Stefania Jablonska

IgA anti‐endomysium antibody. A new immunological marker of dermatitis herpetiformis and coeliac disease

The recently described IgA anti‐endomysial antibodies (IgA‐EmA) are directed against the intermyofibril substance of the smooth muscle, which may correspond either to a reticulin‐like structure or a surface component of smooth muscle fibrils. These antibodies occurred in about 80% of sera of thirty‐eight patients with dermatitis herpetiformis (DH), in about 70% of twenty‐eight patients with coeliac disease and in about 20% of nine patients with other enteropathies. IgG class anti‐gliadin antibodies (AGA) also occur in each of these diseases. Both antibodies were detected on monkey oesophagus by immunofluorescence. The IgA‐EmA could not be detected in 122 control sera from patients with other gut or skin diseases, including fifteen cases with ulcerative colitis and fifteen cases with linear IgA bullous dermatosis (LABD). The presence and the titre of IgA‐EmA and AGA paralleled the severity of the jejunal changes in patients with coeliac disease.

IgA Class Endomysium Antibodies in Dermatitis Herpetiformis and Coeliac Disease

Dermatitis herpetiformis (DH) is a vesicular skin disorder with characteristic histologic features (PMNs, microabscesses in dermal papillae adjacent to the vesicles) and disease-specific immunopathological findings (granular or fibrillar IgA deposits most commonly found in dermal papillae) usually associated with gluten-sensitive enter~pathy.~.’.’ Cases with linear IgA deposits in the basement membrane zone (BMZ) have been referred to by various names: “DH with linear IgA deposit^,^, “lgA bullous pemphigoid,”’O or “polymorphic variant of bullous pemphigoid.”’ It is becoming increasingly evident that this disease is a distinct We refer to it here as “linear IgA bullous dermatosis” or LABD. Detailed reviews appear elsew Two types of antibodies have been detected in sera of DH patients, notably anti-reticulin antibodies (ARA) with reported frequencies of 5-1 8% and anti-gliadin antibodies (AGA) in about 40% of the cases. However, these antibodies occur predominantly in coeliac disease and are chiefly of IgG class: ARA have been reported in 38% of adults and in 59% of children; AGA in 40% of adults’ and over 90% of ~hi1dren.I~ Both types of antibodies are occasionally detected in diseases other than with gluten-sensitive enteropathy.” This report sets forth the first findings on IgA class antibody reacting with endomysium IgA-EmA of smooth muscle, particularly of monkey esophagus. We have found these IgA-EmA in a significant proportion of patients with DH, coeliac disease, and other gut diseases but not in cases of LABD. We have also shown that both IgA-EmA and IgG-AGA can be detected on monkey esophagus in the same serum sample by the indirect IF test.

IMMUNOSUPPRESSANTS IN THE TREATMENT OF PEMPHIGUS

The results are presented of parenteral treatment with methotrexate (12·5 mg. twice a week) in 19 cases of various forms of pemphigus; small doses of corticosteroids (usually 8–32 mg. daily) were given in addition. Two other cases, both of pemphigus erythematosus, were treated with azathioprine.

Autoimmunity in psoriasis

SummaryThe stratum corneum (SC) antibodies are present in all human sera as seen by indirect immunofluorescent (IF) staining. They appear to bind in vivo to the stratum corneum of psoriatic lesions. They fix complement in vitro in a two step complement IF test system using either anti C4 or anti C3 conjugates as indicators. IF tests with proper controls showed that the SC antigen in psoriatic scales is coated not only with IgG but in a majority of the lesions also with complement. In the present studies in fully developed lesions complement was detectable in 88% of the specimens studied and in about 50% of very fresh linear lesions of unintentional Köbner type. These as well as some previously published observations afford indirect evidence for the participation of SC antibodies and the ensuing fixation of complement in the development of psoriatic lesions.ZusammenfassungAntikörper gegen Stratum corneum (SC) befinden sich in Seren aller Menschen und können mittels der indirekten Immunofluorescenzmethode festgestellt werden. In Psoriasis-Herden scheinen sie in vivo im Stratum corneum fixiert zu sein. Sie fixieren Komplement in vitro, was man durch Komplement-Fixierungs-Tests unter Benutzung von anti C4 oder anti C3 Konjugaten beweisen kann. IF-Teste mit unterschiedlichen Kontrollen haben aufgezeigt, daß Stratum corneum als Antigen in Psoriasis-Läsionen nicht nur von IgG, sondern in der Mehrheit der Veränderungen auch von Komplement umgeben ist. In völlig entwickelten Läsionen wurde das Komplement in 88% der Biopsien festgestellt, weniger häufig — in ungefähr 50% — in sehr frühen linearen Hautveränderungen vom Typ des zufälligen Köbnerschen Phänomens. Diese und frühere Beobachtungen erbrigen einen indirekten Beweis, daß Antikörper SC an der Entstehung der Psoriasisherde teilnehmen, und die Komplementfixierung hier von Bedeutung sein könnte.

