Myelin oligodendrocyte glycoprotein (MOG) is the only myelin protein known to initiate a demyelinating autoantibody response in EAE, an animal model for multiple sclerosis (MS). The pathophysiological significance of MOG-specific autoantibodies in MS is, however, controversial, as high titer antibody responses to MOG are also found in many patients with nondemyelinating neurological diseases. In this issue of the European Journal of Immunology, von Büdingen et al. demonstrate that demyelination in a primate model of MOG-induced EAE is mediated by MOG-specific antibodies directed against discontinuous, rather than linear, MOG epitopes. This functional segregation of pathogenic vs. non-pathogenic autoantibodies in terms of epitope specificity may be crucial to understand the relevance of MOGspecific responses in human disease. This commentary discusses these findings in the context of the structure and immunobiology of MOG, and their implications with respect to antibody-mediated demyelination in MS.
Humoral responses in the pathogenesis of multiple sclerosisLoss of immunological self-tolerance to myelin antigens in genetically susceptible individuals plays a major role in the pathogenesis of multiple sclerosis (MS), a complex inflammatory demyelinating disease of the central nervous system (CNS) [1]. MS is often discussed as a purely T cell mediated disease, but there is increasing indirect evidence that antibody-dependent mechanisms are also involved in disease pathogenesis. Immunopathological studies identified immunoglobulins and complementactivation products deposited on the surface of intact myelin sheaths at the active edge of demyelinating lesions, as well as the presence of opsonized myelin debris that is cleared from the lesions by activated macrophages [2][3][4][5][6][7]. Plasma exchange can also dramatically reduce clinical disease activity in a subset of MS patients [8,9]. This provides further circumstantial evidence that humoral factors can be involved in disease pathogenesis, but their mode of action remains obscure.The tacit assumption made on the basis of immunopathological findings is that this mode of action involves autoantibodies recognizing determinants exposed on the surface of the myelin sheath. Immunopathological studies indicate that the clinical significance of antibodymediated demyelination in this response varies between patients. There is no evidence at all that antibody is involved in lesion formation in 20-40% of patients [5,6], whilst in some subtypes of MS such as Devic's disease (neuromyelitis optica) antibody-mediated effects may play a dominant role in disease pathogenesis [7]. There is also a wide variation in the clinical response of MS Eur. J. Immunol. 2004. 34: 2065-2071 patients to plasma exchange [8,9]. This supports the concept that the effector mechanisms involved in disease pathogenesis can vary significantly between patients, but its relationship to antibody-mediated demyelination remains unproven.It is obvious that if we were able to identify those patients in who...