Enrichment of total serum IgG4 in patients with pemphigus

T. Funakoshi, L. Lunardon, C. T. Ellebrecht, A. R. Nagler, C. E. O'Leary, A. S. Payne

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are potentially fatal blistering diseases caused by autoantibodies targeting desmoglein (Dsg) adhesion proteins. Previous studies have shown an IgG4 > IgG1 predominance of anti-Dsg antibodies in pemphigus; however, no studies have examined total serum IgG4 levels in pemphigus. IgG4 is induced by chronic antigen stimulation, which could occur with persistent skin blistering and potentially elevate the total serum IgG4 relative to other IgG subclasses in patients with pemphigus. Objectives The primary aim of the study was to quantitate total and Dsg-specific IgG subclasses in patients with pemphigus. Methods IgG subclasses and Dsg-specific IgG1 and IgG4 were quantitated in patients with PV and PF, and in sera from age-matched controls using a subclass enzyme-linked immunosorbent assay. The effectiveness of IgG4 depletion in blocking IgG pathogenicity in PV was determined using a keratinocyte dissociation assay. Results Dsg-specific antibodies comprised a median of 7·1% and 4·2% of total IgG4 in patients with PV and PF, respectively, with eightfold and fourfold enrichment in IgG4 vs. IgG1. Total serum IgG4, but not other IgG subclasses, was enriched in patients with PV and PF compared with age-matched controls (P = 0·004 and P = 0·005, respectively). IgG4 depletion of PV sera reduced pathogenicity in a keratinocyte dissociation assay and showed that affinity-purified IgG4 is more pathogenic than other serum IgG fractions. Conclusions Dsg-specific autoantibodies are significantly enriched in IgG4, which may explain the enrichment of total serum IgG4 in some patients with pemphigus. By preferentially targeting autoimmune rather than beneficial immune antibodies, IgG4-targeted therapies may offer safer treatment options for pemphigus.

Original languageEnglish
Pages (from-to)1245-1253
Number of pages9
JournalBritish Journal of Dermatology
Volume167
Issue number6
DOIs
Publication statusPublished - 2012 Dec

ASJC Scopus subject areas

  • Dermatology

Fingerprint Dive into the research topics of 'Enrichment of total serum IgG4 in patients with pemphigus'. Together they form a unique fingerprint.

Cite this