An experience for ELISA for desmoglein 1, suggesting a possible diagnostichelp to determine the initial therapy for pemphigus foliaceus

Pemphigus foliaceus (PF) is an autoimmune skin disease in which loss of adh esion between keratinocytes (i.e., acantholysis) in the granular cell layer s appears to be mediated by the binding of autoantibodies against desmoglei n (Dsg) 1. Although it has been suggested that the activity of the disease is rather correlated with the titer of the antibody, there are still no pre cise studies on the relationships between the disease activity and the tite rs of autoantibody against Dsg1 by using ELISA. In this study, we performed ELISA using recombinant: Dsg1 (rDsg1) as antigen on 8 patients with pemphi gus foliaceus in order to examine the reliability of this test for monitori ng disease severity. The resultant index values of ELISA, which were define d by the formula: (OD of tested serum - OD of negative control)/(OD of posi tive control - OD of negative control) X 100, ranged from 16 to 264 compare d with 6.41 of cutoff index value for normal sera. A patient with an index value of 213 had severe widespread erosions with erythema and required puls e therapy of methylpredonisolone (1,000 mg/day for 3 days). A patient with an index value of 111 had a moderate severity and was successfully treated with an initial dose of 30 mg/day (0.64 mg/kg) of predonisolone, The mildes t patient with an index value of 16 was controlled with only topical applic ation of 0.05% betamethasone ointment twice a day. These results suggest th at ELISA index values for rDsg1 will provide a promising tool for monitorin g the disease severity and for determining the initial therapy for pemphigu s foliaceus.