Bieke Broux describes the complexity of the immune system and of the disruptions that cause MS to develop and progress. Although immune cells can be roughly divided into three categories – T cells, B cells and myeloid cells – it has become apparent that each of these categories includes multiple sub-populations, some of which are pro-inflammatory while others reduce and control inflammation. In this “jungle” of cells, it can be very difficult to precisely determine the activity of each subgroup of immune cells and investigate their positive or auto-immune (negative) effects. The discovery of regulating T cells, however, has raised hopes. Not only are they able to regulate the entire immune system; they can also have a reparative effect on established demyelinated lesions. This could be a starting point for a form of cell therapy in which a patient’s T cells were collected and selected, then made to proliferate and activated before being reinjected into the same patient. Although there is still a long way to go before this can happen, it represents a genuine source of hope. 

Moreover, most of the current MS treatments do not penetrate the brain and do not have any direct effect on the immune cells that are already present there. Lemtrada, Tecfidera, Copaxone, Aubagio, beta interferons, Tysabri, Ocrevus, Kesimpta and others have no proven significant activity inside the brain. Only Mavenclad and the sphingosine 1-phosphate receptor modulators (Gilenya, Zeposia, Ponvory, Mayzent) are able to penetrate the nervous system and directly play a beneficial role. It is therefore especially important that we try to improve the transfer of drugs to the brain. One potential method may be the use of nanodrugs and of the nasal route, i.e., the olfactory membrane, which is far more permeable than the blood-brain barrier. Anne de Rieux discusses her current research in this area.

Both articles provide direct insight into the state-of-the-art research performed in Belgium thanks to your support and loyalty.

Happy reading!