Multiple sclerosis therapy also improves gut flora

Summary: Multiple sclerosis patients treated with dimethyl fumarate (Tecfidera) showed a reduced proportion of pro-inflammatory types of gut bacteria and increased growth of “good” bacteria after three months of treatment.

Source: duke university

A drug used to treat multiple sclerosis (MS) also has a beneficial effect on the composition of the intestinal flora, according to researchers from the University of Basel and the University Hospital of Basel. Conversely, the intestinal flora also plays a role in which side effects occur during treatment with the drug.

Few previous studies have looked at the effects of MS treatments on gut flora and the role their composition plays in terms of efficacy and side effects.

A team of researchers from the University of Basel and the University Hospital of Basel examined these questions in a group of 20 patients with multiple sclerosis treated with dimethyl fumarate.

The team led by Professor Anne-Katrin Pröbstel, Senior Neurology Physician and Research Group Leader, and Professor Adrian Egli, who recently moved to the University of Zurich, published their findings in the journal Intestinal microbes.

The drug, sold under the brand name Tecfidera, reduces the number of MS flare-ups by interfering with the metabolic processes of certain immune cells.

However, the therapy is also associated with side effects, including hot flushes and gastrointestinal disturbances, and in some cases lymphopenia, a lack of lymphocytes such as B cells and T cells in the blood. This can lead to serious complications.

More “good” bacteria

In their study, the researchers examined stool and blood samples from participants before and during the first twelve months of treatment. They focused on the composition of the gut microbiome.

Pröbstel and his team also measured the number of lymphocytes in the blood to identify patients who suffered from lymphopenia as a side effect.

After only three months of treatment, the research team was already able to identify changes in the gut microbiome: “We were able to show that the gut bacteria of patients receiving the drug began to resemble more the composition observed in healthy individuals,” Pröbstel explained.

Dimethyl fumarate treatment reduced the proportion of pro-inflammatory types of bacteria, which have been associated with MS, and supported the growth of ‘good’ bacteria.

Multiple sclerosis therapy also improves gut flora
The drug, sold under the brand name Tecfidera, reduces the number of MS flare-ups by interfering with the metabolic processes of certain immune cells. Image is in public domain

In addition, the researchers were able to establish a link between the composition of the intestinal microbiome and the development of lymphopenia: the presence of the bacterium Akkermansia muciniphila combined with the absence of the bacterium Prevotella copri appeared as a risk factor for this effect. secondary. The authors therefore suspect P. copri to protect against lymphopenia.

Interaction between therapy and intestinal flora

“Our data suggest that immunomodulatory therapies not only affect immune cells, but also positively influence the gut microbiome,” says Pröbstel.

The link between gut bacteria and clinical side effects of treatment could potentially allow early identification of patients at risk of developing lymphopenia.

Microbiologist Egli continues: “In the future, this relatively new field of microbiology could help us better understand the effects and side effects of many drugs as they relate to gut bacteria, and tailor treatment accordingly.”

“What we have so far is just a pilot study with a relatively small number of participants,” she cautioned. Larger studies are needed to confirm the results and explore the potential of supporting MS therapies via gut flora and to predict side effects in advance.

About this multiple sclerosis research news

Author: Press office
Source: University of Basel
Contact: Press service – University of Basel
Image: Image is in public domain

See also

This shows a cartoon of a man working on a laptop

Original research: Free access.
“Gut microbiota composition as a candidate risk factor for dimethyl fumarate-induced lymphopenia in multiple sclerosis” by Martin Diebold et al. Intestinal microbes


Summary

Gut microbiota composition as a candidate risk factor for dimethyl fumarate-induced lymphopenia in multiple sclerosis

Mounting evidence points to a central role of the gut microbiota in the pathophysiology of multiple sclerosis (MS).

Yet, whether disease-modifying treatments alter microbiota composition and whether microbiota shape treatment response and side effects remains unclear.

In this prospective observational pilot study, we evaluated the effect of dimethyl fumarate (DMF) on gut microbiota and host/microbial metabolomics in a cohort of 20 MS patients.

By combining state-of-the-art microbial sequencing, metabolome mass spectrometry, and computational analysis, we identified longitudinal changes in the composition of the gut microbiota under DMF treatment and an increase in citric acid cycle metabolites.

Notably, DMF-induced lymphopenia, a clinically relevant safety issue, correlated with distinct baseline microbiome signatures in MS patients. We have identified the gastrointestinal microbiota as a key therapeutic target for the metabolic properties of DMF.

By characterizing gut microbial composition as a candidate risk factor for DMF-induced lymphopenia, we provide new insights into the role of the microbiota in mediating clinical side effects.

Leave a Comment