Neurológia pre prax 3/2024

The role of B lymphocytes in the immunopathogenesis and treatment of multiple sclerosis

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system (CNS) of diverse, unclear etiopathogenesis. However, it is known that, in addition to genetic predispositions, the influence of the environment as well as the patient’s lifestyle play a significant role here. Traditionally, the disease was thought to be primarily mediated by T lymphocytes. Nevertheless, the clinical success of B cell depleting therapy has supported the assumption of key importance of B cells in the pathogenesis of multiple sclerosis. In this article we will provide an overview of current knowledge about the localization, infiltration mechanisms and function of B cells in the CNS as well as in associated tissues in order to better understand their multifactorial role in the CNS leading to innovative therapeutic strategies in several diseases, including neurological ones. Even though MS is still an incurable disease, the possibilities of immunomodulating drugs affecting the course of the disease are still expanding. At the same time, scientific and clinical knowledge currently supports the use of highly effective treatment strategies in the early stages of the disease, which have the potential to slow down the progression of the disease as effectively as possible. Monoclonal antibodies against CD 20 lymphocytes belong precisely to the highly effective drugs with favorable safety profile. Main focus in this article will be on ofatumumab.

Keywords: B depletion treatment, ofatumumab, ocrelizumab, early access to highly effective treatment