphigus foliaceus susceptibility. Exp Dermatol 2021; 30:831-840. [PMID: 33394553 DOI: 10.1111/exd.14275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 01/05/2023]
Abstract
Pemphigus foliaceus (PF) is an autoimmune blistering disease of the skin, clinically characterized by erosions and, histopathologically, by acantholysis. PF is endemic in the Brazilian Central-Western region. Numerous single nucleotide polymorphisms (SNPs) have been shown to affect the susceptibility for PF, including SNPs at long non-coding RNA (lncRNA) genes, which are known to participate in many physiological and pathogenic processes, such as autoimmunity. Here, we investigated whether the genetic variation of immune-related lncRNA genes affects the risk for endemic and sporadic forms of PF. We analysed 692 novel SNPs for PF from 135 immune-related lncRNA genes in 227 endemic PF patients and 194 controls. The SNPs were genotyped by Illumina microarray and analysed by applying logistic regression at additive model, with correction for sex and population structure. Six associated SNPs were also evaluated in an independent German cohort of 76 sporadic PF patients and 150 controls. Further, we measured the expression levels of two associated lncRNA genes (LINC-PINT and LY86-AS1) by quantitative PCR, stratified by genotypes, in peripheral blood mononuclear cells of healthy subjects. We found 27 SNPs in 11 lncRNA genes associated with endemic PF (p < .05 without overlapping with protein-coding genes). Among them, the LINC-PINT SNP rs10228040*A (OR = 1.47, p = .012) was also associated with increased susceptibility for sporadic PF (OR = 2.28, p = .002). Moreover, the A+ carriers of LY86-AS1*rs12192707 mark lowest LY86-AS1 RNA levels, which might be associated with a decreasing autoimmune response. Our results suggest a critical role of lncRNA variants in immunopathogenesis of both PF endemic and sporadic forms.
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Affiliation(s)
- Amanda Salviano-Silva
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | | | - Valéria Bumiller-Bini
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Mariana de Sousa Castro
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Sara Cristina Lobo-Alves
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology (IKMB), Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Michael Wittig
- Institute of Clinical Molecular Biology (IKMB), Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | | | | | - Saleh Ibrahim
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Danillo Gardenal Augusto
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Maria Luiza Petzl-Erler
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Danielle Malheiros
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná, Curitiba, Brazil
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20
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Khil'chenko S, Boch K, van Beek N, Vorobyev A, Zillikens D, Schmidt E, Ludwig RJ. Alterations of Total Serum Immunoglobulin Concentrations in Pemphigus and Pemphigoid: Selected IgG2 Deficiency in Bullous Pemphigoid. Front Med (Lausanne) 2020; 7:472. [PMID: 33015084 PMCID: PMC7493804 DOI: 10.3389/fmed.2020.00472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/14/2020] [Indexed: 12/28/2022] Open
Abstract
Pemphigus and pemphigoid diseases are organ-specific autoimmune diseases of the skin and/or mucous membranes, which are caused by autoantibodies targeting structural proteins of the skin. In other autoimmune diseases, a high prevalence of primary antibody deficiencies was noted. Conversely, a high prevalence of autoimmune diseases is reported in patients with primary antibody deficiencies. With the exception of one study, pointing toward a decrease of IgG in pemphigus patients, with a relative enrichment of IgG4, serum immunoglobulin (Ig) concentrations had not been studied in pemphigus and pemphigoid. Hence, we here aimed to investigate serum concentrations of IgM, IgA, IgG, and IgG1-4 in pemphigus and pemphigoid patients, as well as in healthy controls. Serum Ig concentrations were determined by ELISA in 105 healthy controls, 100 pemphigus vulgaris (PV), 100 pemphigus foliaceus, 99 bullous pemphigoid (BP), and 55 linear IgA bullous dermatosis (LAD) patients. In healthy controls, age had a significant impact on Ig serum concentrations: In controls at ages of 69 years or older, IgM and IgG were decreased, while all other Ig, except IgA and IgG4, were increased. When stratified by sex, lower IgM concentrations were observed in males. When corrected for age and/or sex, and compared to controls, an increase in serum IgA was noted in LAD. In almost all patient cohorts, an increase in IgG1 and IgG4 was observed, while a decrease in IgG2 or IgG3 was seen in BP or PV patients. This points toward a possible association of BP with IgG2 deficiency and warrants evaluation of IgG2 in BP patients prior to immunosuppressive therapy.
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Affiliation(s)
- Stanislav Khil'chenko
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Katharina Boch
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Nina van Beek
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Artem Vorobyev
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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21
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Burmester IAK, Flaswinkel S, Thies CS, Kasprick A, Kamaguchi M, Bumiller-Bini V, Emtenani S, Feldmann N, Kridin K, Schmidt E, van Beek N, Zillikens D, Hammers CM, Hundt JE, Ludwig RJ. Identification of novel therapeutic targets for blocking acantholysis in pemphigus. Br J Pharmacol 2020; 177:5114-5130. [PMID: 32815159 PMCID: PMC7588822 DOI: 10.1111/bph.15233] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose Pemphigus is caused by autoantibodies against desmoglein (Dsg) 1, Dsg3, and/or non‐Dsg antigens. Pemphigus vulgaris (PV) is the most common manifestation of pemphigus, with painful erosions on mucous membranes. In most cases, blistering also occurs on the skin, leading to areas of extensive denudation. Despite improvements in pemphigus treatment, time to achieve remission is long, severe adverse events are frequent and 20% of patients do not respond adequately. Current clinical developments focus exclusively on modulating B cell function or autoantibody half‐life. However, topical modulation of PV autoantibody‐induced blistering is an attractive target because it could promptly relieve symptoms. Experimental Approach To address this issue, we performed an unbiased screening in a complex biological system using 141 low MW inhibitors from a chemical library. Specifically, we evaluated PV IgG‐induced Dsg3 internalization in HaCaT keratinocytes. Validation of the 20 identified compounds was performed using keratinocyte fragmentation assays, as well as a human skin organ culture (HSOC) model. key Results Overall, this approach led to the identification of four molecules involved in PV IgG‐induced skin pathology: MEK1, TrkA, PI3Kα, and VEGFR2. Conclusion and Implications This unbiased screening revealed novel mechanisms by which PV autoantibodies induce blistering in keratinocytes and identified new treatment targets for this severe and potentially life‐threatening skin disease.
