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Paraneoplastic Pemphigus Renders the Lung a Target Organ in Ectopic Ectopic Expression of Epidermal Antigens Renders the Lung a Target Organ in Paraneoplastic Pemphigus This information is current as Tsuyoshi Hata, Shuhei Nishimoto, Keisuke Nagao, Hayato of September 29, 2021. Takahashi, Kazue Yoshida, Manabu Ohyama, Taketo Yamada, Koichiro Asano and Masayuki Amagai J Immunol 2013; 191:83-90; Prepublished online 31 May 2013; doi: 10.4049/jimmunol.1203536 Downloaded from http://www.jimmunol.org/content/191/1/83 Supplementary http://www.jimmunol.org/content/suppl/2013/05/31/jimmunol.120353 Material 6.DC1 http://www.jimmunol.org/ References This article cites 42 articles, 7 of which you can access for free at: http://www.jimmunol.org/content/191/1/83.full#ref-list-1 Why The JI? Submit online. • Rapid Reviews! 30 days* from submission to initial decision by guest on September 29, 2021 • No Triage! Every submission reviewed by practicing scientists • Fast Publication! 4 weeks from acceptance to publication *average Subscription Information about subscribing to The Journal of Immunology is online at: http://jimmunol.org/subscription Permissions Submit copyright permission requests at: http://www.aai.org/About/Publications/JI/copyright.html Email Alerts Receive free email-alerts when new articles cite this article. Sign up at: http://jimmunol.org/alerts The Journal of Immunology is published twice each month by The American Association of Immunologists, Inc., 1451 Rockville Pike, Suite 650, Rockville, MD 20852 Copyright © 2013 by The American Association of Immunologists, Inc. All rights reserved. Print ISSN: 0022-1767 Online ISSN: 1550-6606. The Journal of Immunology Ectopic Expression of Epidermal Antigens Renders the Lung a Target Organ in Paraneoplastic Pemphigus Tsuyoshi Hata,*,† Shuhei Nishimoto,* Keisuke Nagao,* Hayato Takahashi,* Kazue Yoshida,* Manabu Ohyama,* Taketo Yamada,‡ Koichiro Asano,x,{ and Masayuki Amagai* Paraneoplastic pemphigus (PNP) is an autoimmune disease of the skin and mucous membranes that can involve fatal lung com- plications. IgG autoantibodies target the cell adhesion molecules desmoglein (Dsg)3 and plakins, but the nature and targets of infiltrating T cells are poorly characterized. Moreover, the lung involvement in this skin Ag-specific autoimmune condition rep- resents a paradox. To mimic autoimmunity in PNP, we grafted wild-type skin onto Dsg32/2 mice, which resulted in graft rejection and generation of anti-Dsg3 IgG and Dsg3-specific T cells. Transfer of splenocytes from these mice into Rag22/2 mice induced a combination of suprabasilar acantholysis and interface dermatitis, a histology unique to PNP. Furthermore, the recipient mice showed prominent bronchial inflammation of CD4+ and CD8+ T cells with high mortality. Intriguingly, ectopic Dsg3 expression Downloaded from was observed in the lungs of PNP mice, mirroring the observation that squamous metaplasia is often found in the lungs of PNP patients. Dsg3 and other epidermal Ags were ectopically expressed in the lungs after pulmonary injuries by naphthalene, which was sufficient for recruitment of Dsg3-specific CD4+ T cells. These findings demonstrate that squamous metaplasia after pulmo- nary epithelial injury may play a crucial role in redirecting the skin-specific autoimmune reaction to the lungs in PNP. The Journal of Immunology, 2013, 191: 83–90. http://www.jimmunol.org/ mong tissue-specific autoimmune diseases, pemphigus occurs in association with underlying neoplasms, mainly of comprises a group of IgG autoantibody-mediated blis- lymphoid origin, and has characteristic IgG autoantibodies A tering diseases of the skin and mucous membranes, against the plakin family (plectin, desmoplakins I and II, BP230, characterized histologically by intraepidermal blisters due to the loss envoplakin, and periplakin) (5, 6). Additionally, PNP patients of keratinocyte cell–cell adhesion, and immunopathologically by exhibit a cellular immune response in the skin and mucous mem- the in vivo finding of bound and circulating IgG autoantibodies branes. Histological examination shows not only blister formation directed against the surface of keratinocytes. Pemphigus has three caused by IgG autoantibodies against Dsg3 and/or Dsg1, but also major forms: pemphigus foliaceus (PF), pemphigus vulgaris (PV), interface dermatitis showing keratinocyte apoptosis and T cell in- and paraneoplastic pemphigus (PNP) (1). The classic forms of filtration in the epidermis and mucosal epithelia. Furthermore, some by guest on September 29, 2021 pemphigus are PF and PV, which are mediated solely by humoral patients with PNP develop pulmonary involvement, such as bron- autoimmunity involving IgG autoantibodies against desmoglein chiolitis obliterans, which can cause fatal respiratory failure (7–11). (Dsg)1 