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Timing of Future Remyelination Therapies and Their Potential to Stop Multiple Sclerosis Progression

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Multiple Sclerosis: Bench to Bedside

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 958))

Abstract

Prior to the onset of demyelination in multiple sclerosis (MS), early oligodendrocyte injury, axonal degeneration and astroglial scarring occur. The irreversible progressive phase of MS begins when the axonal loss threshold is reached. Progressive disease onset has the highest impact on a poor prognosis in MS. Conversion to progressive disease is essentially an age-dependent process independent of disease duration and initial disease course. Although prevention of relapses has been the primary approach in the disease management, incomplete recovery from even the first relapse correlates with the long-term neurodegenerative phenotype of progressive MS onset. Therefore, the provider should review each patient’s potential for relapse-related disability and start DMDs with the goal of preventing relapses. Existing immunomodulatory medications used to prevent MS relapses do not prevent long-term disability, which requires agents focused on remyelination and axonal repair. If applied immediately after a relapse rather than during the progressive phase of MS, remyelination-stimulating strategies may result in full recovery and prevention of long-term neurodegeneration and progressive disease course.

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Abbreviations

ACTH:

adrenocorticotropic hormone

Ca2+:

calcium

CIS:

clinically isolated syndrome

DMD:

disease-modifying drug

EAE:

experimental autoimmune encephalomyelitis

IgM:

immunoglobulin M

LINGO-1:

leucine-rich repeat neuronal protein 1

MRI:

magnetic resonance imaging

MS:

multiple sclerosis

NAbs:

naturally occurring antibodies

OPCs:

oligodendrocyte progenitor cells

PPMS:

primary progressive multiple sclerosis

RIS:

radiologically isolated syndrome

RRMS:

relapsing remitting multiple sclerosis

SAMS:

single attack multiple sclerosis

SAPMS:

single attack progressive multiple sclerosis

SPMS:

secondary progressive multiple sclerosis

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Acknowledgements

The authors thank Mrs. Lea Dacy for assistance with editing and formatting.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Burcu Zeydan & Orhun H. Kantarci

  2. Departments of Neurology and Immunology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Moses Rodriguez

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  1. Burcu Zeydan
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  2. Moses Rodriguez
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Correspondence to Orhun H. Kantarci .

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Editors and Affiliations

  1. Department of Neuroscience Research, University of Dammam, Damman, Saudi Arabia

    Alexzander A. A. Asea

  2. Department of Biological, Chemical and Pharmaceutical Sciences and Technologies, University of Palermo, Palermo, Italy

    Fabiana Geraci

  3. Department of Microbiology, Biochemistry & Immunology, Morehouse School of Medicine, Atlanta, Georgia, USA

    Punit Kaur

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Zeydan, B., Rodriguez, M., Kantarci, O.H. (2017). Timing of Future Remyelination Therapies and Their Potential to Stop Multiple Sclerosis Progression. In: Asea, A., Geraci, F., Kaur, P. (eds) Multiple Sclerosis: Bench to Bedside. Advances in Experimental Medicine and Biology, vol 958. Springer, Cham. https://doi.org/10.1007/978-3-319-47861-6_10

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