B-cell depletion attenuates serological biomarkers of fibrosis and myofibroblast activation in IgG4-related disease

Published on Dec 1, 2015in Annals of the Rheumatic Diseases16.102
· DOI :10.1136/ANNRHEUMDIS-2014-205799
Emanuel Della-Torre25
Estimated H-index: 25
(Harvard University),
Eoin R. Feeney14
Estimated H-index: 14
(Harvard University)
+ 8 AuthorsJohn H. Stone76
Estimated H-index: 76
(Harvard University)
Objectives Fibrosis is a predominant feature of IgG4-related disease (IgG4-RD). B-cell depletion induces a prompt clinical and immunological response in patients with IgG4-RD, but the effects of this intervention on fibrosis in IgG4-RD are unknown. We used the enhanced liver fibrosis (ELF) score to address the impact of rituximab on fibroblast activation. The ELF score is an algorithm based on serum concentrations of procollagen-III aminoterminal propeptide, tissue inhibitor of matrix metalloproteinase-1 and hyaluronic acid. Methods Ten patients with active, untreated IgG4-RD were enrolled. ELF scores were measured and correlated with the IgG4-RD Responder Index, serum IgG4, circulating plasmablasts and imaging studies. Through immunohistochemical stains for CD3, CD20, IgG4 and α-smooth muscle actin, we assessed the extent of the lymphoplasmacytic infiltration and the degree of fibroblast activation in one patient with tissue biopsies before and after rituximab. Results The ELF score was increased in patients with IgG4-RD compared with healthy controls (8.3±1.4 vs 6.2±0.9; p=0.002) and correlated with the number of organs involved (R 2 =0.41; p=0.04). Rituximab induced significant reductions in the ELF score, the number of circulating plasmablasts and the IgG4-RD Responder Index (p Conclusions The ELF score may be a clinically useful indicator of active fibrosis and the extent of disease in IgG4-RD. B-cell depletion has the potential to halt continued collagen deposition by attenuating the secretory phenotype of myofibroblasts in IgG4-RD lesions.
📖 Papers frequently viewed together
278 Citations
205 Citations
1,443 Citations
#1Suzana Jordan (UZH: University of Zurich)H-Index: 14
#2Jörg H W Distler (FAU: University of Erlangen-Nuremberg)H-Index: 67
Last. Thierry ZenoneH-Index: 13
view all 45 authors...
Objectives To assess the effects of Rituximab (RTX) on skin and lung fibrosis in patients with systemic sclerosis (SSc) belonging to the European Scleroderma Trial and Research (EUSTAR) cohort and using a nested case-control design. Methods Inclusion criteria were fulfilment of American College of Rheumatology classification criteria for SSc, treatment with RTX and availability of follow-up data. RTX-treated patients were matched with control patients from the EUSTAR database not treated with RT...
253 CitationsSource
#1Zachary S. Wallace (Harvard University)H-Index: 25
#2Hamid Mattoo (Harvard University)H-Index: 21
Last. John H. Stone (Harvard University)H-Index: 76
view all 10 authors...
Objectives We examined the utility of circulating total and IgG4+ plasmablasts as biomarkers of diagnosis and disease activity in IgG4-related disease (IgG4-RD). Materials methods We evaluated patients with active, untreated, biopsy-proven IgG4-RD affecting various organs. Flow cytometry was used to measure total plasmablast and IgG4+ plasmablast counts by gating peripheral blood for CD19lowCD38+CD20−CD27+ cells and CD19lowCD38+CD20−CD27+IgG4+ cells. Serum IgG4 concentrations were measured by ne...
278 CitationsSource
#1Hamid Mattoo (Harvard University)H-Index: 21
#2Vinay S. Mahajan (Harvard University)H-Index: 23
Last. Shiv Pillai (Harvard University)H-Index: 50
view all 9 authors...
Background IgG 4 -related disease (IgG 4 -RD) is a poorly understood, multiorgan, chronic inflammatory disease characterized by tumefactive lesions, storiform fibrosis, obliterative phlebitis, and accumulation of IgG 4 -expressing plasma cells at disease sites. Objective The role of B cells and IgG 4 antibodies in IgG 4 -RD pathogenesis is not well defined. We evaluated patients with IgG 4 -RD for activated B cells in both disease lesions and peripheral blood and investigated their role in disea...
205 CitationsSource
#1Gregory J. Keir (Princess Alexandra Hospital)H-Index: 15
#2Toby M. MaherH-Index: 49
Last. Elisabetta RenzoniH-Index: 32
view all 10 authors...
