A longitudinal analysis of SLE patients treated with rituximab (anti-CD20): factors associated with B lymphocyte recovery

Identifying factors associated with B lymphocyte depletion and recovery may aid the development of individualized treatment regimens, optimizing therapy for patients with autoimmune disease. In this study, 12 patients with active SLE were monitored at baseline and monthly following treatment with rituximab. The number and phenotype of peripheral blood B lymphocytes, T lymphocytes and natural killer cells were correlated with the extent and longevity of B lymphocyte depletion. This analysis generated three candidate biomarkers for lymphocyte monitoring in patients with autoimmune disease who are treated with rituximab: circulating transitional B cells, the kappa:lambda ratio and natural killer cells. Further refinement of these potential biomarkers may lead to a better understanding of the role of B cells in disease pathogenesis and a more rational use of B cell depletion therapies.     

外周血CD19+B细胞PD-L1的表达与系统性红斑狼疮发病的相关性分析

目的:探讨程序性死亡配体1(Programmed death ligand-1,PD-L1)在系统性红斑狼疮(Systemic lupus erythema-tosus,SLE)患者外周血B细胞上的表达及临床意义。方法:应用流式细胞仪检测51例SLE患者和38例健康对照者外周血CD19+B细胞表面PD-L1的表达水平,比较SLE稳定组、活动组和健康对照组以及狼疮肾炎组和无狼疮肾炎组之间CD19+B细胞表面PD-L1表达阳性细胞的百分比,并分析其与临床表现及实验室检查数据的相关性。结果:SLE活动组和稳定组CD19+PD-L1+B细胞百分率均低于健康对照组,活动组又低于稳定组,差异均有统计学意义(均P<0.05)。狼疮肾炎患者CD19+PD-L1+B细胞百分率低于无狼疮肾炎患者(P<0.05)。SLE患者CD19+PD-L1+B细胞百分率与SLEDAI评分、尿蛋白定量、呈负相关,与C3呈正相关。SLE患者中抗dsDNA抗体、抗Sm抗体、抗U1snRNP抗体、抗核小体抗体阳性组外周血B细胞PD-L1表达水平均低于对应阴性组,且均有统计学意义(均P<0.05)。结论:SLE患者外周血CD19+B细胞表达PD-L1下降,与病情活动性和抗体产生有很好的相关性。     

The efficacy of novel B cell biologics as the future of SLE treatment: A review

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease with wide ranging multi-systemic effects. Current understanding centralises B cells in SLE pathogenesis with clinical features resulting from autoantibody formation, immune complex deposition, antigen presentation and cytokine activation. Existing standard of care therapies generates adverse side effects; secondary to corticosteroid use and untargeted immunosuppression. The inability to uphold remission and abolish the disease process, in addition to the increasing numbers of patients seen with refractory disease with these therapies, has provoked the development of novel B cell biologics targeting specific pathogenic pathways fundamental to the SLE disease process.     

雷公藤碱戊对系统性红斑狼疮患者B细胞免疫功能的体外实验研究

目的：探讨雷公藤碱戊的免疫药理作用。方法：采用系统性红斑狼疮（ＳＬＥ）病人外周血单个核细胞（ＰＢＭＣ）体外培养观察雷公藤碱戊对ＳＬＥ病人ＰＢＭＣ的Ｂ细胞功能的影响及时效关系。结果：雷公藤碱戊能抑制ＳＬＥ的ＰＢＭＣ自发性增殖反应以及正常人和ＳＬＥ病人ＰＢＭＣ对ＳＡＣ刺激后的增殖反应。同时在培养的７２ｈ前加入雷公藤碱戊均能对正常人ＰＢＭＣ在ＰＷＭ诱导下的ＩｇＧ产生呈现抑制效应。结论：雷公藤碱戊对Ｂ细胞功能的多个环节具有抑制作用，其抑制Ｂ细胞产生ＩｇＧ的作用环节可能在于抑制了Ｂ细胞的活化增殖阶段     

Abnormalities of B cell subsets in patients with systemic lupus erythematosus

The prototypic autoimmune disease, SLE, is known to be associated with polyclonal B cell hyperreactivity. Developing an understanding of the complex nature of human B cell differentiation, largely through the application of multiparameter flow cytometry to an analysis of circulating B cells has permitted an assessment of whether specific stages of B cell maturation are affected by the tendency for polyclonal B cell activation. Moreover, the analysis of perturbations of the specific stages of B cell maturation has generated new information on whether abnormalities in B cell differentiation are primarily involved in autoimmune disease immunopathology or, rather, are secondary to the inflammatory environment characteristic of subjects with this autoimmune disease. Multivariant analysis has begun to document abnormalities in B cell maturation that are primarily associated with lupus, or, alternatively related to disease duration, disease activity and concomitant medication. Together, these analyses have provided new insights on the role of B cell over-reactivity in SLE.     

