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Nervenheilkunde 2010; 29(12): 820-824
DOI: 10.1055/s-0038-1628861
Schwabinger Neuro-Seminar
Schattauer GmbH

Was verursacht Multiple Sklerose?

What causes multiple sclerosis?
M. Paulig
1   Abteilung für Neurologie und klinische Neurophysiologie, Schön Klinik, München Schwabing
› Institutsangaben
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Publikationsverlauf

eingegangen am: 06. September 2010

angenommen am: 06. September 2010

Publikationsdatum:
31. Januar 2018 (online)

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Zusammenfassung

Die Ätiologie der Multiplen Sklerose (MS) ist unbekannt. Obwohl oft vermutet scheint eine monokausale Pathogenese unwahrscheinlich. Gegenwärtig wird die Entstehung der MS als multifaktorieller Prozess gesehen, in dem verschiedene Risikofaktoren wirksam sind, die sowohl eine genetische Suszeptibilität als auch Umwelteinflüsse beinhalten. Verschiedene Risikoallele wurden mittlerweile identifiziert. Unter den Umweltfaktoren gelten aktuell eine geringe Sonnenexposition, niedrige Vitamin-D-Spiegel und eine durchgemachte Infektion mit Epstein-Barr-Virus als Hauptkandidaten für ein erhöhtes Risiko MS zu entwickeln. Darüber hinaus stehen noch Ernährungsgewohnheiten, Rauchen, Hormone und Life Events unter Verdacht, eine Rolle bei MS zu spielen. Allerdings ist keiner dieser Faktoren eine notwendige oder hinlängliche Bedingung für MS. Genauere Kenntnisse der Kausalkette, die zu MS führt, werden wahrscheinlich neue Strategien für die Therapie und Prävention ermöglichen.

Summary

The etiology of multiple sclerosis (MS) is not known yet. Unless often suspected it seems to be unlikely that there is a monocausal pathogenesis. The current view of the emergence of MS represents a multifactorial setting of different risk factors arising from both genetic susceptibility and environmental influences. Several risk alleles have been identified. Among the environmental factors a low sun exposure, a low vitamine D level and an Epstein Barr virus infection are currently considered to be the main candidates for an increased risk to develop MS. Furthermore, nutrition, cigarette smoking, hormones, and life events are under suspicion to play a role in the pathogenesis. However, none of these factors is a sufficient or a necessary condition for MS. A better understanding of the chain of causation of MS probably will provide new strategies for therapy and prevention.

