1
|
Li XX, Maitiyaer M, Tan Q, Huang WH, Liu Y, Liu ZP, Wen YQ, Zheng Y, Chen X, Chen RL, Tao Y, Yu SL. Emerging biologic frontiers for Sjogren's syndrome: Unveiling novel approaches with emphasis on extra glandular pathology. Front Pharmacol 2024; 15:1377055. [PMID: 38828450 PMCID: PMC11140030 DOI: 10.3389/fphar.2024.1377055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
Primary Sjögren's Syndrome (pSS) is a complex autoimmune disorder characterized by exocrine gland dysfunction, leading to dry eyes and mouth. Despite growing interest in biologic therapies for pSS, FDA approval has proven challenging due to trial complications. This review addresses the absence of a molecular-target-based approach to biologic therapy development and highlights novel research on drug targets and clinical trials. A literature search identified potential pSS treatment targets and recent advances in molecular understanding. Overlooking extraglandular symptoms like fatigue and depression is a notable gap in trials. Emerging biologic agents targeting cytokines, signal pathways, and immune responses have proven efficacy. These novel therapies could complement existing methods for symptom alleviation. Improved grading systems accounting for extraglandular symptoms are needed. The future of pSS treatment may involve gene, stem-cell, and tissue-engineering therapies. This narrative review offers insights into advancing pSS management through innovative biologic interventions.
Collapse
Affiliation(s)
- Xiao Xiao Li
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Maierhaba Maitiyaer
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Qing Tan
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Wen Hui Huang
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yu Liu
- Department of Clinical Medicine, The First Clinical Medical School of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhi Ping Liu
- Ophthalmic Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yue Qiang Wen
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yu Zheng
- Department of Urology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xing Chen
- Department of Geriatrics, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Rui Lin Chen
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Yi Tao
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Shui Lian Yu
- Department of Rheumatology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
2
|
IgG-Based Bispecific Anti-CD95 Antibodies for the Treatment of B Cell-Derived Malignancies and Autoimmune Diseases. Cancers (Basel) 2022; 14:cancers14163941. [PMID: 36010934 PMCID: PMC9405798 DOI: 10.3390/cancers14163941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Therapeutic antibodies have become a crucial cornerstone of the standard therapy for lymphoma and autoimmune diseases. However, the respective target antigens are also expressed on healthy B cells resulting in unspecific effects. In this article, we present a novel approach to selectively induce apoptosis in lymphoma cells and autoreactive B cells that express the CD95 death receptor. Therefore, we developed an improved IgG-based bispecific antibody format with favorable production properties and pharmacokinetics for CD20- and CD19-directed induction of apoptosis via CD95. We could show that our bispecific anti-CD95 antibodies are very efficient in the depletion of malignant and autoreactive B cells in vitro and in vivo. Therefore, our antibodies could help to provide a more selective therapy for patients with B cell-derived malignancies and autoimmune diseases. Abstract Antibodies against the B cell-specific antigens CD20 and CD19 have markedly improved the treatment of B cell-derived lymphoma and autoimmune diseases by depleting malignant and autoreactive B cells. However, since CD20 and CD19 are also expressed on healthy B cells, such antibodies lack disease specificity. Here, we optimize a previously developed concept that uses bispecific antibodies to induce apoptosis selectively in malignant and autoreactive B cells that express the death receptor CD95. We describe the development and characterization of bispecific antibodies with CD95xCD20 and CD95xCD19 specificity in a new IgG-based format. We could show that especially the CD95xCD20 antibody mediated a strong induction of apoptosis in malignant B cells in vitro. In vivo, the antibody was clearly superior to the previously used Fabsc format with identical specificities. In addition, both IgGsc antibodies depleted activated B cells in vitro, leading to a significant reduction in antibody production and cytokine secretion. The killing of resting B cells and hepatocytes that lack CD95 and CD20/CD19, respectively, was marginal. Thus, our results imply that bispecific anti-CD95 antibodies in the IgGsc format are an attractive tool for a more selective and efficient depletion of malignant as well as autoreactive B cells.
Collapse
|
3
|
B cells as target for immunotherapy in rheumatic diseases - current status. Immunol Lett 2021; 236:12-19. [PMID: 34077805 DOI: 10.1016/j.imlet.2021.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 01/16/2023]
Abstract
This mini-review is a short overview of different therapeutical strategies targeting B cells in systemic autoimmune rheumatic diseases, mainly: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and primary Sjogren Syndrome (pSS). Many strategies and their rationale are discussed in this review: B cells' depletion (anti-CD20, anti-CD22), long-lived plasma cells depletion (anti-CD19, anti-CD27, anti-CD38 and anti-CD138), changing activation of B cells (anti-BAFF) and inhibiting proteasomes in plasma cells (bortezomib). The past successful therapies and less successful are shown, and the possible reasons for failures are discussed.
Collapse
|
4
|
van Beers JJ, Damoiseaux JG. Immune Monitoring upon Treatment with Biologics in Sjögren's Syndrome: The What, Where, When, and How. Biomolecules 2021; 11:116. [PMID: 33467204 PMCID: PMC7830440 DOI: 10.3390/biom11010116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/25/2022] Open
Abstract
Over the years, a wide variety of therapeutic antibodies has been successfully introduced in the auto-immunology clinic, and many more are on the way. Many of these treatments address either a pathogenic circulating molecule or a cell-bound molecule. Whereas addressing the former target results in neutralization of the soluble factor and binding to the latter target either inhibits cellular function or induces selective cell death. If this targeted molecule or cell is part of the immune system, this therapy evokes a state of immunodeficiency with infections as a possible consequence. Therefore, immune monitoring is needed to prevent such adverse side effects of immunotherapy. In this paper, different immunotherapies used in Sjögren's syndrome, as well as different approaches to monitoring the immune system, are discussed.
Collapse
Affiliation(s)
- Joyce J.B.C. van Beers
- Central Diagnostic Laboratory Maastricht University Medical Center, Laboratory Specialist in Medical Immunology and Clinical Chemistry, 6202 AZ Maastricht, The Netherlands
| | - Jan G.M.C. Damoiseaux
- Central Diagnostic Laboratory Maastricht University Medical Center, Laboratory Specialist in Medical Immunology, 6202 AZ Maastricht, The Netherlands;
| |
Collapse
|
5
|
Sisto M, Ribatti D, Lisi S. Understanding the Complexity of Sjögren's Syndrome: Remarkable Progress in Elucidating NF-κB Mechanisms. J Clin Med 2020; 9:jcm9092821. [PMID: 32878252 PMCID: PMC7563658 DOI: 10.3390/jcm9092821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022] Open
Abstract
Sjögren’s syndrome (SS) is a systemic autoimmune inflammatory disease with a poorly defined aetiology, which targets exocrine glands (particularly salivary and lachrymal glands), affecting the secretory function. Patients suffering from SS exhibit persistent xerostomia and keratoconjunctivitis sicca. It is now widely acknowledged that a chronic grade of inflammation plays a central role in the initiation, progression, and development of SS. Consistent with its key role in organizing inflammatory responses, numerous recent studies have shown involvement of the transcription factor nuclear factor κ (kappa)-light-chain-enhancer of activated B cells (NF-κB) in the development of this disease. Therefore, chronic inflammation is considered as a critical factor in the disease aetiology, offering hope for the development of new drugs for treatment. The purpose of this review is to describe the current knowledge about the NF-κB-mediated molecular events implicated in the pathogenesis of SS.
Collapse
|
6
|
Anti-CD20–mediated B-cell depletion in autoimmune diseases: successes, failures and future perspectives. Kidney Int 2020; 97:885-893. [DOI: 10.1016/j.kint.2019.12.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 12/11/2022]
|
7
|
B cell dysregulation in primary Sjögren's syndrome: A review. JAPANESE DENTAL SCIENCE REVIEW 2019; 55:139-144. [PMID: 31687053 PMCID: PMC6819875 DOI: 10.1016/j.jdsr.2019.09.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/02/2019] [Accepted: 09/19/2019] [Indexed: 12/16/2022] Open
Abstract
Primary Sjögren’s syndrome is a chronic autoimmune disorder of unknown etiology and is characterized by progressive focal lymphocytic infiltration of the lacrimal and salivary glands. Comparison of B cell subsets from the peripheral blood and salivary glands of patients with primary Sjögren’s syndrome and those from healthy individuals shows dysregulation and derangement of B cell subsets in both peripheral circulation and in inflamed glandular tissues. This dysregulation is expressed as a decrease in the percentage of CD27+ memory B cells in peripheral blood and an increase in the CD27+ memory B cells in the affected glands. Further, the overall percentage of long-lived autoantibodies-producing plasma cells within the affected glands is increased. In the last two decades, several studies have shown growing evidences that B cells play multiple roles in primary Sjögren’s syndrome pathophysiology, and that dysregulation of these cells may actually play a central role in the disease development.
