Subepidermal blistering associated with the human skin diseases bullous pemphigoid and herpes gestationis has been thought to be an IgG autoantibody-mediated process; however, previous attempts to demonstrate the pathogenicity of patient autoantibodies have been unsuccessful. An immunodominant and potentially pathogenic epitope associated with these blistering diseases has recently been mapped to the extracellular domain ofa human epidermal antigen, BP180. Patient autoantibodies that react with this well-defined antigenic site failed to crossreact with the murine form of this autoantigen and thus could not be assayed for pathogenicity in a conventional passive transfer mouse model. As an alternative, rabbit polyclonal antibodies were generated against a segment of the murine BP180 protein homologous with the human BP180 autoantibodyreactive site and were passively transferred into neonatal BALB/c mice. The injected animals developed a subepidermal blistering disease that closely mimicked bullous pemphigoid and herpes gestationis at the clinical, histological, and immunological levels. Autoantibodies that recognize the human BP180 ectodomain are therefore likely to play an initiatory role in the pathogenesis of bullous pemphigoid and herpes gestationis. (J.

AAA-PKB did not prevent actin bundling (membrane ruffling), though this response was PI 3-kinase dependent. Therefore, it is unlikely that AAA-PKB acted by inhibiting PI 3-kinase signaling. These results outline an important role for PKB␣/Akt1 in the stimulation of glucose transport by insulin in muscle cells in culture.Translocation of GLUT4 from an intracellular compartment to the plasma membrane largely accounts for the stimulation of glucose transport by insulin in skeletal muscle (16,31,38), cardiac muscle (48), and adipose cells (23,24). Two insulinresponsive cell lines also express this transporter: L6 rat skeletal myotubes (34, 40) and 3T3-L1 mouse adipocytes (24). Transfection of a molecularly engineered form of this transporter containing an exofacial epitope tag between the first and second transmembrane domains allows for the detection of surface transporters in intact cells. GLUT4 molecules with an exofacial epitope tag have been heterologously expressed in rat adipose cells (44, 51), 3T3-L1 adipocytes (26), CHO cells (12, 26), H9c2 cardiomyocytes (55), and rat 3Y1 cells (22). We have recently shown that stable expression of GLUT4myc in L6 myoblasts (L6-GLUT4myc myoblasts) mimics the response to insulin seen with endogenous GLUT4 in differentiated myotubes (29, 60).Insulin-induced translocation of GLUT4 to the plasma membrane requires the activity of phosphatidylinositol (PI) 3-kinase (47) in rat adipocytes (43, 45), 3T3-L1 adipocytes (8,9,21,27,39,51), L6 muscle cells (53), and rat skeletal muscle (62). Moreover, treatment of intact 3T3-L1 adipocytes with a cell-permeant PI 3,4,5-triphosphate [PI (3,4,5)-P 3 ] compound, which is converted into a product of PI 3-kinase once inside the cell, partly rescued the inhibition of insulin-stimulated glucose transport by wortmannin (25). It is unclear how the lipid products of PI 3-kinase relay the insulin signal to the glucose transporters, but the serine/threonine kinase protein kinase B (PKB)/Akt interacts with the lipid products of PI 3-kinase (19), and activation of PKB/Akt by insulin is prevented by inhibitors of PI 3-kinase (1). To date, three isoforms of PKB/Akt have been identified: PKB␣, -␤, and -␥ (Akt1, -2, and -3) (17). In skeletal muscle and L6 muscle cells, PKB␣ and PKB␥, but not PKB␤, are stimulated by insulin (59). Full activation of PKB/ Akt by insulin requires hierarchical phosphorylation on two residues, Thr308 (Thr309 and Thr305 in the case of PKB␤ and -␥, respectively) and Ser473 (Ser474 in the case of PKB␤; PKB␥ lacks an equivalent site) by 3-phosphoinositide-dependent protein kinase 1 (PDK-1) and PDK-2, respectively (1-3, 14, 50).Recent reports have suggested that activation of PKB/Akt may mediate the stimulation of glucose transport by insulin, since stable overexpression of wild-type PKB␣/Akt1 or constitutively active mutants of PKB␣/Akt1 increased glucose transport and translocation of GLUT4 to levels similar to or greater than those achieved with insulin in rat adipocytes (52), 3T3-L1 adipocytes (33,56), and L6 muscle cells (20,56...

