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Interview with Giancarlo Comi: Axoglial Interaction and Pathology of Multiple Sclerosis

COMI PATHOPHYSIOLOGY-HD

Professor Comi emphasized how little was known about the pathophysiology of the progressive phases in relapsing remitting multiple sclerosis. It was unknown why some patients had very quick progression, although this was much slower for others. He asked whether the degenerative phase simply took place at the beginning of the disease, or whether it was something that took place in most patients at a given time point.

Professor Comi considered that the decline in the progressive phase of MS resulted from axon loss. The degenerative phase of the disease was paralleled by degeneration of the axons. This was probably a consequence of long-term demyelination, as the axon-glia interaction could then no longer remain at a safe level. Permanent demyelination determined secondary degeneration. The axons might survive quite a long time without myelin but sooner or later degenerated.

According to Professor Comi, current treatment of progression in the common forms of multiple sclerosis lagged far behind treatment of the relapses. Recent results of clinical trials suggested that the old drug phenytoin could protect against degeneration. Specific antibody treatment might also be able to reverse the process of demyelination. This could in principle prevent damage or enhance recovery.

Professor Comi is in the Department of Neurology in Milan University di Vita.

This interview has been recorded on 30th September 2015 at the San Raffaele Hospital, Milan, Italy.