Figure 4.

Representative image showing the progression of multiple sclerosis disability and T-cell mediated synaptopathy during the course of the disease. During the relapsing phase of RRMS, the disability (EDSS) of patients increase and it is accompanied by exacerbation of T lymphocyte-induced excitatory transmission, a synaptotoxic ability absent during the remitting stages of the disease. The synaptotoxic ability of T lymphocytes re-emerges with disease progression, independently of disease activity, and siponimod is able to rescue this synaptic alteration.