Objective Anti–citrullinated protein antibodies (ACPAs) are a hallmark of rheumatoid arthritis (RA). Aside from autoantibody production, the function of autoantigen‐specific B cells remains poorly understood in the context of this disease. This study set out to elucidate autoantigen‐specific B cell functions through the isolation and immortalization of unique citrullinated protein/peptide (CP)–reactive B cell clones from RA patients. Methods B cell clones from either the blood or synovial fluid of cyclic citrullinated peptide 2 (CCP2) antibody–positive RA patients were immortalized by genetic reprogramming with Bcl‐6 and Bcl‐xL. Enzyme‐linked immunosorbent assay and flow cytometry were used to identify CCP2‐reactive clones and to further characterize surface marker and cytokine expression as well as B cell receptor signaling competence. Global gene expression profiles were interrogated by RNA sequencing. Results Three unique CP‐reactive memory B cell clones were generated from the blood or synovial fluid of 2 RA patients. CP‐reactive memory B cells did not appear to be broadly cross‐reactive, but rather had a fairly restricted epitope recognition profile. These clones were able to secrete both pro‐ and antiinflammatory cytokines and had a unique surface profile of costimulatory molecules and receptors, including CD40 and C5a receptor type 1, when compared to non‐CP–reactive clones from the same patient. In addition, CP‐reactive clones bound citrullinated protein, but not native protein, and could mobilize calcium in response to antigen binding. Conclusion CP‐reactive memory B cells comprise a rare, seemingly oligoclonal population with restricted epitope specificity and distinct phenotypic and molecular characteristics suggestive of antigen‐presenting cells. Cloning by genetic reprogramming opens new avenues to study the function of autoreactive memory B cells, especially in terms of antigen processing, presentation, and subsequent T cell polarization.

Objective Antibodies against citrullinated type II collagen (Cit‐CII) are common in the sera and synovial fluid of patients with rheumatoid arthritis (RA); however, the known T cell epitope of CII is not dependent on citrullination. The aim of this study was to identify and functionally characterize the Cit‐CII–restricted T cell epitopes that are relevant to RA. Methods Peripheral blood mononuclear cells (PBMCs) from HLA–DRB1*10:01–positive patients with RA and healthy donors were stimulated in vitro with candidate CII peptides. CD154 up‐regulation was measured as a marker of antigen‐specific activation, and anti–HLA–DR–blocking experiments confirmed HLA restriction. Cytokine production was measured using a Luminex technique. Direct peptide‐binding assays using HLA–DRB1*10:01 and HLA–DRB1*04:01 monomeric proteins were performed. The T cell receptor (TCR) β‐chain of CD154‐enriched antigen‐specific T cells was analyzed using high‐throughput sequencing. Results A novel Cit‐CII peptide was identified based on its ability to activate CD4+ T cells from HLA–DRB1*10:01–positive individuals. When stimulated in vitro, Cit‐CII autoreactive T cells produced proinflammatory cytokines. Cit‐CII311–325 bound (with low affinity) to HLA–DRB1*10:01 but not to HLA–DRB1*04:01, while the native form was unable to bind either protein. In addition, highly expanded clones were identified in the TCRβ repertoire of Cit‐CII311–325–stimulated PBMCs. Conclusion These results illustrate the ability of the citrullination process to create T cell epitopes from CII, a cartilage‐restricted protein that is relevant to RA pathogenesis. The exclusive binding of Cit‐CII311–325 to HLA–DRB1*10:01 suggests that recognition of citrullinated epitopes might vary between individuals carrying different RA‐associated HLA–DR molecules.

Allergic contact dermatitis caused by contact sensitizers is a T-cell-mediated inflammatory skin disease. The most prevalent contact allergens is nickel. Whereas, memory T cells from nickel-allergic patients are well-characterized, little is known concerning nickel-specific naïve T-cell repertoire. The purpose of this study was to identify and quantify naïve CD4+ and CD8+ T cells recognizing nickel in the general population. Using a T-cell priming in vitro assay based on autologous co-cultures between naïve T cells and dendritic cells loaded with nickel, we were able to detect a naïve CD4+ and CD8+ T-cell repertoire for nickel in 10/11 and 7/8 of the tested donors. We calculated a mean frequency of 0.49 nickel-specific naïve CD4+ T cells and 0.37 nickel-specific naïve CD8+ T cells per million of circulating naïve T cells. The activation of these specific T cells requires MHC molecules and alongside IFN-γ production, some nickel-specific T-cells were able to produce granzyme-B. Interestingly, nickel-specific naïve CD4+ and CD8+ T cells showed a low rate of cross-reactivity with cobalt, another metallic hapten, frequently mixed with nickel in many alloys. Moreover, naïve CD4+ T cells showed a polyclonal TCRβ composition and the presence of highly expanded clones with an enrichment and/or preferentially expansion of some TRBV genes that was donor and T-cell specific. Our results contribute to a better understanding of the mechanism of immunization to nickel and propose the T-cell priming assay as a useful tool to identify antigen-specific naïve T cells.

ObjectiveTo gain more insight into the dynamics of lymphocyte depletion and develop new predictors of clinical response to rituximab in rheumatoid arthritis (RA).MethodsRNA-based next-generation sequencing was used to analyse the B cell receptor (BCR) repertoire in peripheral blood and synovial tissue samples collected from 24 seropositive patients with RA treated with rituximab. Clonal expansion, mutation load and clonal overlap were assessed in samples collected before, at week 4 and at week 16 or 24 after treatment and correlated to the patients’ clinical response.ResultsAfter 4 weeks of rituximab-induced B cell depletion, the peripheral blood BCR repertoire of treated patients consisted of fewer, more dominant and more mutated BCR clones. No significant changes in the synovial tissue BCR repertoire were detected until week 16 post-treatment, when a reduced clonal overlap with baseline and an increased mutation load were observed. In patients who were non-responders at month 3 (n=5) using the European League Against Rheumatism response criteria, peripheral blood samples taken at week 4 after rituximab treatment showed more dominant clones compared with moderate responders (n=9) (median (IQR): 36 (27–52) vs 18 (16–26); p<0.01) and more clonal overlap with the baseline (median (IQR): 5% (2%–20%) vs 0% (0%–0%); p≤0.01).ConclusionSignificant changes in BCR clonality are observed in peripheral blood of patients 4 weeks after rituximab treatment, while changes in synovial tissue were observed at later time points. Incomplete depletion of the dominant baseline peripheral blood BCR repertoire in the first month of treatment might predict clinical non-response at 3 months.