Collapse
|
8
|
van der Heijden EHM, Hartgring SAY, Kruize AA, Radstake TRDJ, van Roon JAG. Additive immunosuppressive effect of leflunomide and hydroxychloroquine supports rationale for combination therapy for Sjögren’s syndrome. Expert Rev Clin Immunol 2019; 15:801-808. [DOI: 10.1080/1744666x.2019.1624527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Eefje HM van der Heijden
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sarita AY Hartgring
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Aike A Kruize
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Timothy RDJ Radstake
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joel AG van Roon
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
9
|
Lanzillotta M, Della-Torre E, Milani R, Bozzolo E, Bozzalla-Cassione E, Rovati L, Arcidiacono PG, Partelli S, Falconi M, Ciceri F, Dagna L. Increase of circulating memory B cells after glucocorticoid-induced remission identifies patients at risk of IgG4-related disease relapse. Arthritis Res Ther 2018; 20:222. [PMID: 30285841 PMCID: PMC6235221 DOI: 10.1186/s13075-018-1718-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
Background Immunoglobulin G4-related disease (IgG4-RD) promptly responds to glucocorticoids but relapses in a considerable fraction of patients. Reliable biomarkers of flare are currently lacking because the pathophysiology of IgG4-RD remains largely elusive. In the present work, we aimed to identify perturbations of B-cell subpopulations that might predict IgG4-RD relapse. Methods Thirty patients were treated with glucocorticoids according to international guidelines. Circulating CD19+ and CD20+ cells, naive B cells, memory B cells, plasmablasts, and plasma cells were measured by flow cytometry at baseline and every 6 months for 2 years after the initiation of corticosteroid therapy. Results Patients with active untreated IgG4-RD showed significantly reduced CD19+ B cells, CD20+ B cells, and naive B cells compared with healthy subjects (p < 0.05), but significantly expanded plasmablasts and plasma cells (p < 0.01). After 6 months of corticosteroid treatment, all patients achieved clinical improvement. Naive B cells, plasmablasts, and plasma cells significantly decreased compared with disease onset, whereas memory B cells significantly increased compared with baseline (p < 0.01). Increase of memory B cells was observed only in patients who relapsed within 2 years of follow-up, however (HR, 12.24; 2.99 to 50.2; p = 0.0005). In these patients, the relapse rates at 12 and 24 months were 30% and 100%, respectively. No abnormalities of other B-cell subpopulations at disease onset or after 6 months of glucocorticoid treatment were found to predict IgG4-RD relapse at 2 years. Conclusions Increase of circulating memory B cells after 6 months of glucocorticoid treatment might predict IgG4-RD relapse.
Collapse
Affiliation(s)
- Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute, Milan, Italy. .,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.
| | - Raffaella Milani
- Unit of Immunohematology and Transfusion Medicine, IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Emanuele Bozzalla-Cassione
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Lucrezia Rovati
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Partelli
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Falconi
- Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Hematology and Bone Marrow Transplantation Unit, IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| |
Collapse
|
10
|
Nguyen XH, Dauvilliers Y, Quériault C, Perals C, Romieu-Mourez R, Paulet PE, Bernard-Valnet R, Fazilleau N, Liblau R. Circulating follicular helper T cells exhibit reduced ICOS expression and impaired function in narcolepsy type 1 patients. J Autoimmun 2018; 94:134-142. [PMID: 30104107 DOI: 10.1016/j.jaut.2018.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 01/08/2023]
Abstract
Despite genetic and epidemiological evidence strongly supporting an autoimmune basis for narcolepsy type 1, the mechanisms involved have remained largely unknown. Here, we aimed to investigate whether the frequency and function of circulating follicular helper and follicular regulatory T cells are altered in narcolepsy type 1. Peripheral blood mononuclear cells were collected from 32 patients with narcolepsy type 1, including 11 who developed disease after Pandemrix® vaccination, and 32 age-, sex-, and HLA-DQB1*06:02-matched healthy individuals. The frequency and phenotype of the different circulating B cell and follicular T cell subsets were examined by flow cytometry. The function of follicular helper T cells was evaluated by assessing the differentiation of naïve and memory B cells in a co-culture assay. We revealed a notable increase in the frequency of circulating B cells and CD4+CXCR5+ follicular T cells in narcolepsy patients compared to age-, sex- and HLA-matched healthy controls. However, the inducible T-cell costimulator molecule, ICOS, was selectively down-regulated on follicular T cells from patients. Reduced frequency of activated ICOS+ and PD1high blood follicular T cells was also observed in the narcolepsy group. Importantly, follicular T cells isolated from patients with narcolepsy type 1 had a reduced capacity to drive the proliferation/survival and differentiation of memory B cells. Our results provide novel insights into the potential involvement of T cell-dependent B cell responses in the pathogenesis of narcolepsy type 1 in which down-regulation of ICOS expression on follicular helper T cells correlates with their reduced function. We hypothesize that these changes contribute to regulation of the deleterious autoimmune process after disease onset.
Collapse
Affiliation(s)
- Xuan-Hung Nguyen
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France.
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia and Kleine-Levin Syndrome, Department of Neurology, Gui-de-Chauliac Hospital, CHU de Montpellier, INSERM U1061, Montpellier, France
| | - Clémence Quériault
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France
| | - Corine Perals
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France
| | - Raphaelle Romieu-Mourez
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France
| | - Pierre-Emmanuel Paulet
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France
| | - Raphaël Bernard-Valnet
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France
| | - Nicolas Fazilleau
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France
| | - Roland Liblau
- INSERM U1043, CNRS UMR, 5282, Toulouse III University, Center for Pathophysiology Toulouse Purpan, Toulouse, France; Department of Immunology, Toulouse University Hospitals, Toulouse, France.
| |
Collapse
|
11
|
Ishioka-Takei E, Yoshimoto K, Suzuki K, Nishikawa A, Yasuoka H, Yamaoka K, Takeuchi T. Increased proportion of a CD38 highIgD + B cell subset in peripheral blood is associated with clinical and immunological features in patients with primary Sjögren's syndrome. Clin Immunol 2017; 187:85-91. [PMID: 29061446 DOI: 10.1016/j.clim.2017.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/13/2017] [Accepted: 10/19/2017] [Indexed: 12/16/2022]
Abstract
We investigated the correlation between the increased proportion of peripheral B cell subsets and clinical and immunological features in primary Sjögren's syndrome (pSS). We found that the proportion of CD19+ B cells was significantly increased in pSS as compared with HC and was correlated with serum IgG levels. Moreover, in vitro IgG production by CD19+ B cells was significantly increased in pSS and was positively and significantly correlated with serum IgG levels. FACS analysis revealed that the proportions of peripherally CD38highIgD+ B cells and CD38highIgD- B cells were significantly increased in pSS. In addition, the proportion of CD38highIgD+ B cells positively correlated with ESSDAI scores and serum levels of IgG, anti-Ro/SSA and anti-La/SSB antibodies while that of CD38highIgD- B cells showed no correlation with these parameters. Our data suggest that increased proportion of CD38highIgD+ B cells in pSS is involved in IgG overproduction including autoantibodies, and correlates with disease progression.
Collapse
Affiliation(s)
- Eriko Ishioka-Takei
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Yoshimoto
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan.
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Nishikawa
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hidekata Yasuoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kunihiro Yamaoka
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
12
|
Riccio LGC, Baracat EC, Chapron C, Batteux F, Abrão MS. The role of the B lymphocytes in endometriosis: A systematic review. J Reprod Immunol 2017; 123:29-34. [PMID: 28910679 DOI: 10.1016/j.jri.2017.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/01/2017] [Accepted: 09/06/2017] [Indexed: 01/06/2023]
Abstract
The physiopathology of endometriosis is not completely understood and its progression is associated with a local and systemic inflammatory reaction. It is important to clarify the potential role of the immune system to better understand its implication in the pathogenesis of endometriosis, which includes the study of the role of B cells and antibodies. The aim of this study was to review the literature about the role of B lymphocytes in endometriosis. A search for "endometriosis", "B cells" and "B lymphocytes" in databases resulted in 140 citations; after applying inclusion and exclusion criteria, a total of 22 studies were assessed. The analyzed samples in the studies varied and different markers and techniques were used by the authors to evaluate the direct or indirect role of B lymphocytes in endometriosis. Most studies demonstrated increased number and/or activation of B cells while seven studies found no difference and two studies showed decreased number of B cells. Increased B lymphocytes and excessive production of autoantibodies in endometriosis have been described in the literature, but their role in the development of the disease is not well understood. Moreover, the association of these factors with clinical symptoms, location and severity of the disease has not been investigated. Further studies are necessary to clarify the role of B cells in the development of endometriosis and propose new therapeutic strategies such as the use of drugs that target these cells.
