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NEUROLOGY 2010;74:S31-S40
© 2010 American Academy of Neurology

Monoclonal antibodies in MS

Mechanisms of action
Bibiana Bielekova, MD and Brenda L. Becker

From the Neuroimmunological Diseases Unit (B.B.), Neuroimmunology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD; and Expert Medical Education (B.L.B.), Washington, DC.

Address correspondence and reprint requests to Dr. Bibiana Bielekova, Neuroimmunological Diseases Unit, National Institute NIH, Building 10, Room 5C-103, 10 Center Drive, MSC 1400, Bethesda, MD 20892 Bibi.Bielekova{at}nih.gov

The development of monoclonal antibodies (mAbs) presents an emerging, highly specific therapeutic strategy for the treatment of multiple sclerosis (MS). mAbs target selective molecules and have shown early promise, along with notable risks, in the treatment of MS and other immune-mediated diseases. The mechanism of action of the 4 mAbs under active investigation for MS (natalizumab, rituximab, alemtuzumab, and daclizumab) are reviewed, with a discussion of how mAb interaction with each target antigen may produce direct and indirect effects (proven and hypothesized) on immune cell activity, CNS-related inflammatory processes, and clinical outcomes.

Abbreviations: ADCC = Ab-dependent cellular cytotoxicity; BBB = blood-brain barrier; CDC = complement-dependent cytotoxicity; CEL = contrast-enhancing lesion; DC = dendritic cell; FDA = Food and Drug Administration; IFNβ-1a = interferon beta-1a; Ig = immunoglobulin; IL = interleukin; IL-2R = interleukin-2 receptor; ITP = immune thrombocytopenic purpura; mAb = monoclonal antibody; MoA = mechanism of action; MS = multiple sclerosis; NK = natural killer; PML = progressive multifocal leukoencephalopathy; RA = rheumatoid arthritis; RRMS = relapsing-remitting multiple sclerosis; SC = subcutaneous; VLA-4 = very late activating antigen-4.

This supplement was supported by an educational grant from Teva Neuroscience. Expert Medical Education contributed to the editorial refinement of this article and to the production of this supplement.

Disclosure: Dr. Bielekova is coinventor on 2 NIH patents related to daclizumab therapy and as such has received patent royalty payments. Ms. Becker reports no disclosures.






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