Which of the following best describes the pathogenic mechanism by which anti-desmoglein antibodies cause acantholysis in pemphigus vulgaris?

• A Steric hindrance of desmoglein binding leading to loss of intercellular adhesion ✓
• B Direct complement-mediated lysis of keratinocytes
• C Antibody-dependent cellular cytotoxicity by NK cells
• D Direct activation of apoptosis via caspase-3 in basal keratinocytes

Explanation

Anti-desmoglein antibodies in pemphigus cause acantholysis primarily through steric hindrance, where antibodies bind to desmosomal cadherines and physically block trans-interaction between desmoglein molecules on adjacent keratinocytes. Desmoglein 3 compensation theory also explains the mucosal-predominant versus mucocutaneous phenotypes. Complement and apoptosis may contribute but are not the primary mechanism.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.