title: Autoantibodies in anti-p200 pemphigoid stain skin lacking laminin 5 and type VII collagen.
abstract: We report the case of a patient with a widespread bullous skin disease and linear deposits of IgG and C3 at the dermal-epidermal junction using direct immunofluorescence microscopy. Indirect immunofluorescence analysis demonstrated circulating IgG autoantibodies that stained, like autoantibodies to laminin 5 and type VII collagen, the dermal side of 1 mol L-1 NaCl-split human skin. By immunoblotting dermal extracts, the patient's serum, like serum samples from two control patients, reacted with a 200-kDa protein. Using immunoelectron microscopy, the serum labelled a component of the lower lamina lucida, but not the lamina densa/sublamina densa region, distinguishing this from the type VII collagen localization pattern. By immunofluorescence microscopy on skin sections from patients lacking either laminin 5 (Herlitz's epidermolysis bullosa) or type VII collagen (recessive dystrophic epidermolysis bullosa of Hallopeau-Siemens), the patient's serum retained reactivity with these test substrates. The patient's disease responded rapidly to the use of topical corticosteroids and lesions healed without scarring or milia formation. Our results provide strong evidence for the hypothesis that the 200 kDa autoantigen is different from laminin 5 and type VII collagen. For this new disease, we propose the designation 'anti-p200 pemphigoid'.
authors.affiliation: Department of Dermatology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany. zillikens-d.derma@mail.uni-wuerzburg.de
authors.forename: D
authors.initials: D
authors.lastname: Zillikens
authors.forename: A
authors.initials: A
authors.lastname: Ishiko
authors.forename: M F
authors.initials: MF
authors.lastname: Jonkman
authors.forename: I
authors.initials: I
authors.lastname: Chimanovitch
authors.forename: H
authors.initials: H
authors.lastname: Shimizu
authors.forename: T
authors.initials: T
authors.lastname: Hashimoto
authors.forename: E B
authors.initials: EB
authors.lastname: Bröcker
mesh_terms: D001323:Autoantibodies / Q000032:analysis*; D001426:Bacterial Proteins / Q000276:immunology*; D015815:Cell Adhesion Molecules / Q000276:immunology; D003094:Collagen / Q000276:immunology; D003875:Drug Eruptions / Q000276:immunology*; D006801:Humans; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D012867:Skin / Q000276:immunology; D012872:Skin Diseases, Vesiculobullous / Q000276:immunology*; D000097794:Kalinin
chemical_list: D001323:Autoantibodies; D001426:Bacterial Proteins; D015815:Cell Adhesion Molecules; D003094:Collagen; D008565:Membrane Proteins; D000097794:Kalinin; C099985:P200 protein, Mycoplasma pneumoniae