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Affiliation(s)
- Imke A K Burmester
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Sarah Flaswinkel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Clara-Sophie Thies
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Anika Kasprick
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Mayumi Kamaguchi
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Valéria Bumiller-Bini
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Shirin Emtenani
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Nick Feldmann
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | | | - Jennifer E Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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22
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Holtsche MM, Goletz S, von Georg A, van Beek N, Hübner F, Pigors M, Zillikens D, Schmidt E. Serologic characterization of anti-p200 pemphigoid: Epitope spreading as a common phenomenon. J Am Acad Dermatol 2020; 84:1155-1157. [PMID: 32711089 DOI: 10.1016/j.jaad.2020.07.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Maike M Holtsche
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Franziska Hübner
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Manuela Pigors
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
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23
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van Beek N, Krüger S, Fuhrmann T, Lemcke S, Goletz S, Probst C, Komorowski L, Di Zenzo G, Dmochowski M, Drenovska K, Horn M, Jedlickova H, Kowalewski C, Medenica L, Murrell D, Patsatsi A, Geller S, Uzun S, Vassileva S, Zhu X, Fechner K, Zillikens D, Stöcker W, Schmidt E, Rentzsch K. Multicenter prospective study on multivariant diagnostics of autoimmune bullous dermatoses using the BIOCHIP technology. J Am Acad Dermatol 2020; 83:1315-1322. [PMID: 32004645 DOI: 10.1016/j.jaad.2020.01.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 12/04/2019] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The current standard in the serologic diagnosis of autoimmune bullous diseases (AIBD) is a multistep procedure sequentially applying different assays. In contrast, the BIOCHIP Mosaic technology combines multiple substrates for parallel analysis by indirect immunofluorescence. METHODS Sera from 749 consecutive, prospectively recruited patients with direct immunofluorescence-positive AIBD from 13 international study centers were analyzed independently and blinded by using (1) a BIOCHIP Mosaic including primate esophagus, salt-split skin, rat bladder, monkey liver, monkey liver with serosa, recombinant BP180 NC16A, and gliadin GAF3X, as well as HEK293 cells expressing recombinant desmoglein 1, desmoglein 3, type VII collagen, and BP230 C-terminus and (2) the conventional multistep approach of the Department of Dermatology, University of Lübeck. RESULTS In 731 of 749 sera (97.6%), specific autoantibodies could be detected with the BIOCHIP Mosaic, similar to the conventional procedure (725 cases, 96.8%). The Cohen κ for both serologic approaches ranged from 0.84 to 1.00. In 6.5% of sera, differences between the 2 approaches occurred and were mainly attributed to autoantigen fragments not present on the BIOCHIP Mosaic. LIMITATIONS Laminin 332 and laminin γ1 are not represented on the BIOCHIP Mosaic. CONCLUSIONS The BIOCHIP Mosaic is a standardized time- and serum-saving approach that further facilitates the serologic diagnosis of AIBD.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Stine Krüger
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Tarek Fuhrmann
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Susanne Lemcke
- Lübeck Institute of Experimental Dermatology, Lübeck, Germany
| | | | - Christian Probst
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - Lars Komorowski
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | | | - Marian Dmochowski
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Sofia University of Medicine, Sofia, Bulgaria
| | - Michael Horn
- University Institute of Clinical Chemistry and Center of Laboratory Medicine, Bern, Switzerland
| | - Hana Jedlickova
- Department of Dermatology, St. Anna University Hospital, Brno, Czech Republic
| | - Cezary Kowalewski
- Department of Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Ljiljana Medenica
- Department of Dermatology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dedee Murrell
- St. George Hospital, University of New South Wales School of Medicine, Sydney, Australia
| | - Aikaterini Patsatsi
- 2nd Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Shamir Geller
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Soner Uzun
- Department of Dermatology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Sofia University of Medicine, Sofia, Bulgaria
| | - Xuejun Zhu
- Department of Dermatology, Beijing University First Hospital, Beijing, China
| | - Kai Fechner
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Winfried Stöcker
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, Lübeck, Germany.
| | - Kristin Rentzsch
- Institute of Experimental Immunology, EUROIMMUN AG, Lübeck, Germany
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24
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Russlies J, Fähnrich A, Witte M, Yin J, Benoit S, Gläser R, Günter C, Eming R, Erdmann J, Gola D, Gupta Y, Holtsche MM, Kern JS, König IR, Kiritsi D, Lieb W, Sadik CD, Sárdy M, Schauer F, van Beek N, Weidinger A, Worm M, Zillikens D, Schmidt E, Busch H, Ibrahim SM, Hirose M. Polymorphisms in the Mitochondrial Genome Are Associated With Bullous Pemphigoid in Germans. Front Immunol 2019; 10:2200. [PMID: 31824475 PMCID: PMC6883920 DOI: 10.3389/fimmu.2019.02200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/30/2019] [Indexed: 01/06/2023] Open
Abstract
Bullous pemphigoid (BP) is the most prevalent autoimmune skin blistering disease and is characterized by the generation of autoantibodies against the hemidesmosomal proteins BP180 (type XVII collagen) and BP230. Most intriguingly, BP is distinct from other autoimmune diseases because it predominantly affects elderly individuals above the age of 75 years, raising the question why autoantibodies and the clinical lesions of BP emerges mostly in this later stage of life, even in individuals harboring known putative BP-associated germline gene variants. The mitochondrial genome (mtDNA) is a potential candidate to provide additional insights into the BP etiology; however, the mtDNA has not been extensively explored to date. Therefore, we sequenced the whole mtDNA of German BP patients (n = 180) and age- and sex-matched healthy controls (n = 188) using next generation sequencing (NGS) technology, followed by the replication study using Sanger sequencing of an additional independent BP (n = 89) and control cohort (n = 104). While the BP and control groups showed comparable mitochondrial haplogroup distributions, the haplogroup T exhibited a tendency of higher frequency in BP patients suffering from neurodegenerative diseases (ND) compared to BP patients without ND (50%; 3 in 6 BP with haplogroup T). A total of four single nucleotide polymorphisms (SNPs) in the mtDNA, namely, m.16263T>C, m.16051A>G, and m.16162A>G in the D-loop region of the mtDNA, and m.11914G>A in the mitochondrially encoded NADH:ubiquinone oxidoreductase core subunit 4 gene (MT-ND4), were found to be significantly associated with BP based on the meta-analysis of our NGS data and the Sanger sequencing data (p = 0.0017, p = 0.0129, p = 0.0076, and p = 0.0132, respectively, Peto's test). More specifically, the three SNPs in the D-loop region were negatively, and the SNP in the MT-ND4 gene was positively associated with BP. Our study is the first to interrogate the whole mtDNA in BP patients and controls and to implicate multiple novel mtDNA variants in disease susceptibility. Studies using larger cohorts and more diverse populations are warranted to explore the functional consequences of the mtDNA variants identified in this study on immune and skin cells to understand their contributions to BP pathology.
