Viability of autoantibody-targets: How to tackle pathogenetic heterogeneity as an obstacle for treatment of multiple sclerosis

The growing complexity number of multiple sclerosis (MS) therapy emphasizes the need for an individualized approach, tailoring therapy to the needs of the individual patient. There is evidence supporting the immunopathological heterogeneity of MS, based on the analysis of biopsy and autopsy tissues. In clinical practice it is impossible to differentiate between the pathological subtypes of MS, because blood or CSF markers of pathological heterogeneity are lacking. Identification of such markers would be important, because “tailored therapy” and “biomarkers for patient stratification” may be considered as two sides of the same coin. In this article, we discuss the emerging role of autoantibodies as potential biomarkers, focusing on myelin oligodendrocyte glycoprotein (MOG) as one of the best characterized autoantigens in MS. In addition, we discuss several strategies for the identification of novel candidate autoantigens.