![]() ![]() Focal cortical lesions may develop in distinct locations. ![]() The disease is characterised by an initial autoimmune-driven, inflammatory phase followed by immune-mediated attack on the myelin surrounding nerve axons. Multiple sclerosis (MS) affects over two million people worldwide (National Multiple Sclerosis Society, ). Small-molecule drugs, once the patent term has expired, provide a uniquely sustainable form of healthcare. A deeper understanding of B-cell biology and the effect on MS disease should lead to new drugs with better selectivity, efficacy, and an improved safety profile. The current B cell–directed therapies often kill B-cell subsets, which can be effective but lead to side effects and toxicity. Small molecules can have diverse actions on B cells and be cytotoxic, anti-inflammatory and anti-viral. The potential for experimental molecules with B-cell effects is also considered. Existing small-molecule therapies for MS with B-cell actions together with new drugs in development are described. The risk genes for MS are examined from the drug target perspective. This review focusses on small-molecule drugs that can affect B-cell biology and may have utility in disease management. ![]() Antibodies and small-molecule drugs directed against B cells have demonstrated good efficacy in slowing progression of the disease. Following an unknown trigger (or triggers), the immune system attacks the myelin sheath surrounding axons, leading to progressive nerve cell death. Multiple sclerosis (MS) is a major cause of disability in young adults. ![]()
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