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Affiliation(s)
- Juliane Russlies
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
| | - Anke Fähnrich
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
- Institute for Cardiogenetics, University of Luebeck, Luebeck, Germany
| | - Mareike Witte
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Junping Yin
- Research Center Borstel, Leibniz-Center for Medicine and Bioscience, Borstel, Germany
| | - Sandrine Benoit
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
| | - Regine Gläser
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Claudia Günter
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, University Hospital of Dresden, Dresden, Germany
| | - Rüdiger Eming
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology and Allergology, Phillips-Universität Marburg, Marburg, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Luebeck, Luebeck, Germany
| | - Damian Gola
- Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany
| | - Yask Gupta
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
| | | | - Johannes S. Kern
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
- Dermatology Department, Faculty of Medicine, Dentistry and Health Sciences, The Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Inke R. König
- Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany
| | - Dimitra Kiritsi
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrecht University of Kiel, Kiel, Germany
- Popgen Biobank, Christian-Albrecht University of Kiel, Kiel, Germany
| | | | - Miklós Sárdy
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Schauer
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Nina van Beek
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Anke Weidinger
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Margitta Worm
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
- Department of Dermatology, Venereology and Allergology, Allergy Center Charité, Charité Medical University Berlin, Berlin, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
| | - Enno Schmidt
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
- Department of Dermatology, University of Luebeck, Luebeck, Germany
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
| | - Hauke Busch
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
- Institute for Cardiogenetics, University of Luebeck, Luebeck, Germany
| | - Saleh M. Ibrahim
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
- The German Autoimmune Bullous Disease Genetic Study Group, Germany
| | - Misa Hirose
- Luebeck Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
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25
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van Beek N, Zillikens D, Schmidt E. Diagnosis of autoimmune bullous diseases. J Dtsch Dermatol Ges 2019; 16:1077-1091. [PMID: 30179336 DOI: 10.1111/ddg.13637] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/28/2018] [Indexed: 12/25/2022]
Abstract
Autoimmune bullous disorders (AIBDs) are a heterogeneous group of rare diseases clinically characterized by erosions and/or blisters on the skin and mucous membranes. AIBDs can be categorized into two groups: pemphigus diseases, characterized by intraepidermal blistering and autoantibodies against desmosomal proteins such as desmoglein (Dsg) 1, Dsg3, members of the plakin family, and subepidermal AIBDs, comprised of pemphigoid diseases and dermatitis herpetiformis. Autoantibodies in dermatitis herpetiformis target transglutaminases 2 and 3, while in pemphigoid disease, autoantibodies are directed against structural proteins of the dermal-epidermal junction. Although analysis of a perilesional biopsy with direct immunofluorescence (IF) microscopy is still the diagnostic gold standard, several assays have become widely available that allow serological diagnosis in the majority of patients. Standard serological diagnosis includes indirect IF on monkey esophagus and salt-split human skin. Assays to further characterize autoantibody specificity include ELISA systems based on recombinant forms of the immunodominant regions of the target antigens as well as multivariant indirect IF microscopy tests with several miniature substrates. These serological assays are complemented by various in-house assays using immunoblotting and ELISA, which are only available in specialized laboratories. Here we review new developments in the diagnosis of AIBDs and describe state-of-the-art diagnostic procedures for this group of diseases.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
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26
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van Beek N, Zillikens D, Schmidt E. Diagnostik blasenbildender Autoimmundermatosen. J Dtsch Dermatol Ges 2019; 16:1077-1092. [PMID: 30179341 DOI: 10.1111/ddg.13637_g] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/28/2018] [Indexed: 01/07/2023]
Abstract
Blasenbildende Autoimmundermatosen (BAIDs) sind eine heterogene Gruppe seltener Erkrankungen, die klinisch durch Erosionen und/oder Blasen an Haut und Schleimhäuten charakterisiert sind. BAIDs können in zwei Gruppen eingeteilt werden: Pemphigus-Erkrankungen, die durch intraepidermale Blasenbildung und Autoantikörper gegen desmosomale Proteine wie Desmoglein (Dsg) 1, Dsg3 und Mitglieder der Plakin-Familie charakterisiert sind, sowie subepidermale BAIDs, die Pemphigoid-Erkrankungen und die Dermatitis herpetiformis umfassen. Bei der Dermatitis herpetiformis greifen die Autoantikörper die Transglutaminasen 2 und 3 an, während sie bei Pemphigoid-Erkrankungen gegen Strukturproteine der dermoepidermalen Junktionszone gerichtet sind. Die Analyse einer periläsionalen Biopsie mittels direkter Immunfluoreszenzmikroskopie (IF-Mikroskopie) stellt zwar nach wie vor den diagnostischen Goldstandard dar, mittlerweile sind jedoch verschiedene Tests allgemein verfügbar, die eine serologische Diagnosefindung für den Großteil der Patienten ermöglichen. Zur serologischen Standarddiagnostik gehört die indirekte IF auf Affenösophagus und NaCl-separierter Spalthaut. Die Spezifität der Autoantikörper kann mit ELISA-Systemen, die auf rekombinanten Formen der immundominanten Regionen der Zielantigene basieren, sowie indirekter IF-Mikroskopie anhand multivarianter Tests mit mehreren multivariate näher charakterisiert werden. Diese serologischen Tests werden durch verschiedene hauseigene Immunoblotting- und ELISA-Systeme ergänzt, die nur in spezialisierten Laboratorien verfügbar sind. In diesem Review geben wir einen Überblick über neue Entwicklungen bei der Diagnose von BAIDs und beschreiben moderne Diagnoseverfahren für diese Krankheitsgruppe.
