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Rizzi M, Knoth R, Hampe CS, Lorenz P, Gougeon ML, Lemercier B, Venhoff N, Ferrera F, Salzer U, Thiesen HJ, Peter HH, Walker UA, Eibel H. Long-lived plasma cells and memory B cells produce pathogenic anti-GAD65 autoantibodies in Stiff Person Syndrome. PLoS One 2010; 5:e10838. [PMID: 20520773 PMCID: PMC2877104 DOI: 10.1371/journal.pone.0010838] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 04/22/2010] [Indexed: 11/25/2022] Open
Abstract
Stiff person syndrome (SPS) is a rare, neurological disorder characterized by sudden cramps and spasms. High titers of enzyme-inhibiting IgG autoantibodies against the 65 kD isoform of glutamic acid decarboxylase (GAD65) are a hallmark of SPS, implicating an autoimmune component in the pathology of the syndrome. Studying the B cell compartment and the anti-GAD65 B cell response in two monozygotic twins suffering from SPS, who were treated with the B cell-depleting monoclonal anti-CD20 antibody rituximab, we found that the humoral autoimmune response in SPS is composed of a rituximab-sensitive part that is rapidly cleared after treatment, and a rituximab-resistant component, which persists and acts as a reservoir for autoantibodies inhibiting GAD65 enzyme activity. Our data show that these potentially pathogenic anti-GAD65 autoantibodies are secreted by long-lived plasma cells, which may either be persistent or develop from rituximab-resistant memory B lymphocytes. Both subsets represent only a fraction of anti-GAD65 autoantibody secreting cells. Therefore, the identification and targeting of this compartment is a key factor for successful treatment planning of SPS and of similar autoimmune diseases.
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Affiliation(s)
- Marta Rizzi
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
- Centre of Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
- Clinical Research Unit for Rheumatology, University Medical Center Freiburg, Freiburg, Germany
| | - Rolf Knoth
- Department of Neuropathology, Institute of Pathology, University Medical Center Freiburg, Freiburg, Germany
| | - Christiane S. Hampe
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Peter Lorenz
- Institute of Immunology, University of Rostock, Rostock, Germany
| | - Marie-Lise Gougeon
- Institut Pasteur, Antiviral Immunity, Biotherapy and Vaccine Unit, Paris, France
| | - Brigitte Lemercier
- Institut Pasteur, Antiviral Immunity, Biotherapy and Vaccine Unit, Paris, France
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
- Centre of Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - Francesca Ferrera
- Centre of Excellence for Biomedical Research, University of Genova, Genova, Italy
| | - Ulrich Salzer
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
- Centre of Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | | | - Hans-Hartmut Peter
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
- Centre of Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
| | - Ulrich A. Walker
- Department of Rheumatology at Basel University, Basel, Switzerland
| | - Hermann Eibel
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Freiburg, Germany
- Centre of Chronic Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany
- Clinical Research Unit for Rheumatology, University Medical Center Freiburg, Freiburg, Germany
- * E-mail:
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