Mycophenolic acid counteracts B cell proliferation and plasmablast formation in patients with systemic lupus erythematosus

Arthritis Research & Therapy, 05/10/2012

Eickenberg S et al. – The thorough inhibition of B cell activation and plasma cell formation by mycophenolate mofetil (MMF) might explain the favorable outcomes of previous clinical trials in patients with systemic lupus erythematosus (SLE), since enhanced B cell proliferation is a hallmark of this disease.

Methods

  • Clinical and paraclinical parameters of 107 patients with SLE were recorded consecutively and analyzed retrospectively.
  • Patients were divided into treatment groups (MMF: n=39, azathioprine (AZA) n=30 and controls without immunosuppressive therapy n=38).
  • To further delineate the effect of mycophenolic acid (MPA) on naive and memory B cells in vitro assays were performed.

Results

  • Although patients taking AZA flared more frequently than patients on MMF or controls, the analysis of clinical parameters did not reveal significant differences.
  • However, profound differences in paraclinical parameters were found.
  • B cell frequencies and numbers were significantly higher in patients taking MMF compared to those on AZA but lower numbers and frequencies of plasmablasts were detected compared to AZA-treated patients or controls.
  • Notably, MMF treatment was associated with a significantly higher frequency and number of transitional B cells as well as naive B cells compared to AZA treatment.
  • Differences in T cell subsets were not significant.
  • MPA abrogated in vitro proliferation of purified B cells completely but had only moderate impact on B cell survival.

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