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Affiliation(s)
- Nina van Beek
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck
| | - Detlef Zillikens
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck
| | - Enno Schmidt
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck.,Lübecker Institut für Experimentelle Dermatologie (LIED), Universität zu Lübeck
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27
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Gratsias E, Hadaschik E, Höfer T, Schimming T, van Beek N, Moelleken M, Dissemond J. Rasch wachsende verruköse axilläre Tumoren, multiple Erosionen, Pusteln und Cheilitis. J Dtsch Dermatol Ges 2018; 16:1269-1273. [DOI: 10.1111/ddg.13661_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Emmanouil Gratsias
- Abteilung für Dermatologie; Venerologie und Allergologie Universitätsklinikum Essen
| | - Eva Hadaschik
- Abteilung für Dermatologie; Venerologie und Allergologie Universitätsklinikum Essen
| | - Thomas Höfer
- Abteilung für Dermatologie; Venerologie und Allergologie Universitätsklinikum Essen
| | - Tobias Schimming
- Abteilung für Dermatologie; Venerologie und Allergologie Universitätsklinikum Essen
| | - Nina van Beek
- Abteilung für Dermatologie; Venerologie und Allergologie; Universitätsklinikum Schleswig-Holstein; Lübeck
| | - Maurice Moelleken
- Abteilung für Dermatologie; Venerologie und Allergologie Universitätsklinikum Essen
| | - Joachim Dissemond
- Abteilung für Dermatologie; Venerologie und Allergologie Universitätsklinikum Essen
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28
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Gratsias E, Hadaschik E, Höfer T, Schimming T, van Beek N, Moelleken M, Dissemond J. Rapidly growing verrucous axillary tumors, multiple erosions, pustules, and cheilitis. J Dtsch Dermatol Ges 2018; 16:1269-1272. [DOI: 10.1111/ddg.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emmanouil Gratsias
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
| | - Eva Hadaschik
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
| | - Thomas Höfer
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
| | - Tobias Schimming
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
| | - Nina van Beek
- Department of Dermatology; Venereology and Allergology; Schleswig-Holstein University Medical Center; Lübeck Germany
| | - Maurice Moelleken
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
| | - Joachim Dissemond
- Department of Dermatology; Venereology and Allergology; Essen University Medical Center; Essen Germany
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29
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Sadik CD, Bischof J, van Beek N, Dieterich A, Benoit S, Sárdy M, Worm M, Meller S, Gläser R, Zillikens D, Homey B, Setterfield J, Minassian D, Schmidt E, Dart J, Ibrahim SM. Genomewide association study identifies GALC
as susceptibility gene for mucous membrane pemphigoid. Exp Dermatol 2017; 26:1214-1220. [DOI: 10.1111/exd.13464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Christian D. Sadik
- Department of Dermatology, Allergy, and Venereology; University of Lübeck; Lübeck Germany
| | - Julia Bischof
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
| | - Nina van Beek
- Department of Dermatology, Allergy, and Venereology; University of Lübeck; Lübeck Germany
| | - Anabelle Dieterich
- Department of Dermatology, Allergy, and Venereology; University of Lübeck; Lübeck Germany
| | - Sandrine Benoit
- Department of Dermatology, Venereology and Allergology; University Hospital Würzburg; Würzburg Germany
| | - Miklós Sárdy
- Department of Dermatology and Allergy; Ludwig Maximilian University; Munich Germany
| | - Margitta Worm
- Department of Dermatology, Allergy, and Venereology; Charité; Berlin Germany
| | - Stephan Meller
- Department of Dermatology; Heinrich Heine University; Düsseldorf Germany
| | - Regine Gläser
- Department of Dermatology, Venereology, and Allergy; Christian Albrechts University zu Kiel; Kiel Germany
| | - Detlef Zillikens
- Department of Dermatology, Allergy, and Venereology; University of Lübeck; Lübeck Germany
| | - Bernhard Homey
- Department of Dermatology; Heinrich Heine University; Düsseldorf Germany
| | - Jane Setterfield
- Guy's and St Thomas's NHS Foundation Trust and King's College London; London UK
| | | | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
| | - John Dart
- Moorfields Eye Hospital NHS Foundation Trust and the UCL Institute of Ophthalmology; London UK
| | - Saleh M. Ibrahim
- Lübeck Institute of Experimental Dermatology; University of Lübeck; Lübeck Germany
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30
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Mindorf S, Dettmann IM, Krüger S, Fuhrmann T, Rentzsch K, Karl I, Probst C, Komorowski L, Fechner K, van Beek N, Lemcke S, Sárdy M, Bangert C, Benoit S, Hashimoto T, Zillikens D, Pas HH, Jonkman MF, Stöcker W, Schmidt E. Routine detection of serum antidesmocollin autoantibodies is only useful in patients with atypical pemphigus. Exp Dermatol 2017; 26:1267-1270. [PMID: 28815795 DOI: 10.1111/exd.13409] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2017] [Indexed: 11/29/2022]
Abstract
Autoantibodies against the 3 desmocollin (Dsc; Dsc1-Dsc3) isoforms have been described in different pemphigus variants. Here, we developed state-of-the-art detection systems for serum anti-Dsc1, Dsc2 and Dsc1 IgG and IgA. These assays were applied in 5 different cohorts including pemphigus vulgaris (PV) patients with compatible direct immunofluorescence (IF) microscopy but no reactivity against desmogleins 1 and 3 (n = 24) and sera from patients with autoimmune blistering diseases with positive direct IF microscopy taken at the time of diagnosis (n = 749). We found that detection of anti-Dsc serum reactivity is not helpful in the routine diagnosis of PV, pemphigus foliaceus and paraneoplastic pemphigus but may be valuable in pemphigus vegetans.
