This video discusses the role of B cells in multiple sclerosis (MS) and explores various B-cell-targeting therapies. Dr. Gavin Giovannoni explains the immunological mechanisms involved, the effectiveness of current treatments like anti-CD20 therapies, and emerging strategies such as BTK inhibitors and CAR T-cell therapy. The presentation also touches upon the potential link between Epstein-Barr Virus (EBV) and MS, suggesting that targeting EBV-infected B cells could be a future therapeutic approach.
Current B-cell depleting therapies, such as anti-CD20 treatments like rituximab and ocrelizumab, are effective at suppressing relapses and reducing MRI activity in multiple sclerosis. However, they do not halt disease progression. A significant portion of patients treated with these therapies continue to experience worsening disability due to progression independent of relapse activity (PIRA). This suggests that these therapies, while managing inflammatory relapses, do not address the underlying neurodegenerative component of MS. The focus is shifting towards targeting "smoldering MS" and its associated pathogenic processes, including persistent demyelination, innate immune activation, and intrathecal B and plasma cell responses, which contribute to this ongoing disability.
