title: Correlation of antimuscarinic acetylcholine receptor antibody titers and antidesmoglein antibody titers with the severity of disease in patients with pemphigus.
abstract: BACKGROUND
  Acetylcholine receptor (AchR) antibody levels significantly correlate with disease severity at initial pemphigus diagnosis and during follow-up. However, it is not clear if they are just an epiphenomenon or a potential trigger of the known pathogenic process in pemphigus vulgaris.
  
  
  OBJECTIVE
  We sought to assess the changes in anti-muscarinic (M3) AchR and anti-desmoglein (Dsg) antibody titers with therapy.
  
  
  METHODS
  This was a hospital-based cohort study involving 45 patients with active pemphigus. Disease was graded clinically using Pemphigus Disease Area Index. Antibody titers were estimated using enzyme-linked immunosorbent assay at baseline, 3 months, and 15 months.
  
  
  RESULTS
  All patients with pemphigus had significantly higher anti-M3 AchR titers when compared with a control group. Only 95.5% of patients had anti-Dsg1 antibodies and 84.4% of patients had anti-Dsg3 antibodies. A statistically significant reduction in all 3 antibody titers from baseline to follow-up with treatment was observed. There was a good correlation between all 3 antibody titer and Pemphigus Disease Area Index score at baseline and after therapy and between anti-M3 AchR and anti-Dsg1 antibody titers.
  
  
  CONCLUSIONS
  Sample size was small and follow-up period was short.
  
  
  CONCLUSIONS
  Anti-M3 AchR antibodies are strongly associated with pemphigus. They significantly correlate with disease activity and their titers decline with therapy along with anti-Dsg antibodies.
authors.affiliation: Department of Dermatology, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Manimegalai Jeyasekaran Dhanabhakya
authors.initials: MJD
authors.lastname: Lakshmi
authors.affiliation: Department of Dermatology, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Telanseri Jaykar
authors.initials: TJ
authors.lastname: Jaisankar
authors.affiliation: Department of Biochemistry, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Medha
authors.initials: M
authors.lastname: Rajappa
authors.affiliation: Department of Dermatology, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Devinder Mohan
authors.initials: DM
authors.lastname: Thappa
authors.affiliation: Department of Dermatology, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India. Electronic address: laxmishac@gmail.com.
authors.forename: Laxmisha
authors.initials: L
authors.lastname: Chandrashekar
authors.affiliation: Department of Biochemistry, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Dakshinamurthy
authors.initials: D
authors.lastname: Divyapriya
authors.affiliation: Department of Dermatology, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Malathi
authors.initials: M
authors.lastname: Munisamy
authors.affiliation: Department of Biochemistry, Jawaharalal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: Gunaseelan
authors.initials: G
authors.lastname: Revathy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D051183:Desmoglein 1 / Q000276:immunology*; D051184:Desmoglein 3 / Q000276:immunology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000097:blood* / Q000188:drug therapy; D011976:Receptors, Muscarinic / Q000276:immunology*; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D051183:Desmoglein 1; D051184:Desmoglein 3; D011976:Receptors, Muscarinic
keywords: acantholysis; antibody titers; desmoglein; enzyme-linked immunosorbent assay; muscarinic acetylcholine receptors; pemphigus