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LABD97 IgG ELISA increases sensitivity of ELISA serologic testing for the diagnosis of bullous pemphigoid
Jeremy P Snook1, Mazdak A Khalighi1, Margaret M Cocks1
1University of Utah, Department of Dermatology, 417 Wakara Way, Suite 2151, Salt Lake City, UT 84108.
Background:
Commercially available, antigen-specific serologic testing for bullous pemphigoid (BP) fails to identify approximately 1 in 4 patients with circulating IgG autoantibodies to the epidermal side of human split skin substrate by indirect immunofluorescence (IIF).
Objective:
Determine the utility of LABD97, a proteolyzed fragment of the shed ectodomain of BP180, as an antigenic target in an IgG ELISA assay to confirm BP diagnosis.
Methods:
Retrospective study of 100 consecutive serum specimens submitted to the Immunodermatology Laboratory at the University of Utah for suspected (initial diagnosis) BP with epidermal pattern IgG/IgG4 on human split skin substrate by IIF.
Results:
Within 100 consecutive BP sera, LABD97 IgG ELISA was the most sensitive antigenic target (87%) compared to the commercial-BP180 (NC16A) IgG ELISA (66%) and BP230 IgG ELISA (52%). Additionally, 83% of BP patients that were double negative for commercially available NC16A/BP230 ELISAs were LABD97 positive.
Limitations:
Single-center study, limited clinical data and patient follow up.
Conclusion:
LABD97 is a more complete and diagnostically relevant portion of BP180 compared to the NC16A BP180 fragment. Utilizing LABD97 ELISA testing significantly increases the sensitivity of serologic BP diagnosis.
