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Updated: Aug 4, 2025
Microbiota Analysis Using Two-step PCR and Next-generation 16S rRNA Gene Sequencing
Published on: October 15, 2019
Disease-modifying therapy for multiple sclerosis: Implications for gut microbiota
Silvy Pilotto1, Magdalena Zoledziewska2, Giuseppe Fenu3
1Multiple Sclerosis Center, ASL Cagliari, Department of Medical Sciences and Public Health, Binaghi Hospital, University of Cagliari, via Is Guadazzonis 2, Cagliari 09126, Italy.
Background:
Growing evidence has suggested the involvement of gut microbiota in the pathophysiology of multiple sclerosis (MS). Disease-modifying therapies (DMTs) exert a parallel effect on the gut microenvironment with subsequent modulation of the intestinal and systemic immune system. Herein, we summarize the current literature on the effect of DMTs on the gut microbiome and possible implications for MS.
Methods:
All the literature available in PubMed on the effects of DMTs on the gut microbiota composition in patients with MS was reviewed. We used multiple combinations of the following keywords: "multiple sclerosis; demyelinating disease; gut microbiome; microbiome; brain-gut axis; diet; fecal microbiome; disease modifying therapy; immunomodulator; interferon; glatiramer acetate; teriflunomide; dimethyl fumarate; natalizumab; alemtuzumab; anti-CD20; fingolimod". All the original research articles available in English were included in this narrative review.
Results:
Ten original full-text articles were considered eligible, including seven case-control and three cohort studies. First-line DMTs, including oral and subcutaneous treatments (dimethyl fumarate, glatiramer acetate, and interferon β 1b) were considered, while a small number of patients with MS were under natalizumab, fingolimod and anti-CD20 treatments.
Conclusions:
Emerging evidence reported changes in the gut microbiome during exposition to DMTs. However, the association between DMTs exposure and microbial changes was mostly indirect, and the results of the different studies needed to be more consistent. The mitigation of methodological bias is necessary for future studies to allow the identification of a "microbial signature" related to MS pathophysiology, the role of DMTs, and possible prognostic implications.
Insights
Disease-modifying therapies (DMTs) for multiple sclerosis (MS) impact the gut microbiome. While studies show microbial changes, the direct association and consistency require further investigation for prognostic implications.
Area of Science:
- Neuroimmunology
- Microbiome Research
- Pharmacology
Background:
- Gut microbiota plays a role in multiple sclerosis (MS) pathophysiology.
- Disease-modifying therapies (DMTs) for MS influence the gut microenvironment and immune system.
- Understanding the impact of DMTs on the gut microbiome is crucial for MS management.
Purpose of the Study:
- To review and summarize the current literature on the effects of DMTs on the gut microbiome in MS patients.
- To explore the implications of these changes for MS pathophysiology and treatment.
Main Methods:
- A comprehensive literature search was conducted on PubMed using keywords related to MS, gut microbiome, and DMTs.
- Original research articles in English were included in this narrative review.
- Studies focused on first-line DMTs (dimethyl fumarate, glatiramer acetate, interferon β 1b) and other treatments (natalizumab, fingolimod, anti-CD20).
Main Results:
- Ten eligible studies were identified, comprising seven case-control and three cohort studies.
- Changes in the gut microbiome were observed in patients exposed to DMTs.
- The association between DMT exposure and microbial alterations was often indirect.
Conclusions:
- Emerging evidence suggests DMTs alter the gut microbiome in MS patients.
- Current findings on the specific microbial changes and their direct association with DMTs are inconsistent.
- Future research needs to mitigate methodological bias to identify a "microbial signature" for MS and DMT roles.
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