Important insights into multiple sclerosis (MS) pathology have recently broadened our view of the disease. Evidence derived mainly from experimental models suggests that MS is a CD4 T-cell driven autoimmune disease with diverse immune effector mechanisms leading to destruction of the myelin sheath. The target antigen has not been identified yet. Damage to axons is the major predictor of persistent disability.
Various myelin proteins, such as myelin basic protein, proteolipid protein, and myelin oligodendrocyte glycoprotein have been studied in detail.
In neuromyelitis optica, a disease believed to be closely related to MS, an astrocytic antigen, aquaporin-4, has recently been found to be the target of the immune response.
Abortive repair mechanisms are increasingly being studied. The improved understanding these provide will pave the way to new therapeutic strategies.
Currently it remains unclear whether exogenous pathogens play a role in predisposing patients to or precipitating disease.
© 2007 Elsevier Masson SAS. Tous droits réservés.