Collapse
Affiliation(s)
- L G C Riccio
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - E C Baracat
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil.
| | - C Chapron
- Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Paris, France; Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - F Batteux
- Department of Development, Reproduction and Cancer, Institut Cochin, INSERM U1016-Batteux, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Department of Immunology, Hôpital Cochin, AP-HP, Paris, France.
| | - M S Abrão
- School of Medicine, University of São Paulo, Endometriosis Division, Obstetrics and Gynecology Department, São Paulo, Brazil.
| |
Collapse
|
13
|
Deligne C, Milcent B, Josseaume N, Teillaud JL, Sibéril S. Impact of Depleting Therapeutic Monoclonal Antibodies on the Host Adaptive Immunity: A Bonus or a Malus? Front Immunol 2017; 8:950. [PMID: 28855903 PMCID: PMC5557783 DOI: 10.3389/fimmu.2017.00950] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/25/2017] [Indexed: 11/16/2022] Open
Abstract
Clinical responses to anti-tumor monoclonal antibody (mAb) treatment have been regarded for many years only as a consequence of the ability of mAbs to destroy tumor cells by innate immune effector mechanisms. More recently, it has also been shown that anti-tumor antibodies can induce a long-lasting anti-tumor adaptive immunity, likely responsible for durable clinical responses, a phenomenon that has been termed the vaccinal effect of antibodies. However, some of these anti-tumor antibodies are directed against molecules expressed both by tumor cells and normal immune cells, in particular lymphocytes, and, hence, can also strongly affect the host adaptive immunity. In addition to a delayed recovery of target cells, lymphocyte depleting-mAb treatments can have dramatic consequences on the adaptive immune cell network, its rebound, and its functional capacities. Thus, in this review, we will not only discuss the mAb-induced vaccinal effect that has emerged from experimental preclinical studies and clinical trials but also the multifaceted impact of lymphocytes-depleting therapeutic antibodies on the host adaptive immunity. We will also discuss some of the molecular and cellular mechanisms of action whereby therapeutic mAbs induce a long-term protective anti-tumor effect and the relationship between the mAb-induced vaccinal effect and the immune response against self-antigens.
Collapse
Affiliation(s)
- Claire Deligne
- Cordeliers Research Center, INSERM UMR-S 1138, "Cancer, Immune Control and Escape" Laboratory, Paris, France.,Sorbonne Universities, Université Pierre et Marie Curie, UMR-S 1138, Paris, France.,Université Paris Descartes, UMR-S 1138, Paris, France.,Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Benoît Milcent
- Cordeliers Research Center, INSERM UMR-S 1138, "Cancer, Immune Control and Escape" Laboratory, Paris, France.,Sorbonne Universities, Université Pierre et Marie Curie, UMR-S 1138, Paris, France.,Université Paris Descartes, UMR-S 1138, Paris, France
| | - Nathalie Josseaume
- Cordeliers Research Center, INSERM UMR-S 1138, "Cancer, Immune Control and Escape" Laboratory, Paris, France.,Sorbonne Universities, Université Pierre et Marie Curie, UMR-S 1138, Paris, France.,Université Paris Descartes, UMR-S 1138, Paris, France
| | - Jean-Luc Teillaud
- Cordeliers Research Center, INSERM UMR-S 1138, "Cancer, Immune Control and Escape" Laboratory, Paris, France.,Sorbonne Universities, Université Pierre et Marie Curie, UMR-S 1138, Paris, France.,Université Paris Descartes, UMR-S 1138, Paris, France
| | - Sophie Sibéril
- Cordeliers Research Center, INSERM UMR-S 1138, "Cancer, Immune Control and Escape" Laboratory, Paris, France.,Sorbonne Universities, Université Pierre et Marie Curie, UMR-S 1138, Paris, France.,Université Paris Descartes, UMR-S 1138, Paris, France
| |
Collapse
|
14
|
Verstappen GM, Kroese FGM, Meiners PM, Corneth OB, Huitema MG, Haacke EA, van der Vegt B, Arends S, Vissink A, Bootsma H, Abdulahad WH. B Cell Depletion Therapy Normalizes Circulating Follicular Th Cells in Primary Sjögren Syndrome. J Rheumatol 2016; 44:49-58. [PMID: 28042126 DOI: 10.3899/jrheum.160313] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the effect of B cell depletion therapy on effector CD4+ T cell homeostasis and its relation to objective measures of disease activity in patients with primary Sjögren syndrome (pSS). METHODS Twenty-four patients with pSS treated with rituximab (RTX) and 24 healthy controls (HC) were included. Frequencies of circulating effector CD4+ T cell subsets were examined by flow cytometry at baseline and 16, 24, 36, and 48 weeks after the first RTX infusion. Th1, Th2, follicular Th (TFH), and Th17 cells were discerned based on surface marker expression patterns. Additionally, intracellular cytokine staining was performed for interferon-γ, interleukin (IL)-4, IL-21, and IL-17 and serum levels of these cytokines were analyzed. RESULTS In patients with pSS, frequencies of circulating TFH cells and Th17 cells were increased at baseline compared with HC, whereas frequencies of Th1 and Th2 cells were unchanged. B cell depletion therapy resulted in a pronounced decrease in circulating TFH cells, whereas Th17 cells were only slightly lowered. Frequencies of IL-21-producing and IL-17-producing CD4+ T cells and serum levels of IL-21 and IL-17 were also reduced. Importantly, the decrease in circulating TFH cells was associated with lower systemic disease activity over time, as measured by the European League Against Rheumatism Sjögren's Syndrome Disease Activity Index scores and serum IgG levels. CONCLUSION B cell depletion therapy in patients with pSS results in normalization of the elevated levels of circulating TFH cells. This reduction is associated with improved objective clinical disease activity measures. Our observations illustrate the pivotal role of the crosstalk between B cells and TFH cells in the pathogenesis of pSS.
Collapse
Affiliation(s)
- Gwenny M Verstappen
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands. .,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen.
| | - Frans G M Kroese
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Petra M Meiners
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Odilia B Corneth
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Minke G Huitema
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Erlin A Haacke
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Bert van der Vegt
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Suzanne Arends
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Arjan Vissink
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Hendrika Bootsma
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| | - Wayel H Abdulahad
- From the departments of Rheumatology and Clinical Immunology, Oral and Maxillofacial Surgery, and Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen; the Department of Pulmonary Medicine, Erasmus MC, Rotterdam, the Netherlands.,G.M. Verstappen, MSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; F.G. Kroese, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; P.M. Meiners, MD, PhD, DMD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; O.B. Corneth, PhD, Department of Pulmonary Medicine, Erasmus MC; M.G. Huitema, BSc, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; E.A. Haacke, MD, departments of Rheumatology and Clinical Immunology, and departments of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; B. van der Vegt, MD, PhD, Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen; S. Arends, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; A. Vissink, DMD, MD, PhD, Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen; H. Bootsma, MD, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen; W.H. Abdulahad, PhD, departments of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen
| |
Collapse
|
15
|
Multiple Roles for B-Lymphocytes in Sjogren's Syndrome. J Clin Med 2016; 5:jcm5100087. [PMID: 27740602 PMCID: PMC5086589 DOI: 10.3390/jcm5100087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 12/22/2022] Open
Abstract
Sjogren’s syndrome (SS) is a complex heterogeneous autoimmune disease resulting in loss of salivary gland and lacrimal gland function that may include multiple systemic manifestations including lymphoma. Multiple cell types participate in disease pathogenesis. This review discusses evidence for abnormal B cell subpopulations in patients with SS, critical roles of B cells in SS and the status of B cell–directed therapies in the management of patients with SS.
Collapse
|
16
|
Alunno A, Carubbi F, Bistoni O, Caterbi S, Bartoloni E, Di Benedetto P, Cipriani P, Giacomelli R, Gerli R. Interleukin (IL)-17-producing pathogenic T lymphocytes co-express CD20 and are depleted by rituximab in primary Sjögren's syndrome: a pilot study. Clin Exp Immunol 2016; 184:284-92. [PMID: 26814615 DOI: 10.1111/cei.12771] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/13/2016] [Accepted: 01/25/2016] [Indexed: 12/18/2022] Open
Abstract
Compelling evidence suggests that interleukin (IL)-17 and IL-17-producing cells play a pivotal role in the pathogenesis of primary Sjögren's syndrome (pSS). We investigated phenotypical and functional effects of the anti-CD20 antibody rituximab (RTX) on circulating and glandular IL-17-producing T cells in pSS. RTX is able to deplete glandular IL-17(+) CD3(+) CD4(-) CD8(-) double-negative (DN) and CD4(+) Th17 cells as well as circulating IL-17(+) DN T cells. A fraction of glandular and circulating IL-17(+) DN cells and CD4(+) T helper type 17 (Th17) cells co-expresses CD20 on the cell surface explaining, at least in part, such depletive capacity of RTX. The exposure to RTX does not rescue the in-vitro corticosteroid resistance of IL-17(+) DN T cells. Our results support further the therapeutic role in pSS of RTX that, despite its B cell specificity, appears able to also hamper IL-17-producing T cells in this disease.
