Remyelination in multiple sclerosis: realizing a long-standing challenge

Multiple sclerosis (MS) is a multifaceted disease, in which an inflammatory autoimmune attack on the myelin in the central nervous system (CNS) leads to extensive demyelination and subsequent axonal pathology. The challenge for MS therapy is to combine effective immunomodulatory therapies with novel neuroprotective approaches that promote repair, in particular remyelination, beyond its limited spontaneous extent. Cumulative findings indicate that immunomodulatory treatments can induce neuroprotective outcomes and provide a supportive milieu for repair processes. Growing understanding of MS pathology together with biotechnological advances has resulted in promising strategies such as inhibitory molecules, monoclonal antibodies and cell therapies. Several candidates that have shown significant effects on the oligodendrocyte population and/or myelin synthesis in animal models are currently or soon to be tested in clinical trials.