B cells play a crucial role in the pathogenesis of autoimmune diseases, such as systemic lupus erythematosus (SLE). However, the relevance of the metabolic pathway in the differentiation of human B cell subsets remains unknown. In this article, we show that the combination of CpG/TLR9 and IFN-α markedly induced the differentiation of CD27IgD unswitched memory B cells into CD27CD38 plasmablasts. The response was accompanied by mammalian target of rapamycin complex 1 (mTORC1) activation and increased lactate production, indicating a shift to glycolysis. However, CpG alone induced the differentiation of unswitched memory B cells into CD27IgD memory B cells with high cytokine production, but such differentiation was suppressed by IFN-α. AMP-activated protein kinase activation enhanced the differentiation to CD27IgD B cells, but it attenuated mTORC1 activation and differentiation into plasmablasts. High mTORC1 activation was noted in CD19 B cells of patients with SLE and correlated with plasmablast differentiation and disease activity. Taken together, differential metabolic reprogramming commits the differentiation of human unswitched memory B cells into plasmablasts (the combination of CpG and IFN-α amplifies mTORC1-glycolysis pathways) or CD27IgD memory B cells (CpG alone amplifies the AMP-activated protein kinase pathway). The former metabolic pathway may play a pivotal role in SLE.

: The rate of recurrence of subacute thyroiditis (SAT) during prednisolone (PSL) therapy is approximately 10 to 20%. However, there is little or no information on the time period to relapse following administration of a tapered dose of PSL and the factors associated with such relapse. The aim of this study was to determine the correlation between SAT recurrence and PSL tapering regimen used in the treatment of SAT. This study was a medical record-based retrospective study and involved 26 patients (3 men, 23 women) who received PSL therapy for SAT. The primary endpoint was the association between recurrence and number of days required to taper daily PSL dose to 5 mg. The secondary endpoint was the relationship between recurrence and several variables including age, clinical score, free thyroxine, inf lammatory reaction, thyroglobulin, total treatment time, total dose of PSL and presence or absence of creeping thyroiditis. The SAT recurrence rate was 15.3%. There was no significant difference in the initial PSL dose between the non-recurrence and recurrence groups (27.5 mg vs 24.5 mg, P = 0.302). However, for the primary endpoint, significant differences were found between the two groups in time required for tapering PSL to 5 mg/day (non-recurrence: 44.3 ± 15.3 days, recurrence: 19.0 ± 11.9 days, P = 0.012). None of the clinical variables evaluated correlated significantly with SAT relapse. In conclusion, to prevent recurrence of SAT, consideration should be given to the period required for PSL tapering to 5 mg/day.

IntroductionThe aim of the present study was to determine the actual state of inter‐day glycemic variability and identify the factors that affect glycemic variability in diabetic outpatients on insulin therapy.Materials and MethodsThe participants were 45 outpatients with diabetes mellitus receiving insulin therapy. The mean plasma glucose (MPG) levels, intra‐day glycemic variability (expressed by standard deviation and mean amplitude of glucose excursion) and inter‐day glycemic variability (expressed by mean of daily differences [MODD] in blood glucose levels) were measured continuously over 7 days with iPro2®. The primary outcome was the relationship between MODD and the life variability index.Results MODD values were high in 93.3% of the participants, and significantly higher in patients with lifestyle changes than in those without (higher in patients with high life variability index). MODD values were not associated with age, but significantly higher in women. MODD values correlated significantly with glycated hemoglobin and glycoalbumin levels, and negatively with 1,5‐anhydroglucitol levels. MODD values were significantly higher in type 1 diabetes patients and not associated with duration of disease. MODD values correlated significantly with insulin dose. Multivariate analysis identified the life variability index as a significant determinant of MODD.ConclusionsiPro2® provided detailed information on glycemic profile in diabetic outpatients receiving insulin therapy. The results suggest that patients with large inter‐day glycemic variability are unlikely to achieve an improvement in their glycated hemoglobin level. Treatment and instructions based on a patient's characteristics, day‐to‐day glycemic variability and lifestyle are important to achieve good glycemic control.

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