Autoantibody detection in bullous pemphigoid: Clinical evaluation of the EUROPLUS™ Dermatology Mosaic

• Published in: Journal of immunological methods 2012-08, Vol.382 (1-2), p.76-80
• Main Authors: Damoiseaux, Jan, van Rijsingen, Margit, Warnemünde, Nicole, Dähnrich, Cornelia, Fechner, Kai, Cohen Tervaert, Jan Willem
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Autoantibodies; Autoantibodies - blood; Autoantibodies - immunology; Autoantibody; Bullous pemphigoid; Dermatology; Diagnosis; Enzyme-Linked Immunosorbent Assay; Esophagus; Female; fluorescent antibody technique; histopathology; Humans; Immunofluorescence; Inflammatory diseases; Male; Mosaics; patients; Pemphigoid, Bullous - blood; Pemphigoid, Bullous - immunology; Pemphigus foliaceus; Retrospective Studies; Sensitivity and Specificity; Skin diseases
• ISSN: 0022-1759; 1872-7905
• DOI: 10.1016/j.jim.2012.05.007

Bullous pemphigoid (BP) is an autoimmune blistering skin disease. Autoantibodies to BP180 and BP230 can be detected by indirect immunofluorescence (IIF) on different substrates (oesophagus, salt-split-skin, BP180-antigen dots, BP230-transfected cells) and ELISA. Here, we compared test characteristics of these test systems. We analysed sera from BP patients (n=60) in whom the clinical diagnosis had been confirmed histopathologically. The control cohort comprised sera from patients with other autoimmune-associated (n=22) or inflammatory (n=35) skin diseases. All samples were tested by IIF (EUROIMMUN™ Dermatology Mosaic) and ELISA (EUROIMMUN and MBL). Anti-BP180 is best detected with BP180-antigen dots by IIF (sensitivity: 88%; specificity: 97%). As compared to IIF, the differences with both BP180 ELISA techniques are small though. Likelihood ratios (LRs) for positive and negative test results are >10 and between 0.1 and 0.2, respectively, for all test systems. Detection of anti-BP230 is highly variable (sensitivity range 38–60%; specificity range 83–98%). Only the IIF test reveals a LR for positive test results >10. Since the LRs for a negative test are all ~0.5, negative test results for anti-BP230 antibodies do not help to exclude BP. In conclusion, the multi-parameter IIF test reveals a good diagnostic performance in BP. Since this test simultaneously allows for the detection of anti-Dsg1 and anti-Dsg3 antibodies, involved in pemphigus foliaceus and vulgaris, a single test-incubation may be sufficient to differentiate between the most frequent autoimmune blistering diseases. ► Anti-BP180, but not anti-BP230 ab, is useful in the diagnosis of BP. ► The multiplex biochip enables detection of anti-BP180 ab on multiple substrates. ► The biochip reveals very good test characteristics for detection of anti-BP180 ab.