Direct Immunofluorescence Using Non-Lesional Buccal Mucosa in Mucous Membrane Pemphigoid

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2018 Feb 24

PMID 29473040

Citations 9

Authors

Mayumi Kamaguchi

Hiroaki Iwata

Inkin Ujiie

Hideyuki Ujiie

Jun Sato

Yoshimasa Kitagawa

Hiroshi Shimizu

Affiliations

Soon will be listed here.

Abstract

Mucous membrane pemphigoid (MMP) is a rare organ-specific autoimmune subepithelial blistering disease with predominantly mucosal erosions, most frequently affecting the gingiva. Erosions in the oral cavity usually result in markedly decreased quality of life. The major autoantigens are BP180 and laminin332, which are components of basement membrane proteins in the skin and mucosa. Diagnosis is usually difficult due to histological destruction of the tissue and low autoantibody titers. In this study, we evaluated the diagnostic value of direct immunofluorescence (DIF) using non-lesional buccal mucosa in seven cases of MMP. In all seven patients, gingival lesions were clinically observed, and in one of the seven patients, buccal lesions were also clinically observed. First, we performed DIF to detect tissue-bound autoantibodies and complement. DIF from non-lesional buccal mucosa revealed linear deposits of IgG and C3 at the basement membrane zone in all cases. To detect autoantibodies, indirect immunofluorescence (IIF), BP180-NC16A ELISA and immunoblotting were performed. Surprisingly, circulating autoantibodies were unable to be detected in any of the cases by ELISA, IIF, or immunoblotting. Furthermore, histological separation was observed in one patient. In conclusion, DIF using non-lesional buccal mucosa was found to be superior to histological and serological tests for diagnosing mucous membrane pemphigoid. The procedure is technically easy and has high diagnostic value.

Citing Articles

Diagnostic Utility of Immunofluorescence in Oral Lesions: a Systematic Review.

Arockiam S, Raj B, Prabha N, Dharani M J Oral Maxillofac Res. 2024; 15(3):e2.

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Oral biopsy in mucous membrane pemphigoid and pemphigus vulgaris with gingival expression: the optimal site. A systematic review and meta-analysis.

Dridi S, Lutz C, Gaultier F, Bellakhdar F, Jungo S, Ejeil A BMC Oral Health. 2024; 24(1):1093.

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Low pH condition impairs BP-IgG binding to the basement membrane zone.

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Direct Immunofluorescence of Skin and Oral Mucosa: Guidelines for Selecting the Optimum Biopsy Site.

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