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Background: The anti-CD20 monoclonal antibody rituximab effectively depletes B lymphocytes and has been successfully used in the therapy of immune-mediated di sorders of the peripheral nervous system. A limited effect of rituximab on B lym phocytes in the cerebrospinal fluid compartment of patients with primary progres sive multiple sclerosis (MS) was recently reported. Objective: To determine the effect of rituximab on clinical, magnetic resonance imaging, and immunological v ariables in a patient with relapsing-remitting MS. Design: A patient with relap sing-remitting MS was treated with rituximab. The patient was repeatedly examin ed clinically and by magnetic resonance imaging. The frequency of peripheral blo od and cerebrospinal fluid B lymphocytes was assessed by flow cytometry before, during, and after rituximab therapy. Results: Rituximab monotherapy resulted in significant clinical improvement. Inflammatory surrogate markers on magnetic res onance imaging were also reduced. B lymphocytes were depleted in the cerebrospin al fluid and peripheral blood. Conclusions: Our data demonstrate beneficial clin ical effects of rituximab in relapsing-remitting MS, mediated through modulatio n of humoral systemic and central nervous system intrinsic immune responses. Cli nical trials should determine optimal therapeutic strategies for patients with r elapsing-remitting MS.
Background: The anti-CD20 monoclonal antibody rituximab efficiently depletes B lymphocytes and has been successfully used in the therapy of immune-mediated di sorders of the peripheral nervous system. A limited effect of rituximab on B lym phocytes in the cerebrospinal fluid compartment of patients with Primary progres sive multiple sclerosis (MS) was recently reported. Objective: To determine the effect of rituximab on clinical, magnetic resonance imaging, and immunological v ariables in a patient with relapsing-remitting MS. Design: A patient with relap sing-remitting MS was treated with rituximab. The patient was repeatedly examin ed clinically and by magnetic resonance imaging. The frequency of peripheral blo od and cerebrospinal fluid B lymphocytes was assessed by flow cytometry before, during, and after rituximab therapy. Results: Rituximab monotherapy resulted in significant clinical improvement. Inflammatory surrogate markers on magnetic res onance imaging were also reduced. B lymphocytes were depleted in the cerebrospin al fluid and peripheral blood. Conclusions: Our data demonstrates beneficial clinical effects of rituximab in relapsing-remitting MS, mediated through modulatio n of humoral systemic and central nervous system intrinsic immune responses. Cli nical trials should determine optimal therapeutic strategies for patients with r elapsing-remitting MS.