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Approaches to Remyelination Therapies in Multiple Sclerosis

  • Multiple Sclerosis and Related Disorders (J Graves, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

While there are a growing number of therapies targeting relapse prevention in multiple sclerosis (MS), there are no approved therapies promoting remyelination. Understanding endogenous myelin formation, remyelination strategies, pre-clinical models, and clinical outcomes is essential to the interpretation of current and future clinical trials of remyelinating agents.

Recent findings

Several recent clinical trials of remyelination therapies, including opicinumab, clemastine, and GSK239512, showed negative or modest results. These results could highlight challenges translating pre-clinical studies into subjects with MS and current strategies to measure remyelination.

Summary

Current approaches to remyelination include (1) blocking inhibitors of remyelination, (2) improving the clearance of myelin debris, (3) increasing the number of oligodendrocyte precursor cells (OPCs), and (4) stimulating OPC differentiation. To date, no therapies have led to robust remyelination. Future efforts to promote remyelination will likely require a combination of these mechanistic strategies.

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Acknowledgments

Dr. Wooliscroft would like to thank the Veterans Administration MS Center of Excellence-West for their support in her fellowship. Dr. Silbermann would like to thank the National MS Society for their support of her fellowship through a Sylvia Lawry Award.

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  1. Lindsey Wooliscroft and Elizabeth Silbermann contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Oregon Health & Science University, L226, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA

    Lindsey Wooliscroft MD, Elizabeth Silbermann MD, Michelle Cameron MD, PT, MCR & Dennis Bourdette MD

  2. Department of Veterans Affairs Portland Health Care System, Portland, OR, 97239, USA

    Lindsey Wooliscroft MD & Michelle Cameron MD, PT, MCR

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Correspondence to Lindsey Wooliscroft MD.

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Conflict of Interest

Lindsey Wooliscroft and Elizabeth Silbermann each declare no potential conflicts of interest. Michelle Cameron reports consulting fees from Adamas Pharmaceuticals and Greenwich Biosciences outside the submitted work. Dennis Bourdette reports consultancy for reviewing patient medical records and providing opinion on treatments for Magellan Health Care and Best Doctors Inc. He also served as an expert witness on MS for the US Department of Justice, reports a bench research grant and collaborative center award from the National MS Society, and reports a founder’s stock valued at $1000 from Llama Therapeutics.

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Wooliscroft, L., Silbermann, E., Cameron, M. et al. Approaches to Remyelination Therapies in Multiple Sclerosis. Curr Treat Options Neurol 21, 34 (2019). https://doi.org/10.1007/s11940-019-0574-1

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