Neuroimmunotherapy

Since 1994, when I edited the last issue on "Immunotherapy of Neurologic Diseases" for Seminars in Neurology, there has been remarkable progress. The explosion in biotechnology during the last decade and the development of new therapeutic agents based on molecular immunology models, have been wisely applied by clinical neurologists. As a result, new drugs have been tested, controlled trials have been conducted, and a variety of new agents have been approved. Most importantly, the new immunotherapies are increasingly target-oriented, directed against molecules that play a fundamental role in activation and transmigration of T cells to the target tissues, such as co-stimulatory molecules, cytokines, adhesion molecules, and receptors. Consequently, a new issue of Seminars that captures and addresses the present and future immunotherapeutic interventions is timely.

The topics and authors have been highly selected to cover the pioneering work on present and future therapies. The first chapter on immunotherapeutic targets by Hohlfeld and Dalakas summarizes the targets of immunotherapies and provides some practical guidelines in reference to the agents we are currently using. New drugs affecting T cell transduction pathways that are in the offing are discussed. The second chapter by Kieseier and Hartung covers the present therapies in multiple sclerosis (MS) where controlled therapies have shown significant promise. The third chapter by Blevins and Martin is an example of where the field is going; it addresses the future of immunotherapies applicable not only to MS but also to other autoimmune neurological diseases. The fourth and fifth chapters by Kieseier and Hartung and by Kissel, summarize the current treatment strategies in Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP); both of these disorders are now better managed based on evidence-based controlled trials, while the application of combination therapies seems logical and promising. The chapter by Kornberg and Pestronk discusses the new approaches in the treatment of the various forms of multifocal motor neuropathies based on the authors' experience. The chapter by John Newsom-Davis summarizes the latest practical guidelines on how best to apply immunotherapies in myasthenia gravis and Lambert-Eaton myasthenic syndrome, two highly treatable neuromuscular transmission disorders. The eighth chapter by Dalakas covers the treatment on inflammatory myopathies where significant progress has been made in our understanding of the immunology of the disease. The ninth chapter by Gold and colleagues addresses the treatment on systemic vasculitis as applied to neurological disorders; and the final chapter by Bataller and Dalmau discusses the prospects of immunotherapy in paraneoplastic autoimmune neurological disorders based on the large experience of the authors.

The accomplishments during the last decade have been significant. We are witnessing the fruits of successful-though still semispecific-immunotherapies, which stemmed from the basic work on immunopathology that started two to three decades ago. Judging from the progress made over the last 10 years and the galloping pace of new discoveries, especially in the form of target-specific humanized monoclonal antibodies, the future of immunotherapies for autoimmune neuropathies, myopathies, junction disorders, multiple sclerosis, and other central or peripheral nervous system disorders is brighter than ever. We can now safely say when it comes to neuroimmunotherapy that "the future is not what it used to be".