Immune Response in the Management of MS - Episode 3

Role of Inflammation in MS

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Regina Berkovich, MD, PhD, defines inflammation in multiple sclerosis and its role in MS pathogenesis.

Ahmed Z. Obeidat, MD, PhD: Dr Berkovich, I’m going to ask you a little about the word inflammation. If you look at the dictionary definition of inflammation, you get terms like red, swollen, and painful that are associated with inflammation, yet inflammation in MS [multiple sclerosis] isn’t that. It’s not painful, red, or swollen. What’s the translation? What’s inflammation in MS? How is it different from the usual word inflammation that people use regularly? What’s the role of it in the pathogenesis of multiple sclerosis?

Regina Berkovich, MD, PhD: If you refer to the old Latin classic definition of rubor, calor, and dolor, we may not see those in MS, although we don’t necessarily see the actual tissues in MS. If we were to have that opportunity, we would see that it has swelling, some edema, and the most important portion of inflammation, which is functio laesa, meaning impairment of function. Remember that impairment of function is a very fine and important classical additional feature of inflammation.

We may not appreciate the rubor and calor because we can’t see the inflammation in MS other than what we see in MRIs. We can’t see or appreciate the temperature of the tissue because it’s under the cranium. But we deal with the impairment of function. In this respect, Barry is absolutely right, that in MS, we’re not only dealing with the acute inflammation, which typically presents itself as MS relapse, gadolinium-enhancing lesions, or enlarging or new T2 lesions. We already have several markers of acute inflammation, but chronic inflammation is key. That explains why progression of MS is happening in between the relapses, and why even for patients who stop having relapses, or don’t have frequent relapses, and don’t have new lesions on MRI, they still deal with active inflammation because it continues to impair function. Therefore it promotes the further progression of the disease.

That inflammation may not be exactly the same as the early stages, but nevertheless, it’s still inflammation. It may be more compartmentalized in certain areas of the central nervous system, but that only makes it more important to be addressed.

Ahmed Z. Obeidat, MD, PhD: Perfect. Thank you very much. Bringing back some of the medical terms and tying them to MS is great. Yes, there could be redness, swelling, all of this, but we don’t see it as much because the brain and spinal cord are concealed organs that we can’t see. MRIs can help us look at the inflammation. Dr Hendin’s point on smoldering inflammation is also well taken. We’re going to be talking about this a little more as we talk about the future of MS treatment.

Transcript Edited for Clarity