Vallerskog Therese, Heimbürger Mikael, Gunnarsson Iva, Zhou Wei, Wahren-Herlenius Marie, Trollmo Christina, Malmström Vivianne
Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, CMM L8:04, Karolinska Hospital, SE-171 76 Stockholm, Sweden.
Arthritis Res Ther. 2006;8(6):R167. doi: 10.1186/ar2076.
The objective of this study was to investigate the interaction between levels of BAFF (B-cell activation factor of the tumour necrosis factor [TNF] family) and APRIL (a proliferation-inducing ligand) and B-cell frequencies in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) treated with the B-cell-depleting agent rituximab. Ten patients with SLE were treated with rituximab in combination with cyclophosphamide and corticosteroids. They were followed longitudinally up to 6 months after B-cell repopulation. Nine patients with RA, resistant or intolerant to anti-TNF therapy, treated with rituximab plus methotrexate were investigated up to 6 months after treatment. The B-cell frequency was determined by flow cytometry, and serum levels of BAFF and APRIL were measured by enzyme-linked immunosorbent assays. BAFF levels rose significantly during B-cell depletion in both patient groups, and in patients with SLE the BAFF levels declined close to pre-treatment levels upon B-cell repopulation. Patients with SLE had normal levels of APRIL at baseline, and during depletion there was a significant decrease. In contrast, patients with RA had APRIL levels 10-fold higher than normal, which did not change during depletion. At baseline, correlations between levels of B cells and APRIL, and DAS28 (disease activity score using 28 joint counts) and BAFF were observed in patients with RA. In summary, increased BAFF levels were observed during absence of circulating B cells in our SLE and RA patient cohorts. In spite of the limited number of patients, our data suggest that BAFF and APRIL are differentially regulated in different autoimmune diseases and, in addition, differently affected by rituximab treatment.
本研究的目的是调查在接受B细胞耗竭剂利妥昔单抗治疗的系统性红斑狼疮(SLE)和类风湿关节炎(RA)患者中,B细胞活化因子(肿瘤坏死因子[TNF]家族的B细胞活化因子)和增殖诱导配体(APRIL)水平与B细胞频率之间的相互作用。10例SLE患者接受了利妥昔单抗联合环磷酰胺和皮质类固醇治疗。对他们进行纵向随访,直至B细胞重新增殖后6个月。对9例对抗TNF治疗耐药或不耐受、接受利妥昔单抗加甲氨蝶呤治疗的RA患者进行治疗后6个月的调查。通过流式细胞术测定B细胞频率,通过酶联免疫吸附测定法测量血清中BAFF和APRIL的水平。在两个患者组中,B细胞耗竭期间BAFF水平均显著升高,在SLE患者中,B细胞重新增殖时BAFF水平降至接近治疗前水平。SLE患者基线时APRIL水平正常,耗竭期间显著下降。相比之下,RA患者的APRIL水平比正常水平高10倍,在耗竭期间没有变化。在RA患者中,基线时观察到B细胞水平与APRIL之间以及疾病活动评分28(使用28个关节计数的疾病活动评分)与BAFF之间存在相关性。总之,在我们的SLE和RA患者队列中,循环B细胞缺失期间观察到BAFF水平升高。尽管患者数量有限,但我们的数据表明,BAFF和APRIL在不同的自身免疫性疾病中受到不同的调节,此外,利妥昔单抗治疗对它们的影响也不同。