REVIEW article
Front. Immunol.
Sec. B Cell Biology
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1635989
B cell depletion as a therapeutic strategy for neuromyelitis optica spectrum disorder: Rationale, evidence, and challenges
Provisionally accepted
- 1Ehime University Graduate School of Medicine, Ehime, Japan
- 2Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
- 3Keio University School of Medicine, Tokyo, Japan
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Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disorder of the central nervous system that predominantly affects the spinal cord and optic nerves. Aquaporin-4 antibodies have been identified as a distinguishing biomarker of NMOSD, allowing for differentiation from multiple sclerosis and other mimicking neurological conditions. Targeted monoclonal antibody treatments are evolving based on an improved understanding of the pathophysiology underlying NMOSD. Of particular influence is the idea that NMOSD is an autoantibody-mediated disease involving B cells. The hope is that targeted treatments will improve not only outcomes but also the impact and burden of the disease on patients. This review summarizes the latest evidence for B cell pathophysiology in NMOSD and highlights the cellular and molecular mechanisms of B cell-driven disease. Finally, we focus on the mechanisms of action of B cell-targeted therapies as they relate to the mechanisms of disease.
Keywords: B cells, Disease mechanisms, mechanism of action, Neuromyelitis optica spectrum disorder, pathophysiology, therapeutic targets
Received: 27 May 2025; Accepted: 29 Jul 2025.
Copyright: © 2025 Ochi, Nakamura and Nakahara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Satoru Nakamura, Mitsubishi Tanabe Pharma Corporation, Tokyo, Japan
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.