UCL in the News: The B Cell Slayer

For someone who has just seen his ideas for treating a crippling disease vindicated after years of rejection, Jonathan Edwards [UCL Medicine] is remarkably self-effacing.

Asked whether he feels he has brought hope to some of the millions with rheumatoid arthritis (RA), the 57-year-old rheumatologist tends to look at his shoes or up at the ceiling. Edwards would much rather talk about where he plans to go next than to dwell on how his University College London (UCL) team's decade-long pursuit of an unfashionable idea has now led to a new RA therapy approved in the United States and in Europe.

The unfashionable idea advocated by Edwards is that RA stems from the misbehavior of denizens of the bloodstream known as B cells. …

Edwards, however, has breathed new life into the B cell theory of RA by providing evidence that eliminating these cells in patients can ease their symptoms. …

B cell-depletion therapy doesn't work for every RA patient, and questions remain about how long the relief it brings lasts. Still, once again challenging conventional wisdom, Edwards is now arguing that B cells hold the key to another autoimmune affliction: multiple sclerosis (MS). …

Edwards and his colleagues have become interested in whether B cell-depletion therapy can treat MS, a neurodegenerative condition stemming from the destruction of the myelin insulation surrounding vital nerve cells. This myelin loss triggers a host of symptoms, from muscle spasms and pain to loss of bladder and speech control. …

Given the poor prognosis of many people with MS and the apparently low risks involved in rebooting the B cell system, Edwards has continued to lobby that rituximab is worth a try. And some MS researchers have started to agree. …

In May at a neurology meeting, a team at the University of California, San Francisco (UCSF), unveiled preliminary results from an ongoing rituximab trial involving more than 100 patients with so-called remittingrelapsing MS. The data, primarily magnetic resonance imaging scans of the patients' nervous systems, indicated that the drug has dramatically reduced the nerve damage caused by the disease. …

The UCL team is playing down any suggestion that they've been proved right again. Edwards says it's far too early for that, although he's hopeful. "The longer we stay in this business, the more we realize there may be further twists to the tale," he says.

Robert Matthews, 'Science'