The significance of preclinical anti-BP180 autoantibodies

Abstract

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease. Although the pathomechanism of BP onset has yet to be elucidated in detail, BP autoantibodies targeting two hemidesmosomal components, BP180 and BP230, are known to play a pivotal role in BP pathogenesis. Thus, the detection and measurement of BP autoantibodies are necessary for diagnosing BP and monitoring the disease activity. Immune assays such as immunofluorescence microscopy, immunoblotting, and ELISAs using BP180 and BP230 detect BP autoantibodies in most BP cases with high specificity; however, BP autoantibodies are sometimes detected in BP patients before the onset of this disease. BP autoantibodies that are detected in patients without typical tense blisters are defined as “preclinical BP autoantibodies”. These preclinical BP autoantibodies are detected even in a low percentage of normal healthy individuals. Although the importance of preclinical BP autoantibodies remains elusive, these autoantibodies might be a potential risk factor for subsequent BP development. Therefore, previous comparative epidemiological studies have focused on the prevalence of preclinical BP autoantibodies in populations susceptible to BP (e.g., the elderly) or in diseases with a higher risk of comorbid BP. This mini-review summarizes the literature on the prevalence of preclinical BP autoantibodies in patients with various conditions and diseases, and we discuss the significance of preclinical BP autoantibody detection.

PD-L1 expression in keratinocyte and infiltration of CD4 + T lymphocyte can predict a severe type of erythema multiforme major induced by the anti-PD-1 antibody, pembrolizumab

“…BP180 is usually elevated in bullous pemphigoid. The sensitivity and specificity of BP180 are 84.4% and 98.9%, respectively, in diagnosing bullous pemphigoid [ 8 ]. However, Sadik et al reported that the positivity of BP180 was observed in four out of nine bullous pemphigoid cases, which presented as skin irAE, from six German dermatology centers [ 9 ].…”

Immunologic Profiling of Immune-Related Cutaneous Adverse Events with Checkpoint Inhibitors Reveals Polarized Actionable Pathways

“…Furthermore, several nonbullous dermatitis ircAE cases showed serum antibody positivity to the common blistering disease epidermal antigens, but these cases were not associated with the corresponding characteristic DIF findings. Of note, preclinical BP antibodies have been reported in aging patients with pruritus, neurological diseases, diabetes mellitus, and rheumatologic collagen diseases ( 58 ). Anti-DSG-1 and DSG-3 antibodies, along with other epidermal protein autoantibodies, have been found in paraneoplastic pemphigus and other autoimmune conditions ( 33 ).…”

Bullous pemphigoid associated with prodromal‐phase by repeated COVID‐19 vaccinations

“…4 Previous studies have demonstrated the presence of anti-BP180 antibodies in healthy individuals. 5 The COVID-19 vaccination might exert an effector phase of BP (i.e., blister formation) in healthy individuals with anti-BP180 antibodies. Further, a prior COVID-19 vaccination may lead to autoantibody production, followed by development of BP later with or without repeated vaccinations.…”