Multiple Sclerosis and biological definitions in neurodegenerative diseases

Area of Science:

• Neuroimmunology
• Neurology
• Biomarker Discovery

Background:

• Recent advances propose biological definitions for Alzheimer's disease (AD) and Parkinson's disease (PD), moving beyond clinical descriptors like dementia or parkinsonism.
• Multiple Sclerosis (MS) is also poised for a similar shift towards biological definitions.
• Unlike AD and PD, MS lacks a single, unifying molecular driver (e.g., amyloid in AD) for its pathogenesis, with historical candidates including T-cells, brain atrophy, and 'smoldering disease'.

Purpose of the Study:

• To explore the implications and challenges of developing biological definitions for Multiple Sclerosis.
• To address the absence of established minimal criteria for MS pathogenesis.
• To proactively consider ethical issues and technological limitations associated with biological assessments in MS.

Main Methods:

• Conceptual analysis of current trends in neurodegenerative disease definition.
• Review of historical and emerging concepts in Multiple Sclerosis pathogenesis.
• Discussion of ethical considerations and technological accessibility for biomarker assessment.

Main Results:

• There is no single, universally accepted molecular driver for Multiple Sclerosis pathogenesis.
• Minimal necessary and sufficient conditions for MS pathogenesis are not yet established.
• Significant ethical considerations and technological disparities exist regarding biological assessments for MS.

Conclusions:

• A critical and constructive dialogue is needed to navigate the transition towards biological definitions in Multiple Sclerosis.
• Addressing ethical concerns and ensuring equitable access to technology are crucial for defining MS pathogenesis.
• Proactive engagement with these issues is timely to guide future research and clinical practice in MS.