The challenge of multiple sclerosis: How do we cure a chronic heterogenic disease?

Source: Weiner, H. (2009). The challenge of multiple sclerosis: How do we cure a chronic heterogenic disease? American Neurological Association, 65(3), 239-248. DOI: 10.1002/ana.21640

Summary: Treatments for multiple sclerosis (MS) have three different goals. Some aim at preventing It, others aim at halting its progression, while others aim at reversing its effects. For a treatment to be successful, it must protect neurons and control the immune system because multiple sclerosis occurs when the immune system attacks and gradually destroys one's own nerve cells.

Halting progression

• Halting the progression of MS is complex because MS itself is complex. To determine the best course of treatment, biomarkers are needed to determine how far along MS has progressed. With that knowledge, there are many courses of treatment. Ultimately, multiple treatments are needed because there needs to be treatments targeting the inflammation of the nervous system and others acting as immunosuppressants that inhibit the activity of the immune system. Some effective immunosuppressants are natalizumab, cyclophosphamide, and alemtuzumab. To treat inflammation, corticosteroids like oral prednisone are often prescribed. The ultimate goal is to create antigen-specific therapies which cause the immune system to recognize and tolerate one’s own organs without altering the immune system.

Reversing the effects of MS

• It must be understood that the odds of significantly reducing the effects of MS are very slim. However, there is evidence that by reducing the inflammation of the nervous system, repair is possible. Such inflammation could be reduced with the addition of anti-Lingo-1 and anti- Nogo which inhibit molecules that block the growth of the axon and myelin (two parts of the neuron) allowing some parts of the neuron to regenerate.

Preventing MS

• The first step in preventing MS is to identify anyone at risk of getting it. To figure this out, one would need to measure the autoantibody counts in the body. Autoantibodies are antibodies produced by the immune system to fight an individual’s own organ which often marks the beginning of MS. Once at-risk people have been identified, primitive data has shown that vitamin D and the Epstein-Barr virus vaccine can be useful in preventing one from getting MS, but the only true preventative measure would be a vaccine which we do not currently have for MS.