What are the possible causes of multiple sclerosis (MS)?

Some scientists believe multiple sclerosis (MS) may be caused by a lack of recognition of self versus nonself. It is possible that the immune system registers myelin as an antigen to attack. This is supported by the knowledge that B cells, T cells, and macrophages accumulate at the lesion site in MS.

What actually causes the myelin damage is still under investigation. Some researchers believe the T cells latch onto myelin and activate the macrophages, which then attack and eat the myelin. Others believe that B lymphocytes make antibodies that bind to myelin and guide macrophages to the target.

Perhaps two or more events are happening simultaneously in MS. Besides lack of recognition, it is also possible that MS is caused by a "screw-up" in the regulation of the immune system - that a helper-inducer subset of immune system cells, which help keep the immune response going, is numerically or functionally overrepresented. Or suppressor-inducer cells, which might tone down immune response, may be numerically or functionally underrepresented in MS.

A study reported in January 1987 by Dr. Howard L. Weiner, co-director of the Center for Neurologic Diseases at Harvard Medical School, showed that the suppressor cells are indeed underrepresented, at least in patients with progressive MS. Weiner discovered the patients had only about half the normal level of the subset T-4 suppressor-inducer cell.In October 1989 British researchers reported that Experimental allergic encephalomyelitis (EAE) was, indeed, related to "bad T-cells."Today, researchers have identified a new T cell, called T regs, which are different from the white blood cells believed to cause the attack in MS.

T regs are now being researched to see if they actually inhibit the immune response. A small study at Harvard's Brigham and Women's Hospital in Boston in 2004 compared T reg cells of 15 people with remitting-relapsing MS to the T regs of 21 people without MS. Although the T reg cell count was the same in each group, the T regs were significantly impaired in the group with MS.

A 2005 study of mice with EAE showed researchers could alter the course of disease progress by helping impaired T reg cells function. One treatment currently under investigation for people with relapsing and progressive MS is a vaccine called NeuroVax, from Immune Response Corporation. Researchers hope the vaccine, which uses protein fragments from T cells, will replenish T reg cells and halt or diminish immune system attacks.

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