Severity and Phenotype of Bullous Pemphigoid Relate to Autoantibody Profile Against the NH2- and COOH-Terminal Regions of the BP180 Ectodomain Silke.

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Severity and Phenotype of Bullous Pemphigoid Relate to Autoantibody Profile Against the NH2- and COOH-Terminal Regions of the BP180 Ectodomain Silke C. Hofmann, Sybille Thoma-Uszynski, Angelika Stauber, Gerold Schuler, Michael Hertl, M.D. Journal of Investigative Dermatology Volume 119, Issue 5, Pages 1065-1073 (November 2002) DOI: 10.1046/j.1523-1747.2002.19529.x Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Scheme of the BP180 recombinants utilized in this ELISA study. (A) BP180 is a type II transmembrane protein containing an intracellular domain (ICD), a transmembrane domain, and an ECD with 15 interrupted collagenous domains. The extracellular NC16A domain is located adjacent to the plasma membrane. The recombinant BP180 fusion proteins are composed of a 6xHis and a GST-tag at the NH2 end, followed by the antigenic epitopes at the COOH-terminus. BP180-N contains the NC16A domain and the collagenous domain Col15 (aa 490–811), and BP180-C encompasses the COOH-terminal domains NC3–NC1 (aa 1351–1497). (B) The purified BP180 recombinants were transferred to nitrocellulose membranes and detected with a monoclonal anti-GST antibody. Lane 1, BP180-N; lane 2, BP180-C; lane 3, GST/6xHis. Numbers shown on the left refer to molecular weight marker. Journal of Investigative Dermatology 2002 119, 1065-1073DOI: (10.1046/j.1523-1747.2002.19529.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Rabbit sera raised against BP180-N and BP180-C bind to the epidermal site of saline-split human skin. Rabbits were immunized with BP180-N and BP180-C, respectively, and sera were collected 12 wk after immunizations. (A) Sera from rabbits raised against BP180-N (NH2-terminus of the BP180 ectodomain) immunoblotted BP180-N protein and cross-reacted with the epidermal roof of saline-split human skin. (B) Accordingly, rabbit sera raised against BP180-C (COOH-terminus of the BP180 ectodomain) immunoblotted BP180-C protein and cross-reacted with the epidermal roof of saline-split human skin. Lane 1, BP180-N; lane 2, BP180-C. Numbers shown on the left refer to molecular weight marker. Journal of Investigative Dermatology 2002 119, 1065-1073DOI: (10.1046/j.1523-1747.2002.19529.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Detection of IgG against the NH2-terminal and COOH-terminal regions of the BP180 ectodomain in BP sera. Detection of serum IgG against the NH2-terminus (BP180-N, top panel) and the COOH-terminus (BP180-C, bottom panel) of the BP180 ectodomain shown as scatter plots and ROC curves (insets). Sera of patients with active BP (n=116) and 100 control sera (NHS, normal human sera; PV, pemphigus vulgaris sera) were incubated with 0.5 μg of immobilized BP180-N and BP180-C proteins. IgG binding was detected with an AP-labeled antihuman IgG antibody. Each sample was run in duplicate and plotted dots represent the mean of the OD reading at 405 nm of a serum sample with BP180 recombinants normalized against IgG reactivity with recombinant GST/6xHis. The solid lines indicate the cut-off values as evaluated by maximization of the Youden index. Journal of Investigative Dermatology 2002 119, 1065-1073DOI: (10.1046/j.1523-1747.2002.19529.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Serologic classification of the investigated BP sera. The sera of all 116 BP patients with clinically active disease were positive by indirect immunofluorescence on saline-split human skin. All the BP sera showed IgG reactivity with the epidermal side (and dermal side in two sera) of the saline-split human skin. Reactivity against the BP180 ectodomain (BP180-N, BP180-C, or BV13), the COOH-terminus of BP230, and laminin 5 was determined by ELISA with recombinant (BP180-N, BP180-C, BV13, BP230) and native (laminin 5) proteins, respectively. Journal of Investigative Dermatology 2002 119, 1065-1073DOI: (10.1046/j.1523-1747.2002.19529.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Distribution of IgG1, IgG4, IgE, and IgA reactivity of BP sera against the NH2- and COOH-terminal regions of the BP180 ectodomain. BP sera and control sera (data not shown) were incubated with immobilized recombinant BP180-N (top panel) and BP180-C (bottom panel) and probed with one of a series of AP- or peroxidase-conjugated antibody specific for IgG1, IgG4, IgE, and IgA (as indicated on the horizontal axes). Each sample was run in duplicate and results are expressed as mean of OD reading at 405 nm. Solid lines indicate the cut-off values as evaluated by maximization of the Youden index (see Table II). Journal of Investigative Dermatology 2002 119, 1065-1073DOI: (10.1046/j.1523-1747.2002.19529.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 6 The titers of IgG against the NH2-terminus of the BP180 ectodomain are related to the clinical activity of BP. Ninety-five sera from BP patients reactive to the NH2-terminus of the ECD of BP180 (BP180-N) with generalized (n=62), localized (n=27), and remittent (n=6) disease were compared with regard to IgG, IgG1, and IgG4 reactivity against BP180-N using a multivariate analysis of covariance. Sera obtained from BP patients with extensive BP showed significantly higher IgG and IgG1 levels than patients with localized or remittent disease. The difference was not as significant when sera were analyzed for IgG4 reactivity. Bars indicate the geometric mean (see Table IV). Journal of Investigative Dermatology 2002 119, 1065-1073DOI: (10.1046/j.1523-1747.2002.19529.x) Copyright © 2002 The Society for Investigative Dermatology, Inc Terms and Conditions