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Why are B-cells such a valuable target in MS?

Giancarlo Comi, MD, Vita-Salute San Raffaele University, Milan, Italy, talks on the use of B-cell targeting agents in multiple sclerosis (MS) and why they are an efficacious treatment option. Traditionally, MS was considered a disease of the central nervous system, driven primarily by CD4+ T-cells. However, increasing evidence has accumulated over time that has implicated B-cells as a major factor in the pathogenesis of MS. Prof. Comi highlights ORATORIO (NCT01194570) and the OPERA I (NCT01247324) and II (NCT01412333) trials of ocrelizumab in relapsing MS as providing major evidence for the relevance of B-cells in the underlying mechanisms of MS, spurring lots of research into this area. It is now realized that B-cell contribute not only via antibody production, but also through pro-inflammatory cytokine production, antigen presentation, T-cell activation, and cortical lesion formation. This interview took place during the European Academy of Neurology 2021 congress.