系统性红斑狼疮患者外周血CD4+CD25high Tr和 CD4+CD25low T细胞PD-1表达的分析和意义

目的 探讨PD-1(programmed death-1)在系统性红斑狼疮(systemic lupus erythematosus,SLE)患者外周血CD4+ CD25high调节性T细胞(regulatory T cell,Tr)和CD4+ CD25lowT细胞上的表达及临床意义.方法 应用流式细胞仪检测51例SLE患者和38例健康对照者外周血CD4+ CD25high Tr和CD4+ CD25lowT细胞表面PD-1表达水平,同时收集SLE患者临床表现、实验室检查数据,比较SLE稳定组、活动组和健康对照组以及狼疮肾炎组和无狼疮肾炎组之间CD4+ CD25 high Tr和CD4+CD25lowT细胞表PD-1表达的百分比,并分析其与临床表现及实验室检查数据的相关性.结果 (1)SLE活动组和稳定组外周血CD4+ CD25 high Tr和CD4+ CD25lowT细胞的百分率均低于对照组.(2)SLE活动组和稳定组外周血CD4+ CD25 highTr表达PD-1的百分率均高于对照组.SLE稳定组和对照组外周血CD4+ CD25lowT细胞表达PD-1的百分率均高于活动组.(3)狼疮肾炎患者外周血CD4+CD25highTr表达PD-1的百分率高于无狼疮肾炎患者.而狼疮肾炎患者CD4+ CD25lowT细胞表达PD-1的百分率低于无狼疮肾炎患者.(4) CD4+CD25high PD-1+T细胞百分率与SLEDAI评分呈正相关;CD4+ CD25high Tr、CD4+CD25lowPD-1+T细胞百分率与SLEDAI评分呈负相关.结论 SLE患者外周血中CD4+ CD25high Tr、CD4+ CD25lowT细胞以及它们表面PD-1表达异常,并且与疾病活动性相关,PD-1/PD-L1信号通路可能对CD4+CD25highTr、CD4+CD25lowT细胞的数量和功能有影响.     

Regulation of B cell growth and differentiation via CD21 and CD40

Stimulation in vitro of murine splenic B cells by lipopolysaccharide, anti-ϰ Sepharose, anti-CD40 or allo-reactive T helper cells all up-regulated CD21 and CD23 surface expression. Neither anti-CD21 nor anti-CD23 antibodies induced B cell growth or differentiation when added in soluble form or coupled to Sepharose. However, anti-CD40-stimulated B cells showed increased proliferation in the presence of anti-CD21 antibodies coupled to Sepharose; co-stimulation via CD21 also induced differentiation to immunoglobulin secretion in a fraction of anti-CD40-stimulated B cells. Furthermore, anti-CD40 antibodies inhibited differentiation to immunoglobulin secretion induced by lipopolysaccharide and, hence, appears to be a dominant negative signal for B cell differentiation.     

CD21–/low B cells in human blood are memory cells

The complement receptor 2 (CR2, CD21) is part of a complex (CD21/CD19/CD81) acting as a co‐receptor to the B cell receptor (BCR). Simultaneous triggering of the BCR and CD21 lowers the threshold for B cell activation. Although CD21 is important, B cells that express low amounts or lack surface CD21 (CD21^–/low) are increased in conditions with chronic inflammation, e.g. autoimmune diseases. However, little is known about the CD21^–/low B cell subset in peripheral blood from healthy donors. Here, we show that CD21^–/low cells represent approximately 5% of B cells in peripheral blood from adults but are barely detectable in cord blood, after excluding transitional B cells. The CD21^–/low subset can be divided into CD38^–24⁺ and CD38^–24^low cells, where most of the CD38^–24⁺ are CD27⁺immunoglobulin (Ig)M⁺IgD⁺ and the CD38^–24^low are switched CD27^–. Expression levels of additional markers, e.g. CD95 and CD62L, are similar to those on classical memory B cells. In contrast to naive cells, the majority of CD21^–/low cells lack expression of the ABCB1 transporter. Stimulation with a combination of BCR, Toll‐like receptor (TLR)?7/8 and interleukin (IL)?2 induces proliferation and differentiation of the CD21^–/low B cells comparable to CD21⁺CD27⁺ memory B cells. The response excluding BCR agonist is not on par with that of classical memory B cells, although clearly above that of naive B cells. This is ascribed to a weaker response by the CD38^–24^low subset, implying that some memory B cells require not only TLR but also BCR triggering. We conclude that the CD21^–/low cells in healthy donors are memory B cells.     

