Autoimmunity to Desmocollin 3 in Pemphigus Vulgaris

Pemphigus vulgaris is a blistering disease associated with autoantibodies to the desmosomal adhesion protein desmoglein 3 Genetic deficiency of desmoglein 3 in mice mimics autoimmunity to desmoglein 3 in pemphigus vulgaris with mucosal dominant blistering in the suprabasal layer of the epidermis Mice with an epidermal specific deletion of desmocollin 3, the other major desmosomal cadherin isoform ex pressed in the basal epidermis develop suprabasal blisters m skin that are histologically identical to those observed in pemphigus vulgaris suggesting that desmocollin 3 might be a target of autoantibodies in some pemphigus vulgaris patients We now demonstrate that desmocollin 3 is an autoantigen m pemphigus vulgaris illustrated in a patient with mucosal dominant blistering Six of 38 pemphigus vulgaris and one of 85 normal serum samples immunoprecipitate desmocollin 3 (P = 0 003) Incubation of patient IgG with human keratinocytes causes loss of intercellular adhesion and adsorption with recombinant desmocollin 3 specifically prevents this pathogenic effect Additionally anti desmocollin 3 sera cause loss of keratinocyte cell surface desmocollin 3 but not desmoglein 3 by immunofluorescence indicating distinct cellular pathogenic effects in anti desmocollin and anti desmoglein pemphigus despite their identical clinical presentations These data demonstrate that desmocollin 3 is a pathogenic autoantigen in pemphigus vulgaris and suggest that pemphigus vulgaris is a histological reaction pattern that may result from autoimmunity to desmoglein 3 desmocollin 3 or both desmosomal cadherins (Am J Pathol 2010 177 2724-2730; DOI 10 2353/ajpath 2010 100483)