2003, Number 1
<< Back Next >>
Med Cutan Iber Lat Am 2003; 31 (1)
Current Concepts in Immunophatology of the Skin
Robledo PMA, Díaz LA
Language: Spanish
References: 126
Page: 3-16
PDF size: 262.58 Kb.
ABSTRACT
This review covers the most relevant scientific information on the immunopathology of the autoimmune blistering diseases, lichen planus and lupus. Emphasis has been placed on the description of the immunoassays that are important and practical for the diagnosis of these diseases. The immunofluorescence techniques continue to be important diagnostic tests available to most clinicians. They provide diagnostic, and in some cases prognostic information, useful in the management of these diseases, e.g. pemphigus. The molecular characterization of the cutaneous antigens that constitute autoantibodies targets and that are present in these autoimmune diseases have allowed investigators to develop newer assays, such as ELISA, immunoprecipitation and immunoblotting, all applicable to the precise diagnosis of each disease. The use of recombinant skin antigens to test the responses of the patients T and B lymphocytes will provide important new information on the pathogenesis of these diseases.
REFERENCES
Coons, A.H., Creech, H.J., Jones, R.N. Immunological properties of an antibody containing a fluorescent group. Pro. Soc. Biol. Med. (NY). 1941,47:200.
Coons, A.H., Creech, H.J., Jones, R N., Berliner, E. The demonstration of pneumococcal antigen in tissues by the use of fluorescent antibody. J. Immunol 1942; 45:159.
Riggs, J.L., Seiwald, R. J, Burckhalter, J., Downs, C.M., Metcalf, T.G. Isotiocyanate compounds as fluorescent labeling agent for immune serum. Am. J. Pathol 1958; 34:1081.
Felton, L.C., McMillion, C.R. Chromatographically pure fluorescein and tetramethylrhodamine isothiocyanates. Anal. Biochem 1961; 2: 178.
Oi, V.J., Glaser, A.N., Stryer, L. Fluorescent phycobiliprotein conjugates for analysis of cells and molecules. J. Cell. Biol 1982; 93:981.
Plem, J.S. The use of a vertical illuminator with interchangeable dichotic mirrors for fluorescent microscopy with incident light. Z. Wiss Mikr 1967; 68:129.
Kawamura, A-Jr., Aoyama, Y. Immunofluorescence in medical Science. University of Tokyo Press, Tokyo.1982; pp. 75-91.
Nakane, P.K., Pierce G.B. Enzyme-labeled antibodies: Preparation and application for the localization of antigens. J. Histochem. Cytochem 1966; 14:929.
Avrameas, S. Coupling of enzymes to proteins with glutar-aldehyde: Use of the conjugates for the detection of antigens and antibodies. Immunochemistry 1969; 6:43.
Roth, J., Bendayan, M., Orci, L. Ultra structural localization of intracellular antigen by the use of protein A-gold complex. J Histochem. Cytochem 1978; 26:1074.
Holgate, C., S., Jackson, P., Cowen, P. N. et al. Immunogold-silver staining: New method of immmunostaining with enhanced sensitivity. J. Histochem. Cytochem 1983; 31:938.
Talmage, D. W., Baker, H.R, Akeson, W. The separation and analysis of labeled antibodies. J. Infect. Dis1954; 94:199.
Kumon, H. Morphologically recognizable markers for scanning immunoelectron microscopy II: An indirect method using T and TMV. Virology 1976; 74:93.
Sternberg, L. A., Hardy P. H.Jr., Cuculis, J.J., Meyer, H.G. The unlabelled antibody enzyme method of immunohistochemistry: Preparation and properties of soluble antigen-antibody complex (horseradish- peroxidase- antihorseadish peroxidase) and its use in identification of spirochetes. J. Histochem 1970; 18: 315.
Hsu, S-M, Raine, L., Fanger, H. Use of avidine-biotin peroxidase complex (ABC) in immunoperoxidase techniques: A comparison between ABC and unlabelled antibody (PAP) procedures. J. Histochem. Cytochem 1981; 29: 577.
Beutner, E.H., Jordon, R.E. Demonstration of skin antibodies in sera of pemphigus vulgaris patients by direct immunofluorescent staining. Proc. Soc. Exp. Biol. Med 1964; 117:505.
