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Prospective studies on the routine use of a novel multivariant enzyme-linked immunosorbent assay for the diagnosis of autoimmune bullous diseases - 18/04/17

Doi : 10.1016/j.jaad.2016.11.002 
Nina van Beek, MD a, Cornelia Dähnrich, PhD d, Nora Johannsen, PhD d, Susanne Lemcke, PhD a, b, c, Stephanie Goletz, PhD b, Franziska Hübner, MD a, Giovanni Di Zenzo, MD e, Marian Dmochowski, MD f, Kossara Drenovska, MD, PhD g, Shamir Geller, MD h, Michael Horn, MD i, Cezary Kowalewski, MD j, Ljiljana Medenica, MD, PhD k, Dedee F. Murrell, MD l, Aikaterini Patsatsi, MD m, Soner Uzun, MD n, Snejina Vassileva, MD, PhD g, Detlef Zillikens, MD a, c, Wolfgang Schlumberger, PhD d, Enno Schmidt, MD, PhD a, b,
a Department of Dermatology, University of Lübeck, Lübeck, Germany 
b Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany 
c Human Immunophenotyping Laboratory, University of Lübeck, Lübeck, Germany 
d Institute of Experimental Immunology, Euroimmun, Lübeck, Germany 
e Molecular and Cell Biology Laboratory, Rome, Italy 
f Autoimmune Blistering Dermatoses Section, Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland 
g Department of Dermatology and Venereology, Medical Faculty of Medicine, Sofia, Bulgaria 
h Dermatology Department Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel 
i University Institute of Clinical Chemistry and Center of Laboratory Medicine, Inselspital, Bern, Switzerland 
j Dermatology and Immunodermatology, Medical University of Warsaw, Warsaw, Poland 
k Department of Dermatology, University of Belgrade, School of Medicine Pasterova 2, Belgrade, Serbia 
l Department of Dermatology St George Hospital, University of New South Wales School of Medicine, Sydney, Australia 
m Second University Dermatology Department, Aristotle University School of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece 
n Akdeniz University Faculty of Medicine Department of Dermatology, Antalya, Turkey 

Reprint requests: Enno Schmidt, MD, PhD, Lübeck Institute of Experimental Dermatology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.Lübeck Institute of Experimental DermatologyUniversity of LübeckRatzeburger Allee 160D-23538LübeckGermany

Abstract

Background

Serologic diagnosis of autoimmune blistering disease (AIBD) usually follows a sophisticated multistep algorithm.

Objective

We sought validation of a multivariant enzyme-linked immunosorbent assay (ELISA) in the routine diagnosis of AIBD.

Methods

The multivariant ELISA comprising 6 recombinant immunodominant forms of major AIBD target antigens, ie, desmoglein 1, desmoglein 3, envoplakin, BP180, BP230, and type VII collagen was applied in: (1) a cohort of well-characterized AIBD (n = 173) and control sera (n = 130), (2) a prospective multicenter study with 204 sera from patients with newly diagnosed AIBD with positive direct immunofluorescence microscopy, and (3) a prospective monocenter study with 292 consecutive sera from patients with clinical suspicion of AIBD in comparison with the conventional multistep diagnostic algorithm.

Results

Concordant results in the multivariant ELISA compared with direct immunofluorescence microscopy were seen in 94% of patients with pemphigus and 71% of patients with pemphigoid (Cohen κ value, 0.95 and 0.66) and with the conventional multistep diagnostic approach in 91% of patients with pemphigus and 88% of patients with bullous pemphigoid and 93% of autoantibody-negative sera (Cohen κ, 0.95, 0.84, and 0.78).

Limitations

IgA autoantibodies and less common target antigens were not analyzed.

Conclusions

The multivariant ELISA is a practical, highly standardized, and widely available novel diagnostic tool for the routine diagnosis of AIBD.

Le texte complet de cet article est disponible en PDF.

Key words : autoantibody, blistering, bullous pemphigoid, epidermolysis bullosa acquisita, pemphigus

Abbreviations used : AIBD, ELISA, IF


Plan


 Drs van Beek and Dähnrich contributed equally to this article.
 Supported by the Schleswig-Holstein Cluster of Excellence Inflammation at Interfaces (DFG EXC306/2), the Clinical Research Unit 303 Pemphigoid Diseases (SCHM 1686/7-1, BE 5866/1-1), and the Australasian Blistering Diseases Foundation (ABDF2013/HYCZNCMKDM/1).
 Disclosure: Drs Schmidt and Zillikens have a scientific collaboration with Euroimmun. Drs Dähnrich and Johannsen are employed at Euroimmun. Dr Dähnrich is a shareholder of Euroimmun. Dr Schlumberger is vice-president and shareholder of Euroimmun. Drs van Beek, Lemcke, Goletz, Hübner, Di Zenzo, Dmochowski, Drenovska, Geller, Horn, Kowalewski, Medenica, Murrell, Patsatsi, Uzun, and Vassileva have no conflicts of interest to declare.
 Supplemental material is available at www.jaad.org/.


© 2016  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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P. 889 - mai 2017 Retour au numéro
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