Joel Oger, MD, FRCPC, FAAN
Over the last 50 years, multiple sclerosis (MS) has been considered to be an autoimmune disease. Most authors supported a concept of accelerating immune stimulation, thus explaining why most relapsing-remit-ting patients become secondary progressive. However, MS is now seen as a disease mixing elements of both an immune disease and a degenerative disease; recent suggestions that the degenerative element could start very early have been appealing to many and are supported by pathologic studies showing axonal loss very early in the disease, even before the progressive phase. This author has found very appealing the most recent attempts to show how both phenomenon are linked.
This chapter covers the basics of immunology followed by the practical approach to immunotherapies in MS. We first review the basic immune mechanisms underlying the response to an antigen as the autoimmune theory holds that in MS, myelin proteins (or oligodendrocytes) are seen as foreign antigens by the immune system. We review experimental allergic encephalomyelitis (EAE), because many characterize it as "the animal model of MS" despite the fact that there exist many variations of this experimental disease that cannot qualify as a model of MS. We review the blood-brain barrier (BBB) and its disruption as the major biophysical obstacle that pathogenic immune system cells must traverse to reach their target. Finally, we describe the MS plaque in terms of immune content and what is known about the magnetic resonance imaging (MRI) correlations.
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