Remyelination in multiple sclerosis: Pathology and treatment strategies

Abstract

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Remyelination is a remarkable regenerative process that occurs in the central nervous system; in MS patients it explains the spontaneous recovery often observed after relapses, especially in younger patients. For some reason, however, this remyelination capacity decreases with MS duration, leaving denuded axons behind. Myelin is indispensable not only for saltatory conduction, but also for the trophic support of axons, and therefore chronic demyelination might lead to irreversible axonal damage and consequent neurodegeneration. For better prognosis of MS, it is mandatory to elucidate the pathology underlying remyelination failure and to promote remyelination, in addition to identifying optimal disease-modifying therapies. For future personalized MS treatment, an evaluation of remyelination capacity in individual MS patients will be of great value. For this purpose, a clinically feasible method of assessing remyelination activity will be required, and very recently a new imaging modality named q-space myelin map imaging has been developed. Together with various candidate remyelination medicines under clinical development, these advances might lead to a novel MS treatment strategy in the near future.