The complex interactions between the central nervous system and the immune system are mainly mediated via synthesis and secretion of cytokines. Disturbance of the fine balance between different cytokine subpopulations is undeniable factor in the development of pathological process in multiple sclerosis. Experimental and clinical studies examining the impact of individual cytokines on the course of the disease often give conflicting results. The reason for this may be searched in the complex interactions within the cytokine network, dependent on the local milieu in the central nervous system. Efforts to modulate autoimmune process in multiple sclerosis have shown that effective treatments alter cytokine expression in a favorable way, indicating cytokines as possible therapeutic targets. The widely approved disease modifying treatments with interferon-beta, glatiramer acetate, cytostatic drugs, but also experimental therapeutic agents like estriol, statins and vitamin D have been proved to exert their beneficial effect partially by impact on different aspects of cytokine production. The purpose of this review is to highlight the importance to consider the complexity of cytokine interactions in pathogenesis and treatment of multiple sclerosis. Increase of the knowledge in this area will create opportunities for more precise determination of targets for immunologically active drugs in order to improve their effectiveness.

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