Recover, repair or restrict? - New therapeutic perspectives for MS patients
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Up until today, the treatment of multiple sclerosis (MS) patients relies on immune modulation. A deeper understanding of MS pathogenesis has generated new perspectives on targeting the cause and consequences in the clinic. Therapies in this new generation can be roughly divided into three categories based on their mechanism of action: recovery, repair, and restriction. Recovering therapies focus on restoring balance in imbalanced systems, such as the immune system itself or the intestinal microbiota. Re-introducing balance leads to indirect amelioration of the autoreactive processes. Therapies inducing repair address the consequence of the intolerant immune response: damage to the central nervous system. Since this is associated with the development of symptoms, repair reduces MS-related impairments. Restricting therapies aim to prevent damage to neuronal fibers, thus preventing symptoms. In addition to the therapies focusing on a specific aspect of pathogenesis, the holistic approach to MS management has gained attention over the years. Specifically, lifestyle adaptations have been shown to be effective in multiple ways, including downregulation of the autoreactive response and neuronal protection. The new generation of MS therapies emphasizes the importance of a look beyond immune modulation. Counteracting the autoreactive response in a multifaceted way will more effectively inhibit disease progression.