AAN 2023 | Understanding of the early disease processes in MS

Augusto A. Miravalle, MD, FAAN, University of Colorado School of Medicine, Aurora, CO, discusses two key processes that occur in multiple sclerosis (MS) and their interplay with each other. The first process is acute inflammation, where there is a loss of peripheral tolerance and autoimmune or auto-reactive immune cells are not deactivated. Epstein-Barr virus is considered an external trigger in this process. The activated cells undergo amplification and peripheral proliferation in the lymph nodes, with T-cells and B-cells playing crucial roles. B-cells act as antigen-presenting cells and help amplify the immune response. The second process is chronic smoldering inflammation, which involves the activation of cells within the central nervous system (CNS), particularly microglial cells. These cells may contribute to antigen presentation or the amplification of the immune response in the CNS. Understanding these processes is essential for gaining insights into the pathophysiology of MS. This interview took place at the American Academy of Neurology Annual Meeting 2023 in Boston, MA.

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