Schlüsselwörter

Multiple Sklerose - Pathogenese

Keywords

Multiple sclerosis - pathogenesis
 

  • Literatur

  • 1 Bagert BA. Epstein-Barr virus in multiple sclerosis. Curr Neurol Neurosci Rep 2009; 09 (05) 405-10.
    CrossrefPubMedSuche in Google Scholar
  • 2 Barnett MH, Parratt JD, Pollard JD, Prineas JW. MS: is it one disease?. Int MS J 2009; 16 (02) 57-65.
    PubMedSuche in Google Scholar
  • 3 Barnett MH, Prineas JW. Relapsing and remitting multiple sclerosis: pathology of the newly forming lesion. Ann Neurol 2004; 55: 458-68.
    CrossrefPubMedSuche in Google Scholar
  • 4 Bayes HK, Weir CJ, O’Leary C. Timing of birth and risk of multiple sclerosis in the Scottish population. Eur Neurol 2010; 63 (01) 36-40.
    CrossrefPubMedSuche in Google Scholar
  • 5 Becklund BR, Severson KS, Vang SV, DeLuca HF. UV radiation suppresses experimental autoimmune encephalomyelitis independent of vitamin D production. Proc Natl Acad Sci USA 2010; 107 (14) 6418-23.
    CrossrefPubMedSuche in Google Scholar
  • 6 Bentzen J, Meulengracht EFlachs, Stenager E, Brønnum-Hansen H, Koch-Henriksen N. Prevalence of multiple sclerosis in Denmark 1950–2005. Mult Scler 2010; 16 (05) 520-5.
    CrossrefPubMedSuche in Google Scholar
  • 7 Cabre P. Environmental changes and epidemiology of multiple sclerosis in the French West Indies. Neurol Sci 2009; 286 (1–2) 58-61.
    CrossrefPubMedSuche in Google Scholar
  • 8 Dalmay F, Bhalla D, Nicoletti A, Cabrera-Gomez J, Cabre P, Ruiz F, Druet-Cabanac M, Dumas M, Preux P. Multiple sclerosis and solar exposure before the age of 15 years: case-control study in Cuba, Martinique and Sicily. Mult Scler. 2010 May, online first.
    PubMedSuche in Google Scholar
  • 9 De Jager PL, Simon KC, Munger KL, Rioux JD, Hafler DA, Ascherio A. Integrating risk factors: HLA-DRB1*1501 and Epstein-Barr virus in multiple sclerosis. Neurology 2008; 70 (13 Pt 2) 1113-8.
    CrossrefPubMedSuche in Google Scholar
  • 10 Gilli F, Lindberg RL, Valentino P, Marnetto F, Malucchi S, Sala A, Capobianco M, di Sapio A, Sperli F, Kappos L, Calogero RA, Bertolotto A. Learning from nature: pregnancy changes the expression of inflammation-related genes in patients with multiple sclerosis. PLoS One 2010; 05 (01) e8962.
    CrossrefPubMedSuche in Google Scholar
  • 11 Goodin DS. The causal cascade to multiple sclerosis: a model for MS pathogenesis. PLoS One 2009; 04 (02) e4565.
    CrossrefPubMedSuche in Google Scholar
  • 12 Grimaldi LM, Palmeri B, Salemi G, Giglia G, D’Amelio M, Grimaldi R, Vitello G, Ragonese P, Savettieri G. High prevalence and fast rising incidence of multiple sclerosis in Caltanissetta, Sicily, southern Italy. Neuroepidemiology 2007; 28 (01) 28-32.
    CrossrefPubMedSuche in Google Scholar
  • 13 Hirst C, Ingram G, Pickersgill T, Swingler R, Compston DA, Robertson NP. Increasing prevalence and incidence of multiple sclerosis in South East Wales. J Neurol Neurosurg Psychiatry 2009; 80 (04) 386-91.
    PubMedSuche in Google Scholar
  • 14 Hoffjan S, Akkad DA. The genetics of multiple sclerosis: An update 2010 Mol Cell Probes. 2010 May 5, online first.
    PubMedSuche in Google Scholar
  • 15 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357 (03) 266-81.
    CrossrefPubMedSuche in Google Scholar
  • 16 Kesselring J. Sunshine on MS. Neuroepidemiology 2008; 31: 280-281.
    CrossrefPubMedSuche in Google Scholar
  • 17 Klupka-Sarić I, Galić M. Epidemiology of multiple sclerosis in western Herzegovina and Herzegovina-Neretva Canton, Bosnia and Herzegovina. Coll Antropol 2010; 34 Suppl 1 189-93.
    PubMedSuche in Google Scholar
  • 18 Kurtzke JF, Heltberg A. Multiple sclerosis in the Faroe Islands: an epitome. J Clin Epidemiol 2001; 54 (01) 1-22.
    CrossrefPubMedSuche in Google Scholar
  • 19 Lassmann H, Brück W, Lucchinetti CF. The immunopathology of multiple sclerosis: an overview. Brain Pathol 2007; 17: 210-8.
    CrossrefPubMedSuche in Google Scholar
  • 20 Lauer K. Diet and multiple sclerosis. Neurology 1997; 49: 55-61.
    CrossrefPubMedSuche in Google Scholar
