The Role of B Cells in Multiple Sclerosis Pathogenesis and Monoclonal Antibody Treatments Targeting B Cells

Abstract

The presence of B cells, plasma cells and increased immunoglobulin (Ig) levels in multiple sclerosis (MS) lesions and cerebrospinal fluid (CSF) samples has suggested that the humoral immunity plays an important role in MS pathogenesis. Moreover, the demonstration of correlation of CSF B lymphocyte and Ig levels with the clinical course and prognosis of the disease has substantiated this notion. However, until the advent of clinical trials performed with B cell-targeting monoclonal antibodies, the role of B lymphocytes in MS pathogenesis has been a matter of controversy. Clinical trials testing the chimeric anti-CD20 monoclonal antibody rituximab and other monoclonal antibodies have shown that B-cell depletion significantly decreases MS relapse rate, disability progression and development of new contrast-enhancing MRI lesions. With the introduction of novel antibodies and fusion proteins that are currently being produced and tested, treatment methods with higher efficacy and lower side-effect profile are expected to be developed in the forthcoming years. (Archives of Neuropsychiatry 2011; 48 Supplement 2: 73-8)