Background and objective In patients with severe interstitial lung disease (ILD) progressing despite conventional immunosuppression, rituximab, a B-lymphocyte depleting monoclonal antibody, may offer an effective rescue therapy. Methods Retrospective assessment of 50 patients with severe, progressive ILD (of varying aetiologies, excluding idiopathic pulmonary fibrosis (IPF)) treated with rituximab between 2010 and 2012. Change in pulmonary function tests compared with pre-rituximab levels was as...
145 CitationsSource
#1Giuseppina Abignano (University of Leeds)H-Index: 13
#2Giovanna Cuomo (Seconda Università degli Studi di Napoli)H-Index: 25
Last. Francesco Del Galdo (University of Leeds)H-Index: 25
view all 7 authors...
Objectives: The absence of a serological surrogate outcome measure of fibrosis in systemic sclerosis (SSc) is a major deficiency for intervention studies and clinical management. An algorithm including the serum concentration of procollagen-III aminoterminalpropeptide, tissue inhibitor of matrix metalloproteinase-1 and hyaluronic acid, has recently been validated as predictive of severity and clinical outcome in chronic liver diseases (enhanced liver fibrosis (ELF) test) and implemented as a cli...
31 CitationsSource
#1Emily R. Pierson (UW: University of Washington)H-Index: 6
#2Ingunn M. Stromnes (UW: University of Washington)H-Index: 23
Last. Joan Goverman (UW: University of Washington)H-Index: 33
view all 3 authors...
The efficacy of rituximab treatment in multiple sclerosis has renewed interest in the role of B cells in CNS autoimmunity. In this study, we show that B cells are the predominant MHC class II + subset in the naive CNS in mice, and they constitutively express proinflammatory cytokines. Incidence of experimental autoimmune encephalomyelitis induced by adoptive transfer was significantly reduced in C3HeB/Fej μMT (B cell–deficient) mice, suggesting an important role for CNS B cells in initiating inf...
61 CitationsSource
: Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated condition that can affect almost any organ and is now being recognized with increasing frequency. IgG4-RD is characterized by a lymphoplasmacytic infiltrate composed of IgG4(+) plasma cells, storiform fibrosis, obliterative phlebitis, and mild to moderate eosinophilia. The diagnosis of IgG4-RD unifies many eponymous fibroinflammatory conditions that had previously been thought to be confined to single organs. IgG4-RD lesi...
213 CitationsSource
#1Antoine François (UDS: University of Strasbourg)H-Index: 5
#2Emmanuel ChatelusH-Index: 18
Last. Jacques-Eric Gottenberg (UDS: University of Strasbourg)H-Index: 48
view all 7 authors...
Introduction B lymphocytes might play a pathogenic role in dermal fibrosis in systemic sclerosis (SSc). B-cell activating factor (BAFF), a key cytokine for B-cell activation, is increased in the serum and the skin of patients with SSc. However, the ability of B cells directly to stimulate dermal fibroblasts and the role of BAFF are not fully understood. We therefore investigated the involvement of B cells and BAFF in the expression of collagen and profibrotic markers by dermal fibroblasts.
75 CitationsSource
#1Ralf Lichtinghagen (MHH: Hannover Medical School)H-Index: 38
#2Daniel Pietsch (MHH: Hannover Medical School)H-Index: 6
Last. Matthias J. Bahr (MHH: Hannover Medical School)H-Index: 34
view all 6 authors...
Background & Aims Progressive fibrosis is a major cause of morbidity and mortality in chronic liver disease. To replace liver biopsy for disease staging, multiple serum markers are under evaluation with multiparametric panels yielding the most promising results. The Enhanced Liver Fibrosis (ELF) score is an ECM marker set consisting of tissue inhibitor of metalloproteinases 1 (TIMP-1), amino-terminal propeptide of type III procollagen (PIIINP) and hyaluronic acid (HA) showing good correlations w...
156 CitationsSource
#1Georg WickH-Index: 66
#2Cecilia GrundtmanH-Index: 16
Last. Dolores WolframH-Index: 13
view all 8 authors...
Fibrosis is the production of excessive amounts of connective tissue, i.e., scar formation, in the course of reactive and reparative processes. Fibrosis develops as a consequence of various underlying diseases and presents a major diagnostically and therapeutically unsolved problem. In this review, we postulate that fibrosis is always a sequela of inflammatory processes and that the many different causes of fibrosis all channel into the same final stereotypical pathways. During the inflammatory ...
182 CitationsSource
Cited By65
#1Marco Lanzillotta (UniSR: Vita-Salute San Raffaele University)H-Index: 14
#2Andreu Fernández-Codina (UWO: University of Western Ontario)H-Index: 9
Last. Emanuel Della-Torre (UniSR: Vita-Salute San Raffaele University)H-Index: 25
view all 7 authors...
