Rituximab: beyond simple B cell depletion.
Rituximab, a chimeric anti-CD20 monoclonal antibody, has a proven track record for over a decade in the treatment of lymphomas, where it has been used to eradicate malignant lymphocytes. In appreciation of the putative role of B cells, especially with respect to autoantibody production, in the pathogenesis of autoimmune diseases, successful trials of B-cell depletion therapy in RA, SLE, and other autoimmune diseases have been carried out. In these trials, clinical benefit has generally correlated with the extent and duration of B-cell depletion, but at times imperfectly, and autoantibody reduction only selectively. Additional mechanisms whereby rituximab may assert its clinical benefit in autoimmune diseases have been examined including a look at B-cell functions as T-cell modulator and antigen-presenting cell, T-regulatory cell behavior, NK cell activity, and macrophage activities in immune inflammation. The available data on rituximab's action in autoimmune diseases is reviewed.
Kessel
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A
Division of Clinical Immunology and Allergy, Bnai Zion Medical Center, Technion, Rappaport Faculty of Medicine, Haifa, P.O.B. 4940, Israel.
Rosner
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I
Toubi
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E
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001402:B-Lymphocytes / Q000276:immunology*; D002986:Clinical Trials as Topic; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007694:Killer Cells, Natural / Q000276:immunology*; D008212:Lymphocyte Depletion; D008223:Lymphoma / Q000188:drug therapy / Q000276:immunology; D000069283:Rituximab; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab