Indeed, this need for interaction between the binding of autoantibodies and additional changes in ceramide metabolism may be one explanation for the low levels of anti-Dsg antibodies without concomitant disease seen in some individuals in the El Bagre area [37] and fogo selvagem [61], as well as non-pathogenic antibodies observed in some pemphigus patients (reviewed in [62]). The gene discussed is DSG1; the disease is pemphigus.