B Cell Therapy for Multiple Sclerosis

B lymphocytes and plasma cells play an important role in pathogenesis of multiple sclerosis and induce progression of disease by cytokine secretion, antibody production and antigen presentation. B cell directed therapies have very interested in recent years, B lymphocyte cell depletion therapy offers a compelling and promising new option for multiple sclerosis. B cell activation in multiple sclerosis can inducetumefactive lesions, prominent GAD enhacing lesions meningeal enhancement, subpial demyelination and… .Monoclonal antibodies targeting CD-20 positive B cells (such as rituximab), can reduce relapses of multiple sclerosis and also delay disability progression of the disease. Ocrelizumab which is a humanized anti CD- 20 monoclonal antibody, reduces the inflammation inrelapsing forms of multiple sclerosis and also reduces disability progression in primary progressive ms. Ocrelizumab, now approved for relapsing and primary progressive multiple sclerosis, differ from rituximab in that it has humanized antibody backbone. Other anti-CD20 monoclonal antibodies include ofatumumab (fully humanized with subcutaneous injection), Obinutuzumab (humanized Ig G1) and Ublituximab (an anti-CD20 antibody glycoenginered). Although most disease modifying therapies for MS have traditionally been conceptualized as functioning via T cell based mechanisms, a growing body of data indicates that all have demonstrable effects on B cells as well, for example beta interferon, glatiramer acetate and fingolimd by shifting B-cell cytokines towards an anti-inflammatory tone. Other mechanism are increasing B-regs, decreasing class II MHC expression and costimulatory molecules on B cells required for Ag presentstion, sequestering B cells in lymphoid organs.