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Yamawaki M, Katayama K, Fujimoto M, Goto H, Yuasa H, Kozuka Y, Mori M, Takahashi D, Saiki R, Hirabayashi Y, Murata T, Yamanaka K, Dohi K. Bullous Pemphigoid in X-linked Alport Syndrome. Intern Med 2023; 62:2375-2379. [PMID: 36543213 PMCID: PMC10484771 DOI: 10.2169/internalmedicine.0972-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
Skin lesions in X-linked Alport syndrome (XLAS) are rarely observed. Bullous pemphigoid (BP) is caused by autoantibodies against BP180, also called α1 (XVII) chain, in the basement membrane zone (BMZ). A 48-year-old man with XLAS developed tense blisters. A skin biopsy showed a cleft between the basal cell layer and dermis, with the infiltration of neutrophils and eosinophils. α1 (XVII) staining was positive on the epidermal side of α2/5 (IV) staining. Oral prednisolone improved his symptoms gradually. Abundant tense blisters on the palms and soles might suggest an important role of the α5 (IV) chain in the integrity of BMZ.
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Affiliation(s)
- Masahiro Yamawaki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Mika Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Hiroyuki Goto
- Department of Dermatology, Mie University Graduate School of Medicine, Japan
| | - Hiroto Yuasa
- Department of Pathology, Mie University Hospital, Japan
| | - Yuji Kozuka
- Department of Pathology, Mie University Hospital, Japan
| | - Mutsuki Mori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Daisuke Takahashi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Ryosuke Saiki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Yosuke Hirabayashi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Tomohiro Murata
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Keiichi Yamanaka
- Department of Dermatology, Mie University Graduate School of Medicine, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
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2
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Oyama N, Hasegawa M. Lichen Sclerosus: A Current Landscape of Autoimmune and Genetic Interplay. Diagnostics (Basel) 2022; 12. [PMID: 36553077 DOI: 10.3390/diagnostics12123070] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Lichen sclerosus (LS) is an acquired chronic inflammatory dermatosis predominantly affecting the anogenital area with recalcitrant itching and soreness. Progressive or persistent LS may cause urinary and sexual disturbances and an increased risk of local skin malignancy with a prevalence of up to 11%. Investigations on lipoid proteinosis, an autosomal recessive genodermatosis caused by loss-of-function mutations in the extracellular matrix protein 1 (ECM1) gene, led to the discovery of a humoral autoimmune response to the identical molecule in LS, providing evidence for an autoimmune and genetic counterpart targeting ECM1. This paper provides an overview of the fundamental importance and current issue of better understanding the immunopathology attributed to ECM1 in LS. Furthermore, we highlight the pleiotropic action of ECM1 in homeostatic and structural maintenance of skin biology as well as in a variety of human disorders possibly associated with impaired or gained ECM1 function, including the inflammatory bowel disease ulcerative colitis, Th2 cell-dependent airway allergies, T-cell and B-cell activation, and the demyelinating central nervous system disease multiple sclerosis, to facilitate sharing the concept as a plausible therapeutic target of this attractive molecule.
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3
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Fujimura Y, Watanabe M, Ohno K, Kobayashi Y, Takashima S, Nakamura H, Kosumi H, Wang Y, Mai Y, Lauria A, Proserpio V, Ujiie H, Iwata H, Nishie W, Nagayama M, Oliviero S, Donati G, Shimizu H, Natsuga K. Hair follicle stem cell progeny heal blisters while pausing skin development. EMBO Rep 2021; 22:e50882. [PMID: 34085753 DOI: 10.15252/embr.202050882] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
Injury in adult tissue generally reactivates developmental programs to foster regeneration, but it is not known whether this paradigm applies to growing tissue. Here, by employing blisters, we show that epidermal wounds heal at the expense of skin development. The regenerated epidermis suppresses the expression of tissue morphogenesis genes accompanied by delayed hair follicle (HF) growth. Lineage tracing experiments, cell proliferation dynamics, and mathematical modeling reveal that the progeny of HF junctional zone stem cells, which undergo a morphological transformation, repair the blisters while not promoting HF development. In contrast, the contribution of interfollicular stem cell progeny to blister healing is small. These findings demonstrate that HF development can be sacrificed for the sake of epidermal wound regeneration. Our study elucidates the key cellular mechanism of wound healing in skin blistering diseases.
