Patients with systemic lupus erythematosus show increased proportions of CD19+CD20 B cells and secretion of related autoantibodies



At present, anti-CD20 monoclonal antibody treatments targeting systemic lupus erythematosus (SLE) are complex, variable, and often have disappointing outcomes. High levels of programmed cell death-1 (PD-1) and its ligands (PD-L1, PD-L2) or CD80/CD86 on B cell surfaces are markers of increased B cell activity. However, their expression levels on CD19+CD20+/− B cells and their clinical significance for SLE dynamics have not been carefully investigated.


Flow cytometry was used to detect the expression levels of PD-1, PD-L1, PD-L2, CD80, and CD86 on CD19+CD20+/− B cells in peripheral blood from SLE patients and healthy controls (HCs). The amount of anti-dsDNA and immunoglobin G (IgG) secreted by CD19+CD20+/− B cells was measured by enzyme-linked immunosorbent assay.


CD19+CD20 B cell frequency was significantly higher in SLE patients than in HCs (P < 0.001), and was positively correlated with disease activity. In SLE patients, frequencies of PD-1, PD-L1, PD-L2, and CD86 on CD19+CD20 B cells were significantly higher than CD19+CD20+ B cells (P ≤ 0.002) and were significantly correlated with individual laboratory and clinically based parameters (P < 0.05). In vitro tests, we found that the levels of anti-dsDNA and IgG secreted by CD19+CD20 B cells from patients with SLE were significantly higher than the HC group (P < 0.05).


We found abnormal frequency of CD19+CD20 B cells and increased expression of surface markers on these cells from SLE patients. And the CD19+CD20 B cells had the ability to proliferate and secrete anti-dsDNA and IgG. Additionally, our results suggested that CD19+CD20 B cells from SLE patients may be the activated B cells and caused poor efficacy of rituximab.

Key Points
• CD19+CD20B cell frequencies were significantly higher in SLE patients.
• Frequencies of PD-1 and its ligands on CD19+CD20B cells increased significantly in SLE patients.
• CD19+CD20B cells in SLE patients had the ability to secrete anti-dsDNA and IgG.
• CD19+CD20B cells in SLE patients may be the activated B cells and caused poor efficacy of rituximab.

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complement 3


complement 4


carboxy fluorescence in succinimidyl ester






division Index


double negative


double-stranded DNA


enzyme-linked immunosorbent assay


erythrocyte sedimentation rate


immunoglobulin M


immunoglobulin A


immunoglobulin G


lupus nephritis




neuropsychiatric systemic lupus erythematosus


non-switched memory


phosphate-buffered saline


peripheral blood mononuclear cells


plasmablast cells


programmed death 1


programmed death ligand 1


programmed death ligand 2


proliferation Index












Statistical Package for Social Sciences


systemic lupus erythematosus


systemic lupus erythematosus disease activity index


switched memory


follicular helper T-cells


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The authors wish to thank Chuanwang Song, Hongtao Wang, Jie Tang for their direction and supervision during the experiment.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


Research was supported by funding from the Anhui Provincial Natural Science Foundation (1608085MH215), the Key Project of the Natural Science Foundation Universities Anhui Province (KJ2019A0319, KJ2016A475), the Natural Science Foundation of Universities in Anhui Province (KJ2013B139), the Postgraduate Science and Technology Innovation Project of Bengbu Medical College in Anhui Province (Byycx1824), and the Undergraduate Training Programs for Innovation and Entrepreneurship in Anhui Province (201,810,367,017, and 201,810,367,056).

Author information




CX, YW conceived and designed the work. MW, ZC contribute to collect peripheral blood samples of subjects. QZ, YL and LZ performed the experiments. QZ, JS, JL analyzed data and statistical analysis. CX and QZ drafted the manuscript. BL, CX and ZL critically revised the manuscript for important intellectual content.

Corresponding authors

Correspondence to Yuanyuan Wang or Changhao Xie.

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Ethics approval and consent to participate

All participants provided informed written consent. This study was approved by the institutional review board of the First Affiliated Hospital of Bengbu Medical College.

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The authors declare no financially oriented conflicts of interest. Ethical approvals and informed written consent were obtained and provided from and to all participants. The study design was approved by the Institutional Review Board of the First Affiliated Hospital of Bengbu Medical College.

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Zhu, Q., Li, Y., Zhang, L. et al. Patients with systemic lupus erythematosus show increased proportions of CD19+CD20 B cells and secretion of related autoantibodies. Clin Rheumatol (2020).

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  • Autoantibody
  • B cell
  • Surface marker
  • Systemic lupus erythematosus