Collapse
Affiliation(s)
- A Alunno
- Rheumatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - F Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - O Bistoni
- Rheumatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - S Caterbi
- Rheumatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - E Bartoloni
- Rheumatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| | - P Di Benedetto
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - R Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - R Gerli
- Rheumatology Section, Department of Medicine, University of Perugia, Perugia, Italy
| |
Collapse
|
17
|
Delli K, Haacke EA, Kroese FGM, Pollard RP, Ihrler S, van der Vegt B, Vissink A, Bootsma H, Spijkervet FKL. Towards personalised treatment in primary Sjögren's syndrome: baseline parotid histopathology predicts responsiveness to rituximab treatment. Ann Rheum Dis 2016; 75:1933-1938. [PMID: 26757748 DOI: 10.1136/annrheumdis-2015-208304] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 12/20/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aims of this study were (1) to assess the effect of rituximab (RTX; anti-CD20) treatment in patients with primary Sjögren's syndrome (pSS) based on sequential parotid biopsies obtained in a placebo-controlled, randomised clinical trial, and (2) to assess the prognostic value of the histological characteristics of parotid gland tissue with regard to responsiveness to RTX treatment. METHODS In a double-blinded, placebo-controlled trial, sequential parotid gland biopsies were taken from 20 RTX-treated and 10 placebo-treated patients with pSS, at baseline and 12 weeks after treatment. The relative amount of lymphocytic infiltrate (stained for CD45), absolute number of T cells and B cells per mm2 parenchyma (stained for CD3 and CD20, respectively), focus score, number of germinal centres and of lymphoepithelial lesions per mm2 in parotid gland parenchyma were assessed. Histopathological data were compared between clinical responders (decrease in European League Against Rheumatism Sjögren's Syndrome Disease Activity Index (ESSDAI) score of ≥3 at 12 weeks compared with baseline) and non-responders (change in ESSDAI<3) to RTX treatment. RESULTS In RTX-treated patients, a significant reduction in the number of CD20+ B cells/mm2 parenchyma was observed, while no such reduction was observed in placebo-treated patients. The number of CD3+ T cells/mm2 in parenchyma did not change in either group. Furthermore, the number and the severity of lymphoepithelial lesions/mm2 and number of germinal centres/mm2 was significantly reduced in RTX-treated patients, but did not change in placebo-treated patients. When comparing the pretreatment characteristics of clinical responders with non-responders, the median number of CD20+ B cells/mm2 parenchyma at baseline was significantly higher in responders (1871 vs 353 cells/mm2, p<0.05). Other histopathological baseline characteristics were not predictive for response to RTX treatment. CONCLUSIONS RTX treatment in pSS leads to a major reduction of lymphocytic infiltration and to fewer B cells, germinal centres and lymphoepithelial lesions in parotid gland parenchyma. A high pretreatment number of CD20+ B cells/mm2 parotid gland parenchyma predicts better responsiveness of patients with pSS to RTX treatment. Pretreatment parotid gland histopathological characteristics could therefore contribute to a more personalised treatment approach to pSS.
Collapse
Affiliation(s)
- Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erlin A Haacke
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rodney P Pollard
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan Ihrler
- Laboratory for Dermatohistology & Oral Pathology, Munich, Germany
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
18
|
Franquesa M, Mensah FK, Huizinga R, Strini T, Boon L, Lombardo E, DelaRosa O, Laman JD, Grinyó JM, Weimar W, Betjes MGH, Baan CC, Hoogduijn MJ. Human adipose tissue-derived mesenchymal stem cells abrogate plasmablast formation and induce regulatory B cells independently of T helper cells. Stem Cells 2015; 33:880-91. [PMID: 25376628 DOI: 10.1002/stem.1881] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 09/25/2014] [Accepted: 10/11/2014] [Indexed: 12/14/2022]
Abstract
Mesenchymal or stromal stem cells (MSC) interact with cells of the immune system in multiple ways. Modulation of the immune system by MSC is believed to be a therapeutic option for autoimmune disease and transplant rejection. In recent years, B cells have moved into the focus of the attention as targets for the treatment of immune disorders. Current B-cell targeting treatment is based on the indiscriminate depletion of B cells. The aim of this study was to examine whether human adipose tissue-derived MSC (ASC) interact with B cells to affect their proliferation, differentiation, and immune function. ASC supported the survival of quiescent B cells predominantly via contact-dependent mechanisms. Coculture of B cells with activated T helper cells led to proliferation and differentiation of B cells into CD19(+) CD27(high) CD38(high) antibody-producing plasmablasts. ASC inhibited the proliferation of B cells and this effect was dependent on the presence of T cells. In contrast, ASC directly targeted B-cell differentiation, independently of T cells. In the presence of ASC, plasmablast formation was reduced and IL-10-producing CD19(+) CD24(high) CD38(high) B cells, known as regulatory B cells, were induced. These results demonstrate that ASC affect B cell biology in vitro, suggesting that they can be a tool for the modulation of the B-cell response in immune disease.
Collapse
Affiliation(s)
- M Franquesa
- Nephrology and Transplantation, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kuhn A, Wenzel J, Bijl M. Lupus erythematosus revisited. Semin Immunopathol 2015; 38:97-112. [PMID: 26637330 DOI: 10.1007/s00281-015-0550-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022]
Abstract
Lupus erythematosus (LE) is a multifactorial autoimmune disease with clinical manifestations of differing severity. The exact pathomechanisms and interactions resulting in the inflammatory and immunological processes of this heterogeneous disease remain elusive. Approaches in the understanding of the pathomechanisms revealed that the clinical expression of LE is predisposed by susceptibility genes and that various environmental factors are responsible for an abnormal immune response. Several studies demonstrated that ultraviolet (UV) light is one of the major factors in the pathogenesis of the disease. Standardized photoprovocation in patients with LE has been shown to be a safe and efficient model for evaluating the underlying pathomechanisms which lead to the production of autoantibodies and immune complexes. In particular, interferons were defined as important players in the early activation of the immune system and were observed to play a specific role in the immunological interface between the innate and the adaptive immune system. Abnormalities or disturbances in the different processes of cell death, such as apoptosis or necrosis, have also been recognized as crucial in the pathogenesis of LE. Although each process is different and characterized by unique features, the processes are interrelated and result in a complex disease.
Collapse
Affiliation(s)
- Annegret Kuhn
- Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
- Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Joerg Wenzel
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, Netherlands
| |
Collapse
|
20
|
Colucci M, Carsetti R, Cascioli S, Casiraghi F, Perna A, Ravà L, Ruggiero B, Emma F, Vivarelli M. B Cell Reconstitution after Rituximab Treatment in Idiopathic Nephrotic Syndrome. J Am Soc Nephrol 2015; 27:1811-22. [PMID: 26567244 DOI: 10.1681/asn.2015050523] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/25/2015] [Indexed: 12/12/2022] Open
Abstract
The pathogenesis of nephrotic syndrome is unclear. However, the efficacy of rituximab, a B cell-depleting antibody, in nephrotic syndrome suggests a pathogenic role of B cells. In this retrospective study, we determined by flow cytometry levels of B and T cell subpopulations before and after rituximab infusion in 28 pediatric patients with frequently relapsing or steroid-dependent nephrotic syndrome. At baseline, patients had lower median percentages of transitional and mature B cells than age-matched healthy controls (P<0.001). Rituximab induced full depletion of B cells (<1% of lymphocytes). At 1 year, most patients exhibited complete total and mature B cell recovery, whereas memory B cell subsets remained significantly depleted. Total T cell concentration did not change with rituximab, whereas the CD4(+)/CD8(+) T cell ratio tended to increase. Fourteen patients relapsed within 24 months, with a median follow-up of 11.2 months (interquartile range, 8-17.7 months). We observed no difference at baseline between nonrelapsing and relapsing patients in several clinical parameters and cell subset concentrations. Reconstitution of all memory B cell subpopulations, number of immunosuppressive drugs, and dose of tacrolimus during the last 4 months of follow-up were predictive of relapse in univariate Cox regression analysis. However, only delayed reconstitution of switched memory B cells, independent of immunosuppressive treatment, was protective against relapse in multivariate (P<0.01) and receiver operator characteristic (P<0.01 for percentage of lymphocytes; P=0.02 for absolute count) analyses. Evaluation of switched memory B cell recovery after rituximab may be useful for predicting relapse in patients with nephrotic syndrome.
Collapse
Affiliation(s)
| | - Rita Carsetti
- Immunology Unit, Immunology and Pharmacotherapy Area
| | | | - Federica Casiraghi
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche "Mario Negri," Clinical Research Center for Rare Diseases "Aldo e Cele Daccò," Ranica, Bergamo, Italy
| | - Annalisa Perna
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche "Mario Negri," Clinical Research Center for Rare Diseases "Aldo e Cele Daccò," Ranica, Bergamo, Italy
| | - Lucilla Ravà
- Clinical Epidemiology Unit, Medical Direction, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; and
| | - Barbara Ruggiero
- Istituto di Ricovero e Cura a Carattere Scientifico, Istituto di Ricerche Farmacologiche "Mario Negri," Clinical Research Center for Rare Diseases "Aldo e Cele Daccò," Ranica, Bergamo, Italy
| | | | | |
Collapse
|
21
|
Carubbi F, Alunno A, Cipriani P, Berardicurti O, Ruscitti P, Liakouli V, Ciccia F, Triolo G, Gerli R, Giacomelli R. Use of Rituximab in the Management of Sjögren’s Syndrome. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2015. [DOI: 10.1007/s40674-015-0025-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
22
|
Lin M, Lin J, Wang Y, Bonheur N, Kawai T, Wang Z, Han X. Lipopolysaccharide Attenuates CD40 Ligand-Induced Regulatory B10 Cell Expansion and IL-10 Production in Mouse Splenocytes. ACTA ACUST UNITED AC 2015; 5:1-8. [PMID: 26236564 PMCID: PMC4517687 DOI: 10.4236/oji.2015.51001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Toll-like receptors (TLRs) play a key role in B cell-mediated innate and adaptive immunity. It has been shown that interleukin 10 (IL-10)-producing regulatory B cells (B10 cells) can negatively regulate cellular immune responses and inflammation in autoimmune diseases. In this study, we determined the effect of TLR4 signaling on the CD40-activated B10 cell competency. The results demonstrated that LPS and CD40L synergistically stimulated proliferation of mouse splenocytes. The percentage of B10 cells in cultured splenocytes was significantly increased after CD40L stimulation but such increase was diminished by the addition of LPS. Such effects by LPS were only observed in cells from WT but not TLR4−/− mice. IL-10 mRNA expression and protein production in B10 cells from cultured splenocytes were significantly up-regulated by CD40L stimulation but were inhibited after the addition of LPS in a TLR4-dependent manner. This study suggests that LPS-induced TLR4 signaling attenuate CD40L-activated regulatory B10 cell competency.
Collapse
Affiliation(s)
- Mei Lin
- Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, USA ; Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jiang Lin
- Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, USA ; Department of Stomatology, Fourth Hospital of Harbin Medical University, Harbin, China
| | - Yuhua Wang
- Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, USA ; Department of Stomatology, Shanghai 9th People's Hospital, Shanghai, China
| | - Nathalie Bonheur
- Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, USA
| | - Toshihisa Kawai
- Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, USA
| | - Zuomin Wang
- Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaozhe Han
- Department of Immunology and Infectious Diseases, The Forsyth Institute, Cambridge, USA
| |
Collapse
|
23
|
Hamza N, Hershberg U, Kallenberg CGM, Vissink A, Spijkervet FKL, Bootsma H, Kroese FGM, Bos NA. Ig gene analysis reveals altered selective pressures on Ig-producing cells in parotid glands of primary Sjögren's syndrome patients. THE JOURNAL OF IMMUNOLOGY 2014; 194:514-21. [PMID: 25488989 DOI: 10.4049/jimmunol.1302644] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this study, we sought to understand the selective pressures shaping the Ig-producing cell repertoire in the parotid glands of primary Sjögren's syndrome (pSS) patients before and after rituximab treatment (RTX). In particular, we evaluated the role of potential N-glycosylation motifs acquired by somatic hypermutation (ac-Nglycs) within Ig H chain V region (IGHV) genes as alternative selective pressures for B cells in pSS. Five pSS patients received RTX. Sequential parotid salivary gland biopsies were taken before RTX, at 12 wk and at 36-52 wk after treatment. Parotid biopsies from four non-pSS patients served as controls. Sequence analysis was carried out on the IgA and IgG RNA transcripts expressing IGHV3 genes in all parotid biopsies. Both IgG and IgA sequences from pSS patients exhibited no evidence for positive Ag-driven selection pressure in their CDRs in contrast to non-pSS controls. The prevalence of IgG sequences with ac-Nglycs was significantly higher in pSS patients than in non-pSS controls. Selection pressures shaping the IgG and IgA repertoire within pSS patients' parotid glands are distinct from those in non-pSS controls, with very little evidence for positive (auto)antigen selection. The higher prevalence of ac-Nglycs on pSS-IgG compared with non-pSS IgG indicates that ac-Nglycs could be an alternative form of selection pressure. We speculate that B cell hyperproliferation within parotid glands of pSS patients may result from Ag-independent interactions such as that between glycosylated B cell receptors and lectins within the microenvironment rather than (auto)antigen-specific stimulation. Our study brings a new perspective into research on pSS.
Collapse
Affiliation(s)
- Nishath Hamza
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, the Netherlands
| | - Uri Hershberg
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104; and
| | - Cees G M Kallenberg
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, the Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, the Netherlands
| | - Frederik K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, the Netherlands
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, the Netherlands
| | - Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, the Netherlands
| | - Nicolaas A Bos
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 AV Groningen, the Netherlands;
| |
Collapse
|
24
|
Kroese FGM, Baeten D, Huizinga TWJ. Autoimmunity: break-through in the diagnosis and treatment of immune-mediated inflammatory diseases. Immunol Lett 2014; 162:150-62. [PMID: 25455603 DOI: 10.1016/j.imlet.2014.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The study of fundamental mechanisms of autoimmunity has been instrumental to clinical progress in the diagnosis and treatment of a range of immune-mediated inflammatory disorders. Dutch immunology has made major contributions to these developments, ranging from fundamental studies on immune cells, antibodies and cytokines to translational and clinical studies with targeted therapies in patients. In this paper we illustrate the progress made in our understanding of autoimmunity and the translational implications for human disease management by focusing on three areas: the autoantibody response in rheumatoid arthritis (RA), T-B cell interactions in Sjögren's syndrome (SS), and cytokine targeting in spondylarthritis (SpA).
Collapse
Affiliation(s)
- Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Dominique Baeten
- Department of Clinical Immunology and Rheumatology, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, C1-41 Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| |
Collapse
|
25
|
Díaz-Torné C, Ortiz de Juana MA, Geli C, Cantó E, Laiz A, Corominas H, Casademont J, de Llobet JM, Juárez C, Díaz-López C, Vidal S. Rituximab-induced interleukin-15 reduction associated with clinical improvement in rheumatoid arthritis. Immunology 2014; 142:354-62. [PMID: 24219764 DOI: 10.1111/imm.12212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 10/24/2013] [Accepted: 11/07/2013] [Indexed: 12/21/2022] Open
Abstract
Rituximab therapy alters all aspects of B-cell participation in the disturbed immune response of rheumatoid arthritis patients. To determine the impact of B-cell depletion on other immune compartments, we analysed levels of soluble and surface interleukin-15 (IL-15) along with the frequency of IL-15-related subsets after rituximab treatment. We then studied the correlation of observed changes with clinical activity. Heparinized blood samples from 33 rheumatoid arthritis patients were collected on days 0, 30, 90 and 180 after each of three rituximab cycles. Serum cytokine levels were determined by ELISA. Interleukin-15 trans-presentation was analysed by cytometry. Flow cytometry with monoclonal antibodies was performed to analyse circulating cell subsets. Interleukin-15 was detected in the serum of 25 patients before initiating the treatment. Rituximab then progressively reduced serum IL-15 (138 ± 21 pg/ml at baseline, 48 ± 18 pg/ml after third cycle, P = 0·03) along with IL-17 (1197 ± 203 pg/ml at baseline, 623 ± 213 pg/ml after third cycle, P = 0·03) and tended to increase the frequency of circulating regulatory T cells (3·1 ± 1 cells/μl at baseline, 7·7 ± 2 cells/μl after third cycle). Rituximab also significantly decreased IL-15 trans-presentation on surface monocytes of patients negative for IL-15 serum (mean fluorescence intensity: 4·82 ± 1·30 at baseline, 1·42 ± 0·69 after third cycle P = 0·05). Reduction of serum IL-15 was associated with decrease in CD8(+) CD45RO(+) /RA(+) ratio (1·17 ± 0·21 at baseline, 0·36 ± 0·06 at third cycle, P = 0·02). DAS28, erythrocyte sedimentation rate and C-reactive protein correlated significantly with CD8(+) CD45RO(+) /RA(+) ratio (R = 0·323, R = 0·357, R = 0·369 respectively, P < 0·001). Our results suggest that sustained clinical improvement after rituximab treatment is associated with IL-15/memory T-cell-related mechanisms beyond circulating B cells.
Collapse
Affiliation(s)
- César Díaz-Torné
- Rheumatology Unit, Internal Medicine Department Hospital Sant Pau, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Sisto M, Lisi S, D'Amore M, Lofrumento DD. Rituximab-mediated Raf kinase inhibitor protein induction modulates NF-κB in Sjögren syndrome. Immunology 2014; 143:42-51. [PMID: 24655025 DOI: 10.1111/imm.12288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 12/01/2022] Open
Abstract
Primary Sjögren syndrome (pSS) is an autoimmune disorder characterized by an epithelial injury surrounded by dense lymphocytic infiltrates. The conditions for the long-term maintenance of human salivary gland epithelial cells from pSS patients and a co-culture system with pSS lymphocytes were used to assess the effect of Rituximab (RTX) on the inflammatory condition and progression in pSS. Quantitative real-time PCR, genes and protein array analysis, Western blot, flow cytometry, small interfering RNA transfection and nuclear factor-κB (NF-κB) DNA binding assays were used as methods. Supporting the benefits of RTX, this study demonstrates that RTX decreases NF-κB activity and interrupts the NF-κB signalling pathway through the up-regulation of the Raf-1 kinase inhibitor protein (RKIP). Over-expression of RKIP down-regulates interleukins, their receptors and the expression of genes encodes proteins that attracted lymphocytes. Silencing of the RKIP gene leads to significantly increased expression and release of pro-inflammatory mediators supporting that RKIP expression could be involved in the suppression of NF-κB activation in pSS salivary gland epithelial cells.
