Anticytokine therapy impacting on B cells in autoimmune diseases

PURPOSE OF REVIEW: To evaluate the impact of particular anticytokine therapies able to indirectly target B cells with emphasis on the tumor necrosis factor (TNF) family members, B cell activating factor/B lymphocyte stimulator (BAFF/BLyS) and a proliferation-inducing ligand (APRIL). RECENT FINDINGS: Although blockade of TNF/lymphotoxin by etanercept has been shown to have an impact on memory B cells, recent studies of inhibiting the TNF family members BAFF/BlyS or simultaneously blocking BAFF/BlyS and APRIL in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) clearly demonstrated biologic activity, including reductions of immunoglobulin levels. However, clear evidence of clinical activity by any of the compounds interfering with BAFF/BLys or APRIL has not yet been shown. SUMMARY: Although anticytokine therapies mainly blocking signaling pathways of innate immunity, that is TNF-alpha, have shown efficacy in the treatment of arthritides and have partial effects on memory B cells, current studies evaluate effects on adaptive immunity by blocking BAFF/BlyS and/or APRIL which indirectly act on B and plasma cells.