Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system characterized by severe attacks of optic neuritis (ON), longitudinally extensive transverse myelitis (LETM), and area postrema syndrome. The majority of patients with NMOSD are seropositive for autoantibodies against the astrocyte water channel aquaporin-4 (AQP4). As convergent clinical and laboratory-based investigations have indicated that B cells play a fundamental role in NMO immunopathology, B cells have become an attractive therapeutic target. Rituximab is a therapeutic monoclonal antibody against CD20 expressed on B cells and increasingly used for the treatment of NMOSD. Although there is robust evidence for the efficacy and safety of rituximab in NMOSD, considerable variability has been noted in biological and clinical responses in patients. Therefore, the focus now is on understanding the mechanisms underlying the variability in response to rituximab and optimizing the use of rituximab for NMOSD. Identification of biomarkers for prediction of clinical response, and effective dosing and timing of treatment may provide useful tools for patient-tailored treatment in NMOSD. Herein, we review current evidence on factors that affect biological and clinical responses to rituximab and highlight the importance of individualized therapies for NMOSD.

中文翻译：

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视神经脊髓炎频谱疾病的个体化B细胞靶向治疗。

视神经脊髓炎光谱疾病（NMOSD）是中枢神经系统的一种自身免疫性炎性疾病，其特征在于视神经炎（ON），纵向广泛性横贯性脊髓炎（LETM）和区域性区域性后综合征的严重发作。NMOSD的大多数患者针对星形胶质细胞水通道aquaporin-4（AQP4）的自身抗体呈血清阳性。由于基于临床和实验室的综合研究表明B细胞在NMO免疫病理学中起着基本作用，因此B细胞已成为有吸引力的治疗靶标。利妥昔单抗是针对B细胞上表达的CD20的治疗性单克隆抗体，越来越多地用于治疗NMOSD。尽管有充分的证据证明利妥昔单抗在NMOSD中的有效性和安全性，在患者的生物学和临床反应中已经注意到相当大的可变性。因此，现在的重点是了解对利妥昔单抗有反应的变异性的潜在机制，以及将利妥昔单抗用于NMOSD的最优化方法。鉴定用于预测临床反应的生物标志物以及有效的剂量和治疗时机可能为NMOSD中针对患者量身定制的治疗提供有用的工具。本文中，我们回顾了影响利妥昔单抗生物学和临床反应的因素的现有证据，并强调了个体化治疗对NMOSD的重要性。有效的剂量和治疗时机可为NMOSD中针对患者量身定制的治疗提供有用的工具。本文中，我们回顾了影响利妥昔单抗生物学和临床反应的因素的现有证据，并强调了个体化治疗对NMOSD的重要性。有效的剂量和治疗时机可为NMOSD中针对患者量身定制的治疗提供有用的工具。本文中，我们回顾了影响利妥昔单抗生物学和临床反应的因素的现有证据，并强调了个体化治疗对NMOSD的重要性。