title: MS Forum/MS Over the Past 17 Years.
abstract: At its final meeting, the MS Forum Executive Committee reviewed highlights of where things stood prior to the immunomodulatory era, and how things have evolved subsequently. What the future might hold was discussed in a second session. Prior to 1990: Genetic predisposition to multiple sclerosis (MS), as determined by human leukocyte antigen expression, was established and an environmental trigger (Epstein-Barr virus?) was suspected, as was lack of sunshine. Substantial evidence for activated T-cells as relapse initiators had accumulated. Defective regulatory cell function that correlated with disease activity was shown. Adrenocorticotropic hormone lessened relapse severity as did its steroid replacement. A trial of cyclosporine, a T-cell inhibitor, in progressive MS failed. The drug, not the patients chosen, was blamed. 1990-2010: Approval of interferon-beta (IFNB)-1b was followed promptly by IFNB-1a, glatiramer acetate, mitoxantrone and then by natalizumab and fingolimod. All reduce MS attack frequency and new lesion accumulation. None have reduced disability progression in progressive MS. Brain atrophy, cognitive loss and axonal interruption in progressive MS depend on innate immune system activation rather than on T-cells. New strategies are needed.
authors.affiliation: Barry GW Arnason Department of Neurology Surgery Brain Research Institutes 5812 South Ellis Avenue SBRI J209 (MC 2030) Chicago, IL 60637 USA Tel: +1 773 702 6386 Fax: +1 773 702 9060 E-mail: barnason@neurology.bsd.uchicago.edu.
authors.forename: Bgw
authors.initials: B
authors.lastname: Arnason
mesh_terms: D000068876:Fingolimod Hydrochloride; D000068717:Glatiramer Acetate; D006801:Humans; D000068556:Interferon beta-1a; D000068576:Interferon beta-1b; D016899:Interferon-beta; D008942:Mitoxantrone / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000139:chemically induced; D012008:Recurrence
chemical_list: D000068576:Interferon beta-1b; D000068717:Glatiramer Acetate; D016899:Interferon-beta; D008942:Mitoxantrone; D000068876:Fingolimod Hydrochloride; D000068556:Interferon beta-1a