ABSTRACT
Pemphigus is a broad term denoting a subset of potentially life-threatening autoimmune blistering skin diseases
with a prevalence of 5.2 cases per 100,000 adults in the United States. Several genetic variants strongly increase
PF risk, including variants within the major histocompatibility complex (MHC), such as the human leukocyte
antigen (HLA) class I and II genes. The PI has contributed significantly to uncovering susceptibility genetic
variants in PF, including a recent genome-wide association study. Remarkably, variants in genes encoding
natural NK receptors have been strongly associated with PF susceptibility, and some of these associations were
explained by differential expression levels. Despite the compelling evidence for the role of NK cell receptor
variation in this autoimmune blistering skin disease, the precise function of NK cells in mediating pemphigus risk
and outcomes is poorly understood. The overall goal is to develop a comprehensive map of sequence and
structural variation of the entire NK cell receptome in pemphigus, encoded by approximately 90 genes within the
LRC (leukocyte receptor complex) and NKC (natural killer complex). To bring novel insights about the role of NK
cells in disease, we will characterize the nature and extent of the association of genetic variation of NK receptors
achieved via our novel high-throughput, high-resolution next-generation sequencing (NGS) assays and applied
across a set of diverse, established, and well-characterized cohorts. Using state-of-art methods, we will
contextualize this genomic variation by considering NK cell phenotype in disease. Finally, we will explore the
functional implications of the observed NK receptor variation, allowing a mechanistic explanation of the impact
of NK receptor expression to understand better the role of these highly variable receptors in pemphigus and lay
the foundation for understanding disease mechanisms. As we aim to explore and uncover regulatory
mechanisms, our research will significantly expand the comprehension of NK cell biology, cytotoxicity, and
function. Our ultimate goal is to reveal biological processes that lay the foundation for advancing disease
comprehension and treatment by discovering potential targets for NK-cell-mediated immunotherapies.