Characterization of the mucosal immune response to dietary antigens in patients with dermatitis herpetiformis.
Characterization of the mucosal immune response to dietary antigens in patients with dermatitis herpetiformis.
复制标题
疱疹样皮炎患者对饮食抗原的粘膜免疫反应的特征。
DOI：
10.1111/1523-1747.ep12560821
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Waldbauer,GV
中科院分区：
文献类型：
--
作者：
Hall,RP;Waldbauer,GV
疱疹样皮炎（DH）与颗粒状伊加沉积在真皮-表皮交界处和谷蛋白敏感性肠病（GSE）的关联表明粘膜免疫反应可能在DH的发病机制中起重要作用。然而，DH患者的抗原限制程度、免疫球蛋白类和亚类对饮食抗原的反应以及针对饮食抗原的抗体与含IgA的循环免疫复合物（dC）的关系尚不清楚。我们检测了33例DH患者血清中的抗麦醇溶蛋白和3种与GSE无关的膳食蛋白--β-乳球蛋白（β-lactoglobulin，β-lacto）、牛丙种球蛋白（bovine gamma globulin，BGG）和酪蛋白的IgG和伊加抗体。33例DH患者中有11例（33%）有IgA抗麦胶蛋白抗体，而33例患者中有11例（33%）有伊加抗β-乳糖抗体，32例患者中有15例（47%）有IgA抗BGG抗体，33例患者中有6例（18%）有IgA抗酪蛋白抗体; 32例患者中有17例（53%）有IgA抗一种或多种这些饮食抗原抗体。在这组抗体阳性患者中，检测到针对β-乳糖（2，500 ± 2，320 ng/ml，平均值± SEM）和BGG（2，340 ± 1，890 ng/ml）的伊加抗体水平显著高于麦醇溶蛋白（1，250 ± 851 ng/ml）（p < 0.05，Wilcoxon符号秩检验）。17例伊加抗体对饮食抗原的患者中有11例被发现有IgA含CIC，而15例抗体阴性患者中只有1例有IgA含CIC（p = 0.0008，Fisher精确检验）。发现伊加抗麦胶蛋白抗体含有IgA 1和IgA 2，与总血清伊加的IgA 2组成相比，IgA 2的比例显著增加（IgA 2：抗麦胶蛋白抗体= 34 ± 4.2%;总血清伊加= 19 ± 4.8%，p = 0.02，Students配对t检验）。发现针对这些抗原的IgG抗体以不显著大于伊加抗体的量稍微更频繁地出现。这些数据表明，血清伊加和IgG抗体反应的饮食抗原发生在约50%的DH患者具有较高的porporporporportion IgA 2比总血清伊加，似乎并不限于麦醇溶蛋白。这与DH患者皮肤免疫反应物的模式显著不同，并表明DH皮肤中伊加的沉积可能是非典型粘膜免疫反应的结果，IgA 1和DH皮肤的非免疫学相互作用，或来自非粘膜来源。
The association of dermatitis herpetiformis (DH) with granular IgA deposits at the dermal-epidermal junction and a gluten sensitive enteropathy (GSE) suggests that a mucosal immune response may play an important role in the pathogenesis of DH. The degree of antigenic restriction, the immunoglobulin class and subclass response to dietary antigens, and the relationship of antibodies against dietary antigens to IgA-containing circulating immune complexes (dC) in patients with DH, however, are not known. We have examined the serum of 33 patients with DH for IgG and IgA antibodies against gliadin, and against 3 dietary proteins not thought to be related to GSE, β-lactoglobulin (β-lacto), bovine gamma globulin (BGG), and casein. Eleven of 33 (33%) patients with DH had IgA anti-gliadin antibodies, whereas IgA antibodies against β-lacto were found in 11 of 33 patients (33%), against BGG in 15 of 32 (47%), and against casein in 6 of 33 (18%); 17 of 32 (53%) patients had IgA antibodies against one or more of these dietary antigens. Significantly higher levels of IgA antibodies were detected against β-lacto (2,500 ± 2,320 ng/ml, mean ± SEM) and BGG (2,340 ± 1,890 ng/ml) than gliadin (1,250 ± 851 ng/ml) in this group of antibody positive patients (p < 0.05, Wilcoxon signed ranks test). Eleven of 17 patients with IgA antibodies against dietary antigens were found to have IgA-containing CIC, whereas only one of the 15 antibody negative patients had IgA-containing CIC (p = 0.0008, Fisher's exact test). IgA anti-gliadin antibodies were found to contain both IgA1and IgA2with a significantly increased proportion of IgA2when compared with the IgA2composition of the total serum IgA (IgA2: anti-gliadin antibodies = 34 ± 4.2%; total serum IgA = 19 ± 4.8%, p = 0.02, Students paired t test). IgG antibodies against these antigens were found to occur slightly more frequently in amounts not significantly greater than IgA antibodies. This data demonstrates that a serum IgA and IgG antibody response to dietary antigens occurs in approximately 50% of DH patients with a higher porportion IgA2than total serum IgA and does not appear to be restricted to gliadin. This is significantly different from the pattern of cutaneous immunoreactants in patients with DH, and suggests that the deposition of IgA in DH skin may be the result of an atypical mucosal immune response, a non-immunologic interaction of IgA1and DH skin, or arise from a non-mucosal source.