Immunotherapy of multiple sclerosis: Where are we? Where should we go?

Differences in multiple sclerosis patient's disease and their responses to standard drugs indicate that today's therapies need to be more individualized. It is proposed that gene expression profiling in conjunction with magnetic resonance imaging be used to optimize future treatment approaches. The treatment of autoimmune diseases is still in its infancy, and corticosteroids and immunosuppression remain the mainstay therapies. More subtle strategies of immunomodulation - such as the use of interferon beta (IFN- beta ) and glatiramer acetate (GA) in the treatment of multiple sclerosis (MS) - are well accepted, and the use of engineered antibodies or receptors to tumor necrosis factor- alpha (TNF- alpha ) in the treatment of rheumatoid arthritis (RA) have been introduced as new therapies. However, the heterogeneity of autoimmune diseases, as well as characteristics of the target tissue, pose challenges to induce more effective immune intervention. Recent advances in our understanding of autoimmune disease pathogenesis, in imaging techniques and in the use of other biomarkers, require the reassessment of conventional therapeutic approaches and the development of new ones. Using MS as an example, we describe here the current state of immunotherapy, highlight important questions and stress where we should focus our efforts in the future.