Towards a pathogenetic definition of multiple sclerosis in terms of integrative transformation of generic pathologic...

The multiple sclerosis disease process is presented in the light of a generic pathobiologic phenomenon on equal terms with such other phenomena as ischemia, neoplasia, infection and congenital malformation, with the added improviso that it would also constitute a true form of integrative resolution of these other generic phenomena towards a real transformation of events in terms of both cellular forms of injury and also in terms of pathogenesis and evolution. Perhaps, in the final analysis, a putative infectious agent is implicated in multiple sclerosis whose peculiar attributes are reflected in a distinctive immunologic response beyond even the conventional concepts of either hypersensitivity or of immunologic surveillance. In a sense, perhaps, a particular patient immunologic constitution in an environment conducive to exposure to a putative agent results in a form of integration of this agent leading to persistent demyelinative relapse of the affected oligodendrocyte on an essential background of a distinct plaque centered on a specific vessel of supply. The recognition of the oligodendrocyte as a specialized astrocyte might in itself strictly characterize such a generic demyelinative process of multiple sclerosis in terms of its essential remitting/relapsing course.