status of the research as of 2019
http://www.dickyricky.com/Medicine/Pape ... erosis.pdf
- Evidence from MRI and pathological assessment (biopsies and autopsies) indicates that the earliest stages of white-matter demyelination (known as early active white-matter lesions) are heterogeneous and evolve over the course of months. Regardless of the particular immunologic pattern of early demyelination, analysis of active lesions, over both time and space, suggests that a single immune-effector mechanism dominates in each person.
- Consistent with this notion are the observations that plasma exchange, which removes pathogenic antibodies from the circulation, ameliorates relapses that are refractory to initial treatment with glucocorticoids in patients whose active lesions contain immunoglobulin and complement and that cerebrospinal fluid (CSF) profiles differ according to lesion pattern
- The optic nerve is also a major target in multiple sclerosis, and loss of the contiguous retinal ganglion cells is well documented. Retinal damage can be assessed in vivo by means of optical coherence tomography,26 which reveals substantial thinning of the retinal nerve-fiber and ganglion-cell layers despite their lack of myelin. A particularly exciting innovation has been the use of optical coherence tomography to rapidly assess the retina at micron-level resolution.
- Microglial activation, often remote from established lesions, has been found in the white matter of autopsy specimens from patients with multiple sclerosis and may represent the earliest stage of lesion development
- Clonal expansion of B cells in the CNS results in the characteristic finding of CSF-specific oligoclonal bands. Although the targets of these immunoglobulins are probably multifaceted, their presence implies a CNS-restricted immune response.
- The recent approval of ocrelizumab for primary progressive multiple sclerosis is a promising step, but the reasons for
the ability of ocrelizumab to slow progression remain uncertain.
- There is an emerging consensus that slowing the rate of cerebral or spinal cord atrophy is a feasible goal, which, at the proof-of concept stage, can be undertaken in several hundred people over a period of a few years.