Bălăceanu-Gurău Beatrice, Dumitrascu Adrian, Giurcăneanu Călin, Tatar Raluca, Gurău Cristian-Dorin, Orzan Olguța Anca
Department of Oncologic Dermatology, "Elias" Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
Clinic of Dermatology, "Elias" Emergency University Hospital, 011461 Bucharest, Romania.
Vaccines (Basel). 2024 Jul 30;12(8):857. doi: 10.3390/vaccines12080857.
Autoimmune bullous diseases (AIBDs) are characterized by the formation of vesicles, bullous lesions, and mucosal erosions. The autoantibodies target the cellular anchoring structures from the surface of epidermal keratinocyte named desmosomes, leading to a loss of cellular cohesion named acantholysis. AIBDs are classified into intraepidermal or subepidermal types based on clinical features, histological characteristics, and immunofluorescence patterns. Pemphigus foliaceus (PF) is an acquired, rare, autoimmune skin condition associated with autoantibodies that specifically target desmoglein-1, leading to a clinical presentation characterized by delicate cutaneous blisters, typically sparing the mucous membranes. Several factors, including genetic predisposition, environmental triggers, malignancies, medication use, and vaccination (for influenza, hepatitis B, rabies, tetanus, and more recently, severe acute respiratory syndrome Coronavirus 2 known as SARS-CoV-2), can potentially trigger the onset of pemphigus. With the advent of vaccines playing a pivotal role in combatting the 2019 coronavirus disease (COVID-19), extensive research has been conducted globally to ascertain their efficacy and potential cutaneous adverse effects. While reports of AIBDs post-COVID-19 vaccination exist in the medical literature, instances of PF following vaccination have been less commonly reported worldwide. The disease's pathophysiology is likely attributed to the resemblance between the ribonucleic acid (RNA) antigen present in these vaccines and cellular nuclear matter. The protein produced by the BNT-162b2 messenger ribonucleic acid (mRNA) vaccine includes immunogenic epitopes that could potentially trigger autoimmune phenomena in predisposed individuals through several mechanisms, including molecular mimicry, the activation of pattern recognition receptors, the polyclonal stimulation of B cells, type I interferon production, and autoinflammation. In this review, we present a comprehensive examination of the existing literature regarding the relationship between COVID-19 and PF, delving into their intricate interactions. This exploration improves the understanding of both pemphigus and mRNA vaccine mechanisms, highlighting the importance of close monitoring for PF post-immunization.
自身免疫性大疱性疾病（AIBDs）的特征是形成水疱、大疱性皮损和黏膜糜烂。自身抗体靶向表皮角质形成细胞表面名为桥粒的细胞锚定结构，导致细胞黏附丧失，即棘层松解。根据临床特征、组织学特征和免疫荧光模式，AIBDs可分为表皮内型或表皮下型。落叶型天疱疮（PF）是一种获得性、罕见的自身免疫性皮肤病，与特异性靶向桥粒芯糖蛋白-1的自身抗体有关，临床表现为精致的皮肤水疱，通常不累及黏膜。包括遗传易感性、环境触发因素、恶性肿瘤、药物使用和疫苗接种（如流感、乙型肝炎、狂犬病、破伤风疫苗，以及最近的严重急性呼吸综合征冠状病毒2即SARS-CoV-2疫苗）等多种因素都可能引发天疱疮。随着疫苗在抗击2019冠状病毒病（COVID-19）中发挥关键作用，全球开展了广泛研究以确定其疗效和潜在的皮肤不良反应。虽然医学文献中有关于COVID-19疫苗接种后发生AIBDs的报道，但全球范围内接种疫苗后发生PF的病例报道较少。该病的病理生理学可能归因于这些疫苗中存在的核糖核酸（RNA）抗原与细胞核物质之间的相似性。BNT-162b2信使核糖核酸（mRNA）疫苗产生的蛋白质包含免疫原性表位，这些表位可能通过多种机制在易感个体中引发自身免疫现象，包括分子模拟、模式识别受体的激活、B细胞的多克隆刺激、I型干扰素的产生和自身炎症。在本综述中，我们对现有关于COVID-19与PF之间关系的文献进行了全面审视，深入探讨它们之间的复杂相互作用。这一探索增进了对天疱疮和mRNA疫苗机制的理解，强调了免疫后密切监测PF的重要性。
