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Straus Farber R, Walker EL, Diallo F, Onomichi K, Riley C, Zhang L, Zhu W, De Jager PL, Xia Z. A randomized cross-over trial of prebiotics and probiotics in multiple sclerosis: Trial feasibility, supplement tolerability and symptom abatement. Mult Scler Relat Disord 2024; 89:105762. [PMID: 39047340 DOI: 10.1016/j.msard.2024.105762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/06/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Dietary supplements can modulate the gut microbial ecosystem and affect the immune system. This has potential implications for autoimmune diseases, including multiple sclerosis (MS). Prior studies explored tolerability, symptomatic improvement, and immunologic effects of probiotics in people with MS (pwMS), but no study has examined prebiotics in this population or compared prebiotics with probiotics. METHODS This is a randomized, open-label trial of participants with relapsing-remitting MS on B-cell depletion therapy from two MS centers. 22 participants enrolled in the original cross-over study in which probiotic (Visbiome, containing Lactobacillus, Bifidobacterium and Streptococcus species) or prebiotic (Prebiotin, containing oligofructose enriched inulin) supplementation for 6 weeks was randomized, each followed by a washout period. Due to pandemic-related interruptions and expiration of the study supply of probiotics, another 15 participants enrolled in a single-arm study to receive prebiotic supplementation for 6 weeks followed by a washout period. We assessed supplement tolerability and patient-reported outcomes (PRO) relevant to MS (disability, fatigue, mood, and bowel symptoms) before and after each supplement administration period and each washout period. We bio-archived plasma, serum, peripheral blood mononuclear cells and stool samples at each timepoint for future multi-omic assessment. RESULTS Prebiotics and probiotics had comparable adherence rates and both supplements were well tolerated in pwMS. Participants on either supplement reported minor adverse events, most of which were mild and self-limited. There was a subjective preference for prebiotics over probiotics. Comparing supplement-associated changes in PRO scores from baseline to 6 weeks post-supplementation, there were significant difference between prebiotics and probiotics for the change in patient-reported global symptom burden (MSRS-R Total) and bowel control (BWCS), but only probiotics statistically improved bowel control from baseline to post-supplementation. CONCLUSION Supplementation with either prebiotics or probiotics is reasonably well-tolerated and safe. Probiotics improved bowel control, but did not improve other PROs in a 6-week time frame. These data regarding feasibility, tolerability, adherence, and adverse events of supplements will inform future clinical trial designs to definitively compare the efficacy and safety of prebiotics and probiotics. The biological data that will be generated from this study in the future will provide mechanistic insights into the effects of these dietary supplements on MS pathophysiology.
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Affiliation(s)
- Rebecca Straus Farber
- Columbia Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Neuroimmunology Division, Department of Neurology, Columbia University Irving Medical Center, 710 West 168th St, New York, NY 10032, USA.
| | - Elizabeth Ls Walker
- Department of Neurology, University of Pittsburgh, 3501 5th Avenue, BST-3 Suite 10044, Pittsburgh, PA 15260, USA
| | - Fatoumata Diallo
- Columbia Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Neuroimmunology Division, Department of Neurology, Columbia University Irving Medical Center, 710 West 168th St, New York, NY 10032, USA
| | - Kaho Onomichi
- Columbia Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Neuroimmunology Division, Department of Neurology, Columbia University Irving Medical Center, 710 West 168th St, New York, NY 10032, USA
| | - Claire Riley
- Columbia Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Neuroimmunology Division, Department of Neurology, Columbia University Irving Medical Center, 710 West 168th St, New York, NY 10032, USA
| | - Lili Zhang
- Department of Neurology, University of Pittsburgh, 3501 5th Avenue, BST-3 Suite 10044, Pittsburgh, PA 15260, USA
| | - Wen Zhu
- Department of Neurology, University of Pittsburgh, 3501 5th Avenue, BST-3 Suite 10044, Pittsburgh, PA 15260, USA
| | - Philip L De Jager
- Columbia Multiple Sclerosis Center and the Center for Translational & Computational Neuroimmunology, Neuroimmunology Division, Department of Neurology, Columbia University Irving Medical Center, 710 West 168th St, New York, NY 10032, USA
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, 3501 5th Avenue, BST-3 Suite 10044, Pittsburgh, PA 15260, USA.
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Bierhansl L, Hartung HP, Aktas O, Ruck T, Roden M, Meuth SG. Thinking outside the box: non-canonical targets in multiple sclerosis. Nat Rev Drug Discov 2022; 21:578-600. [PMID: 35668103 PMCID: PMC9169033 DOI: 10.1038/s41573-022-00477-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 12/11/2022]
Abstract
Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system that causes demyelination, axonal degeneration and astrogliosis, resulting in progressive neurological disability. Fuelled by an evolving understanding of MS immunopathogenesis, the range of available immunotherapies for clinical use has expanded over the past two decades. However, MS remains an incurable disease and even targeted immunotherapies often fail to control insidious disease progression, indicating the need for new and exceptional therapeutic options beyond the established immunological landscape. In this Review, we highlight such non-canonical targets in preclinical MS research with a focus on five highly promising areas: oligodendrocytes; the blood-brain barrier; metabolites and cellular metabolism; the coagulation system; and tolerance induction. Recent findings in these areas may guide the field towards novel targets for future therapeutic approaches in MS.
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Affiliation(s)
- Laura Bierhansl
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Michael Roden
- Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- German Center of Diabetes Research, Partner Düsseldorf, Neuherberg, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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Liu H, Chen B, Zhu Q. Potential application of hydrogel to the diagnosis and treatment of multiple sclerosis. J Biol Eng 2022; 16:10. [PMID: 35395765 PMCID: PMC8991948 DOI: 10.1186/s13036-022-00288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/12/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. This disorder may cause progressive and permanent impairment, placing significant physical and psychological strain on sufferers. Each progress in MS therapy marks a significant advancement in neurological research. Hydrogels can serve as a scaffold with high water content, high expansibility, and biocompatibility to improve MS cell proliferation in vitro and therapeutic drug delivery to cells in vivo. Hydrogels may also be utilized as biosensors to detect MS-related proteins. Recent research has employed hydrogels as an adjuvant imaging agent in immunohistochemistry assays. Following an overview of the development and use of hydrogels in MS diagnostic and therapy, this review discussed hydrogel’s advantages and future opportunities in the diagnosis and treatment of MS. Graphical abstract ![]()
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Affiliation(s)
- Haochuan Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, TX, 130031, PR China
| | - Bing Chen
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, TX, 130031, PR China.
| | - Qingsan Zhu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Xiantai Street No. 126, Changchun, TX, 130031, PR China.
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