Are current immunological concepts of multiple sclerosis reflected by the immunopathology of its lesions?

Immunopathological studies on multiple sclerosis (MS) brain clearly indicate that a T cell-mediated immune response is the driving force in the induction of the lesions. This T cell-mediated response alone, however, is not sufficient to explain the widespread and selective destruction of myelin sheaths. According to present evidence, it is likely that antibodies directed against surface components of myelin sheaths are at least one factor involved in the demyelinating process. The patterns of inflammation, demyelination and oligodendrocyte destruction, however, suggest that the pathogenesis of the lesions may be fundamentally different in individual MS patients and that autoimmunity may not be the sole cause. In the case of autoimmune reactions various different proteins of the nervous system may become targets and it appears unlikely, that myelin basic protein is a major candidate for a pathogenetic role in MS.