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Clin J Am Soc Nephrol. 2013 Mar;8(3):382-91. doi: 10.2215/CJN.03950412. Epub 2013 Jan 4.

Decreased CD5⁺ B cells in active ANCA vasculitis and relapse after rituximab.

Author information

1
UNC Kidney Center, University of North Carolina, Chapel Hill, North Carolina 27599, USA. donna_bunch@med.unc.edu

Abstract

BACKGROUND AND OBJECTIVES:

B cell significance in ANCA disease pathogenesis is underscored by the finding that ANCA alone can cause disease in mouse models and by the effectiveness of rituximab as therapy in ANCA-small vessel vasculitis (ANCA-SVV). To avoid infections and adverse events from therapy, clinicians require improved markers of disease activity and impending relapse to guide immunosuppression strategies after rituximab treatment.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

The B cell phenotype was investigated in patients with active ANCA-SVV and in remission. From 2003 to 2009, 54 patients were followed longitudinally for 4-99 months and compared with 68 healthy controls. In a subset of 19 patients, the B cell immunophenotype was examined in samples after rituximab therapy.

RESULTS:

Patients with active ANCA-SVV had lower %CD5(+) B cells, whereas %CD5(+) B cells from patients in remission were indistinguishable from healthy controls. After rituximab, median time to relapse was 31 months in patients maintaining normalized %CD5(+) B cells, with or without maintenance immunosuppression. Among patients whose B cells repopulated with low %CD5(+) B cells or had a sharply declining %CD5(+) B cells, those who were on low or no maintenance immunosuppression relapsed sooner (median 17 months) than patients who were maintained on high levels of oral maintenance immunosuppression (29 months; P=0.002).

CONCLUSIONS:

The %CD5(+) B cells, as a component of the human B regulatory cell phenotype, is a useful indicator of disease activity, remission, and future relapse, and thus may guide remission maintenance therapy after rituximab treatment.

PMID:
23293123
PMCID:
PMC3586963
DOI:
10.2215/CJN.03950412
[Indexed for MEDLINE]
Free PMC Article

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