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Updated: Mar 18, 2026
Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination
Published on: September 12, 2016
[Cell depletion and myoablation for neuroimmunological diseases]
M Diebold1, L Kappos1, T Derfuss2
1Neurologische Klinik und Poliklinik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
Background:
The treatment of autoimmune disorders of the nervous system is based on interventions for the underlying immune phenomena.
Objective:
To summarize concepts of cell depletion and myeloablation studied in the context of neuroimmunological disorders.
Method:
Evaluation of the available literature on multiple sclerosis as the most widely studied neuroimmunological entity.
Results:
Three concepts have been introduced: classical immunosuppressants, such as azathioprine, mitoxantrone and cyclophosphamide exert general lymphopenic effects and thereby moderately decrease disease activity. Myeloablative regimens combined with autologous hematopoietic stem cell transplantation have a profound and in most cases long-lasting impact on autoimmunity at the cost of potentially life-threatening side effects. Alemtuzumab (anti-CD52), rituximab and ocrelizumab (both anti-CD20) are depleting antibodies directed against certain lymphocyte subsets and substantially ameliorate disease activity in relapsing-remitting multiple sclerosis. Ocrelizumab also shows efficacy in the primary progressive form of multiple sclerosis.
Conclusions:
Most of the presented cell-depleting and myeloablative therapies are highly effective treatment options but are also accompanied by significant risks. In the context of the increasing number of alternative immunomodulatory options the indications for use should be cautiously considered.