Collapse
Affiliation(s)
- Margherita Sisto
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, Human Anatomy and Histology Section, Laboratory of Cell Biology, University of Bari Medical School, Bari, Italy
| | | | | | | |
Collapse
|
27
|
Alunno A, Carubbi F, Bartoloni E, Bistoni O, Caterbi S, Cipriani P, Giacomelli R, Gerli R. Unmasking the pathogenic role of IL-17 axis in primary Sjögren's syndrome: a new era for therapeutic targeting? Autoimmun Rev 2014; 13:1167-73. [PMID: 25183242 DOI: 10.1016/j.autrev.2014.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 07/04/2014] [Indexed: 01/09/2023]
Abstract
Compelling evidence suggests that the IL-17 axis plays a pivotal role in the pathogenesis of several autoimmune disorders including primary Sjögren's syndrome (pSS). However, although several studies have been carried out in experimental models and patients with pSS, many aspects of this field are not fully elucidated. In particular, the role played by different Th17 cell subsets as well as the effects of pharmacological therapies on IL-17 balance represent an intriguing issue. Furthermore, the understanding of IL-17 axis pathogenic role in pSS may be of interest for therapeutic purposes as a variety of compounds targeting IL-17, IL-17 receptor and other related cytokines and transcription factors involved in Th17 cell commitment are under intense investigation. The aim of this review article is to provide an overview of current knowledge in IL-17/Th17 cells in pSS and discuss their potential therapeutic targeting in this disease.
Collapse
Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Onelia Bistoni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Sara Caterbi
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
| |
Collapse
|
28
|
Carubbi F, Alunno A, Cipriani P, Bartoloni E, Ciccia F, Triolo G, Gerli R, Giacomelli R. Rituximab in primary Sjögren's syndrome: a ten-year journey. Lupus 2014; 23:1337-49. [DOI: 10.1177/0961203314546023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disorder affecting exocrine glands and characterized in most cases by a rather mild clinical picture. However, a subgroup of pSS patients experience systemic extraglandular involvement leading to a worsening of disease prognosis. Current therapeutic options for the treatment of pSS are mainly empirical, often translated by other autoimmune diseases, and recent systematic reviews have highlighted the lack of evidence-based recommendations for most of the drugs commonly employed in the spectrum of extraglandular involvement. Because of the well-established role of B-lymphocytes in the pathogenesis of pSS, a B-cell targeting therapy may represent a new and intriguing therapeutic approach; in this context, growing evidence suggests that B-cell depletion by rituximab (RTX) is also effective in pSS. Of interest, besides clinical efficacy, RTX also showed biologic effects, consistently affecting the inflammation and the lymphoid organization that occur in target tissue. Moreover, the good results observed in the published trials after RTX treatment in pSS should represent the starting point to develop evidence-based guidelines for the use of biologic therapy in this disease.
Collapse
Affiliation(s)
- F Carubbi
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy
| | - A Alunno
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - P Cipriani
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy
| | - E Bartoloni
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - F Ciccia
- Department of Internal Medicine, Division of Rheumatology, University of Palermo, Palermo, Italy
| | - G Triolo
- Department of Internal Medicine, Division of Rheumatology, University of Palermo, Palermo, Italy
| | - R Gerli
- Department of Medicine, Rheumatology Unit, University of Perugia, Perugia, Italy
| | - R Giacomelli
- Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
29
|
Disturbed B Cell Homeostasis in Newly Diagnosed Giant Cell Arteritis and Polymyalgia Rheumatica. Arthritis Rheumatol 2014; 66:1927-38. [DOI: 10.1002/art.38625] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 03/06/2014] [Indexed: 01/08/2023]
|
30
|
Kroese FGM, Abdulahad WH, Haacke E, Bos NA, Vissink A, Bootsma H. B-cell hyperactivity in primary Sjögren's syndrome. Expert Rev Clin Immunol 2014; 10:483-99. [PMID: 24564507 DOI: 10.1586/1744666x.2014.891439] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary Sjögren's syndrome (pSS) is characterized by mononuclear inflammatory infiltrates and IgG plasma cells in salivary and lacrimal glands which lead to irreversible destruction of the glandular tissue and is accompanied by sensation of dryness of mouth and eyes. B cells play a central role in the immunopathogenesis and exhibit signs of hyperactivity. Hyperactivity of B cells is the consequence of the coordinated and integrated action of stimulation of the B-cell receptor, CD40 and toll-like receptors in the presence of appropriate cytokines. As discussed, overexpression of type I IFN and BAFF on one hand and IL-6 and IL-21 on the other hand are critically involved in the enhanced plasma cell formation in pSS patients. Hyperactivity of B cells results in secretion of autoantibodies and production of various cytokines. These insights in the role of B cells in the pathogenetic process of pSS offer ample targets for successful therapeutical intervention in pSS.
Collapse
Affiliation(s)
- Frans G M Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
31
|
Carubbi F, Cipriani P, Marrelli A, Benedetto P, Ruscitti P, Berardicurti O, Pantano I, Liakouli V, Alvaro S, Alunno A, Manzo A, Ciccia F, Gerli R, Triolo G, Giacomelli R. Efficacy and safety of rituximab treatment in early primary Sjögren's syndrome: a prospective, multi-center, follow-up study. Arthritis Res Ther 2013; 15:R172. [PMID: 24286296 PMCID: PMC3979092 DOI: 10.1186/ar4359] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 10/09/2013] [Indexed: 12/14/2022] Open
Abstract
Introduction Primary Sjögren’s syndrome (pSS) is an autoimmune disorder affecting exocrine glands; however, a subgroup of pSS patients experience systemic extra-glandular involvement leading to a worsening of disease prognosis. Current therapeutic options are mainly empiric and often translated by other autoimmune diseases. In the last few years growing evidence suggests that B-cell depletion by rituximab (RTX) is effective also in pSS. Patients with early active disease appear to be those who could benefit the most from RTX. The aim of this study was to investigate the efficacy and safety of RTX in comparison to disease modifying anti-rheumatic drugs (DMARDs) in early active pSS patients. Methods Forty-one patients with early pSS and active disease (EULAR Sjogren’s syndrome disease activity index, ESSDAI ≥ 6) were enrolled in the study. Patients were treated with either RTX or DMARDs in two different Rheumatology centers and followed up for 120 weeks. Clinical assessment was performed by ESSDAI every 12 weeks up to week 120 and by self-reported global disease activity pain, sicca symptoms and fatigue on visual analogic scales, unstimulated saliva flow and Schirmer’s I test at week 12, 24, 48, 72, 96, and 120. Laboratory assessment was performed every 12 weeks to week 120. Two labial minor salivary gland (MSG) biopsies were obtained from all patients at the time of inclusion in the study and at week 120. Results Our study demonstrated that RTX treatment results in a faster and more pronounced decrease of ESSDAI and other clinical parameters compared to DMARDs treatment. No adverse events were reported in the two groups. We also observed that RTX is able to reduce glandular infiltrate, interfere with B/T compartmentalization and consequently with the formation of ectopic lymphoid structures and germinal center-like structures in pSS-MSGs. Conclusions To our knowledge, this is the first study performed in a large cohort of early active pSS patients for a period of 120 weeks. We showed that RTX is a safe and effective agent to be employed in pSS patients with systemic, extra-glandular involvement. Furthermore, our data on pSS-MSGs provide additional biological basis to employ RTX in this disease.
