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Demyelination in MS. CD4+ T cells (T helper 1/17 cells) and CTLs can pass through the blood–brain barrier (BBB) by endocytosis or diapedesis. Self-antigens can be presented by APCs to CTLs, Th1 or Th17 cells. Th1 cells release cytokines such as IFNγ and TNFα, whereas Th17 cells release IL-17, IL-21, IL-22 and IFNγ cytokines. These cytokines affect CTLs and increase granzyme and perforin production and release which leads to myelin destruction.
