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Immune reconstitution therapies: concepts for durable remission in multiple sclerosis
Jan D Lünemann1, Tobias Ruck2, Paolo A Muraro3
1Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany. jan.luenemann@ukmuenster.de.
Nature Reviews. Neurology
|October 26, 2019
Summary
Immune reconstitution therapies (IRTs) may offer lasting remission for multiple sclerosis (MS) by allowing the immune system to renew. However, their efficacy and mechanisms require further understanding for optimal use in MS treatment.
Area of Science:
- Immunology
- Neurology
- Pharmacology
Background:
- New immune reconstitution therapies (IRTs) show promise for long-term, drug-free remission in multiple sclerosis (MS).
- These therapies aim to deplete and renew the immune system, with examples including stem cell transplantation and certain drugs like cladribine and monoclonal antibodies (alemtuzumab, rituximab, ocrelizumab).
Purpose of the Study:
- To critically evaluate the efficacy and potential mechanisms of IRTs in the context of immune system renewal for MS.
- To understand how IRTs foster immune cell changes and their correlation with clinical outcomes for durable MS therapeutic strategies.
Main Methods:
- Review and critical discussion of existing evidence on IRTs in multiple sclerosis.
- Analysis of immunological changes induced by IRTs, focusing on immune cell repertoire renewal and functional phenotype acquisition.
Main Results:
- Evidence for IRTs truly renewing adaptive immune cell repertoires in MS is variable.
- IRTs may promote the expansion of surviving immune cells, potentially leading to new functional phenotypes.
Conclusions:
- Understanding the immunological shifts caused by IRTs is crucial for optimizing their use as a durable strategy in MS.
- Further research is needed to clarify the mechanisms behind IRT-induced immune renewal and its impact on long-term MS remission.
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