The efficacy of TNF antagonists and B cell depletion therapy (BCDT) in rheumatoid arthritis (RA) have fundamentally altered pathophysiologic paradigms and raised new questions about disease mechanisms. The observation that both TNF and B cells are of central importance provides a strong impetus to improve our understanding ofthe relationship between TNF over-production and inflammation pathways mediated by B cells, particularly in regards to disease flares and inadequate treatment response. The TNF-transgenic (TNF-tg) mouse strain is the only chronically progressive model for RA with a clinically proven etiology, and thus invaluable to address the cellular and immunological events in RA. We have developed a series of novel small animal imaging approaches, including contrast enhanced (CE) MRI, in vivo micro-CT and near infrared indocyanin green (NIR-ICG) analysis of lymphatic flow, to study longitudinally the events associated with progression of joint arthritis. The results from these studies, combined with histology and flow cytometry, showed dramatic changes unfolding in a predictable temporal sequence in the draining popliteal lymph-node (PLN) before and during the onset of knee disease. Prior to knee synovitis, the draining PLNs

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Rheumatoid arthritis (RA) is a debilitating joint disease, which is manifested by episodic flares, and affects >1% of our populations. Here we propose to elucidate the role of B cells in arthritic flares, and evaluate a novel clinical outcome measures in RA patients undergoing B cell depletion therapy (rituximab) to better understand the differences between responders and non-responders.

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National Institute of Allergy and Infectious Diseases (NIAID)
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Emory University
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Meednu, Nida; Zhang, Hengwei; Owen, Teresa et al. (2016) Production of RANKL by Memory B Cells: A Link Between B Cells and Bone Erosion in Rheumatoid Arthritis. Arthritis Rheumatol 68:805-16
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