Jordon, R.E., Beutner, E.H., Witebski, E. Basement zone antibodies in bullous pemphigoid. JAMA 1967; 100:751.
Burnham, T.K., Neblett, T.R., Fine, G. The application of the fluorescent antibody technique to the investigation of lupus eritematosus and various dermatoses. J. Invest. Dermatol 1963; 41:451.
Van Weemen, B.K., Shurs, A.H.W.M. Immunoassay using antigen-enzyme conjugates. FEBS Lett.1971; 15:232-236.
Engval, E., Perlmann, P. Enzyme-linked immunosorbent assay (ELISA) quantitative assay of immunoglobulin G. Immunochemistry1971; 8:871-879.
Engval, E, Permann. Enzyme-linked immunosorbent assay ELISA. III. Quantitation of specific antibodies by enzyme–labeled anti-immunoglobulin in antigen-coated tubes. J Immunol 1978; 109:129-135.
Kohler, G., Milstein, C. Continuous cultures of fused cell secreting antibody of predefined specificity. Nature 1975; 256:495.
Glover, D.M. Gene Cloning. The Mechanics of DNA Manipulation. Chapman and Hall. 1984.
Liebman JM, La Sala D, Wong W, Steed PM. When less is more: enhanced baculovirus production of recombinant proteins at very low multiplicities of infection. Biotecniques 1999; 26:36-42.
Ding X, Aoki V, Mascaro JM Jr, Lopez-Swiderski A, Díaz LA, Fairley JA. Mucosal and mucocutaneous (generalized) pemphigus vulgaris show distinct autoantibody profiles. J Invest Dermatol 1997; 109:592-6.
Ishii K, Amagai M, Hall RP, Hashimoto T, Takayanagi A, Gamou S, et al. Characterization of auto antibodies in pemphigus using antigen-specific ELISAs with baculovirus expressed recombinant desmoglieins. J Immunol 1997; 159:2010-7.
Nishikawa T. Desmoglein ELISAs. Arch Dermatol 1999; 135:195-6.
Michel B, Milner Y, David K. Preservation of tissue fixed immunoglobulins in skin biopsies of patients with lupus erythematosus and bullous diseases. J. Invest. Dermatol 1973; 59: 449.
Beutner E.H, Kumar V, Krasny S.A, Chorzelski, T.P. Defined Immunofluorescence In Immunodermatology. In: Beutner EH, Chorzelski TP, Kumar V, editors. Immunopathology of the skin. 3rd ed. New York: John Wiley & Sons; 1987;pp 3-40.
Gammon WR, Kowalewsi C, Chorzelski TP, et al. Direct immunofluorescence studies of sodium chloride-separated skin in the differential diagnosis of bullous pemphigoid and epidermolisis bullosa acquisita. J. Am Acad Dermatol 1990; 22: 664.
Amagi M, Komai A, Hashimoto T, Shirakata Y, Hashimoto K, Yamada T, et al. Usefulness of enzyme-linked immunosorbent assay (ELISA) using recombinant desmogleins 1 and 3 for sero diagnosis of Pemphigus. Br. J Dermatol 1999; 140:351-7.
Hata Y, Fujii Y, Tsunoda K, Amagai M. Production of the entire extracellular domain of Bp 180 (type XVII collagen) by baculovirus expression. J Dermatol Sci 2000; 23:183-90.
Lever WF. Pemphigus. Medicine 1953; 32:1-123.
Anhalt GJ, Labib RS, Voorhees JJ, Beals TF, Diaz La. Induction of pemphigus in neonatal mice by passive transfer of IgG from patients with the disease N Engl J Med 1982; 306:1189-96.
Roscoe JT, Díaz L, Sampaio SA, Castro RM, Labib RS, Takahashi Y, et al. Brasilian pemphigus foliaceus autoantibodies are pathogenic to BALB/c mice by passive transfer J. Invest Dermatol 1985; 85:538-41.
Díaz LA, Giudice GJ. End of century overview of skin blisters. Arch Dermatol 2000; 136:106-12.
Amagai M. Autoimmunity against desmosomal cadheins in pemphigus. J Dermatol Sci 1999; 20:92-102.
