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 In 1995 Rex enlightened us with a new way of looking at MS. He told us the
history of the description of MS and outlined the various ways that it shows itself. Then
came the statement which had stirred participants at the John Curtin School of Medical
Research seminar on MS in September.
 MS is not primarily an auto immune disease.

There are difficulties with the idea of MS being primarily an auto immune disease.
1. It is not like other autoimmune diseases.
2. there is a missing autoantigen. (If it existed it would have been found by now.)
3. the non-specific inflammatory profile of the lesion.
4. Immunotherapy is only marginally effective.
5. There is a wide clinical spectrum. (MS shows itself in many different ways, but it is
still the same disease.)
6. Immunogenetic alleles are missing.

Rex asked many questions, and made certain points. Among them were:
b. There are multiple auto antigens, so, why is MS organ specific?
c. Biochemically, the inflammation of MS plaques looks like any other chronic
inflammation. “No adhesion or cytokine molecule [unique to MS] was apparent.”
d. If auto immunity is the only event going on in MS then we should be able to cure it.
e. The association of MS with genes controlling the immune system (HLA) is weaker
than expected for an auto immune disease. (and, if MS is only genetically determined
then we should see more connection. For example, for identical twins, if one twin has
MS then there is a 38% chance that the other twin will also have MS. Genetics are
involved but there is obviously some environmental influence.)

The conclusion that Rex reached was that a Bifactor system was operating in MS. The
two factors were (i)the immune response and (ii)the inherited Central Nervous System
impairment. He suggested a polygenetic inheritance of impairment/susceptibility (?) in
both the immune system and the Central Nervous System. The genetic inheritance (?)
could be weak or strong. Something (perhaps infection) triggered an immune response
which then triggered the impairment in the CNS. This produced the pathology (or
symptoms) of MS and by inflaming stimuli, a feedback loop to the immune system was
started.
It looked like this: