2021
DOI: 10.1111/jdv.17465
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The burden of neurological comorbidities in six autoimmune bullous diseases: a population‐based study

Abstract: Background Apart from bullous pemphigoid (BP), the association of other autoimmune bullous diseases (AIBDs) with neurological conditions is poorly understood. Objective To estimate the association between a wide array of AIBDs and neurological conditions. Methods A retrospective cross‐sectional study recruited patients with BP, mucous membrane pemphigoid (MMP), epidermolysis bullosa acquisita (EBA), pemphigoid gestationis (PG), pemphigus vulgaris (PV) and pemphigus foliaceus (PF). These patients were compared … Show more

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Cited by 18 publications
(18 citation statements)
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“… 23 , 24 The presence of proteins shared between the central nervous system and the skin which are recognized at autoantigens in the central nervous system and the epidemiological data between BP and neurological diseases lead to the hypothesis that neurodegeneration or neuroinflammation may disrupt the blood-brain barrier, causing a cross-reactive immune response between skin and brain autoantigens and thus resulting in BP. 25 This hypothesis has also been further supported by anatomical and autoimmunological evidence. BP180 has been found mainly in pyramidal cells from the ganglionic layer of the cortex and hippocampus, which is also the common lesion site of Alzheimer’s disease.…”
Section: Alzheimer’s Disease and Bullous Pemphigoidmentioning
confidence: 76%
“… 23 , 24 The presence of proteins shared between the central nervous system and the skin which are recognized at autoantigens in the central nervous system and the epidemiological data between BP and neurological diseases lead to the hypothesis that neurodegeneration or neuroinflammation may disrupt the blood-brain barrier, causing a cross-reactive immune response between skin and brain autoantigens and thus resulting in BP. 25 This hypothesis has also been further supported by anatomical and autoimmunological evidence. BP180 has been found mainly in pyramidal cells from the ganglionic layer of the cortex and hippocampus, which is also the common lesion site of Alzheimer’s disease.…”
Section: Alzheimer’s Disease and Bullous Pemphigoidmentioning
confidence: 76%
“…34,35 Some proposed that the exposure of neural isoforms of BP180 and BP230 in neurological diseases may induce cross-reactive autoantibodies against cutaneous antigens and lead to subsequent BP. 36 DPP4i, a common anti-diabetic agent, has been linked to BP in recent years, with growing evidence supporting this association. 6,8,15 Dipeptidyl peptidase 4 (DPP4) is a cell surface receptor that takes part in the conversion of plasminogen into plasmin, which could cleave BP180 at the NC16A domain.…”
Section: Discussionmentioning
confidence: 99%
“…Neurological diseases have shown to be important risk factors for BP in several large‐scale observational studies and meta‐analysis 34,35 . Some proposed that the exposure of neural isoforms of BP180 and BP230 in neurological diseases may induce cross‐reactive autoantibodies against cutaneous antigens and lead to subsequent BP 36 . DPP4i, a common anti‐diabetic agent, has been linked to BP in recent years, with growing evidence supporting this association 6,8,15 .…”
Section: Discussionmentioning
confidence: 99%
“…Pathophysiological mechanism BP Psoriasis Psoriatic degradation of laminin 1 and laminin a1 in the BM lowers the threshold for the generation of anti-BM autoantibodies that are also involved in BP 24 Neutrophilic infiltrate histologically present in both conditions. 25 Neutrophils secrete several metalloproteases that may be implicated in the degradation of matrix proteins, leading to the exposure of antigenic epitopes of the BM 26 IL-1 is essential for the initiation and formation of psoriatic lesions 27 and is also increased in blister fluid of BP 28,29 IL-17 and T helper type 17 cells play a major role in the pathogenesis of both BP and psoriasis 30,31 The breakdown of the BM by antipsoriatic treatments may facilitate the exposure of BM antigens to the circulation and generate anti-BP autoantibodies [32][33][34] BP Neurological diseases Co-expression of epithelial and neuronal isoforms of BP autoantigens (BP180 and BP230) in the skin and the central nervous system 35 Autoantibodies against the neuronal isoforms of BP180 and BP230 may lead to neuroinflammation and may expose these antigens to the immune system resulting in a cross-reactive immune response against their cutaneous isoforms, leading to BP 36…”
Section: Aibd Autoimmune Diseasementioning
confidence: 99%
“… 35 That is to say, autoantibodies against the neuronal isoforms of BP180 and BP230 may lead to neuroinflammation and this may result in a cross-reactive immune response against their cutaneous isoforms, leading to BP. 36 …”
Section: Pemphigoid and Neurological Diseasesmentioning
confidence: 99%