Efficacy and safety of CD 271 alcoholic gels in the topical treatment of acne vulgaris.

CD 271, a naphthoic acid, is a powerful modulator of epidermal differentiation. This double‐blind, randomized study compared the efficacy and safety of two concentrations (0.03% w/w and 0.1% w/w) of CD 271 alcoholic gel. With 0.025% w/w tretinoin gel in 72 male patients with acne vulgaris over a period of 12 weeks. Efficacy was measured by counting facial inflammatory and non‐inflammatory lesions and by grading the severity of the acne at each visit. Skin tolerance was assessed with subjective symptoms, such as burning and pruritus, as well as clinical assessment of erythema, dryness and scaling on the treated areas. The alcoholic 0.1% CD 271 gel was as effective as 0.025% tretinoin gel in reducing total comedone counts (83% reduction for both products after 12 weeks’treatment). The reduction in the number of inflammatory lesions and the total number of acne lesions were significantly greater with 0.1% CD 271 gel than with tretinoin gel (69% and 79% for 0.1% CD 271.50% and 73% for tretinoin gel, respectively, P < 0.05). All three treatments were well tolerated and there were no changes in any major blood paramenters. No CD 271 could be detected in blood plasma at the end of the study (detection limit = 1 ng/ml).

THE SCOPE AND LIMITATIONS OF THE IMMITNOFLUORESCENCE METHOD IN THE DIAGNOSIS OF LUPUS ERYTHEMATOSUS

Immunofluorescence studies were made in 51 cases of rosacea and 8 cases of telangiectasia of various origins. Immunoglobulins were found—as in LE—at the epidermal‐dermal junction in 35 of the cases of rosacea and in all telangiectasias, irrespective of their origin. The need for great caution in the interpretation of biopsy studies of facial lesions is stressed. Detection of immunoglobulins at the epidermal‐dermal junction in clinically normal skin is, however, very important for the diagnosis of SLE

Pathogenesis of pemphigus erythematosus

SummaryImmunofluorescence studies were made by the indirect method in 54 cases of pemphigus erythematosus, in 50 of which skin specimens from lightexposed and unexposed regions were investigated also by the direct IF method. IF Band was shown to be demonstrable in skin specimens from exposed regions in 81% of cases and from unexposed regions in 23%.ANA were found in some 31% of patients, though usually in titers below those of IC antibodies. There were 2 cases each of coexistence with myastenia gravis and thymoma and with SLE. Virus-like particles, however, were found by electron microscopy only in 1 case with coexisting SLE.Detection of IF Band in skin specimens from a significant majority of patients with pemphigus erythematosus, presence of ANA in some, and occasional coexistence of SLE suggest some relation of the disease with lupus erythematosus.ZusammenfassungDie Immunofluorescenz-Untersuchungen wurden mittels der indirekten Methode in 54 Fällen von Pemphigus erythematosus durchgeführt, in 50 davon auch mittels der direkten Methode an den Biopsien sowohl von lichtexponierten, als auch nicht lichtexponierten Stellen. Es wurde nachgewiesen, daß das IF-Band in der lichtexponierten Haut in rund 81% der Fälle, in der nicht lichtexponierten Haut in rund 23% der Fälle auftritt.ANA wurden in rund 31% der Fälle festgestellt, obgleich ihr Titer gewöhnlich niedriger als der IC-Antikörper war. In 2 Fällen koexistierten Myasthenia gravis und Thymom, in 2-SLE. Virusähnliche Partikel dagegen hat man bei elektronenmikroskopischen Untersuchungen nur in einem Fall von koexistierendem SLE festgestellt.Das Vorhandensein des IF-Bandes bei der großen Mehrheit der Fälle von Pemphigus erythematosus, das Auftreten von ANA bei einem Teil der Fälle, sowie die mögliche Koexistenz mit SLE spricht für einen Zusammenhang zwischen Pemphigus erythematosus und Lupus erythematosus.

