NMR Research Unit, Queen Square Multiple Sclerosis Centre, University College London (UCL) Institute of Neurology, London, UK.
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, and IRCCS AOU San Martino-IST, Genoa, Italy.
Brain. 2021 Jul 28;144(6):1646-1654. doi: 10.1093/brain/awab025.
While multiple sclerosis can affect any part of the CNS, it does not do so evenly. In white matter it has long been recognized that lesions tend to occur around the ventricles, and grey matter lesions mainly accrue in the outermost (subpial) cortex. In cortical grey matter, neuronal loss is greater in the outermost layers. This cortical gradient has been replicated in vivo with magnetization transfer ratio and similar gradients in grey and white matter magnetization transfer ratio are seen around the ventricles, with the most severe abnormalities abutting the ventricular surface. The cause of these gradients remains uncertain, though soluble factors released from meningeal inflammation into the CSF has the most supporting evidence. In this Update, we review this 'surface-in' spatial distribution of multiple sclerosis abnormalities and consider the implications for understanding pathogenic mechanisms and treatments designed to slow or stop them.
虽然多发性硬化症可以影响中枢神经系统的任何部位，但它的影响并不均匀。在白质中，人们早就认识到病变往往发生在脑室周围，而灰质病变主要累积在外层（皮质下）。在皮质灰质中，最外层的神经元损失更大。这种皮质梯度已经在体内通过磁化转移率得到了复制，并且在脑室周围的灰质和白质磁化转移率中也观察到了类似的梯度，最严重的异常与脑室表面相邻。这些梯度的原因仍不确定，尽管脑膜炎症释放到脑脊液中的可溶性因子最有支持证据。在本更新中，我们回顾了多发性硬化症异常的这种“面向表面”的空间分布，并考虑了对理解发病机制和设计减缓或阻止其进展的治疗方法的影响。
