Dermatitis herpetiformis (DH) is an autoimmune blistering skin disease associated with gluten-sensitive enteropathy (CD). In order to investigate the pathogenesis of skin lesions at molecular level, we analysed the gene expression profiles in skin biopsies from 6 CD patients with DH and 6 healthy controls using Affymetrix HG-U133A 2.0 arrays. 486 genes were differentially expressed in DH skin compared to normal skin: 225 were upregulated and 261 were downregulated. Consistently with the autoimmune origin of DH, functional classification of the differentially expressed genes (DEGs) indicates a B- and T-cell immune response (LAG3, TRAF5, DPP4, and NT5E). In addition, gene modulation provides evidence for a local inflammatory response (IL8, PTGFR, FSTL1, IFI16, BDKRD2, and NAMPT) with concomitant leukocyte recruitment (CCL5, ENPP2), endothelial cell activation, and neutrophil extravasation (SELL, SELE). DEGs also indicate overproduction of matrix proteases (MMP9, ADAM9, and ADAM19) and proteolytic enzymes (CTSG, ELA2, CPA3, TPSB2, and CMA1) that may contribute to epidermal splitting and blister formation. Finally, we observed modulation of genes involved in cell growth inhibition (CGREF1, PA2G4, and PPP2R1B), increased apoptosis (FAS, TNFSF10, and BASP1), and reduced adhesion at the dermal epidermal junction (PLEC1, ITGB4, and LAMA5). In conclusion, our results identify genes that are involved in the pathogenesis of DH skin lesions. 1. Introduction Dermatitis herpetiformis (DH) is an autoimmune subepidermal blistering skin disease characterized by intense pruritic papulovesicular eruptions mainly localized on extensor surfaces . DH typically develops in patients with celiac disease (CD). The two conditions share the same genetic background (HLA genes DQ2–DQ8), improve following a gluten-free diet (GFD), and are mediated by IgA autoantibodies . IgA antibodies against tissue transglutaminase (tTG) are detectable both in CD and DH, while autoantibodies directed against epidermal transglutaminase (eTG) are a typical serological marker of patients with DH . The key feature of DH is a granular deposition of IgA within the tips of dermal papillae and along the basement membrane of perilesional skin. eTG has been shown to colocalize with such IgA deposits . Typical histopathologic features of DH consist of accumulation of neutrophils and a few eosinophils with formation of papillary microabscesses which then coalescence to form a subepidermal bulla. Moreover, a perivascular cellular infiltrate composed mainly by CD4+ lymphocytes is also present . In
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