Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significance
In multiple sclerosis (MS), increasing disability is considered to occur due to persistent, chronic inflammation trapped within the central nervous system (CNS). This condition, known as smoldering neuroinflammation, is present across the clinical spectrum of MS and is currently understood to be rel...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-12-01
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| Series: | Therapeutic Advances in Neurological Disorders |
| Online Access: | https://doi.org/10.1177/17562864241306684 |
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| author | Assunta Dal-Bianco Jiwon Oh Pascal Sati Martina Absinta |
| author_facet | Assunta Dal-Bianco Jiwon Oh Pascal Sati Martina Absinta |
| author_sort | Assunta Dal-Bianco |
| collection | DOAJ |
| description | In multiple sclerosis (MS), increasing disability is considered to occur due to persistent, chronic inflammation trapped within the central nervous system (CNS). This condition, known as smoldering neuroinflammation, is present across the clinical spectrum of MS and is currently understood to be relatively resistant to treatment with existing disease-modifying therapies. Chronic active white matter lesions represent a key component of smoldering neuroinflammation. Initially characterized in autopsy specimens, multiple approaches to visualize chronic active lesions (CALs) in vivo using advanced neuroimaging techniques and postprocessing methods are rapidly emerging. Among these in vivo imaging correlates of CALs, paramagnetic rim lesions (PRLs) are defined by the presence of a perilesional rim formed by iron-laden microglia and macrophages, whereas slowly expanding lesions are identified based on linear, concentric lesion expansion over time. In recent years, several longitudinal studies have linked the occurrence of in vivo detected CALs to a more aggressive disease course. PRLs are highly specific to MS and therefore have recently been incorporated into the MS diagnostic criteria. They also have prognostic potential as biomarkers to identify patients at risk of early and severe disease progression. These developments could significantly affect MS care and the evaluation of new treatments. This review describes the latest knowledge on CAL biology and imaging and the relevance of CALs to the natural history of MS. In addition, we outline considerations for current and future in vivo biomarkers of CALs, emphasizing the need for validation, standardization, and automation in their assessment. |
| format | Article |
| id | doaj-art-d52e5c4a50094888ad99c09a5e61d06c |
| institution | Kabale University |
| issn | 1756-2864 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Neurological Disorders |
| spelling | doaj-art-d52e5c4a50094888ad99c09a5e61d06c2025-01-24T06:03:20ZengSAGE PublishingTherapeutic Advances in Neurological Disorders1756-28642024-12-011710.1177/17562864241306684Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significanceAssunta Dal-BiancoJiwon OhPascal SatiMartina AbsintaIn multiple sclerosis (MS), increasing disability is considered to occur due to persistent, chronic inflammation trapped within the central nervous system (CNS). This condition, known as smoldering neuroinflammation, is present across the clinical spectrum of MS and is currently understood to be relatively resistant to treatment with existing disease-modifying therapies. Chronic active white matter lesions represent a key component of smoldering neuroinflammation. Initially characterized in autopsy specimens, multiple approaches to visualize chronic active lesions (CALs) in vivo using advanced neuroimaging techniques and postprocessing methods are rapidly emerging. Among these in vivo imaging correlates of CALs, paramagnetic rim lesions (PRLs) are defined by the presence of a perilesional rim formed by iron-laden microglia and macrophages, whereas slowly expanding lesions are identified based on linear, concentric lesion expansion over time. In recent years, several longitudinal studies have linked the occurrence of in vivo detected CALs to a more aggressive disease course. PRLs are highly specific to MS and therefore have recently been incorporated into the MS diagnostic criteria. They also have prognostic potential as biomarkers to identify patients at risk of early and severe disease progression. These developments could significantly affect MS care and the evaluation of new treatments. This review describes the latest knowledge on CAL biology and imaging and the relevance of CALs to the natural history of MS. In addition, we outline considerations for current and future in vivo biomarkers of CALs, emphasizing the need for validation, standardization, and automation in their assessment.https://doi.org/10.1177/17562864241306684 |
| spellingShingle | Assunta Dal-Bianco Jiwon Oh Pascal Sati Martina Absinta Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significance Therapeutic Advances in Neurological Disorders |
| title | Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significance |
| title_full | Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significance |
| title_fullStr | Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significance |
| title_full_unstemmed | Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significance |
| title_short | Chronic active lesions in multiple sclerosis: classification, terminology, and clinical significance |
| title_sort | chronic active lesions in multiple sclerosis classification terminology and clinical significance |
| url | https://doi.org/10.1177/17562864241306684 |
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