Regulatory B cells in autoimmune diseases: how do they work?

B lymphocytes contribute to the pathogenesis of autoimmune disorders since B-cell depletion treatment improves such diseases. However, B cells seem ambivalent. Murine strains of nonorgan-specific as well as organ-specific autoimmune conditions present with aggravated symptoms when B cells are depleted. It is thus likely that some B cells are pathogenic while other have regulatory function. There is not only one regulatory B cell (Breg) subset, but different types of Breg cells. Regulatory function can thus be ascribed to autoreactive B cells, marginal zone B cells, transitional type 2-like B cells, or CD5(+) B cells. Regulatory activity is induced only following cell activation through a B-cell receptor, CD40, and/or TLR9. Regulatory effects are then mediated by a soluble agent, such as IL-10, and/or direct cell-to-cell contacts that involve CD40 or B7 co-stimulatory molecules. Targeted cells also vary from one disease to another. Antigen-specific autoreactive T cells, dendritic cells, macrophages, and regulatory T lymphocytes can thus be either inhibited or activated to finally modulate the autoimmune response. Taken as a whole, it appears that Breg cells participate in the control of autoimmunity within a complex cellular network that may differ for each pathology. Adapted stimulation and control of regulatory activity would thus be a prerequisite to an efficient usage of these B cells as an alternative therapy for autoimmune diseases.