Pemphigus Associated with Psoriasis Vulgaris: A Retrospective Study of Seven Patients and a Review of the Literature.

The aim of this study was to analyze the characteristics and the treatment for patients with psoriasis who presented with subsequent pemphigus after their treatment. A retrospective study of seven patients with psoriasis associated with pemphigus was performed, including the clinical assessment and treatments. The patients with a median age of 74 (range from 54 to 85) were significantly older than those in previously reported cases, where the median age was 58 (range from 15 to 77) (P<0.05). Six out of seven patients were male, which represents a higher ratio than that reported in literature (10/20). The duration between the diagnosis of psoriasis and onset of pemphigus ranged from 4 to 30 years, and previous studies reported a much wider range that, from a few months to 52 years. Patients developed pemphigus after the treatments for psoriasis with ultraviolet light, steroids, or immunosuppressant. Our study represents a distinct subset of patients with psoriasis accompanied with pemphigus who share typical clinical characteristics. Among these patients, most are elderly men and the dominant subtype is pemphigus foliaceus. Our data suggests that no treatment for psoriasis specifically correlated with the development of pemphigus. The combination treatment of steroids with immunosuppressant lead to an improvement of the disease.

Pivotal Role of Lesional and Perilesional T/B Lymphocytes in Pemphigus Pathogenesis.

Pemphigus is a skin and mucosal membrane-targeting autoimmune bullous disease. Previous studies have shown that circulating anti-desmoglein1/3 antibodies are pathogenic and mediate blister formation. However, the role of infiltrating immune cells in lesional skin has not been fully investigated. In this study we showed that there existed a large number of B and T lymphocytes and plasma cells in the skin lesions by immunohistochemistry and immunofluorescence staining. In addition, a significantly increased number of Dsg1- and Dsg3-specific B cells could be identified by flow cytometric analysis or enzyme-linked immunospot technique (i.e., ELISPOT) assay. Furthermore, anti-Dsg1 and Dsg3 antibodies could be detected from the supernatant of in vitro cultures with isolated lymphocytes from lesional skin. We found that most T lymphocytes infiltrating pemphigus vulgaris lesions were CD4+ T helper cells expressing IL-21 and IL-17a but not typical T follicular helper cells expressing CXCR5. Additionally, our microarray assay showed that the level of chemokine CCL19 was significantly elevated, suggesting active T-/B-lymphocyte trafficking and aggregation in the pemphigus vulgaris lesions. Collectively, our results suggest a critical role of locally infiltrating lymphocytes in pemphigus pathogenesis.

Immune cellular regulation on autoantibody production in pemphigus.

Pemphigus is an autoantibody-mediated blistering disease in the skin and mucous membranes. The autoantibodies primarily target desmoglein (Dsg)1 or/and Dsg3, transmembrane glycoproteins of skin epidermal cells, leading to loss of desmosome adhesion and acantholysis through signaling dependent and independent pathways. Thus, the pemphigus autoantibodies themselves and immune processes, particularly cellular regulation of antibody production, remain as interesting topics in probing pemphigus pathogenesis. In this review, we focus on current advances regarding how the pemphigus antibody production is highly regulated by the key immune effectors including T cells, B cells and their secreted cytokines. Specifically targeting these immune effectors involved in the pemphigus autoantibody production should provide better therapeutic options for disease treatment of pemphigus.

The imbalance of Th17 and regulatory T cells in pemphigus patients.

UNLABELLED: Pemphigus is a complex dermatologic autoimmune bullous disease whose pathogenic mechanism is not fully understood. Anti-desmoglein-1 (Dsg1) and anti- Dsg3 autoantibodies play an important role in the pathogenesis of pemphigus. OBJECTIVES: To investigate the role of T-helper17 (Th17) and regulatory T (Treg) cells in the pathogenesis of pemphigus in fifty-one patients and twenty-six healthy individuals (control group). METHODS: Levels of CD3(+)CD8(-) IL-17 expressing Th cells and CD4(+)CD25(hi)Foxp3(+) Treg cells were determined by FACS in both groups, along with anti-Dsg1 and Dsg3 antibody titers. An analysis of the correlation between Th17 and Treg cells was performed. RESULTS: Th17 cell numbers were significantly higher in pemphigus patients than in normal controls (P = 0.014), especially in the acute onset and chronic active stages (P = 0.004 and 0.022). Conversely, Treg cells in pemphigus patients were significantly fewer than in the control group (P<0.001). The same trend was observed between the acute onset and the remittent stage patients (P = 0.006). We found a negative correlation between Th17 and Treg cell populations (r = -0.532, P<0.001). Anti-Dsg1 and Dsg3 antibody titers were higher in patients in the active stage than in the remittent stage, with an increased IgG4/IgG1 subclass ratio. There was no statistically significant correlation between Th17/Treg ratios and anti-Dsg1 or Dsg3 antibody titers. CONCLUSION: These findings show an imbalance of Th17 and Treg cell populations in pemphigus patients, which might result in the activation and proliferation of effector T cells, further up-regulating B cell activity and antibody production.

Effects of high temperature during grain filling under control conditions on the physicochemical properties of waxy maize flour.

The effects of high temperature during different grain filling stages (1-15 d and 16-30 d after pollination) on the physicochemical properties of four varieties of waxy maize grain were studied. Heat stress during grain filling decreased grain weight and starch deposition, while it increased protein content, starch granule size, abnormal granule numbers and iodine binding capacity. These effects were more severe when heat stress was introduced at early development stage than at late grain filling stage. The peak intensities and crystallinities were decreased when plants were exposed to high temperature at early development stage. By contrast, responses to high temperature at late development stage were variety-dependent. High temperature during grain filling decreased the peak and breakdown viscosities and increased the gelatinization temperature and enthalpy, and retrogradation percentage of flours, especially during early development stage. In conclusion, high temperature during grain filling changed the grain proximate and starch structure, resulting in the deterioration of pasting and thermal properties.