The Role of B Cells in Autoimmunity: Insights on B Lymphocyte Stimulation (Blys) as a Target for Biologics in Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a heterogenous condition with significant impact on morbidity and mortality among affected individuals, usually young females during their most productive stage in life. The production of pathogenic autoantibodies has been the classical hallmark for the disease. B cells, the precursor of the antibody producing plasma cells, are believed to play a central role in SLE disease activity. It has long been considered a difficult disease to manage and diagnose due to its wide raging manifestations and severity. This systemic autoimmune condition has attracted many clinicians and researchers for decades in the hope of fully unraveling the disease pathogenesis in order to come up with more effective treatments. Treatment strategies have been broadly directed at dampening the immune response with consequential adverse effects in the long term care of diseased patients. An improved understanding of the role B cells play in lupus pathology has led to the development of belimumab, a monoclonal antibody which became the first successful treatment for SLE introduced after more than half a century. The drug is among the class of targeted biologic therapies now evolving in the field of rheumatology and clinical immunology. It is directed to inhibit the survival of autoreactive B cells that are implicated in SLE disease activity. This review article discusses the stages in B cell ontogeny predisposing SLE development and reports the critical role of B lymphocyte stimulator in the occurrence of SLE disease flares.