Molecular and Cell Biology Laboratory, IDI-IRCCS, Rome, Italy.
First Dermatology Clinic, IDI-IRCCS, Rome, Italy.
J Am Acad Dermatol. 2022 Jul;87(1):56-63. doi: 10.1016/j.jaad.2022.02.036. Epub 2022 Mar 1.
Recently, several case-control studies demonstrated an association between gliptins and bullous pemphigoid (BP) occurrence. However, data on the clinical and immunologic features of gliptin-associated bullous pemphigoid (GABP) are controversial.
This study aimed to clinically and immunologically characterize a large cohort of GABP patients to get an insight into the pathophysiology of this emerging drug-induced variant of BP.
Seventy-four GABP patients were prospectively enrolled and characterized from 9 different Italian dermatology units between 2013 and 2020.
Our findings demonstrated the following in the GABP patients: (1) a noninflammatory phenotype, which is characterized by low amounts of circulating and skin-infiltrating eosinophils, is frequently found; (2) immunoglobulin (Ig)G, IgE, and IgA humoral responses to BP180 and BP230 antigens are reduced in frequency and titers compared with those in patients with idiopathic BP; (3) IgG reactivity targets multiple BP180 epitopes other than noncollagenous region 16A.
A limitation of the study is that the control group did not comprise only type 2 diabetes mellitus patients with BP.
GABP patients show peculiar features of anti-BP180 and -BP230 humoral responses, laying the foundation for diagnostic improvements and getting novel insights into understanding the mechanism of BP onset.
最近，几项病例对照研究表明，二肽基肽酶-4 抑制剂（gliptins）与大疱性类天疱疮（BP）的发生之间存在关联。然而，关于gliptin 相关性大疱性类天疱疮（GABP）的临床和免疫特征的数据仍存在争议。
本研究旨在对大量 GABP 患者进行临床和免疫学特征分析，以深入了解这种新兴的药物诱导的 BP 变异型的发病机制。
2013 年至 2020 年期间，我们从意大利 9 个不同的皮肤科单位前瞻性地纳入并分析了 74 例 GABP 患者。
我们的研究结果表明，GABP 患者具有以下特征：（1）非炎症表型，其特点是循环和皮肤浸润的嗜酸性粒细胞数量较少；（2）与特发性 BP 患者相比，针对 BP180 和 BP230 抗原的免疫球蛋白（Ig）G、IgE 和 IgA 体液反应的频率和滴度降低；（3）IgG 反应靶向 BP180 的多个非胶原区 16A 以外的表位。
本研究的一个局限性是对照组不仅包括患有 BP 的 2 型糖尿病患者。
GABP 患者表现出针对 BP180 和 BP230 的独特的体液反应特征，为诊断的改进奠定了基础，并为深入了解 BP 发病机制提供了新的见解。