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Affiliation(s)
- Yu Fujimura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Mika Watanabe
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Life Sciences and Systems Biology, Molecular Biotechnology Centre, University of Turin, Turin, Italy
| | - Kota Ohno
- Research Institute for Electronic Science, Hokkaido University, Sapporo, Japan
| | - Yasuaki Kobayashi
- Research Institute for Electronic Science, Hokkaido University, Sapporo, Japan
| | - Shota Takashima
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideki Nakamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideyuki Kosumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yunan Wang
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yosuke Mai
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Andrea Lauria
- Department of Life Sciences and Systems Biology, Molecular Biotechnology Centre, University of Turin, Turin, Italy.,Italian Institute for Genomic Medicine, Candiolo, Italy
| | - Valentina Proserpio
- Italian Institute for Genomic Medicine, Candiolo, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Wataru Nishie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaharu Nagayama
- Research Institute for Electronic Science, Hokkaido University, Sapporo, Japan
| | - Salvatore Oliviero
- Department of Life Sciences and Systems Biology, Molecular Biotechnology Centre, University of Turin, Turin, Italy.,Italian Institute for Genomic Medicine, Candiolo, Italy
| | - Giacomo Donati
- Department of Life Sciences and Systems Biology, Molecular Biotechnology Centre, University of Turin, Turin, Italy
| | - Hiroshi Shimizu
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ken Natsuga
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Condorelli AG, Dellambra E, Logli E, Zambruno G, Castiglia D. Epidermolysis Bullosa-Associated Squamous Cell Carcinoma: From Pathogenesis to Therapeutic Perspectives. Int J Mol Sci 2019; 20:E5707. [PMID: 31739489 DOI: 10.3390/ijms20225707] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 12/22/2022] Open
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of inherited skin disorders determined by mutations in genes encoding for structural components of the cutaneous basement membrane zone. Disease hallmarks are skin fragility and unremitting blistering. The most disabling EB (sub)types show defective wound healing, fibrosis and inflammation at lesional skin. These features expose patients to serious disease complications, including the development of cutaneous squamous cell carcinomas (SCCs). Almost all subjects affected with the severe recessive dystrophic EB (RDEB) subtype suffer from early and extremely aggressive SCCs (RDEB-SCC), which represent the first cause of death in these patients. The genetic determinants of RDEB-SCC do not exhaustively explain its unique behavior as compared to low-risk, ultraviolet-induced SCCs in the general population. On the other hand, a growing body of evidence points to the key role of tumor microenvironment in initiation, progression and spreading of RDEB-SCC, as well as of other, less-investigated, EB-related SCCs (EB-SCCs). Here, we discuss the recent advances in understanding the complex series of molecular events (i.e., fibrotic, inflammatory, and immune processes) contributing to SCC development in EB patients, cross-compare tumor features in the different EB subtypes and report the most promising therapeutic approaches to counteract or delay EB-SCCs.
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Wang M, Lehman JS, Camilleri MJ, Drage LA, Wieland CN. Circulating bullous pemphigoid autoantibodies in the setting of negative direct immunofluorescence findings for bullous pemphigoid: A single-center retrospective review. J Am Acad Dermatol 2019; 81:472-479. [PMID: 30928465 DOI: 10.1016/j.jaad.2019.03.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 12/14/2018] [Revised: 03/11/2019] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bullous pemphigoid (BP) autoantibody levels are generally elevated in patients with BP but can be present nonspecifically in patients without BP. OBJECTIVE To analyze the clinical findings of patients with elevated BP180 or BP230 autoantibody levels and negative direct immunofluorescence (DIF) study findings. METHODS We retrospectively reviewed records of patients seen at our institution during January 1, 2005-December 31, 2015, who were positive for BP180 or BP230 autoantibodies and had a negative DIF study finding. These patients' demographic characteristics and BP180 and BP230 levels were compared with those of a BP control group who were positive for BP180 or BP230 autoantibodies and had positive DIF study findings. RESULTS We identified 208 patients with BP autoantibodies but without positive DIF study findings. These patients' mean age and enzyme-linked immunosorbent assay values were significantly lower than those of the control group. Dermatitis was the most common final clinical diagnosis. Of the 208 patients, 41 (19.7%) had at least 2 years' follow-up. Four patients had positive DIF results upon repeating the test and ultimately received pemphigoid diagnoses. LIMITATIONS Retrospective design with limited follow-up. CONCLUSION Patients might harbor serum BP autoantibodies in the context of a wide range of dermatoses. Low positive BP180 and BP230 autoantibody levels should not be overinterpreted as evidence for BP in the setting of a negative DIF.
