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Opening Lecture Series B Cell-Targeted Therapy Unravels the Critical Roles of B Cells in Demyelinating Disease

While MS has traditionally been thought of as principally a T cellmediated disease, the substantial impact of selective B cell targeting on disease activity underscores key roles for B cells at least in the relapsing biology of MS. Of note, this contribution of B cells invokes important antibody-independent functions of B cells including their potential to act as either pro-inflammatory or anti-inflammatory mediators, thereby influencing disease-relevant T cell responses. Contrasting results of different treatments targeting B cells in patients (in spite of predictions of therapeutic benefits from animal models) call for a better understanding of the multiple roles that distinct human B cell responses likely play in MS. Most recently, the implication of a GM-CSF expressing subset of B cells in patients with MS points to a role of B cells in the activation of myeloid cells which, in turn, can induce pro-inflammatory T cell responses. The implications of such cascades of cellular immune interactions (B cell: Myeloid: T cell) in MS relapses are coming to the fore with growing interest also in their potential relevance to the CNS-compartmentalized processes influencing progressive (non-relapsing) disease.