Utility of oral mucosa as a substrate for the serodiagnosis of pemphigus: A descriptive analysis.

BACKGROUND The indirect immunofluorescence test is useful in the serodiagnosis of pemphigus. As indirect immunofluorescence titers correlate with disease activity in pemphigus, it is often used as a monitoring tool. The sensitivity of indirect immunofluorescence depends on the substrate used, and the preferred substrates are monkey esophagus for pemphigus vulgaris and normal human skin for pemphigus foliaceus. AIMS We evaluated oral mucosa as a substrate for indirect immunofluorescence in pemphigus. METHODS Fifty patients with pemphigus (40 with pemphigus vulgaris and ten with pemphigus foliaceus) and 50 controls were enrolled for study. Demographic and clinical details were recorded and indirect immunofluorescence using two substrates (oral mucosa and normal human skin) was carried out in serial dilution. Desmoglein (Dsg) 1 and 3 enzyme-linked immunosorbent assay was also evaluated simultaneously. RESULTS Indirect immunofluorescence was positive in 40 patients (80%) with oral mucosa substrate and 34 patients (68%) with normal human skin substrate. Circulating antibodies were detected with oral mucosa in 33 (82.5%) of the 40 pemphigus vulgaris patients and in 26 (65%) patients using normal human skin. Antibodies were detected in eight of the ten pemphigus foliaceus patients (80%) with normal human skin and in seven (70%) patients with oral mucosa. Dsg enzyme-linked immunosorbent assay was positive in 45 (90%) patients, and 37 of these were also indirect immunofluorescence positive with oral mucosa. In the five Dsg enzyme-linked immunosorbent assay-negative patients, indirect immunofluorescence with oral mucosa was positive in three. LIMITATIONS A comparison of oral mucosa with monkey esophagus could not be performed. CONCLUSION Oral mucosa is a suitable and sensitive substrate for indirect immunofluorescence in pemphigus. Further studies comparing the sensitivity of indirect immunofluorescence using oral mucosa with monkey esophagus are recommended.

[1]  E. Schmidt,et al.  Pemphigus , 2019, The Lancet.

[2]  C. Probst,et al.  Serological Diagnosis of Autoimmune Bullous Skin Diseases , 2019, Front. Immunol..

[3]  R. Bergman,et al.  The Usefulness of Indirect Immunofluorescence in Pemphigus and the Natural History of Patients With Initial False-Positive Results: A Retrospective Cohort Study , 2018, Front. Med..

[4]  H. Shimizu,et al.  Oral mucosa is a useful substrate for detecting autoantibodies of mucous membrane pemphigoid , 2018, The British journal of dermatology.

[5]  M. Mustapa,et al.  British Association of Dermatologists’ guidelines for the management of pemphigus vulgaris 2017 , 2017, The British journal of dermatology.

[6]  M. Jonkman,et al.  Laboratory diagnosis of pemphigus: direct immunofluorescence remains the gold standard , 2016, The British journal of dermatology.

[7]  M. Richard,et al.  Calculation of cut‐off values based on the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Pemphigus Disease Area Index (PDAI) pemphigus scoring systems for defining moderate, significant and extensive types of pemphigus , 2016, The British journal of dermatology.

[8]  P. Suthipinittharm,et al.  Human cervix: an alternative substrate for detecting circulating pemphigus antibodies , 2016, Archives of Dermatological Research.

[9]  M. Servitzoglou,et al.  Correlation of antibodies against desmogleins 1 and 3 with indirect immunofluorescence and disease status in a Greek population with pemphigus vulgaris , 2013, Journal of the European Academy of Dermatology and Venereology : JEADV.

[10]  D. Giavarina,et al.  Diagnostic accuracy of enzyme-linked immunosorbent assays (ELISA) to detect anti-skin autoantibodies in autoimmune blistering skin diseases: a systematic review and meta-analysis. , 2012, Autoimmunity reviews.

[11]  Enno Schmidt,et al.  Modern diagnosis of autoimmune blistering skin diseases. , 2010, Autoimmunity reviews.

