Multiple Sclerosis: Therapeutic Strategies on the Horizon

Abstract

Multiple sclerosis (MS) is a chronic disease affecting the brain and the spinal cord. It is a chronic inflammatory demyelinating disease of the central nervous system. It is the leading cause of non-traumatic disability in young adults. The clinical course of the disease is quite variable, ranging from stable chronic disease to rapidly evolving debilitating disease. The pathogenesis of MS is not fully understood. Still, there has been a rapid shift in understanding the immune pathology of MS away from pure T cell-mediated disease to B cells and microglia/astrocytes having a vital role in the pathogenesis of MS. This has helped in the emergence of new therapies for management. Effective treatment of MS requires a multidisciplinary approach to manage acute attacks, prevent relapses and disease progression and treat the disabling symptoms associated with the disease. In this review, we discuss the pathogenesis of MS, management of acute relapses, disease-modifying therapies in MS, new drugs and drugs currently in trial for MS and the symptomatic treatment of MS. All language search was conducted on Google Scholar, PubMed, MEDLINE, and Embase till February 2022. The following search strings and medical subheadings (MeSH) were used: "Multiple Sclerosis", "Pathogenesis of MS", and "Disease-modifying therapies in MS". We explored literature on the pathogenic mechanisms behind MS, management of acute relapses, disease-modifying therapies in MS and symptomatic management.

Gut Microbes and Neuropathology: Is There a Causal Nexus?

“…MS is an autoimmune disorder associated with the demyelination of neurones in the brain and spinal cord [ 56 ]. The most common presentation shows a relapsing/remitting pattern, but some patients present with a more severe form of primary progressive disorder.…”

Sustainable Release of Propranolol Hydrochloride Laden with Biconjugated-Ufasomes Chitosan Hydrogel Attenuates Cisplatin-Induced Sciatic Nerve Damage in In Vitro/In Vivo Evaluation

“…The spinal cord microglia model demonstrated that propranolol treatment decreases interleukins’ production and frequency of spinal cord Th17 cells, enhancing MBP expression [ 55 , 198 ]. Furthermore, propranolol improved functional disability, tremors, and ataxia in multiple sclerosis, restoring MBP [ 199 , 200 ]. All these reports confirmed our results that propranolol administration along with cisplatin protects rats’ sensory and motor neuropathy, evidenced by enhancement of MBP expression.…”

The Diversity of Astrocyte Activation during Multiple Sclerosis: Potential Cellular Targets for Novel Disease Modifying Therapeutics

“…The current treatment for MS is based on three main objectives: the treatment of relapses, symptomatic control, and disease-modifying therapies (DMTs) which primarily target the adaptive immune system. Most of the available therapeutic options are focused on the relapsing-remitting form, while only ocrelizumab (a monoclonal antibody targeting CD20+ B cells) has been approved for the primary progressive disease [75,76].…”

“…The development of treatments targeting astrocytes constitutes a key goal of studying astrocytic subsets. In this context, the challenges are to elucidate the role of astrocytes in disease pathogenesis and design disease-specific therapies [75]. The characterization of the heterogeneous astrocyte subgroups, through the identification of sets of characteristic molecular markers for each subgroup, may provide a targeted approach in the pursuit of limiting the neurodegenerative changes associated with CNS inflammation.…”