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We are all creatures of the sun. Increasingly, studies emphasize the complex interplay between our environment and our neuroimmunologic systems. Both brain and immune system start out largely nonspecific and receive much of their exquisite complexity through a nature–nurture dynamic. Both learn as they go and remember what they have seen. Multiple sclerosis (MS) is a complex disease at the interface of this dynamic; prevalence and progression vary greatly; its etiology remains elusive. Disease progression is commonly reflected as recurring bouts of inflammatory disease activity leading to axonal demyelination and loss, gliosis, and secondary (Wallerian) degeneration. The cumulative burden of this activity, some of it clinically silent, eventually surfaces in chronic disability.
With etiology still incompletely elucidated, MS is the result of a complex and dynamic interplay among genetic, immunologic, and largely unknown environmental factors. Those genes with a link to MS susceptibility all encode immune function. While we all carry the T cells that perpetuate MS, only 1 in 1,000 appears to have the particular, at least partly acquired, signature of immune reactivity that leads to MS. It is well-established that MS prevalence is characterized by a geographic latitude …
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