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[Preprint]. 2023 Nov 13:2023.11.09.566503. [Version 1] doi: 10.1101/2023.11.09.566503

Figure 5: Rituximab-resistant B cell foci in treatment-resistant cLN.

Figure 5:

(A) Diagram depicting immunosuppressive therapies and timing of serial kidney biopsies in subject SLE8. Stars indicate individual doses of rituximab (1000mg, red), IV methylprednisolone (500mg, yellow), and cyclophosphamide (900–1200mg, blue). Bars indicate duration of oral medication use. (B, C) Trajectory of clinical biomarkers of cLN disease activity (B) and circulating CD19+ B cell numbers (C) in SLE8. Each dot indicates an individual laboratory value. Stars indicate values above/below the limit of detection. Dashed lines indicate normal range for clinical assay. (D) Intrarenal B cells (black circle) and plasma cells (open circle), as percentage of total kidney cells, in 3 serial biopsies from subject SLE8. Grey bars indicate % B cells/plasma cells in control kidney. (E) Representative image showing persistent tubulointersitial foci of B cells (orange) and plasma cells (blue) in sample SLE8.1 (obtained prior to rituximab treatment) and sample SLE8.3 (post-rituximab in the setting of circulating B cell depletion). Scale bars, 200μm.