Effect of rituximab on the peripheral blood and cerebrospinal fluid B cells in patients with primary progressive multiple sclerosis.
BACKGROUND
Rituximab, an anti-CD20 monoclonal antibody that depletes CD20(+) B cells, has demonstrated efficacy in peripheral neurological diseases. Whether this efficacy can be translated to neurological diseases of the central nervous system with possible autoimmune B-cell involvement remains unknown.


OBJECTIVE
To determine the effect of rituximab on cerebrospinal fluid B cells in patients with multiple sclerosis.


METHODS
Four patients with primary progressive multiple sclerosis were treated with rituximab. Cerebrospinal fluid and peripheral blood B-cell subsets were identified by flow cytometry from each patient before and after rituximab treatment.


RESULTS
The B cells in cerebrospinal fluid were not as effectively depleted as their peripheral blood counterparts. Rituximab treatment temporarily suppressed the activation state of B cells in cerebrospinal fluid. The residual B cells underwent expansion after rituximab treatment.


CONCLUSIONS
The effect(s) of rituximab on the cerebrospinal fluid B-cell compartment is limited in comparison with the effect(s) on the B cells in the periphery, but this finding will need to be confirmed in a larger group of MS patients.
Monson
Nancy L
NL
Department of Neurology and Center for Immunology, The University of Texas Southwestern Medical Center, Dallas 75390, USA. nancy.monson@utsouthwestern.edu
Cravens
Petra D
PD
Frohman
Elliot M
EM
Hawker
Kathleen
K
Racke
Michael K
MK
D000328:Adult; D000906:Antibodies / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19 / Q000378:metabolism; D018951:Antigens, CD20 / Q000276:immunology*; D001402:B-Lymphocytes / Q000187:drug effects* / Q000378:metabolism; D016009:Chi-Square Distribution; D005260:Female; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000097:blood / Q000134:cerebrospinal fluid; D000069283:Rituximab
D000906:Antibodies; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018941:Antigens, CD19; D018951:Antigens, CD20; D000069283:Rituximab