The presence of anti–basement membrane zone antibodies in the sera of patients with non–bullous lupus erythematosus

Abstract

We performed indirect immunofluorescence (IF) studies using 1 mol/l sodium chloride split skin to determine whether or not a positive IF is specific to patients with bullous lupus erythematosus (LE). We examined the sera from 21 patients with systemic LE (SLE), three of which were obtained from two SLE patients and one subacute cutaneous LE (SCLE) patient with bullous eruptions. As a comparison, we also studied the sera from patients with discoid LE (DLE, n = 7), SCLE (n = 1), systemic sclerosis (SSc, n = 20), bullous pemphigoid (n = 2) and normal individuals (n = 10). Sera from 16 SLE, four DLE and two SSc revealed a linear deposition of IgG isotype antibody at the epidermal side and/or the dermal side on indirect IF of split skin. The sera from three patients with bullous eruption and from 12 patients of SLE, SCLE, DLE without bullous eruption or SSc were further analysed by immunoblotting using five defined antigens, i.e. dermal extract, epidermal extract, three fusion proteins of 230 kDa bullous pemphigoid antigen (BPAG). 180 kDa BPAG, and human epidermolysis bullosa acquisita (EBA) antigen. Two SLE sera as well as one of the SCLE and the DLE serum reacted with 230 kDa BPAG in epidermal extract, and one of the SCLE and the DLE serum also reacted with the fusion protein of 180 kDa BPAG. No serum reacted with the dermal extract or the fusion protein of 230 kDa BPAG or EBA antigen. There was no consistent correlation between split-skin IF results and immunoblotting results. These results may suggest that even non-bullous LE patients often have autoantibodies to the basement membrane zone antigens, most of which are less pathogenic. Although we rarely examine the sera from non-bullous LE patients, we should keep this phenomenon in mind to avoid overestimating the results of split-skin test and immunoblotting.

The study of the participation of basement membrane zone antibodies in the formation of the lupus band in systemic lupus erythematosus

“…In our study, the existence of BMZ-Ab in SLE sera was further confirmed by IIF on salt-split skin, IB, and colloid gold-labeled IEM techniques. Our results are not completely consistent with those of Burge et al 6 and Ishikawa et al 7 In the results of Burge et al, owing to the high titer of antibodies to collagen VII, it was difficult to find small amounts of immunoglobulin bound to other antigens. When the sera were diluted strongly, the lower titer antibodies could not be detected.…”

“…In 1991, Burge et al 6 found BMZ-Ab in the sera of patients with SLE by IIF. Ishikawa et al 7 reported that BMZ-Ab in SLE sera could be bound to a 230 kDa epidermal antigen and BP180 fusion protein. This posed a new problem of whether BMZ-Ab participates in the development of the lupus band.…”

“…5 In addition, recent studies have found BMZ autoantibodies (BMZ-Abs) in the sera of SLE patients. 6,7 It has not been confirmed, however, whether BMZ-Abs are present in the lupus band. In this study, immunoblot (IB), immunofluorescence (IF) and goldlabeled immunoelectron microscopy (IEM) techniques were applied to explore whether cutaneous BMZ-Abs are involved in the formation of the lupus band.…”

Lichenoid Dermatitis in Paraneoplastic Pemphigus

“…The hypothesis that an inflammatory process directed against the basement membrane results in tissue damage that can predispose toward the development of humoral-mediated bullous disease was cogently stated and reviewed by Chan et al 13 They pointed to several case series in which an inflammatory cutaneous or noncutaneous disease was followed by the development of an antibody-mediated blistering disease: lichen planus pemphigoides, 15 psoriasis, 16,17 chronic cutaneous lupus, 18 and ulcerative colitis. 19,20 In addition, ocular cicatricial pemphigoid occurring as a sequela to StevensJohnson syndrome 21 and linear IgA disease developing after long-standing ulcerative colitis 22,23 have also been reported.…”

Long-Term Cefuroxime Axetil in Subacute Cutaneous Lupus erythematosus

“…Subacute cutaneous lupus erythematosus (SCLE) is a subset of lupus erythematosus [1, 2, 3]characterized by prominent photoaggravated cutaneous manifestations [4, 5]and immunological abnormalities [6, 7, 8, 9]. Some patients with SCLE show additionally symptoms of systemic involvement [2], especially hemolytic anemia, leukopenia, thrombocytopenia and arthralgia [1].…”