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      A SYSTEMATIC METANALYSIS ON DIAGNOSTIC VALUE OF DsG3 ELISA FOR PEMPHIGUS VULGARIS

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      Indian Journal of Dermatology
      Medknow Publications

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          Abstract

          Sir, Pemphigus vulgaris is an important dermatological immune disorder. It presents with blistering skin lesions. Recently, enzyme-linked immunosorbent assay (ELISA) using desmoglein (Dsg) 3 has become the new diagnostic tool for this skin disease. The diagnostic value of Dsg3 ELISA test is varied in different settings. In addition, most reports on the diagnostic value of Dsg3 ELISA contained only a few subjects. Therefore, a systematic metanalysis on this topic is required. In this paper, the author summarizes the diagnostic value of Dsg3 ELISA for pemphigus vulgaris. There are four quoted papers[1–4] on this topic. There are 232 cases and 446 controls [Table 1]. According to this study, the overall sensitivity and specificity are equal to 90.5 and 98.7%, respectively. This can imply the good diagnostic property of Dsg3 ELISA for pemphigus vulgaris. Table 1 Reports on diagnostic value of Dsg3 ELISA for pemphigus vulgaris Authors Number of subject Sensitivity (%) Specificity (%) Cases Controls Huang et al.[1] 20 114 85 99.1 Harmann et al.[2] 82 77 95 98 Amagai et al.[3] 81 179 85.2 100 Ishi et al.[4] 49 76 94 96

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          The clinical phenotype of pemphigus is defined by the anti-desmoglein autoantibody profile.

          Some patients with pemphigus vulgaris (PV) have mucous membrane erosions with minimal skin involvement (mucosal dominant type), and others show extensive skin blisters and erosions in addition to mucous membrane involvement (mucocutaneous type). Patients with pemphigus foliaceus (PF) show only skin involvement. The purpose of this study is to determine whether there is a difference in autoantibody profile among mucosal dominant PV, mucocutaneous PV, and PF. Antibody titer against desmoglein 1 (Dsg 1) and desmoglein 3 (Dsg3) were measured with enzyme-linked immunosorbent assay using recombinant Dsg1 and Dsg3. Sera were obtained during clinically active disease from 24 patients with mucosal dominant PV, 20 with mucocutaneous PV, and 23 with PF. All sera samples from patients with mucosal dominant PV sera were negative against Dsgl but positive against Dsg3. All sera samples from those with mucocutaneous PV were positive against both Dsg1 and Dsg3. All sera samples from patients with PF were positive against Dsg1, but negative against Dsg3. Each subtype has its own anti-Dsg autoantibody profile, indicating that the clinical phenotype of pemphigus is defined by the autoantibody profile.
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            Diagnosis of pemphigus by ELISA: a critical evaluation of two ELISAs for the detection of antibodies to the major pemphigus antigens, desmoglein 1 and 3.

            Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are characterized by autoantibodies to the desmosomal glycoproteins desmoglein 3 (Dsg 3) and Dsg 1 (Dsg 1), respectively. In this study, two enzyme-linked immunosorbent assays (ELISA) which detect IgG autoantibodies to Dsg 1 and Dsg 3 have been evaluated. A total of 317 normal and disease controls, 82 patients with PV and 25 with PF were studied. The Dsg 3 ELISA was positive in all 34 patients with untreated PV and the Dsg 1 ELISA was positive in all 10 with untreated PF. When patients undergoing treatment were included, the sensitivities fell to 95% and 92%, respectively, but still compared favourably to the sensitivity of indirect immunofluorescence which was 79% in PV and 84% in PF. All PF sera were negative in the Dsg 3 ELISA and the specificity of both assays was 98% or greater. Large numbers of samples could be analysed simultaneously over a relatively short time period. The Dsg 1 and Dsg 3 ELISAs also provided objective, quantitative, reproducible data which allowed differentiation of PV from PF and in view of these advantages, they are likely to become a routine technique in diagnostic laboratories.
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              Development of pemphigus vulgaris in a patient with pemphigus foliaceus: antidesmoglein antibody profile shift confirmed by enzyme-linked immunosorbent assay.

              We describe a patient with pemphigus foliaceus (PF) in whom pemphigus vulgaris (PV) subsequently developed. The clinical change was accompanied by a shift of autoantibody profile confirmed by enzyme-linked immunosorbent assay. Antidesmoglein (Dsg) 1 antibodies alone were detected in the PF stage, whereas both anti-Dsg3 and anti-Dsg1 antibodies were detected in the PV stage.
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                Author and article information

                Journal
                Indian J Dermatol
                IJD
                Indian Journal of Dermatology
                Medknow Publications (India )
                0019-5154
                1998-3611
                Apr-Jun 2009
                : 54
                : 2
                : 192
                Affiliations
                From Wiwanitkit House, Bangkhae, Bangkok, Thailand 10160. E-mail: wviroj@ 123456yahoo.com
                Article
                IJD-54-192a
                10.4103/0019-5154.53181
                2807167
                20101324
                a4fe22f9-e8d8-4c06-9975-362812527a71
                © Indian Journal of Dermatology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Correspondence

                Dermatology
                Dermatology

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