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Sensitive B-cell receptor repertoire analysis shows repopulation correlates with clinical response to rituximab in rheumatoid arthritis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年3月16日

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  • Sabrina Pollastro,
  • Anne Musters,
  • Giulia Balzaretti,
  • Ilse Niewold,
  • Barbera van Schaik,
  • Signe Hässler,
  • Catharina M. Verhoef,
  • Marc Pallardy,
  • Antoine van Kampen,
  • Xavier Mariette,
  • Niek de Vries,
  • Natacha Szely,
  • Aude Gleizes,
  • Salima Hacein-Bey Abina,
  • Christophe Richez,
  • Martin Soubrier,
  • Jérome Avouac,
  • Olivier Brocq,
  • Jérémie Sellam,
  • Tom Huizinga,
  • Elizabeth Jury,
  • Jessica Manson,
  • Claudia Mauri,
  • Andrea Matucci

摘要

Background

Although B-cell depleting therapy in rheumatoid arthritis (RA) is clearly effective, response is variable and does not correlate with B cell depletion itself.

Methods

The B-cell receptor (BCR) repertoire was prospectively analyzed in peripheral blood samples of twenty-eight RA patients undergoing rituximab therapy. Timepoints of achieved BCR-depletion and -repopulation were defined based on the percentage of unmutated BCRs in the repertoire. The predictive value of early BCR-depletion (within one-month post-treatment) and early BCR-repopulation (within 6 months post-treatment) on clinical response was assessed.

Results

We observed changes in the peripheral blood BCR repertoire after rituximab treatment, i.e., increased clonal expansion, decreased clonal diversification and increased mutation load which persisted up to 12 months after treatment, but started to revert at month 6. Early BCR depletion was not associated with early clinical response but late depleters did show early response. Patients with early repopulation with unmutated BCRs showed a significant decrease in disease activity in the interval 6 to 12 months. Development of anti-drug antibodies non-significantly correlated with more BCR repopulation.

Conclusion

Our findings indicate that rather than BCR-depletion it is repopulation with unmutated BCRs, possibly from naïve B cells, which induces remission. This suggests that (pre-existing) differences in B-cell turnover between patients explain the interindividual differences in early clinical effect.