Multiple sclerosis: Glial cell activation - Biomarker advances and their translational significance

The diagnosis of multiple sclerosis (MS) predominantly hinges on the 2017 McDonald criteria, integrated with adjunctive diagnostic modalities including cerebrospinal fluid (CSF) analysis and magnetic resonance imaging (MRI). Notwithstanding their utility, these established methods exhibit inherent limitations in fully elucidating the complex histopathological transformations characteristic of MS. Specifically, they encounter difficulties in precisely quantifying and standardizing patient-specific pathological features, and often lack the requisite precision to delineate the disease's nuanced pathological hallmarks. Recent advancements in neuroimaging, biomarker discovery, and genomic profiling have yielded substantial evidence implicating glial cell activation as a central pathogenic mechanism in MS. In particular, the activation of astrocytes and microglia has been shown to play a pivotal role in disease progression, precipitating a cascade of events that culminate in neuronal axonal demise. The identification of distinct glial cell subsets represents a critical step towards the development of targeted therapeutic strategies. Biomarker-based approaches offer a powerful paradigm for in-vivo interrogation of disease processes, facilitating a more comprehensive understanding of MS pathophysiology and potentially paving the way for personalized treatment modalities. This paper provides a comprehensive overview of the current research on the pathophysiology of glial cells in MS, emphasizing newly identified biomarkers with potential value related to the damage of microglia and astrocytes in MS in recent years.