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. Author manuscript; available in PMC: 2024 Aug 20.
Published in final edited form as: Neurology. 2010 Jan 5;74(Suppl 1):S31–S40. doi: 10.1212/WNL.0b013e3181c97ed3

Table 2.

Mechanisms of action of natalizumab19,22,80

Direct effects Indirect effects Consequences (therapeutic and side effects)
Inhibition of migration of immune cells into CNS Stabilization of BBB Probably most important early therapeutic MoA
Decreased CNS immunosurveillance
Inhibition of APC turnover in the CNS Decreased antigen presentation in the CNS Possibly MoA that underlies prolonged efficacy, but also further limits CNS immunosurveillance
Mobilization of lymphoid (especially pre-B) and lymphoid/myeloid (CD34+) precursors from the BM Likely contributes to risk of PML

CNS, central nervous system; BBB, blood-brain barrier; MoA, mechanism of action, APC, antigen-presenting cell; PML, progressive multifocal leukoencephalopathy; BM, bone marrow