Bullous pemphigoid (BP) is a blistering skin disease associated with an IgG autoimmune response directed against the ectodomain of the hemidesmosomal protein, BP180. An animal model of BP has recently been developed by our laboratory based on the passive transfer of rabbit antimurine BP180 antibodies into neonatal BALB/c mice. The experimental animals develop a blistering disease that reproduces all of the key immunopathological features of BP. In the present study we have investigated the role of complement in the pathogenesis of subepidermal blistering in the mouse model of BP. We demonstrate the following. (a) Rabbit anti-murine-BP180 IgG was effective in inducing cutaneous blisters in a C5-sufficient mouse strain, but failed to induce disease in the syngeneic C5-deficient strain; (b) neonatal BALB/c mice, pretreated with cobra venom factor to deplete complement, became resistant to the pathogenic effects of the anti-BP180 IgG; (c) F(ab')2 fragments generated from the anti-BP180 IgG exhibited no pathogenic activity in the mouse model; and (d) histologic evaluation of the skin of mice described in points b and c above showed minimal or no neutrophilic cell infiltration in the upper dermis. Thus, anti-BP180 antibodies trigger subepidermal blistering in this BP model via complement activation. This experimental model of BP should greatly facilitate future studies on the pathophysiology of autoantibody-mediated diseases of the dermal-epidermal junction. (J. Clin. Invest. 1995Invest. . 95:1539Invest. -1544

In humans, circulating anti-neutrophil cytoplasm autoantibodies (ANCAs) with specificity for myeloperoxidase (MPO) are strongly associated with the development of pauci-immune necrotizing and crescentic glomerulonephritis (NCGN). In mice, we have demonstrated that intravenous injection of mouse antibodies specific for mouse MPO induces NCGN that closely mimics the human disease. We now report that the development of NCGN in this experimental model is accompanied by glomerular accumulation of neutrophils and macrophages. Neutrophil infiltration was most conspicuous at sites of glomerular necrosis and crescent formation, with macrophages also most numerous in crescents. Lymphocytes, however, were sparse in acute lesions. Importantly, mice that were depleted of circulating neutrophils with NIMP-R14 rat monoclonal antibodies were completely protected from anti-MPO IgG-induced NCGN. These findings provide direct evidence that neutrophils play a major role in the pathogenesis of anti-MPO-induced NCGN in this animal model and implicate neutrophils in the induction of human ANCA disease. This raises the possibility that therapeutic strategies to reduce circulating neutrophils could be beneficial to patients with ANCA-induced NCGN.

Numerous mechanisms of action have been proposed for intravenous Ig (IVIG). In this study, we used IgG passive transfer murine models of bullous pemphigoid (BP), pemphigus foliaceus (PF), and pemphigus vulgaris (PV) to test the hypothesis that the effect of IVIG in autoantibody-mediated cutaneous bullous diseases is to accelerate the degradation of pathogenic IgG by saturation of the MHC-like Fc receptor neonatal Fc receptor (FcRn). BP, PF, and PV are organ-specific antibody-mediated diseases in which autoantibodies target the hemidesmosomal antigen BP180 and desmosomal antigens Dsg1 and Dsg3, respectively. Antibodies against BP180, Dsg1, and Dsg3, when injected into neonatal mice, induce the BP, PF, and PV disease phenotypes, respectively. We found that FcRn-deficient mice were resistant to experimental BP, PF, and PV. Circulating levels of pathogenic IgG in FcRndeficient mice were significantly reduced compared with those in WT mice. Administration of high-dose human IgG (HDIG) to WT mice also drastically reduced circulating pathogenic IgG levels and prevented blistering. In FcRn-deficient mice, no additional protective effect with HDIG was realized. These data demonstrate that the therapeutic efficacy of HDIG treatment in the pemphigus and pemphigoid models is dependent on FcRn. Thus, FcRn is a promising therapeutic target for treating such IgG-mediated autoimmune diseases.

