Figure 1 Targets for monoclonal antibodies in B-cell lineages

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Figure 1 Targets for monoclonal antibodies in B-cell lineages Figure 1 | Targets for monoclonal antibodies in B-cell lineages. B cells emerge from bone marrow stem cells as pro-B cells and mature into pre-B cells, immature B cells, mature B cells, and activated B cells. Eventually, they develop into antibody-secreting cells, including plasmablasts, plasma cells, and long-lived memory plasma cells that secrete IgA, IgE, IgG, and IgM antibodies. Autoreactive B-cell clones can produce anti-M-type phospholipase A2 receptor (PLA2R) and anti-thrombospondin type 1 domain containing 7A protein (THSD7A) antibodies and conceivably, autoantibodies against unknown antigens expressed on podocytes. As B cells mature, they develop various markers on the cell surface that can become targets for specific monoclonal antibodies. Anti-CD20 monoclonal antibodies, such as rituximab and ofatumumab, bind and kill CD20-expressing B cells (pre-B cells, and immature, mature, and activated B cells), but not plasmablasts, mature plasma cells or memory plasma cells as they do not express this antigen. Plasma cells express CD38 and might, therefore, be a target for anti-CD38 antibodies such as daratumumab and isatuximab. Immature, mature, and activated B cells express receptors for the B lymphocyte stimulator (BLyS, also known as BAFF) such as B cell activating factor receptor (BAFF-R), B cell maturation antigen (BCMA), and the transmembrane activator and calcium-modulating cyclophilin ligand interactor (TACI). The anti-BLyS monoclonal antibody belimumab might, therefore, prevent B-cell differentiation into plasma cells by blocking the interaction between this lymphocyte stimulator and its receptors. Proteasome inhibitors, such as bortezomib, can prevent antibody production by inducing plasma cell apoptosis, whereas anti-CD38 monoclonal antibodies, such as daratumumab and isatuximab, can directly induce plasma cell cytolysis. Ruggenenti, P. et al. (2017) Treatment of membranous nephropathy: time for a paradigm shift Nat. Rev. Nephrol. doi:10.1038/nrneph.2017.92