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Affiliation(s)
- Michael Wang
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Michael J Camilleri
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
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Kanda N, Nakadaira N, Otsuka Y, Ishii N, Hoashi T, Saeki H. Linear IgA bullous dermatosis associated with ulcerative colitis: A case report and literature review. Australas J Dermatol 2019; 61:e82-e86. [PMID: 31319433 DOI: 10.1111/ajd.13121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/25/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
We report the case of a 59-year-old Japanese woman who developed linear IgA bullous dermatosis during treatment for ulcerative colitis that manifested as pruritic vesicles with erythema on the trunk and scalp. Histopathological examination revealed subepidermal bulla with neutrophil and eosinophil infiltration in the upper dermis. Direct immunofluorescence revealed linear IgA deposits at the basement membrane zone, and indirect immunofluorescence using split skin revealed IgA reaction to the epidermal side (lamina lucida type). We reviewed 33 reported cases of linear IgA bullous dermatosis associated with ulcerative colitis and found that ulcerative colitis preceded the onset of linear IgA bullous dermatosis in 94% of the patients and that IgA-positive patients in split skin indirect immunofluorescence all showed the lamina lucida type, indicating that target antigens for serum IgA antibodies may reside in the lamina lucida. Regarding the pathogenetic association of ulcerative colitis and linear IgA bullous dermatosis, intestinal inflammation may induce the exposure and presentation of intestinal antigens that are cross-reactive to cutaneous antigens, stimulating autoimmune response to antigens of cutaneous basement membrane zones.
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Affiliation(s)
- Naoko Kanda
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba
| | - Nanami Nakadaira
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba
| | - Yohei Otsuka
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Fukuoka
| | | | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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7
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van den Berg MCW, MacCarthy-Morrogh L, Carter D, Morris J, Ribeiro Bravo I, Feng Y, Martin P. Proteolytic and Opportunistic Breaching of the Basement Membrane Zone by Immune Cells during Tumor Initiation. Cell Rep 2019; 27:2837-2846.e4. [PMID: 31167131 PMCID: PMC6581915 DOI: 10.1016/j.celrep.2019.05.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/02/2019] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
Cancer-related inflammation impacts significantly on cancer development and progression. From early stages, neutrophils and macrophages are drawn to pre-neoplastic cells in the epidermis, but before directly interacting, they must first breach the underlying extracellular matrix barrier layer that includes the basement membrane. Using several different skin cancer models and a collagen I-GFP transgenic zebrafish line, we have undertaken correlative light and electron microscopy (CLEM) to capture the moments when immune cells traverse the basement membrane. We show evidence both for active proteolytic burrowing and for the opportunistic use of pre-existing weak spots in the matrix layer. We show that these small holes, as well as much larger, cancer cell-generated or wound-triggered gaps in the matrix barrier, provide portals for immune cells to access cancer cells in the epidermis and thus are rate limiting in cancer progression.
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Affiliation(s)
- Maaike C W van den Berg
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - Lucy MacCarthy-Morrogh
- School of Biochemistry, Biomedical Sciences Building, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - Deborah Carter
- School of Biochemistry, Biomedical Sciences Building, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - Josephine Morris
- School of Biochemistry, Biomedical Sciences Building, University of Bristol, University Walk, Bristol BS8 1TD, UK
| | - Isabel Ribeiro Bravo
- University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK
| | - Yi Feng
- University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh BioQuarter, Edinburgh EH16 4TJ, UK.
| | - Paul Martin
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, University Walk, Bristol BS8 1TD, UK; School of Biochemistry, Biomedical Sciences Building, University of Bristol, University Walk, Bristol BS8 1TD, UK; School of Medicine, Cardiff University, Cardiff CF14 4XN, UK.
