B cell depletion can improve disease in patients with no pathogenic autoantibodies.
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B cells can produce multiple relevant cytokines in autoimmune diseases.
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B cells control the activity of monocytes via cytokines in autoimmune diseases.
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B cell depletion can lead to improvement of tissue repair in autoimmune diseases.
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Regulatory plasma cells inhibit chronic inflammation in autoimmune diseases.
Abstract
B cells are the only cell type that can give rise to antibody-producing cells, and the only cell type whose selective depletion can, today, lead to an improvement of a wide range of immune-mediated inflammatory diseases, including disorders not primarily driven by autoantibodies. Here, I discuss this paradoxical observation, and propose that the capacity of B cells to act as cytokine-producing cells explains how they can control monocyte activity and subsequently disease pathogenesis. Together with current data on the effect of anti-CD20 B cell-depleting reagents in the clinic, this novel knowledge on B cell heterogeneity opens the way for novel safer and more efficient strategies to target B cells. The forthcoming identification of disease-relevant B cell subsets is awaited to permit their monitoring and specific targeting in a personalized medicine approach.