The Autoantigen in Anti-p200 Pemphigoid Is Synthesized by Keratinocytes and Fibroblasts and Is Distinct from Nidogen-2 Silke C. Hofmann, Ursula Voith,

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The Autoantigen in Anti-p200 Pemphigoid Is Synthesized by Keratinocytes and Fibroblasts and Is Distinct from Nidogen-2 Silke C. Hofmann, Ursula Voith, Takako Sasaki, Ralph M. Trüeb, Roswitha Nischt, Leena Bruckner-Tuderman Journal of Investigative Dermatology Volume 128, Issue 1, Pages 87-95 (January 2008) DOI: 10.1038/sj.jid.5700952 Copyright © 2008 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Patient P1 displays clinical, histological, and IF findings compatible with anti-p200 pemphigoid. (a and b) Clinically, the patient presented with disseminated small blisters and erosions. (c) Hematoxylin-eosin-stained histology demonstrated subepidermal blistering with a mixed inflammatory infiltrate (bar=100μm) and (d) direct IF using a FITC-labeled antihuman C3 antibody (DAKO) showed linear C3 deposits at the dermal–epidermal junction (bar=50μm). Journal of Investigative Dermatology 2008 128, 87-95DOI: (10.1038/sj.jid.5700952) Copyright © 2008 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 P200 is expressed by keratinocytes and fibroblasts in vitro. (a) The extractability of p200 is dependent on the presence of EDTA in contrast to collagen XVII. Extracts of normal human keratinocytes (KE) were prepared in the presence (+) or absence (−) of EDTA, subjected to 7% SDS-PAGE under reducing conditions and immunoblotted with anti-p200 pemphigoid serum and a well-characterized BP serum containing autoantibodies to 180kDa-collagen XVII. Migration positions of molecular weight marker (kDa) are shown on the left. (b) p200 is expressed by primary and immortalized keratinocytes. Extracts from normal human keratinocytes (KE), HaCaT keratinocytes (HE), and SCC-25 cells (SE) were assessed for the presence of p200 and the BP-autoantigen collagen XVII. (c) p200 is present in extracts of fibroblasts. Extracts of keratinocytes (KE) and fibroblasts (FE), and conditioned medium of keratinocytes (KM) and fibroblasts (FM) were reacted with anti-p200 sera P1–P3 and a BP serum. Sera of patients P1–P3 recognized p200 in extracts of keratinocytes and fibroblasts (black arrow) and a 170kDa-band in fibroblast medium (white arrow). In fibroblast medium, some additional weak bands are also visible, the identity and specificity of which remains unknown at present. As expected, the BP serum reacted with 180kDa-collagen XVII (black arrowhead) and its shed 120kDa ectodomain (white arrowhead), but did not display immunoreactivity with fibroblast extracts or medium. Additional controls with normal human sera did not show reactivity with keratinocytes or fibroblasts (not shown). Journal of Investigative Dermatology 2008 128, 87-95DOI: (10.1038/sj.jid.5700952) Copyright © 2008 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Keratinocyte-derived p200 is distinct from the major basement membrane proteins. Keratinocyte extracts were separated on a 4.5–15% gradient gel and transferred to nitrocellulose, which was subsequently incubated with NC1F3 antibodies to collagen VII (290kDa, lane 1), BP serum containing autoantibodies to BP230 (230kDa, lane 2) or collagen XVII (180kDa, lane 3), the 9LN5 antibody to the α3-chain of laminin 332 (165kDa, lane 4), serum of P1 (lane 5), and a normal human serum (lane 6). The antibodies were visualized by alkaline phosphatase-conjugated anti-rabbit or anti-human IgG. The migration positions of molecular weight markers (kDa) are indicated on the left. Journal of Investigative Dermatology 2008 128, 87-95DOI: (10.1038/sj.jid.5700952) Copyright © 2008 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Keratinocyte-derived p200 is an N-glycosylated non-collagenous protein. (a) Collagenase digestion. The untreated (lane 1 and 3) and digested keratinocyte extract (lane 2 and 4) was immunostained with anti-p200 serum P1 (lane 1 and 2) and the NC1F3-antibody to collagen VII (lane 3 and 4). Although p200 was collagenase resistant, collagen VII was cleaved to yield the 145kDa non-collagenous NC1-domain. Collagenase digestion of collagen XVII has been previously published by us and yielded a fragment of about 65kDa corresponding to the endodomain (Schäcke et al., 1998). (b and c) Trypsin and N-glycosidase F digestion. Immunoreacitivity of anti-p200 serum P1 (lane 1, before digestion; lane 2, after digestion) was compared with a BP-serum containing autoantibodies against collagen XVII (lane 5, before digestion; lane 6, after digestion). Trypsin digestion of keratinocyte extracts completely abolished reactivity with anti-p200 sera, in contrast to collagen XVII, which was cleaved to the trypsin resistant triple-helical fragment of about 90kDa (Franzke et al., 2004). Deglycosylation with N-glycosidase F resulted in a small increase in the electrophoretic mobility of p200, similarly to collagen XVII. Journal of Investigative Dermatology 2008 128, 87-95DOI: (10.1038/sj.jid.5700952) Copyright © 2008 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 p200 is distinct from collagen XVII, collagen VII, or laminin 332 and colocalizes with nidogen-2. (a, e, i) For indirect IF, a representative BP serum with autoantibodies to BP230 and collagen XVII, anti-p200 pemphigoid serum P1 and polyclonal nidogen-2 antibodies were incubated with sections of normal human salt-split-skin (SSS), (b, f, j, m) lesional skin of a patient with dystrophic EB Hallopeau–Siemens, (c, g, k, n) lesional skin of a patient with Herlitz JEB, (d, h, l, o) and lesional skin of a patient with non-Herlitz JEB. (m) The absence of collagen VII, (n) laminin 332, and (o) collagen XVII from the skin was verified by antibodies LH 7.2 to the NC1-domain of collagen VII, BM165 to human laminin α3 chain, and ColXVII-NC16a to human collagen XVII, respectively (controls). Immunoreactivity was visualized with FITC-conjugated antihuman IgG4, anti-rabbit IgG or anti-mouse IgG. BP autoantibodies bind to the epidermal side of the split in all specimens. Anti-p200 serum and nidogen-2 antibodies label the dermal side of the blister in JEB and the epidermal side in dystrophic EB (bar=50μm). Journal of Investigative Dermatology 2008 128, 87-95DOI: (10.1038/sj.jid.5700952) Copyright © 2008 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 6 Nidogen-2 is distinct from p200. (a) Fibroblast extracts (FE) were separated by 7% SDS-PAGE and assayed for immunoreactivity with anti-p200 serum and polyclonal nidogen-2 antibodies (Nd-2). Both antibodies recognize a protein of identical size. (b) To verify whether nidogen-2 is the candidate autoantigen of anti-p200 pemphigoid, 5μg of recombinant human nidogen-2 were immunoblotted with anti-p200 sera. Comparison of the reactivities of anti-p200 sera and nidogen-2 antibodies shows that p200 is distinct from nidogen-2. The migration positions of molecular weight markers (kDa) are indicated on the left. Journal of Investigative Dermatology 2008 128, 87-95DOI: (10.1038/sj.jid.5700952) Copyright © 2008 The Society for Investigative Dermatology, Inc Terms and Conditions