More MS news articles for May 2002

Immunology for the Rest of Us

InsideMS, Winter 2002, Vol. 20, Issue 1
by Martha King

You are not your illness. If you live with MS, this is a cardinal concept. But for most people, MS is a foreign country at first, with its own language. Just learning to pronounce “multiple sclerosis” is a task.

At the Society, we say, “knowledge is power,” and consider learning to be a wise way to cope. Most doctors offer people with MS treatment choices or say things like “I’d like to try you on x because ... ” People who volunteer for clinical trials must give their “informed” consent. Without some basic knowledge, how can you make a choice, be informed, or assess risks and benefits?

Even the beginning is complicated

We’re told MS is almost certainly an “autoimmune” disease, the kind of disease in which a person’s immune system attacks portions of the person’s own self. In MS, the target is a fatty protein called myelin that insulates nerve fibers (or axons). While this takes place, there’s inflammation in the brain or spinal cord. Later, two things may or may not happen: limited myelin repair, called remyelination, and scarring where healthy myelin once was.

Both inflammation and scarring lead to MS symptoms, but the relationship between them isn’t neat or predictable. Inflammation comes and goes silently—or may accompany a major exacerbation, or MS attack. Scarring is also silent and it is permanent. Remyelination means the myelin regrows, which often leads to recovery of some lost abilities. Natural remyelination is often incomplete and over the years tends to stall altogether. Some recovered functions may be due not to myelin repair but to the fact that other nerve cells have taken over the work done by the damaged ones. All three processes—inflammation, de- and remyelination, and scarring—offer opportunities for therapy.

In an autoimmune disease, the immune system attacks the healthy self instead of aliens or cancerous oddballs. It’s friendly fire, in military terms. Autoimmune diseases include rare ills like lupus, and more common ones, like rheumatoid arthritis. Even arteriosclerosis now appears to have autoimmune aspects.

Vast, complicated, only partly understood

That’s the immune system. Scientists learned to activate some of it with vaccinations, a major medical breakthrough in the 19th century. Today, scientists can suppress some of it, which makes organ transplantation possible, and boost or tamp down certain functions. Understanding it in full is the ultimate goal of international research in fields ranging from fertility, through cancer and AIDS, to animal health.

Not surprisingly, the immune system looms large in our minds. We’re constantly advised to make our immune systems healthy or strong. But for people with an autoimmune disease, a strong immune system might not be an advantage. A “strong” immune system is sensitized, alert, quick to react. In MS and other autoimmune diseases; some part of the immune system has lost tolerance for a healthy tissue. It is too alert, and it attacks aggressively when it should stay calm.

© 2002 The National Multiple Sclerosis Society