Center for Brain Research, Medical University of Vienna, Spitalgasse 4, A-1090 Wien, Austria.
J Neurol Sci. 2011 Jul 15;306(1-2):167-9. doi: 10.1016/j.jns.2010.07.023. Epub 2010 Aug 16.
Many new therapies have become available for multiple sclerosis patients during the last decade. They are mainly effective in the early relapsing stage of the disease. Despite this undisputed progress, there are still major deficits in the treatment of the patients. Effective anti-inflammatory treatments profoundly decrease disease activity, although this may occur on the expense of a partially impaired immune surveillance of the central nervous system. Furthermore, the clinical outcome of recent trials does not always meet the expectations of the neuroimmunological community. This suggests that preclinical testing in experimental models, although useful and necessary, has its limitations. For treatment of the progressive stage of the disease blood brain barrier penetration of drugs appears to be one crucial issue. Additionally, little is known on the immunological mechanisms of slow burning inflammation present in the brain of patients with progressive MS. Finally, it is suggested that neuroprotective strategies, which target mitochondrial injury and its downstream effects on neurons and axons are promising future therapeutic options.
在过去的十年中，许多新的疗法已经可用于多发性硬化症患者。它们主要在疾病的早期复发阶段有效。尽管取得了无可争议的进展，但在患者的治疗方面仍存在重大缺陷。有效的抗炎治疗可显著降低疾病活动度，尽管这可能会以中枢神经系统免疫监视部分受损为代价。此外，最近试验的临床结果并不总是符合神经免疫学界的期望。这表明，实验模型中的临床前测试虽然有用且必要，但也有其局限性。对于疾病进展阶段的治疗，药物穿透血脑屏障似乎是一个关键问题。此外，对于进展性多发性硬化症患者大脑中存在的缓慢燃烧炎症的免疫机制知之甚少。最后，有人提出，针对线粒体损伤及其对神经元和轴突下游影响的神经保护策略是很有前途的未来治疗选择。
