tretinoin and Pemphigoid--Bullous

We have demonstrated the clinical efficacy of topical all-trans retinoic acid ointment in the treatment of four severe cases of the following dry eye disorders: Keratoconjunctivitis sicca, Stevens-Johnson syndrome, drug-induced pseudopemphigoid, surgery-induced dry eye. In all four cases, impression cytology confirmed that improvements in symptoms, visual acuity, keratopathy, and Schirmer test resulted from reversal of the process of squamous metaplasia. This treatment represents the first nonsurgical approach with action directed specifically at the diseased ocular surface epithelia.

Topics: Administration, Topical; Adult; Aged; Conjunctiva; Cornea; Female; Humans; Keratoconjunctivitis; Male; Metaplasia; Pemphigoid, Bullous; Stevens-Johnson Syndrome; Tretinoin; Xerophthalmia

Vitamin A and its derivatives (retinoids) have both profound effects on epidermal differentiation and beneficial therapeutic effects in various dermatologic diseases. In order to understand these effects, much work has been done with cultured keratinocytes, which show specific morphologic, cellular, and biochemical changes modulated by retinoids. In an attempt to further define specific molecular effects of retinoids in cultured human keratinocytes, we studied the expression of pemphigus (P) and pemphigoid (BP) antigens by human keratinocytes cultured with retinoic acid (RA) in concentrations which modulated differentiation. Cultures of human keratinocytes in medium with 10% delipidized fetal bovine serum (vitamin A-depleted medium) demonstrated areas of extensive differentiation with flattened stratifying cells, keratohyaline granules, and an anucleate stratum corneum-like superficial layer. These cells also synthesized a 67 kd keratin, characteristic of well-differentiated epidermis. In contrast, cultures of human keratinocytes in the same medium supplemented with (10(-7) M, 3 X 10(-7) M, or 10(-6) M) RA demonstrated less differentiated small cuboidal cells that were stratified but did not form an anucleate layer or keratohyaline granules, and did not synthesize the 67 kd keratin. In order to detect P and BP antigens in these cultures, we used indirect immunofluorescence. In vitamin A-depleted cultures, P antigen either was not detected or was seen focally on the cell surface of basal cells. BP antigen was seen on the basal pole of the basal cells, approximating its in vivo location. In RA-treated cells, P antigen was seen on the cell surface of most of the cells, and BP antigen was seen throughout the cytoplasm of the basal cells. In order to study the expression of newly synthesized antigens, we radiolabeled cultures with 14C-amino acids and quantitatively immunoprecipitated the antigens, which were then identified by sodium dodecyl sulfate polyacrylamide gel electrophoresis. We detected a major decrease in newly synthesized P antigen precipitated from extracts of vitamin A-depleted cells compared to RA-supplemented cells, whereas amounts of newly synthesized BP antigen were about the same. Taken together these data demonstrate that RA, at concentrations that decrease differentiation of cultured human keratinocytes, increases the expression of P antigen and changes the subcellular location of BP antigen.

Topics: Antigens; Cells, Cultured; Fluorescent Antibody Technique; Humans; Keratins; Pemphigoid, Bullous; Pemphigus; Skin; Skin Diseases, Vesiculobullous; Tretinoin; Vitamin A

The appearance of cell surface glycoconjugates (detected by fluorescein-isothiocyanate-conjugated lectins and bullous pemphigoid antibody) was serially examined in mouse epidermal cell cultures treated with trans-retinoic acid and aromatic retinoic acid (etretinate) and in cultures maintained under low calcium conditions. The changes in lectin staining occurred in concert with the process of differentiation as assessed by cell morphology and colony growth characteristics, and they correlated with the patterns observed in whole mouse skin. The keratocyte cultures treated with retinoic acid showed delayed and reduced differentiation and stratification, and this was associated with markedly reduced binding of lectins specific for N-acetyl-glucosamine and fucose. The low calcium concentration produced similar changes. Thus, the loss of surface glycoconjugates in the epidermal cell culture system was not specific for either retinoic acid or low calcium, but correlated with the degree of cell differentiation.

Topics: Animals; Antibodies; Calcium; Cell Differentiation; Cell Division; Cells, Cultured; Epidermal Cells; Epidermis; Etretinate; Fluorescent Antibody Technique; Glycosides; Lectins; Mice; Mice, Inbred BALB C; Pemphigoid, Bullous; Tretinoin