and Dsg3, respectively, both of which are cadherin-type cell– Further investigation is required to determine the target Ag(s) of cell adhesion molecules in desmosomes (2, 3). T cells that infiltrate the skin and mucous membranes as well as the PNP shares the basic feature of pemphigus in that IgG auto- reason that such T cells also attack the lungs. The technical hurdles antibodies against Dsg3 or Dsg1 play a pathogenic role by me- to identification of these T cell Ags and the rarity of the disease diating blister formation in the mucous membranes and skin (4), hamper progress in solving these questions. but its phenotype is more complex than those of PV and PF. PNP An active disease mouse model for PV has been generated by adoptive transfer of T and B lymphocytes from Dsg32/2 mice immunized with recombinant mouse Dsg3 plus Freund’s adjuvant *Department of Dermatology, Keio University School of Medicine, Tokyo 160-8582, to Dsg3-expressing Rag22/2 mice (12, 13). PV model mice per- Japan; †Cutaneous Research Section, Fundamental Research Laboratories, KOSE´ Corporation, Tokyo 174-0051, Japan; ‡Department of Pathology, Keio University sistently produce anti-Dsg3 IgG and develop blisters on the skin School of Medicine, Tokyo 160-8582, Japan; xDepartment of Respiratory Medicine, and mucous membranes, as found in PV patients. Subsequently, { Keio University School of Medicine, Tokyo 160-8582, Japan; and Division of Dsg3-specific CD4+ T cell clones were isolated, and Dsg3-specific Pulmonary Medicine, Department of Medicine, Tokai University School of Medi- cine, Kanagawa 259-1193, Japan TCR transgenic (Dsg3H1) mice were generated (14, 15). Inter- + Received for publication December 27, 2012. Accepted for publication April 30, estingly, Dsg3-specific transgenic CD4 T cells, which developed 2/2 2013. in the absence of Dsg3 or in Dsg3 mice, induced not only the This work was supported by Grants-in-Aid for Scientific Research from the Ministry blisterformationcausedbyanti-Dsg3 IgG, but also interface of Education, Culture, Sports, Science and Technology of Japan, Health and Labor dermatitis with CD4+ T cell infiltration in the epidermis and Sciences Research Grants for Research on Measures for Intractable Diseases from the 2/2 Ministry of Health, Labor, and Welfare of Japan, and Keio Gijuku Academic Devel- keratinocyte necrosis upon adoptive transfer with Dsg3 B cells opment Funds. (15). This demonstrates that the cellular autoimmune response Address correspondence and reprint requests to Prof. Masayuki Amagai, Department against Dsg3 can lead to the formation of interface dermatitis, of Dermatology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, suggesting that Dsg3 may be a target autoantigen of the cellular Tokyo 160-8582, Japan. E-mail address: [email protected] immune reaction seen in PNP. The online version of this article contains supplemental material. In this study, by adoptive transfer of lymphocytes from Dsg32/2 Abbreviations used in this article: B6, C57BL/6J; Dsg, desmoglein; PF, pemphigus mice immunized with wild-type (WT) skin grafts, we generated foliaceus; PNP, paraneoplastic pemphigus; PV, pemphigus vulgaris. a PNP model mouse that showed both humoral and cellular im- Copyright Ó 2013 by The American Association of Immunologists, Inc. 0022-1767/13/$16.00 mune reactions against Dsg3. PNP model mice showed supra- www.jimmunol.org/cgi/doi/10.4049/jimmunol.1203536 84 CELLULAR AUTOIMMUNITY IN PARANEOPLASTIC PEMPHIGUS basilar acantholysis caused by anti-Dsg3 IgG Abs as well as in- Immunization of Dsg32/2 mice via Dsg3+/+ skin grafts + + terface dermatitis with CD4 as well as CD8 T cell infiltration Dorsal skin from Dsg3+/+ WT mice (B6) was grafted onto the backs of sex- and keratinocyte apoptosis. Furthermore, these mice demonstrated matched Dsg32/2 or Dsg3+/2 mice, as described previously (17), and the bronchial inflammation with a high mortality rate. Surprisingly, grafted skin was biopsied at various times after transplantation. A second Dsg3 was ectopically expressed in the lungs of the PNP model skin graft was performed 28 d after the first graft for adoptive transfer mice, but not in the lungs of WT or PV model mice. Ectopic studies. Graft survival was determined in accordance with a method de- scribed previously (18). For adoptive transfer studies, splenocytes from expression of Dsg3 and other epidermal Ags in the lungs was mice that received a second skin graft for 14 d or more were transferred detected during epithelial remodeling after naphthalene-induced adoptively into Rag22/2 mice via the tail vein. In control PV model mice, 2 2 pulmonary injury. CD4+ T cells containing retrovirally transduced Dsg3 / mice were immunized with recombinant mouse Dsg3 in CFA, as Dsg3-specific TCR (15) preferentially infiltrated into bronchial described
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