Ding X, Díaz LA Fairley JA, Giudice GJ, Lui Z.. The Anti Desmolein 1 Auto antibodies in Pemphigus Vulgaris sera are Pathogenic. J Invest Dermatol 1999; 112:739-43.
Masayuki A, Tsunoda K, Zillikens D, Nagai T, Nishikawa T. The clinical phenotype of pemphigus is defined by the anti-desmoglein autoantibody profile, J Am Acad Dermatol 1999; 40: 167-70.
Harman KE, Seed PT, Gratian MJ, Bhogal BS, Challacombe SJ, Black MM. The severity of cutaneous and oral pemphigus is related to desmoglein 1 and 3 anti-body levels. Br J Dermatol 2001; 144:775-80.
Harman KE, Gratian MI, Bhogal BS, Challacombe SJ, Black MM. A study of desmoglein 1 autoantibodies in pemphigus vulgaris: racial differences infrecuency and the association with a more severe phenotype. Br J Dermatol 2000; 143:343-8.
Miyagawa S, Amagai M, Iida T, Yamamoto Y, Nishikawa T, Shirai T. Late development of antidesmoglein 1 antibodies in pemphigus vulgaris: correlation with disease progression. Br J Dermatol 1999; 141:1084-7.
Komai A, Amagai M, Ishii K, Nishikawa T, Chorzelski T, Matsuo I, Hashimoto T. The clinical transition between pemphigus foliaceus and pemphigus vulgaris correlates well with the changes in autoantibody profile assessed by an enzyme-linked immunosorbent assay. Br J Dermatol 2001; 144:1177-82.
Santi CG, Maruta CW, Aoki V, Sotto MN, Rivitti EA, Diaz LA. Pemphigus herpetiformis is a rare clinical expression of nonendemic pemphigus foliaceus, fogo selvagem, and pemphigus vulgaris. J Am Acad Dermatol 1996; 34:40-6.
Karpati S, Amagai M, Lui WL, Dmochowski M, Hashimoto T, Horvath A. Identification of desmoglein 1 as autoantigen in a patient with intraepidermal neutrophilic IgA dermatosis type of IgA pemphigus. Exp Dermatol 2000; 9:224-8.
Kim SC, Kwon YD, Lee IJ, Chang SN, Lee TG. CDNA cloning of the 210-kD paraneoplastic pemphigus antigen reveals that envoplakin is a component of the antigen complex. J Invest Dermatol 1997; 109:365-9.
Proby C, Fuji Y, Owaribe K, Nishikawa T, Amagai M. Human autoantibodies against HD1/plectin in paraneoplasic pemphigus Invest Dermatol 1999; 112:153-6.
Mutasim DF, Adams BB Immunofluorescence in dermatology J Am Acad Dermatol 2001; 45:803-22.
Becker BA, Gaspari AA. Pemphigus vulgaris and vegetans. Dermatol. Clin 1993; 11:429-52.
Dugan EM, Anhalt G, Diaz LA. Pemphigus. In: Jordan RE, editor. Immunologic disease of the skin. Norwalk (CT): Appleton & Lange: 1991; p.279-91.
Harman KE, Gratian MJ, Bhogal BS, Challacombe SJ, Blach MM. The use of two substrates to improve the sensitivity of indirect immunofluorescence in diagnosis of pemphigus. Br J Dermatol 2000; 142:1135-9.
Nishifuji K, Amagai M, Kuwana M, Iwasaki T, Nishikawa T. Detection of antigen-specific B cell in patients with pemphigus vulgaris by enzyme linked immunospot assay: requirement of T cell collaboration for auto antibody production. J Invest Dermatol 2000; 114:88-94.
Sekiguchi M Futei Y, Fujii Y, Iwasaki T, Nishikawa T, Amagai M. Dominant auto immune epitopes recognized by pemphigus antibodies map to the n-terminal adhesive region of desmogleins. J Immuno 2001; 167:5439-48.
Crosby DL, Diaz LA. Endemic pemphigus foliaceus (fogo selvagem). In: Crosby DL, Diaz LA (G. Eds): Dermatol. Clin: Bullous diseases. W.B. Saunders Co. Philadelphia. 1993; 11:453-72.
