Joan Beal recently put up a very useful Note on Protective Autoimmunity in MS (http://www.facebook.com/notes/ccsvi-in-multiple-sclerosis/protective-autoimmunity-part-4/475147737210 )

I thought I would add my views on this important topic.

It is well established that everyone carries T cells which are sensitive to myelin antigens and I have always thought the reason why such immune cells were not deleted in the thymus during the formation of the immune system was that they are useful for myelin repair. Given that head/brain trauma was a relatively common event during the evolution of humans and and our primate ancestors, the presence of such immune cells would be favourable for survival.

However, given such immune cells cause much damage in persons with MS, the question becomes what has turned useful immune cells into problematic ones for those with MS.

To me, the best answer is that MS involves the loss of proper immune regulation, that is, persons with MS have a damaged immune system such that it cannot efficiently turn off the activity of the myelin-sensitive immune cells. Notably, there is a wealth of data which shows persons with MS have impaired immune regulation.

I agree that MS is a vascular disease because it is mandatory to have impaired venous drainage which in turn results in a leaky BBB and a myriad of consequent problems. However MS is also an immune-related disease in that it is also necessary to have impaired immune regulation. It is important to understand that both factors are necessary, a vascular one and an immune one.

The current squabbling of one side shouting MS is a vascular disease and the other side shouting just as loudly that MS is an immune disease is ridiculous and counter-productive. Notably some people have kept MS very well controlled by only countering the immune effects (e.g. those who have used nutritional strategies but have not resolved their CCSVI). It may well be that those who resolve CCSVI and do not address the immune problems may also keep MS well controlled. However, common sense says the best strategy it is to treat both the vascular and the immune components to ensure MS does not cause a problem.