多发性硬化症致病机制与治疗方案综述研究
A Review of the Pathogenesis and Treatment Options of Multiple Sclerosis
DOI: 10.12677/acm.2025.152380, PDF,    科研立项经费支持
作者: 王梓桐*:延安大学医学院,陕西 延安;郭春艳:陕西省人民医院中心实验室,陕西 西安;徐翠香#:延安大学医学院,陕西 延安;陕西省人民医院中心实验室,陕西 西安
关键词: 多发性硬化症免疫性疾病致病机制治疗方案Multiple Sclerosis Immune Diseases Pathogenic Mechanisms Treatment Options
摘要: 多发性硬化症(MS)作为一种中枢神经系统的炎性脱髓鞘疾病,给年轻人群带来了严重危害,已成为非创伤性残疾的首要原因。目前,学界普遍认为其致病机制是多因素共同作用的结果。本文深入探讨了可能触发MS的几种关键致病因素,主要涵盖遗传因素、病毒因素以及自身免疫因素等方面。此外,还对MS的疾病修饰治疗、对症治疗和间充质干细胞治疗方案进行了全面综述,详细分析了各种治疗方案的优缺点以及临床应用前景。通过对这些内容的研究,旨在为进一步理解MS的发病机制以及优化治疗策略提供有益的参考和依据。
Abstract: Multiple sclerosis (MS), as an inflammatory demyelinating disease of the central nervous system, has brought serious harm to young people and has become the leading cause of non-traumatic disability. At present, it is generally believed that the pathogenic mechanism is the result of the combined action of multiple factors. This article provides an in-depth discussion of several key pathogenic factors that may trigger MS, mainly covering genetic factors, viral factors, and autoimmune factors. In addition, the disease-modifying therapy, symptomatic treatment and mesenchymal stem cell treatment regimens of MS are comprehensively reviewed, and the advantages and disadvantages of each treatment regimen and the clinical application prospects are analyzed in detail. Through the study of these contents, it aims to provide a useful reference and basis for further understanding the pathogenesis of MS and optimizing treatment strategies.
文章引用:王梓桐, 郭春艳, 徐翠香. 多发性硬化症致病机制与治疗方案综述研究[J]. 临床医学进展, 2025, 15(2): 563-571. https://doi.org/10.12677/acm.2025.152380

参考文献

[1] Rey, L.K., Wieczorek, S., Akkad, D.A., Linker, R.A., Chan, A. and Hoffjan, S. (2011) Polymorphisms in Genes Encoding Leptin, Ghrelin and Their Receptors in German Multiple Sclerosis Patients. Molecular and Cellular Probes, 25, 255-259. [Google Scholar] [CrossRef] [PubMed]
[2] Garg, N. and Smith, T.W. (2015) An Update on Immunopathogenesis, Diagnosis, and Treatment of Multiple Sclerosis. Brain and Behavior, 5, e00362. [Google Scholar] [CrossRef] [PubMed]
[3] Cross, A.H., Trotter, J.L. and Lyons, J. (2001) B Cells and Antibodies in CNS Demyelinating Disease. Journal of Neuroimmunology, 112, 1-14. [Google Scholar] [CrossRef] [PubMed]
[4] Tomsone, I Logina, A Millers, S Cha, V. (2001) Association of Human Herpesvirus 6 and Human Herpesvirus 7 with Demyelinating Diseases of the Nervous System. Journal of Neurovirology, 7, 564-569. [Google Scholar] [CrossRef] [PubMed]
[5] Canto, E. and Oksenberg, J.R. (2018) Multiple Sclerosis Genetics. Multiple Sclerosis Journal, 24, 75-79. [Google Scholar] [CrossRef] [PubMed]
[6] Moutsianas, L., Jostins, L., Beecham, A.H., et al. (2015) Class II HLA Interactions Modulate Genetic Risk for Multiple Sclerosis. Nature Genetics, 47, 1107-1113. [Google Scholar] [CrossRef] [PubMed]
[7] Mycko, M.P., Cichalewska, M., Machlanska, A., Cwiklinska, H., Mariasiewicz, M. and Selmaj, K.W. (2012) MicroRNA-301a Regulation of a T-Helper 17 Immune Response Controls Autoimmune Demyelination. Proceedings of the National Academy of Sciences of the United States of America, 109, E1248-E1257. [Google Scholar] [CrossRef] [PubMed]
