title: Overexpanded B cell clone mediating leukemic arthritis by abundant secretion of interleukin-1beta: a case report.
abstract: The role of cytokines in leukemic arthritis is unknown. The presentation of a patient with B cell chronic lymphocytic leukemia and destructive arthritis of the wrist joints prompted us to study the synovial cytokine pattern by immunohistologic analysis. In addition, rearranged V(H) and V(L) immunoglobulin genes were sequenced to assess B cell clonality. Heavy infiltrations of CD20+ cells with lambda light chain restriction were found in the synovial tissue. Sequencing demonstrated overexpansion of a single B cell clone (DP58/D/J(H)4b and IGLV3S2/Jlambda2-Jlambda3 for V(H) and V(L), respectively) in the peripheral blood. Identical V(H) and V(L) rearrangements were found in the synovial infiltrates. Somatic mutations were found in both the peripheral blood and the synovial clone. Immunohistologic study revealed the presence of abundant interleukin-1beta (IL-1beta) and, to a lesser degree, tumor necrosis factor beta (TNFbeta) (lymphotoxin). In contrast, TNFalpha, interferon-gamma, IL-4, IL-6, and IL-10 were rarely found in the synovial infiltrates. Therefore, IL-1beta secreted in great amounts by leukemic B cells appears to be the major cytokine that mediates joint destruction in leukemic arthritis.
authors.affiliation: University Hospital Benjamin Franklin, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Rudwaleit
authors.forename: F
authors.initials: F
authors.lastname: Elias
authors.forename: T
authors.initials: T
authors.lastname: Humaljoki
authors.forename: L
authors.initials: L
authors.lastname: Neure
authors.forename: W
authors.initials: W
authors.lastname: Knauf
authors.forename: H
authors.initials: H
authors.lastname: Stein
authors.forename: A
authors.initials: A
authors.lastname: Distler
authors.forename: J
authors.initials: J
authors.lastname: Sieper
authors.forename: C
authors.initials: C
authors.lastname: Berek
authors.forename: J
authors.initials: J
authors.lastname: Braun
mesh_terms: D000595:Amino Acid Sequence; D001168:Arthritis / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D001402:B-Lymphocytes / Q000276:immunology / Q000378:metabolism*; D001483:Base Sequence; D002999:Clone Cells / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism; D017931:DNA Primers / Q000737:chemistry; D004273:DNA, Neoplasm / Q000032:analysis; D015321:Gene Rearrangement; D005803:Genes, Immunoglobulin / Q000235:genetics; D006801:Humans; D007124:Immunoenzyme Techniques; D007375:Interleukin-1 / Q000378:metabolism*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D013583:Synovial Membrane / Q000378:metabolism / Q000473:pathology; D014955:Wrist Joint / Q000473:pathology
chemical_list: D016207:Cytokines; D017931:DNA Primers; D004273:DNA, Neoplasm; D007375:Interleukin-1