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Affiliation(s)
- Swantje Mindorf
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Inga M Dettmann
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Stine Krüger
- Lübeck Institute of Experimental Dermatology (LIED), Lübeck, Germany
| | - Tarek Fuhrmann
- Lübeck Institute of Experimental Dermatology (LIED), Lübeck, Germany
| | - Kristin Rentzsch
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Ingolf Karl
- Lübeck Institute of Experimental Dermatology (LIED), Lübeck, Germany
| | - Christian Probst
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Lars Komorowski
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Kai Fechner
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Susanne Lemcke
- Lübeck Institute of Experimental Dermatology (LIED), Lübeck, Germany.,Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany
| | - Miklós Sárdy
- Department of Dermatology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christine Bangert
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Sandrine Benoit
- Department of Dermatology, Venereology and Allergy, University Hospital Würzburg, Würzburg, Germany
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine and Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Hendri H Pas
- Department of Dermatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marcel F Jonkman
- Department of Dermatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Winfried Stöcker
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology (LIED), Lübeck, Germany.,Department of Dermatology, University of Lübeck, Lübeck, Germany
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van Beek N, Dähnrich C, Johannsen N, Lemcke S, Goletz S, Hübner F, Di Zenzo G, Dmochowski M, Drenovska K, Geller S, Horn M, Kowalewski C, Medenica L, Murrell DF, Patsatsi A, Uzun S, Vassileva S, Zillikens D, Schlumberger W, Schmidt E. Prospective studies on the routine use of a novel multivariant enzyme-linked immunosorbent assay for the diagnosis of autoimmune bullous diseases. J Am Acad Dermatol 2017; 76:889-894.e5. [PMID: 28038887 DOI: 10.1016/j.jaad.2016.11.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Serologic diagnosis of autoimmune blistering disease (AIBD) usually follows a sophisticated multistep algorithm. OBJECTIVE We sought validation of a multivariant enzyme-linked immunosorbent assay (ELISA) in the routine diagnosis of AIBD. METHODS The multivariant ELISA comprising 6 recombinant immunodominant forms of major AIBD target antigens, ie, desmoglein 1, desmoglein 3, envoplakin, BP180, BP230, and type VII collagen was applied in: (1) a cohort of well-characterized AIBD (n = 173) and control sera (n = 130), (2) a prospective multicenter study with 204 sera from patients with newly diagnosed AIBD with positive direct immunofluorescence microscopy, and (3) a prospective monocenter study with 292 consecutive sera from patients with clinical suspicion of AIBD in comparison with the conventional multistep diagnostic algorithm. RESULTS Concordant results in the multivariant ELISA compared with direct immunofluorescence microscopy were seen in 94% of patients with pemphigus and 71% of patients with pemphigoid (Cohen κ value, 0.95 and 0.66) and with the conventional multistep diagnostic approach in 91% of patients with pemphigus and 88% of patients with bullous pemphigoid and 93% of autoantibody-negative sera (Cohen κ, 0.95, 0.84, and 0.78). LIMITATIONS IgA autoantibodies and less common target antigens were not analyzed. CONCLUSIONS The multivariant ELISA is a practical, highly standardized, and widely available novel diagnostic tool for the routine diagnosis of AIBD.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Nora Johannsen
- Institute of Experimental Immunology, Euroimmun, Lübeck, Germany
| | - Susanne Lemcke
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany; Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Franziska Hübner
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Marian Dmochowski
- Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kossara Drenovska
- Department of Dermatology and Venereology, Medical Faculty of Medicine, Sofia, Bulgaria
| | - Shamir Geller
- Dermatology Department Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Horn
- University Institute of Clinical Chemistry and Center of Laboratory Medicine, Inselspital, Bern, Switzerland
| | - Cezary Kowalewski
- Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland
| | - Ljiljana Medenica
- Department of Dermatology, University of Belgrade, School of Medicine Pasterova 2, Belgrade, Serbia
| | - Dedee F Murrell
- Department of Dermatology St George Hospital, University of New South Wales School of Medicine, Sydney, Australia
| | - Aikaterini Patsatsi
- Second University Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Soner Uzun
- Akdeniz University Faculty of Medicine Department of Dermatology, Antalya, Turkey
| | - Snejina Vassileva
- Department of Dermatology and Venereology, Medical Faculty of Medicine, Sofia, Bulgaria
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany
| | | | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.
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Sadik CD, Pas HH, Bohlmann MK, Mousavi S, Benoit S, Sárdy M, Terra JB, Lima AL, Hammers CM, van Beek N, Bangert C, Zillikens D, Schmidt E. Value of BIOCHIP Technology in the Serological Diagnosis of Pemphigoid Gestationis. Acta Derm Venereol 2017; 97:128-130. [PMID: 27174635 DOI: 10.2340/00015555-2460] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Christian D Sadik
- Department of Dermatology, Allergy, and Venereology, University of Lübeck, DE-23538 Lübeck, Germany.
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van Beek N, Lüttmann N, Huebner F, Recke A, Karl I, Schulze FS, Zillikens D, Schmidt E. Correlation of Serum Levels of IgE Autoantibodies Against BP180 With Bullous Pemphigoid Disease Activity. JAMA Dermatol 2017; 153:30-38. [PMID: 27829102 DOI: 10.1001/jamadermatol.2016.3357] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
