Abstract
Bullous pemphigoid (BP), a cutaneous autoimmune blistering disease, has provided a useful model to elucidate a role for IgE in autoimmunity. IgE antibodies specific for the BP180 autoantigen are detected in sera and biopsy samples from the majority of BP patients. In BP biopsies, both IgE and BP180 antigen localize to the surface of mast cells, and incubation of circulating basophils from these patients with BP180 protein triggered degranulation. The in vivo pathogenicity of BP180-specific IgE was confirmed in mouse models, where injection of purified BP IgE into human skin grafted onto nu/nu mice replicated the early phase of lesion development, including mast cell degranulation, eosinophil infiltration and development of urticarial plaques. In addition, IgE antibodies from patient sera bind to BP180 on basal keratinocytes, resulting in internalization of BP180, production of inflammatory cytokines, IL-6 and IL-8, and a decrease in the number of hemidesmosomes at the basement membrane zone. These findings have led to therapeutic trials of the anti-IgE monoclonal antibody omalizumab in BP, resulting in substantial improvement in the patients' disease. Overall, the work in BP provides the first evidence for a pathogenic role for IgE in autoimmunity.
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References
Gould HJ, et al. The biology of IGE and the basis of allergic disease. Annu Rev Immunol. 2003;21:579–628.
Gould HJ, Sutton BJ. IgE in allergy and asthma today. Nat Rev Immunol. 2008;8(3):205–17.
Frossi B, De Carli M, Pucillo C. The mast cell: an antenna of the microenvironment that directs the immune response. J Leukoc Biol. 2004;75(4):579–85.
Permin H, Wiik A. The prevalence of IgE antinuclear antibodies in rheumatoid arthritis and systemic lupus erythematosus. Acta Pathol Microbiol Scand C. 1978;86C(5):245–9.
Provost TT, Tomasi TB Jr. Immunopathology of bullous pemphigoid. Basement membrane deposition of IgE, alternate pathway components and fibrin. Clin Exp Immunol. 1974;18(2):193–200.
Guo J, Rapoport B, McLachlan SM. Thyroid peroxidase autoantibodies of IgE class in thyroid autoimmunity. Clin Immunol Immunopathol. 1997;82(2):157–62.
Sato A, et al. A possible role of immunoglobulin E in patients with hyperthyroid Graves’ disease. J Clin Endocrinol Metab. 1999;84(10):3602–5.
Sekigawa I, et al. Possible importance of immunoglobulin E in foetal loss by mothers with anti-SSA antibody. Scand J Rheumatol. 2004;33(1):44–6.
Mikol DD, et al. Serum IgE reactive against small myelin protein-derived peptides is increased in multiple sclerosis patients. J Neuroimmunol. 2006;180(1–2):40–9.
Dema B, et al. Autoreactive IgE is prevalent in systemic lupus erythematosus and is associated with increased disease activity and nephritis. PLoS ONE. 2014;9(2):e90424.
Jordon RE, et al. Basement zone antibodies in bullous pemphigoid. JAMA. 1967;200(9):751–6.
Giudice GJ, Emery DJ, Diaz LA. Cloning and primary structural analysis of the bullous pemphigoid autoantigen BP180. J Invest Dermatol. 1992;99(3):243–50.
Wintroub BU, et al. Morphologic and functional evidence for release of mast-cell products in bullous pemphigoid. N Engl J Med. 1978;298(8):417–21.
Dvorak AM, et al. Bullous pemphigoid, an ultrastructural study of the inflammatory response: eosinophil, basophil and mast cell granule changes in multiple biopsies from one patient. J Invest Dermatol. 1982;78(2):91–101.
Dimson OG, et al. Identification of a potential effector function for IgE autoantibodies in the organ-specific autoimmune disease bullous pemphigoid. J Invest Dermatol. 2003;120(5):784–8.
Arbesman CE, et al. IgE levels in sera of patients with pemphigus or bullous pemphigoid. Arch Dermatol. 1974;110(3):378–81.
Messingham KA, et al. A novel ELISA reveals high frequencies of BP180-specific IgE production in bullous pemphigoid. J Immunol Methods. 2009;346(1–2):18–25.
