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首页> 外文期刊>Journal of neurology >Modulating processes within the central nervous system is central to therapeutic control of multiple sclerosis.
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Modulating processes within the central nervous system is central to therapeutic control of multiple sclerosis.

机译：中枢神经系统内的调节过程对多发性硬化症的治疗控制至关重要。

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Historically considered to be an autoimmune demyelinating disease, multiple sclerosis is now recognized to be characterized by significant axonal and neuronal pathology. Addressing this neurodegenerative component of the disease is an important treatment objective, since axonal injury is believed to underlie the accumulation of disability and disease progression. The precise relationship between the inflammatory and neurodegenerative components in multiple sclerosis remains poorly elucidated, although neurodegeneration appears to be at least partially independent from neuroinflammation. The mechanisms underlying axonal injury appear complex and are likely to be multifactorial. Specific treatment strategies need to be developed that act within the central nervous system to prevent neurodegeneration and need to be provided from the earliest stages of disease. It is likely that immunomodulatory treatments acting purely in the periphery will provide only indirect and not direct neuroprotection. A promising approach is to enhance neuroprotective autoimmunity inside the brain, believed to be mediated, at least in part, by the release of neurotrophic factors within the nervous system from infiltrating immune cells. Such a beneficial process would be inhibited by a non-selective immunosuppressive strategy. In summary, treatments of multiple sclerosis should take into account the heterogeneous pathophysiology of the disease. The pathogenic process in the central nervous system itself should be the major focus in multiple sclerosis therapy in order to protect against demyelination and axonal loss and to promote remyelination and regeneration directly in the target tissue, independently of peripheral immune status. In conclusion, selective treatment strategies aimed at preventing axonal injury within the central nervous system are required to complement existing, peripherally acting treatments targeting the immune system.
机译：历史上被认为是一种自身免疫性脱髓鞘疾病，现已认识到多发性硬化症的特征在于明显的轴突和神经元病理。解决该疾病的这种神经退行性成分是重要的治疗目标，因为据信轴突损伤是残障和疾病发展的基础。尽管神经变性似乎至少部分独立于神经炎症，但多发性硬化症中炎症和神经退行性成分之间的确切关系仍然难以阐明。轴突损伤的潜在机制似乎很复杂，并且可能是多因素的。需要开发在中枢神经系统内起作用的特定治疗策略，以防止神经退行性变，并且需要在疾病的最早阶段提供。纯粹在外围起作用的免疫调节治疗可能仅提供间接而非直接的神经保护作用。一种有前途的方法是增强脑内的神经保护性自身免疫，据信这至少部分是由浸润的免疫细胞在神经系统内释放神经营养因子介导的。这样的有益过程将被非选择性免疫抑制策略所抑制。总之，多发性硬化症的治疗应考虑该疾病的异质病理生理。中枢神经系统本身的致病过程应成为多发性硬化症治疗的主要重点，以防止脱髓鞘和轴突丢失，并直接在靶组织中促进髓鞘再生和再生，而与周围免疫状态无关。总之，需要有针对性地预防中枢神经系统内轴突损伤的选择性治疗策略，以补充针对免疫系统的现有外围作用治疗。

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