[8] Guerau-de-Arellano, M., Smith, K.M., Godlewski, J., Liu, Y., Winger, R., Lawler, S.E., et al. (2011) Micro-RNA Dysregulation in Multiple Sclerosis Favours Pro-Inflammatory T-Cell-Mediated Autoimmunity. Brain, 134, 3578-3589. [Google Scholar] [CrossRef] [PubMed]
[9] Zhang, L., Wu, H., Zhao, M. and Lu, Q. (2020) Identifying the Differentially Expressed Micrornas in Autoimmunity: A Systemic Review and Meta-Analysis. Autoimmunity, 53, 122-136. [Google Scholar] [CrossRef] [PubMed]
[10] Raphael, I., Webb, J., Stuve, O., Haskins, W. and Forsthuber, T. (2014) Body Fluid Biomarkers in Multiple Sclerosis: How Far We Have Come and How They Could Affect the Clinic Now and in the Future. Expert Review of Clinical Immunology, 11, 69-91. [Google Scholar] [CrossRef] [PubMed]
[11] Lünemann, J.D., Jelčić, I., Roberts, S., Lutterotti, A., Tackenberg, B., Martin, R., et al. (2008) Ebna1-Specific T Cells from Patients with Multiple Sclerosis Cross React with Myelin Antigens and Co-Produce IFN-γ and IL-2. The Journal of Experimental Medicine, 205, 1763-1773. [Google Scholar] [CrossRef] [PubMed]
[12] 孟俊, 彭奕冰, 王学锋, 等. 多发性硬化症与EB病毒及白细胞介素17/白细胞介素23关联性分析[J]. 诊断学理论与实践, 2017, 16(1): 88-92.
[13] Robinson, W.H. and Steinman, L. (2022) Epstein-Barr Virus and Multiple Sclerosis. Science, 375, 264-265. [Google Scholar] [CrossRef] [PubMed]
[14] Jakhmola, S., Upadhyay, A., Jain, K., Mishra, A. and Jha, H.C. (2021) Herpesviruses and the Hidden Links to Multiple Sclerosis Neuropathology. Journal of Neuroimmunology, 358, Article ID: 577636. [Google Scholar] [CrossRef] [PubMed]
[15] Donati, D. (2020) Viral Infections and Multiple Sclerosis. Drug Discovery Today: Disease Models, 32, 27-33. [Google Scholar] [CrossRef] [PubMed]
[16] Junker, A., Krumbholz, M., Eisele, S., Mohan, H., Augstein, F., Bittner, R., et al. (2009) MicroRNA Profiling of Multiple Sclerosis Lesions Identifies Modulators of the Regulatory Protein CD47. Brain, 132, 3342-3352. [Google Scholar] [CrossRef] [PubMed]
[17] Bartholomäus, I., Kawakami, N., Odoardi, F., Schläger, C., Miljkovic, D., Ellwart, J.W., et al. (2009) Effector T Cell Interactions with Meningeal Vascular Structures in Nascent Autoimmune CNS Lesions. Nature, 462, 94-98. [Google Scholar] [CrossRef] [PubMed]
[18] Moser, T., Akgün, K., Proschmann, U., Sellner, J. and Ziemssen, T. (2020) The Role of TH17 Cells in Multiple Sclerosis: Therapeutic Implications. Autoimmunity Reviews, 19, Article ID: 102647. [Google Scholar] [CrossRef] [PubMed]
[19] Li, R. and Bar-Or, A. (2018) The Multiple Roles of B Cells in Multiple Sclerosis and Their Implications in Multiple Sclerosis Therapies. Cold Spring Harbor Perspectives in Medicine, 9, a029108. [Google Scholar] [CrossRef] [PubMed]
[20] Zozulya, A.L. and Wiendl, H. (2008) The Role of Regulatory T Cells in Multiple Sclerosis. Nature Clinical Practice Neurology, 4, 384-398. [Google Scholar] [CrossRef] [PubMed]
[21] Solomon, A.J. and Whitham, R.H. (2010) Multiple Sclerosis and Vitamin D: A Review and Recommendations. Current Neurology and Neuroscience Reports, 10, 389-396. [Google Scholar] [CrossRef] [PubMed]
[22] Rodgers, J., Friede, T., Vonberg, F.W., Constantinescu, C.S., Coles, A., Chataway, J., et al. (2021) The Impact of Smoking Cessation on Multiple Sclerosis Disease Progression. Brain, 145, 1368-1378. [Google Scholar] [CrossRef] [PubMed]
