Multiple sclerosis is a neurodegenerative disease of the central nervous system. It is a white matter disease, in which myelin sheaths surrounding the axons of neurons are destroyed. Myelin sheath is important in isolating axon from the environment. It works like the plastic wrapped around your electrical cords. Without these myelin sheaths, the electrical impulse will not be as conductive as before. In MS patients, the myelin destruction is found in the cerebellum, the brain stem, the spinal cord, and optical nerves. Symptoms of MS depend on the part of the brain or spinal cord the disease attacks, even though there are no symptoms that are unique to MS. Generally, MS patients feel fatigue, having difficulty walking, stiffness and muscular spasms. They may also have bladder problem, memory problem and pain or unpleasant sensations.
- Functions: regulates migration of activated immune cells by activating S1P G-protein coupled receptors, leading to increased sequestering of lymphocytes influx into the lymph node.
- FTY720: approved for treating for relapse remitting MS; phase II clinical trial showed suppression of relapse.
- Natalizumab (anti-a4b1 antibody)/Tyzabri
- Functions: blocking the a4b1 integrin expressed on activated lymphocytes, which a4b1 integrin is required to interact with VCAM-1 on endothelial cells for the activated cells to cross vasculature to the CNS.
- Alemtuzumab (anti-CD52 antibody)
- Functions: blocking CD-52 expressed on immune cells. Thus, it will deplete immune cells from circulation.
- Anti-CD20 (Rituximab, Ocrelizumab)
- Functions: blocking the CD-20 expressed on B cell, thus it will stop maturation of B cell into antibody secreting plasma cells.
- Functions: purine nucleoside that impairs synthesis and repair of DNA.
- Cladribine: reduce relapse rate; but has side effects: neutropenia, thomboctopenia, panctopenia and increased infection rate. Clinical trials are halted.
For full list of immune-modulating treatments available for MS, click here