Immune Attack: Primary or Secondary?
Peter Stys acknowledges that overwhelming evidence supports the traditional view of multiple sclerosis (MS) as an autoimmune inflammatory disorder, where T cells wrongly attack the myelin sheathing of neurons and damage the underlying axons. But what if MS first arises from an underlying primary degenerative disorder in the central nervous system (CNS), and is then made worse by a secondary immune attack in the brain, spinal cord, and eye?
If so, by concentrating on the inflammatory aspects, MS researchers may be neglecting an equally crucial disease component and missing out on potentially better treatments, suggests Peter Stys, a neurologist at University of Calgary, Canada. He and his co-authors recently made their case in an eight-page article in the July 2012 Nature Reviews Neuroscience (Stys et al., 2012). In talks, Stys projects a persuasive image of a train wreck to make his point by analogy.
MSDF invited Stys to kick off a discussion on the question, evidence, implications, and limitations of thinking about MS as a neurodegenerative disease at its root.
Do you agree with Stys that neurodegeneration might be the primary cause of MS? How might thinking about MS as a neurodegenerative disorder advance research and therapeutic strategies? What else can the autoimmune inflammatory disease model contribute? What experiments would you propose—even completely impossible ones—to elucidate the roles of inflammation and neurodegeneration in MS.