Is Cerebrospinal Fluid Responsible for Innate Immune Cell Activation and Neurotoxicity in Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic neuroinflammatory disease characterized not only by the classic focal demyelinating plaques but also by a cytotoxic neurodegenerative process of the brain.1 Magnetization transfer ratio (MTR) on MRI has shown that microstructural damage is more evident in brain areas closer to CSF, including the cortex and periventricular white matter (WM), suggesting a common pathophysiologic mechanism of damage.2,3 Even though microglial activation has been associated with cortical damage postmortem,4 the exact mechanism of tissue damage in areas around the CSF and the role of CSF in it have yet to be identified.

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