whether saliva as a testing medium for enzyme-linked immunosorbent assay
(ELISA) maybe a suitable diagnostic tool for mucous membrane pemphigoid (MMP)
and whether serum and salivary antibody titres reflect disease activity in
were analysed using commercially available ELISA plates pre-coated with the
non-collagenous domain of bullous pemphigoid antigen 2 (BP180-NC16a). Seventy
eight (n=78) MMP patients provided paired serum and whole saliva samples 20
of whom provided parotid saliva as well. Healthy controls (n=50) were
included, an additional 6 healthy controls as well as 16 disease controls
(Lichen planus (LP) = 10 and pemphigus vulgaris (PV) = 6) provided matched
serum, whole and parotid saliva.
Furthermore, 20 MMP patients who provided matched serum, whole and
parotid saliva 3 monthly over a 6-month period.
Results: Serum IgG
and/or IgA antibodies were detected in 46% of MMP patients (36/78). In whole saliva, specific IgG and IgA
antibodies were detected in 14% (11/78) and 38% (30/78) respectively. Parotid saliva showed 50% (10/20)
positivity of specific IgA antibody shown to be both IgA and secretory
component positive. Sequential samples
show that the change in serum antibodies (IgG and IgA) have a significant
influence on the change in severity scores (p=0.038 and 0.011
Conclusion: BP180-NC16a specific serum IgG and IgA are both highly specific for
diagnosing and monitoring MMP.
Assay of specific
salivary IgA antibody is as sensitive as specific antibody detection in serum
and indicates a secretory origin. Salivary
biomarkers may be useful in the diagnosis of MMP patients. The novel finding of locally produced
antibodies needs further investigation as it might provide some insight into the
pathogenesis of the disease.