Gomi H, Kawada A, Amagai M, Matsuo I. Pemphigus eryhematosus: detection of anti-desmoglein -1 antibodies by ELISA. Dermatology 1999; 199:188-9.
Warren SJP, Lin MS, Giudice GJ, Hoffmann RG, et al. The prevalence of antibodies against desmoglein 1 in endemic Pemphigus foliaceus in Brazil. N. Engl. J Med 2000; 343:23-30.
Amagai M. Desmoglein as a target in autoimmunity and infection. J Am Acad Dermatol 2003; 48:244-52.
Jablonska S, Chorzelski T, Beutner E. Chorzelska J. Herpetiform pemphigus, a variable pattern of pemphigus. Int J Dermatol 1975; 14:353-9.
Ishii K, Amagai M, Komai A, Ebihara T Chorzelski TP, Jablonska S Ohya K, Nishikawa T, Hashimoto T. Desmoglein 1 and Desmoglein 3 are the Target Autoantigens in Herpetiform Pemphigus. Arch Dermatol1999; 135:943-7.
Robinson ND, Hashimoto T, Amagai M, Chan LS. The new pemphigus variants: J. Am Acad Dermato 1999; 40:649-71.
Wallach D. Intraepidermal IgA pustulosis. J. Am Acad Dermatol 1992; 27:993-1000.
Snedon IB, Wilkinson DS. Subcorneal pustular dermatosis. Br J Dermatol 1979; 100: 61-8.
Hashimoto T Komai A, Futei Y Nishikawa T, Amagai M. Detection of IgA autoantibodies to desmogleins by an enzyme-linked immunosorbent assay: the presence of new minor subtypes of IgA pemphigus. Arch Dermatol 2001; 137:735-8.
Anhalt GJ, Kim SC, Stanley JR. et al. Paraneoplastic pemphigus an autoimmune mucocutaneous disease associated with neoplasia. N Engl J Med 1990; 323:1729.
Anhalt GJ. Paraneoplastic pemphigus. Adv Dermatol 1997; 12:77-97.
Horn TD, Anhalt GJ. Histologic features of paraneoplastic pemphigus. Arch Dermatol 1992; 128:1091-5.
Shaeppi H, Bauer JW, Hametner R, MetzeD, Ortiz-Urda S, Salmhofer W, Rappersberger K, Hintner H. Alocalized variant of paraneoplastic pemphigus:acantholysis associated with malignant melanoma. Br J Dermatol 2001 144:1249-54.
Beutner EH, Pelton S, Hashimoto T, Xu Y, Plunkett RW, Korman NJ, Heim TN Jablonska S. A nonfatal case and 2 fatal cases of paraneoplastic pemphigus: Can a complement indirect immunofluorescent test help to identify fatal “group A” paraneoplastic pemphigus cases? J Am Acad Dermat 2002; 47:841-51.
Kiyokawa C, Ruhrberg C, Nie Z, Karashima T, Mori O, Nishikawa T, et al. Envoplakin and periplaquin are components of the paraneoplastic pemphigus antigen complex (letter). J Invest Dermatol 1998; 111:1236-8.
Borradori L, Trueb RM, Jaunin F, Limat A, Favre B, Saurat J.H. Autoantibodies from a patient whit paraneoplastic pemphigus bind periplakin, a novel member of the plakin family (Letter). J Invest Dermatol 1998; 111:338-40.
Mahoney MG Aho S, Stanley JR. The members of the plakin family of proteins recognized by paraneoplastic pemphigus antibodies include periplakin. J Invest Dermatol 1998; 111:308-13.
Ohyama M, Amagai M, Hashimoto T, Nousari H, Anhalt GJ, Nishikawa T. Clinical phenotype and anti-desmoglein autoantibody profile in paraneoplastic pemphigus. J Am Acad Dermatol 2001; 44:593-8.
Pisani M, Ruocco V. Drug-induced pemphigus. Clin Dermatol 1986; 4:118-32.
Mutasim DF, Pelc NJ, Anhalt GJ. Drug-induced pemphigus. Dermatol Clin 1993; 11:463-71.
Korman NJ, Eyre RW, Zone j, Stanley JR. Drug-induced pemphigus: autoantibodies directed against the pemphigus antigen complex are present in penicillamine and captopril induced pemphigus. J Invest Dermatol 1991; 96:273-6.