INTRODUCTION Awareness of IgG4-related disease (IgG4-RD) is increasing worldwide and specialists are now familiar with most of its clinical manifestations and mimickers. IgG4-RD promptly responds to glucocorticoids and repeated courses are typically used to induce and maintain remission because the disease relapses in most patients. If left untreated it can lead to organ dysfunction, organ failure and death. Advancement in our understanding of IgG4-RD pathogenesis is leading to the identificatio...
#1Emanuel Della-Torre (UniSR: Vita-Salute San Raffaele University)H-Index: 25
#2Marco Lanzillotta (UniSR: Vita-Salute San Raffaele University)H-Index: 14
Last. Lorenzo Dagna (UniSR: Vita-Salute San Raffaele University)H-Index: 33
view all 8 authors...
OBJECTIVE Rituximab is increasingly used in IgG4-related disease (IgG4-RD) but high costs limit its wide off-label administration. European and US regulatory agencies have recently approved rituximab biosimilars for the treatment of different rheumatologic and hematological conditions. No data are available, yet, on the efficacy and safety of rituximab biosimilars for the treatment of IgG4-RD. Scope of the present work is to evaluate the efficacy and safety of the rituximab biosimilar CT-P10 (RT...
1 CitationsSource
#1Lucrezia Rovati (UniSR: Vita-Salute San Raffaele University)H-Index: 6
#2Naoki Kaneko (Ragon Institute of MGH, MIT and Harvard)H-Index: 10
Last. Emanuel Della-Torre (UniSR: Vita-Salute San Raffaele University)H-Index: 25
view all 13 authors...
OBJECTIVES IgG4-related disease (IgG4-RD) is a systemic fibro-inflammatory disorder characterized by a dysregulated resolution of inflammation and wound healing response that might develop after an apoptotic insult induced by cytotoxic T lymphocytes (CTLs). Mer receptor tyrosine kinase (MerTK) and its ligand Protein S (ProS1) have a pivotal role in the resolution of inflammation, being implicated in the clearance of apoptotic cells, quenching of the immune response and development of tissue fibr...
#1Aamina T Shakir (University of Oklahoma Health Sciences Center)
Last. Guha Krishnaswamy (Wake Forest University)H-Index: 4
view all 3 authors...
Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disease characterised by multiorgan lymphoplasmacytic infiltration, obliterative phlebitis and storiform fibrosis. It can be associated with cardiovascular pathology. The objective of this narrative review is to summarise the published literature on cardiovascular manifestations of IgG4-RD and to provide a basis for diagnosis and management of the condition by the practising cardiologist. We propose the following categor...
#1Cory A. Perugino (Harvard University)H-Index: 13
#2John H. Stone (Harvard University)H-Index: 76
IgG4-related disease (IgG4-RD) has only existed as a unique disease entity since 2003, yet remarkable progress has already been achieved in describing the essential features of the disease. A framework for systematic clinical studies has been created by the development of a quantitative disease activity tool (the IgG4-RD Responder Index) and the validation of classification criteria, both of which were the products of international, multi-centre investigations. In addition, substantial strides h...
11 CitationsSource
#1Shaozhe CaiH-Index: 3
#2Yu Chen (HUST: Huazhong University of Science and Technology)H-Index: 5
Last. Lingli DongH-Index: 16
view all 6 authors...
1 CitationsSource
#1Christian Schmidkonz (FAU: University of Erlangen-Nuremberg)H-Index: 7
#2Simon Rauber (FAU: University of Erlangen-Nuremberg)H-Index: 6
Last. Andreas Ramming (FAU: University of Erlangen-Nuremberg)H-Index: 19
view all 24 authors...
Objectives To date, there is no valuable tool to assess fibrotic disease activity in humans in vivo in a non-invasive way. This study aims to uncouple inflammatory from fibrotic disease activity in fibroinflammatory diseases such as IgG4-related disease. Methods In this cross-sectional clinical study, 27 patients with inflammatory, fibrotic and overlapping manifestations of IgG4-related disease underwent positron emission tomography (PET) scanning with tracers specific for fibroblast activation ...
13 CitationsSource
#1Song-Chou Hsieh (NTU: National Taiwan University)H-Index: 15
#2Chieh-Yu Shen (NTU: National Taiwan University)H-Index: 6
Last. Chia-Li Yu (NTU: National Taiwan University)H-Index: 29
view all 11 authors...
IgG4-related disease (IgG4-RD) is a spectrum of complex fibroinflammatory disorder with protean manifestations mimicking malignant neoplasms, infectious or non-infectious inflammatory process. The histopathologic features of IgG4-RD include lymphoplasmacytic infiltration, storiform fibrosis and obliterative phlebitis together with increased in situ infiltration of IgG4 bearing-plasma cells which account for more than 40% of all IgG-producing B cells. IgG4-RD can also be diagnosed based on an ele...