1. Nat. Rev. Rheumatol. doi:10.1038/nrrheum.2016.18
Figure 2 The relationship between BAFF, anti-dsDNA antibodies and B-cell numbers in SLE, before and after rituximab therapy
Figure 2 | The relationship between BAFF, anti-dsDNA antibodies and B-cell numbers in SLE, before and after rituximab therapy. Relapse of systemic lupus erythematosus (SLE) before rituximab therapy is associated with a modest B-cell lymphopenia and an increased proportion of plasmablasts, compared with the situation in healthy individuals. Those patients who flare after rituximab treatment with elevated levels of antibodies to double-stranded DNA (anti-dsDNA antibodies) also have high levels of B-cell activating factor (BAFF, also known as TNF ligand superfamily member 13B or BLyS), often with very low B-cell numbers, among which autoreactive plasmablasts predominate. This phenomenon can be compounded by repeated rituximab infusions (see also Fig. 3). By contrast, patients who remain in remission after B-cell depletion have moderate-to-low BAFF levels. Understanding the relationship between BAFF levels, B-cell subsets and SLE flare will be crucial for the appropriate selection of therapy in these patients.
Ehrenstein, M. R. & Wing, C. (2016) The BAFFling effects of rituximab in lupus: danger ahead?
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