B-Cell Targeted Therapies in Neuromyelitis Optica Spectrum Disorders
Summary
B-cell targeted therapies have transformed the management of neuromyelitis optica spectrum disorders (NMOSD), a rare autoimmune disease of the central nervous system characterised by recurrent optic neuritis and myelitis. The majority of NMOSD cases are driven by immunoglobulin G autoantibodies against aquaporin-4, implicating B cells at multiple stages: antigen presentation, germinal centre maturation and autoantibody production. Therapeutic monoclonal antibodies directed against B-cell markers have demonstrated efficacy in reducing relapse rates, stabilising disability and modulating disease activity. Agents such as rituximab, an anti-CD20 chimeric antibody, deplete mature B cells and memory populations, interrupting autoantibody generation. Emerging strategies refine dosing regimens to balance efficacy and safety, while novel constructs enhance effector functions via antibody-dependent cell-mediated cytotoxicity. Mechanistic studies have revealed that B-cell depletion curtails intranodal aquaporin-4 antibody synthesis within germinal centres, offering insights into long-term disease suppression. The global significance of these therapies extends beyond NMOSD, informing treatment paradigms for other autoantibody-mediated neurological diseases. Ongoing research aims to optimise patient-specific approaches, including biomarker-guided retreatment intervals and the development of fully human or engineered antibodies to minimise immunogenicity and adverse events.
Research from Nature Portfolio
No recent Nature Portfolio content available.
B-Cell Targeted Therapies in Neuromyelitis Optica Spectrum Disorders publication trend
The graph below shows the total number of articles in b-cell targeted therapies in neuromyelitis optica spectrum disorders across all publications each year (not limited to Nature Index journals).
Technical terms
B cell: A lymphocyte subtype responsible for antibody production and antigen presentation.
CD20: A surface antigen expressed on mature B cells, target for depletion by monoclonal antibodies.
Aquaporin-4 autoantibody: Pathogenic immunoglobulin G directed against the water channel aquaporin-4 on astrocytes.
Monoclonal antibody: A laboratory-produced molecule engineered to bind selectively to a specific antigen.
Antibody-dependent cell-mediated cytotoxicity (ADCC): An immune mechanism where antibodies direct effector cells to lyse target cells.
Germinal centre: A specialised microenvironment in lymphoid tissue where B cells undergo maturation and affinity maturation.
Annualised relapse rate (ARR): The average number of disease relapses a patient experiences per year.
Expanded disability status scale (EDSS): A method of quantifying disability in patients with demyelinating diseases.
References
- Rituximab at lower dose for neuromyelitis optica spectrum disorder: a multicenter, open-label, self-controlled, prospective follow-up study. Frontiers in Immunology (2023).
- First‐in‐Human Study of BAT4406F, an ADCC‐Enhanced Fully Humanized Anti‐CD20 Monoclonal Antibody in Patients With Neuromyelitis Optica Spectrum Disorders. CNS Neuroscience & Therapeutics (2024).
- Rituximab abrogates aquaporin-4–specific germinal center activity in patients with neuromyelitis optica spectrum disorders. Proceedings of the National Academy of Sciences of the United States of America (2022).
- Evolution of Anti-B Cell Therapeutics in Autoimmune Neurological Diseases. Neurotherapeutics (2022).
Turn complex research questions into confident strategic decisions
When you're under pressure to set direction, justify investment, or understand your competitive position, you need more than raw data — you need trusted insights you can act on.
Benchmark your performance against global peers using robust, methodologically sound analysis.
Combine quantitative metrics with qualitative expert insight to uncover strengths, gaps and emerging opportunities.
Gain tailored, decision-ready recommendations aligned to your strategic priorities.
Talk to us to learn more about our data dashboards and bespoke strategy reports.
Grow research skills, confidence and careers with training built for every stage of the research lifecycle.
Developed with Nature Portfolio journal Editors and internationally renowned experts. Discover three ways to learn:
Self-paced, online courses in convenient bite-sized units, covering key skills across scientific writing, publishing, grant writing, data analysis, and more.
Expert trainer-led workshops with hands-on exercises and real-time feedback across core research skills, delivered via interactive group sessions.
Editor-led workshops combining core principles in writing and publishing, personalised 1:1 feedback from Nature Portfolio Editors and hands-on exercises.
Explore course catalogues and workshop agendas, enquire about the options or request institutional pricing.