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BOX 1.1

Recent Research Advances with Far-Reaching Implications for People with MS

THERAPEUTIC DEVELOPMENTS

  • Development of the first therapies that can modify the course of MS. These therapies include the beta-interferons (Betseron, Rebif, and Avonex), anti-inflammatory agents that suppress cell migration into the central nervous system (CNS); and glatiramer acetate (Copaxone), a mixture of peptide fragments thought to act as a decoy for the immune system to spare myelin from further attack.

  • Development of neuroimaging techniques that allow much more sensitive detection of pathological changes associated with the MS disease process than was possible in the past

    • Allows noninvasive exploration of pathological changes in MS patients

    • Provides a tool to measure the effect of therapeutic interventions at an earlier stage than was previously possible

  • Discovery that neurologic function can fully recover after acute inflammation, despite persistent demyelination

  • Discovery of endogenous pluripotent neural stem cells and their potential to be used to repair damaged neural cells in the brain

  • Discovery of the therapeutic potential for neural, glial, and stem cell transplantation in the brain and spinal cord

  • Development of standardized methods for conducting clinical trials

  • Increased awareness of the need for objective evaluation of patient perspectives in health care assessment and clinical trials, and the incorporation of quality-of-life measures into research on MS

  • Introduction of rigorous evaluation of therapy and rehabilitation in MS patients

BASIC RESEARCH DISCOVERIES THAT ARE IMPORTANT FOR NEW THERAPEUTIC STRATEGIES IN MS

  • Recognition of involvement of axonal pathology in MS and its association with the development of disability

  • Characterization of the formation and function of the myelin sheath, including:

    • Discovery of the myelin cell lineage

    • Understanding of how demyelination interferes with nerve conduction

    • Discovery that a number of different cell types can remyelinate neurons

  • Molecular dissection of myelinated axons, leading to an understanding of mechanisms of electrical impulse conduction in normal myelinated axons and of the restoration of conduction in demyelinated axons



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