Proteomic Analysis Reveals Oxidative Phosphorylation and JAK‐STAT Pathways Mediated Pathogenesis of Pemphigus Vulgaris

ABSTRACT Pemphigus vulgaris (PV) stands as a rare autoimmune bullous disease, while the precise underlying mechanism remains incompletely elucidated. High‐throughput proteomic methodologies, such as LC‐MS/MS, have facilitated the quantification and characterisation of proteomes from clinical skin samples, enhancing our comprehension of PV pathogenesis. The objective of this study is to elucidate the signalling mechanisms underlying PV through proteomic analysis. Proteins and cell suspension were extracted from skin biopsies obtained from both PV patients and healthy volunteers and subsequently analysed using LC‐MS/MS and scRNA‐seq. Cultured keratinocytes were treated with PV serum, followed by an assessment of protein expression levels using immunofluorescence and western blotting. A total of 880, 605, and 586 differentially expressed proteins (DEPs) were identified between the lesion vs. control, non‐lesion vs. control, and lesion vs. non‐lesion groups, respectively. The oxidative phosphorylation (OXPHOS) pathway showed activation in PV. Keratinocytes are the major cell population in the epidermis and highly expressed ATP5PF, ATP6V1G1, COX6B1, COX6A1, and NDUFA9. In the cellular model, there was a notable increase in the expression levels of OXPHOS‐related proteins (V‐ATP5A, III‐UQCRC2, II‐SDHB, I‐NDUFB8), along with STAT1, p‐STAT1, and p‐JAK1. Furthermore, both the OXPHOS inhibitor metformin and the JAK1 inhibitor tofacitinib demonstrated therapeutic effects on PV serum‐induced cell separation, attenuating cell detachment. Metformin notably reduced the expression of V‐ATP5A, III‐UQCRC2, II‐SDHB, I‐NDUFB8, p‐STAT1, p‐JAK1, whereas tofacitinib decreased the expression of p‐STAT1 and p‐JAK1, with minimal impact on the expression of V‐ATP5A, III‐UQCRC2, II‐SDHB, and I‐NDUFB8. Our results indicate a potential involvement of the OXPHOS and JAK‐STAT1 pathways in the pathogenesis of PV.