Cited by 1,033Multiple Sclerosis Research StudiesNeuroinflammation and Neurodegeneration MechanismsPeripheral Neuropathies and Disorders

Progressive multiple sclerosis: pathology and pathogenesis

Lassmann, Hans, van Horssen, Jack, Mahad, Don·2012·Nature Reviews Neurology

Abstract

Major progress has been made during the past three decades in understanding the inflammatory process and pathogenetic mechanisms in multiple sclerosis (MS). Consequently, effective anti-inflammatory and immunomodulatory treatments are now available for patients in the relapsing-remitting stage of the disease. This Review summarizes studies on the pathology of progressive MS and discusses new data on the mechanisms underlying its pathogenesis. In progressive MS, as in relapsing-remitting MS, active tissue injury is associated with inflammation, but the inflammatory response in the progressive phase occurs at least partly behind the blood-brain barrier, which makes it more difficult to treat. The other mechanisms that drive disease in patients with primary or secondary progressive MS are currently unresolved, although oxidative stress resulting in mitochondrial injury might participate in the induction of demyelination and neurodegeneration in both the relapsing-remitting and progressive stages of MS. Oxidative stress seems to be mainly driven by inflammation and oxidative burst in microglia; however, its effects might be amplified in patients with progressive MS by age-dependent iron accumulation in the brain and by mitochondrial gene deletions, triggered by the chronic inflammatory process.

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Registry

Crossref · 10.1038/nrneurol.2012.168

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  • A defect in myelination signaling has been detected in PMS patients.

    “Accordingly, a defect in myelination signaling has been detected in PMS patients (Lassmann et al. 2012; Nicaise et al. 2017, 2019).”
  • As MS shifts towards a more progressive phase, microglia are once more involved in the slow expansion of chronic active lesions.

    “As MS shifts towards a more progressive phase, microglia are once more involved in the slow expansion of chronic active lesions54.”
  • An inflammatory milieu might cause excessive breakdown of oligodendrocytes associated with demyelination, releasing additional redox-active ferrous iron into the brain and further enhancing oxidative stress.

    “Such an inflammatory milieu might cause the excessive breakdown of oligodendrocytes associated with demyelination, releasing additional redox-active ferrous iron into the brain and further enhancing oxidative stress.158”
  • There are two different types of inflammation in MS: the first is the initial response to the disease, involving infiltration of CD4+ and CD8+ T-cells and robust microglial activation; the second occurs due to myelin destruction, stimulating secondary recruitment of T cells, B cells and macrophages.

    “Hereupon, there are two different types of inflammation in MS. The first consists in the initial response to the disease, involving the infiltration of CD4+ and CD8+ T-cells and robust microglial activation; the second occurs due to the myelin destruction, stimulating the secondary recruitment of T cells, B cells and macrophages (Lassmann et al., 2012).”

    From The impact of microglial activation on blood-brain barrier in brain diseases (2014) · cites this paper as Lassmann et al., 2012

  • MS is a chronic, progressive and neuroinflammatory demyelinating disease of the CNS, which involves an energy deficit, tissue remodeling, microglial activation and loss of BBB integrity.

    “Multiple sclerosis is a chronic, progressive and neuroinflammatory demyelinating disease of the CNS, which involves an energy deficit, tissue remodeling, microglial activation and loss of BBB integrity (Lassmann et al., 2012).”

    From The impact of microglial activation on blood-brain barrier in brain diseases (2014) · cites this paper as Lassmann et al., 2012

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Authors
Lassmann, H., van Horssen, J., & Mahad, D.
Affiliations
  • Medical University of Vienna (AT)
  • Newcastle University (GB)
Corresponding author
Lassmann, Hans
Venue
Nature Reviews Neurology
Published
2012-09-25
Volume
8
Issue
11
Pages
647-656
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
OpenAlex
W2162978315
Cited by
1,033
References
129
Citations by year
2026: 49 · 2025: 67 · 2024: 88 · 2023: 78 · 2022: 77 · 2021: 80 · 2020: 89 · 2019: 74 · 2018: 88 · 2017: 80 · 2016: 70 · 2015: 77 · 2014: 71 · 2013: 41 · 2012: 3
FWCI
8.98
Type
journal article
Language
en
Open access
closed
Locations
  • Nature Reviews Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • Wellcome Trust (WT078415MA)
  • Medizinische Universität Wien
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
  • Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
Keywords
progressive multiple sclerosis, pathogenesis, oxidative stress, mitochondrial injury, demyelination, neurodegeneration, iron accumulation, blood-brain barrier, inflammation, relapsing-remitting multiple sclerosis, primary progressive multiple sclerosis, secondary progressive multiple sclerosis
MeSH terms
Animals, Humans, Immunologic Factors, Mitochondria, Oxidative Stress, Disease Progression, Multiple Sclerosis, Chronic Progressive

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