Detalle Publicación

Monopathogenic vs multipathogenic explanations of pemphigus pathophysiology

Autores: Razzaque, A.; Carrozo, M.; Caux, F.; Cirillo, N.; Dmochowski, M.; España Alonso, Agustín; Gniadecki, R.; Hertl, M.; López Zabalza, María Jesús; Lotti, R.; Pincelli, C.; Pittelkow, M.; Schmidt, E.; Sinha, A.; Sprecher, E.; Grando, S.
ISSN: 0906-6705
Volumen: 25
Número: 11
Páginas: 839 - 846
Fecha de publicación: 2016
This viewpoint highlights major, partly controversial concepts about the pathogenesis of pemphigus. The monopathogenic theory explains intra-epidermal blistering through the "desmoglein (Dsg) compensation" hypothesis, according to which an antibody-dependent disabling of Dsg 1- and/or Dsg 3-mediated cell-cell attachments of keratinocytes (KCs) is sufficient to disrupt epidermal integrity and cause blistering. The multipathogenic theory explains intra-epidermal blistering through the "multiple hit" hypothesis stating that a simultaneous and synchronized inactivation of the physiological mechanisms regulating and/or mediating intercellular adhesion of KCs is necessary to disrupt epidermal integrity. The major premise for a multipathogenic theory is that a single type of autoantibody induces only reversible changes, so that affected KCs can recover due to a self-repair. The damage, however, becomes irreversible when the salvage pathway and/or other cell functions are altered by a partnering autoantibody and/or other pathogenic factors. Future studies are needed to (i) corroborate these findings, (ii) characterize in detail patient populations with non-Dsg-specific autoantibodies, and (iii) determine the extent of the contribution of non-Dsg antibodies in disease pathophysiology.