VIDEO: Lecture highlights role of inflammation in MS disease course, treatment

In this video perspective, Benjamin Segal, MD, discusses the Kenneth P. Johnson Memorial Lecture he delivered at the ACTRIMS virtual meeting.

Segal, the chair of neurology and director of the Neuroscience Research Institute at The Ohio State University Wexner Medical Center, reviewed the types of inflammation that cause relapsing-remitting MS vs. progressive MS “in terms of inflicting damage to the nervous system.” According to Segal, researchers have “a good grasp” on the types of inflammation that drive RRMS, but less is known about the pathways involved in progressive MS.

In his talk, he discussed the immunopathology of RRMS and progressive MS, highlighting “the unappreciated role” of certain leukocytes, including CD8 T cells and B cells. He also highlighted changes in the immune system that occur as people age.

“Could these changes in the immune system that occur with aging be responsible for changes in terms of the pathological mechanisms that then translate into different clinical courses?” he said.

According to Segal, it has been established that B cells contribute to damage in MS, “because B cell-depleting antibodies are therapeutic.” This connection between plasma cells and damage is not as well-established, though there are “some red flags” in the literature that show they may have an unexpected protective role. The take-home message is that better drugs may need to be developed for progressive MS.

“The drugs that we now use in MS, we believe, act mainly by blocking lymphocytes as opposed to myeloid cells and work in the periphery to prevent those cells from getting into the central nervous system,” Segal said. “With progressive MS, the inflammation is already there. ... We need drugs that get into the nervous system and also block these microglia. On the other hand, we should begin thinking about whether plasma cells may be protective in RRMS. If we create drugs that simulate those protective mechanisms, maybe that would be a new way for treating relapsing MS.”