[23] Freeman, L., Longbrake, E.E., Coyle, P.K., Hendin, B. and Vollmer, T. (2022) High-Efficacy Therapies for Treatment-Naïve Individuals with Relapsing-Remitting Multiple Sclerosis. CNS Drugs, 36, 1285-1299. [Google Scholar] [CrossRef] [PubMed]
[24] Montalban, X., Gold, R., Thompson, A.J., Otero-Romero, S., Amato, M.P., Chandraratna, D., et al. (2018) ECTRIMS/EAN Guideline on the Pharmacological Treatment of People with Multiple Sclerosis. Multiple Sclerosis Journal, 24, 96-120. [Google Scholar] [CrossRef] [PubMed]
[25] Cohan, S.L., Hendin, B.A., Reder, A.T., Smoot, K., Avila, R., Mendoza, J.P., et al. (2021) Interferons and Multiple Sclerosis: Lessons from 25 Years of Clinical and Real-World Experience with Intramuscular Interferon β-1a (Avonex). CNS Drugs, 35, 743-767. [Google Scholar] [CrossRef] [PubMed]
[26] O’Connor, P., Wolinsky, J.S., Confavreux, C., Comi, G., Kappos, L., Olsson, T.P., et al. (2011) Randomized Trial of Oral Teriflunomide for Relapsing Multiple Sclerosis. New England Journal of Medicine, 365, 1293-1303. [Google Scholar] [CrossRef] [PubMed]
[27] Hauser, S.L. and Cree, B.A.C. (2020) Treatment of Multiple Sclerosis: A Review. The American Journal of Medicine, 133, 1380-1390.e2. [Google Scholar] [CrossRef] [PubMed]
[28] Gross, R.H. and Corboy, J.R. (2019) Monitoring, Switching, and Stopping Multiple Sclerosis Disease-Modifying Therapies. Continuum: Lifelong Learning in Neurology, 25, 715-735. [Google Scholar] [CrossRef] [PubMed]
[29] Vasileiou, E.S. and Fitzgerald, K.C. (2023) Multiple Sclerosis Pathogenesis and Updates in Targeted Therapeutic Approaches. Current Allergy and Asthma Reports, 23, 481-496. [Google Scholar] [CrossRef] [PubMed]
[30] Ayache, S.S. and Chalah, M.A. (2017) Fatigue in Multiple Sclerosis—Insights into Evaluation and Management. Neurophysiologie Clinique/Clinical Neurophysiology, 47, 139-171. [Google Scholar] [CrossRef] [PubMed]
[31] Murray, T.J. (1985) Amantadine Therapy for Fatigue in Multiple Sclerosis. Canadian Journal of Neurological Sciences/Journal Canadien des Sciences Neurologiques, 12, 251-254. [Google Scholar] [CrossRef] [PubMed]
[32] Solaro, C., Trabucco, E. and Messmer Uccelli, M. (2012) Pain and Multiple Sclerosis: Pathophysiology and Treatment. Current Neurology and Neuroscience Reports, 13, Article No. 320. [Google Scholar] [CrossRef] [PubMed]
[33] Aboud, T. and Schuster, N.M. (2019) Pain Management in Multiple Sclerosis: A Review of Available Treatment Options. Current Treatment Options in Neurology, 21, Article No. 62. [Google Scholar] [CrossRef] [PubMed]
[34] Nazari, F., Soheili, M., Hosseini, S. and Shaygannejad, V. (2015) A Comparison of the Effects of Reflexology and Relaxation on Pain in Women with Multiple Sclerosis. Journal of Complementary and Integrative Medicine, 13, 65-71. [Google Scholar] [CrossRef] [PubMed]
[35] Andrews, K.L. and Husmann, D.A. (1997) Bladder Dysfunction and Management in Multiple Sclerosis. Mayo Clinic Proceedings, 72, 1176-1183. [Google Scholar] [CrossRef] [PubMed]
[36] Kuhlemeier, K.V., McEachran, A.B., Lloyd, L.K., et al. (1984) Serum Creatinine as an Indicator of Renal Function after Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 65, 694-697.
