Rituximab in a patient with multiple sclerosis--effect on B cells, plasma cells and intrathecal IgG synthesis.
OBJECTIVE
To study the time course of immunoglobulin, B and plasma cells in the blood and cerebrospinal fluid (CSF) before and during rituximab treatment in a patient with severe relapsing-remitting multiple sclerosis (MS) in relation to clinical and MRI findings.


METHODS
Immunoglobulins in the CSF were measured by nephelometry and detected by isoelectrical focussing. CSF and blood cell subtypes from seven time points were analysed by flow cytometry.


RESULTS
Treatment with rituximab induced a dramatic and sustained improvement in clinical and MRI findings over a follow-up period of 20 months. By contrast, the initially completely suppressed B and plasma cells in both the blood and CSF reappeared after 5 and 10 months, CSF cells being the first to reappear. Interestingly, intrathecal IgG synthesis persisted throughout the study period.


CONCLUSIONS
Although highly effective in this case, the clinical effect in larger series and the mechanism of rituximab in MS deserves further evaluation.
Petereit
H F
HF
Department of Neurology, University of Colgne, D-50824 Cologne, Germany. petereit@hgk-koeln.de
Moeller-Hartmann
W
W
Reske
D
D
Rubbert
A
A
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D000917:Antibody Formation; D001402:B-Lymphocytes / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000096:biosynthesis* / Q000097:blood / Q000134:cerebrospinal fluid; D008279:Magnetic Resonance Imaging; D008297:Male; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D010950:Plasma Cells / Q000276:immunology; D000069283:Rituximab; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007074:Immunoglobulin G; D000069283:Rituximab