Characterization of splenic CD21hi T2 B cells

B cell development is a highly regulated process that initiates in the bone marrow (BM) of adult mice. After reaching the IgM⁺ immature stage in the BM, these B cells migrate to the spleen to complete maturation and incorporation into the long-lived peripheral lymphocyte pool. Studies have identified these splenic immature B cells, and have further attempted to delineate the sequence whereby they transition into mature B cells. As such, these immature splenic populations are termed transitional B cells and have been the focus of intense study. The review summarizes the phenotype and currently known functions of the four putative transitional B cell subsets identified to date. Although most appear to represent short-lived transitional B cells, the CD21^hi T2 B cell population exhibits a number of qualities that question its label as a transitional B cell subset.     

Peripheral B cell receptor editing may promote the production of high-affinity autoantibodies in CD22-deficient mice

CD22-deficient mice are characterized by B cell hyperactivity and autoimmunity. We have constructed knock-in CD22-/- mice, expressing an anti-DNA heavy (H) chain (D42), alone or combined with Vkappa1-Jkappa1 or Vkappa8-Jkappa5 light (L) chains. The Ig-targeted mice produced a lupus-like serology that was age- and sex-dependent. High-affinity IgG autoantibodies were largely dependent on the selection of B cells with a particular H/L combination, in which a non-transgenic, endogenous L chain was assembled by secondary rearrangements through the mechanism of receptor editing. Moreover, we present evidence that these secondary rearrangements are very prominent in splenic peripheral B cells. Since CD22 is primarily expressed on the surface of peripheral B cells, we propose a model for the development of a lupus-like autoimmune disease by a combination of peripheral receptor editing and abnormal B cell activation.     

SLE患者外周血T细胞亚群ICOS与CD28共表达水平与疾病的关系

目的观察系统性红斑狼疮(systemic lupus erythematosus，SLE)病人外周血CD4^ 及CD8^ T细胞表面可诱导共刺激分子(inducible co-stimulator，ICOS)及CD28共表达水平，探讨ICOS和CD28共表达水平与SLE疾病的关系。方法采用三色流式细胞术检测SLE病人(n=51)及正常人(n=30)外周血CD4^ 及CD8^ T细胞表面ICOS与CD28共表达水平，并结合SLE病人疾病活动程度、临床表现等进行分析。结果与正常人相比，SLE活动期和稳定期病人外周血CD4^ T细胞中仅表达ICOS不表达CD28(即CD28^-ICOS^ )的细胞比例明显升高，但活动期病人和稳定期病人之间并无差异；活动期病人外周血CD8^ T细胞上同时表达CD28和ICOS的细胞(即CD28^ ICOS^ 细胞)和CD28^-ICOS^ 细胞比例都明显升高；同一SLE病人在疾病活动期CD4^ 和CD8^ T细胞中CD28^ ICOS^ 的细胞比例和CD8^ T细胞中CD28-ICOS^ 细胞比例明显高于该病人经过治疗病情稳定时；初发未治疗SLE病人仅CD4^ T细胞中CD28^ ICOS^ 细胞的比例比复发病人明显升高；血清抗dsDNA抗体( )病人和血清免疫球蛋白含量(IsG、IgA和IgM中任何一种)异常升高的病人外周血CD4^ T细胞中CD28^ ICOS^ 细胞和CD8^ T细胞中CD28-ICOS^ 细胞比例分别明显高于血清抗dsDNA抗体(-)和血清免疫球蛋白含量正常的病人。结论CD28和ICOS在SLE病人外周血CD4^ 和CD8^ T细胞上共表达水平与SLE疾病的活动程度、病程及临床表现等存在一定的关联。     

SLE及IDDM患者外周血单个核细胞中基因表达差异的研究

目的 :了解系统性红斑狼疮 (Systemiclupuserythematosus,SLE)和胰岛素依赖型糖尿病 (insulindependentdiabetesmellitusdisease,IDDM)外周血单个核细胞 (PBMC)的基因表达概况 ,为探讨这些基因表达的差异与该 2种疾病的关系奠定基础。方法 :以分别来自SLE和IDDM患者的PBMCpolyA RNA为模板逆转录合成cDNA表达探针 ,与AtlascDNA表达阵列膜进行差异杂交。结果 :放射自显影结果显示在SLE疾病所分析的 1176种已知基因中 ,有表达差异的 376个 ,其中表达上调差异率大于 3的 8个 ,表达下调差异率大于 6的 6个 ;在IDDM疾病所分析的 1176种已知基因中 ,有表达差异的 5 5 8个 ,其中表达上调差异率大于 6的 13个 ,表达下调差异率大于 6的 3个。与细胞的分化增殖、粘附与信号转导、凋亡、转录与调控及DNA损伤修复等相关的基因表达水平发生了明显的改变。结论 :AtlascDNA表达阵列差异杂交分析为初步了解SLE及IDDN患者PBMC的基因表达概况 ,进而了解基因表达差异在疾病发生发展中的作用提供了一个较好的方法。     

BXSB小鼠外周B淋巴细胞异常增生的研究

系统性红斑狼疮（ＳＬＥ）突出的免疫学异常表现是Ｂ淋巴细胞的异常增生与活化，其发生机制至今不明，本文以遗传性自发性ＳＬＥ模型ＢＸＳＢ小鼠为对象，采用体内ＢｒｄＵ标记法及ＨＵ增殖细胞删除法研究了ＢＸＳＢ小鼠脾脏Ｂ细胞的增殖动力学。结果表明，与正常对照相比，ＢＸＳＢ小鼠脾脏Ｂ细胞更新速率明显增高。提示Ｂ细胞更新加速可能是ＢＸＳＢ小鼠外周Ｂ细胞异常增生的原因。     

CD21−/low B cells associate with joint damage in rheumatoid arthritis patients

Depletion of B cells is beneficial in rheumatoid arthritis (RA) patients with autoantibodies to citrullinated proteins (ACPA) and/or the Fc portion of immunoglobulins (rheumatoid factor [RF]), suggesting a role for B cells in disease pathogenesis. To date, however, the identity of specifically pathogenic B cell subsets has not been discovered. One candidate population is identified by the low expression or absence of complement receptor 2 (CD21^?/low B cells). In this study, we sought to determine whether there was any correlation between CD21^?/low B cells and clinical outcome in patients with established RA, either ACPA⁺/RF⁺ (n = 27) or ACPA^?/RF^? (n = 10). Healthy donors (n = 17) were included as controls. The proportion of the CD21^?/low CD27^?IgD^? memory B cell subset in peripheral blood (PB) was significantly increased in ACPA⁺/RF⁺ RA patients compared with healthy donors, and the frequency of this subset correlated with joint destruction (r = 0.57, P < 0.04). The levels of the chemokines CXCL‐9 and CXCL‐10 were higher in synovial fluid than in plasma, and PB CD21^?/low cells expressed the receptor, CXCR3. In synovial fluid, most of the B cells were CD21^?/low, approximately 40% of that population was CD27^?IgD^?, and a third of those expressed the pro‐osteoclastogenic factor receptor activator of the nuclear factor κB ligand (RANKL). This subset also secreted RANKL, in addition to other factors such as IL‐6, even in the absence of stimulation. We interpret these data as reason to propose the hypothesis that the CD27^?IgD^? subset of CD21^?/low B cells may mediate joint destruction in patients with ACPA⁺/RF⁺ RA.     

Complement receptor expression and activation of the complement cascade on B lymphocytes from patients with systemic lupus erythematosus (SLE).

It has previously been reported that the expression of the complement receptors, CR1 on erythrocytes and blood leucocytes and CR2 on B cells, is reduced in patients with SLE, and that the reduced expression of CR1 on erythrocytes is related to disease activity. We have earlier demonstrated that normal B cells are capable of activating the alternative pathway (AP) of complement in a CR2-dependent fashion. In this study we have investigated whether disturbances in this activity may be related to the altered phenotype of SLE B cells. Flow cytometry was used to measure expression of complement receptors and regulatory proteins on B cells from SLE patients, as well as the deposition of C3 fragments occurring in vivo or after in vitro AP activation. We have confirmed, for a proportion of the patients studied, reduced expression of CR1 and CR2 on B cells, and shown a consistency between low CR2 expression and reduced in vitro AP activation in the presence of homologous, normal serum. In addition, the B cells, like erythrocytes, bear raised levels of in vivo-deposited C3dg, but not C3b fragments, compared with normal B cells. The erythrocytes from SLE patients were unable to inhibit in vitro AP activation by B cells in homologous serum. Finally, we demonstrated an inverse relationship between SLE disease activity index (SLEDAI) and the expression of complement receptor 2 (CR2) on SLE B cells. Thus, determination of CR2 on B cells may emerge as an additional laboratory tool in the assessment of SLE activity.     

