Immunologic sequelae of thermal injury. I. Frequency and relationship of epithelial antibodies to extent of burn

Anti-nuclear antibodies and antibodies reactive with the intercellular area ("pemphigus-like"), basement-membrane zone and basal cells of squamous epithelium were observed in the sera of acute and convalescent burn patients by the method of indirect immunofluorescence (IF). Tests for the presence of lymphocytotoxic and anti-IgG (rheumatoid factor) antibodies were negative. Irrespective of the extent (percentage) of thermal injury, higher titers of "pemphigus-like" and basal cell antibodies were observed in the acute than convalescent patients. When viewed according to the percentage of total body surface and third degree (3°) burn area, initial empirical observations suggested an increased frequency and higher titers of pemphigus-like and basal cell antibodies in patients with a 21-50% total body surface burn area, with higher titers of pemphigus-like antibodies observed in patients with ≤20% 3° burn vs those patients with >20% 3° burn area. However, statistical evaluation of these observations showed that there was no significance (P > 0.05) between the frequency and IF staining titer of these antibodies to the percentage of total body surface or 3° burn area. Comparison of the incidence of epithelial antibodies in the present and previous studies of burn patients suggests the presence of variations in the tissue and species specificities of these antibodies for various types of epithelia (substrates). Such variations may explain, in part, the different frequencies of epithelial antibodies observed in this and previous studies and suggest, if valid comparisons and the possible significance of these antibodies are to be made, that a mutually available agreed-upon substrate be used. Consideration of the etiology and significance of the development of epithelial antibodies and speculation as to their relationship to increased mortality and exacerbation of pathology following thermal injury are alluded to.