Collapse
|
32
|
Pollard RPE, Abdulahad WH, Bootsma H, Meiners PM, Spijkervet FKL, Huitema MG, Burgerhof JGM, Vissink A, Kroese FGM. Predominantly proinflammatory cytokines decrease after B cell depletion therapy in patients with primary Sjogren's syndrome. Ann Rheum Dis 2013; 72:2048-50. [PMID: 23864239 DOI: 10.1136/annrheumdis-2013-203447] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- R P E Pollard
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, , Groningen, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
St Clair EW, Levesque MC, Prak ETL, Vivino FB, Alappatt CJ, Spychala ME, Wedgwood J, McNamara J, Moser Sivils KL, Fisher L, Cohen P. Rituximab therapy for primary Sjögren's syndrome: an open-label clinical trial and mechanistic analysis. ACTA ACUST UNITED AC 2013; 65:1097-106. [PMID: 23334994 DOI: 10.1002/art.37850] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 12/27/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the safety and clinical efficacy of rituximab therapy for primary Sjögren's syndrome, as well as to investigate its mechanisms. METHODS Patients with primary Sjögren's syndrome were enrolled in an open-label trial, were given rituximab (1 gm) infusions on days 1 and 15, and were monitored through week 52. The primary end point was safety, with secondary end points evaluating clinical and biologic efficacy. Blood was obtained for enumeration of lymphocyte subsets, measurement of serum autoantibody and BAFF levels, and analysis of gene expression. RESULTS Twelve female patients with primary Sjögren's syndrome were administered rituximab. They had a median age of 51 years (range 34-69 years) and a median disease duration of 8.0 years (range 2-18 years). We observed no unexpected toxicities from the rituximab therapy. Modest improvements were observed at week 26 in patient-reported symptoms of fatigue and oral dryness, with no significant improvement in the objective measures of lacrimal and salivary gland function. The recovery of blood B cells following the nadir from rituximab therapy was characterized by a predominance of transitional B cells and a lack of memory B cells. While blood B cell depletion was associated with an increase in serum BAFF levels, no significant changes were observed in the levels of serum anti-Ro/SSA, anti-La/SSB, and anti-type 3 muscarinic acetylcholine receptor autoantibodies or in the blood interferon signature. CONCLUSION In patients with primary Sjögren's syndrome, a single treatment course of rituximab was not associated with any unexpected toxicities and led to only modest clinical benefits despite effective depletion of blood B cells.
Collapse
Affiliation(s)
- E William St Clair
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Blüml S, McKeever K, Ettinger R, Smolen J, Herbst R. B-cell targeted therapeutics in clinical development. Arthritis Res Ther 2013; 15 Suppl 1:S4. [PMID: 23566679 PMCID: PMC3624127 DOI: 10.1186/ar3906] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
B lymphocytes are the source of humoral immunity and are thus a critical component of the adaptive immune system. However, B cells can also be pathogenic and the origin of disease. Deregulated B-cell function has been implicated in several autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, and multiple sclerosis. B cells contribute to pathological immune responses through the secretion of cytokines, costimulation of T cells, antigen presentation, and the production of autoantibodies. DNA-and RNA-containing immune complexes can also induce the production of type I interferons, which further promotes the inflammatory response. B-cell depletion with the CD20 antibody rituximab has provided clinical proof of concept that targeting B cells and the humoral response can result in significant benefit to patients. Consequently, the interest in B-cell targeted therapies has greatly increased in recent years and a number of new biologics exploiting various mechanisms are now in clinical development. This review provides an overview on current developments in the area of B-cell targeted therapies by describing molecules and subpopulations that currently offer themselves as therapeutic targets, the different strategies to target B cells currently under investigation as well as an update on the status of novel therapeutics in clinical development. Emerging data from clinical trials are providing critical insight regarding the role of B cells and autoantibodies in various autoimmune conditions and will guide the development of more efficacious therapeutics and better patient selection.
Collapse
Affiliation(s)
- Stephan Blüml
- MedImmune, LLC, Department of Research, One MedImmune Way, Gaithersburg, MD 20854, USA
| | | | | | | | | |
Collapse
|
35
|
Wakefield D, Di Girolamo N, Thurau S, Wildner G, McCluskey P. Scleritis: Immunopathogenesis and molecular basis for therapy. Prog Retin Eye Res 2013; 35:44-62. [PMID: 23454614 DOI: 10.1016/j.preteyeres.2013.02.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 02/10/2013] [Accepted: 02/15/2013] [Indexed: 12/19/2022]
Abstract
Scleritis is a heterogeneous group of diseases characterized by inflammation of the sclera, which may be due to local or systemic infections or immune mediated diseases. Numerous studies over the last decade have lead to significant progress in understanding the pathogenesis and treatment of this severe and potentially blinding disease. Immunological investigations of non-infectious scleritis and associated diseases have indicated that scleritis is an autoimmune disease and studies on the nature of the local inflammatory response have revealed the prominent role of T and B cells and cytokines, such as TNF-alpha, which in turn has resulted in clinical trials showing the effectiveness of local steroid treatment, anti-TNF and anti-B cell therapy. The widespread use of imaging has led to the realization that posterior scleritis is more common than previously recognized and testing for ANCA antibodies has revealed the prominent role of immune mechanisms in a subset of patients with scleritis and associated systemic vasculitis.
Collapse
Affiliation(s)
- Denis Wakefield
- School of Medical Sciences, UNSW Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | | | | | | | | |
Collapse
|
36
|
Updates on B-cell immunotherapies for systemic lupus erythematosus and Sjogren's syndrome. Curr Opin Rheumatol 2013; 24:451-6. [PMID: 22871954 DOI: 10.1097/bor.0b013e32835707e4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Last year was marked by important clinical and mechanistic studies that improved our understanding of B-cell immunotherapy for systemic lupus erythematosus (SLE) and Sjogren's syndrome. Here, we will highlight the most relevant studies published in the last 18 months. RECENT FINDINGS The highlight of the year was the approval of belimumab on the basis of two major trials. On the flip side, the disappointing results of rituximab in lupus nephritis provided a clinical and mechanistic counterpoint in SLE. Still, major limitations in the LUpus Nephritis Assessment with Rituximab (LUNAR) trial, positive subset analysis and new open studies and registries continue to provide hope for and major insights into the use of B-cell depletion. In Sjogren's syndrome, the role of B-cell depletion has been further investigated, both for glandular and extraglandular manifestations of the disease with mixed results in a disease in which outcomes are notoriously hard to measure. SUMMARY The approval of anti-B cell activating factor therapy and an increasing body of open studies with rituximab as well as subset studies and secondary analysis of the Efficacy and Safety of Rituximab in Moderately-to-Severely Active Systemic Lupus Erythematosus (EXPLORER) and LUNAR trials provide hope for B-cell immunotherapy and significant insight into its mechanisms of action and utilization in a selected subset of patients. Ongoing clinical trials of other B-cell targeting agents are eagerly anticipated.
Collapse
|
37
|
Kaminski DA, Wei C, Qian Y, Rosenberg AF, Sanz I. Advances in human B cell phenotypic profiling. Front Immunol 2012; 3:302. [PMID: 23087687 PMCID: PMC3467643 DOI: 10.3389/fimmu.2012.00302] [Citation(s) in RCA: 189] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/10/2012] [Indexed: 12/11/2022] Open
Abstract
To advance our understanding and treatment of disease, research immunologists have been called-upon to place more centralized emphasis on impactful human studies. Such endeavors will inevitably require large-scale study execution and data management regulation (“Big Biology”), necessitating standardized and reliable metrics of immune status and function. A well-known example setting this large-scale effort in-motion is identifying correlations between eventual disease outcome and T lymphocyte phenotype in large HIV-patient cohorts using multiparameter flow cytometry. However, infection, immunodeficiency, and autoimmunity are also characterized by correlative and functional contributions of B lymphocytes, which to-date have received much less attention in the human Big Biology enterprise. Here, we review progress in human B cell phenotyping, analysis, and bioinformatics tools that constitute valuable resources for the B cell research community to effectively join in this effort.
Collapse
Affiliation(s)
- Denise A Kaminski
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Rochester, NY, USA
| | | | | | | | | |
Collapse
|
38
|
Hamza N, Bos NA, Kallenberg CG. B-cell populations and sub-populations in Sjögren's syndrome. Presse Med 2012; 41:e475-83. [DOI: 10.1016/j.lpm.2012.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/23/2012] [Indexed: 11/26/2022] Open
|
39
|
Current world literature. Curr Opin Rheumatol 2012; 24:586-94. [PMID: 22871955 DOI: 10.1097/bor.0b013e32835793df] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Bowman S, Barone F. Biologic treatments in Sjögren's syndrome. Presse Med 2012; 41:e495-509. [PMID: 22836195 DOI: 10.1016/j.lpm.2012.05.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/11/2012] [Indexed: 02/08/2023] Open
Abstract
Primary Sjögren's Syndrome (pSS) is characterized by focal lymphocytic infiltration of secretory exocrine glands associated with severe dryness of eyes and mouth in particular. Systemic features such as disabling fatigue, cutaneous vasculitis, lung, neurological, haematological or other systemic involvement also occur. Conventional immunosuppressive therapies such as corticosteroids or disease-modifying drugs, have been used in some patients with these systemic features with variable benefit. Current therapy for dryness is principally symptomatic although medications to stimulate residual glandular secretion can be helpful for appropriate individuals. As the pathogenesis of the condition becomes better understood, particularly, in recent years, the role of systemic B-cell activation, biologic therapies specifically targeted against molecules involved in disease pathogenesis represent a more targeted approach to therapeutic intervention. The greatest experience in pSS is with rituximab, an anti-CD20 (expressed on a subset of B-cells) monoclonal antibody already in use for the treatment of some B-cell lymphomas and rheumatoid arthritis. Randomised placebo-controlled studies in pSS are currently underway. This review discusses the rationale for using biologic therapies in pSS, the current data on rituximab and the potential use of other biologic therapies in pSS in the future.
