Was gibt es Neues in der multiplen Sklerose?

Zusammenfassung

Nach der Erweiterung der MS-Therapie in den zurückliegenden Jahren um eine Reihe von Immunmodulatoren wie den β-Interferonen und Glatiramerazetat gibt es aktuell eine Vielzahl von Substanzen, für deren Wirksamkeit sich sowohl in In-vitro-Untersuchungen als auch im Tiermodell der MS gute Belege gefunden haben und von denen einige sich bereits in der klinischen Erprobung befinden. Neben der Demyelinisierung und dem axonalen Schaden als wichtigen Pathomechanismen bei der MS wird zunehmend auch die Bedeutung von pathologischen Veränderungen im Bereich der Blut-Hirn-Schranke deutlich. Aufbauend auf diesen Erkenntnissen lassen sich neue Therapieprinzipien für die Behandlung der MS ableiten. Die Beschreibung von Subtypen bei der MS-Erkrankung anhand von histopathologischen Untersuchungen weist auf die Existenz von verschiedenen Pathomechanismen hin. Ziel wird es sein, diese Erkenntnisse über die zugrunde liegenden Unterschiede für eine individuell adaptierte Therapie zur besseren Behandlung des einzelnen Patienten umzusetzen. Als zukünftige Kandidaten für die Behandlung der MS gelten eine Reihe von monoklonalen Antikörpern, die Komponenten der Immunfunktion blockieren können wie z. B. Natalizumab (Antegren®). Weitere potenzielle Kandidaten sind die bisher als Cholesterinsenker eingesetzten Statine, ein charakteristisches Schwangerschaftshormon, Östriol, (Nerven-)Wachstumsfaktoren (u. a. Neurotrophine) und andere (Neuro-)Protektiva. Der Artikel stellt aktuelle Untersuchungsergebnisse zu diesen Substanzen vor und diskutiert ihre Wirkungsmechanismen.

Abstract

In the last years, MS therapy has been extended by usage of immunomodulators like interferon-β and glatirameracetate. Recently, several new molecules showed effectiveness in animal models of MS as well as in vitro studies and are now under further clinical investigation. Besides demyelination and axonal damage as important mechanisms in MS pathology alterations of the blood brain barrier have been identified to play an important role. Based on these experiences new therapeutical approaches for MS treatment are in preparation. Subtypes of MS were described by histopathological findings which indicate different underlying pathomechanisms. Understanding of these differences will end in a better treatment optimized for each indiviual patient. Several monoclonal antibodies directed to influence immune functions are looked at as promising future candidates for MS therapy e. g. Natalizumab (Antegren®). Further potential therapeutic candidates are the statins, widely used to lower serum cholesterol levels, a characteristic hormone of pregnancy, estriol, and (nerve) growth factors as well as neuroprotective agents. In this article, recent results and possible mechanisms of action of these molecules will be discussed.

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