Yokel BK, Hood AF, Anhalt GJ. Induction of acantholysis in organ explants culture by penicillamine and captopril. Arch Dermatol 1989; 125:1367-70.
Korman NJ. Bullous pemphigoid. In: Crosby DL, Diaz LA (G Eds): Dermatol. Clin: Bullous diseases. W. B. Sauders Co. Philadelphia 1993; 11:527-33.
Lui Z, Guiddice GJ, Zhou X, Swartz SJ, Troy JL Fairley JA, et al. A major roll for neutrophils in experimental bullous pemphigoid. J Clin Invest 1997; 100:1256-63.
Lui Z, Díaz LA, Troy JL, Taylor AF, Emery DJ, Fairley JA et al. A passive transfer model of the organ-specific autoimmune disease, bullous pemphigoid, using antibodies generated against the hemidesmosomal antigen, BP 180. J Clin Invest 1993; 92:2480-8.
Labib RS, Anhalt GJ, Patel, et al. Molecular heterogeneity of the bullous pemphigoid antigenes as detected by immunoblotting. J. Immunol 1986; 136:1231-5.
Diaz LA, Ratrie H, Sauders WS, et al. Isolation of a human epidermal cDNA corresponding to the 180 KD autoantigen recognized by bullous pemphigoid and herpes gestationis sera. J Clin Invest 1990; 86:1088-94.
Giudice GJ, Emery DE, Zelickson BD, et al. Bullous pemphigoid and herpes gestationis autoantibodies recognize a common non-collagenous autoantibodies ectodomain. J Immunol 1993; 151:5742-50.
Zillikens D, Mascaro JM, Rose PA, et al. A highly sensitive enzyme-linked immunosorbent assay for the detection of circulating anti- BP180 autoantibodies in patients with bullous pemphigoid. J Invest Dermatol 1997; 109:679-83.
Hata Y, Fujii Y, Tsunoda K, Amagai M. Production of the entire extracellular domain of BP 180 (type XVII collagen) by baculovirus expression. J Dermatol Sci 2000; 23:183-90.
Shornick JK. Herpes gestationis. In: Crosby DL, Diaz LA (G. Eds): Dermatol. Clin: Bullous diseases. W.B. Saunders Co. Philadelphia 1993; 11:527-33.
Morrison LH. Labib RS, Zone JJ, Et al. Herpes gestationis autoantibodies recognize a 180-KD human epidermal antigen. J Clin Invest 1988; 81:2023-26.
Mutasim DF, Pelc J, Anhalt GA. Cicatricial pemphigoid. In: Dermatol. Clin 1993; 11:499-510.
Bean SF: Cicatricial pemphigoid. In: Beutner E.H., Chorzelski T. P., Kumar (Eds): Immunopathology of the Skin. Wiley Medical Press. New York pp 1987; 355-60.
Kirtschig G, Marinkovich P, Burgeson RE, Yancey KB. Anti-basement membrane autoantibodies in patients with anti-epiligrin cicatricial pemphigoid bind the alfa-subunit of laminin 5. J Invest Dermatol 1995; 105:543-48.
Ueki H, Yaoita H. Epidermolisis bullosa acquisita. In: A Colour Atlas of Dermato-Immunohistocytology. Wolfe Medical Publication Ltd. London pp. 1989; pp 72-73.
Gammon WR. Briggaman RA. Epidermolysis bullosa acquisita and bullous systemic lupus eritematosus: Diseases of autoimmunity to type VII collagen. In: Crosby DL, Diaz LA (G. Eds): Dermatol. Clin: Bullous diseases. W.B. Saunders Co. Philadelphia 1993; 11:535-547.
Gammon WR, Wilson BD, Briggamn RA. Epidermolysis bullosa acquisita. In: Beutner EH, Chorzelski TP, Kumar V, editors. Immunopathology of the skin. 3rd ed. New York: John Wiley & Sons 1987; pp 383-98.
93.Ghohestani RF, Nicolas JF, Rouselle P, Claudy AL. Diagnostic value of indirect immunofluorescence on sodium chloride-split skin in differential diagnosis of sub epidermal autoimmune bullous dermatoses. Arch Dermatol 1997; 133:1102-7.
