MECHANISMS OF NEURODEGENERATION IN MULTIPLE SCLEROSIS: PREMISE FOR NEUROPROTECTION?

• Main Author: O. Bajenaru
• Format: Article
• Language: English
• Published: Amaltea Medical Publishing House 2007-06-01
• Series: Romanian Journal of Neurology
• Subjects: chronic inflammatory disease; disease heterogeneicity; pathophysiological patterns; focal demyelination; diffuse axonal loss; normal appearing white matter (nawm); brain and spinal cord atrophy; neuroprotection
• Online Access: https://revistemedicale.amaltea.ro/Romanian_Journal_of_NEUROLOGY/Revista_Romana_de_NEUROLOGIE-2007-Nr.2/RJN_2007_2_Art-01.pdf

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS), in which both focal demyelinating lesions and diffuse axonal loss are present. The relationship between the inflammatory/ demyelinating process and the neurodegenerative component of the disease are extremely complex and not yet fully understood, but recent data show that their coexistence is present very early during the evolution, even in the preclinical stages of the disease. There are also extremely important clinical correlations between the focal inflammatory/ demyelinating lesions and the potential reversible clinical relapses and between the permanent axonal loss and continuous neurodegenerative process (extended also beyond the focal lesions in the normal appearing white matter and gray matter) and the irreversible brain and spinal cord atrophy which are irreversible and is the cause of clinical invalidity, mainly in the progressive forms of disease. MS is a heterogenous disease and there are now described four pathophysiologic patterns which are also correlated with the clinical heterogenity. Many factors, including genetic and environmental conditions, are responsible for this heterogeneicity, influencing the extremly complex pathogenic pathways. Recent data put into evidence details concerning the mechanisms of the neurodegenerative pathways in MS, which could be the background for future neuroprotective therapeutic strategies which could have, in association with the immunomodulatory treatments (now available in clinical practice) the potential capacity to slow-down or even to stop the clinical deterioration of these patients. These potential therapeutic strategies are reviwed in the final discussion.