ORLANDO, Florida — Despite all the evidence to the contrary — and maybe even common sense — there’s some indication that multiple sclerosis (MS) is not primarily an autoimmune disease but instead is due to a neurodegenerative process that sparks an inflammatory response.
That point was argued by Peter Stys, MD, professor, neurology, University of Calgary, Alberta, Canada, during a debate here at the 5th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research In Multiple Sclerosis (ACTRIMS).
“MS is an autoimmune disease, but the question is, is MS primarily an autoimmune disease?” said Dr. Stys.
He squared off with Richard Ransohoff, MD, director, Neuroinflammation Research Center, Cleveland, Ohio, who argued the more “orthodox” view of MS.
Little Evidence
While he conceded there is “overwhelming evidence” that MS is an immunologic disorder, Dr. Stys pointed out several factors that raise doubts that the condition is primarily autoimmune. For one thing, in the earliest lesions, where there is profound myelination, there’s little evidence of any inflammatory response.
Dr. Stys pointed out that anti-inflammatory treatments don’t have much effect on the progressive phase of the disease and that some nonautoimmune diseases share pathologic and immunologic characteristics with MS.
The argument that because some patients with MS benefit from bone marrow transplants, MS must be an autoimmune disease doesn’t hold up, said Dr. Stys. He noted some “clearly genetically mediated neurometabolic disorders” that are “absolutely not primarily autoimmune” disorders are also helped by bone marrow transplants.
One example he used was adrenoleukodystrophy (ALD), a genetically inherited disorder in which patients lack a protein necessary to sustain myelin.
Dr. Stys believes that MS has 2 key contributing factors: dysimmunity and an underlying cytodegeneration. “In my mind, the underlying degeneration may well be primary,” he said.
He pointed out that the overwhelming majority of patients in MS studies have relapsing-remitting MS (RRMS). This research, he said, has taught scientists little about the progressive phase of the disease.
“Despite common sense, despite what’s obvious, maybe the real MS is primary progressive disease, and relapsing-remitting MS, which curiously represents the vast majority of our patients, is actually a reaction, a distraction if you will, to the primary root cause,” said Dr. Stys. “I don’t know the reason for that reaction, but I suspect it has to do with myelin being so antigenic.”
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