[在自身免疫性疾病中使用抗CD20抗体的B细胞靶向治疗]
[B cell targeting therapy using the anti-CD20 antibody in autoimmune diseases].
作者信息
Tanaka Yoshiya
机构信息
The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan.
出版信息
Yakugaku Zasshi. 2009 Jun;129(6):675-9. doi: 10.1248/yakushi.129.675.
Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are representative autoimmune diseases thought to involve disturbances in T and B cell functions. Immune complexes consisting of antigens and autoantibodies secreted from activated B cells cause severe inflammation in various organs. Since often patients with RA and SLE are refractory to these conventional treatments such as immunosuppressants and corticosteroids, innovative approaches need to be developed. CD20 is a surface molecule specific for B cells and rituximab is a chimeric antibody specific for human CD20 and is known to deplete B cells. Recently, the potential efficacy of B-cell depletion therapy with rituximab has been reported in several autoimmune diseases. Rituximab is now approved for use in combination with methotrexate in refractory RA patients in the United States and EU. We reported that SLE patients with organ-threatening disorders that are resistant to intensive conventional therapies, were treated by once a week administration of anti-CD20 antibody rituximab, and that sufficient evidence concerning the excellent tolerability and high efficacy of rituximab therapy was obtained in both a pilot study and a nation-wide phase I/II clinical examination Moreover, a rapid and marked reduction in the expression of the co-stimulatory molecules CD40 and CD80 on B-cells was found in SLE patients, implying that reduction of both the quantity and the quality of B-cells by rituximab could improve the disease course in refractory SLE. Therefore, targeting B-cells may have potential interests by bringing about a breakthrough in the treatment of RA, SLE and other autoimmune diseases.
系统性红斑狼疮(SLE)和类风湿性关节炎(RA)是典型的自身免疫性疾病,被认为涉及T细胞和B细胞功能紊乱。由活化B细胞分泌的抗原和自身抗体组成的免疫复合物会在各个器官引发严重炎症。由于RA和SLE患者通常对免疫抑制剂和皮质类固醇等传统治疗方法具有耐药性,因此需要开发创新方法。CD20是B细胞特有的表面分子,利妥昔单抗是一种针对人CD20的嵌合抗体,已知可消耗B细胞。最近,有报道称利妥昔单抗进行B细胞清除疗法在几种自身免疫性疾病中具有潜在疗效。目前,在美国和欧盟,利妥昔单抗已被批准与甲氨蝶呤联合用于难治性RA患者。我们报道,对强化传统疗法耐药的有器官威胁性疾病的SLE患者,通过每周一次给予抗CD20抗体利妥昔单抗进行治疗,并且在一项初步研究和一项全国性的I/II期临床检查中均获得了关于利妥昔单抗疗法具有良好耐受性和高效性的充分证据。此外,在SLE患者中发现B细胞上共刺激分子CD40和CD80的表达迅速且显著降低,这意味着利妥昔单抗减少B细胞的数量和质量可能会改善难治性SLE的病程。因此,靶向B细胞可能通过在RA、SLE和其他自身免疫性疾病的治疗中取得突破而具有潜在价值。