Australian study helps to better understand MS disease

A new study published by Dr. John Prineas and colleagues at Australia’s University of Sydney provides new information that may help to refine our understanding of the MS disease process (Annals of Neurology, 2004;55: 458-468). Their work -- using fresh brain samples from a young person who, unusually, died after a particularly severe MS attack -- showed that the primary pathology in this individual’s brain was a killing-off of myelin-making cells, there being little or no evidence of an immune attack. This is contrary to the generally accepted evidence of immune attack prior to damage to myelin and the oligodendrocytes that make and maintain myelin.

With this evidence in hand, the researchers searched a bank of stored MS brain samples and discovered that while the majority showed clear-cut immune pathology, a portion of the stored samples also showed myelin and oligodendrocyte damage in the absence of immune problems. This work was supported in part by the National Multiple Sclerosis Society.  

These new data need to be expanded and confirmed in other studies. While this study raises some intriguing questions about the MS disease process and how it begins, there is no doubt that the disease involves immune pathology. It is not clear if Dr. Prineas’s findings represent rare and unusual cases of MS -- potentially a special sub-type of disease -- or if they indicate that in ALL types of MS, the disease begins with a dying off of myelin and oligodendrocytes in ways not yet understood, which is then followed by, not preceded by, problems with immune responses.

Answers to these questions may come from the National MS Society’s MS Lesion Project (an international collaboration led by Dr. Claudia Lucchinetti at the Mayo Clinic), on which Dr. Prineas serves as a special advisor, and from ongoing work in other laboratories. At issue could be a better understanding of disease subtypes and disease pathology, and perhaps, a revolutionary change in our view of the disease process, which could have implications for diagnosis, treatment and prognosis.