期刊
RHEUMATOLOGY
卷 58, 期 6, 页码 1075-1085出版社
OXFORD UNIV PRESS
DOI: 10.1093/rheumatology/key428
关键词
rheumatoid arthritis; lymphocytes; B cells; T cells; cytokines and inflammatory mediators
类别
资金
- Innovative Medicines Initiative (IMI) project BTCure [115142-1]
- Euro-TEAM FP7-HEALTH programme [FP7-HEALTH-F2-2012-305549]
- Dutch Arthritis Foundation [11-1-308]
- Netherlands Organisation for Health Research and Development (ZonMw) Veni [916.12.109]
Objectives. The exact underlying mechanism of rituximab treatment in patients with RA is poorly defined and knowledge about the effect of B cell depletion on immune cells in secondary lymphoid organs is lacking. We analysed lymphoid tissue responses to rituximab in RA patients. Methods. Fourteen RA patients received 2 x 1000 mg rituximab intravenously, and lymph node (LN) biopsies were obtained before and 4 weeks after the first infusion. Tissues were examined by flow cytometry, immunohistochemistry and quantitative PCR. LN biopsies from five healthy individuals (HC) served as controls. Results. LN biopsies of RA patients showed increased frequencies of CD21(+)CD23(+)IgD(high)IgM(variable) follicular B cells and CD3(+)CD25(+)CD69(+) early activated, tissue resident T cells when compared with HCs. After treatment, there was incomplete depletion of LN B cells. There was a significant decrease in CD27(-)IgD(+) naive B cells, and CD27(+)IgD(+)unswitched memory B cells including the CD27(+)IgD(+)IgM(+) subset and follicular B cells. Strikingly, CD27(+)IgD(-) switched memory B cells persisted in LN biopsies after rituximab treatment. In the T cell compartment, a significant decrease was observed in the frequency of early activated, tissue resident T cells after rituximab treatment, but late activated T cells persisted. B cell proliferation inducing cytokine IL-21 was higher expressed in LN biopsies of RA patients compared with HC and expression was not affected by rituximab treatment. Conclusion. Rituximab does not cure RA, possibly due to persistence of switched memory B cells in lymphoid tissues suggesting that factors promoting B cell survival and differentiation need to be additionally targeted.
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