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Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Grey matter damage in multiple sclerosis: a pathology perspective
Roel Klaver1, Helga E De Vries, Geert J Schenk
1Deptartment of Anatomy & Neurosciences, Clinical Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands. r.klaver@vumc.nl
Abstract:
Over the past decade, immunohistochemical studies have provided compelling evidence that gray matter (GM) pathology in multiple sclerosis (MS) is extensive. Until recently, this GM pathology was difficult to visualize using standard magnetic resonance imaging (MRI) techniques. However, with newly developed MRI sequences, it has become clear that GM damage is present from the earliest stages of the disease and accrues with disease progression. GM pathology is clinically relevant, as GM lesions and/or GM atrophy were shown to be associated with MS motor deficits and cognitive impairment. Recent autopsy studies demonstrated significant GM demyelination and microglia activation. However, extensive immune cell influx, complement activation and blood-brain barrier leakage, like in WM pathology, are far less prominent in the GM. Hence, so far, the cause of GM damage in MS remains unknown, although several plausible underlying pathogenic mechanisms have been proposed. This paper provides an overview of GM damage in MS with a focus on its topology and histopathology.
Insights
Gray matter (GM) pathology in multiple sclerosis (MS) is extensive and detectable with new MRI techniques. This GM damage impacts motor and cognitive functions, though its exact cause in MS remains unknown.
Area of Science:
- Neuroimmunology
- Neuroimaging
- Neuropathology
Background:
- Gray matter (GM) pathology is increasingly recognized in multiple sclerosis (MS).
- Traditional magnetic resonance imaging (MRI) techniques struggled to visualize GM damage.
- GM pathology is linked to motor and cognitive impairments in MS patients.
Purpose of the Study:
- To provide an overview of gray matter damage in multiple sclerosis.
- To focus on the topology and histopathology of GM lesions in MS.
- To discuss the clinical relevance and potential causes of GM pathology in MS.
Main Methods:
- Review of immunohistochemical and autopsy studies on MS brain tissue.
- Analysis of newly developed MRI sequences for visualizing GM pathology.
- Correlation of GM lesions and atrophy with clinical deficits.
Main Results:
- GM pathology in MS is extensive, present from early disease stages, and progresses over time.
- GM demyelination and microglia activation are evident in autopsy studies.
- Unlike white matter, GM shows less immune cell influx, complement activation, and blood-brain barrier leakage.
Conclusions:
- Newly developed MRI techniques reveal widespread GM damage in MS, correlating with clinical symptoms.
- The precise pathogenic mechanisms driving GM damage in MS require further investigation.
- Understanding GM pathology is crucial for MS diagnosis and treatment strategies.
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