Resumen
La esclerosis múltiple es la enfermedad inflamatoria, crónica y degenerativa más frecuente del sistema nervioso central y representa la primera causa de discapacidad en adultos jóvenes. En México, 11 a 20 de cada 100 000 habitantes padecen la enfermedad. Aún se desconocen las causas de su origen, pero se han formulado varias teorías: la interacción de factores ambientales, infecciosos virales y susceptibilidad genética e inmunológica propia de cada paciente, que inducen una respuesta autoinmune y promueven la degeneración neuronal/axonal. En esta revisión se analizan los principales componentes de la respuesta inmune y la neurodegeneración presentes en la esclerosis múltiple, así como la cascada inflamatoria asociada con la desmielinización. Los tratamientos disponibles tienen como objetivo principal modular los aspectos relacionados con la respuesta inmune adaptativa (células B y T). El reto terapéutico será la inducción de tolerancia inmune antígeno-específica, por ejemplo, mediante el uso de protocolos de tolerancia con péptidos, vacunas de ADN o nanopartículas. Las futuras terapias deberán dirigirse a controlar los componentes innatos del sistema inmune (microglías, macrófagos, astrocitos) y a promover la remielinización. Para optimizar el tratamiento será necesario un enfoque terapéutico combinado dirigido al control de los componentes inflamatorios y neurodegenerativos de la enfermedad y al monitoreo de biomarcadores.
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