Lassmann Hans
Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Wien, Austria.
Rinsho Shinkeigaku. 2009 Nov;49(11):715-8. doi: 10.5692/clinicalneurol.49.715.
Therapeutic options for patients with progressive multiple sclerosis are currently limited. This is in part due to lack of knowledge regarding the pathophysiology of the disease in this stage. This review summarizes recent findings, showing profound differences in the pathology between relapsing and progressive MS. Pathological hallmarks in progressive MS are slow expansion of pre-existing white matter lesions, massive cortical demyelination and extensive diffuse injury of the normal appearing white matter. As in relapsing MS also in progressive MS active tissue injury is invariably associated with inflammation, but inflammation seems to be trapped behind a closed blood brain barrier. Different immunological mechanisms are involved in tissue destruction in progressive MS, but inflammation induced mitochondrial injury appears to be a dominant pathway. Future therapeutic interventions will have to target inflammation, which is compartmentalized in the central nervous system. In addition, however, neuroprotective therapies may be necessary.
目前，进行性多发性硬化症患者的治疗选择有限。部分原因是对该疾病此阶段的病理生理学缺乏了解。本综述总结了近期的研究结果，显示复发型和进行性多发性硬化症在病理学上存在显著差异。进行性多发性硬化症的病理特征是先前存在的白质病变缓慢扩展、大量皮质脱髓鞘以及正常外观白质的广泛弥漫性损伤。与复发型多发性硬化症一样，进行性多发性硬化症中的活跃组织损伤也总是与炎症相关，但炎症似乎被困在封闭的血脑屏障之后。不同的免疫机制参与了进行性多发性硬化症中的组织破坏，但炎症诱导的线粒体损伤似乎是主要途径。未来的治疗干预将必须针对中枢神经系统中分隔的炎症。然而，此外可能还需要神经保护疗法。
