In Vivo Dynamics of Immunoregulatory Lymphocyte Reconstitution: A Seven-year Longitudinal Study of Sustained Remission in Class IV Lupus Nephritis Following Rituximab Therapy
11 affiliations
- 1School of Medicine, National Defense Medical University, Taipei, Taiwan, R.O.C.
- 2Department of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan, R.O.C.
- 3Biotech Research and Innovation Centre, University of Copenhagen, Copenhagen, Denmark
- 4The Finsen Laboratory, Rigshospitalet/National University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- 5School of Pharmacy, National Defense Medical University, Taipei, Taiwan, R.O.C.
- 6Graduate Institute of Life Sciences, National Defense Medical University, Taipei, Taiwan, R.O.C.
- 7Department of Internal Medicine, Linkou Chang-Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.
- 8Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.
- 9Cancer Center, Hualien Tzu-Chi Hospital, Hualien, Taiwan, R.O.C.
- 10Department of Engineering Medicine, Shizuoka Center for Molecular Intelligence, Hamamatsu, Shizuoka, Japan
- 11Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical University, Taipei, Taiwan, R.O.C.
Abstract
Background/Aim: Rituximab (RTX)-induced B-cell depletion is an established treatment for refractory lupus nephritis (LN). However, the in vivo kinetics of B-cell reconstitution and their association with sustained clinical remission remain poorly characterized. Because cluster of differentiation 19-positive (CD19+) B-cell monitoring provides a practical measure of immune reconstitution after RTX therapy, we investigated the longitudinal in vivo immunophenotypic recovery of B-cell subsets in a patient with refractory Class IV LN who achieved durable remission.
Case Report: A 20-year-old woman presented in 2019 edema, nephrotic proteinuria (8.1 g/day), hematuria, hypoalbuminemia, anemia, and acute kidney injury. Laboratory investigations revealed an antinuclear antibody (ANA) titer >1:1,280, anti-double-stranded DNA (anti-dsDNA) antibodies of 2,525 IU/mL, and hypocomplementemia. Renal biopsy confirmed Class IV lupus nephritis with diffuse proliferative glomerulonephritis and a full-house immunofluorescence pattern. Treatment with intravenous methylprednisolone, RTX, hydroxychloroquine, and immunosuppressive therapy resulted in complete depletion of CD19+ B cells (46.83% to 0%), accompanied by marked reductions in anti-dsDNA antibody levels and improvement in renal function. During seven years of follow-up, CD19+ B cells gradually reconstituted to approximately 20%; however, sustained clinical remission was maintained, with stable renal function, persistently low anti-dsDNA antibody levels, normalization of complement levels, no renal flare, and progressive decline of Antinuclear antibody (ANA) titers to 1:40 and became undetectable.
Conclusion: The case demonstrates a persistent dissociation between peripheral CD19+ B-cell repopulation and renal disease activity in vivo. The findings suggest that the quality of immune reconstitution, rather than the absolute number of CD19+ B cells, may be associated with sustained remission after RTX therapy and support the potential value of longitudinal immunophenotypic monitoring.
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BibTeX
@article{hung2026vivo,
title = {{In Vivo Dynamics of Immunoregulatory Lymphocyte Reconstitution: A Seven-year Longitudinal Study of Sustained Remission in Class IV Lupus Nephritis Following Rituximab Therapy}},
author = {SHAU-JIE HUNG and JENG-WEI LU and YI-JUNG HO and SHAN-WEN LUI and TING-YU HSIEH and WUN-LONG JHENG and FENG-CHENG LIU},
journal = {In Vivo},
year = {2026},
month = oct,
doi = {10.21873/invivo.14532},
url = {https://doi.org/10.21873/invivo.14532},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - In Vivo Dynamics of Immunoregulatory Lymphocyte Reconstitution: A Seven-year Longitudinal Study of Sustained Remission in Class IV Lupus Nephritis Following Rituximab Therapy
AU - SHAU-JIE HUNG
AU - JENG-WEI LU
AU - YI-JUNG HO
AU - SHAN-WEN LUI
AU - TING-YU HSIEH
AU - WUN-LONG JHENG
AU - FENG-CHENG LIU
PY - 2026
DA - 2026/10/29
JO - In Vivo
DO - 10.21873/invivo.14532
UR - https://doi.org/10.21873/invivo.14532
AB - Background/Aim: Rituximab (RTX)-induced B-cell depletion is an established treatment for refractory lupus nephritis (LN). However, the in vivo kinetics of B-cell reconstitution and their association with sustained clinical remission remain poorly characterized. Because cluster of differentiation 19-positive (CD19+) B-cell monitoring provides a practical measure of immune reconstitution after RTX therapy, we investigated the longitudinal in vivo immunophenotypic recovery of B-cell subsets in a patient with refractory Class IV LN who achieved durable remission. Case Report: A 20-year-old woman presented in 2019 edema, nephrotic proteinuria (8.1 g/day), hematuria, hypoalbuminemia, anemia, and acute kidney injury. Laboratory investigations revealed an antinuclear antibody (ANA) titer >1:1,280, anti-double-stranded DNA (anti-dsDNA) antibodies of 2,525 IU/mL, and hypocomplementemia. Renal biopsy confirmed Class IV lupus nephritis with diffuse proliferative glomerulonephritis and a full-house immunofluorescence pattern. Treatment with intravenous methylprednisolone, RTX, hydroxychloroquine, and immunosuppressive therapy resulted in complete depletion of CD19+ B cells (46.83% to 0%), accompanied by marked reductions in anti-dsDNA antibody levels and improvement in renal function. During seven years of follow-up, CD19+ B cells gradually reconstituted to approximately 20%; however, sustained clinical remission was maintained, with stable renal function, persistently low anti-dsDNA antibody levels, normalization of complement levels, no renal flare, and progressive decline of Antinuclear antibody (ANA) titers to 1:40 and became undetectable. Conclusion: The case demonstrates a persistent dissociation between peripheral CD19+ B-cell repopulation and renal disease activity in vivo. The findings suggest that the quality of immune reconstitution, rather than the absolute number of CD19+ B cells, may be associated with sustained remission after RTX therapy and support the potential value of longitudinal immunophenotypic monitoring.
SN - 0258-851X
SN - 1791-7549
ER -