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A clinical randomised trial is investigating whether it is safe for patients with ANCA‑vasculitis to cease Rituximab maintenance therapy in a stable phase of the disease.Ìý

The study includes 140 patients and is conducted at 16 clinics in Sweden, at renal as well as rheumatological units, and at some centres abroad. Half of the patients discontinue Rituximab treatment while the others continue.

The study is led by Annette Bruchfeld, and the first five patients were included in the autumn of 2025; three in Linköping and two in Stockholm. A large number of samples are being collected during the study and stored in a biobank in Linköping. Broadened expertise in our laboratory operations will enable examination of the samples, to answer questions about the presence or absence of relapse risk markers.

Within the framework of a research project in collaboration with SciLifeLab, blood samples from 100 vasculitis patients from our local sample collection have been analysed using advanced technology measuring approximately 5,000 proteins (Olink).

The aim is to investigate how these proteins are linked to, for example, age, gender, disease activity, organ impairment and previous treatment. We are the only Swedish site participating in this study. Also, the ongoing national study AUTOVASC is collecting samples from several Swedish university hospitals to identify new autoantibodies in vasculitis and inflammatory kidney diseases.

The goal is to find better markers for disease activity and severity, which can lead to more individualised care. Professor Annette Bruchfeld is responsible for the study together with docent Elisa Pin, project manager at the Unit of Affinity Proteomics at SciLifeLab and KTH. LiU postdoc Vanja Ivković will act as coordinator and be responsible for the statistical analyses in the project.

A research project in collaboration with SciLifeLab. In this study, blood samples from 100 vasculitis patients from our local sample collection have been analysed using advanced technology measuring approximately 5,000 proteins (Olink).

The purpose of the study is to see how these proteins are linked to, for example, age, gender, disease activity, which organs are affected and what treatment the patient has received. We are the only Swedish site participating in this study. Also, the ongoing national study AUTOVASC, where samples from several Swedish university hospitals are collected, will study new autoantibodies in vasculitis and inflammatory kidney diseases.

The goal is to find better markers for disease activity and severity, which can lead to more individualised care. Professor Annette Bruchfeld is responsible for the study together with docent Elisa Pin, project manager at the Unit of Affinity Proteomics at SciLifeLab and KTH. LiU postdoc Vanja Ivković will act as coordinator and be responsible for the statistical analyses in this project.

LUVA is a long-term study following people in Östergötland with ANCA-associated vasculitis, with the aim of finding better ways to adapt treatment and follow-up to each individual. We study whether different substances in patients’ blood reflect vasculitis disease activity and the risk of relapse.

Launched in 2022, the longitudinal study LUVA follows patients from Östergötland who have recently been diagnosed with ANCA-associated vasculitis (AAV). The LUVA study builds on an existing vasculitis cohort including about 300 patients, with biobank samples from about 200 of these. The overall aim of the project is to identify and validate biomarkers for disease activity and risk of AAV relapse. The goal is for these, together with clinical data, to be used to individualise treatment and follow-up of AAV patients.

All adults living in Östergötland who have recently been diagnosed with AAV can be included in the study. Data are collected on disease activity, organ involvement, treatment, relapse and outcome in the form of kidney failure and death. Blood and urine samples are stored in a biobank for analysis of potential biomarkers. We also examine health-related quality of life through the use of a specific instrument developed for AAV. Follow-up in the study, including blood and urine tests, takes place in conjunction with a doctor’s visit on three occasions during the first 6 months after the onset of the disease (months 0, 3 and 6) and then after 1, 2, 5 and 10 years and in the event of relapse.

The samples are stored in a biobank in the Linköping Biobank Facility.
The sample collection for the LUVA study, run by Maria Weiner, is ongoing and has so far included 23 patients, of whom 13 completed a 12–month follow-up and nine completed a 24–month follow-up.

The project explores how DNA released from cells in the body’s immune system contributes to inflammation in kidney disease, especially ANCA-associated vasculitis, in order to find new, more effective treatment targets.

