Molecular pathogenesis of multiple sclerosis

Multiple sclerosis (MS) is best understood as an inflammatory disease of th e central nervous system (CNS) white matter characterized by demyelination, focal T cell and macrophage infiltrates, axonal injury and loss of neurolo gical function. Our current understanding invokes proinflammatory cells and mediators that may be triggered by environmental factors to mediate diseas e in a genetically susceptible host. Five major themes which have been asso ciated with the pathogenesis of MS lesions will be discussed: (1) The diffe rential activation states of myelin-reactive T cells from MS patients vs. n ormal individuals, (2) the selective expression of chemokines, adhesion mol ecules and matrix metalloproteinases, (3) the proposed roles of the B7 cost imulatory pathway, (4) the proinflammatory cytokines and (5) the role of mo lecular mimicry. (C) 1999 Elsevier Science B,V. All rights reserved.