Multiple sclerosis (MS) is a neurodegenerative disease in which misdirected, persistent activity of the immune system degrades the protective myelin sheaths of nerve axons. Historically, treatment of MS has relied on disease-modifying therapies that involve immunosuppression, such as targeting of the blood-brain barrier (BBB) to restrict lymphocyte movement. New therapeutic ideas in the development pipeline are instead designed to promote populations of myelin producing cells, oligodendrocytes, by exploiting their innate resilience to the stressors of MS or restoring their numbers. Given the significant advancements made in immunological disease understanding due to mathematical and computational modelling, we sought to develop a platform to (1) interrogate our understanding of the neuroimmunological mechanisms driving MS development and (2) examine the impact of different therapeutic strategies. To this end we propose a novel, open-source, agent-based model of lesion development in the CNS. Our model includes crucial populations of T cells, perivascular macrophages, and oligodendrocytes. We examine the sensitivity of the model to key parameters related to disease targets and conclude that lesion stabilisation can be achieved when targeting the integrated stress response of oligodendrocytes. Most significantly, complete prevention of lesion formation is observed when a combination of approved BBB-permeability targeting therapies and integrated-stress response targeting therapies is administered, suggesting the potential to strike a balance between a patient’s immune inflammation and their reparative capacity. Given that there are many open questions surrounding the etiology and treatment of MS, we hope that this malleable platform serves as a tool for experimentalists and modellers to test and generate further hypotheses regarding this disease.
Weatherley et al. (Tue,) studied this question.