In this installment of the “Need to Know” column series, columnist Tamara Sellman takes an in-depth look into remyelination therapy.
What is remyelination?
Multiple sclerosis (MS) can be defined as the demyelination, or erosion, of the myelin coating of central nervous system neurons by a rogue immune system. This impairs their function, reducing the speed and precision of nerve signal delivery. Messaging delays can cause problems including vision loss, muscle incoordination, incontinence, and speech pathologies.
Remyelination describes the repair of myelin. A healthy brain can replace lost or damaged myelin if given time and opportunity. But for someone with MS, disease progression interferes with these efforts.
Remyelination therapy basics
Why remyelination therapy?
No cure for MS exists. Treatments aim to halt progression and relieve symptoms. Disability remains an expected outcome.
Remyelination therapy, ideally, could offset progression and potentially reverse disability for some.
The authors of the study “Remyelination Therapy in Multiple Sclerosis,” published in the journal Frontiers in Neurology, state:
“Neuronal loss correlates highly with clinical disability, highlighting the need for treatments that promote neuronal survival in both relapsing and progressive forms of MS. Experimental models of MS … have shown that preservation of myelin and remyelination of axons can increase neuronal survival.”
How does remyelination therapy work?
Remyelination can restore nerve function, prevent further damage, and reduce the risk for clinical disability. For example:
- Myelin regulation involves “running interference” for remyelination to take effect. Strategies include pharmacological modulation of signal pathways, cleaning up myelin debris, providing metabolic support for neurons, and inflammation control.
- Myelin repair and restoration enlists a “repair crew” to enter the neuron to patch or replace damaged myelin, restoring signal pathways so messages can be delivered without disruption in signal speed or quality.
- Improved measurement of remyelination in clinical trials can deliver proof of effective remyelination therapy.
Let’s take a closer look
Oligodendrocytes are responsible for the myelination of neurons. The process is dynamic, requiring these special cells to regulate myelin production in every neuron, then maintain it through oligodendrocyte progenitor cells (OPCs).
By themselves, neurons cannot regenerate independently, requiring OPCs to perform myelin repair.
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