Pemphigus provoked by D(-)penicillamine. An experimental approach using in vitro tissue cultures

We present the results of our experiments with in vitro tissue cultures of normal human skin, carried out in order to clarify the mechanism(s) by which D(-) penicillamine provokes pemphigus. Various concentrations of D(-) penicillamine were added to the culture medium and produced acantholytic splitting, closely similar to control lesions produced by pemphigus serum, whereas no lesions occurred in controls cultured without the drug. This suggests to us that the pemphigus of D(-)penicillamine is due to biochemical mechanisms and is not mediated by antibodies. Integrating our data with those of previous clinical and experimental studies on idiopathic pemphigus vulgaris leads us to think that the pemphigus antigen(s) might be present in certain structures of the cell membrane of epithelial cells, which are linked with the initial phases of keratin differentiation.