Antidesmoglein 1 and 3 serum IgG and positivity by direct immunofluorescence microscopy is associated with relapse in pemphigus in a prospective bicontinental study

JAAD International Pub Date : 2025-01-20 DOI:10.1016/j.jdin.2024.12.004

Dipankar De MD , Shipla Shilpa MSc , Sheetanshu Kumar MD , Kossara Drenovska MD, PhD , Hitaishi Mehta MD , Nina van Beek MD , Naresh Sachdeva PhD , Alexandra Fleva PhD , Martin Shahid MD, PhD , Sanjeev Handa MD , Anastasia Giannakou MD , Elissaveta Naumova MD, PhD, DSci , Rahul Mahajan MD , Aikaterini Kyriakou MD , Spaska Lesichkova MD , Elisabeth Lazaridou MD, PhD , Bishan Dass Radotra MD, PhD , Kamal Kishore PhD , Snejina Vassileva MD, PhD , Aikaterini Patsatsi MD, PhD , Enno Schmidt MD, PhD

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Abstract

Background

Prospective studies identifying immunological parameters that can predict clinical relapse in pemphigus are scarce.

Objective

To periodically assess immunological parameters in patients with pemphigus vulgaris and foliaceous in remission to understand immunological events preceding clinical relapse.

Methods

A total of 105 patients were included. Baseline assessment included direct immunofluorescence (DIF), serum IgG against desmoglein (Dsg) 1, IgG, IgG1, and IgG4 against Dsg 3, IgG against the extracellular domains 1 and 2 of Dsg 3, IgG against muscarinic (M3)-AchR, and peripheral CD19+CD27+ memory B cells/plasma cells, repeated every 3 months for up to 12 months or until clinical relapse. DIF was repeated at month 12 and on relapse.

Results

About 29 of 105 patients (28%) experienced a relapse. Longer duration of clinical remission, presence of pruritus and positive anti-Dsg1 at baseline correlated with higher relapse rates. Compared with the visit immediately preceding relapse, a significantly increased number of patients with positive anti-Dsg1 (38% vs 31.1%, P = .01), anti-Dsg3 (51.7% vs 41.4%, P = .01) and IgG positivity by DIF (85.7% vs 25%, P < .001) was observed at the time of relapse.

Conclusion

Regular monitoring of anti-Dsg 1 and anti-Dsg 3 serum levels and DIF positivity during the course of the disease in remission may predict relapse.

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在一项前瞻性的双洲研究中，直接免疫荧光显微镜检测的抗粘粒蛋白1和3血清IgG和阳性与天疱疮复发有关

背景：确定能够预测天疱疮临床复发的免疫学参数的前瞻性研究很少。目的定期评估寻常型天疱疮和叶状天疱疮缓解期患者的免疫学指标，了解临床复发前的免疫学事件。方法共纳入105例患者。基线评估包括直接免疫荧光（DIF）、抗粘粒蛋白（Dsg） 1的血清IgG、抗Dsg 3的IgG、IgG1和IgG4、抗Dsg 3细胞外结构域1和2的IgG、抗毒蕈碱(M3)-AchR的IgG和外周CD19+CD27+记忆B细胞/浆细胞，每3个月重复一次，持续12个月或直到临床复发。在第12个月和复发时重复DIF。结果105例患者中29例（28%）复发。较长的临床缓解期、瘙痒的存在和基线抗dsg1阳性与较高的复发率相关。与复发前立即就诊相比，抗dsg1阳性（38% vs 31.1%, P = 0.01）、抗dsg3阳性（51.7% vs 41.4%, P = 0.01）和IgG阳性(85.7% vs 25%, P <；在复发时观察到。001)。结论在缓解期定期监测血清抗dsg1、抗dsg3水平及DIF阳性可预测复发。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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