title: Increased Circulating T Follicular Helper Cells Are Inhibited by Rituximab in Neuromyelitis Optica Spectrum Disorder.
abstract: Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune disease of the central nervous system. The existence of autoantibody targeting aquaporin-4 (AQP4-Ab) indicates the involvement of humoral immunity in the pathogenesis of this disease. Rituximab (RTX), a monoclonal antibody against CD20, has been used to treat NMOSD by depleting circulating B cells and overall satisfactory outcome has been achieved. Although T follicular helper cells have been proved to regulate B cell activation and antibody production, the role of these cells in NMOSD and the impact of RTX treatment on these cells remain less understood. In this study, we found that frequencies of circulating T follicular helper (cTfh) cells and B cells together with the related cytokines, IL-21 and IL-6, were closely correlated with disease activity of NMOSD. Furthermore, B cell depletion with RTX treatment inhibited the expansion of cTfh cells, and these effects were achieved through eliminating IL-6-producing B cells and blocking the direct contact between cTfh cells and B cells. These findings imply the complicated cross talk between cTfh cells and B cells and may provide a novel therapeutic target for NMOSD.
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Cong
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Hong-Zeng
authors.initials: HZ
authors.lastname: Li
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Dai-Di
authors.initials: DD
authors.lastname: Zhao
authors.affiliation: Department of Cardiology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Chao
authors.initials: C
authors.lastname: Ma
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China; Department of Neurology, Xi'an Children's Hospital, Xi'an, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Ya-Nan
authors.initials: YN
authors.lastname: Bai
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Zhu-Yi
authors.initials: ZY
authors.lastname: Li
authors.affiliation: Department of Neurology, Tangdu Hospital, Fourth Military Medical University , Xi'an , China.
authors.forename: Jun
authors.initials: J
authors.lastname: Guo
keywords: B cells; circulating T follicular helper cells; interleukin-6; neuromyelitis optica spectrum disorder; rituximab