Assessing the autoantibody levels in relation to disease severity and therapy response in pemphigus patients

Abstract

Background:In pemphigus, autoantibodies are directed against adhesion molecules, which make the junctions between keratinocytes, and thus determining their level can reflect the disease activity.Aim:The purpose of this study is to determine the clinical significance of the autoantibody levels in pemphigus management.Materials and Methods:The clinical features of 47 pemphigus vulgaris patients were assessed and patients′ sera were investigated by indirect immunofluorescence using monkey esophagus as a substrate for autoantibody levels.Results:We found a significant correlation between antibody titers and mucosal severity scores. Initial antibody titers of the patients with at least one mucosal lesion at the end of the first month of the therapy were found significantly higher than the patients who had no mucosal lesion. With the therapy, lesions resolved earlier than the antibody titers.Conclusion:In patients with pemphigus, especially in cases who were not treated before, sera antibody levels are a valuable tool in evaluating disease severity and choosing initial treatment. In patients who had been taking any systemic treatment, it is difficult to make a relationship between antibody levels and disease severity, because therapy improves disease earlier than the antibody titers. However, estimating antibody levels can be helpful for clinicians in disease management, in reducing or ceasing treatment dosage and anticipating recurrence.

Comparative study of direct and indirect immunofluorescence for diagnosis of canine pemphigus foliaceus

“…In contrast, in this study, we also observed that IIF titers decreased dramatically after the introduction of immunosuppressive therapy in the majority of dogs with PF, as seen in other papers (Nishifuji et al, 2005;Aksu et al, 2010). A parallel relationship between IIF titers and disease activity was seen in two of the 14 dogs with PF.…”

Usefulness of specific anti‐desmoglein 1 and 3 enzyme‐linked immunoassay and indirect immunofluorescence in the evaluation of pemphigus activity

“…Early reports suggested that the titers obtained by IIF could help to monitor therapy in these patients, but later studies raised doubts about the value of this test in the follow‐up of the disease. The issue remains a topic of debate …”

“…The issue remains a topic of debate. [1][2][3][4][5] The detection of circulating anti-Dsg1 and anti-Dsg3 antibodies using an enzyme-linked immunosorbent assay (ELISA) is of high diagnostic value in patients with pemphigus, and in the active phase, this test can help to establish the phenotype of pemphigus. [6][7][8] Patients with mucosal dominant PV typically demonstrate anti-Dsg3 antibodies only, while patients with mucocutaneous PV have both anti-Dsg3 and anti-Dsg1 antibodies.…”

Human cervix: an alternative substrate for detecting circulating pemphigus antibodies

“…It should be noted that a false-positive result from IIF in our study was obtained from sera of two patients with toxic epidermal necrolysis. Table 4 demonstrates the sensitivity and specificity of IIF on different substrates including ME, guinea pig esophagus, and human tissues on different locations of the body for the diagnosis of pemphigus [2,7,9,14,15,20,24,27,[32][33][34]37]. For the sensitivity of IIF in the diagnosis of PV, HC was comparable to ME and guinea pig esophagus.…”

“…Monkey esophagus (ME) and guinea pig esophagus are well-accepted substrates for pemphigus vulgaris (PV) and pemphigus foliaceous (PF), respectively [11,14]. Sensitivity of IIF on ME ranged from 81 to 100 % [2,14,[32][33][34]37]. However, availability of monkey and guinea-pig esophageal tissues is sometimes limited due to ethical concerns relating to animal experimentation.…”