Journal Club: MRI reveals acute inflammation in cortical lesions during early MS

Early multiple sclerosis is characterized by immune-associated demyelination of CNS axons. In a recent Neurology (R) article, Maranzano et al. evaluated MRI scans of patients with early multiple sclerosis to study the evolution of leukocortical lesions. Their novel data suggest that acute inflammation after blood-brain barrier leakage may contribute to gray matter cortical lesions in early multiple sclerosis. Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative disease that affects approximately 2.5 million people in the United States. 1 Challenges with efficacy of existing drugs suggest the need for better understanding of mechanisms underlying MS. Demyelination of axons within the CNS, a hallmark of MS, is likely induced or worsened by inflammation. 1 Due to technical limitations, white matter MS lesions have been easier to detect, but gray matter also appears susceptible to early inflammatory pathology. Indeed, leukocortical lesions, which are combined gray and white matter inflammatory lesions, and cortical demyelination can precede or co-present with meningeal inflammation. 2 However, there remains an incomplete understanding about the temporal dynamics of leukocortical lesion development in MS. In a recent article published in Neurology (R), Maranzano et al. 3 compiled MRI scans of patients with early MS to better understand the evolution of these inflammatory cortical lesions (CLs). They reveal the dynamics of gray matter pathology during early MS, laying a foundation for identifying targets for ameliorating CL development and disease progression/ severity.