Summary and Conclusions
The character of treatment for autoimmune diseases is dramatically changing due to the constant identification of new targets and the subsequent development of corresponding agents. The enormous efforts in identifying new target structures are based on a substantially refined understanding of the underlying autoimmune disorder. B cells symbolize this recent development, since they attract a lot of attention as key players in the dysregulation of autoimmune mechanisms. It has been appreciated that B cells are not restricted to (auto) antibody dependent functions, but they demonstrate various effects contributing to the complex procedures finally resulting in clinical symptoms of autoimmunity. Consequently, new targets directly affecting B cell function and interfering with (auto) antibody release, respectively, are being developed and evaluated for their clinical benefit. High clinical need for better therapeutic outcomes still exists for many autoimmune disorders, although major progress since the initial introduction of the biologic agents, at least for treatment of diseases such as rheumatoid arthritis, psoriasis or pemphigus, has been made. It can be expected that additional monoclonal antibodies and fusion proteins directed against newly identified targets as well as pharmacologically improved compounds directed against existing targets will be brought to the clinic. Translational research and the decision for some therapeutic agents to move to clinical application has mainly been based on preclinical, and that means animal, studies. It has been a disappointing experience that in some cases results from animal studies poorly predicted successful application in humans. Thus, factors that need to be considered in the future include deeper knowledge of the pathogenic mechanisms, the identification of valuable biomarkers assessing efficacy and safety and finally the more defined characterization of optimum treatment paradigms and most appropriate patient populations for the use of new therapeutic agents.