Importance Bullous pemphigoid (BP) is by far the most frequent autoimmune blistering disease. The presence of IgE autoantibodies against the transmembrane protein BP antigen 2 (BP180, type XVII collagen) has previously been reported in 22% to 100% of BP serum samples, and the pathogenic relevance of anti-BP180 IgE has been suggested in various experimental models and by the successful use of omalizumab in individual patients with BP. Objectives To determine the rate of anti-BP180-reactive IgE in BP, to evaluate the diagnostic relevance of anti-BP180 IgE in BP, and to correlate anti-BP180 IgE with disease activity and the clinical phenotype of patients with BP. Design, Setting, and Participants This case-control cohort study examined 3 groups of patients with BP. Sixty-five patients with BP underwent an enzyme-linked immunosorbent assay for IgE antibodies against the 16th noncollagenous domain of BP180 (NC16A); 52 consecutive patients with BP underwent clinical evaluation with the Bullous Pemphigoid Disease Activity Index (BPDAI); and 36 patients with BP without anti-BP180 NC16A IgG reactivity underwent evaluation of the diagnostic importance of serum anti-BP180 IgE. In addition, 49 age-matched control individuals with noninflammatory dermatoses, 127 controls undergoing allergy testing for IgE levels, and 30 controls with pemphigus vulgaris or pemphigus foliaceus were included for comparison. Patients were seen at a university clinic from January 1, 2008, to July 31, 2014. Main Outcomes and Measures Serum anti-BP180 NC16A IgE and IgG levels and BPDAI scores. Results Of 117 patients with BP (69 women and 48 men), anti-BP180 NC16A serum IgE was detected in 47 (40.2%) and correlated with disease activity as measured by total BPDAI (r = 0.918; P = .06). An intraindividual correlation of anti-BP180 NC16A serum levels with the total BPDAI was observed during the course of the disease in 10 randomly selected patients with BP (r = 0.983; P = .003). Although no association of circulating BP180 NC16A IgE antibodies with urticarial or erythematous lesions was observed (r = 0.481; P = .31), the presence of IgG anti-BP180 NC16A antibodies was associated with the occurrence of erosions and blisters (r = 0.985; P = .006) but not urticarial and erythematous lesions (r = 0.632; P = .23). Assaying for anti-BP180 IgE increased the diagnostic sensitivity by only 2.2% (1 of 46 serum samples) when combined with the IgG anti-BP180 enzyme-linked immunosorbent assay. Conclusions and Relevance Although detection of serum anti-BP180 IgE is not of diagnostic importance, it may be relevant for therapeutic decisions (eg, the use of anti-IgE treatment). The correlation of serum anti-BP180 NC16A IgE levels with disease activity in patients with BP supports the notion that anti-BP180 IgE is of pathogenic relevance. Our observation that IgG anti-BP180 antibodies are related to the occurrence of blisters and erosions may encourage further studies on the association of fine autoantibody reactivities with clinical features of BP.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Nadine Lüttmann
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Andreas Recke
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Ingolf Karl
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany2Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
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Abstract
Autoimmune bullous diseases (AIBDs) are characterized by autoantibodies against structural proteins of the dermal-epidermal junction (in pemphigoid diseases) and the epidermal/ epithelial desmosomes (in pemphigus diseases). By far, the most common AIBD is bullous pemphigoid, which is immunopathologically characterized by autoantibodies against BP180 (type XVII collagen) and BP230. IgG and, to a lesser extent, IgA autoantibodies are the major autoantibody isotypes in these disorders. IgE autoantibodies are increasingly reported in particular in bullous pemphigoid. The development of specific and sensitive anti-BP180 IgE ELISA systems, the report of two experimental murine models employing IgE autoantibodies against BP180, and the successful treatment of bullous pemphigoid with the anti-IgE antibody omalizumab have raised interest in the role of IgE autoantibodies and the modulation of their production in AIBDs. Here, the relevance of IgE autoantibodies in the diagnosis, pathophysiology, and treatment decisions of AIBDs, with a focus on bullous pemphigoid, is reviewed.
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Affiliation(s)
- Nina van Beek
- a Department of Dermatology , University of Lübeck , Lübeck , Germany
| | - Franziska S Schulze
- b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
| | - Detlef Zillikens
- a Department of Dermatology , University of Lübeck , Lübeck , Germany
| | - Enno Schmidt
- a Department of Dermatology , University of Lübeck , Lübeck , Germany
- b Lübeck Institute of Experimental Dermatology (LIED) , University of Lübeck , Lübeck , Germany
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Iwata H, Pipi E, Möckel N, Sondermann P, Vorobyev A, van Beek N, Zillikens D, Ludwig RJ. Recombinant Soluble CD32 Suppresses Disease Progression in Experimental Epidermolysis Bullosa Acquisita. J Invest Dermatol 2015; 135:916-919. [DOI: 10.1038/jid.2014.451] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kasperkiewicz M, Schulze F, Meier M, van Beek N, Nitschke M, Zillikens D, Schmidt E. Treatment of bullous pemphigoid with adjuvant immunoadsorption: a case series. J Am Acad Dermatol 2014; 71:1018-20. [PMID: 25437968 DOI: 10.1016/j.jaad.2014.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 05/23/2014] [Accepted: 06/05/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Markus Meier
- Department of Medicine, University of Lübeck, Germany
| | - Nina van Beek
- Department of Dermatology, University of Lübeck, Germany
| | | | | | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Germany; Comprehensive Center for Inflammatory Medicine, University of Lübeck, Germany
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Schulze F, van Beek N, Terheyden P, Zillikens D, Schmidt E. Concomitant bullous pemphigoid and dermatitis herpetiformis. Dermatology 2013; 226:217-21. [PMID: 23775006 DOI: 10.1159/000349982] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 02/04/2013] [Indexed: 11/19/2022] Open
Abstract
Dermatitis herpetiformis and bullous pemphigoid are bullous autoimmune diseases of the skin microscopically characterized by subepidermal blisters. We present a 77-year-old patient with an 18-month history of disseminated pruritic papular lesions. Direct immunofluorescence microscopy revealed linear deposition of IgG at the basement membrane zone as well as granular deposits of IgA in the papillary dermis. Circulating IgG antibodies against BP180, BP230 and gliadin as well as IgA reactivity against endomysium, tissue transglutaminase, and gliadin were detected compatible with both bullous pemphigoid and dermatitis herpetiformis. Here, we review the English literature on all previously reported patients with co-occurrence of both entities. Interestingly, in previous cases, tissue-bound and serum autoantibodies against the respective target antigens had not yet been completely characterized.
