Oxidative stress in patients with endemic pemphigus foliaceus and healthy subjects with anti-desmoglein 1 antibodies

Abstract

BackgroundPrevious studies have shown oxidative stress in pemphigus vulgaris and pemphigus foliaceus, nevertheless, it remains unknown whether a similar response is characteristic of endemic pemphigus foliaceus in Peru.ObjectivesTo determine the oxidative stress response in endemic pemphigus foliaceus patients and subjects with positive for anti-desmoglein1 antibodies (anti-dsg1) from endemic areas of Peru.Subjects and MethodsThis is a cross-sectional study. The study population included 21 patients with Endemic Pemphigus foliaceus and 12 healthy subjects with anti-dsg1 antibodies from the Peruvian Amazon (Ucayali), as well as 30 healthy control subjects. Malondialdehyde, an indicator of lipid peroxidation by free radicals, was measured in serum.ResultsWe collected 21 cases of endemic pemphigus foliaceus, 15 of them with active chronic disease and 6 in clinical remission. Serum malondialdehyde values in patients with chronic active evolution and healthy subjects with anti-dsg1 antibodies were statistically higher than those of healthy controls (p<0.001). There was no significant difference between serum values of localized and generalized clinical forms.Study limitationsThe main limitation of this present study is the small number of patients with endemic pemphigus and healthy subjects positive for desmoglein 1 antibodies.ConclusionsThe increased serum levels of malondialdehyde in patients with chronic active endemic pemphigus foliaceus and healthy subjects from endemic areas with anti-dsg1 antibodies may suggest a contribution of systemic lipid peroxidation in the pathogenesis of endemic pemphigus foliaceus.

Ultrastructural skin alterations of healthy subjects with anti-desmoglein 1 antibodies in endemic areas to pemphigus foliaceus: A case series

“…The studies previously done by our research group have demonstrated that healthy individuals in areas endemic to pemphigus foliaceus in the Peruvian Amazon can develop anti DSG-1 (31–46%) and anti DSG- 3 antibodies (31.7%) [ [7] , [8] , [9] ]. Additionally, it has been shown that despite these subjects being disease-free, they present biochemical anomalies, such as elevated lipid peroxidation levels, which could be attributed to the presence of anti DSG-1 and anti DSG- 3 antibodies [ 10 ].…”

“…Since immunological and biochemical disorders exist [ [8] , [9] , [10] ], it is feasible that, as a consequence of an incipient autoimmune phenomenon, healthy patients positive to anti DSG-1 antibodies develop ultrastructural alterations in the epidermis only visible through transmission electron microscopy but not optical microscopy. The manifestation of ultrastructural skin alterations may justify the recommendation to abandon their residence in the endemic areas and settle in non-endemic zones, where the environment does not play a negative role on the induction of cutaneous autoimmunity from endemic pemphigus foliaceus [ 8 ].…”