AAN 2023 | Understanding of the peripheral immune system in MS

João José Cerqueira, MD, PhD, University of Minho, Braga, Portugal, discusses the role of the peripheral immune system in the pathophysiology of primary progressive multiple sclerosis (MS). Studies evaluating several drugs targeting the peripheral immune system have shown that most drugs don’t significantly delay disease progression, suggesting that part of the mechanism in primary progressive disease is driven by cells within the central nervous system (CNS), such as microglia and astrocytes. However, data from studies on ocrelizumab have shown that B-cells are also involved in the pathophysiological mechanisms of progression, as treatment with the anti-CD20 antibody has delayed progression in patients with primary progressive MS. Currently, it is thought that both peripheral B-cells and those that enter the CNS and are activated in ectopic follicles in the meninges contribute to disease progression. This indicates that there is still a role for drugs that target the peripheral immune system since they can suppress B-cells in the periphery and prevent them from entering the CNS. Early treatment with such drugs might also prevent the inflammatory events that drive progression. This interview took place at the American Academy of Neurology Annual Meeting 2023 in Boston, MA.

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