Multipla skleroza: novi aspekt imunopatogeneze

Multiple sclerosis (MS) is a multicomponent disease characterized by inflammation, neurodegeneration, and cancellation of the central nervous system recovery mechanisms. The cause of MS is still unknown, but it is undeniable that genetic, environmental and immune factors are involved in the etiopathogenesis of this complex and heterogeneous disease. From the aspect of im-munopathogenesis, until recently the opinion prevailed that autoreactive T lymphocytes played a major role, the activation of which is a key step in MS. The knowledge of the effector and regulatory roles of B cells supports a new concept of MS immunopathogenesis that is based on the highly complex interaction of T and B cells, with B cells actively participating in cellular immunity by directing the intensity and quality of cellular immune response. The mechanisms of B cell activity in MS immunopathogenesis are multiple and include antigen presentation and T cell costimulation, cytokine secretion, antibody synthesis, and formation of ectopic lymphoid B cell aggregates in the intrameningeal spaces. The importance of B cells has been confirmed by modern therapeutic options for the treatment of MS.Multipla skleroza (MS) je multikomponentna bolest koju karakterizira upala, neurodegeneracija i otkazivanje mehanizama za obnavljanje središnjega živčanog sustava. Uzrok MS još uvijek je nepoznat, ali je nedvojbeno da su genetski, okolišni i imuni čimbenici uključeni u etiopatogenezu ove složene i heterogene bolesti. S aspekta imunopatogeneze, donedavno je prevladavalo mišljenje da glavnu ulogu imaju autoreaktivni T limfociti aktiviranje kojih predstavlja ključni korak u nastanku MS. Saznanja o efektorskim i regulatornim ulogama B stanica podupiru novi koncept imunopatogeneze MS koji se temelji na vrlo kompleksnoj interakciji T i B stanica, s tim da B stanice aktivno sudjeluju u staničnoj imunosti tako što usmjeravaju intenzitet i kvalitetu staničnog imunog odgovora. Mehanizmi djelovanja B stanica u imunopatogenezi MS su višestruki te uključuju prezentaciju antigena i kostimulaciju T stanica, lučenje citokina, sintezu protutijela i formiranje ektopičnih limfoidnih B staničnih agregata u intrameningealnim prostorima. Značenje B stanica u imunopatogenezi MS potvrđuju i suvremene terapijske opcije za liječenje MS