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8
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Kumudhini S, Pai S, Rao C, Rao R. A comparative study of Michel's medium versus honey as a transport medium for skin specimens prior to direct immunofluorescence microscopy and antigen mapping. J Cutan Pathol 2019; 46:729-735. [PMID: 31087406 DOI: 10.1111/cup.13494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/24/2018] [Revised: 03/25/2019] [Accepted: 05/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Michel's medium (MM) is currently the recommended transport medium for skin biopsy specimens prior to direct immunofluorescence (DIF) microscopy. OBJECTIVE To compare the utility of honey with that of MM as a transport medium for skin biopsy specimens used for DIF and antigen mapping. METHODS Group I consisted of 45 freshly-taken skin specimens earmarked for DIF testing. It was divided into three groups (A, B and C), each containing 15 specimens. Biopsy specimens were sliced into two, one each for MM and honey. Samples in group A were processed at the end of week 1 while those in group B and C were processed at the end of weeks 2 and 4, respectively. Group II consisted of five specimens of epidermolysis bullosa (EB) which was further divided into three groups; two specimens were processed for antigen mapping at the end of week 1, while others were processed at the end of week 2 (two specimens) and 4 (one specimen). RESULTS Sensitivity of honey as a transport medium for skin biopsy specimens was 100%, 92.6% and 53.8% at weeks 1, 2 and 4, respectively. The antigen mapping was positive in all specimens. CONCLUSION Utility of honey was comparable to MM for DIF samples tested at weeks 1 and 2 but was lower at week 4.
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Affiliation(s)
- Subraminiam Kumudhini
- Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Sathish Pai
- Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Chythra Rao
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Raghavendra Rao
- Department of Dermatology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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9
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Goletz S, Zillikens D, Schmidt E. Structural proteins of the dermal-epidermal junction targeted by autoantibodies in pemphigoid diseases. Exp Dermatol 2017; 26:1154-1162. [PMID: 28887824 DOI: 10.1111/exd.13446] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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] [Accepted: 08/31/2017] [Indexed: 12/12/2022]
Abstract
The dermal-epidermal junction consists of a network of several interacting structural proteins that strengthen adhesion and mediate signalling events. This structural network consists of hemidesmosomal-anchoring filament complexes connecting the basal keratinocytes to the basement membrane. The anchoring filaments in turn interact with the anchoring fibrils to attach the basement membrane to the underlying dermis. Several of these structural proteins are recognized by autoantibodies in pemphigoid diseases, a heterogeneous group of clinically and immunopathologically diverse entities. Targeted proteins include the two intracellular plakins, plectin isoform 1a and BP230 (also called bullous pemphigoid antigen (BPAG) 1 isoform e (BPAG1e)). Plectin 1a and BP230 are connected to the intermediate filaments and to the cell surface receptor α6β4 integrin, which in turn is connected to laminin 332, a component of the anchoring filaments. Further essential adhesion proteins are BP180, a transmembrane protein, laminin γ1 and type VII collagen. Latter protein is the major constituent of the anchoring fibrils. Mutations in the corresponding genes of these adhesion molecules lead to inherited epidermolysis bullosa emphasizing the importance of these proteins for the integrity of the dermal-epidermal junction. This review will provide an overview on the structure and function of the proteins situated in the dermal-epidermal junction targeted by autoantibodies.
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Affiliation(s)
- Stephanie Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- 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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10
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Gordon MK, DeSantis-Rodrigues A, Hahn R, Zhou P, Chang Y, Svoboda KKH, Gerecke DR. The molecules in the corneal basement membrane zone affected by mustard exposure suggest potential therapies. Ann N Y Acad Sci 2017; 1378:158-165. [PMID: 27737494 DOI: 10.1111/nyas.13226] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 04/11/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 01/05/2023]
Abstract
Mustard exposures result in epithelial-stromal separations in the cornea and epidermal-dermal separations in the skin. Large blisters often manifest in skin, while the cornea develops microblisters, and, when enough form, the epithelium sloughs. If the exposure is severe, healing can be imperfect and can result in long-term adverse consequences. For the cornea, this could manifest as recurrent corneal erosions. Since the corneal epithelial-stromal separations are in the region identified by electron microscopy as the lamina lucida, the same region affected by the blistering disease junctional epidermolysis bullosa (JEB), we postulated that the molecules that are defective in JEB would be the same ones cleaved by mustard compounds. These molecules are α6β4 integrin and collagen XVII, which can be cleaved by matrix metalloproteinase-9 (MMP-9) and ADAM17, respectively. Therefore, our laboratory has tested MMP-9 and ADAM17 inhibitors as potential therapies to attenuate corneal mustard injury. Our results demonstrated that inhibiting MMP-9 and ADAM17 resulted in less epithelial-stromal separation in the corneas at 24 h postexposure, as compared with using only medium as a therapy.