Collapse
Affiliation(s)
- Simon Bowman
- Queen Elizabeth Hospital, Rheumatology Department, Edgbaston, Birmingham B15 2TH, United Kingdom.
| | | |
Collapse
|
41
|
Venhoff N, Effelsberg NM, Salzer U, Warnatz K, Peter HH, Lebrecht D, Schlesier M, Voll RE, Thiel J. Impact of rituximab on immunoglobulin concentrations and B cell numbers after cyclophosphamide treatment in patients with ANCA-associated vasculitides. PLoS One 2012; 7:e37626. [PMID: 22629432 PMCID: PMC3357389 DOI: 10.1371/journal.pone.0037626] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 04/23/2012] [Indexed: 12/20/2022] Open
Abstract
Objective To assess the impact of immunosuppressive therapy with cyclophosphamide (CYC) and rituximab (RTX) on serum immunoglobulin (Ig) concentrations and B lymphocyte counts in patients with ANCA-associated vasculitides (AAVs). Methods Retrospective analysis of Ig concentrations and peripheral B cell counts in 55 AAV patients. Results CYC treatment resulted in a decrease in Ig levels (median; interquartile range IQR) from IgG 12.8 g/L (8.15-15.45) to 9.17 g/L (8.04-9.90) (p = 0.002), IgM 1.05 g/L (0.70-1.41) to 0.83 g/L (0.60-1.17) (p = 0.046) and IgA 2.58 g/L (1.71-3.48) to 1.58 g/L (1-31-2.39) (p = 0.056) at a median follow-up time of 4 months. IgG remained significantly below the initial value at 14.5 months and 30 months analyses. Subsequent RTX treatment in patients that had previously received CYC resulted in a further decline in Ig levels from pre RTX IgG 9.84 g/L (8.71-11.60) to 7.11 g/L (5.75-8.77; p = 0.007), from pre RTX IgM 0.84 g/L (0.63-1.18) to 0.35 g/L (0.23-0.48; p<0.001) and from pre RTX IgA 2.03 g/L (1.37-2.50) to IgA 1.62 g/L (IQR 0.84-2.43; p = 0.365) 14 months after RTX. Treatment with RTX induced a complete depletion of B cells in all patients. After a median observation time of 20 months median B lymphocyte counts remained severely suppressed (4 B-cells/µl, 1.25-9.5, p<0.001). Seven patients (21%) that had been treated with CYC followed by RTX were started on Ig replacement because of severe bronchopulmonary infections and serum IgG concentrations below 5 g/L. Conclusions In patients with AAVs, treatment with CYC leads to a decline in immunoglobulin concentrations. A subsequent RTX therapy aggravates the decline in serum immunoglobulin concentrations and results in a profoundly delayed B cell repopulation. Surveying patients with AAVs post CYC and RTX treatment for serum immunoglobulin concentrations and persisting hypogammaglobulinemia is warranted.
Collapse
Affiliation(s)
- Nils Venhoff
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
| | - Nora M. Effelsberg
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
- Centre for Chronic Immunodeficiency (CCI), University Hospital Freiburg, Freiburg, Germany
| | - Klaus Warnatz
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
- Centre for Chronic Immunodeficiency (CCI), University Hospital Freiburg, Freiburg, Germany
| | - Hans Hartmut Peter
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
- Centre for Chronic Immunodeficiency (CCI), University Hospital Freiburg, Freiburg, Germany
| | - Dirk Lebrecht
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
| | - Michael Schlesier
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
- Centre for Chronic Immunodeficiency (CCI), University Hospital Freiburg, Freiburg, Germany
| | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
- Centre for Chronic Immunodeficiency (CCI), University Hospital Freiburg, Freiburg, Germany
| | - Jens Thiel
- Department of Rheumatology and Clinical Immunology, University Hospital Freiburg, Freiburg, Germany
- Centre for Chronic Immunodeficiency (CCI), University Hospital Freiburg, Freiburg, Germany
- * E-mail:
| |
Collapse
|
42
|
Rudulier CD, Kroeger DR, Bretscher PA. Distinct roles of dendritic and B cells in the activation of naive CD4+ T cells. Immunotherapy 2012; 4:355-7. [DOI: 10.2217/imt.12.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Christopher D Rudulier
- Department of Microbiology & Immunology, University of Saskatchewan, Saskatchewan, Canada
| | - David R Kroeger
- Department of Microbiology & Immunology, University of Saskatchewan, Saskatchewan, Canada
| | - Peter A Bretscher
- Department of Microbiology & Immunology, University of Saskatchewan, A305–107 Wiggins Road, Saskatoon, Saskatchewan, S7N 5E5, Canada
| |
Collapse
|
43
|
Abdulahad WH, Kroese FGM, Vissink A, Bootsma H. Immune regulation and B-cell depletion therapy in patients with primary Sjögren's syndrome. J Autoimmun 2012; 39:103-11. [PMID: 22341852 DOI: 10.1016/j.jaut.2012.01.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 01/07/2012] [Indexed: 11/30/2022]
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune exocrinopathy characterized by chronic inflammation and destruction of the salivary and lacrimal glands. B- and T- lymphocyte infiltrations in the salivary glands with development of germinal center-like structures are characteristic for pSS. Overexpression of soluble factors, such as interferon α (IFNα) and B-cell activating factor (BAFF), are supposed to be important factors in the initiation and continuation of this disorder. The efficacy and success of B-cell depleting therapy in reducing disease activity in pSS patients for about six to nine months supports the notion that B-cells are major key players in disease manifestation of pSS. In addition to B-cells, also Th-cells (mainly Th17) seem to be involved in the pathogenetic process. In this review, we will discuss recent research findings regarding the cytokines IFNα and BAFF as wells as the role of B- and T-cells in pSS. Emphasis will be put on the impact of B-cell depletion therapy as well as on the presumed impact of therapies aimed for targeting BAFF, either as a sole modality or as a combined treatment with B-cell depletion.
Collapse
Affiliation(s)
- Wayel H Abdulahad
- Department Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | | | | | | |
Collapse
|
44
|
Meiners PM, Vissink A, Kallenberg CGM, Kroese FGM, Bootsma H. Treatment of primary Sjögren's syndrome with anti-CD20 therapy (rituximab). A feasible approach or just a starting point? Expert Opin Biol Ther 2011; 11:1381-94. [PMID: 21819314 DOI: 10.1517/14712598.2011.605352] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In vitro and in vivo experimental data have suggested new immunopathogenic mechanisms in primary Sjögren's syndrome (pSS). The availability of targeted treatment modalities has opened new ways to selectively target these mechanistic pathways in vivo. Amongst these new treatment modalities, monoclonal antibodies specific for the B-cell surface molecule CD20 have been shown to be the most promising treatment option to date. AREAS COVERED A search of the Pubmed, MEDLINE, EMBASE, Cochrane and Ovid databases was performed to review literature on the efficacy and safety profile of anti-CD20 therapy in pSS patients. EXPERT OPINION A single course of the chimeric humanized anti-CD20 antibody rituximab was effective in reducing disease activity in pSS patients for about six to nine months. Retreatment of responders resulted in a similar effect to initial treatment. When combined with corticosteroids during infusion, rituximab was shown to be a safe drug to administer. Thus, anti-CD20 therapy can be considered an effective treatment option in pSS patients. However, large randomized controlled trials with anti-CD20 therapy, for example rituximab, are warranted in order to: 1) assess long-term effects of such treatment, 2) determine which pSS patients will benefit most from anti-CD20 treatment and 3) assess which retreatment schedule should be followed.
Collapse
Affiliation(s)
- Petra M Meiners
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, The Netherlands
| | | | | | | | | |
Collapse
|
45
|
Kallenberg CGM, Vissink A, Kroese FGM, Abdulahad WH, Bootsma H. What have we learned from clinical trials in primary Sjögren's syndrome about pathogenesis? Arthritis Res Ther 2011; 13:205. [PMID: 21371351 PMCID: PMC3157640 DOI: 10.1186/ar3234] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
In vitro and in vivo experimental data have pointed to new immunopathogenic mechanisms in primary Sjögren's syndrome (pSS). The availability of targeted treatment modalities has opened new ways to selectively target these mechanistic pathways in vivo. This has taught us that the role of proinflammatory cytokines, in particular TNFα, is not crucial in the immunopathogenesis of pSS. B cells appear to play a major role, as depletion of B cells leads to restoration of salivary flow and is efficacious for treatment of extraglandular manifestations and mucosa-associated lymphoid tissue lymphoma. B cells also orchestrate T-cell infiltration and ductal epithelial dearrangement in the salivary glands. Gene profiling of salivary gland tissue in relation to B-cell depletion confirms that the axis of IFNα, B-cell activating factor, B-cell activation, proliferation and survival constitutes a major pathogenic route in pSS.
Collapse
Affiliation(s)
- Cees G M Kallenberg
- Department of Rheumatology and Clinical Immunology, AA21, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
| | | | | | | | | |
Collapse
|