ANCA-associated vasculitis is characterised by chronic vascular inflammation, often in the kidneys. Neutrophils in the immune system drive the inflammation initially and T cells, among others, are important for the chronic phase. One characteristic of these diseases is the presence of extracellular DNA in inflamed areas and in the blood of patients, which may consist of nuclear or mitochondrial DNA, be free or bound to proteins from the cell from which it was released. Both neutrophils and T cells have the capacity to release such DNA, which is inflammatory, and are therefore of great interest to study in ANCA-associated vasculitis. There is still no drug on the market that blocks the release of inflammatory extracellular DNA.

The purpose of the study is to study the release and inflammatory mechanisms of extracellular DNA from neutrophils and T cells in ANCA-associated vasculitis, and to block this release.

Method: Blood samples drawn from the bend of the arm (peripheral blood) are taken from patients and healthy controls at the kidney clinic at Linköping University Hospital. Peripheral blood mononuclear cells (PBMC), made up of various cells in the immune system, are isolated from blood by density centrifugation. Magnetic cell sorting is used to isolate T cells from PBMC and neutrophils directly from the blood. Neutrophils and T cells are activated to release DNA, partly with separate inflammatory mediators that we think may be relevant but also with plasma from healthy controls and patients. This happens with or without the different inhibitors we work with. Extracellular DNA is quantified or isolated and cultured with, for example, PBMC and endothelial cells.

Quantification is done by several methods, such as quantifying nuclear and mitochondrial DNA with droplet digital PCR, adding fluorescent substances targeting DNA and proteins and studying them under a microscope, measuring complexes of DNA and proteins with ELISA in plate readers, and by adding fluorescent substances targeting DNA and measuring them in plate readers.

Inflammatory properties of extracellular DNA are studied, for example, by cultivating it with PBMC or endothelial cells. Cytokines released from PBMC during activation are measured with ELISA, and endothelial cell death is evaluated.

Expected outcome/clinical relevance: The study leads to increased knowledge about the degree to which extracellular DNA is released from different cells, how this DNA can contribute to inflammation, and whether the release of this DNA can be blocked. Such knowledge is fundamental to the development of drugs against these mechanisms.

In systemic lupus erythematosus (SLE), autoreactive B cells play an important role in the development of the disease. Benlysta (belimumab) is used in SLE to downregulate these, but affects all B cells that rely on the B-cell activating factor (BAFF). Some SLE patients have developed inflammation of the kidneys during treatment with belimumab. If this drug also has an effect on regulatory B cells, the purpose of which is to inhibit/regulate activation of the immune system, this would be of great interest to study.

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory systemic disease. The disease is complex and can cause symptoms from many different organs, where the kidneys are attacked in at least one-third of patients. B cells play an important role in the development of the disease, including by producing autoantibodies. Drugs against B cells have therefore been developed, of which belimumab is one of those used in SLE. Belimumab is an antibody to B-cell activating factor (BAFF). BAFF helps B cells to live longer and by blocking BAFF, B cell lifespan is reduced. Although treatment with belimumab in the case of renal inflammation (nephritis) appears to have a good additional effect, there have also been reports of the onset of renal inflammation during ongoing therapy in patients with no history of renal impairment. Our hypothesis is that inhibition of BAFF with belimumab leads to a decreased population of regulatory B cells, the purpose of which is to suppress or regulate activation of the immune system and that this can contribute to the development of lupus nephritis.

Purpose: To investigate the impact of treatment with belimumab on the development of regulatory B cells.

Method: Blood samples drawn from the bend of the arm (peripheral blood) are taken from SLE patients and healthy controls at Linköping University Hospital. Peripheral blood mononuclear cells (PBMC) are isolated from blood by density centrifugation on Ficoll. B cells and T cells are then isolated from PBMC via negative selection using the magnetic cell sorting method. B cells are cultivated alone or together with activated T cells. BAFF is then added to the cultivations with or without belimumab to investigate their effect on the B cells. After a number of days, the presence of regulatory B cells and their capacity to regulate activation and proliferation of T cells are analysed.

Expected outcome/clinical relevance: The study can contribute with knowledge about whether belimumab affects the development of regulatory B cells. As some SLE patients without inflammation of the kidneys develop nephritis over time during treatment with belimumab, increased knowledge of the drug's mechanisms of action is of great importance in order to ensure adequate prescriptions. If belimumab affects regulatory B cells, and this can be confirmed in more cohorts and studies, this is something that can be monitored in the near future in treated patients with the hope of avoiding the development of lupus nephritis during treatment with belimumab.