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van Beek N, Rentzsch K, Probst C, Komorowski L, Kasperkiewicz M, Fechner K, Bloecker IM, Zillikens D, Stöcker W, Schmidt E. Serological diagnosis of autoimmune bullous skin diseases: prospective comparison of the BIOCHIP mosaic-based indirect immunofluorescence technique with the conventional multi-step single test strategy. Orphanet J Rare Dis 2012; 7:49. [PMID: 22876746 PMCID: PMC3533694 DOI: 10.1186/1750-1172-7-49] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 08/02/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Various antigen-specific immunoassays are available for the serological diagnosis of autoimmune bullous diseases. However, a spectrum of different tissue-based and monovalent antigen-specific assays is required to establish the diagnosis. BIOCHIP mosaics consisting of different antigen substrates allow polyvalent immunofluorescence (IF) tests and provide antibody profiles in a single incubation. METHODS Slides for indirect IF were prepared, containing BIOCHIPS with the following test substrates in each reaction field: monkey esophagus, primate salt-split skin, antigen dots of tetrameric BP180-NC16A as well as desmoglein 1-, desmoglein 3-, and BP230gC-expressing human HEK293 cells. This BIOCHIP mosaic was probed using a large panel of sera from patients with pemphigus vulgaris (PV, n=65), pemphigus foliaceus (PF, n=50), bullous pemphigoid (BP, n=42), and non-inflammatory skin diseases (n=97) as well as from healthy blood donors (n=100). Furthermore, to evaluate the usability in routine diagnostics, 454 consecutive sera from patients with suspected immunobullous disorders were prospectively analyzed in parallel using a) the IF BIOCHIP mosaic and b) a panel of single antibody assays as commonly used by specialized centers. RESULTS Using the BIOCHIP mosaic, sensitivities of the desmoglein 1-, desmoglein 3-, and NC16A-specific substrates were 90%, 98.5% and 100%, respectively. BP230 was recognized by 54% of the BP sera. Specificities ranged from 98.2% to 100% for all substrates. In the prospective study, a high agreement was found between the results obtained by the BIOCHIP mosaic and the single test panel for the diagnosis of BP, PV, PF, and sera without serum autoantibodies (Cohen's κ between 0.88 and 0.97). CONCLUSIONS The BIOCHIP mosaic contains sensitive and specific substrates for the indirect IF diagnosis of BP, PF, and PV. Its diagnostic accuracy is comparable with the conventional multi-step approach. The highly standardized and practical BIOCHIP mosaic will facilitate the serological diagnosis of autoimmune blistering diseases.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Kristin Rentzsch
- Institute of Experimental Immunology, EUROIMMUN AG, Luebeck, Germany
| | - Christian Probst
- Institute of Experimental Immunology, EUROIMMUN AG, Luebeck, Germany
| | - Lars Komorowski
- Institute of Experimental Immunology, EUROIMMUN AG, Luebeck, Germany
| | | | - Kai Fechner
- Institute of Experimental Immunology, EUROIMMUN AG, Luebeck, Germany
| | - Inga M Bloecker
- Institute of Experimental Immunology, EUROIMMUN AG, Luebeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Winfried Stöcker
- Institute of Experimental Immunology, EUROIMMUN AG, Luebeck, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Luebeck, Luebeck, Germany
- Comprehensive Center for Inflammation Medicine (CCIM), University of Luebeck, Luebeck, Germany
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Beek NV, Knuth- Rehr D, Altmeyer P, Assaf C, Babilas P, Bayerl C, Benoit S, Dippel E, Effendy I, Eming R, Fischer M, Glaenz T, Gläser R, Goebeler M, Gollnick H, Götze S, Gross G, Hadaschik E, Herbst R, Hermes B, Homey B, Hunzelmann N, Jünger M, Kapp A, Kern JS, Körber A, Luger T, Mechtel D, Megahed M, Moll I, Peters KP, Pfeiffer C, Ring J, Röcken M, Sárdy M, Seitz CS, Stadler R, Steinbrink K, Sticherling M, Szeimies RM, Tronnier M, Ulrich J, Vogt T, Wagner N, Welzel J, Wenzel J, Wozel G, Zouboulis CC, Zillikens D, Schmidt E. Diagnostik blasenbildender Autoimmundermatosen an deutschen Hautkliniken. J Dtsch Dermatol Ges 2012. [DOI: 10.1111/j.1610-0387.2011.07840_suppl.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van Beek N, Knuth-Rehr D, Altmeyer P, Assaf C, Babilas P, Bayerl C, Benoit S, Dippel E, Effendy I, Eming R, Fischer M, Glaenz T, Gläser R, Goebeler M, Gollnick H, Götze S, Gross G, Hadaschik E, Herbst R, Hermes B, Homey B, Hunzelmann N, Jünger M, Kapp A, Kern JS, Körber A, Luger T, Mechtel D, Megahed M, Moll I, Peters KP, Pfeiffer C, Ring J, Röcken M, Sárdy M, Seitz CS, Stadler R, Steinbrink K, Sticherling M, Szeimies RM, Tronnier M, Ulrich J, Vogt T, Wagner N, Welzel J, Wenzel J, Wozel G, Zouboulis CC, Zillikens D, Schmidt E. Diagnostics of autoimmune bullous diseases in German dermatology departments. J Dtsch Dermatol Ges 2012; 10:492-9. [PMID: 22304433 DOI: 10.1111/j.1610-0387.2011.07840.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND No consistent data are available on the currently employed diagnostic tools for autoimmune bullous diseases in Germany. The aim of this survey was to describe currently performed diagnostic methods for bullous autoimmune diseases in German dermatology departments. METHODS A standardized questionnaire evaluated the available diagnostic methods i. e. direct immunofluorescence microscopy (IFM), indirect IFM, commercial ELISA systems, and non-commercial serological tests as well as the number of samples per year in all 34 university and 39 non-university dermatology departments. RESULTS The overall return rate was 89 %, 100 % and 79 % for the university and non-university departments, respectively. Direct IFM was the most frequently used method and was applied in 98 % of the responding departments. In 74 % of the responding departments, indirect IFM was used mainly on monkey esophagus and human salt-split skin. Commercial ELISA systems were employed in 58 % of the clinics; all of them used anti-desmoglein ELISA, while anti-BP180 and anti-BP230 ELISA were established in 49 % and 48 % of departments, respectively. Non-commercial analytic methods were only performed in 22 % of the departments. CONCLUSIONS The high return rate of this survey allows a relatively precise description of the current diagnostic methods used in German dermatology departments. Standard diagnostic tests are available nationwide and in bullous pemphigoid and pemphigus, the antigen-specific detection of autoantibodies is routinely performed in half of the departments. Rare disorders may be diagnosed by cooperation with some specialized centers.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, Allergology and Venereology, University of Lübeck, Germany
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Bodó E, Kany B, Gáspár E, Knüver J, Kromminga A, Ramot Y, Bíró T, Tiede S, van Beek N, Poeggeler B, Meyer KC, Wenzel BE, Paus R. Thyroid-stimulating hormone, a novel, locally produced modulator of human epidermal functions, is regulated by thyrotropin-releasing hormone and thyroid hormones. Endocrinology 2010; 151:1633-42. [PMID: 20176727 DOI: 10.1210/en.2009-0306] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Several elements of the hypothalamic-pituitary-thyroid axis (HPT) reportedly are transcribed by human skin cell populations, and human hair follicles express functional receptors for TSH. Therefore, we asked whether the epidermis of normal human skin is yet another extrathyroidal target of TSH and whether epidermis even produces TSH. If so, we wanted to clarify whether intraepidermal TSH expression is regulated by TRH and/or thyroid hormones and whether TSH alters selected functions of normal human epidermis in situ. TSH and TSH receptor (TSH-R) expression were analyzed in the epidermis of normal human scalp skin by immunohistochemistry and PCR. In addition, full-thickness scalp skin was organ cultured and treated with TSH, TRH, or thyroid hormones, and the effect of TSH treatment on the expression of selected genes was measured by quantitative PCR and/or quantitative immunohistochemistry. Here we show that normal human epidermis expresses TSH at the mRNA and protein levels in situ and transcribes TSH-R. It also contains thyrostimulin transcripts. Intraepidermal TSH immunoreactivity is up-regulated by TRH and down-regulated by thyroid hormones. Although TSH-R immunoreactivity in situ could not be documented within the epidermis, but in the immediately adjacent dermis, TSH treatment of organ-cultured human skin strongly up-regulated epidermal expression of involucrin, loricrin, and keratins 5 and 14. Thus, normal human epidermis in situ is both an extrapituitary source and (possibly an indirect) target of TSH signaling, which regulates defined epidermal parameters. Intraepidermal TSH expression appears to be regulated by the classical endocrine controls that determine the systemic HPT axis.
