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This study investigated whether BAFF-pathway inhibition alters the balance between regulatory B cells (Bregs) and type 1 innate lymphoid cells (ILC1s) in paediatric LN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, open-label randomised study, 60 paediatric patients with biopsy-confirmed class III\/IV LN were randomised to standard therapy (mycophenolate mofetil and corticosteroids; n=30) or standard therapy plus the belimumab (10 mg\/kg intravenously every 4 weeks for 6 months; n=30). Ten healthy children and three patients with biopsy-confirmed minimal change disease served as controls. Flow cytometry quantified IL-10-producing Bregs and circulating ILC1s. Clinically indicated paired renal biopsies (n=3) underwent transcriptomic and immunofluorescence analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Belimumab was associated with greater increases in serum C3, reductions in antidouble-stranded DNA titres, decreased proteinuria, improved Systemic Lupus Erythematosus Disease Activity Index 2000 scores and reduced corticosteroid exposure. Belimumab expanded memory B cells and IL-10-producing CD19\n                      <jats:sup>+<\/jats:sup>\n                      CD5\n                      <jats:sup>+<\/jats:sup>\n                      and CD19\n                      <jats:sup>+<\/jats:sup>\n                      CD24\n                      <jats:sup>hi+<\/jats:sup>\n                      CD38\n                      <jats:sup>hi+<\/jats:sup>\n                      Bregs, with enhanced suppression of CD4\n                      <jats:sup>+<\/jats:sup>\n                      T cell proliferation. Treatment reduced circulating and renal ILC1s, downregulated interferon (IFN)-stimulated genes and modulated inflammatory pathways. Serum cytokine profiling showed decreased IFN-\u03b3, interleukin (IL)-17A, IL-10 and BAFF levels, alongside increased IL-35. Phosphorylation of the aryl hydrocarbon receptor and signal transducer and activator of transcription 3 (STAT3) in Bregs was partially restored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BAFF inhibition in paediatric LN is associated with rebalancing of innate and adaptive immunity through enhancement of Breg function and suppression of ILC1-driven inflammation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006492","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T14:26:25Z","timestamp":1778682385000},"page":"e006492","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Regulatory B cell expansion and type 1 innate lymphoid cell suppression characterise immune modulation in paediatric lupus 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Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Hung","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology and Rheumatology, Changhua Christian Hospital, Changhua, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya-Chih","family":"Tien","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology and Rheumatology, Changhua Christian Hospital, Changhua, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tzu-Cheng","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Pathology, Changhua Christian Hospital, Changhua, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Ching","family":"Wei","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, China Medical University Children\u2019s Hospital, Taichung City, Taiwan"},{"name":"Division of Allergy, Immunology and Rheumatology, 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