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This article is part of the supplement: 22nd European Workshop for Rheumatology Research

Meeting abstract

Long term immune reconstitution after immunoablation and autologous CD34 cell therapy in autoimmune diseases

AT Thiel1, A Thiel1, T Alexander1, O Rosen2, E Gromnica-Ihle3, GR Burmester4, R Arnold2, F Hiepe4 and A Radbruch1

Author Affiliations

1 DRFZ Berlin, Berlin, Germany

2 Haematology, Charité, Berlin, Germany

3 Rheumaklinik, Berlin-Buch, Berlin, Germany

4 Rheumatology, Charité, Berlin, Germany

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Arthritis Res 2002, 4(Suppl 1):107  doi:10.1186/ar442


The electronic version of this article is the complete one and can be found online at:


Received:15 January 2002
Published:4 February 2002

©

Introduction

Immunoablation in combination with autologous stem cell transplantation (ASCT) is used as a therapy for severe autoimmune diseases. We have analysed reconstitution of the immune system in patients treated with ASCT.

Results

During a follow-up period of up to 42 months after ASCT, one polychondritis and two systemic lupus erythematosus (SLE) patients in clinical remission were analysed for reappearance of naive, activated and memory B and T lymphocytes, for reactivity against pathogens and autoantigens, and for presence of autoantibodies. Titers of disease-specific autoantibodies decreased after ASCT with the half-life of secreted antibodies, and did not reappear. NaiveT and naive Bcells reappeared and reached normal levels within one year after ASCT. T cells activated and expanded by pathogens were easily detectable, but not T cells reacting to any of an array of autoantigens tested, in a cytometric cytokine provocation test. A third SLE patient suffered from a relapse of disease after being free of any clinical and serological symptoms for 17 months. In this patient, autoantibodies with old (anti-dsDNA antibodies) and new specificities (anti-Sm and anti-U1RNP antibodies) appeared upon relapse. A sudden decrease of peripheral naive and increase of peripheral memory B and Th cells preceeded the relapse.

Conclusion

ASCT for autoimmune diseases can result in longlasting remissions. According to frequencies and phenotypes of naive lymphocytes, the reconstituted immune system resembles a 'juvenile' immune system. Our results reveal that autoreactive and plasma cells do not survive the therapy but protective immune memory has to be re-established.