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Abstract
Recently approved therapies for treatment of relapsing-remitting multiple sclerosis (MS) include interferon β1b (IFNβ1b) (Betaseron®), IFNβ1a (Avonex®) and co-polymer-1 (Copaxone®). These drugs modulate the immune response and curtail the apparent autoimmunity to antigens present in the central nervous system (CNS). New therapies for MS seek to promote more lasting recovery from the impairment of neurologic function in addition to decreasing the ongoing damage to the CNS. Prominent pathologic features of MS include inflammation, demyelination and axonal damage in the CNS. Identification of effector molecules linked with the emergence of these neuropathologic features and clinical signs of disease is a hot area of research. Preclinical research for therapeutics for MS has focused on compounds with increased specificity for an array of targets that include released factors (cytokines), cell surface molecules (T-cell receptors, co-stimulatory molecules, matrix metalloproteinases [MMPs]), intracellular enzymes in signalling cascades (phosphodiesterase [PDE], nitric oxide synthase [NOS]), and regulatory molecules involved in programmed cell death pathways or regulation of gene expression. Our increased understanding of immune regulation, oligodendrocyte biology and pathogenic events in MS has expanded the spectrum of potential targets for drug development in MS, ranging from activation of autoreactive T-cells through the cascade of events that ultimately leads to demyelination, loss of axons and permanent clinical disability. Moreover, rapidly advancing techniques in neuroimaging may allow earlier predictions of efficacy by monitoring the integrity of myelin and neurones. This review summarises recent progress in the preclinical drug development for MS, including therapeutic agents that modulate neural and immune system interactions, cytokine production, T-cell phenotypes, lymphocyte migration and oligodendrocyte survival.
