Anti-CD20 antibody therapy and susceptibility to Pneumocystis pneumonia

W Elsegeiny, T Eddens, K Chen, JK Kolls - Infection and immunity, 2015 - Am Soc Microbiol
Infection and immunity, 2015Am Soc Microbiol
Anti-CD20 antibody therapy has been a useful medication for managing non-Hodgkin's
lymphoma as well as autoimmune diseases characterized by autoantibody generation.
CD20 is expressed during most developmental stages of B lymphocytes; thus, CD20
depletion leads to B-lymphocyte deficiency. As the drug has become more widely used,
there has been an increase in the number of case reports of patients developing
Pneumocystis pneumonia. The role of anti-CD20 in Pneumocystis jirovecii infection is under …
Abstract
Anti-CD20 antibody therapy has been a useful medication for managing non-Hodgkin's lymphoma as well as autoimmune diseases characterized by autoantibody generation. CD20 is expressed during most developmental stages of B lymphocytes; thus, CD20 depletion leads to B-lymphocyte deficiency. As the drug has become more widely used, there has been an increase in the number of case reports of patients developing Pneumocystis pneumonia. The role of anti-CD20 in Pneumocystis jirovecii infection is under debate due to the fact that most patients receiving it are on a regimen of multiple immunosuppressive medications. To address the specific role of CD20 depletion in host immunity against Pneumocystis, we examined a murine anti-CD20 depleting antibody. We demonstrated that anti-CD20 alone is permissive for Pneumocystis infection and that anti-CD20 impairs components of type II immunity, such as production of interleukin-4 (IL-4), IL-5, and IL-13 by whole-lung cells, in response to Pneumocystis murina. We also demonstrated that CD4+ T cells from mice treated with anti-CD20 during Pneumocystis infection are incapable of mounting a protective immune response when transferred into Rag1−/− mice. Thus, CD20+ cells are critical for generating protective CD4+ T-cell immune responses against this organism.
American Society for Microbiology