The Association between Anti-Acetylcholine Receptor Antibodies and Pemphigus Vulgaris Clinical Status

Over the past three decades, research has examined the role of acetylcholine (ACh) in keratinocyte adhesion and acantholysis, with a focus on the pathogenesis of autoimmune blistering dermatoses. Flaccid blisters and non healing erosions of the oral mucosa and occasionally the skin are caused by autoantibody mediated suprabasilarintraepidermal splitting in pemphigus vulgaris (PV). In total, 15 patients with PV and 15 control patients (6 men, 9 women) who were planned to receive Rituximab, dexamethasone and cyclophosphamide pulse therapy were enrolled. Disease activity was assessed by using the Pemphigus Disease Area Index (PDAI) and Using ELISA, acetylcholine receptors (AchR) antibodies activity. Abs was determined at baseline and three months treatment of rituximab, dexamethasone and cyclophosphamide pulse therapy. At baseline, 83.50 ± 5.3 ng/dL and PDAI score 32.93 ± 2.7 for acetylcholine receptors (AchR) Abs, acetylcholine receptors (AchR) Abs values were dramatically decreased for the three month treatment of rituximab, dexamethasone and cyclophosphamide pulse therapy 15.92 ± 2.3 ng/dL(95% confidence interval)(p < 0.001) and PDAI score 15.25 ± 1.4. There was a significant positive correlation between disease activity and AchR values at baseline (P = 0.04), the reduction in antibody titers from baseline to the end of three month treatment was statistically significant (p = 0.04). The present study suggests that three month treatment of rituximab, dexamethasone and cyclophosphamide pulse therapy combination steroid and oral cyclophosphamide are similar in their ability to influence disease progression and plasma levels of reduction in AchR Abs with clinical improvement in this study may suggest a role for AchR Abs it could be an epiphenomenon..