Martin Weber, MD: The Role of B Cells and Antibodies in MS

Martin Weber, MD, associate professor of neurology at the University of Göttingen: The presentation that I'm giving at [MS Paris 2017] is about the role of B cells and antibodies on both sides of the blood-brain barrier, so meaning in the central nervous system (CNS), in the cerebral spinal fluid, but also within the periphery - the periphery being then the blood of course - and the lymphatic system. I think what we learned from this lecture is that B cells actually travel through these different compartments and accelerate pathogenicity basically by going from one compartment to the next compartment.

This means that the older idea that B cells simply get ready in the periphery, then they infiltrate and do their job inside the CNS, is outdated and that multiple circulations of B cells leaving the CNS can actually happen. That's kind of new, and that is probably also true for antibodies. This whole concept of not one-directed, or a one direction road so to say, of immune cells into the CNS is kind of the general concept that we are following.

I think it's impacting in 2 ways. The general concept and agreement is still that MS should be treated early and very aggressively (although I don't like that word so much because it sounds harmful somehow). But MS activity needs to be silenced very early on in the disease, meaning that after establishing a diagnosis, one should really think of multiple options and choose wisely. [You must choose] the one option that is really silencing MS activity entirely, more or less, and because that's the only opportunity that we have to influence what happens later on.

Unfortunately, what happens later on is mainly the process I just mentioned - CNS intrinsic processes that are really hard to influence. So, given that we only have anti-inflammatory agents, we should treat really efficiently and effectively the very early inflammatory phase of the disease.