Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter in Response to Previous Publication
87 (
2
); 238-239
doi:
10.25259/IJDVL_758_20

Response to a reader’s query on CD19+ B cell as predictor of relapse in pemphigus vulgaris

Department of Dermatology, Venereology and Leprology, Institute of Medical Education and Research, Chandigarh, India
Department of Endocrinology (Immunology Division), Institute of Medical Education and Research, Chandigarh, India
Department of Histopathology Institute of Medical Education and Research, Chandigarh, India
Biostatistics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Corresponding author: Dr. Dipankar De, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India. dr_dipankar_de@yahoo.in
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Guliani A, De D, Handa S, Mahajan R, Sachdeva N, Radotra BD, et al. Response to a reader’s query on CD19+ B cell as predictor of relapse in pemphigus vulgaris. Indian J Dermatol Venereol Leprol 2021;87:238-9.

Sir,

We thank the authors1 for their interest in our article 'Identification of clinical and immunological factors associated with clinical relapse of pemphigus vulgaris in remission.'2

We understand that 40 may be a small control sample size to derive the normal value, and that sampling a larger number of normal individuals would have been better. We agree that use of a normative data from Indian population of over 1000 subjects would be useful. However, the journal that published the data of 1000 healthy Indians is indexed by Web of Science, Current Contents, Geobase, Chemical Abstracts, IndMed, and Scopus and not indexed in PubMed. Hence, we missed the reference to this article.3 We appreciate the authors’ efforts in finding it out.

However, since we were interested in not just the frequency of CD19+B cells but also the CD19+CD27+ memory B cells (which is lacking in the study referred to), we would still have to study the same age and sex-matched normal control subjects for comparison of CD19+CD27+B cells. The purpose of this analysis was not to project these data as a reference for normal healthy control subjects of North India, but only for comparative analysis of the study subjects in question. Moreover, since the blood samples of controls and subjects with pemphigus vulgaris were stained with the same lot and clone of the antibodies and were analyzed on the same flow cytometry platform, we were able to ensure assay uniformity. Additionally, practical difficulties such as willingness to participate despite not having the disease in question and financial constrains in respect to study funding are some important considerations in this type of study.

The controls were age and gender matched individuals with other dermatological diseases attending our outpatient department. One qualified as a control if s(he) did not have any recent infectious disease or autoimmune disease including pemphigus.

We agree with the authors that: 'Peripheral CD19+ B cell count being significantly influenced by steroid use and steroid withdrawal and rituximab being the most potent and total CD19+ B lymphocyte depleter among all the previous treatment', and that is why rituximab induces remission for a longer time. Other treatments also have effects on CD19+ B cells. The objective of the study was to see repopulation of CD19+ B cells and subsequent effects, not to study depletion of B cells with a particular treatment that is assumed to have had happened since the patients were in remission when they were included in the study.

To have clinical relapse, first step is immunological reactivation in the form of B-cell repopulation. There is no other known source of immunoglobulins. In other words, it can be assumed that B-cell repopulation must occur irrespective of treatment modality employed preceding clinical relapse in a prototype IgG-mediated disease such as pemphigus. Yes, this is an assumption and it may be an endeavor of scientific community to establish in a future research.

The authors also mention: 'During discussion of results, author has compared their findings with one published by Albers et al.; study referred by author was strictly limited to B cell repopulation after rituximab therapy.' We had considerable difficulty in understanding context of their reference to this study. We studied B-cell repopulation along with other parameters and we think that it is logical and prudent to do additional things.

We agree to the authors’ suggestion: 'Analysis of patient previously treated with rituximab vis a vis other treatment modalities and baseline CD19+ B cell count among them and subsequent trend in both the groups would have thrown more light on this very interesting aspect of relapse in pemphigus vulgaris.' However, the number of patients required in each treatment group and thus overall number of pemphigus patients in remission (who are willing to follow-up periodically for a long time when they do not have a clinical disease) is likely to be very high to have meaningful statistical result and thus practically difficult. This shall definitely give a better understanding of achievement of remission.

We also agree to the suggestion: 'Pilot study on CD19+ B cell behavior with various treatment modalities may also help understand this immunological marker in pemphigus.' The authors also mention: 'No other treatment like steroid, azathioprine, DCP are known to thoroughly deplete B cell from circulation as rituximab.' If the latter statement is based on scientifically established fact, the pilot study as suggested in the first statement is perhaps not required, but can still be done if there is uncertainty regarding the latter.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , . A cluster of differentiation 19+ B-lymphocyte cell as a predictor of relapse in pemphigus vulgaris. Indian J Dermatol Venereol Leprol XX:XX-XX
    [Google Scholar]
  2. , , , , , , et al. Identification of clinical and immunological factors associated with clinical relapse of pemphigus vulgaris in remission. Indian J Dermatol Venereol Leprol. 2020;86:233-9.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , , , et al. Normal ranges of some select lymphocyte sub-populations in peripheral blood of normal healthy Indians. Curr Sci. 2004;86:969-75.
    [Google Scholar]

Fulltext Views
831

PDF downloads
371
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections