An update on immunopathogenesis, diagnosis, and treatment of multiple sclerosis

Abstract

BackgroundMultiple sclerosis is an acquired demyelinating disease of the central nervous system. It is the second most common cause of disability in adults in United States after head trauma.DiscussionThe etiology of MS is probably multifactorial, related to genetic, environmental, and several other factors. The pathogenesis is not fully understood but is believed to involve T-cell-mediated inflammation directed against myelin and other related proteins with a possible role for B cells. The McDonald criteria have been proposed and revised over the years to guide the diagnosis of MS and are based on clinical presentation and magnetic resonance imaging (MRI) of the brain and spinal cord to establish dissemination in time and space. The treatment of MS includes disease modification with immunomodulator drugs and symptom management to address the specific symptoms such as fatigue, spasticity, and pain.ConclusionAn update on etiology, pathogenesis, diagnosis, and immunomodulatory treatment of MS is presented.

Silencing Leukocyte Immunoglobulin-Like Receptor A1 in Monocytes Inhibits Inflammation in Mice with Multiple Sclerosis

“…The etiology of MS remains unknown; however, it is presumably involved in the interaction between inflammatory and neurodegeneration, which characteristically lead to intermittent neurologic disturbance along with progressive accumulation of disability [4]. The majority of immunopathogeneses of MS are known from the study of experimental autoimmune encephalomyelitis (EAE), which has many of the histologic traits of MS [2]. While there may be genetic causes, information obtained from identical twins showing low concordance rates suggests that nongenetic influences also contribute to the induction of MS [5].…”

“…Characterized by central nervous system (CNS) impairment causing pain, fatigue, depression, anxiety, and neurologic dysfunction [1], multiple sclerosis (MS) is a chronic inflammatory disease of unknown etiology [2]. Initially, most patients experience a stage of cycles of relapses and remissions, and enter into the progressive stage after 10–15 years [3].…”

Processo epigenéticos envolvidos na fisiopatologia da esclerose múltipla com ênfase na função dos miRNAs

“…As placas remielinizadas são evidenciadas à margem das placas ativas e contem axônios mielinizados e um número aumentado de precursores dos oligodendrócitos. A detecção das lesões é de extrema importância para confirmar o diagnóstico que segundo o critério de McDonald é baseado na detecção de duas áreas ou mais afetadas, em dois episódios distintos (GARG, SMITH, 2015;MURRAY, 2006). Atualmente a etiologia da esclerose múltipla é desconhecida, porém estudos epidemiológicos descrevem-na como uma doença multifatorial que surge a partir de causas hereditárias e não hereditárias.…”

“…Em relação aos fatores herdáveis, o human leukocyte antigen (HLA) locus é o mais associado com a patologia (MECHELLI et al, 2010). Os alelos HLA-DR1501 e o HLA-DQ0601 codificam elementos restritos às células T e estão associados com um aumento quatro vezes maior no risco de desenvolver a EM (GARG, SMITH, 2015). Além disso, pesquisas recentes relatam alterações em genes que codificam receptores de citocinas, moléculas de adesão e coestimulação, e genes com envolvimento em canais de transporte e desenvolvimento cerebral (MECHELLI et al, 2010).…”

Cytokines in Multiple Sclerosis – Possible Targets for Immune Therapies

“…Through series of interactions they pass the bloodbrain barrier and invade the CNS. After second activation and in connection with other immune cells autoreactive T cells develop pathological process, leading to focal immune demyelination and axonal loss in the brain and spinal cord [1].…”