EAN 2024 | Understanding smoldering pathology in MS

Alicja Kalinowska, MD, PhD, Poznan University of Medical Sciences, Poznań, Poland, explains the difference between smoldering multiple sclerosis (MS) and progressive MS. A smoldering lesion involves ongoing immune activity in the macrophages surrounding the center of the plaque. However, smoldering MS is a term that goes beyond smoldering lesions, describing a diffuse smoldering pathological process thought to drive progressive accumulation of disability in MS in the absence of clinical relapses. Other processes are involved in smoldering MS, including cortical lesions, spinal cord degeneration, and B-cell meningeal infiltration, highlighting the complexity of MS. These processes may be correlated to progression independent of relapse activity (PIRA). Prof. Kalinowska highlights how PIRA is challenging to target using the current MS therapies and notes the promise of BTK inhibitors to act on both innate and adaptive immune cells that are linked to the pathology of MS. BTK inhibitors are currently being trialed for the treatment of MS. Prof. Kalinowska concludes that there is a need to establish new terms and definitions in this therapeutic area. This interview took place at the European Academy of Neurology (EAN) Annual Meeting 2024 in Helsinki, Finland.

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