B-cell phenotype and IgD-CD27- memory B cells are affected by TNF-inhibitors and tocilizumab treatment in rheumatoid arthritis

• Published in: PloS one 2017-09, Vol.12 (9), p.e0182927-e0182927
• Main Authors: Moura, Rita A, Quaresma, Cláudia, Vieira, Ana R, Gonçalves, Maria J, Polido-Pereira, Joaquim, Romão, Vasco C, Martins, Nádia, Canhão, Helena, Fonseca, João E
• Format: Article
• Language: English
• Subjects: Antibodies, Monoclonal, Humanized - pharmacology; Antibodies, Monoclonal, Humanized - therapeutic use; Apoptosis; Arthritis; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - immunology; Arthritis, Rheumatoid - metabolism; B-Lymphocyte Subsets - drug effects; B-Lymphocyte Subsets - immunology; B-Lymphocyte Subsets - metabolism; Bcl-2 protein; Biology and Life Sciences; Biomarkers; BLyS protein; CD19 antigen; CD23 antigen; CD27 antigen; CD38 antigen; CD5 antigen; CD69 antigen; CD86 antigen; CD95 antigen; Chemokine CXCL13 - blood; Circulation; CXCL13 protein; CXCR5 protein; Cytokines; Cytometry; Disease; Enzyme-linked immunosorbent assay; Flow cytometry; Follow-Up Studies; Gene expression; Gene Expression Profiling; Gene Expression Regulation - drug effects; Gene flow; Histocompatibility antigen HLA; Hospitals; Humans; Immunoglobulin D; Immunoglobulin D - metabolism; Immunoglobulin M; Immunologic Memory; Immunological memory; Immunophenotyping; Immunosuppressive agents; Inhibitors; Interleukin 6; Interleukin 6 receptors; Kinases; Lymphocyte Count; Lymphocyte receptors; Lymphocytes B; Medicine and Health Sciences; Methotrexate; Methotrexate - pharmacology; Methotrexate - therapeutic use; Monoclonal antibodies; Patients; Phenotype; Receptors, CXCR5 - metabolism; Receptors, IgE - blood; Rheumatism; Rheumatoid arthritis; Rheumatology; Subpopulations; TNF inhibitors; Treatment Outcome; Tumor Necrosis Factor Receptor Superfamily, Member 7 - metabolism; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Tumor necrosis factor-TNF
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0182927

The use of TNF-inhibitors and/or the IL-6 receptor antagonist, tocilizumab, in rheumatoid arthritis (RA) have pleiotropic effects that also involve circulating B-cells. The main goal of this study was to assess the effect of TNF-inhibitors and tocilizumab on B-cell phenotype and gene expression in RA. Blood samples were collected from untreated early RA (ERA) patients, established RA patients under methotrexate treatment, established RA patients before and after treatment with TNF-inhibitors and tocilizumab, and healthy donors. B-cell subpopulations were characterized by flow cytometry and B-cell gene expression was analyzed by real-time PCR on isolated B-cells. Serum levels of BAFF, CXCL13 and sCD23 were determined by ELISA. The frequency of total CD19+ B cells in circulation was similar between controls and all RA groups, irrespective of treatment, but double negative (DN) IgD-CD27- memory B cells were significantly increased in ERA and established RA when compared to controls. Treatment with TNF-inhibitors and tocilizumab restored the frequency of IgD-CD27- B-cells to normal levels, but did not affect other B cell subpopulations. TACI, CD95, CD5, HLA-DR and TLR9 expression on B-cells significantly increased after treatment with either TNF-inhibitors and/ or tocilizumab, but no significant changes were observed in BAFF-R, BCMA, CD69, CD86, CXCR5, CD23, CD38 and IgM expression on B-cells when comparing baseline with post-treatment follow-ups. Alterations in B-cell gene expression of BAFF-R, TACI, TLR9, FcγRIIB, BCL-2, BLIMP-1 and β2M were found in ERA and established RA patients, but no significant differences were observed after TNF-inhibitors and tocilizumab treatment when comparing baseline and follow-ups. Serum levels of CXCL13, sCD23 and BAFF were not significantly affected by treatment with TNF-inhibitors and tocilizumab. In RA patients, the use of TNF-inhibitors and/ or tocilizumab treatment affects B-cell phenotype and IgD-CD27- memory B cells in circulation, but not B-cell gene expression levels.