title: Anti-desmoglein 1 antibodies in healthy related and unrelated subjects and patients with pemphigus foliaceus in endemic and non-endemic areas from Tunisia.
abstract: BACKGROUND
  Pemphigus foliaceus is an autoimmune blistering skin disease characterized by the production of pathogenic IgG autoantibodies directed against desmoglein 1.
  
  
  OBJECTIVE
  To determine the prevalence of anti-desmoglein 1 antibodies in healthy subjects and their distribution in the different regions of Tunisia and to better identify endemic areas of pemphigus foliaceus.
  
  
  METHODS
  We tested, by enzyme-linked immunoserbent assay, sera of 270 normal subjects recruited from different Tunisian areas and 203 related healthy relatives to 90 Tunisian pemphigus foliaceus patients. Results Seventy-six patients (84.4%), 20 healthy controls (7.4%), and 32 relatives (15.76%) had anti-desmoglein 1 antibodies. In southern regions where pemphigus foliaceus is associated with a significant sex ratio imbalance (9 female : 1 male in the south vs. 2.3 : 1 in the north) and a lower mean age of disease onset (33.5 in the south vs. 45 years in the north), a higher prevalence of anti-desmoglein 1 antibodies in healthy controls was observed (9.23% vs. 5.71% in the north). Interestingly, the highest prevalence of anti-desmoglein 1 antibodies in healthy relatives (up to 22%) was observed in the most rural southern localities. More than half anti-desmoglein 1-positive healthy controls were living in rural conditions with farming as occupation, which suggests that this activity may expose the subjects to particular environmental conditions.
  
  
  CONCLUSIONS
  These results show that the endemic features of Tunisian pemphigus foliaceus are focused in these southern areas more than in other areas and that both environmental and genetic factors contribute to the disease.
authors.affiliation: Immunology Department, Habib Bourguiba Hospital, Sfax, Tunisia. olfaabida@yahoo.fr
authors.forename: O
authors.initials: O
authors.lastname: Abida
authors.forename: M
authors.initials: M
authors.lastname: Kallel-Sellami
authors.forename: P
authors.initials: P
authors.lastname: Joly
authors.forename: M
authors.initials: M
authors.lastname: Ben Ayed
authors.forename: M
authors.initials: M
authors.lastname: Zitouni
authors.forename: A
authors.initials: A
authors.lastname: Masmoudi
authors.forename: M
authors.initials: M
authors.lastname: Mokni
authors.forename: B
authors.initials: B
authors.lastname: Fezzaa
authors.forename: A
authors.initials: A
authors.lastname: Ben Osman
authors.forename: M R
authors.initials: MR
authors.lastname: Kammoun
authors.forename: D
authors.initials: D
authors.lastname: Gilbert
authors.forename: H
authors.initials: H
authors.lastname: Turki
authors.forename: F
authors.initials: F
authors.lastname: Tron
authors.forename: H
authors.initials: H
authors.lastname: Masmoudi
authors.forename: S
authors.initials: S
authors.lastname: Makni
mesh_terms: D000328:Adult; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D051182:Desmogleins / Q000235:genetics / Q000276:immunology*; D019353:Endemic Diseases; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D010392:Pemphigus / Q000097:blood / Q000453:epidemiology* / Q000276:immunology*; D015995:Prevalence; D014416:Tunisia / Q000453:epidemiology
chemical_list: D000888:Antibodies, Anti-Idiotypic; D015415:Biomarkers; D051182:Desmogleins; D007074:Immunoglobulin G