{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T12:27:14Z","timestamp":1787660834346,"version":"build-2736575974"},"reference-count":22,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lupus"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Current B-cell depletion strategies in lupus nephritis (LN) may encounter a mechanistic \u201cglass ceiling.\u201d While rituximab remains an important therapeutic option, its activity can be constrained by CD20 internalization, antigenic modulation, and greater reliance on complement-dependent mechanisms, which may be less efficient in complement-consuming inflammatory states. Type II anti-CD20 antibodies, particularly obinutuzumab, offer a biologically distinct approach by favoring stronger effector-cell recruitment and direct cell-death programs while reducing target internalization. In this perspective, we examine whether these properties may support deeper B-cell depletion in proliferative LN. Drawing conceptually from hematologic oncology, we propose that minimal residual disease (MRD) may serve as a useful analogue for thinking about depletion depth in nephrology; however, MRD-like peripheral depletion should not be interpreted as a validated renal endpoint or as direct proof of intrarenal immune quiescence. High-sensitivity flow cytometry may refine quantification of residual circulating B cells, whereas biomarkers such as uCD163 may provide complementary information on ongoing intrarenal inflammatory activity rather than tissue B-cell depletion per se. At present, surveillance-based retreatment and fixed peripheral thresholds remain investigational. Overall, obinutuzumab expands the mechanistic and clinical horizon of LN therapy, while underscoring the need for studies linking depletion depth, tissue biology, safety, and durability of response.<\/jats:p>","DOI":"10.1177\/09612033261458553","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T16:27:26Z","timestamp":1780504046000},"page":"997-1002","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["From clinical to immunologic remission in lupus nephritis: Toward MRD-grade B-cell depletion"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7247-4950","authenticated-orcid":false,"given":"Lucas Maciel de Almeida","family":"Corr\u00eaa","sequence":"first","affiliation":[{"name":"Department of Nephrology, Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiggi Kevin Virgino","family":"Brand\u00e3o","sequence":"additional","affiliation":[{"name":"School of Medicine, Centro Universit\u00e1rio Uninorte (UNINORTE)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara Belo Gamon","family":"Santiago","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Estadual de Mato Grosso do Sul (UEMS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre de Assis","family":"Barbosa","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Estadual de Mato Grosso do Sul (UEMS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Rian","family":"Mazur","sequence":"additional","affiliation":[{"name":"School of Medicine, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1 (PUCPR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel Costa","family":"de Santana","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Salvador (UNIFACS)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan Roberth Delmiro","family":"Silva","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Federal de Alagoas (UFAL)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Let\u00edcia Esteves","family":"Dante","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Faculdade de Medicina de S\u00e3o Jos\u00e9 do Rio Preto (FAMERP)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan Felipe","family":"Dutra J\u00fanior","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidade Estadual de Mato Grosso do Sul (UEMS)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.34359"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard-2023-224762"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1454747"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI70972"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-01-330357"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.imlet.2012.01.004"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-01-263533"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-07-296913"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers11030291"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2021-220920"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2410965"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2023.109265"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ker526"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.43212"},{"issue":"9","key":"e_1_3_2_16_2","first-page":"LB13","article-title":"Obinutuzumab leads to deep B-Cell depletion in the kidney parenchyma of patients with lupus nephritis: an exploratory analysis of the REGENCY trial [abstract]","volume":"77","author":"Rovin B","year":"2025","unstructured":"Rovin B, Martins E, Austin C, et al. Obinutuzumab leads to deep B-Cell depletion in the kidney parenchyma of patients with lupus nephritis: an exploratory analysis of the REGENCY trial [abstract]. Arthritis Rheumatol. 2025; 77(suppl 9): LB13.","journal-title":"Arthritis Rheumatol"},{"issue":"9","key":"e_1_3_2_17_2","first-page":"0665","article-title":"Infusion-related reactions (IRRs) and hematologic events associated with obinutuzumab in lupus nephritis: a secondary analysis of a phase III trial [abstract]","volume":"77","author":"Furie R","year":"2025","unstructured":"Furie R, Baczkowska T, Saxena A, et al. Infusion-related reactions (IRRs) and hematologic events associated with obinutuzumab in lupus nephritis: a secondary analysis of a phase III trial [abstract]. 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