Anticentromere antibody: an immunological marker of a subset of systemic sclerosis

Our clinical and immunological studies of 114 cases of systemic sclerosis, 54 of Raynauds disease and 46 of other connective tissue diseases, centered on the diagnostic and prognostic significance of anticentromere antibodies (ACA). The ACA occurred in 21 of 84 patients with acrosclerosis, in four of 54 patients with Raynauds disease but in none of 30 patients with diffuse scleroderma or transitional form, acrosclerosis‐diffuse scleroderma, or 46 cases of other connective tissue diseases. The ACA‐positive patients had no contracture or immobilization of the fingers, the indurations and/or indurative oedema were confined to fingers and usually no other types of ANA were detected. However, systemic involvement and the course of the disease were comparable in ACA‐negative and ACA‐positive acrosclerosis patients.

Continuous peritoneal dialysis for treatment of psoriasis

Psoriatic lesions were found to disappear spontaneously under haemodialysis [1 4] or continuous peritoneal dialysis [5] without any additional topical application of tar and corticosteroids, and/or systemic treatment with cytostatic drugs. Since both procedures recently introduced for therapy of psoriasis did not interfere directly with the excessive epidermal cell proliferation, a characteristic feature of the disease, the mechanism of the clearing of psoriatic lesions, remains completely unknown. Some hypotheses were raised such as removal of an noxious substance probably of epidermal origin which may be filtered by the normal kidney, but not excreted owing to tubular reabsorption in psoriasis [5], as well as immunological activation, inactivation of substances, or alteration of feedback systems [4]. Taking into consideration that lymphocytes and polymorphonuclear leucocytes [PMNL] may play an important rote in the pathogenesis of psoriasis, we decided to explore an alternative hypothesis that not elimination of low molecular dialysable factor, but removal of white blood cells with dialysate could be reponsible for the clearing of psoriasis. Lymphocytes and PMNL are known to form infiltrates in psoriatic lesions [ 6 7]. Furthermore, they could be a carrier of immunological factors, such as immune complexes, rheumatoid-like factors, anti-basal cell nuclei autoantibodies, or other immunoglobulins, and complement [8-9]. Complement activation products generated after binding of stratum corneum (SC) antigens with circulating anti-SC autoantibodies [t0] are presumed to exert chemotactic activity on PMNL which penetrate into the horny layer-forming Munro microabscesses [11]. Abnormalities of T-lymphocyte function were also reported [12]. The purpose of our paper was to determine : (1) whether white blood cells are removed by continuous peritoneal dialysis in a significant number, (2) whether some immunological factors related to these cells are eliminated on their surface

Is chemotactic activity of polymorphonuclear leukocytes increased in psoriasis

SummaryChemotactic activity of PMNs of 44 patients with common psoriasis and 20 healthy individuals was studied by modified Boyden chamber assay and casein as a chemoattractant. The patients were classified according to the activity of the disease, extent of skin lesions, and duration of the disease and of the last relapse. There was a high statistically significant increase in chemotactic response of the PMNs of psoriatics as compared with controls.The increase in chemotactic activity correlated positively with the activity of the disease but not with the extent of skin lesions. Very low values in some patients with longlasting and/or extensive lesions could depend upon the presence of inhibitory factors in plasma. The possible explanation for divergent results obtained by other autors could be due to the fact that various clinical parameters were not taken into account.