B cell depletion in diffuse progressive systemic sclerosis

Safety, skin score modification and IL-6 modulation in an up to thirty-six months follow-up open-label trial

Silvia Bosello, Maria De Santis, Gina Lama, Cristina Spanò, Cristiana Angelucci, Barbara Tolusso, Gigliola Sica, Gianfranco Ferraccioli

Research output: Contribution to journalArticle

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Abstract

Introduction: An over-expression of CD19 has been shown in B cells of systemic sclerosis (SSc) and B cells are thought to contribute to the induction of skin fibrosis in the tight skin mouse model. The aim was to define the outcome on safety and the change in skin score after rituximab therapy in SSc patients and to correlate the clinical characteristics with the levels of interleukin (IL)-6 and with the immune cell infiltrate detected by immunohistochemistry.Methods: Nine patients with SSc with mean age 40.9 ± 11.1 years were treated with anti-CD20, 1 g at time 0 and after 14 days. Skin biopsy was performed at baseline and during the follow-up. B-cell activating factor (BAFF) and IL-6 levels were also determined at the follow-up times.Results: After 6 months patients presented a median decrease of the skin score of 43.3% (range 21.1-64.0%), and a decrease in disease activity index and disease severity index. IL-6 levels decreased permanently during the follow up. After treatment, a complete depletion of peripheral blood B cells was observed in all but 2 patients. Only 3 patients presented CD20 positive cells in the biopsy of the involved skin at baseline.Conclusions: Anti-CD20 treatment has been well tolerated and SSc patients experienced an improvement of the skin score and of clinical symptoms. The clear fall in IL-6 levels could contribute to the skin fibrosis improvement, while the presence of B cells in the skin seems to be irrelevant with respect to the outcome after B cell depletion.Trial registration: ISRCTN77554566.

Original languageEnglish
Article numberR54
JournalArthritis Research and Therapy
Volume12
Issue number2
DOIs
Publication statusPublished - Mar 25 2010

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Diffuse Scleroderma
Interleukin-6
B-Lymphocytes
Safety
Skin
Systemic Scleroderma
Fibrosis
B-Cell Activating Factor
Biopsy
Blood Cells
Therapeutics
Immunohistochemistry

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy
  • Medicine(all)

Cite this

B cell depletion in diffuse progressive systemic sclerosis : Safety, skin score modification and IL-6 modulation in an up to thirty-six months follow-up open-label trial. / Bosello, Silvia; De Santis, Maria; Lama, Gina; Spanò, Cristina; Angelucci, Cristiana; Tolusso, Barbara; Sica, Gigliola; Ferraccioli, Gianfranco.

In: Arthritis Research and Therapy, Vol. 12, No. 2, R54, 25.03.2010.

Research output: Contribution to journalArticle

Bosello, Silvia ; De Santis, Maria ; Lama, Gina ; Spanò, Cristina ; Angelucci, Cristiana ; Tolusso, Barbara ; Sica, Gigliola ; Ferraccioli, Gianfranco. / B cell depletion in diffuse progressive systemic sclerosis : Safety, skin score modification and IL-6 modulation in an up to thirty-six months follow-up open-label trial. In: Arthritis Research and Therapy. 2010 ; Vol. 12, No. 2.
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abstract = "Introduction: An over-expression of CD19 has been shown in B cells of systemic sclerosis (SSc) and B cells are thought to contribute to the induction of skin fibrosis in the tight skin mouse model. The aim was to define the outcome on safety and the change in skin score after rituximab therapy in SSc patients and to correlate the clinical characteristics with the levels of interleukin (IL)-6 and with the immune cell infiltrate detected by immunohistochemistry.Methods: Nine patients with SSc with mean age 40.9 ± 11.1 years were treated with anti-CD20, 1 g at time 0 and after 14 days. Skin biopsy was performed at baseline and during the follow-up. B-cell activating factor (BAFF) and IL-6 levels were also determined at the follow-up times.Results: After 6 months patients presented a median decrease of the skin score of 43.3{\%} (range 21.1-64.0{\%}), and a decrease in disease activity index and disease severity index. IL-6 levels decreased permanently during the follow up. After treatment, a complete depletion of peripheral blood B cells was observed in all but 2 patients. Only 3 patients presented CD20 positive cells in the biopsy of the involved skin at baseline.Conclusions: Anti-CD20 treatment has been well tolerated and SSc patients experienced an improvement of the skin score and of clinical symptoms. The clear fall in IL-6 levels could contribute to the skin fibrosis improvement, while the presence of B cells in the skin seems to be irrelevant with respect to the outcome after B cell depletion.Trial registration: ISRCTN77554566.",
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