2003 Volume 113 Issue 2 Pages 151-158
We investigated the correlation between the clinical severity scores and desmoglein (Dsg) titers in differently diluted sera, from 13 patients with pemphigus exhibiting high levels of Dsg titers over 150 (Index value) by using regular enzyme-linked immunosorbent assays (ELISA) during their clinical time courses. They were including pemphigus vulgaris with predominant mucosal lesion (n=3), mucocutaneous lesion (n=5), and typical pemphigus foliaceus (n=5). Their sera were diluted in the ordinal rate (×100) and compared at different dilution rates (×400 and ×1600) in Dsg titers detected by Dsg ELISA. In this system, Dsg titers showed more specific correlation with the clinical severity scores in the sera diluted at 1,600 times than in the sera diluted at 100 or 400 times. Even in the cases who showed only one step change in clinical severity score, this tendency was clearly shown. The results indicate that the Dsg titers in highly diluted sera exhibite clearer correlation with the clinical severity scores in patients with Dsg titers over 150 in regular ELISA. It is of interest that the Dsg titers in highly diluted sera seemed to clearly monitor the decrease in the titers in cases showing stable clinical presentations during the time course (4/10 cases). These data indicate that the Dsg titers in highly diluted sera enable us to detect the subclinical activity of pemphigus patients and help us to plan treatment. Conclusively, in patients with pemphigus showing very high Dsg titers by reqular ELISA, the measurement of Dsg titers in more highly diluted sera will help us to assess the true disease activity.