title: Apoptosis is not required for acantholysis in pemphigus vulgaris.
abstract: The autoimmune blistering skin disease pemphigus vulgaris (PV) is caused primarily by autoantibodies against desmosomal cadherins. It was reported that apoptosis can be detected in pemphigus skin lesions and that apoptosis can be induced by PV-IgG in cultured keratinocytes. However, the role of apoptosis in PV pathogenesis is unclear at present. In this study, we provide evidence that apoptosis is not required for acantholysis in PV. In skin lesions from two PV patients, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) positivity, but not cleaved caspase-3, was detected in single keratinocytes in some lesions but was completely absent in other lesions from the same patients. In cultures of human keratinocytes (HaCaT and normal human epidermal keratinocytes), PV-IgG from three different PV patients caused acantholysis, fragmented staining of Dsg 3 staining, and cytokeratin retraction in the absence of nuclear fragmentation, TUNEL positivity, and caspase-3 cleavage and hence in the absence of detectable apoptosis. To further rule out the contribution of apoptotic mechanisms, we used two different approaches that are effective to block apoptosis induced by various stimuli. Inhibition of caspases by z-VAD-fmk as well as overexpression of Fas-associated death domain-like interleukin-1beta-converting enzyme (FLICE)-like inhibitory proteins FLIP(L) and FLIP(S) to inhibit receptor-mediated apoptosis did not block PV-IgG-induced effects, indicating that apoptosis was not required. Taken together, we conclude that apoptosis is not a prerequisite for skin blistering in PV but may occur secondary to acantholysis.
authors.affiliation: Department of Dermatology, University of Würzburg, Würzburg, Germany.
authors.forename: Enno
authors.initials: E
authors.lastname: Schmidt
authors.forename: Judith
authors.initials: J
authors.lastname: Gutberlet
authors.forename: Daniela
authors.initials: D
authors.lastname: Siegmund
authors.forename: Daniela
authors.initials: D
authors.lastname: Berg
authors.forename: Harald
authors.initials: H
authors.lastname: Wajant
authors.forename: Jens
authors.initials: J
authors.lastname: Waschke
mesh_terms: D000051:Acantholysis / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D000590:Amino Acid Chloromethyl Ketones / Q000494:pharmacology; D023102:Anoikis; D017209:Apoptosis / Q000187:drug effects; D001706:Biopsy; D053446:CASP8 and FADD-Like Apoptosis Regulating Protein / Q000235:genetics / Q000378:metabolism; D053148:Caspase 3 / Q000378:metabolism; D002460:Cell Line; D053144:Cell Nucleus Shape; D015853:Cysteine Proteinase Inhibitors / Q000494:pharmacology; D053938:DNA Fragmentation; D051184:Desmoglein 3 / Q000378:metabolism; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007150:Immunohistochemistry; D020287:In Situ Nick-End Labeling; D015603:Keratinocytes / Q000187:drug effects / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D007633:Keratins / Q000378:metabolism; D010392:Pemphigus / Q000276:immunology / Q000378:metabolism / Q000473:pathology*; D014162:Transfection
chemical_list: D000590:Amino Acid Chloromethyl Ketones; D053446:CASP8 and FADD-Like Apoptosis Regulating Protein; D015853:Cysteine Proteinase Inhibitors; C071894:DSG3 protein, human; D051184:Desmoglein 3; D007074:Immunoglobulin G; C096713:benzyloxycarbonylvalyl-alanyl-aspartyl fluoromethyl ketone; D007633:Keratins; C505407:CASP3 protein, human; D053148:Caspase 3