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Affiliation(s)
- Marion K Gordon
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey.
| | - Andrea DeSantis-Rodrigues
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - Rita Hahn
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - Peihong Zhou
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - Yokechen Chang
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - Kathy K H Svoboda
- Department of Biomedical Sciences, Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Texas
| | - Donald R Gerecke
- Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
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11
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Hayakawa T, Hirako Y, Teye K, Tsuchisaka A, Koga H, Ishii N, Karashima T, Kaneda M, Oyu Y, Tateishi C, Sugawara K, Yonamine A, Shinkuma S, Shimizu H, Fukano H, Shimozato K, Nguyen NT, Marinkovich MP, Tsuruta D, Hashimoto T. Unique mouse monoclonal antibodies reactive with maturation-related epitopes on type VII collagen. Exp Dermatol 2017; 26:811-819. [PMID: 28111846 DOI: 10.1111/exd.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 01/17/2017] [Indexed: 11/26/2022]
Abstract
In this study, we generated a new set of monoclonal antibodies (mAbs) to bovine and human type VII collagen (COL7) by immunizing mice with bovine cornea-derived basement membrane zone (BMZ) fraction. The four mAbs, tentatively named as COL7-like mAbs, showed speckled subepidermal staining in addition to linear BMZ staining of normal human skin and bovine cornea, a characteristic immunofluorescence feature of COL7, but showed no reactivity with COL7 by in vitro biochemical analyses. Taking advantage of the phenomenon that COL7-like mAbs did not react with mouse BMZ, we compared immunofluorescence reactivity between wild-type and COL7-rescued humanized mice and found that COL7-like mAbs reacted with BMZ of COL7-rescued humanized mice. In ELISAs, COL7-like mAbs reacted with intact triple-helical mammalian recombinant protein (RP) of COL7 but not with bacterial RP. Furthermore, COL7-like mAbs did not react with COL7 within either cultured DJM-1 cells or basal cells of skin of a bullous dermolysis of the newborn patient. These results confirmed that COL7-like mAbs reacted with human and bovine COL7. The epitopes for COL7-like mAbs were considered to be present only on mature COL7 after secretion from keratinocytes and deposition to BMZ and to be easily destroyed during immunoblotting procedure. Additional studies indicated association of the speckled subepidermal staining with both type IV collagen and elastin. These unique anti-COL7 mAbs should be useful in studies of both normal and diseased conditions, particularly dystrophic epidermolysis bullosa, which produces only immature COL7.
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Affiliation(s)
- Taihei Hayakawa
- Department of Dermatology, Kurume University School of Medicine, Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan.,Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
| | - Yoshiaki Hirako
- Division of Biological Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Kwesi Teye
- Department of Dermatology, Kurume University School of Medicine, Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Atsunari Tsuchisaka
- Department of Dermatology, Kurume University School of Medicine, Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Hiroshi Koga
- Department of Dermatology, Kurume University School of Medicine, Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Tadashi Karashima
- Department of Dermatology, Kurume University School of Medicine, Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
| | - Minori Kaneda
- Division of Biological Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Yuka Oyu
- Division of Biological Science, Graduate School of Science, Nagoya University, Nagoya, Japan
| | - Chiharu Tateishi
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Sugawara
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayano Yonamine
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoru Shinkuma
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hideo Fukano
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
| | - Kazuo Shimozato
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
| | - Ngon T Nguyen
- Department of Dermatology, Stanford University School of Medicine, Center for Clinical Sciences Research, Stanford, CA, USA
| | - M Peter Marinkovich
- Department of Dermatology, Stanford University School of Medicine, Center for Clinical Sciences Research, Stanford, CA, USA.,Department of Dermatology, Veterans Administration Hospital, Palo Alto Medical Center, Palo Alto, CA, USA
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Kurume University Institute of Cutaneous Cell Biology, Kurume, Japan
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12
