Remyelinating versus neuroprotective therapies for multiple sclerosis

Remyelinating versus neuroprotective therapies for multiple sclerosis Reducing clinical relapses and improving quality of life is at the heart of MS treatment; here, Tara M. DeSilva explores the benefits of remyelinating versus neuroprotective therapies for tackling MS. Clinical relapses in the demyelinating and neurodegenerative disease multiple sclerosis (MS) are characterised by neurological symptoms resulting from damage to the myelin sheath that surrounds axons. This damage is perpetrated by immune cells that extravasate into the central nervous system (CNS), including the brain, spinal cord, and optic nerves and are a key underlying pathogenesis of lesion formation. Current therapies for MS reduce the infiltration of immune cells, thereby reducing clinical relapses and improving quality of life. However, inflammatory lesions in the CNS can occur even during remission leading to "silent" lesions that damage myelin and axons. This may explain why current immunomodulatory therapies are effective early in the disease course but do not prevent long-term progressive disease. Therefore, strategies are being developed to promote direct protection of the axon and recovery of the myelin sheath. These strategies, in combination with immunomodulatory therapies, may help to prevent long-term disease progression and promote recovery in MS.