TY - JOUR
T1 - Effect of rituximab treatment on T and B cell subsets in lymph node biopsies of patients with rheumatoid arthritis
AU - Ramwadhdoebe, Tamara H.
AU - van Baarsen, Lisa G. M.
AU - Boumans, Maria J. H.
AU - Bruijnen, Stefan T. G.
AU - Safy, Mary
AU - Berger, Ferco H.
AU - Semmelink, Johanna F.
AU - van der Laken, Conny J.
AU - Gerlag, Danielle M.
AU - Thurlings, Rogier M.
AU - Tak, Paul P.
N1 - © The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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 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+IgDhighIgMvariable 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 CD27IgD+ naïve 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.
AB - 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 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+IgDhighIgMvariable 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 CD27IgD+ naïve 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85065039132&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30649469
U2 - https://doi.org/10.1093/rheumatology/key428
DO - https://doi.org/10.1093/rheumatology/key428
M3 - Article
C2 - 30649469
SN - 1462-0324
VL - 58
SP - 1075
EP - 1085
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 6
ER -