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Hashimoto T, Jin Z, Ishii N. Clinical and immunological studies for 105 Japanese seropositive patients of epidermolysis bullosa acquisita examined at Kurume University. Expert Rev Clin Immunol 2016; 12:895-902. [PMID: 27247994 DOI: 10.1080/1744666x.2016.1196136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Using our serological diagnostic criteria, we selected 105 Japanese patients with epidermolysis bullosa acquisita (EBA), an autoimmune bullous disease (AIBD) reacting with type VII collagen, from our cohort of 5063 AIBD patients. METHODS We examined the patients clinically and immunologically. RESULTS We found diversity of clinical manifestations in both cutaneous and oral mucosal lesions and a high rate of inflammatory-type EBA patients in Japan. Common treatments were systemic steroids, followed by immunosuppressives, DDS, tetracycline/minocycline and colchicine. Immunological studies revealed that indirect immunofluorescence of 1M-NaCl-split skin, immunoblotting of dermal extract, and type VII collagen ELISA were sensitive methods, with possible multiplicity of circulating autoantibodies against other basement membrane autoantigens. CONCLUSION The present study analyzed the largest cohort of EBA patients, confirming the scarcity of EBA (only 105 of the 5063 AIBD patients), and showed that the three serological tests are useful for the diagnosis of EBA.
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Affiliation(s)
- Takashi Hashimoto
- a Department of Dermatology , Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology , Fukuoka , Japan
| | - Zhexiong Jin
- a Department of Dermatology , Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology , Fukuoka , Japan
| | - Norito Ishii
- a Department of Dermatology , Kurume University School of Medicine, and Kurume University Institute of Cutaneous Cell Biology , Fukuoka , Japan
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13
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Lemcke S, Sokolowski S, Rieckhoff N, Buschtez M, Kaffka C, Winter-Keil A, Schaller C, Rottmann N, Sadik CD, Stöcker W, Zillikens D, Schmidt E. Automated direct immunofluorescence analyses of skin biopsies. J Cutan Pathol 2015; 43:227-35. [PMID: 26454250 DOI: 10.1111/cup.12637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 06/25/2015] [Revised: 09/22/2015] [Accepted: 10/03/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diagnosis of autoantibody- and immune complex-induced skin diseases is primarily based on direct immunofluorescence (DIF) microscopy. DIF staining is usually performed manually and, therefore, is labor intensive. The quality of immunohistochemical results considerably depends on the experience of the person conducting the tests. The novel EUROTide(™) technique in combination with the biochip-based system EUROPath represents a new technology for automation of DIF staining. METHODS Frozen sections of previously characterized skin biopsies from bullous pemphigoid and pemphigus vulgaris patients were incubated with fluorescein-labelled anti-human IgG and complement C3c following the standard manual procedure and, for comparison, applying EUROTide/EUROPath in an automated version. RESULTS Both, the manual and the automated procedure, detected IgG and C3c deposits in all samples. However, DIF stainings performed with EUROTide/EUROPath displayed more intense specific IF signals and distinctly less background staining. The detecting antibody could be used at a ×4 higher dilution. CONCLUSION EUROTide/EUROPath applied in an automated system improves diagnostic accuracy and saves reagents. Larger studies in other routine laboratories may further explore the value of the EUROTide/EUROPath technology and may include comparison with other automated stainers.
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Affiliation(s)
- Susanne Lemcke
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany
| | | | | | | | | | - Antje Winter-Keil
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany
| | | | | | | | | | - 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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14
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Saraiya A, Yang CS, Kim J, Bercovitch L, Robinson-Bostom L, Telang G. Dermal eosinophilic infiltrate in junctional epidermolysis bullosa. J Cutan Pathol 2015; 42:559-63. [PMID: 25950805 DOI: 10.1111/cup.12521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 02/10/2015] [Revised: 03/27/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022]
Abstract
Junctional epidermolysis bullosa (JEB) is a rare genodermatosis characterized by a split in the lamina lucida usually because of mutations in LAMA3, LAMB3 and LAMC2 resulting in absence or reduction of laminin-332. Rare subtypes of JEB have mutations in COL17A1, ITGB4, ITGA6 and ITGA3 leading to reduction or dysfunction of collagen XVII, integrin α6β4 and integrin α3. The classic finding under light microscopy is a paucicellular, subepidermal split. We describe the unusual presence of an eosinophilic infiltrate in the bullae and subjacent dermis in a neonate with JEB, generalized intermediate (formerly known as non-Herlitz-type JEB), discuss the histologic differential diagnosis for a subepidermal blister in a neonate, review the literature regarding cases of epidermolysis bullosa (EB) presenting with inflammatory infiltrates, and discuss mechanisms to explain these findings. This case highlights that eosinophils can rarely be seen in EB and should not mislead the dermatopathologist into diagnosing an autoimmune blistering disorder.