Feliciani C, Di Muzio M, Mohammad Pour S, Allegretti T, Amerio P, Toto P, Coscione G, Proietto G, Amerio P. Suction split’ as a routine method to differentiate epidermolysis bullosa acquisita from bullous pemphigoid. J Eur Acad Dermatol Venereol 1998; 10:243-7.
Fine JD, Hintner H, Katz SI. Immunofluorescence studies in Epidermolysis bullosa utilizing polyclonal and monoclonal Antibodies. In: Beutner EH, Chorzelski TP, Kumar V, editors. Immunopathology of the skin. 3rd ed. New York: John Wiley & Sons 1987; pp 399-405.
Karpati S, Stolz W, Meurer M Braun-Falco O, Krieg T. In situ localization of IgG in epidermolisis bullosa acquisita by immunogold technique. J Am Acad Dermatol 1992; 27:280.
Briggaman RA, Gammon WR. Epidermolisis bullosa acquisita and other acquired blister diseases manifesting autoimmunity type VII collagen. Curr Prob Dermatol 1991; 3:47-74.
Gammon WR. Herman Pincus Memorial Lecture 1992. Autoimmunity to collagen VII: Autoantibody mediated pathomechanisms regulate clinical-pathological phenotypes of acquired epidermolysis bullosa and bullous SLE.J Cutan Pathol 1993; 20:109-14.
Chan LS, Lapiere J Ch, Chen M, Traczyk T, Mancini AJ, Paller AS, Woodley DT, Marinkovich MP. Bullous systemic lupus erythematosus with autoantibodies recognizing multiple skin basement membrane components, bullous pemphigoid antigen 1, laminin-5, laminin –6, and type VII collagen. Arch Dermat 1999,135:569-573.
Leonard JN, Haffenden GP, Fry L. Dermatitis herpetiformis. In: Beutner EH, Chorzelski TP, Kumar V, editors. Immunopathology of the skin. 3rd ed. New York: John Wiley & Sons 1987; pp 433-453.
Smith EP, Zone JJ. Dermatitis Herpetiformis and linear IgA bullous dermatosis. In: Crosby DL, Diaz LA (G. Eds): Dermatol. Clin: Bullous diseases. W.B. Saunders Co. Philadelphia 1993; 11:511-526.
Kumar V, Jarzabek-Chorzelska M, Sulej J, Rajadhyaksha M, Jablonska S. Tissue transglutaminase and endomisian antibodies-diagnostic markers of gluten-sensitive enteropathy in dermatitis herpetiformis. Clin Immunol 2001; 98: 378-82.
Dahele AV, Aldhous MC, Humphreys K, Ghosh S. Serum IgA tissue transglutaminase antibodies in celiac disease and other gastrointestinal diseases. QJM 2001; 94:195-205.
Kanitakis J, Mauduit G, Cozzani E, et al. Linear IgA bullous dermatosis of childhood with autoantibodies to a 230 kD epidermal antigen. Pediatric Dermatol 1994; 11:139-44.
Zillikens D, Herzele K, Georgi M Schmidt E, Chimanovitch I, Schumann H, Mascaró JM JR, Diaz LA, Bruckner-Tuderman L, Brocker EB, Giudice GJ. Autoantibodies in a subgroup of patients with linear IgA disease react with the NC16A domain of BP 180. J Invest Dermatol 1999; 113:947-53.
Zillikens D, Kawahara Y, Ishiko A, et al. A novel subepidermal blistering disease with autoantibodies to a 200-kDa antigen of the basement membrane zone. J Invest Dermatol 1996; 106:1333-8.
Mascaró JM, Zillikens D, Giudice GJ, et al. A subepidermal bullous eruption associated with IgG autoantibodies to a 200 Kd dermal antigen: The first case report from the United States. J Am Acad Dermatol 2000; 42:309-15.
Bergfeld WF, Valenzuela R, Beutner EH. Lichen planus. In: Beutner EH, Chorzelski TP, Kumar V, editors. Immunopathology of the skin. 3rd ed. New York: John Wiley & Sons; 1987.pp 647-58.
