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Clinical and histologic evidence of salivary gland restoration supports the efficacy of rituximab treatment in Sjögrens syndrome
Arthritis & Rheumatism, 11/06/09

Pijpe J et al. – Sequential parotid biopsy specimens obtained from patients with primary SS before and after rituximab treatment demonstrated histopathologic evidence of reduced glandular inflammation and redifferentiation of lymphoepithelial duct lesions to regular striated ducts as a putative morphologic correlate of increased parotid flow and normalization of the salivary sodium content. These histopathologic findings in a few patients underline the efficacy of B cell depletion and indicate the potential for glandular restoration in SS

Methods

Phase II study
Incisional parotid biopsy specimen obtained from 5 patients with primary SS before and 12 weeks after rituximab treatment (4 infusions of 375 mg/m2)
Relative amount of parotid parenchyma, lymphocytic infiltrate, and fat, and the presence/quantity of germinal centers and lymphoepithelial duct lesions evaluated
Immunohistochemical characterization performed to analyze the B:T cell ratio of lymphocytic infiltrate (CD20, CD79a, CD3) and cellular proliferation in acinar parenchyma (by double immunohistologic labeling for cytokeratin 14 and Ki-67)
Histologic data assessed for correlations with parotid flow rate and saliva composition

Results

4 patients showed increased salivary flow rate and normalization of initially increased salivary sodium concentration
Following rituximab treatment, lymphocytic infiltrate reduced, with decreased B:T cell ratio and (partial) disappearance of germinal centers
Amount and extent of lymphoepithelial lesions decreased in 3 patients and completely absent in 2 patients
Initially increased proliferation of acinar parenchyma in response to inflammation reduced in all patients