Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Int J Mol Sci. 2021 Dec 30;23(1):387. doi: 10.3390/ijms23010387.
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a systemic autoimmune disease that affects small sized blood vessels and can lead to serious complications in the lungs and kidneys. The prominent presence of ANCA autoantibodies in this disease implicates B cells in its pathogenesis, as these are the precursors of the ANCA-producing plasma cells (PCs). Further evidence supporting the potential role of B lineage cells in vasculitis are the increased B cell cytokine levels and the dysregulated B cell populations in patients. Confirmation of the contribution of B cells to pathology arose from the beneficial effect of anti-CD20 therapy (i.e., rituximab) in AAV patients. These anti-CD20 antibodies deplete circulating B cells, which results in amelioration of disease. However, not all patients respond completely, and this treatment does not target PCs, which can maintain ANCA production. Hence, it is important to develop more specific therapies for AAV patients. Intracellular signalling pathways may be potential therapeutic targets as they can show (disease-specific) alterations in certain B lineage cells, including pathogenic B cells, and contribute to differentiation and survival of PCs. Preliminary data on the inhibition of certain signalling molecules downstream of receptors specific for B lineage cells show promising therapeutic effects. In this narrative review, B cell specific receptors and their downstream signalling molecules that may contribute to pathology in AAV are discussed, including the potential to therapeutically target these pathways.
抗中性粒细胞胞质抗体(ANCA)相关性血管炎(AAV)是一种系统性自身免疫性疾病,影响小血管,并可导致肺部和肾脏的严重并发症。在这种疾病中,ANCA 自身抗体的显著存在表明 B 细胞在其发病机制中起作用,因为这些细胞是产生 ANCA 的浆细胞(PC)的前体。进一步支持 B 细胞谱系细胞在血管炎中具有潜在作用的证据是患者中 B 细胞细胞因子水平升高和 B 细胞群体失调。B 细胞对病理学的贡献得到了证实,因为抗 CD20 治疗(即利妥昔单抗)对 AAV 患者有效。这些抗 CD20 抗体耗尽循环中的 B 细胞,从而改善疾病。然而,并非所有患者都能完全反应,并且这种治疗不能针对可以维持 ANCA 产生的 PCs。因此,为 AAV 患者开发更具特异性的治疗方法非常重要。细胞内信号通路可能是潜在的治疗靶点,因为它们可以在某些 B 细胞谱系细胞(包括致病性 B 细胞)中显示出(疾病特异性)改变,并有助于 PCs 的分化和存活。关于抑制 B 细胞谱系细胞特异性受体下游某些信号分子的初步数据显示出有希望的治疗效果。在这篇叙述性综述中,讨论了可能导致 AAV 发病机制的 B 细胞特异性受体及其下游信号分子,包括针对这些途径进行治疗的潜力。