[37] Bai, L., Lennon, D.P., Caplan, A.I., DeChant, A., Hecker, J., Kranso, J., et al. (2012) Hepatocyte Growth Factor Mediates Mesenchymal Stem Cell-Induced Recovery in Multiple Sclerosis Models. Nature Neuroscience, 15, 862-870. [Google Scholar] [CrossRef] [PubMed]
[38] Freedman, M.S., Bar-Or, A., Atkins, H.L., Karussis, D., Frassoni, F., Lazarus, H., et al. (2010) The Therapeutic Potential of Mesenchymal Stem Cell Transplantation as a Treatment for Multiple Sclerosis: Consensus Report of the International MSCT Study Group. Multiple Sclerosis Journal, 16, 503-510. [Google Scholar] [CrossRef] [PubMed]
[39] Gugliandolo, A., Bramanti, P. and Mazzon, E. (2020) Mesenchymal Stem Cells in Multiple Sclerosis: Recent Evidence from Pre-Clinical to Clinical Studies. International Journal of Molecular Sciences, 21, Article 8662. [Google Scholar] [CrossRef] [PubMed]
[40] Wang, J., Sun, H., Guo, R., Guo, J., Tian, X., Wang, J., et al. (2023) Exosomal miR-23b-3p from Bone Mesenchymal Stem Cells Alleviates Experimental Autoimmune Encephalomyelitis by Inhibiting Microglial Pyroptosis. Experimental Neurology, 363, Article ID: 114374. [Google Scholar] [CrossRef] [PubMed]
[41] Li, J., Zhang, D., Geng, T., Chen, L., Huang, H., Yin, H., et al. (2014) The Potential of Human Umbilical Cord-Derived Mesenchymal Stem Cells as a Novel Cellular Therapy for Multiple Sclerosis. Cell Transplantation, 23, 113-122. [Google Scholar] [CrossRef] [PubMed]
[42] Charabati, M., Wheeler, M.A., Weiner, H.L. and Quintana, F.J. (2023) Multiple Sclerosis: Neuroimmune Crosstalk and Therapeutic Targeting. Cell, 186, 1309-1327. [Google Scholar] [CrossRef] [PubMed]
[43] Clark, I.C., Wheeler, M.A., Lee, H., Li, Z., Sanmarco, L.M., Thaploo, S., et al. (2023) Identification of Astrocyte Regulators by Nucleic Acid Cytometry. Nature, 614, 326-333. [Google Scholar] [CrossRef] [PubMed]
[44] Sanmarco, L.M., Wheeler, M.A., Gutiérrez-Vázquez, C., Polonio, C.M., Linnerbauer, M., Pinho-Ribeiro, F.A., et al. (2021) Gut-licensed IFNγ+ NK Cells Drive LAMP1+TRAIL+ Anti-Inflammatory Astrocytes. Nature, 590, 473-479. [Google Scholar] [CrossRef] [PubMed]
[45] Dangond, F., Donnelly, A., Hohlfeld, R., Lubetzki, C., Kohlhaas, S., Leocani, L., et al. (2021) Facing the Urgency of Therapies for Progressive MS—A Progressive MS Alliance Proposal. Nature Reviews Neurology, 17, 185-192. [Google Scholar] [CrossRef] [PubMed]
[46] Kappos, L., Li, D., Calabresi, P.A., O’Connor, P., Bar-Or, A., Barkhof, F., et al. (2011) Ocrelizumab in Relapsing-Remitting Multiple Sclerosis: A Phase 2, Randomised, Placebo-Controlled, Multicentre Trial. The Lancet, 378, 1779-1787. [Google Scholar] [CrossRef] [PubMed]
[47] Allanach, J.R., Farrell, J.W., Mésidor, M. and Karimi-Abdolrezaee, S. (2021) Current Status of Neuroprotective and Neuroregenerative Strategies in Multiple Sclerosis: A Systematic Review. Multiple Sclerosis Journal, 28, 29-48. [Google Scholar] [CrossRef] [PubMed]
[48] Scolding, N.J., Pasquini, M., Reingold, S.C., Cohen, J.A., Atkins, H., Banwell, B., et al. (2017) Cell-Based Therapeutic Strategies for Multiple Sclerosis. Brain, 140, 2776-2796. [Google Scholar] [CrossRef] [PubMed]
[49] Vishwakarma, S.K., Bardia, A., Tiwari, S.K., Paspala, S.A.B. and Khan, A.A. (2014) Current Concept in Neural Regeneration Research: NSCs Isolation, Characterization and Transplantation in Various Neurodegenerative Diseases and Stroke: A Review. Journal of Advanced Research, 5, 277-294. [Google Scholar] [CrossRef] [PubMed]
[50] Bezukladova, S., Genchi, A., Panina-Bordignon, P. and Martino, G. (2022) Promoting Exogenous Repair in Multiple Sclerosis: Myelin Regeneration. Current Opinion in Neurology, 35, 313-318. [Google Scholar] [CrossRef] [PubMed]
[51] Duncan, I.D., Marik, R.L., Broman, A.T. and Heidari, M. (2017) Thin Myelin Sheaths as the Hallmark of Remyelination Persist over Time and Preserve Axon Function. Proceedings of the National Academy of Sciences of the United States of America, 114, E9685-E9691. [Google Scholar] [CrossRef] [PubMed]
[52] Franklin, R.J.M., Frisén, J. and Lyons, D.A. (2021) Revisiting Remyelination: Towards a Consensus on the Regeneration of CNS Myelin. Seminars in Cell & Developmental Biology, 116, 3-9. [Google Scholar] [CrossRef] [PubMed]