Summary: Analyzing immune cell profiles across human blood, cerebrospinal fluid (CSF), and intestinal mucosal tissues from control subjects and B-cell-depleted MS patients, researchers demonstrated that B-cell depletion therapy alters key regulatory factors that stimulate the trafficking of protective, gut-derived B cells. Rather than acting strictly through systemic immunosuppression, B-cell depletion actively recruits regulatory B cells from the gut reservoir into the circulation and central nervous system, where they help mitigate neuroinflammation.
Key Facts
- Gut-to-CNS Migration: B-cell depletion therapy triggers a systemic shift in B-cell regulatory factors, promoting the mobilization of protective, regulatory B cells from the intestinal mucosa into the bloodstream and central nervous system.
- Dual Action Mechanism: The findings demonstrate that anti-B-cell immunotherapies do not merely eliminate disease-causing auto-reactive B cells; they actively promote the recruitment of beneficial, immune-regulating B-cell subsets.
- Clinical Biomarker Link: Elevated levels of B-cell-regulating factors following depletion therapy directly correlated with superior clinical outcomes and reduced disease progression in MS patients.
- Cross-Tissue Human Profiling: The research team validated these migratory pathways by performing comparative cellular analyses across human blood, CSF, and gut mucosal biopsies.
- Therapeutic Implications: Uncovering this gut-brain immune circuit opens new therapeutic avenues aimed at directly manipulating gut-derived regulatory lymphocytes to suppress central neuroinflammation in MS and other autoimmune conditions.
Source: University of Bonn
B-cell depletion therapies, in which B cells of the immune system, which may drive disease activity in multiple sclerosis (MS), are temporarily removed, have contributed significantly to improved treatment for patients in recent years.
Researchers from the University Hospital of Bonn (UKB), the Universities of Bonn, Basel, Toronto, and Yale, along with their collaborators, have uncovered a previously unknown mechanism through which B-cell depletion therapies contribute to a better disease course in patients with MS. Surprisingly, the treatment appears to exert part of its beneficial effect by mobilizing regulatory immune cells that naturally reside in the gut.
This study has now been published in the journal Science Translational Medicine.
In multiple sclerosis (MS), the most common chronic inflammatory disease of the central nervous system, B cells, which are part of our immune system, mistakenly attack the protective sheath surrounding nerves, known as the myelin sheath. This role in the development and progression of MS has brought this type of white blood cell into focus as a therapeutic target.
It is important to note that researchers now know that not all B cells are harmful in MS. In addition to disease-causing B cells, there are also beneficial B cells that, in accordance with their actual function, help regulate immune responses and may have a positive effect on the course of the disease.
An international research team led by Prof. Anne-Katrin Pröbstel from the UKB, as well as from the Universities of Basel and Bonn and the German Center for Neurodegenerative Diseases (DZNE), investigated in the study how B-cell depletion therapies affect these protective B-cell populations.
To this end, the first authors, Dr. Tradite Neziraj and Dr. Elisabeth Pössnecker, analyzed immune cells from various tissues. To do so, they collected cells from the blood, cerebrospinal fluid, and intestinal mucosal tissue of in the study participating control subjects and B-cell-depleted MS patients and examined the collected cells for type and function. They observed that B-cell depletion therapy promoted the trafficking of beneficial B cells from the gut into the bloodstream and the central nervous system of people with MS.
Immunotherapy promotes cell migration from the gut
“Our research shows that B cell depletion changes the levels of factors that regulate B cells and is associated with an increased migration of protective gut-derived B cells,” explains Prof. Dr. Pröbstel, Managing Director of the Center for Neurology at the University Hospital Bonn (UKB), a member of the Cluster of Excellence ImmunoSensation3 at the University of Bonn, and research group leader at the DZNE. “Interestingly, higher levels of these B cell-regulating factors were linked to better outcomes in patients with MS.”
The findings provide new insights into why B-cell depletion therapies are so effective. Rather than simply removing harmful immune cells, the treatment may also help recruit beneficial immune cells from the gut. This discovery opens up new possibilities for developing future therapies that harness beneficial gut immune cells in MS and other inflammatory diseases.
