A Precision Framework for Restoring Remyelination in Chronic Multiple Sclerosis Lesions

Chronic multiple sclerosis (MS) lesions are characterized by persistent demyelination and a failure of endogenous repair mechanisms, particularly remyelination. Despite advances in immunomodulatory therapies, effective strategies targeting neural repair remain limited. This work introduces a precision conceptual framework aimed at restoring remyelination in chronic MS lesions by integrating immune modulation with targeted neural and glial reprogramming. The framework focuses on overcoming key biological barriers such as oligodendrocyte progenitor cell dysfunction, inhibitory lesion microenvironments, and chronic neuroinflammation. By emphasizing targeted, lesion-specific intervention strategies, this approach seeks to bridge the gap between immunological disease control and true neural repair. This framework may inform future translational research and therapeutic development for progressive and chronic forms of multiple scle rosis.