系统性红斑狼疮患者B淋巴细胞EBV-LMP1和ZEBRA的表达研究

目的：探讨ＥＢＶ－ＬＭＰ１和ＺＥＢＲＡ在系统性红斑狼疮患者（ＳＬＥ）的表达情况。方法：间接荧光免疫标记，流式细胞仪检测。结果：ＳＬＥ患者Ｂ淋巴细胞中ＥＢＶ－ＬＭＰ１和ＺＥＢＲＡ的表达显著高于正常对照组（Ｐ＜０．０１）。活动期患者ＣＤ２３＋细胞ＥＢＶ－ＬＭＰ１和ＺＥＢＲＡ的表达率均高于ＣＤ１９＋细胞（Ｐ＜０．０１）。非活动期患者ＣＤ２３＋细胞ＥＢＶ－ＬＭＰ１表达也高于ＣＤ１９＋细胞（Ｐ＜０．０１）。但ＥＢＶ－ＺＥＢＲＡ表达在两亚群间差异没有统计学意义（Ｐ＞０．０５）。结论：朋病毒参与了ＳＬＥ的发病机制，病毒主要以潜伏期状态存在于患者中，病毒复制促进病情发展，检测Ｂ淋巴细胞ＥＢＶ－ＬＭＰ１和ＺＥＢＲＡ的表达率，有助于病情活动指标的判断。     

系统性红斑狼疮病人血T,B淋巴细胞Bcl—2的表达

目的：探讨Ｂｃｌ－２在系统性红斑狼疮（ＳＬＥ）发病机制中作用。方法：采用流式细胞仪双标记法检测３１例ＳＬＥ病人外周血Ｔ、Ｂ细胞Ｂｃｌ－２蛋白表达。结果：发现活动期ＳＬＥ病人活动期ＳＬＤ病人ＣＤ３＾＋、ＣＤ４＾＋和ＣＤ８＾＋Ｔ细胞Ｂｃｌ－２蛋白表达明显高于非活动期ＳＬＥ病人、其他疾病组和正常对照组。ＣＤ１９＾＋Ｂ细胞Ｂｃｌ－２蛋白表达在各组之间并无统计学差异。ＣＤ３＾＋Ｔ细胞Ｂｃｌ－２蛋白表达的平均     

系统性红斑狼疮患者外周血CD4+和CD8+T细胞PD-1的表达和意义

目的 探讨程序性死亡分子1 (PD-1)在系统性红斑狼疮(SLE)患者外周血CD4+和CD8+T细胞上的表达及临床意义.方法 应用流式细胞仪检测51例SLE患者和38例健康对照者外周血T细胞亚群表面PD-1表达水平,比较SLE稳定组、活动组和健康对照组以及狼疮肾炎组和无狼疮肾炎组之间CD4+和CD8+T细胞表面PD-1表达的百分比,并分析其与临床表现及实验室检查数据的相关性.结果 SLE活动组CD4+T细胞PD-1表达水平高于健康对照组和不活动组,差异均有统计学意义(P＜0.05).SLE活动组、稳定组CD8+T细胞PD-1表达水平均高于健康对照组,差异有统计学意义(P＜0.05).狼疮肾炎患者CD4+PD-1+和CD8+PD-1+T细胞分别高于无狼疮肾炎患者(P＜0.01).SLE患者中抗dsDNA抗体、抗Sm抗体、抗核小体抗体阳性组外周血CD4+和CD8+T细胞PD-1表达水平均高于对应阴性组.SLE患者CD4+和CD8+T细胞PD-1表达百分率与SLE疾病活动度指数(SLEDAI)、尿蛋白定量呈正相关,与补体C3呈负相关.结论 SLE患者外周血CD4+和CD8+T细胞PD-1表达异常,与SLEDA1和自身抗体产生有明确的相关性.