Collaborations and Funding:
Funding: The study was conducted in collaboration with Université de Lausanne and UMC Amsterdam. The research team of Prof. Pröbstel received funding for the study from the Swiss Multiple Sclerosis Society (SMSG), the Propatient Stiftung of the University Hospital of Basel, the Fondation Pierre Mercier pour la Science, the National Multiple Sclerosis Society, the Swiss National Science Foundation, the State Secretariat for Education, Research an Innovation (SERI) under the European Union’s Horizon 2020 research and innovation program grant and the German Research Foundation (DFG) as part of Germany’s Excellence Strategy. Dr. Neziraj received funding through an “Early Investigator Research Award” from the U.S. Department of Defense’s Multiple Sclerosis Research Program and a postdoctoral fellowship from the SNF.
Key Questions Answered:
A: In MS, autoreactive B cells mistakenly identify the myelin sheath insulating central nervous system axons as foreign, launching immune attacks that cause demyelination, neuroinflammation, and neurological deficits. However, non-pathogenic B-cell subsets simultaneously produce anti-inflammatory cytokines that keep autoimmunity in check.
A: B-cell depletion changes the systemic concentration of specific regulatory signals and cytokines. This biochemical environment signals protective regulatory B cells residing in the gut mucosal lining to enter the circulation and migrate into the central nervous system, where they help restore immune balance.
A: Understanding that the gut serves as a reservoir for protective immune cells allows researchers to design next-generation MS therapies that specifically boost or recruit these intestinal regulatory B cells, potentially enhancing treatment efficacy while minimizing broad immunosuppressive side effects.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this multiple sclerosis research news
Author: Inka Väth
Source: Universitatsklinikum Bonn
Contact: Inka Väth – Universitatsklinikum Bonn
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Anti-CD20 B cell depletion is associated with elevated mucosal-originating circulating regulatory IgA B cells in multiple sclerosis” by Tradite Neziraj, Elisabeth Pössnecker, Angela A. Wang, Paul Saary, Adrian-Minh Schumacher, Florian Ingelfinger, Amandine Mathias, Edoardo Galli, Marco Häfelfinger, Michelle Zuo, Samuel Jones, Vasiliki Pantazou, Joep Killestein, Sabine Schädelin, Pascal Benkert, Cristina Granziera, Caroline Pot, Antje Bischof, Jan Hendrik Niess, Magdalena Filipowicz Sinnreich, Tobias Derfuss, Charlotte E. Teunissen, Jens Kuhle, David A. Hafler, Renaud Du Pasquier, Yoshiaki Yasumizu, Jennifer L. Gommerman, Anne-Katrin Pröbstel. Science Translational Medicine
DOI:10.1126/scitranslmed.aee1580
Abstract
Anti-CD20 B cell depletion is associated with elevated mucosal-originating circulating regulatory IgA B cells in multiple sclerosis
Therapy with anti-CD20 monoclonal antibodies is highly efficacious in various autoimmune diseases including multiple sclerosis (MS), a prototypic autoimmune inflammatory disease of the central nervous system (CNS). However, which B cell subsets and altered B cell–regulating factors mediate the clinical efficacy of anti-CD20 treatment is unclear.
To address this gap in knowledge, we performed longitudinal high-dimensional single-cell transcriptomic and proteomic profiling of blood, cerebrospinal fluid (CSF), and intestinal samples from people with MS (pwMS), combined with immune profiling in a preclinical autoimmune encephalomyelitis model during anti-CD20 therapy. CSF analyses were performed using previously published datasets.
Multisite intestinal profiling was conducted in one anti-CD20–treated patient with MS and one control participant. By applying algorithm-guided analyses of flow cytometry, single-cell transcriptomic, and immune receptor repertoire data, we found that anti-CD20 B cell depletion was associated with increased frequencies of regulatory mucosal-derived IgA-producing B cells in the periphery and CSF, together with increased B cell receptor clonal overlap between mucosal and systemic compartments, indicating enhanced trafficking of IgA B cells from gut mucosal tissues to the systemic circulation and the CNS.
Moreover, we demonstrated that higher levels of B cell–activating factor and a proliferation-inducing ligand were related to favorable outcomes in pwMS during anti-CD20 treatment. Together, our findings suggest that mucosal immune regulatory mechanisms may be harnessed by anti-CD20 B cell depletion, opening previously unknown therapeutic avenues for MS.
