Multiple Sclerosis: Immunopathological heterogeneity and its implications.

Multiple sclerosis (MS) is the most common autoimmune demyelinating disease of the central nervous system (CNS). For the past decades several immunomodulatory disease modifying treatments with multiple presumed mechanisms of action have been developed, but MS remains an incurable disease. Whereas high efficacy, at least in early disease, corroborates underlying immunopathophysiology, there is profound heterogeneity in clinical presentation as well as immunophenotypes that may also vary over time. In addition, functional plasticity in the immune system as well as in the inflamed central nervous system further contributes to disease heterogeneity. In this review, we will highlight immune-pathophysiological and associated clinical heterogeneity that may have an implication for more precise immunomodulatory therapeutic strategies in MS. This article is protected by copyright. All rights reserved.