Abstract：Objective To investigate the change in the distribution of memory B cell subsets in children with frequently relapsing nephrotic syndrome (FRNS) during the course of the disease. Methods A total of 35 children with primary nephrotic syndrome (PNS) who attended the Department of Pediatrics of the Affiliated Hospital of Xuzhou Medical University from October 2020 to October 2021 were enrolled as subjects in this prospective study. According to the response to glucocorticoid (GC) therapy and frequency of recurrence, the children were divided into two groups: FRNS (n=20) and non-FRNS (NFRNS; n=15). Fifteen children who underwent physical examination were enrolled as the control group. The change in memory B cells after GC therapy was compared between groups, and its correlation with clinical indicators was analyzed. Results Before treatment, the FRNS and NFRNS groups had significantly increased percentages of total B cells, total memory B cells, IgD+ memory B cells, and IgE+ memory B cells compared with the control group, and the FRNS group had significantly greater increases than the NFRNS group (P<0.05); the FRNS group had a significantly lower percentage of class-switched memory B cells than the NFRNS and control groups (P<0.05). After treatment, the FRNS and NFRNS groups had significant reductions in the percentages of total B cells, total memory B cells, IgM+IgD+ memory B cells, IgM+ memory B cells, IgE+ memory B cells, IgD+ memory B cells, and IgG+ memory B cells (P<0.05) and a significant increase in the percentage of class-switched memory B cells (P<0.05). The FRNS group had a significantly higher urinary protein quantification than the NFRNS and control groups (P<0.05) and a significantly lower level of albumin than the control group (P<0.05). In the FRNS group, urinary protein quantification was negatively correlated with the percentage of class-switched memory B cells and was positively correlated with the percentage of IgE+ memory B cells (P<0.05). Conclusions Abnormal distribution of memory B cell subsets may be observed in children with FRNS, and the percentages of IgE+ memory B cells and class-switched memory B cells can be used as positive and negative correlation factors for predicting recurrence after GC therapy in these children.
YUAN Wen-Jun,CHENG Jin,LIU Chun-Mei et al. Distribution of memory B cell subsets in peripheral blood of children with frequently relapsing nephrotic syndrome[J]. CJCP, 2023, 25(2): 172-178.
Iijima K, Sako M, Oba M, et al. Mycophenolate mofetil after rituximab for childhood-onset complicated frequently-relapsing or steroid-dependent nephrotic syndrome[J]. J Am Soc Nephrol, 2022, 33(2): 401-419. PMID: 34880074. PMCID: PMC8819987. DOI: 10.1681/ASN.2021050643.
Fribourg M, Cioni M, Ghiggeri G, et al. CyTOF-enabled analysis identifies class-switched B cells as the main lymphocyte subset associated with disease relapse in children with idiopathic nephrotic syndrome[J]. Front Immunol, 2021, 12: 726428. PMID: 34621271. PMCID: PMC8490633. DOI: 10.3389/fimmu.2021.726428.
Cancro MP, Tomayko MM. Memory B cells and plasma cells: the differentiative continuum of humoral immunity[J]. Immunol Rev, 2021, 303(1): 72-82. PMID: 34396546. DOI: 10.1111/imr.13016.
Si R, Zhao P, Yu Z, et al. Increased non-switched memory B cells are associated with plasmablasts, serum IL-6 levels and renal functional impairments in IgAN patients[J]. Immunol Invest, 2020, 49(1-2): 178-190. PMID: 31670996. DOI: 10.1080/08820139.2019.1683026.
Odendahl M, Jacobi A, Hansen A, et al. Disturbed peripheral B lymphocyte homeostasis in systemic lupus erythematosus[J]. J Immunol, 2000, 165(10): 5970-5979. PMID: 11067960. DOI: 10.4049/jimmunol.165.10.5970.
Lanio N, Sarmiento E, Gallego A, et al. Alterations of na?ve and memory B-cell subsets are associated with risk of rejection and infection in heart recipients[J]. Transpl Int, 2013, 26(8): 800-812. PMID: 23746145. DOI: 10.1111/tri.12131.
Guo M, Chen R, Xiang F, et al. Decreased percentage of memory B cells is independently associated with increased susceptibility to infection in patients on maintenance hemodialysis[J]. Int Urol Nephrol, 2018, 50(11): 2081-2090. PMID: 30276601. DOI: 10.1007/s11255-018-1977-8.
Hilgendorf I, Mueller-Hilke B, Kundt G, et al. The lack of memory B cells including T cell independent IgM+ IgD+ memory B cells in chronic graft-versus host disease is associated with susceptibility to infection[J]. Transpl Int, 2012, 25(1): 87-96. PMID: 22098606. DOI: 10.1111/j.1432-2277.2011.01388.x.
Shi Y, Agematsu K, Ochs HD, et al. Functional analysis of human memory B-cell subpopulations: IgD+ CD27+ B cells are crucial in secondary immune response by producing high affinity IgM[J]. Clin Immunol, 2003, 108(2): 128-137. PMID: 12921759. DOI: 10.1016/s1521-6616(03)00092-5.
Colucci M, Carsetti R, Cascioli S, et al. B cell phenotype in pediatric idiopathic nephrotic syndrome[J]. Pediatr Nephrol, 2019, 34(1): 177-181. PMID: 30267238. DOI: 10.1007/s00467-018-4095-z.