[12]  A. Troxel,et al.  Reliability and convergent validity of two outcome instruments for pemphigus. , 2009, The Journal of investigative dermatology.

[13]  A. Khamesipour,et al.  Desmoglein 1 and 3 enzyme‐linked immunosorbent assay in Iranian patients with pemphigus vulgaris: correlation with phenotype, severity, and disease activity , 2007, Journal of the European Academy of Dermatology and Venereology : JEADV.

[14]  S. Tan,et al.  Comparison of desmoglein ELISA and indirect immunofluorescence using two substrates (monkey oesophagus and normal human skin) in the diagnosis of pemphigus , 2005, The Australasian journal of dermatology.

[15]  R. Bergman,et al.  A comparison of anti‐desmoglein antibodies and indirect immunofluorescence in the serodiagnosis of pemphigus vulgaris , 2005, International journal of dermatology.

[16]  K. E Harman.  New laboratory techniques for the assessment of acquired immunobullous disorders , 2002 .

[17]  S. Jabłońska,et al.  The use of two substrates for indirect immunofluorescence in the diagnosis of pemphigus , 2001, The British journal of dermatology.

[18]  P. Seed,et al.  The severity of cutaneous and oral pemphigus is related to desmoglein 1 and 3 antibody levels , 2001, The British journal of dermatology.

[19]  S. Challacombe,et al.  The use of two substrates to improve the sensitivity of indirect immunofluorescence in the diagnosis of pemphigus , 2000, The British journal of dermatology.

[20]  T. Nishikawa,et al.  The clinical phenotype of pemphigus is defined by the anti-desmoglein autoantibody profile. , 1999, Journal of the American Academy of Dermatology.

[21]  Komai,et al.  Usefulness of enzyme‐linked immunosorbent assay using recombinant desmogleins 1 and 3 for serodiagnosis of pemphigus , 1999, The British journal of dermatology.

[22]  J. Bystryn,et al.  Sensitivity of indirect immunofluorescence, substrate specificity, and immunoblotting in the diagnosis of pemphigus. , 1997, Journal of the American Academy of Dermatology.

[23]  R. Phelps,et al.  Regional variation in the expression of pemphigus foliaceus, pemphigus erythematosus, and pemphigus vulgaris antigens in human skin. , 1991, The Journal of investigative dermatology.

[24]  M. Sabolinski,et al.  Substrate specificity of anti-epithelial antibodies of pemphigus vulgaris and pemphigus foliaceus sera in immunofluorescence tests on monkey and guinea pig esophagus sections. , 1987, The Journal of investigative dermatology.

[25]  E. Beutner,et al.  Immunofluorescence Tests , 1985, International journal of dermatology.

[26]  Y. Takahashi,et al.  Pemphigus and pemphigoid antigens are expressed in human amnion epithelium. , 1984, The Journal of investigative dermatology.

[27]  Ahmed Ar,et al.  Anti-Intercellular Substance Antibodies: Presence in Serum Samples of 14 Patients Without Pemphigus , 1983 .

[28]  L. Ivanyi,et al.  Comparison of the reactivity of various epithelial substrates for the titration of pemphigus antibodies by indirect immunofluorescence. , 1982, The British journal of dermatology.

[29]  T. Provost,et al.  Pemphigus Vulgaris: Superior Sensitivity of Monkey Esophagus in the Determination of Pemphigus Antibody , 1981 .

[30]  H. Mescon,et al.  Comparison of different epithelial substrates useful for indirect immunofluorescence testing of sera from patients with active pemphigus. , 1979, The Journal of investigative dermatology.

[31]  S. O'loughlin,et al.  Fate of pemphigus antibody following successful therapy. Preliminary evaluation of pemphigus antibody determinations to regulate therapy. , 1978, Archives of dermatology.

[32]  K. Osserman,et al.  Intercellular antibodies: presence in a Trichophyton rubrum infection. , 1972, The Journal of investigative dermatology.

[33]  J. V. von Weiss,et al.  Clinical significance of autoantibodies in pemphigus. , 1966, Archives of Dermatology.