LAUSR

The established picture of immunological dysfunction in Multiple Sclerosis (MS) posits a central role for T cells. As a consequence, the development of disease-modifying treatments (DMTs) has been targeted at sequestering, lysing or depressing production of T cells. This approach has been generally successful in reducing relapses and surrogate imaging markers of diseases activity, but has not been so effective in delaying the onset of progressive disease, and/or disability accumulation. In addition response to even high efficacy treatments is often not complete and there remain small groups of non-responders suggesting a degree of biological diversity. As a result much remains to be achieved in the field of MS therapeutics. Conversely the role of B cells has remained relatively under-explored. However, converging lines of evidence have suggested a key role in antibody presentation, cytokine production, meningeal inflammation, axonal degeneration and grey matter demyelination. In particular, this latter feature may offer an alternative therapeutic target for the development of therapies which might expect to have greater efficacy on later and more progressive forms of disease. This month’s journal club reviews four papers addressing the role of B cell treatments in MS. Ocrelizumab versus interferon beta-1a in relapsing multiple sclerosis