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Nervenheilkunde 2005; 24(04): 294-300
DOI: 10.1055/s-0038-1629965
Geist & Gehirn
Schattauer GmbH

Neue Therapieansätze bei Multipler Sklerose

New therapeutic approaches in multiple sclerosis
P. Rieckmann
1   Klinische Forschungsgruppe für Multiple Sklerose und Neuroimmunologie, Neurologische Universitätsklinik Würzburg
,
B. Kallmann
1   Klinische Forschungsgruppe für Multiple Sklerose und Neuroimmunologie, Neurologische Universitätsklinik Würzburg
› Author Affiliations
Further Information

Publication History

Publication Date:
31 January 2018 (online)

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Zusammenfassung

Die verlaufsmodifizierende Behandlung der Multiplen Sklerose (MS) hat sich durch den Einsatz der rekombinanten Beta-Interferone und Glatirameracetat (sowie Mitoxantron in der Eskalationstherapie) innerhalb der letzten fünf Jahre verbessert. Bei frühzeitigem Einsatz und individueller Therapiemodifikation entsprechend der vorliegenden klinischen Krankheitsaktivität lassen sich die entzündlichen Aspekte der Erkrankung (Schübe und aktive Läsionen im Kernspintomogramm) in vielen Fällen gut kontrollieren. Neue Ansätze der Therapie beschäftigen sich derzeit mit der spezifischen Modulation von Molekülen, die am Entzündungsgeschehen bei der Multiplen Sklerose beteiligt sind. Hier kommen insbesondere gezielte Interventionen bei Zytokinen, Chemokinen und Adhäsionsmolekülen in Betracht. Diese Gruppen von Molekülen spielen eine entscheidende Rolle bei der Regulation der Immunzellinfiltration und Ausbreitung der Entzündung im Gehirn. Erste vielversprechende Ergebnisse konnten so mit einem humanisierten Antikörper gegen das Adhäsionsmolekül VLA-4 (Natalizumab/ Tysabri®) in zwei Phase-III Studien erreicht werden. Weitere Fortschritte werden auch durch die Entwicklung oraler Therapeutika in diesem Bereich erwartet. Nach wie vor schwierig ist die Behandlung der progredienten Verlaufsform der MS, wenn sich eine langsam schleichende Behinderung auch ohne begleitende entzündliche Veränderungen entwickelt. Hierbei scheinen degenerative Komponenten der Erkrankung (Demyelinisierung und axonaler Schaden) zu überwiegen. Rationelle Ansatzpunkte sind hier axon/ neuroprotektive und regenerationsfördernde Therapieverfahren. Diese Stufe der Therapie befindet sich aber noch weitestgehend im experimentellen Stadium.

Summary

Disease modifying therapy of multiple sclerosis (MS) has improved during the last five years due to recombinant beta-interferons and glatiramer acetate as well as mitoxantrone for treatment escalation. Early use and individual modification of treatment allows for control of inflammatory aspects of the disease (relapses and magnetic resonance lesions) in many cases. New approaches to therapy include specific modulation of molecules involved in pathophysiology of MS. Mainly, targeted interventions of cytokine, chemokine and adhesion molecule expression are considered. These molecules are important mediators of immune cell infiltration and spreading of inflammation within the brain. Initial results from two phase-III studies with a humanized antibody against the adhesion molecule VLA-4 (natalizumab/Tysabri®) are very encouraging. Further achievements are anticipated for the development of oral therapies. The treatment of chronic progressive MS without superimposed inflammatory disease activity is still a major problem due to the fact that degenerative aspects of the disease (demyelination and axonal loss) are prominent. New therapeutic strategies, like axon/neuroprotection or induction of regeneration are still in pre-clinical development.

Schlüsselwörter

Multiple Sklerose - Immuntherapie - klinische Studien - humanisierte Antikörper

Keywords

Multiple sclerosis - immunotherapy - clinical studies - humanized antibodies
 

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