Vitiligo after alemtuzumab treatment: Secondary autoimmunity is not all about B cells

Ruck T, Pfeuffer S, Schulte-Mecklenbeck A, Gross CC, Lindner M, Metze D, Ehrchen J, Sondermann W, Pul R, Kleinschnitz C, Wiendl H, Meuth SG, Klotz L (2018)

Publication Type: Journal article

Publication year: 2018

Journal

Neurology American Academy of Neurology (AAN)

Book Volume: 91

Pages Range: E2233-E2237

Journal Issue: 24

DOI: 10.1212/WNL.0000000000006648

Abstract

Objective To report 3 patients with relapsing-remitting multiple sclerosis (RRMS) showing vitiligo after treatment with alemtuzumab. Methods Retrospective case series including flow cytometric analyses and T-cell receptor (TCR) sequencing of peripheral blood mononuclear cells. Results We describe 3 cases of alemtuzumab-treated patients with RRMS developing vitiligo 52, 18, and 14 months after alemtuzumab initiation. Histopathology shows loss of epidermal pigmentation with absence of melanocytes and interface dermatitis with CD8+ T-cell infiltration. Also compatible with pathophysiologic concepts of vitiligo, peripheral blood mononuclear cells of one patient showed high proportions of CD8+ T cells with an activated (human leukocyte antigen-DR+), memory (CD45RO+), and type 1 cytokine (interferon-γ + tumor necrosis factor-α) phenotype at vitiligo onset compared to a control cohort of alemtuzumab-treated patients with RRMS (n = 30). Of note, analysis of CD8 TCR repertoire in this patient revealed a highly increased clonality and reduced repertoire diversity compared to healthy controls and treatment-naive patients with RRMS. We observed a predominance of single clones at baseline in this patient and alemtuzumab treatment did not substantially affect the proportions of most abundant clones over time. Conclusion The 3 cases represent a detailed description of vitiligo as a T-cell-mediated secondary autoimmune disease following alemtuzumab treatment. The prevailing concept of unleashed B-cell responses might therefore not cover all facets of alemtuzumab-related secondary autoimmunity. Mechanistic studies, especially on TCR repertoire, might help clarify the underlying mechanisms.

Involved external institutions

Westfälische Wilhelms-Universität (WWU) Münster DE Germany (DE) Universitätsklinikum Essen DE Germany (DE)

How to cite

APA:

Ruck, T., Pfeuffer, S., Schulte-Mecklenbeck, A., Gross, C.C., Lindner, M., Metze, D.,... Klotz, L. (2018). Vitiligo after alemtuzumab treatment: Secondary autoimmunity is not all about B cells. Neurology, 91(24), E2233-E2237. https://doi.org/10.1212/WNL.0000000000006648

MLA:

Ruck, Tobias, et al. "Vitiligo after alemtuzumab treatment: Secondary autoimmunity is not all about B cells." Neurology 91.24 (2018): E2233-E2237.

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