Multipl Sklerozda İmmünolojik ve Nöropatolojik Gelişmeler Işığında Geleceğe Yönelik Yaklaşımlar

Abstract

Multipl Skleroz, santral sinir sistemi beyaz cevherinin inflamatuar hastalığıdır. Multipl Sklerozun etiyolojisinin halen tam olarak bilinmemesine karşılık bazı bulgular hastalığın patogenezinde immün sistemin ana rolüne işaret eder. Bu düşünce immunomodulatuar ve immuno-supresor tedavilerin hastalık aktivitesi üzerindeki faydalı etkileri ile desteklenir. Aktive myelin reaktif T hücreleri hastalıkta majör aracılardır. Ek olarak Multipl Skleroz immunopatolojisinde B hücrelerin muhtemel katkısının altı çizilmektedir. Multipl Skleroz plaklarında farklı patolojik paternlerin gösterilmesi, çeşitli mekanizmaların doku hasarına katkıda bulunabileceğine ve önde giden mekanizmanın hastalarda aynı olmayabileceğine işaret eder. Multipl Sklerozda mevcut olan hastalık modifiye edici tedavilerin açıkça faydalı etkileri vardır. Bununla beraber bu tedavilerden bazı hastalar diğerlerinden daha fazla fayda görmektedir. Multipl Skleroz patolojisi üzerine yapılan çalışmalarda farklı hastalarda heterojenite olduğu gösterildi. Plak patolojisindeki farklılıklar, gözlenen klinik hastalık gidişi ve ciddiyetindeki heterojeniteyi ve hastalarda tedaviye farklı yanıt alınmasını açıklayabilir. Multipl Sklerozlu hastalarda patolojiye özgü tedavi seçenekleri daha faydalı olabilir ancak yaşayan hastalarda plak alt grubunu belirlemek halen çok zor olmaktadır. Gelecekte, hastalarda patolojik alt tiplerin belirlenmesi ile spesifik patolojik özelliği olan hastalara spesifik tedaviler uygulanabilecektir.

Keywords

• Multipl skleroz; immünoloji;
• patoloji
• , multi

Future Approaches on Multiple Sclerosis Towards the Immunological and Neuropathological Advances

Abstract

Multiple Sclerosis is an inflammatory disease of central nervous system white matter. Although the etiology of multiple sclerosis is still unknown, many findings point a central role for the immune system in the pathogenesis of disease. This is supported by the beneficial effect of immunomodulatory and immunosuppressive therapy on disease activity. Activated myelin reactive T cells as major mediators of the disease. In addition possible contribution of B cells to multiple sclerosis immunopathology has been outlined. The demonstration of distinct pathologic patterns in multiple sclerosis plaques suggests that several mechanisms may contribute to tissue injury and that the prevailing mechanism may not be the same across patients. Existing disease modifying treatments for multiple sclerosis clearly have beneficial effects. However some patients benefiting more than others. Studies on the pathology of multiple sclerosis have demonstrated that there is heterogeneity between different multiple sclerosis patients. Differences in plaque’s pathology may explain the observed heterogeneity of clinical disease course and severity and the different response to therapy. Pathology specific treatment options in multiple sclerosis patients may be more beneficial, but identification of plaques subtype in living patiens is still difficult. In the future with identification of specific pathological subtypes in living patients which will require the identification of specific markers, subsequent specific therapies would be applicable in the patients with the specific pathological characteristics.

Keywords

• Multiple sclerosis
• immunology; pathology
• , pathology

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