We focus on agents targeting key pathogenic mechanisms in MSA-including α-synuclein aggregation (e.g., sirolimus/rapamycin, rifampicin, lithium, nilotinib, epigallocatechin gallate), neuroinflammation (e.g., minocycline, intravenous immunoglobulin), mitochondrial dysfunction and excitotoxicity (e.g., ubiquinol, rasagiline, safinamide, riluzole), and impaired neurotrophic support (e.g., fluoxetine/selective serotonin reuptake inhibitors, insulin, exendin-4). Here, INS is linked to multiple system atrophy.