441- The focus in treatment of multiple sclerosis is on neuroprotection, i.e. therapy
that stops or slows the progression of the disease in contrast to symptomatic
treatment, which may not have any durable effect. Glatiramer acetate, approved
for primary progressive form of multiple sclerosis, is a neuroprotective agent.
A statistically signifi cant association has been detected between glatiramer ace-
tate response and a SNP in a T-cell receptor beta variant in patients with MS
(Grossman et al. 2007 ). - MRI has become established as a reliable, sensitive and reproducible technique
for studying the pathophysiology of MS and provides a means for optimizing
treatment in for individual patients. - Future approaches to multiple sclerosis should integrate clinical and imaging
data with pharmacogenomic and pharmacogenetic databases to develop prog-
nostic profi les of patients, which can be used to select therapy based on genetic
biomarkers.
Genomics of Multiple Sclerosis
Genome-wide association studies have identifi ed several risk loci, and variation
within the major histocompatibility complex (MHC) exerts the greatest individual
effect on risk of developing MS. MHC in chromosome 6p21.3 represents by far the
strongest MS susceptibility locus genome-wide and was unambiguously identifi ed
in all studied MS populations (Oksenberg 2013 ). Immunologically relevant genes
are overrepresented among those mapping close to the identifi ed loci and implicate
T helper cell differentiation in the pathogenesis of MS (International Multiple
Sclerosis Genetics et al. 2011 ).
Research is in progress to fully characterize the genes that predispose to MS and
modulate its presentation as well as clinical course, which will pose a major chal-
lenge in MS genetics research in the coming years. An important advance is func-
tional characterization of the MS risk variant on chromosome 12p13.31 containing
the gene TNFRSF1A, which encodes the tumor necrosis factor (TNF) receptor
superfamily member 1A with apoptotic activity. TNFRSF1A shows association
with MS risk and provides an insight into the pathophysiology that can lead to novel
therapeutic strategies (Lill 2014 ).
Pharmacogenetic Approach to Management of Multiple Sclerosis
A pharmacogenetic research models based on high-throughput single nucleotide
polymorphism (SNP) technology have been used to establish the correlation
between drug-responsiveness and genetic polymorphisms of MS patients, which
may promote the development of personalized medicine for this disease.
Spectratyping has shown that T cells bearing particular types of receptors are acti-
vated in MS patients. T-cell receptor-based immunotherapy can be applicable to MS
Personalized Treatment of Multiple Sclerosis