The good, the bad and the ugly. Macrophages/microglia with a focus on myelin repair.

A feature of most neurological disorders is demyelination, whereby myelin is lost from axons partly through stripping by macrophages/microglia. Spontaneous remyelination by oligodendrocytes that mature from oligodendrocyte precursor cells occurs following demyelination, even in the chronic inflammatory disorder of the central nervous system, multiple sclerosis. If remyelination does not occur or is prevented, then one consequence besides the loss of saltatory nerve conduction is the degeneration of axons. Thus, promoting remyelination is a desired result. In this article, we review the data that despite a reputation as "bad" factors for CNS wellbeing, including the promotion of neuroinflammation and demyelination, some aspects of macrophages/microglia activity are indeed "good", and can engender repair from the "ugly" phenomenon of demyelination. We discuss factors that help promote the benefits of macrophages/microglia activity for remyelination.