The stress-axis in multiple sclerosis: Clinical, cellular, and molecular aspects

Area of Science:

• Neuroendocrinology
• Immunology
• Neurology

Background:

• The hypothalamus-pituitary-adrenal (HPA) stress-axis is crucial for stress response.
• Dysregulation of the HPA-axis is increasingly recognized in autoimmune diseases like multiple sclerosis (MS).
• HPA-axis alterations in MS are associated with disease pathogenesis, progression, and specific clinical manifestations.

Purpose of the Study:

• To provide a comprehensive overview of HPA-axis activity in MS.
• To explore the causes, sex- and subtype-dependent differences, and pathological effects of HPA-axis dysregulation in MS.
• To correlate HPA-axis activity with clinical symptoms and comorbidities in MS patients.

Main Methods:

• Literature review and synthesis of existing research on HPA-axis function in MS.
• Analysis of studies investigating HPA-axis activation, hyporesponsiveness, and their triggers.
• Examination of pathological, cellular, and molecular mechanisms underlying HPA-axis alterations in MS.

Main Results:

• HPA-axis is generally activated or hyperresponsive in MS patients.
• A subgroup of MS patients exhibits a hyporesponsive HPA-axis, linked to more severe disease progression.
• Sex and MS subtype influence HPA-axis activity patterns and clinical correlations.

Conclusions:

• HPA-axis dysregulation is a significant factor in MS pathogenesis and clinical presentation.
• Understanding HPA-axis alterations is vital for managing MS symptoms and comorbidities.
• Further research into HPA-axis modulation may offer therapeutic strategies for MS.