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Updated: Jan 25, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Multiple Sclerosis: Mechanisms and Immunotherapy
Clare Baecher-Allan1, Belinda J Kaskow1, Howard L Weiner1
1Department of Neurology, Ann Romney Center for Neurologic Diseases, Partners MS Center, Evergrande Center for Immunologic Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Abstract:
Multiple sclerosis (MS) is an autoimmune disease triggered by environmental factors that act on a genetically susceptible host. It features three clinical stages: a pre-clinical stage detectable only by MRI; a relapsing-remitting (RRMS) stage characterized by episodes of neurologic dysfunction followed by resolution; and a progressive stage, which usually evolves from the relapsing stage. Advances in our understanding of the immune mechanisms that contribute to MS have led to more than ten FDA-approved immunotherapeutic drugs that target effector T cells, regulatory cells, B cells, and cell trafficking into the nervous system. However, most drugs for relapsing MS are not effective in treating progressive disease. Progressive MS features a compartmentalized immune response in the central nervous system, involving microglia cells and astrocytes, as well as immune-independent processes that drive axonal dysfunction. Major challenges for MS research involve understanding the mechanisms of disease progression, developing treatment for progressive MS, and determining the degree to which progressive disease can be prevented by early treatment. Key priorities for MS research include developing biomarkers, personalized medicine and advanced imaging, and a better understanding of the microbiome. With a better understanding of the genetic and epidemiological aspects of this disease, approaches to prevent MS are now also being considered.
Insights
Multiple sclerosis (MS) is an autoimmune disease with distinct stages. Current immunotherapies are effective for relapsing MS but not progressive MS, highlighting a need for new treatments.
Area of Science:
- Neuroimmunology
- Autoimmune Diseases
- Neurology
Background:
- Multiple sclerosis (MS) is an autoimmune disease influenced by genetic and environmental factors.
- MS progresses through pre-clinical, relapsing-remitting (RRMS), and progressive stages.
- Existing immunotherapies target immune cells and trafficking but are less effective for progressive MS.
Purpose of the Study:
- To review the current understanding of MS pathophysiology, focusing on challenges in treating progressive MS.
- To highlight key research priorities for advancing MS treatment and prevention.
- To discuss the potential of personalized medicine, advanced imaging, and microbiome research in MS.
Main Methods:
- Review of current scientific literature on multiple sclerosis.
- Analysis of immunotherapeutic targets and their efficacy across different MS stages.
- Discussion of emerging research areas and future directions in MS.
Main Results:
- Progressive MS involves distinct central nervous system immune responses and immune-independent processes.
- Current treatments are largely ineffective against the progression of MS.
- Significant challenges remain in understanding disease mechanisms and developing treatments for progressive MS.
Conclusions:
- Further research is crucial to understand progressive MS mechanisms and develop targeted therapies.
- Biomarkers, personalized medicine, advanced imaging, and microbiome research are key priorities.
- Preventative strategies for MS are being explored with improved genetic and epidemiological insights.
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