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Affiliation(s)
- Ami Saraiya
- Tufts Dermatology Research Department, Tufts Medical Center, Boston, MA, USA
| | - Catherine S Yang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Jinah Kim
- Department of Pathology, Division of Dermatopathology, Stanford University, Palo Alto, CA, USA
| | - Lionel Bercovitch
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Leslie Robinson-Bostom
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
| | - Gladys Telang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, USA
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15
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Rabelo DF, Nguyen T, Caufield BA, Ahmed AR. Mucous membranepemphigoid in two half-sisters. The potential roles of autoantibodies to β4 integrin subunits and HLA-DQβ1*0301. J Dermatol Case Rep 2014; 8:9-12. [PMID: 24748904 DOI: 10.3315/jdcr.2014.1162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 12/31/2013] [Accepted: 01/12/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) is a subepithelial autoimmune mucocutaneous disease. It most frequently affects the oral mucosa, followed by ocular and nasal mucosa, nasopharyngeal, anogenital, skin, laryngeal and esophageal mucosa. MAIN OBSERVATION Two half-sisters developed mucous membrane pemphigoid at approximately the same age. The older sister presented with primarily mucosal disease, while the younger had a more cutaneous disease. The histopathology demonstrated a subepithelial blister and direct immunofluorescence showed deposition of IgG and C3 at the basement membrane zone of perilesional tissues in both sisters. Antibodies to human β4 integrin were present in the sera of both patients and correlated with disease activity. Both sisters carried the same HLADQβ1* 0301 allele. CONCLUSIONS This is the first case of mucous membrane pemphigoid occurring in two half-sisters. Perhaps, it is the low incidence of mucous membrane pemphigoid that may account for the lack of reports on familial cases of the disease.
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Affiliation(s)
| | - Tegan Nguyen
- The Center for Blistering Diseases, Boston, MA, USA
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16
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Sárdy M, Kostaki D, Varga R, Peris K, Ruzicka T. Comparative study of direct and indirect immunofluorescence and of bullous pemphigoid 180 and 230 enzyme-linked immunosorbent assays for diagnosis of bullous pemphigoid. J Am Acad Dermatol 2013; 69:748-753. [PMID: 23969034 DOI: 10.1016/j.jaad.2013.07.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [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: 03/12/2013] [Revised: 06/29/2013] [Accepted: 07/06/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Direct immunofluorescence (DIF), indirect immunofluorescence (IIF), and enzyme-linked immunosorbent assay (ELISA) are used for the laboratory diagnosis of bullous pemphigoid (BP). OBJECTIVE The diagnostic value of DIF and IIF on rabbit and monkey esophagus or human salt-split skin and commercial ELISAs was assessed. METHODS This was a single-center retrospective study where 313 patients with BP were compared with 488 control subjects. RESULTS DIF was the most sensitive test (90.8%) whereas sensitivities for IIF on rabbit esophagus, IIF on monkey esophagus, IIF on salt-split skin, BP180 ELISA, and BP230 ELISA were 76.0%, 73.2%, 73.3%, 72.0%, and 59.0%, respectively. The sensitivity of the serologic tests was 88.8% altogether. The specificities for DIF, IIF on rabbit esophagus, IIF on monkey esophagus, IIF on salt-split skin, BP180 ELISA, and BP230 ELISA were 98%, 96.5%, 97.1%, 100%, 94.1%, and 99.2%, respectively. LIMITATIONS The retrospective nature of study was a limitation. Correlation of diagnostic data with clinical manifestations or disease course was not possible. CONCLUSIONS In suspected BP, both serologic tests and DIF have to be performed because of a sensitivity issue. Although the ELISAs had a relatively low sensitivity, the serologic tests altogether almost reached the level of sensitivity of DIF. The specificities of all assays were excellent.
