New insights into the immunoultrastructural organization of cutaneous basement membrane zone molecules

Abstract: The epidermal basement membrane zone (BMZ) is composed of various molecules, each of which plays an important role in dermo‐epidermal adhesion. Genetic abnormality of certain BMZ molecules leads to an inherited group of skin diseases collectively referred to as epidermolysis bullosa, whose hallmark is skin fragility of varying degrees. Furthermore, development of autoantibodies to certain BMZ molecules leads to the onset of a number of acquired autoimmune blistering diseases in which dermo‐epidermal separation occurs, including bullous pemphigoid and epidermolysis bullosa acquisita. The ultrastructural location of each BMZ molecule has been studied using a range of immunoelectron microscopy (immuno‐EM) techniques. Recent technical advances in immuno‐EM and in molecular engineering for production of epitope‐specific antibodies have enabled a more correct and precise elucidation of the native ultrastructural molecular organization of the respective molecules and their relationship to each other. These recent studies have also revealed several misinterpretations in the previously established model of the immunoultrastructural organization of BMZ molecules. In response to these findings, this review focuses on three major BMZ‐related molecules, type VII collagen, BPAG2 and laminin 5, for which recent immuno‐EM studies have produced a revision in the accepted dogma on their ultrastructural distribution at the BMZ.