Divisions of Nephrology and Intensive Care, and.
Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
J Am Soc Nephrol. 2018 Mar;29(3):741-758. doi: 10.1681/ASN.2017040367. Epub 2018 Jan 11.
The unique contributions of memory B cells and plasma cells in kidney diseases remain unclear. In this review, we evaluate the clinical experience with treatments directed at B cells, such as rituximab, and at plasma cells, such as proteasome inhibition, to shed light on the role of these two B lineage compartments in glomerular diseases. Specifically, analysis of these targeted interventions in diseases such as ANCA-associated vasculitis, SLE, and antibody-mediated transplant rejection permits insight into the pathogenetic effect of these cells. Notwithstanding the limitations of preclinical models and clinical studies (heterogeneous populations, among others), the data suggest that memory B and plasma cells represent two engines of autoimmunity, with variable involvement in these diseases. Whereas memory B cells and plasma cells appear to be key in ANCA-associated vasculitis and antibody-mediated transplant rejection, respectively, SLE seems likely to be driven by both autoimmune compartments. These conclusions have implications for the future development of targeted therapeutics in immune-mediated renal disease.
在肾脏疾病中，记忆 B 细胞和浆细胞的独特贡献仍不清楚。在这篇综述中，我们评估了针对 B 细胞（如利妥昔单抗）和浆细胞（如蛋白酶体抑制）的治疗方法的临床经验，以期阐明这两个 B 细胞谱系在肾小球疾病中的作用。具体来说，对血管炎、SLE 和抗体介导的移植排斥等疾病中这些靶向干预的分析可以深入了解这些细胞的发病机制作用。尽管临床前模型和临床研究（例如，人群异质性等）存在局限性，但这些数据表明，记忆 B 细胞和浆细胞代表两种自身免疫的引擎，它们在这些疾病中的参与程度不同。虽然记忆 B 细胞和浆细胞似乎分别是血管炎和抗体介导的移植排斥的关键因素，但 SLE 似乎可能由两个自身免疫细胞群驱动。这些结论对免疫介导的肾脏疾病靶向治疗的未来发展具有重要意义。