Bowszyc-Dmochowska MSW, Dmochowski M. Detection of IgG4 deposits using a single-step direct immunofluorescence on natrium chloride-separated skin and elevated levels of serum total IgE in active bullous pemphigoid. J Invest Dermatol. 2000;114:804a.
Friedmann PS. Assessment of urticaria and angio-oedema. Clin Exp Allergy. 1999; 29 Suppl 3: 109–112; discussion 113–5.
Tharp MD, Suvunrungsi RT, Sullivan TJ. IgE-mediated release of histamine from human cutaneous mast cells. J Immunol. 1983;130(4):1896–901.
Schmidt E, et al. Serum levels of autoantibodies to BP180 correlate with disease activity in patients with bullous pemphigoid. Arch Dermatol. 2000;136(2):174–8.
Amo Y, et al. Clinical significance of enzyme-linked immunosorbent assay for the detection of circulating anti-BP180 autoantibodies in patients with bullous pemphigoid. J Dermatol Sci. 2001;26(1):14–8.
Tsuji-Abe Y, et al. Correlation of clinical severity and ELISA indices for the NC16A domain of BP180 measured using BP180 ELISA kit in bullous pemphigoid. J Dermatol Sci. 2005;37(3):145–9.
Hofmann S, et al. Severity and phenotype of bullous pemphigoid relate to autoantibody profile against the NH2- and COOH-terminal regions of the BP180 ectodomain. J Invest Dermatol. 2002;119(5):1065–73.
Fairley JA, et al. A pathogenic role for IgE in autoimmunity: bullous pemphigoid IgE reproduces the early phase of lesion development in human skin grafted to nu/nu mice. J Invest Dermatol. 2007;127(11):2605–11.
Christophoridis S, et al. IgG, IgA and IgE autoantibodies against the ectodomain of BP180 in patients with bullous and cicatricial pemphigoid and linear IgA bullous dermatosis. Br J Dermatol. 2000;143(2):349–55.
Delaporte E, et al. IgE autoantibodies directed against the major bullous pemphigoid antigen in patients with a severe form of pemphigoid. J Immunol. 1996;157(8):3642–7.
Dopp R, et al. IgG4 and IgE are the major immunoglobulins targeting the NC16A domain of BP180 in Bullous pemphigoid: serum levels of these immunoglobulins reflect disease activity. J Am Acad Dermatol. 2000;42(4):577–83.
Iwata Y, et al. Correlation of IgE autoantibody to BP180 with a severe form of bullous pemphigoid. Arch Dermatol. 2008;144(1):41–8.
Ishiura N, et al. Serum levels of IgE anti-BP180 and anti-BP230 autoantibodies in patients with bullous pemphigoid. J Dermatol Sci. 2008;49(2):153–61.
Zone JJ, et al. IgE basement membrane zone antibodies induce eosinophil infiltration and histological blisters in engrafted human skin on SCID mice. J Invest Dermatol. 2007;127(5):1167–74.
Nishie W, et al. Humanization of autoantigen. Nat Med. 2007;13(3):378–83.
Liu Z, et al. A passive transfer model of the organ-specific autoimmune disease, bullous pemphigoid, using antibodies generated against the hemidesmosomal antigen, BP180. J Clin Invest. 1993;92(5):2480–8.
Liu Z, et al. Subepidermal blistering induced by human autoantibodies to BP180 requires innate immune players in a humanized bullous pemphigoid mouse model. J Autoimmun. 2008;31(4):331–8.
Baba T, et al. An eosinophil chemotactic factor present in blister fluids of bullous pemphigoid patients. J Immunol. 1976;116(1):112–6.
Chen R, et al. Macrophages, but not T and B lymphocytes, are critical for subepidermal blister formation in experimental bullous pemphigoid: macrophage-mediated neutrophil infiltration depends on mast cell activation. J Immunol. 2002;169(7):3987–92.
Valent P. Mast cell activation syndromes: definition and classification. Allergy. 2013;68(4):417–24.
