Impact of Glatiramer Acetate on B Cell-Mediated Pathogenesis of Multiple Sclerosis

CNS Drugs. 2018 Nov;32(11):1039-1051. doi: 10.1007/s40263-018-0567-8.


Growing evidence indicates that B cells play a key role in the pathogenesis of multiple sclerosis (MS). B cells occupy distinct central nervous system (CNS) compartments in MS, including the cerebrospinal fluid and white matter lesions. Also, it is now known that, in addition to entering the CNS, B cells can circulate into the periphery via a functional lymphatic system. Data suggest that the role of B cells in MS mainly involves their in situ activation in demyelinating lesions, leading to altered pro- and anti-inflammatory cytokine secretion, and a highly effective antigen-presenting cell function, resulting in activation of memory or naïve T cells. Clinically, B cell-depleting agents show significant efficacy in MS. In addition, many disease-modifying therapies (DMTs) traditionally understood to target T cells are now known to influence B cell number and function. One of the earliest DMTs to be developed, glatiramer acetate (GA), has been shown to reduce the total frequency of B cells, plasmablasts, and memory B cells. It also appears to promote a shift toward reduced inflammation by increasing anti-inflammatory cytokine release and/or reducing pro-inflammatory cytokine release by B cells. In the authors' opinion, this may be mediated by cross-reactivity of B cell receptors for GA with antigen (possibly myelin basic protein) expressed in the MS lesion. More research is required to further characterize the role of B cells and their bidirectional trafficking in the pathogenesis of MS. This may uncover novel targets for MS treatments and facilitate the development of B cell biomarkers of drug response.

Publication types

  • Review

MeSH terms

  • Animals
  • B-Lymphocytes / drug effects*
  • B-Lymphocytes / metabolism
  • Central Nervous System / drug effects
  • Central Nervous System / metabolism
  • Cytokines / metabolism
  • Glatiramer Acetate / pharmacology*
  • Glatiramer Acetate / therapeutic use*
  • Humans
  • Immunosuppressive Agents / pharmacology*
  • Immunosuppressive Agents / therapeutic use*
  • Inflammation / drug therapy
  • Inflammation / metabolism
  • Multiple Sclerosis / drug therapy*
  • Multiple Sclerosis / metabolism


  • Cytokines
  • Immunosuppressive Agents
  • Glatiramer Acetate