Ageing and multiple sclerosis.

The factor that is most relevant and strongly associated with the clinical course of multiple sclerosis is chronological age. Very young patients exclusively have relapsing remitting disease, whereas those with later onset disease face a more rapid development of permanent disability. For people with progressive multiple sclerosis, the poor response to current disease modifying therapies might be related to ageing in the immune system and CNS. Ageing is also associated with increased risks of side-effects caused by some multiple sclerosis therapies. Both somatic and reproductive ageing processes might contribute to development of progressive multiple sclerosis. Understanding the role of ageing in immune and neural cell function in patients with multiple sclerosis might be key to halting non-relapse-related progression. The growing literature on potential therapies that target senescent cells and ageing processes might provide effective strategies for remyelination and neuroprotection.

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Declaration of interests No authors received funding for the writing of this manuscript or had direct conflicts of interest with regard to the content of the manuscript. Unrelated to the current work, JSG has received grant or clinical trial funding from the US National Multiple Sclerosis Society (NMSS), University of California San Diego (UCSD), Octave, Biogen, EMD Serono, Novartis, and Sanofi; serves on a steering committee for a clinical trial with Novartis; has served on advisory boards for Genentech and Bayer; and has received educational speaker fees from Alexion. Unrelated to the current work, KMK has received fellowship funding from the NMSS and Biogen; and has received honoraria from Normative, Biogen, Novartis, Roche, and EMD Serono. Unrelated to the current work, MA has received consultancy and speaking honoraria from Sanofi-Genzyme and GlaxoSmithKline (GSK); and has received speaking honoraria from Celgene. Unrelated to the current work, LHH has received honoraria for speaking, consulting, or advisory board activities from Genzyme, Novartis, Genentech, Bristol Myers Squibb, EMD Serono, Horizon Therapeutics, and Greenwich Biosciences; receives research support paid to her institution from Biogen; and receives salary support from the Eric and Sheila Samson Foundation. RJMF has received research support from the Adelson Medical Research Foundation, MS Society UK, and the Wellcome Trust; and participates on a data safety monitoring or advisory board for Biogen and Frequency Therapeutics. Unrelated to the current work, BS has received grant support from the US National Institute of Health and consulting fees from Bloom Burton, Neurodiem, and Senda Biosciences; has received speaking honoraria from Advances Curriculum for Multiple Sclerosis Continuing Medical Education course and PRIME; has a patent optioned by Vaccinex and a second provisional patent that has been filed; and is on a safety monitoring board for Eli Lilly.