B cell reductive therapy in the treatment of autoimmune diseases: a focus on monoclonal antibody treatment of rheumatoid arthritis.
The therapeutic approach to patients with autoimmune disorders is in the midst of a dramatic change. Monoclonal antibody technology has allowed us to dissect and now manipulate the human immune system with greater precision. It is now widely recognized that B lymphocytes play a role in the pathogenesis of many autoimmune diseases, though the extent and contribution is a matter of debate and active investigation. There is emerging data to suggest that both antibody-dependent and independent mechanisms contribute to disease pathogenesis. However, given the heterogeneous nature of autoimmune diseases, and the varied responses to B lymphocyte reduction, the role of B lymphocytes is likely disease-specific. The two clinical trials discussed in this review demonstrate remarkable consistency in the ability of B cell reduction to ameliorate the clinical manifestations of rheumatoid arthritis with minimal toxicity. B lymphocyte targeted approaches to autoimmune disease in general, and RA specifically, will not only provide an effective and potentially less toxic alternative treatment option, but also allow for a better understanding of the pathogenesis of these complex and morbid diseases.
Tuscano
Joseph M
JM
University of California, Davis Department of Inter Medicine, Sacramento, CA 95817, USA. joseph.tuscano@ucdmc.ucdavis.edu
Martin
Shiloh
S
Song
Kyle
K
Wun
Theodore
T
D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000628:therapy; D001327:Autoimmune Diseases / Q000276:immunology* / Q000628:therapy*; D001402:B-Lymphocytes / Q000276:immunology*; D002986:Clinical Trials as Topic; D006801:Humans; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab