THE USE OF MICHELS TRANSPORT MEDIUM FOR IMMUNOFLUORESCENCE AND IMMUNOELECTRON MICROSCOPY IN AUTOIMMUNE BULLOUS DISEASES

We report the use of Michel's solution, already a well established tra nsport medium, in the combined use of direct immunofluorescence (IMF) and pre-embedding immunoelectron microscopy in 3 subepidermal bullous diseases - bullous pemphigoid (BP), epidermolysis bullosa acquisita (E BA) and dermal binding linear IgA disease (LABD). Our studies demonstr ated that electron microscopy of normal skin maintained in Michel's me dium for up to 28 days showed remarkable preservation of all component s of the basement membrane zone, including the ultrastructure of the b asal keratinocytes, dermoepidermal junction and papillary dermis. Howe ver, epidermal cell cytolysis occurred after just 48 hours. Immunoelec tron microscopy using a gold probe has enabled us to localise the immu noreactants in bullous pemphigoid, epidermolysis bullosa acquisita and dermal-binding linear IgA bullous dermatoses. Our findings are compar able to and as equally reliable as those on immunoelectron microscopy of fresh skin biopsies with no loss of antigen deposition, and demonst rate an effective new use of a well established transport medium.