title: Immunofluorescence serration pattern analysis as a diagnostic criterion in antilaminin-332 mucous membrane pemphigoid: immunopathological findings and clinical experience in 10 Dutch patients.
abstract: BACKGROUND
  Antilaminin-332 mucous membrane pemphigoid (anti-LN-332 MMP) is a chronic subepidermal blistering disease characterized by IgG anti-epidermal basement membrane zone (BMZ) autoantibodies against laminin-332 (LN-332).
  
  
  METHODS
  with anti-LN-332 MMP have an increased relative risk of malignancy. Laboratory techniques that are difficult to obtain are needed for diagnosis of anti-LN-332 MMP. Objectives  To incorporate direct immunofluorescence (DIF) serration pattern analysis of IgG depositions in the diagnostic criteria of anti-LN-332 MMP.
  
  
  METHODS
  Patients who met our revised inclusion criteria for anti-LN-332 MMP were selected from our biobank over the period 1997-2009. Inclusion criteria were clinical symptoms, DIF serration pattern analysis, indirect immunofluorescence (IIF) on salt-split skin, and antigen-specificity analysis of the serum including immunoblotting and/or immunoprecipitation and/or enzyme-linked immunosorbent assay (ELISA) against native LN-332.
  
  
  RESULTS
  Ten patients met the inclusion criteria. A malignancy was found in two patients (20%). In all patients in whom it was performed (n = 9), DIF showed linear IgG deposition along the BMZ in an n-serrated pattern. Nine sera reacted by salt-split skin analysis and bound to the dermal side of the split skin. ELISA against native LN-332 was positive in 78% of the tested sera.
  
  
  CONCLUSIONS
  Anti-LN-332 MMP can clinically resemble other forms of pemphigoid. Although state-of-the-art laboratory diagnostics are necessary for definite diagnosis, the combination of simple DIF serration pattern and IIF salt-split skin analysis will exclude other forms of MMP and epidermolysis bullosa acquisita from the differential diagnosis. Because of the increased risk for malignancy patients should be thoroughly oncologically screened.
authors.affiliation: Center for Blistering Diseases, Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, the Netherlands. j.b.terra@umcg.nl
authors.forename: J B
authors.initials: JB
authors.lastname: Terra
authors.forename: H H
authors.initials: HH
authors.lastname: Pas
authors.forename: M
authors.initials: M
authors.lastname: Hertl
authors.forename: F G
authors.initials: FG
authors.lastname: Dikkers
authors.forename: N
authors.initials: N
authors.lastname: Kamminga
authors.forename: M F
authors.initials: MF
authors.lastname: Jonkman
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001323:Autoantibodies / Q000032:analysis; D015815:Cell Adhesion Molecules / Q000276:immunology*; D042241:Early Diagnosis; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D015151:Immunoblotting; D008297:Male; D008856:Microscopy, Fluorescence; D008875:Middle Aged; D010390:Pemphigoid, Benign Mucous Membrane / Q000175:diagnosis* / Q000276:immunology; D000097794:Kalinin
chemical_list: D001323:Autoantibodies; D015815:Cell Adhesion Molecules; D000097794:Kalinin