Utility of desmoglein ELISA in the clinical correlation and disease monitoring of pemphigus vulgaris

Background Pemphigus vulgaris (PV) is a relatively common autoimmune blistering disease in India. Recently, enzyme-linked immunosorbent assay (ELISA) test against desmoglein1 (Dsg 1) and desmoglein3 (Dsg 3) has been developed, which is found to be highly sensitive and specific. Objective To assess the utility of ELISA for monitoring the disease of PV. Methods Serum samples from 63 active PV patients were tested for anti-Dsg1 and anti-Dsg3 using ELISA. They were tested for anti-Dsg1 and anti-Dsg3 reactivity before treatment. The test was performed during remission period and after relapse using commercially available ELISA kit. Results Both anti-Dsg1 and anti-Dsg3 levels were found to be raised in PV patients. Thirty-eight patients went on remission during treatment phase with mean anti-Dsg1 and anti-Dsg3 values, 13.18 U/mL and 18.89 U/mL respectively. Difference of baseline from remission was found to be significant (P < 0.001). Of these, 23 patients relapsed either during treatment phase or after stoppage of therapy and their mean anti-Dsg1 and anti-Dsg3 titres were 39.49 U/mL and 96.99 U/mL respectively. Difference of remission from relapse was also found to be significant (P < 0.001). The 50 U/mL cut-off for anti-Dsg1 ELISA provided 73.91% sensitivity and 72.5% specificity respectively. The 98.57 U/mL cut-off for anti-Dsg3 provided 82.61% sensitivity and 82.5% specificity respectively. Conclusion ELISA is less time consuming, less expensive and a potential diagnostic test for PV. It is also highly sensitive and specific test for Indian patients in whom the mean anti-Dsg titres are raised.