TO THE EDITOR: Epidermolysis bullosa acquisita (EBA) is a prototypic organ-specific autoimmune disease, which is characterized by chronic mucocutaneous subepidermal blistering (Gupta et al., 2012; Schmidt and Zillikens, 2013).The autoimmune response is directed against a 290-kDa protein located at the dermal-epidermal junction (DEJ), which has been identified as the type VII collagen (Woodley et al., 1988).Despite major achievements in the understanding of EBA pathogenesis (Gupta et al., 2012), therapy of EBA patients remains difficult, and, because of the low incidence of the disease, data from clin. trials are still missing.Most commonly corticosteroids in combination with other (immunosuppressive) drugs are used (Engineer and Ahmed, 2001), which is associated with severe and potentially life-threatening adverse reactions.Therefore, there is a great and so far unmet medical need for effective and safe treatment options in EBA.We have recently established a mouse model of EBA induced by immunization with an immunodominant domain located within the non-collagenous 1 domain of murine type VII collagen (Iwata et al., 2013).Induction of skin blistering in exptl. EBA depends on the expression of activating Fc gamma receptor (FcγR; Kasperkiewicz et al., 2012).The detrimental contribution of FcγR binding to tissue-deposited immune complexes (ICs) has been well documented in models of autoantibody-mediated diseases, such as rheumatoid arthritis (Kleinau et al., 2000), immune-mediated thrombocytopenia (McKenzie et al., 1999), and autoimmune bullous dermatoses (Ludwig et al., 2013).On the basis of these findings, FcγR seems to be a promising therapeutic target for the treatment of autoantibody-mediated inflammatory diseases.Currently, several novel compounds targeting the interaction of ICs with FcγR are pursued either in preclin. model systems or in clin. trials.Notably, pharmacol. modifications of IgG glycosylation at the Fc fragment, which alters IgG's affinity to FcγR, have prophylactic and therapeutic effects in several models of autoimmunity (Collin and Ehlers, 2013).Other potentially promising FcγR targeting strategies, such as competitive binding of ICs by recombinant soluble FcγR2B (soluble CD32, sCD32, and SM101) in idiopathic thrombocytopenia or systemic lupus erythematosus, are already evaluated in phase I/II clin. trials (http://www.controlled-trials.com/isrctn/search.htmlsrch=SM101).Here, we evaluated whether treatment with sCD32 has therapeutic effects in exptl. EBA. sCD32 binds to IC and thereby blocks the binding of FcγR expressed on the surface of immune cells.Eventually, effector cells cannot be activated via FcγR (Ierino et al., 1993).First, we investigated the effect of sCD32 on activating FcγR-dependent reactive oxygen species (ROS) release from IC-activated neutrophils (Supplementary Materials and Methods online). sCD32 inhibited IC-induced neutrophil ROS production in a dose-dependent manner (Figure 1a).In detail, compared with pos. control, 0.01, 0.1, and 0.5 mg ml-1 sCD32 significantly reduced ROS production by 30, 65, and 75%, resp.Next, we tested whether sCD32 could hinder dermal-epidermal separation in an ex vivo model of autoimmune bullous dermatoses.Accordingly, in the presence of leukocytes, sCD32 successfully impaired FcγR-dependent dermal-epidermal separation on cryosections of human skin incubated with sera containing pathogenic antibodies against DEJ structures (Figure 1b and c; Supplementary Materials and Methods online).To validate this ex vivo inhibitory activity of sCD32 on antibody-induced tissue injury in vivo, we next induced exptl. EBA in mice by immunization with vWFA2 (Supplementary Materials and Methods online).After immunization, mice were allocated to sCD32 or phosphate-buffered saline (PBS) treatment if individual mice had 2% or more of their body-surface area affected by skin lesions (Supplementary Materials and Methods online).Compared with PBS-injected mice, sCD32 treatment led to a significantly lower clin. disease severity (Figure 2a, left, *P<0.05, t-test).At inclusion to treatment (week 0), average disease scores were not different between the groups (3.4±0.21% and 3.4±0.20%) of affected body-surface area in PBS and sCD32 treatment, resp.Cumulative disease severity expressed as area under the curve during the entire observation period was also significantly lower in sCD32-treated mice as compared with PBS control mice (Figure 2a, right, P=0.031, t-test).At the end of the 4-wk treatment period, PBS-treated mice showed diffuse erythema and crusts on the ear and tail, and hair loss around the eyes (Figure 2b, left).In contrast, less erythema on the ear and no disease on tail or around the eyes in mice treated with sCD32 were observed (Figure 2b, right).Histol., mice treated with sCD32 showed a significant decrease in the dermal leukocyte infiltration, compared with PBS-treated mice (P<0.05, Figure 2c). sCD32 treatment also led to an ∼20% reduction in circulating antigen-specific autoantibodies compared with PBS-treated mice (Figures 2d, P=0.048; t-test), whereas total IgG levels were not significantly different (data not shown).At the same time point, all mice showed similar IgG deposits at DEJ as determined by direct immunofluorescence (Figure 2e, upper).Representative pictures of direct immunofluorescence show IgG deposits at DEJ (Figure 2e, down).This discrepancy between circulating and tissue bound autoantibodies may be because of their different half-lives. sCD32 treatment has also demonstrated beneficial effects in models of other autoantibody-mediated diseases, such as nephritis in lupus-prone NZB/NZW F(1) hybrid mice (Werwitzke et al., 2008) and joint inflammation in collagen-induced arthritis (Magnusson et al., 2008).On the basis of our observations ex vivo and in vivo, the therapeutic effect of sCD32 can be attributed to both direct and indirect mechanisms, which mean the inhibition of neutrophil function and autoantibody production, resp.On the basis of our observation of therapeutic efficacy in exptl. EBA, it is tempting to speculate that sCD32 binds to the in situ deposited ICs.This assumption, however, needs further exptl. exploration.Regarding the effect on autoantibody production, controversial results have been reported.In the lupus-prone NZM/NZW mouse model neither prophylactic nor therapeutic treatment with sCD32 affected anti-double stranded DNA serum titers (Werwitzke et al., 2008).In contrast, sCD32 suppressed secondary and primary in vitro antibody responses (Varin et al., 1989) and caused a temporary decrease in collagen-specific autoantibodies in CIA (Magnusson et al., 2008).In support of these later observations, we here report a sustained reduction of antigen-specific but not of total circulating IgG in immunization-induced EBA.This effect may be mediated through a blockade of the IgG2a-mediated enhancement of antibody and T-cell responses via increased antigen presentation to CD4+ T cells by FcγR-expressing antigen-presenting cells (Getahun et al., 2004).Taken together, our findings provide evidence for a beneficial role of sCD32 in exptl. EBA.As this model mostly reflects the inflammatory variant of EBA, our findings may pave the way for its clin. application in patients with autoimmune bullous dermatoses, where disease manifestation depends on an interaction of ICs with effector myeloid cells.