Pathogenic autoantibodies in multiple sclerosis - from a simple idea to a complex concept.

Area of Science:

• Neuroimmunology
• Autoimmunity
• Neurology

Background:

• The role of autoantibodies in multiple sclerosis (MS) has been debated for decades.
• Intrathecal immunoglobulin production is a known feature in MS patients.
• Evidence suggests MS pathology may be heterogeneous, potentially including an antibody-associated subtype.

Purpose of the Study:

• To review studies investigating MS-associated autoantibodies.
• To discuss the potential roles of autoantibodies in MS pathophysiology.
• To address the question of whether a distinct autoantibody-mediated MS subtype exists.

Main Methods:

• Literature review of studies on autoantibodies in multiple sclerosis.
• Analysis of evidence differentiating MS from neuromyelitis optica spectrum disorder and MOGAD.
• Synthesis of current understanding and expert opinion on autoantibody roles.

Main Results:

• Some previously identified "MS-associated autoantibodies" may actually indicate other conditions like NMOSD or MOGAD.
• The existence of a distinct autoantibody-mediated MS subtype is uncertain.
• The precise role of autoantibodies in MS pathophysiology requires further elucidation.

Conclusions:

• The identification and role of pathogenic autoantibodies in multiple sclerosis require further research.
• Distinguishing MS from antibody-mediated disorders like NMOSD and MOGAD is crucial.
• Autoantibodies may play diverse roles in MS, from disease definition to immune response amplification.