  • 21 Liu XJ, Ye HX, Li WP, Dai R, Chen D, Jin M. Relationship between psychosocial factors and onset of multiple sclerosis. Eur Neurol 2009; 62 (03) 130-6.
    CrossrefPubMedSuche in Google Scholar
  • 22 Lucchinetti CF, Bruck W, Lassmann H. Evidence for pathogenic heterogeneity in multiple sclerosis. Ann Neurol 2004; 56: 308.
    CrossrefPubMedSuche in Google Scholar
  • 23 Marrie RA, Yu N, Blanchard J, Leung S, Elliott L. The rising prevalence and changing age distribution of multiple sclerosis in Manitoba. Neurology 2010; 74 (06) 465-71.
    CrossrefPubMedSuche in Google Scholar
  • 24 McElroy JP, Oksenberg JR. Multiple sclerosis genetics. Curr Top Microbiol Immunol 2008; 318: 45-72.
    PubMedSuche in Google Scholar
  • 25 Moses Jr H, Sriram S. An infectious basis for multiple sclerosis: perspectives on the role of Chlamydia pneumoniae and other agents. BioDrugs 2001; 15 (03) 199-206.
    CrossrefPubMedSuche in Google Scholar
  • 26 Munger KL, Chitnis T, Ascherio A. Body size and risk of MS in two cohorts of US women. Neurology 2009; 73 (19) 1543-50.
    CrossrefPubMedSuche in Google Scholar
  • 27 Murray S, Bashir K, Penrice G, Womersley SJ. Epidemiology of multiple sclerosis in Glasgow. Scott Med J 2004; 49 (03) 100-4.
    CrossrefPubMedSuche in Google Scholar
  • 28 Niino M, Hirotani M, Fukazawa T, Kikuchi S, Sasaki H. Estrogens as potential therapeutic agents in multiple sclerosis. Cent Nerv Syst Agents Med Chem 2009; 09 (02) 87-94.
    CrossrefPubMedSuche in Google Scholar
  • 29 Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med 2000; 343 (13) 938-52.
    CrossrefPubMedSuche in Google Scholar
  • 30 Pittas F, Ponsonby AL, van der Mei IA, Taylor BV, Blizzard L, Groom P, Ukoumunne OC, Dwyer T. Smoking is associated with progressive disease course and increased progression in clinical disability in a prospective cohort of people with multiple sclerosis. J Neurol 2009; 256 (04) 577-85.
    CrossrefPubMedSuche in Google Scholar
  • 31 Pugliatti M, Rosati G, Carton H, Riise T, Drulovic J, Vécsei L, Milanov I. The epidemiology of multiple sclerosis in Europe. Eur J Neurol 2006; 13 (07) 700-22.
    CrossrefPubMedSuche in Google Scholar
  • 32 Ramagopalan SV, Link J, Byrnes JK, Dyment DA, Giovannoni G, Hintzen RQ, Sundqvist E, Kockum I, Smestad C, Lie BA, Harbo HF, Padyukov L, Alfredsson L, Olsson T, Sadovnick AD, Hillert J, Ebers GC. HLA-DRB1 and month of birth in multiple sclerosis. Neurology 2009; 73 (24) 2107-11.
    CrossrefPubMedSuche in Google Scholar
  • 33 Ramagopalan SV, Maugeri NJ, Handunnetthi L, Lincoln MR, Orton SM, Dyment DA, Deluca GC, Herrera BM, Chao MJ, Sadovnick AD, Ebers GC, Knight JC. Expression of the multiple sclerosis-associated MHC class II Allele HLA-DRB1*1501 is regulated by vitamin D. PLoS Genet 2009; 05 (02) e1000369.
    CrossrefPubMedSuche in Google Scholar
  • 34 Ramagopalan SV, Maugeri NJ, Handunnetthi L, Lincoln MR, Orton SM, Dyment DA, Deluca GC, Herrera BM, Chao MJ, Sadovnick AD, Ebers GC, Knight JC. Expression of the multiple sclerosis-associated MHC class II Allele HLA-DRB1*1501 is regulated by vitamin D. PLoS Genet 2009; 05 (02) e1000369.
    CrossrefPubMedSuche in Google Scholar
  • 35 Sadovnick AD, Yee IM, Guimond C, Reis J, Dyment DA, Ebers GC. Age of onset in concordant twins and other relative pairs with multiple sclerosis. Am J Epidemiol 2009; 170 (03) 289-96.
    CrossrefPubMedSuche in Google Scholar
  • 36 Shapira Y, Agmon-Levin N, Shoenfeld Y. Defining and analyzing geoepidemiology and human autoimmunity. J Autoimmun 2010; 34 (03) J168-77.
    CrossrefPubMedSuche in Google Scholar
  • 37 Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Tacconi G, Dall’Ara S, Bartolomei I, Salvi F. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80 (04) 392-9.
    CrossrefPubMedSuche in Google Scholar
  • 38 Zamboni P. The big idea: iron-dependent inflammation in venous disease and proposed parallels in multiple sclerosis. J R Soc Med 2006; 99 (11) 589-93.
    CrossrefPubMedSuche in Google Scholar