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EAN 2021 | Tackling disease progression in MS

Nikolaos Grigoriadis, MD, PhD, Aristotle University of Thessaloniki, Thessaloniki, Greece, discusses current methods and promising research concerning halting disease progression in multiple sclerosis (MS). Current methods involve targeting the adaptive immune system of the central nervous system (CNS) using disease-modifying therapies (DMTs), this has been shown to control annual relapses and disease activity in MS patients; however, it does not halt long-term disease progression. There is an increasing body of research suggesting that the innate immune system of the CNS is important in disease progression, creating new opportunities for therapeutic targets. This interview took place during the European Academy of Neurology 2021 congress.

Transcript (edited for clarity)

What seems to be most important in multiple sclerosis management is the control of the ongoing progression of the disease. What we have succeeded to do so far with all the DMTs we use is to control the relapses, the annual relapse of the MS patients, and of course control the disease activity. However, no matter how much easy or how much successful we’re going to be in doing so, it seems that our patients in the long term, they keep on being progressively disabled...

What seems to be most important in multiple sclerosis management is the control of the ongoing progression of the disease. What we have succeeded to do so far with all the DMTs we use is to control the relapses, the annual relapse of the MS patients, and of course control the disease activity. However, no matter how much easy or how much successful we’re going to be in doing so, it seems that our patients in the long term, they keep on being progressively disabled. So this indicates that the part of the immune system, we are able to control with DMTs. Although they help us to control relapses, although they help us also to control the underlying disease activity as indicated in the MRI scans, we are not able still to control the progression of the disease.

Thus indicating again, that the progression of the disease is not strictly related to the adaptive immune system activation. And there is growing evidence indicating that it is the innate immune system of the central nervous system. In other words, the microglia, the macrophages of the central nervous system, which seems to play a major role in this ongoing progression of disability and the ongoing, due to the ongoing neurodegeneration and synaptopathy, which is also a very typical finding in the ongoing process of the disease in the CNS.

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