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Affiliation(s)
- Eniko Bodó
- Department of Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
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Kloepper JE, Sugawara K, Al-Nuaimi Y, Gáspár E, van Beek N, Paus R. Methods in hair research: how to objectively distinguish between anagen and catagen in human hair follicle organ culture. Exp Dermatol 2009; 19:305-12. [PMID: 19725870 DOI: 10.1111/j.1600-0625.2009.00939.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The organ culture of human scalp hair follicles (HFs) is the best currently available assay for hair research in the human system. In order to determine the hair growth-modulatory effects of agents in this assay, one critical read-out parameter is the assessment of whether the test agent has prolonged anagen duration or induced catagen in vitro. However, objective criteria to distinguish between anagen VI HFs and early catagen in human HF organ culture, two hair cycle stages with a deceptively similar morphology, remain to be established. Here, we develop, document and test an objective classification system that allows to distinguish between anagen VI and early catagen in organ-cultured human HFs, using both qualitative and quantitative parameters that can be generated by light microscopy or immunofluorescence. Seven qualitative classification criteria are defined that are based on assessing the morphology of the hair matrix, the dermal papilla and the distribution of pigmentary markers (melanin, gp100). These are complemented by ten quantitative parameters. We have tested this classification system by employing the clinically used topical hair growth inhibitor, eflornithine, and show that eflornithine indeed produces the expected premature catagen induction, as identified by the novel classification criteria reported here. Therefore, this classification system offers a standardized, objective and reproducible new experimental method to reliably distinguish between human anagen VI and early catagen HFs in organ culture.
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Bodó E, Kromminga A, Bíró T, Borbíró I, Gáspár E, Zmijewski MA, van Beek N, Langbein L, Slominski AT, Paus R. Human female hair follicles are a direct, nonclassical target for thyroid-stimulating hormone. J Invest Dermatol 2008; 129:1126-39. [PMID: 19052559 DOI: 10.1038/jid.2008.361] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pituitary thyroid-stimulating hormone (TSH) regulates thyroid hormone synthesis via receptors (TSH-R) expressed on thyroid epithelial cells. As the hair follicle (HF) is uniquely hormone-sensitive and, hypothyroidism with its associated, increased TSH serum levels clinically can lead to hair loss, we asked whether human HFs are a direct target for TSH. Here, we report that normal human scalp skin and microdissected human HFs express TSH-R mRNA. TSH-R-like immunoreactivity is limited to the mesenchymal skin compartments in situ. TSH may alter HF mesenchymal functions, as it upregulates alpha-smooth muscle actin expression in HF fibroblasts. TSH-R stimulation by its natural ligand in organ culture changes the expression of several genes of human scalp HFs (for example keratin K5), upregulates the transcription of classical TSH target genes and enhances cAMP production. Although the functional role of TSH in human HF biology awaits further dissection, these findings document that intracutaneous TSH-Rs are fully functional in situ and that HFs of female individuals are direct targets for nonclassical, extrathyroidal TSH bioregulation. This suggests that organ-cultured scalp HFs provide an instructive and physiologically relevant human model for exploring nonclassical functions of TSH, in and beyond the skin.
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Affiliation(s)
- Enikö Bodó
- Department of Dermatology, University Hospital Schleswig-Holstein, University of Lübeck, Lübeck, Germany
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van Beek N, Bodó E, Kromminga A, Gáspár E, Meyer K, Zmijewski MA, Slominski A, Wenzel BE, Paus R. Thyroid hormones directly alter human hair follicle functions: anagen prolongation and stimulation of both hair matrix keratinocyte proliferation and hair pigmentation. J Clin Endocrinol Metab 2008; 93:4381-8. [PMID: 18728176 DOI: 10.1210/jc.2008-0283] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Both insufficient and excess levels of thyroid hormones (T3 and T4) can result in altered hair/skin structure and function (e.g. effluvium). However, it is still unclear whether T3 and T4 exert any direct effects on human hair follicles (HFs), and if so, how exactly human HFs respond to T3/T4 stimulation. OBJECTIVE Our objective was to asses the impact of T3/T4 on human HF in vitro. METHODS Human anagen HFs were isolated from skin obtained from females undergoing facelift surgery. HFs from euthyroid females between 40 and 69 yr (average, 56 yr) were cultured and treated with T3/T4. RESULTS Studying microdissected, organ-cultured normal human scalp HFs, we show here that T4 up-regulates the proliferation of hair matrix keratinocytes, whereas their apoptosis is down-regulated by T3 and T4. T4 also prolongs the duration of the hair growth phase (anagen) in vitro, possibly due to the down-regulation of TGF-beta2, the key anagen-inhibitory growth factor. Because we show here that human HFs transcribe deiodinase genes (D2 and D3), they may be capable of converting T4 to T3. Intrafollicular immunoreactivity for the recognized thyroid hormone-responsive keratins cytokeratin (CK) 6 and CK14 is significantly modulated by T3 and T4 (CK6 is enhanced, CK14 down-regulated). Both T3 and T4 also significantly stimulate intrafollicular melanin synthesis. CONCLUSIONS Thus, we present the first evidence that human HFs are direct targets of thyroid hormones and demonstrate that T3 and/or T4 modulate multiple hair biology parameters, ranging from HF cycling to pigmentation.
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Affiliation(s)
- Nina van Beek
- Department of Dermatology, University Hospital Schleswig-Holstein, University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
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