Extrafollicular B cell responses are associated with autoreactivity against the slit diaphragm in idiopathic podocytopathies
Bibliographic record
Abstract
ABSTRACT Idiopathic podocytopathies lack mechanistic biomarkers and rely on empirical immunosuppression, yet the recent discovery of autoantibodies against slit diaphragm proteins implicates podocyte-directed autoimmunity as a driver of podocyte injury. However, the immune mechanisms underlying autoreactivity and phenotypic heterogeneity, particularly across age groups, remain unclear. Here, we identify expansion of CD21 low T-bet + atypical B cells (atBCs) in peripheral blood as a shared immunologic feature across idiopathic podocytopathies. In children, atBC accumulation was associated with heightened B cell activation, favoring extrafollicular responses and plasmablast differentiation. Serologic profiling revealed that autoantibodies against the slit diaphragm protein CRB2 are highly prevalent across disease phenotypes and frequently co-occur with anti-Nephrin antibodies, particularly in adults. Autoantibody abundance correlated with atBC expansion in affected children, implicating extrafollicular B cell responses as a key pathway for their generation, whereas adults showed additional involvement of follicular pathways. Complementary mouse modeling demonstrated intermolecular epitope spreading as a mechanism linking anti-CRB2 and anti-Nephrin autoreactivity. Together, these findings define a shared immune framework for idiopathic podocytopathies in which extrafollicular B cell responses drive autoreactivity to multiple slit diaphragm proteins, with implications for biomarker development and therapeutic stratification.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".