The Heterogeneous Multiple Sclerosis Lesion: How Can We Assess and Modify a Degenerating Lesion?

Abstract

Multiple sclerosis (MS) is a heterogeneous disease of the central nervous system that is governed by neural tissue loss and dystrophy during its progressive phase, with complex reactive pathological cellular changes. The immune-mediated mechanisms that promulgate the demyelinating lesions during relapses of acute episodes are not characteristic of chronic lesions during progressive MS. This has limited our capacity to target the disease effectively as it evolves within the central nervous system white and gray matter, thereby leaving neurologists without effective options to manage individuals as they transition to a secondary progressive phase. The current review highlights the molecular and cellular sequelae that have been identified as cooperating with and/or contributing to neurodegeneration that characterizes individuals with progressive forms of MS. We emphasize the need for appropriate monitoring via known and novel molecular and imaging biomarkers that can accurately detect and predict progression for the purposes of newly designed clinical trials that can demonstrate the efficacy of neuroprotection and potentially neurorepair. To achieve neurorepair, we focus on the modifications required in the reactive cellular and extracellular milieu in order to enable endogenous cell growth as well as transplanted cells that can integrate and/or renew the degenerative MS plaque.

Characteristics of fibrin/fibrinogen degradation products in multiple sclerosis following SARS-CoV-2 infection

“…3 , Мельник В.С. 3 , Савчук О.М. Ключові слова: розсіяний склероз; інфекція SARS-CoV-2; фібриноген; D-димер; розчинні фібрин-мономерні комплекси…”

“…MS lesions are widely acknowledged to originate from an autoimmune process that affects the myelination of the neurons present in the CNS. This leads to the formation of demyelinated plaques, which cause injury to neurons and their axonal extensions [3]. Numerous studies have empha-sized the existence of relationship between the activation of the coagulation cascade and neuroinflammation, indicating that coagulation factors may play a more comprehensive role involving neurodegeneration and neuroinflammation in addition to being essential for the activation of the hemostatic cascade [4][5][6].…”