Weigand DA, Ziegler TR. Lichen planus. In: Jordon RE, editor. Immunologic disease of the skin. Norwalk (CT): Appleton & Lange; 1991.pp. 623-9.
Faille-Kuyper EH, Faille H. An immunopathology: the diagnostic use of direct and indirect immunofluorescence techniques in dermatologic disease. Hum Pathol 1979; 90:365-71.
Abell E, Presbury DGC, Marks R, Ramnarain D. The diagnostic significance of immunoglobulin and fibrin deposition in lichen planus. Br J Dermatol 1975; 93:17-24.
Davis AL, Bhogal BS, Whitehead P, et al. Lichen planus penfigoides: Its relationship to bullous pemphigoid. Br J Dermatol 1991; 125: 263.
Whitehead P, Bhogal BS, Das AK, et al. Lichen planus pemphigoides: A clinicopathological study of nine cases. Histopatology 1991; 19: 147.
Zillikens D, Caux F, Mascaro JM, Wesselmann U, Schmidt E, Prost C, Callen JP, Brocker EB, Diaz LA, Giudice GJ. Autoantibodies in lichen planus pemphigoides react with a nove epitope within the C-terminal NC16A domain of BP180. J Invest Dermatol 1999; 113: 117-21.
Tan EM, Cohen AS, Fries JF, Masi AT, McShane D J, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erytematosus. Arthitis Rheum 1982; 25:1271-7.
Cormane RH. “Bound” globulin in the skin of patients whit chronic discoid lupus erytematosus and systemic lupus erythematosus. Lancet 1964; 1:534.
Dahl MV, Gilliam JN. Direct Immunofluorescence in Lupus Erythematosus. In: Beutner E.H, Chorzelski T. P., Kumar (Eds): Immunopathology of the Skin. Wiley Medical Press. New York 1987; pp 499-516.
Burnham TK, Bank PW. Antinuclear antibodies: I. Patterns of nuclear immunofluorescence. J Invest Dermatol 1974; 62:526-34.
Burnham TK. Antinuclear antibodies: II. The prognostic significance of nuclear immunofluorescent patterns in lupus erytematosus. Arch Dermatol 1975; 111:203-7.
Ulvestad E. Performance characteristics and clinical utility of a hybrid ELISA for detection of ANA. APMIS 2001; 109:217-22.
Linnemann M, Geisen C, Menn S, Dinser R, Herzberg C, Wielckens K. Compararison of three different ds-DNA ELISA with special regard to their efficiency in the diagnosis of systemic lupus eritematosus. In: Conrad K, Humbel R-L, Meurer M, Shoenfeld Y, Tan EM (ed). Autoantigens and Autoantibodies: Diagnostic Tools and Clues to Understanding Autoimmunity. Lengerich: PABST Science Publishers; 2000.
Kumar V, Beutner EH, Dabski K et al. A standardized method of detecting antibodies to extractable nuclear antigens (RNP and Sm) by gel precipitation. J Clin Lab Immunol 1984; 15:163-66.
Struckmann J, Manthorpe R, Bendixen G.: Anti-ENA antibodies in serum determined by ELISA-e-technique. Description of method and recommended procedure. Allergy 1981; 36:397-403.
Yasuma M, Takasaki Y, Matsumoto K, Kodama A, Hashimoto H, Hirose S. Clinical significance of IgG anti-Sm antibodies in patients with Lupus Erythematosus.J Reumatol 1990; 17:469-75.
Amoura Z, Koutouzov S, Chabre H, Cacoub P, Amoura I, Musset L, et al. Presence of antinucleosome autoantibodies in a restricted set of connective tissue diseases. Antinucleosome antibodies of the IgG subclass are markers of renal pathogenity in systemic lupus eritematosus. Arthritis Rheum 2000; 43:76-84.
Koutouzov S, Bach JF, Jerónimo A, Campos H, Peitte JC, Amoura Z.: The antinucleosome antibodies. Clinical significance and role in the diagnosis of autoimmune diseases. In: Conrad K, Humbel R-L, Meurer M, Shoenfeld Y, Tan EM (ed). Autoantigens and Autoantibodies: Diagnostic Tools and Clues to Understanding Autoimmunity. Lengerich: PABST Science Publishers; 2000.