Diagnosis and Treatment of Pemphigus

Tsuruta, Daisuke; Ishii, Norito; Hashimoto, Takashi

doi:10.2217/imt.12.67

Cited by 37 publications

(49 citation statements)

References 89 publications

(72 reference statements)

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“…Treatment of other antibody-mediated autoimmune disorders, as myasthenia or pemphigus, includes corticosteroids, immunosuppressants (azathioprine, calcineurin inhibitors, or mycophenolate mofetil), and biological therapies [50–52]. …”

Section: Discussionmentioning

confidence: 99%

Renal Transplantation Dramatically Reduces IgA Anti-beta-2-glycoprotein I Antibodies in Patients with Endstage Renal Disease

Serrano

Martínez-Flores

Castro

et al. 2014

Journal of Immunology Research

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IgA anti-beta-2-glycoprotein I (aB2GPI) antibodies have been related to vascular pathology in the general population and mainly in hemodialyzed patients (prevalence 33%) in whom an elevated incidence of thrombosis and mortality is found. In this paper we have studied the presence of IgA aB2GPI antibodies at pretransplant and their evolution after transplantation with a cross-sectional-based follow-up study of a cohort of 288 endstage renal disease (ESRD) patients treated with kidney transplantation. Pretransplant IgA aB2GPI levels were elevated 31.7 ± 4.2 U/mL without differences in age or type of dialysis. Patients with different etiologies of ESRD showed higher levels of IgA aB2GPI than blood donors, except the groups of non-IgA glomerular disease and systemic erythematosus lupus, whose nonsignificant differences were observed. IgA aB2GPI antibodies dropped immediately after transplantation (10.7 ± 1.0 U/mL, P < 0.0001), coinciding with a high degree of immunosuppression, and remained significantly lower than that observed in pretransplant status. Prevalence of patients with elevated antibodies was also less in transplanted patients (8.9% versus 30.4%, P < 0.0001). Among, positivity for IgA aB2GPI was higher than in patients who had received their first transplant that those were retransplanted. This finding could have important clinical implications and can suggest new therapeutic strategies in patients with IgA aB2GPI antibodies.

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Section: Discussionmentioning

confidence: 99%

Renal Transplantation Dramatically Reduces IgA Anti-beta-2-glycoprotein I Antibodies in Patients with Endstage Renal Disease

Serrano

Martínez-Flores

Castro

et al. 2014

Journal of Immunology Research

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“…The mainstay of PV treatment is systemic administration of corticosteroids aiming at reducing inflammation and autoantibody production [89, 90]. PV patients have traditionally been treated with glucocorticoids and adjuvant immunosuppressive therapies.…”

Section: Targeting P38 Mapk In Pemphigus: Corticosteroids Versus Mmentioning

confidence: 99%

p38 MAPK Signaling in Pemphigus: Implications for Skin Autoimmunity

Mavropoulos

Orfanidou

Liaskos

et al. 2013

Autoimmune Diseases

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p38 mitogen activated protein kinase (p38 MAPK) signaling plays a major role in the modulation of immune-mediated inflammatory responses and therefore has been linked with several autoimmune diseases. The extent of the involvement of p38 MAPK in the pathogenesis of autoimmune blistering diseases has started to emerge, but whether it pays a critical role is a matter of debate. The activity of p38 MAPK has been studied in great detail during the loss of keratinocyte cell-cell adhesions and the development of pemphigus vulgaris (PV) and pemphigus foliaceus (PF). These diseases are characterised by autoantibodies targeting desmogleins (Dsg). Whether autoantibody-antigen interactions can trigger signaling pathways (such as p38 MAPK) that are tightly linked to the secretion of inflammatory mediators which may perpetuate inflammation and tissue damage in pemphigus remains unclear. Yet, the ability of p38 MAPK inhibitors to block activation of the proapoptotic proteinase caspase-3 suggests that the induction of apoptosis may be a consequence of p38 MAPK activation during acantholysis in PV. This review discusses the current evidence for the role of p38 MAPK in the pathogenesis of pemphigus. We will also present data relating to the targeting of these cascades as a means of therapeutic intervention.

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“…Immunosuppressive therapy for PV includes systemic steroids (conventional or pulse therapy), azathioprine, cyclophosphamide, mycophenolate mofetil, and cyclosporine (Tsuruta et al, 2012). Although many of these drugs have demonstrated potent efficacy in the treatment of nail manifestations in PV (Serratos and Rashid, 2009), several reports indicate that these drugs may induce a variety of nail alterations (Rault, 2000, Tosti et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Nail changes in female pemphigus vulgaris patients on immunosuppressive therapy

El-Komy

Halim

Samir

et al. 2015

International Journal of Women's Dermatology

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BackgroundPemphigus vulgaris (PV) patients receiving immunosuppressive therapy may develop nail alterations resulting from infection, skin disorder, or drug regimen.ObjectiveThis study aims to describe nail changes in PV female patients receiving immunosuppressive therapy and to report the frequency of associated fungal and bacterial growth in the patients’ nails.MethodsTwenty-five female PV patients who had at least one acquired finger or toenail abnormality and had been administered at least one immunosuppressive drug were included in the study. Nail alterations were recorded. Nail scrapings were collected from abnormal nails for fungal and bacterial examination.ResultsPositive fungal and bacterial cultures were detected in 20 (80%) of patients’ nail samples. Five patients reported nail alterations coinciding with disease onset, whereas 13 reported nail changes after administration of immunosuppressive therapy.LimitationsLack of a control group (patients on similar immunosuppressive medications for conditions other than PV) which would have further supported the findings demonstrated in this observational study.ConclusionNail abnormalities in severe PV patients are frequently associated with fungal and bacterial growth. Immunosuppressive therapy potentially initiates such changes.

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Diagnosis and Treatment of Pemphigus

Cited by 37 publications

References 89 publications

Renal Transplantation Dramatically Reduces IgA Anti-beta-2-glycoprotein I Antibodies in Patients with Endstage Renal Disease

Renal Transplantation Dramatically Reduces IgA Anti-beta-2-glycoprotein I Antibodies in Patients with Endstage Renal Disease

p38 MAPK Signaling in Pemphigus: Implications for Skin Autoimmunity

Nail changes in female pemphigus vulgaris patients on immunosuppressive therapy

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