Sorbonne University, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau (ICM), Groupe Hospitalier APHP-Sorbonne University, Paris, France; Neurology Department Pitié-Salpêtrière, Groupe Hospitalier APHP-Sorbonne University, Paris, France.
Sorbonne University, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Institut du Cerveau (ICM), Groupe Hospitalier APHP-Sorbonne University, Paris, France.
Lancet Neurol. 2020 Aug;19(8):678-688. doi: 10.1016/S1474-4422(20)30140-X.
The treatment of multiple sclerosis has been transformed by the successful development of immunotherapies that efficiently reduce disease activity and related clinical relapses during the relapsing-remitting phase of the disease. However, the prevention of disability progression, which is due to axonal and neuronal damage and loss, has yet to be achieved and is therapeutically challenging, particularly during the progressive phase of the disease. One strategy to counteract neurodegeneration is to promote neuroprotection by enhancing myelin regeneration, hence restoring nerve conduction and metabolic support to the axon. Animal studies have provided targets for interventions to improve brain and spinal cord remyelination, paving the way for the translation of this research to humans. From these initial and promising forays, further problems have emerged, including questions on how best to design these clinical trials and appropriately measure the outcomes. Solving these problems will need additional work before efficacious pro-remyelination therapies will be ready for people with multiple sclerosis, but there is a real sense of hope that researchers are getting closer to a successful therapy.
多发性硬化症的治疗已经发生了革命性的变化,免疫疗法的成功开发有效地降低了疾病活动度,并减少了疾病缓解复发期的相关临床复发。然而,轴突和神经元损伤和丢失导致的残疾进展仍然难以预防,这在疾病的进展期尤其具有挑战性。对抗神经退行性变的一种策略是通过增强髓鞘再生来促进神经保护,从而恢复轴突的神经传导和代谢支持。动物研究为干预措施提供了目标,以改善脑和脊髓的髓鞘再生,为将这项研究转化为人类奠定了基础。从这些初步的、有希望的尝试中,又出现了进一步的问题,包括如何最好地设计这些临床试验以及如何适当衡量结果。在多发性硬化症患者能够接受有效的促髓鞘再生治疗之前,还需要做更多的工作来解决这些问题,但研究人员确实越来越有希望取得成功的治疗效果。