Advances in laboratory diagnosis of autoimmune bullous dermatoses

doi:10.16150/j.1671-2870.2023.03.16

Abstract

Abstract:

Autoimmune bullous dermatoses (AIBD) are associated with autoantibodies against structural components in the skin and mucous membranes. Pemphigus diseases are associated with autoantibodies against the components of desmoglein, while pemphigoid diseases are associated with autoantibodies targeting the structural proteins of the dermal‐epidermal junction. Depending on the components targeted by the autoimmune system, treatments for the two types of diseases are different, so laboratory diagnosis is required for identification. Traditional laboratory diagnosis methods include direct immunofluorescence (DIF), indirect immunofluorescence (IIF), enzyme‐linked immunosorbent assay (ELISA) and immunoblotting (IBT). In recent years, new technologies have emerged. The low‐cost and efficient BIOCHIP technology simplifies the interpretation of IIF, and detection rates of Dsg3 and BP180 are as high as 97%-100% and 94% respectively. EUROTide^TM technology is more sensitive and specific than traditional DIF methods, with less background fluorescence. MESACUP anti-Skin profile TEST (ASPT) can detect multiple antibodies simultaneously, and the detection specificity for Dsg1 and Dsg3 reaches 100%. Lateral flow immunoassay (LFIA) can be used for rapid qualitative testing and results can be checked visually. Chemiluminescence enzyme immunoassay is highly automated and efficient, with 94%-99% compliance rate compared with ELISA. Fluorescence overlay antigen mapping using laser‐scanning confocal microscopy (FOAM‐LSCM) can differentially stain different components of the skin basement membrane zone by one‐ime, which is more efficient than the traditional manual DIF method, and is useful for diagnosing the AIBD that is difficult to differentiate from bullous pemphigoid or acquired epidermolysis bullosa under traditional methods. Laboratory diagnostic technology plays an important role in the treatment and prognosis of AIBD. Based on traditional laboratory methods, this article compares and discusses the value of new technologies in the diagnosis of AIBD.

Key words: Autoimmune bullous dermatoses, Direct immunofluorescence assay, Bullous pemphigoid antigen 180, Laboratory

CLC Number:

R758.66

WU Xinyi, PAN Meng, ZHUN Haiqin. Advances in laboratory diagnosis of autoimmune bullous dermatoses[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(03): 306-310.

Figures/Tables 2

References 34

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表皮内水疱病	桥粒黏附结构
寻常型天疱疮	Dsg3，Dsg1
落叶型天疱疮	Dsg1
红斑型天疱疮	Dsg1
增殖型天疱疮	Dsg3，Dsg1，Dsc3
副肿瘤型天疱疮	Dsg3，Dsg1，Dsc1，Dsc2，Dsc3，
	斑蛋白家族，α₂-巨球样蛋白1，
	BP230，BP180
IgA天疱疮	Dsg1，Dsg3，Dsc1，Dsc2，Dsc3
疱疹样天疱疮	Dsg1，Dsg3，Dsc1，Dsc3

表皮下水疱病	真表皮连接成分
大疱性类天疱疮	BP180，BP230
妊娠性类天疱疮	BP180
线状IgA大疱性皮病	LAD-1，LABD-97，BP180，BP230，
	VII型胶原
黏膜类天疱疮	BP180，BP230，层粘连蛋白332，
	α6β4整合素，Ⅶ型胶原
抗p200类天疱疮	p200
获得性大疱性表皮松解症	Ⅶ型胶原
疱疹样皮炎	谷氨酰胺转移酶
扁平苔藓类天疱疮	BP180，BP230
瘢痕性类天疱疮	BP180，BP230，层粘连蛋白332