Abstract

Multiple sclerosis (MS) is an intricate autoimmune disorder characterized by persistent inflammation that results in the demyelination of the central nervous system (CNS). Its multifactorial nature, including infection exposure, disrupts the blood–brain barrier (BBB), allowing immune cells to infiltrate the CNS. Its spectrum of complications ranges from fatigue to severe mobility impairment, underscoring the need for a comprehensive understanding and effective therapeutic strategies. This review aimed to highlight the pivotal role of B cells in the pathogenesis of MS and the potential of B–cell–targeted therapies in the management of MS. The PubMed database was systematically searched to identify studies on B cells in the pathogenesis and treatment of MS. The bone marrow produces autoreactive B cells, which are usually eliminated through many checkpoints. However, in MS, these B cells can inexplicably escape these checkpoints, reach the BBB, and infiltrate the brain, where they are activated by B cells, leading to the destruction of the myelin sheath. Consequently, antibodies against B cells were developed to help deplete B and T cells by directly targeting their surface protein channels, such as membrane spanning 4-domains A1 (MS4A1/CD20) and intercellular adhesion molecule 1 (ICAM1/CD54), thereby decreasing the severity of MS. The precise cause of MS remains unknown. However, current study findings suggested that B cells play a key role in the development of MS. Therefore, therapies to decrease B cells have been developed and have shown excellent efficacy by directly hitting particular transmembrane protein ion channels, resulting in cell lysis.

Key words: Multiple sclerosis, B cells, anti-CD20, monoclonal antibody, narrative review