The BP180 antigen, a component of the epidermal anchoring complex, has been identified as one of the major antigenic targets of autoantibodies associated with the blistering skin disease, bullous pemphigoid. Our research group has recently demonstrated that reactivity of bullous pemphigoid autoantibodies to the BP180 ectodomain is almost entirely restricted to a set of four antigenic sites clustered within the membrane-proximal noncollagenous stretch (NC16A). Using a passive transfer mouse model, antibodies to the corresponding noncollagenous region of murine BP180 were shown to trigger an inflammatory subepidermal blistering disease that closely mimics bullous pemphigoid. We now report the development of an enzyme-linked immunoabsorbent assay system that is extremely sensitive in detecting disease-specific autoantibodies in the sera of bullous pemphigoid patients. The target antigen in this assay is a recombinant form of the BP180 NC16A domain that contains all four of the well-defined bullous pemphigoid-associated antigenic sites. Of 50 randomly selected bullous pemphigoid sera tested, 47 (94%) were positive in this assay, whereas no specific reactivity was detected in any of the 107 controls. Interestingly, all three of the bullous pemphigoid sera that were negative in this assay had been obtained from patients who were already undergoing treatment. The NC16A enzyme-linked immunosorbent assay is more sensitive than any of the standard techniques for detecting circulating bullous pemphigoid autoantibodies, including other enzyme-linked immunosorbent assays, immunoblotting, and indirect immunofluorescence. Finally, the NC16A enzyme-linked immunosorbent assay provides immunologic information that cannot be obtained from direct immunofluorescence studies of skin biopsies, and that may well be relevant in the diagnosis and treatment of bullous pemphigoid.

IntroductionBullous pemphigoid (BP) is an acquired autoimmune skin disease characterized by autoantibodies against two hemidesmosomal antigens, BP230 (BPAG1) and BP180 (BPAG2), and subepidermal blisters (1). These antihemidesmosomal autoantibodies can be detected, along with complement proteins, bound to the dermal-epidermal junction (DEJ) of perilesional skin. In the skin lesions of these patients, basal keratinocytes detach from the underlying dermis at the level of the lamina lucida, leading to subepidermal blistering (1, 2). Eosinophils (3, 4), neutrophils (5), lymphocytes (6), monocyte/macrophages (7,8), and mast cells (MCs; 7, 9) are present in the upper dermis of lesional areas in patients with BP. Interestingly, MC degranulation is a feature of BP (7, 9). Chemoattractants from MCs, including eosinophilic/neutrophilic chemotactic factors and histamine, are present at high concentrations in BP blister fluids (10, 11). Similar skin lesions are observed in the pregnancy-associated nonviral disorder herpes gestationis (12). These observations imply that MCs may play a role in blister formation.We have used an experimental model of BP that involves the passive transfer of anti-mBP180 antibodies into neonatal BALB/c mice to reproduce the key immunopathological features of this human autoimmune disease: IgG and complement deposition at the DEJ, inflammatory infiltration of the upper dermis, and subepidermal blistering (13). The pathogenicity of anti-mBP180 antibodies depends on complement activation (14) and polymorphonuclear leukocyte (PMN) recruitment (15). In the present study, we have investigated the role of MCs in experimental BP using mice genetically deficient in MCs. Preparation of pathogenic rabbit anti-mouse IgG. The preparation of recombinant mBP180 and the immunization of rabbits were performed as described previ- Methods Laboratory animals. Breeding pairs of MC-deficient WCB6F1-Mgf

Insulin stimulates glucose transport in muscle and fat cells by inducing translocation of GLUT4 glucose transporters from a storage site to the cell surface. The mechanism of this translocation and the identity of the storage site are unknown, but it has been hypothesized that transporters recycle between an insulin-sensitive pool, endosomes, and the cell surface. Upon cell homogenization and fractionation, the storage site migrates with light microsomes (LDM) separate from the plasma membrane fraction (PM). Cellubrevin is a recently identified endosomal protein that may be involved in the reexocytosis of recycling endosomes. Here we describe that cellubrevin is expressed in 3T3-L1 adipocytes and is more abundant in the LDM than in the PM. Cellubrevin was markedly induced during differentiation of 3T3-L1 fibroblasts into adipocytes, in parallel with GLUT4, and the development of insulin regulated traffic. In response to insulin, the cellubrevin content decreased in the LDM and increased in the PM, suggesting translocation akin to that of the GLUT4 glucose transporter. Vesicle-associated membrane protein 2 (VAMP-2)/synaptobrevin-II, a protein associated with regulated exocytosis in secretory cells, also redistributed in response to insulin. Both cellubrevin and VAMP-2 were susceptible to cleavage by tetanus toxin. Immunopurified GLUT4-containing vesicles contained cellubrevin and VAMP-2, and immunopurified cellubrevin-containing vesicles contained GLUT4 protein, but undiscernible amounts of VAMP-2. These observations suggest that cellubrevin and VAMP-2 are constituents of the insulin-regulated pathway of membrane traffic. These results are the first demonstration that cellubrevin is present in a regulated intracellular compartment. We hypothesize that cellubrevin and VAMP-2 may be present in different subsets of GLUT4-containing vesicles.