In conclusion, the ASPT has a similar clinical performance to each previous, specific ELISA alone, so it is suitable for routine diagnostics. The BP230 test of the ASPT has been considerably improved compared to the previous BP230 ELISA. The incubation time of the ASPT is just half of that of the previous specific tests and the setup of the assay makes the testing of one single serum sample economic. In addition, the ASPT is an excellent tool to examine problematic sera, overlap syndromes, and it can also indicate the appearance of epitope spreading during follow-up.
CFT is useful for the diagnosis of not only pemphigoid gestationis but also BP, and we recommend to use it as a secondary test for patients who are either negative or borderline-positive for other serological assays or DIF. Given its high specificity, a positive result has a very high positive predictive value; false positive results are not expected. Thus it is especially useful for confirming borderline positive results and for the diagnosis of serologically challenging cases.
We showed that detection of mainly IgG1 and IgG4, but also IgG3 anti-subclass antibodies by IIF on monkey oesophagus significantly improved sensitivity and maintained the high specificity of the standard IIF, therefore their detection can be recommended for analysis of BP sera that are negative for traditional IIF microscopy. We recommend further studies to determine which secondary antibody cocktail (e.g. a mixture of anti-total-IgG with anti-IgG1 and anti-IgG4 subclass secondary antibodies) is most suitable for a cost-effective and efficient IIF assay for the diagnosis of BP.
In conclusion, linear deposits of IgG along the BM of sweat gland ducts (SGDs) are highly sensitive for BP in each level of dermis; however, only strong fluorescence has acceptable specificity. SGD positivity in the upper dermis was found to be more BP-specific than in the lower dermis. Thus, evaluation of the localization and the intensity of adnexal IgG fluorescence is important, and SGD immunoreactivity may have diagnostic relevance in BP. However, further controlled studies are necessary to recommend SGD fluorescence as the basis for diagnosis of BP (also in case of fragmented samples), even with strong signal intensity.
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A dolgozatban felhasznált DIF-képek a szerző ill. Prof. Sárdy Miklós saját felvételei, az klinikai képeket pedig a Ludwig-Maximilian Egyetem Bőrgyógyászati Klinka, Fotólabor munkatársai készítették.
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X. Saját publikációk jegyzéke
Az értekezés témájában megjelent eredeti közlemények:
1. Horváth ON, Varga R, Kaneda M, Schmidt E, Ruzicka T, Sárdy M. (2016) Diagnostic performance of the "MESACUP anti-Skin profile TEST". Eur J Dermatol, 26: 56-63.
2. Jankásková J, Horváth ON, Varga R, Ruzicka T, Sárdy M. (2016) Complement Fixation Test: An Update of an Old Method for Diagnosis of Bullous Pemphigoid. Acta Derm Venereol, 96: 197-201.
3. Jankásková J, Horváth ON, Varga R, Arenberger P, Schmidt E, Ruzicka T, Sárdy M. (2018) Increased sensitivity and high specificity of indirect immunofluorescence in detecting IgG subclasses for diagnosis of bullous pemphigoid. Clin Exp Dermatol, 43: 248-253.
4. Sinem Bağcı I, Horváth ON, Schmidt E, Ruzicka T, Sárdy M. (2017) Diagnostic Value of Linear Fluorescence Along the Basement Membrane of Sweat Gland Ducts in Bullous Pemphigoid. Acta Derm Venereol, 97: 622-626.
Egyéb közlemények:
1. Horváth ON, Jankásková J, Walker A, Sárdy M. (2015) Pemphigoid diseases. Autoimmune diseases in the elderly. Hautarzt, 66: 583-588.
2. Horváth ON, Kapser C, Sárdy M. (2016) Inflammatory diseases of oral mucous membranes. Hautarzt, 67: 786-792.
3. Horváth ON, Borovaya A, Roider E, Klose J, Hartlieb E, Waschke J, Ruzicka T, Sárdy M. (2015) Successful methotrexate treatment of oesophageal pemphigus vulgaris in an immunosuppressed patient with Crohn's disease. Acta Derm Venereol, 95: 868-869.
4. N Horváth O, Letulé V, Ruzicka T, Herzinger T, Goldscheider I, von Braunmühl T. (2017) Periocular discoloration after using a prostaglandin analog for eyelash enhancement: evaluation with reflectance confocal microscopy. J Cosmet Dermatol, 16: 18-20.
5. Horváth ON, von Braunmühl T, Sárdy M. (2018) Pediatric linear IgA/IgG dermatosis. Hautarzt, 69: 28-30.
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6. Bağcı IS, Horváth ON, Ruzicka T, Sárdy M. (2017) Bullous pemphigoid.
Autoimmun Rev, 16: 445-455.
7. Sárdy M, Borovaya A, Horváth ON, Folwaczny C, Schmitt W, Schmidt T, Hertl M, Ruzicka T. (2016) Successful rituximab treatment of juvenile bullous pemphigoid with esophageal scarring due to epitope spreading. J Dtsch Dermatol Ges, 14: 618-621.
8. Bağcı IS, Ruini C, Niesert AC, Horváth ON, Berking C, Ruzicka T, von Braunmühl T. (2018) Effects of Short-Term Moisturizer Application in Different Ethnic Skin Types: Noninvasive Assessment with Optical Coherence Tomography and Reflectance Confocal Microscopy. Skin Pharmacol Physiol, 31: 125-133.
9. Walter E, Vielmuth F, Rotkopf L, Sárdy M, Horváth ON, Goebeler M, Schmidt E, Eming R, Hertl M, Spindler V, Waschke J. (2017) Different signaling patterns contribute to loss of keratinocyte cohesion dependent on autoantibody profile in pemphigus. Sci Rep, 7: 3579.
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XI. Köszönetnyilvánítás
Szeretném megköszönni Prof. Sárdy Miklósnak a PhD tanulmányaim alatt nyújtott folyamatos támogatását. Az ő óriási tapasztalata és útmutatásai segítettek abban, hogy egy számomra teljesen ismeretlen témát néhány év alatt nagyon mélyen elsajátítottam, eljutottam a szakvizsgáig és a PhD munka megírásáig. Sárdy prof. úr hihetetlen szakmai tudással kezelte a betegeket és ennek átadását soha nem tekintette tehernek. Naptól és napszaktól függetlenül fordulhattam hozzá a komoly kérdésektől az
Szeretném megköszönni Prof. Sárdy Miklósnak a PhD tanulmányaim alatt nyújtott folyamatos támogatását. Az ő óriási tapasztalata és útmutatásai segítettek abban, hogy egy számomra teljesen ismeretlen témát néhány év alatt nagyon mélyen elsajátítottam, eljutottam a szakvizsgáig és a PhD munka megírásáig. Sárdy prof. úr hihetetlen szakmai tudással kezelte a betegeket és ennek átadását soha nem tekintette tehernek. Naptól és napszaktól függetlenül fordulhattam hozzá a komoly kérdésektől az