B lymphocyte stimulator overexpression in patients with systemic lupus erythematosus: longitudinal observations.
OBJECTIVE
To assess the overexpression of B lymphocyte stimulator (BLyS) over time in patients with systemic lupus erythematosus (SLE).


METHODS
Sixty-eight SLE patients were followed up longitudinally for a median 369 days. At each physician encounter, disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index, and blood was collected for determination of the serum BLyS level, blood BLyS messenger RNA (mRNA) level, and cell surface BLyS expression. Twenty normal control subjects underwent similar laboratory evaluations.


RESULTS
In contrast to the uniformly normal serum BLyS and blood BLyS mRNA phenotypes in control subjects, SLE patients displayed marked heterogeneity, with 50% and 61% of patients manifesting persistently or intermittently elevated serum BLyS and blood BLyS mRNA phenotypes, respectively. Surface BLyS expression by SLE peripheral blood mononuclear cells was also often increased. Treatment of patients who had elevated serum BLyS levels with intensive courses of high-dose corticosteroids resulted in marked reductions in serum BLyS levels, and tapering of the corticosteroid dosage often resulted in increases in serum BLyS levels. Serum BLyS levels generally correlated with anti-double-stranded DNA (anti-dsDNA) titers (in those with detectable anti-dsDNA titers), but changes in serum BLyS levels did not correlate with changes in disease activity in individual patients. Serum BLyS phenotype did not associate with specific organ system involvement.


CONCLUSIONS
Dysregulation of BLyS over extended periods of time is common in patients with SLE. Neutralization of BLyS activity with an appropriate BLyS antagonist may be therapeutically beneficial.
Stohl
William
W
Los Angeles County + University of Southern California Medical Center, and University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA. stohl@usc.edu
Metyas
Samy
S
Tan
Soon-Min
SM
Cheema
Gurtej S
GS
Oamar
Bonifacia
B
Xu
Dong
D
Roschke
Viktor
V
Wu
Youmei
Y
Baker
Kevin P
KP
Hilbert
David M
DM
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000954:Antigens, Surface / Q000235:genetics; D001323:Autoantibodies / Q000097:blood; D053264:B-Cell Activating Factor; D001402:B-Lymphocytes / Q000276:immunology*; D004247:DNA / Q000276:immunology; D005260:Female; D015870:Gene Expression / Q000276:immunology; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology*; D008297:Male; D008565:Membrane Proteins / Q000097:blood / Q000235:genetics*; D008875:Middle Aged; D012333:RNA, Messenger / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics*
D000305:Adrenal Cortex Hormones; D000954:Antigens, Surface; D001323:Autoantibodies; D053264:B-Cell Activating Factor; D008565:Membrane Proteins; D012333:RNA, Messenger; C505719:TNFSF13B protein, human; D014409:Tumor Necrosis Factor-alpha; D004247:DNA