Objectives of the Project
Lupus nephritis (LN) remains a severe complication of SLE. Several studies have demonstrated that an absence of early response to therapy is a poor long-term renal prognostic factor and special care should be given to these patients.
In order to test the efficacy of rituximab (RTX) in this niche indication, an investigator-initiated trial, entitled RING, was designed. REFRACT is a RING sub-study in which baseline and 6-month repeat renal biopsy will be performed. Cells infiltrating the kidneys, especially B-cells responsible for autoantibody production, will be scrutinized (flow cytometry, transcriptome, cloning, etc.), in order to unravel the mechanisms underlying refractoriness.
One of the hypothesis to explain resistance to therapy is that the kidney itself is not only a target for autoantibodies but also acts as a true lymphoid organ that hosts immunologically relevant processes resulting in further B-cell stimulation.