B lymphocyte stimulator overexpression in patients with systemic lupus erythematosus: Longitudinal observations (original) (raw)

2003, Arthritis & Rheumatism

Objective. To assess the overexpression of B lymphocyte stimulator (BLyS) over time in patients with systemic lupus erythematosus (SLE). Methods. Sixty-eight SLE patients were followed up longitudinally for a median 369 days. At each physician encounter, disease activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index, and blood was collected for determination of the serum BLyS level, blood BLyS messenger RNA (mRNA) level, and cell surface BLyS expression. Twenty normal control subjects underwent similar laboratory evaluations. Results. In contrast to the uniformly normal serum BLyS and blood BLyS mRNA phenotypes in control subjects, SLE patients displayed marked heterogeneity, with 50% and 61% of patients manifesting persistently or intermittently elevated serum BLyS and blood BLyS mRNA phenotypes, respectively. Surface BLyS expression by SLE peripheral blood mononuclear cells was also often increased. Treatment of patients who had elevated serum BLyS levels with intensive courses of high-dose corticosteroids resulted in marked reductions in serum BLyS levels, and tapering of the corticosteroid dosage often resulted in increases in serum BLyS levels. Serum BLyS levels generally correlated with anti-double-stranded DNA (anti-dsDNA) titers (in those with detectable anti-dsDNA titers), but changes in serum BLyS levels did not correlate with changes in disease activity in individual patients. Serum BLyS phenotype did not associate with specific organ system involvement. Conclusion. Dysregulation of BLyS over extended periods of time is common in patients with SLE. Neutralization of BLyS activity with an appropriate BLyS antagonist may be therapeutically beneficial. B lymphocyte stimulator (BLyS; trademark of Human Genome Sciences, Rockville, MD) protein (also known as BAFF, TALL-1, THANK, TNFSF13B, and zTNF4) is a 285-amino acid member of the tumor necrosis factor (TNF) ligand superfamily (1-6). It is expressed as a type II transmembrane protein, which is cleaved from the cell surface by a furin protease to release a biologically active soluble 17-kd protein (1-5). BLyS is a potent B cell survival factor (7-10). The numbers of mature B cells in secondary lymphoid organs, as well as baseline serum Ig levels and Ig responses to T cell-dependent and T cell-independent antigens, are markedly reduced in mice rendered genetically deficient in BLyS (11,12). Conversely, in vivo administration of exogenous BLyS to mice induces B cell expansion and polyclonal hypergammaglobulinemia (1). Although 3 distinct BLyS receptors are known (BCMA, TACI, and BAFF-R) (6,7,13-18), the agonist effects of BLyS on B cells are mediated predominantly (if not solely) via BAFF-R (17-20). A clear relationship between BLyS overexpression and systemic lupus erythematosus (SLE) has been