Relationship between target antigens and major histocompatibility complex (MHC) class II genes in producing two pathogenic antibodies simultaneously.
In this report,we present 15 patients with histological and immunopathologically proven pemphigus vulgaris (PV). After a mean of 80 months since the onset of disease, when evaluated serologically, they had antibodies typical of PV and pemphigoid (Pg). Similarly, 18 patients with bullous pemphigoid (BP) and mucous membrane pemphigoid (MMP) were diagnosed on the basis of histology and immunopathology.After a mean of 60 months since the onset of disease, when their sera were evaluated they were found to have Pg and PV autoantibodies. In both groups of patients the diseases were characterized by a chronic course, which included several relapses and recurrences and were non-responsive to conventional therapy. The major histocompatibility complex class II (MHC II) genes were studied in both groups of patients and phenotypes associated typically with them were observed. Hence, in 33 patients, two different pathogenic autoantibodies were detected simultaneously. The authors provide a computer model to show that each MHC II gene has relevant epitopes that recognize the antigens associated with both diseases. Using the databases in these computer models, the authors present the hypothesis that these two autoantibodies are produced simultaneously due to the phenomena of epitope spreading.
Center for Blistering Diseases, Department of Medicine, New England Baptist Hospital, Boston, MA 02120, USA.
L R
LR
Zakka
D B
DB
Keskin
P
P
Reche
A R
AR
Ahmed
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000595:Amino Acid Sequence; D000917:Antibody Formation / Q000235:genetics / Q000276:immunology*; D000954:Antigens, Surface / Q000276:immunology; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D001324:Autoantigens / Q000235:genetics / Q000276:immunology*; D002352:Carrier Proteins / Q000235:genetics / Q000276:immunology; D003598:Cytoskeletal Proteins / Q000235:genetics / Q000276:immunology; D051183:Desmoglein 1 / Q000276:immunology; D051184:Desmoglein 3 / Q000235:genetics / Q000276:immunology; D000071821:Dystonin; D018984:Epitopes, T-Lymphocyte / Q000235:genetics / Q000276:immunology; D005260:Female; D005802:Genes, MHC Class II / Q000235:genetics / Q000276:immunology*; D006683:HLA-DQ Antigens / Q000235:genetics / Q000276:immunology; D059866:HLA-DQ beta-Chains; D006684:HLA-DR Antigens / Q000235:genetics / Q000276:immunology; D059811:HLA-DRB1 Chains; D006801:Humans; D039503:Integrin alpha6 / Q000235:genetics / Q000276:immunology; D039663:Integrin beta4 / Q000235:genetics / Q000276:immunology; D015603:Keratinocytes / Q000276:immunology; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009419:Nerve Tissue Proteins / Q000235:genetics / Q000276:immunology; D024041:Non-Fibrillar Collagens / Q000235:genetics / Q000276:immunology; D010390:Pemphigoid, Benign Mucous Membrane / Q000235:genetics / Q000276:immunology*; D010391:Pemphigoid, Bullous / Q000235:genetics / Q000276:immunology*; D010392:Pemphigus / Q000235:genetics / Q000276:immunology*; D012984:Software; D055815:Young Adult; D000097805:Collagen Type XVII
D000954:Antigens, Surface; D001323:Autoantibodies; D001324:Autoantigens; D002352:Carrier Proteins; D003598:Cytoskeletal Proteins; D051183:Desmoglein 1; D051184:Desmoglein 3; D000071821:Dystonin; D018984:Epitopes, T-Lymphocyte; D006683:HLA-DQ Antigens; D059866:HLA-DQ beta-Chains; D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; D039503:Integrin alpha6; D039663:Integrin beta4; D009419:Nerve Tissue Proteins; D024041:Non-Fibrillar Collagens; D000097805:Collagen Type XVII; C071894:DSG3 protein, human; C486268:DST protein, human; C069051:HLA-DQB1 antigen