Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus Vulgaris

In pemphigus vulgaris (PV), IgG autoantibodies against the ectodomain of desmoglein 3 (Dsg3) have been shown to be directly responsible for the loss of keratinocyteadhesion. The aim of the present study was to study the effect of the B cell depleting anti-CD20 monoclonal antibody, rituximab, on the...

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Main Authors: Ralf Müller, Nicolas Hunzelmann, Vera Baur, Guido Siebenhaar, Elke Wenzel, Rüdiger Eming, Andrea Niedermeier, Philippe Musette, Pascal Joly, Michael Hertl
Format: Article
Language:English
Published: Wiley 2010-01-01
Series:Dermatology Research and Practice
Online Access:http://dx.doi.org/10.1155/2010/321950
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author Ralf Müller
Nicolas Hunzelmann
Vera Baur
Guido Siebenhaar
Elke Wenzel
Rüdiger Eming
Andrea Niedermeier
Philippe Musette
Pascal Joly
Michael Hertl
author_facet Ralf Müller
Nicolas Hunzelmann
Vera Baur
Guido Siebenhaar
Elke Wenzel
Rüdiger Eming
Andrea Niedermeier
Philippe Musette
Pascal Joly
Michael Hertl
author_sort Ralf Müller
collection DOAJ
description In pemphigus vulgaris (PV), IgG autoantibodies against the ectodomain of desmoglein 3 (Dsg3) have been shown to be directly responsible for the loss of keratinocyteadhesion. The aim of the present study was to study the effect of the B cell depleting anti-CD20 monoclonal antibody, rituximab, on the profile of pathogenic IgG against distinct regions of the Dsg3 ectodomain in 22 PV patients who were followed up clinically and serologically by Dsg3 ELISA over 12-24 months. Prior to rituximab, all the 22 PV patients showed IgG against Dsg3 (Dsc3EC1-5). Specifically, 14/22 showed IgG reactivity against the Dsg3EC1 subdomain, 5/22 patients against Dsg3EC2, 7/22 against Dsg3EC3, 11/22 against Dsg3EC4, and 2/22 against Dsg3EC5. Within 6 months after rituximab, all the patients showed significant clinical improvement and reduced IgG against Dsg3 (5/22) and the various subdomains, that is, Dsg3EC1 (7/22), Dsg3EC2 (3/22), Dsg3EC3 (2/22), sg3EC4 (2/22), and Dsg3EC5 (0/22). During the entire observation period, 6/22 PV patients experienced a clinical relapse which was associated with the reappearance of IgG against previously recognized Dsg3 subdomains, particularly against the Dsg3EC1. Thus, in PV, rituximab only temporarily depletes pathogenic B cell responses against distinct subdomains of Dsg3 which reappear upon clinical relapse.
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spelling doaj-art-7898ee40cd7943caa30a6c25de985a152025-08-20T02:07:30ZengWileyDermatology Research and Practice1687-61051687-61132010-01-01201010.1155/2010/321950321950Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus VulgarisRalf Müller0Nicolas Hunzelmann1Vera Baur2Guido Siebenhaar3Elke Wenzel4Rüdiger Eming5Andrea Niedermeier6Philippe Musette7Pascal Joly8Michael Hertl9Department of Dermatology and Allergology, University of Marburg, D-35033 Marburg, GermanyDepartment of Dermatology and Venerology, University of Cologne, D-50937 Cologne, GermanyDepartment of Dermatology and Allergology, University of Marburg, D-35033 Marburg, GermanyDepartment of Dermatology and Venerology, University of Cologne, D-50937 Cologne, GermanyDepartment of Dermatology and Allergology, University of Marburg, D-35033 Marburg, GermanyDepartment of Dermatology and Allergology, University of Marburg, D-35033 Marburg, GermanyDepartment of Dermatology and Allergology, University of Marburg, D-35033 Marburg, GermanyDepartment of Dermatology, Rouen University Hospital, F-7600 Rouen, France Department of Dermatology, Rouen University Hospital, F-7600 Rouen, France Department of Dermatology and Allergology, University of Marburg, D-35033 Marburg, GermanyIn pemphigus vulgaris (PV), IgG autoantibodies against the ectodomain of desmoglein 3 (Dsg3) have been shown to be directly responsible for the loss of keratinocyteadhesion. The aim of the present study was to study the effect of the B cell depleting anti-CD20 monoclonal antibody, rituximab, on the profile of pathogenic IgG against distinct regions of the Dsg3 ectodomain in 22 PV patients who were followed up clinically and serologically by Dsg3 ELISA over 12-24 months. Prior to rituximab, all the 22 PV patients showed IgG against Dsg3 (Dsc3EC1-5). Specifically, 14/22 showed IgG reactivity against the Dsg3EC1 subdomain, 5/22 patients against Dsg3EC2, 7/22 against Dsg3EC3, 11/22 against Dsg3EC4, and 2/22 against Dsg3EC5. Within 6 months after rituximab, all the patients showed significant clinical improvement and reduced IgG against Dsg3 (5/22) and the various subdomains, that is, Dsg3EC1 (7/22), Dsg3EC2 (3/22), Dsg3EC3 (2/22), sg3EC4 (2/22), and Dsg3EC5 (0/22). During the entire observation period, 6/22 PV patients experienced a clinical relapse which was associated with the reappearance of IgG against previously recognized Dsg3 subdomains, particularly against the Dsg3EC1. Thus, in PV, rituximab only temporarily depletes pathogenic B cell responses against distinct subdomains of Dsg3 which reappear upon clinical relapse.http://dx.doi.org/10.1155/2010/321950
spellingShingle Ralf Müller
Nicolas Hunzelmann
Vera Baur
Guido Siebenhaar
Elke Wenzel
Rüdiger Eming
Andrea Niedermeier
Philippe Musette
Pascal Joly
Michael Hertl
Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus Vulgaris
Dermatology Research and Practice
title Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus Vulgaris
title_full Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus Vulgaris
title_fullStr Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus Vulgaris
title_full_unstemmed Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus Vulgaris
title_short Targeted Immunotherapy with Rituximab Leads to a Transient Alteration of the IgG Autoantibody Profile in Pemphigus Vulgaris
title_sort targeted immunotherapy with rituximab leads to a transient alteration of the igg autoantibody profile in pemphigus vulgaris
url http://dx.doi.org/10.1155/2010/321950
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