Details

Autor(en) / Beteiligte

• Bunch, Donna O'Dell
• McGregor, JulieAnne G
• Khandoobhai, Nirmal B
• Aybar, Lydia T
• Burkart, Madelyn E
• Hu, Yichun
• Hogan, Susan L
• Poulton, Caroline J
• Berg, Elisabeth A
• Falk, Ronald J
• Nachman, Patrick H

Titel

Decreased CD5+ B Cells in Active ANCA Vasculitis and Relapse after Rituximab

Ist Teil von

• Clinical journal of the American Society of Nephrology, 2013-03, Vol.8 (3), p.382-391

Ort / Verlag

United States: American Society of Nephrology

Erscheinungsjahr

2013

Link zum Volltext

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• B cell significance in ANCA disease pathogenesis is underscored by the finding that ANCA alone can cause disease in mouse models and by the effectiveness of rituximab as therapy in ANCA-small vessel vasculitis (ANCA-SVV). To avoid infections and adverse events from therapy, clinicians require improved markers of disease activity and impending relapse to guide immunosuppression strategies after rituximab treatment. The B cell phenotype was investigated in patients with active ANCA-SVV and in remission. From 2003 to 2009, 54 patients were followed longitudinally for 4-99 months and compared with 68 healthy controls. In a subset of 19 patients, the B cell immunophenotype was examined in samples after rituximab therapy. Patients with active ANCA-SVV had lower %CD5(+) B cells, whereas %CD5(+) B cells from patients in remission were indistinguishable from healthy controls. After rituximab, median time to relapse was 31 months in patients maintaining normalized %CD5(+) B cells, with or without maintenance immunosuppression. Among patients whose B cells repopulated with low %CD5(+) B cells or had a sharply declining %CD5(+) B cells, those who were on low or no maintenance immunosuppression relapsed sooner (median 17 months) than patients who were maintained on high levels of oral maintenance immunosuppression (29 months; P=0.002). The %CD5(+) B cells, as a component of the human B regulatory cell phenotype, is a useful indicator of disease activity, remission, and future relapse, and thus may guide remission maintenance therapy after rituximab treatment.