The development and evolution of targeted therapy to any disease require the identification of targets amenable
to treatment of patients. Here the pathogenetic signalling systems involved in multiple sclerosis are scrutinised to locate
nodes of deregulation and dysfunction in order to devise strategies of drug development for targeted intervention.
Oliogoclonal bands (OCB) are isoelectric focusing profiles of immunoglobulins synthesised in the central nervous system.
OCBs enable the diagnosis of multiple sclerosis with high sensitivity and specificity and are related to the course of the
disease and progression. The OCB patterns can be linked with the expression of angiogenic molecular species.
Angiogenic signalling which has also been implicated in demyelination provides the option of using angiogenesis
inhibitors in disease control.
The PI3K (phosphoinositide 3-kinase)/Akt axis has emerged with a key role in myelination with its demonstrable links
with mTOR mediated transcription of downstream target genes. Inflammatory signals and innate and acquired immunity
from the activation of NF-κB (nuclear factor κB) responsive genes are considered. NF-κB signalling could be implicated
in myelination. The transcription factor STAT (signal transducers and activators of transcription) and the EBV (Epstein-
Barr virus) transcription factor BZLF1 contributing significantly to the disease process are a major environmental factor
linked to MS. EBV can activate TGF (transforming growth factor) and VEGF (vascular endothelial growth factor)
signalling. EBV microRNAs are reviewed as signalling mediators of pathogenesis. Stem cell transplantation therapy has
lately gained much credence, so the current status of mesenchymal and hematopoietic stem cell therapy is reviewed with
emphasis on the differential expression immune-related genes and operation of signalling systems.
Keywords: Angiogenic growth factors, chemokines, EBV, immunomodulation, MicroRNAs, molecular therapy, multiple
sclerosis, signalling systems, stem cells, targeted therapy, transcription factors, vitamin D.
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