Objective: Autoreactive B cells are responsible for antineutrophil cytoplasmic antibody (ANCA) production in ANCA-associated vasculitis (AAV). Rituximab (RTX) depletes circulating B cells, including autoreactive B cells. We aimed to evaluate changes and associations with relapse of the circulating autoreactive B cell pool following therapeutic B cell depletion in AAV. Methods: Sequential flow cytometry was performed on 148 samples of peripheral blood mononuclear cells from 23 patients with proteinase 3 (PR3)-ANCA-positive AAV who were treated with RTX for remission induction and monitored after stopping therapy during long-term follow-up in a prospective clinical trial. PR3 was used as a ligand to target autoreactive PR3-specific (PR3+) B cells. B cell recurrence was considered as the first blood sample with ≥10 B cells/μl after RTX treatment. Results: At B cell recurrence, PR3+ B cell frequency among B cells was higher than baseline (P < 0.01). Within both PR3+ and total B cells, frequencies of transitional and naive subsets were higher at B cell recurrence than at baseline, while memory subsets were lower (P < 0.001 for all comparisons). At B cell recurrence, frequencies of B cells and subsets did not differ between patients who experienced relapse and patients who remained in remission. In contrast, the plasmablast frequency within the PR3+ B cell pool was higher in patients who experienced relapse and associated with a shorter time to relapse. Frequencies of PR3+ plasmablasts higher than baseline were more likely to be found in patients who experienced relapse within the following 12 months compared to those in sustained remission (P < 0.05). Conclusion: The composition of the autoreactive B cell pool varies significantly following RTX treatment in AAV, and early plasmablast enrichment within the autoreactive pool is associated with future relapses.

Autoreactive Plasmablasts After B Cell Depletion With Rituximab and Relapses in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis / Berti, Alvise; Hillion, Sophie; Konig, Maximilian F; Moura, Marta Casal; Hummel, Amber M; Carmona, Eva; Peikert, Tobias; Fervenza, Fernando C; Kallenberg, Cees G M; Langford, Carol A; Merkel, Peter A; Monach, Paul A; Seo, Philip; Spiera, Robert F; Brunetta, Paul; St Clair, E William; Harris, Kristina M; Stone, John H; Grandi, Guido; Pers, Jacques-Olivier; Specks, Ulrich; Cornec, Divi. - In: ARTHRITIS & RHEUMATOLOGY. - ISSN 2326-5205. - 75:5(2023), pp. 736-747. [10.1002/art.42388]

Autoreactive Plasmablasts After B Cell Depletion With Rituximab and Relapses in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Berti, Alvise
Primo
;
Grandi, Guido;
2023-01-01

Abstract

Objective: Autoreactive B cells are responsible for antineutrophil cytoplasmic antibody (ANCA) production in ANCA-associated vasculitis (AAV). Rituximab (RTX) depletes circulating B cells, including autoreactive B cells. We aimed to evaluate changes and associations with relapse of the circulating autoreactive B cell pool following therapeutic B cell depletion in AAV. Methods: Sequential flow cytometry was performed on 148 samples of peripheral blood mononuclear cells from 23 patients with proteinase 3 (PR3)-ANCA-positive AAV who were treated with RTX for remission induction and monitored after stopping therapy during long-term follow-up in a prospective clinical trial. PR3 was used as a ligand to target autoreactive PR3-specific (PR3+) B cells. B cell recurrence was considered as the first blood sample with ≥10 B cells/μl after RTX treatment. Results: At B cell recurrence, PR3+ B cell frequency among B cells was higher than baseline (P < 0.01). Within both PR3+ and total B cells, frequencies of transitional and naive subsets were higher at B cell recurrence than at baseline, while memory subsets were lower (P < 0.001 for all comparisons). At B cell recurrence, frequencies of B cells and subsets did not differ between patients who experienced relapse and patients who remained in remission. In contrast, the plasmablast frequency within the PR3+ B cell pool was higher in patients who experienced relapse and associated with a shorter time to relapse. Frequencies of PR3+ plasmablasts higher than baseline were more likely to be found in patients who experienced relapse within the following 12 months compared to those in sustained remission (P < 0.05). Conclusion: The composition of the autoreactive B cell pool varies significantly following RTX treatment in AAV, and early plasmablast enrichment within the autoreactive pool is associated with future relapses.
2023
5
Berti, Alvise; Hillion, Sophie; Konig, Maximilian F; Moura, Marta Casal; Hummel, Amber M; Carmona, Eva; Peikert, Tobias; Fervenza, Fernando C; Kallenberg, Cees G M; Langford, Carol A; Merkel, Peter A; Monach, Paul A; Seo, Philip; Spiera, Robert F; Brunetta, Paul; St Clair, E William; Harris, Kristina M; Stone, John H; Grandi, Guido; Pers, Jacques-Olivier; Specks, Ulrich; Cornec, Divi
Autoreactive Plasmablasts After B Cell Depletion With Rituximab and Relapses in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis / Berti, Alvise; Hillion, Sophie; Konig, Maximilian F; Moura, Marta Casal; Hummel, Amber M; Carmona, Eva; Peikert, Tobias; Fervenza, Fernando C; Kallenberg, Cees G M; Langford, Carol A; Merkel, Peter A; Monach, Paul A; Seo, Philip; Spiera, Robert F; Brunetta, Paul; St Clair, E William; Harris, Kristina M; Stone, John H; Grandi, Guido; Pers, Jacques-Olivier; Specks, Ulrich; Cornec, Divi. - In: ARTHRITIS & RHEUMATOLOGY. - ISSN 2326-5205. - 75:5(2023), pp. 736-747. [10.1002/art.42388]
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