News for the Multiple Sclerosis Community

Rethinking the primary problem in MS

With the recent studies showing iron deposits in MS brains, it seems to me that we should be re-thinking what the primary problem in MS is. Currently, we think of MS as an autoimmune disorder, and consequently the majority of research is focused on that. Should we not, instead, start thinking of MS primarily as a disorder of the BBB (Blood Brain Barrier)? Damage to the brian and CNS by iron and the body's own (killer) immune cells are a secondary consequence of the BBB breakdown. If the BBB functioned properly and these agents were not able to enter the brain/CNS, myelin destruction seen in MS would not be an issue, correct? So why are we all so focused on the autoimmune problem? Is that not secondary to the BBB problem? Sure, there is some research being done on the BBB problem (hence things like Antegren), but it's such a a small fraction.

art's picture
I've been wondering this since my diagnosis. It struck me as odd that one of the primary tools in diagnosis is a gadolinium enhanced MRI that shows where there is breakdown in the BBB, yet almost no research is done looking at BBB breakdown mechanisms and consequences. My guess is that the big focus on autoimmune factors stems from large amounts of money dumped into immune research due to AIDS funding - and researchers go where the money is, its not the other way around. Thus, immune response seen in MS + dollars for autoimmunity research = many hypothesis that MS may be autoimmune. We need to reboot the MS research system and start over with a logical perspective, not an historical one.
I think it's possible the damage to myelin seen in MS may be caused by immune reactions to any of some number of possible antigens crossing the barrier in close proximity to it. Food antigens, infections, anything foreign that has DNA and can react with the myelin, making it appear foreign to immune cells which also cross the barrier at that point. The damage is often reversible. Many MS sufferers, including CP and SP, know that there are occasional moments of "lucidity" when the faculties lost (balance, walking, coordination, fine motor control, skin sensations, strength), return to near their original state. The problem is that whatever puts the body in this state is fleeting, and not maintained over a full day, or in some cases even for an hour. Until the core of the nerve is damaged the myelin is repairable with full recovery. Maybe the ability to do this repair has some lifetime limit that, once exceeded, puts a patient in the progressive category. Perhaps some have very little of this capability or their BBB breaches cover too much area and that's why they start off progressive. The fact that the faculties are lost again soon afterward may mean that the damage happens again to new myelin, perhaps only thinly applied, and perhaps the plaques are sites where repeated damage has occurred, thickening the myelin scars each time. LDN users and people who do a lot of exercise (like a body builder I know of who has MS) are aware that the repair process has something to do with their endorphin levels. In rehab this kind of health and stamina is built up via exercise which provokes the repair process.