Blank U, Rivera J. The ins and outs of IgE-dependent mast-cell exocytosis. Trends Immunol. 2004;25(5):266–73.
Van den Bergh F, Giudice GJ. BP180 (type XVII collagen) and its role in cutaneous biology and disease. Adv Dermatol. 2003;19:37–71.
Franzke CW, Bruckner-Tuderman L, Blobel CP. Shedding of collagen XVII/BP180 in skin depends on both ADAM10 and ADAM9. J Biol Chem. 2009;284(35):23386–96.
Sutton BJ, Gould HJ. The human IgE network. Nature. 1993;366(6454):421–8.
Messingham KN, et al. FcR-independent effects of IgE and IgG autoantibodies in bullous pemphigoid. J Immunol. 2011;187(1):553–60.
Kitajima Y, et al. Internalization of the 180 kDa bullous pemphigoid antigen as immune complexes in basal keratinocytes: an important early event in blister formation in bullous pemphigoid. Br J Dermatol. 1998;138(1):71–6.
Schmidt E, et al. Autoantibodies to BP180 associated with bullous pemphigoid release interleukin-6 and interleukin-8 from cultured human keratinocytes. J Invest Dermatol. 2000;115(5):842–8.
Iwata H, et al. IgG from patients with bullous pemphigoid depletes cultured keratinocytes of the 180-kDa bullous pemphigoid antigen (type XVII collagen) and weakens cell attachment. J Invest Dermatol. 2009;129(4):919–26.
Kitajima Y, et al. A possible cell-biologic mechanism involved in blister formation of bullous pemphigoid: anti-180-kD BPA antibody is an initiator. Dermatology. 1994;189(Suppl 1):46–9.
Dufour C, et al. Successful management of severe infant bullous pemphigoid with omalizumab. Br J Dermatol. 2012;166(5):1140–2.
London VA, et al. Successful treatment of bullous pemphigoid with omalizumab. Arch Dermatol. 2012;148(11):1241–3.
Milgrom H, et al. Treatment of allergic asthma with monoclonal anti-IgE antibody. rhuMAb-E25 Study Group. N Engl J Med. 1999;341(26):1966–73.
Djukanovic R, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma. Am J Respir Crit Care Med. 2004;170(6):583–93.
Holgate ST, et al. Anti-immunoglobulin E treatment with omalizumab in allergic diseases: an update on anti-inflammatory activity and clinical efficacy. Clin Exp Allergy. 2005;35(4):408–16.
MacGlashan DW Jr, et al. Serum IgE level drives basophil and mast cell IgE receptor display. Int Arch Allergy Immunol. 1997;113(1–3):45–7.
Prussin C, et al. Omalizumab treatment downregulates dendritic cell FcepsilonRI expression. J Allergy Clin Immunol. 2003;112(6):1147–54.
Scheinfeld N. Omalizumab: a recombinant humanized monoclonal IgE-blocking antibody. Dermatol Online J. 2005;11(1):2.
Plewako H, et al. The effect of omalizumab on nasal allergic inflammation. J Allergy Clin Immunol. 2002;110(1):68–71.
Noga O, Hanf G, Kunkel G. Immunological and clinical changes in allergic asthmatics following treatment with omalizumab. Int Arch Allergy Immunol. 2003;131(1):46–52.
Fairley JA, et al. Pathogenicity of IgE in autoimmunity: successful treatment of bullous pemphigoid with omalizumab. J Allergy Clin Immunol. 2009;123(3):704–5.
Autoimmune disease: statistics. Retrieved March 15, 2014, from http://www.aarda.org.
Yu KPD, Crew A, Messingham KAN, Fairley JA, Woodley DT. Successful omalizumab therapy for bullous pemphigoid patients. J Am Acad Dermatol. 2014 (in press).
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Messingham, K.A.N., Holahan, H.M. & Fairley, J.A. Unraveling the significance of IgE autoantibodies in organ-specific autoimmunity: lessons learned from bullous pemphigoid. Immunol Res 59, 273–278 (2014). https://doi.org/10.1007/s12026-014-8547-7
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DOI: https://doi.org/10.1007/s12026-014-8547-7