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Affiliation(s)
- Miklós Sárdy
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany.
| | - Dimitra Kostaki
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany; Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Rita Varga
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
| | - Ketty Peris
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - Thomas Ruzicka
- Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany
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17
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Graham JS, Schoneboom BA. Historical perspective on effects and treatment of sulfur mustard injuries. Chem Biol Interact. 2013;206:512-522. [PMID: 23816402 DOI: 10.1016/j.cbi.2013.06.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022]
Abstract
Sulfur mustard (2,2'-dichlorodiethyl sulfide; SM) is a potent vesicating chemical warfare agent that poses a continuing threat to both military and civilian populations. Significant SM injuries can take several months to heal, necessitate lengthy hospitalizations, and result in long-term complications affecting the skin, eyes, and lungs. This report summarizes initial and ongoing (chronic) clinical findings from SM casualties from the Iran-Iraq War (1980-1988), with an emphasis on cutaneous injury. In addition, we describe the cutaneous manifestations and treatment of several men recently and accidentally exposed to SM in the United States. Common, chronic cutaneous problems being reported in the Iranian casualties include pruritis (the primary complaint), burning, pain, redness, desquamation, hyperpigmentation, hypopigmentation, erythematous papular rash, xerosis, multiple cherry angiomas, atrophy, dermal scarring, hypertrophy, and sensitivity to mechanical injury with recurrent blistering and ulceration. Chronic ocular problems include keratitis, photophobia, persistent tearing, sensation of foreign body, corneal thinning and ulceration, vasculitis of the cornea and conjunctiva, and limbal stem cell deficiency. Chronic pulmonary problems include decreases in lung function, bronchitis with hyper-reactive airways, bronchiolitis, bronchiectasis, stenosis of the trachea and other large airways, emphysema, pulmonary fibrosis, decreased total lung capacity, and increased incidences of lung cancer, pulmonary infections, and tuberculosis. There are currently no standardized or optimized methods of casualty management; current treatment strategy consists of symptomatic management and is designed to relieve symptoms, prevent infections, and promote healing. New strategies are needed to provide for optimal and rapid healing, with the goals of (a) returning damaged tissue to optimal appearance and normal function in the shortest period of time, and (b) ameliorating chronic effects. Further experimental research and clinical trials will be needed to prevent or mitigate the acute clinical effects of SM exposure and to reduce or eliminate the long-term manifestations.
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18
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Liu Z, Shipley JM, Vu TH, Zhou X, Diaz LA, Werb Z, Senior RM. Gelatinase B-deficient mice are resistant to experimental bullous pemphigoid. J Exp Med 1998; 188:475-82. [PMID: 9687525 PMCID: PMC2212482 DOI: 10.1084/jem.188.3.475] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/1998] [Revised: 06/01/1998] [Indexed: 01/27/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease characterized by deposition of autoantibodies at the basement membrane zone. In an experimental BP model in mice, the subepidermal blistering is mediated by antibodies directed against the hemidesmosomal protein BP180 (collagen XVII, BPAG2), and depends on complement activation and neutrophil infiltration. Gelatinase B is present in BP blister fluid and can cleave BP180. In this study we investigated the role of gelatinase B in the immunopathogenesis of experimental BP using mice containing targeted disruption of the gelatinase B (MMP-9, 92 kD gelatinase) gene. Gelatinase B-deficient mice were resistant to the blistering effect of intracutaneous anti-mBP180 antibodies, although these mice showed deposition of autoantibodies at the basement membrane zone and neutrophil recruitment to the skin comparable to that observed in the control mice. Interleukin 8 given intradermally concomitantly with pathogenic anti-mBP180 elicited a significant neutrophil recruitment into the skin in gelatinase B-deficient mice, but blistering did not occur. However, gelatinase B-deficient mice reconstituted with neutrophils from normal mice developed blistering in response to anti-mBP180 antibodies. These results implicate neutrophil-derived gelatinase B in the pathogenesis of experimental BP and might lead to novel therapeutic strategies for BP.
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Affiliation(s)
- Z Liu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA.
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