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Updated: Jul 8, 2025
Microbiota Analysis Using Two-step PCR and Next-generation 16S rRNA Gene Sequencing
Published on: October 15, 2019
Disease-modifying therapies used to treat multiple sclerosis and the gut microbiome: a systematic review
Chia-Chen Tsai1,2, Sophia Jette1, Helen Tremlett3
1Division of Neurology, Faculty of Medicine, Djavad Mowafaghian Centre for Brain Health, Room S126, 2211 Wesbrook Mall, University of British Columbia, Vancouver, BC, V6T 2B5, Canada.
Background:
The gut microbiome may play a role in multiple sclerosis (MS). However, its relationship with the disease-modifying therapies (DMTs) remains unclear. We systematically reviewed the literature to examine the relationship between DMTs and the gut microbiota among persons with MS (pwMS).
Methods:
MEDLINE, EMBASE, Web of Science, and Scopus were searched (01/2007-09/2022) for studies evaluating potential gut microbiota differences in diversity, taxonomic relative abundances, and functional capacity between DMT-exposed/unexposed pwMS or before/after DMT initiation. All US FDA-approved MS DMTs (1993-09/2022) and rituximab were included.
Results:
Of the 410 studies, 11 were included, totalling 1243 pwMS. Of these, 821 were DMT exposed and 473 unexposed, including 51 assessed before/after DMT initiation. DMT use duration ranged from 14 days to > 6 months. No study found a difference in gut microbiota alpha-diversity between DMT exposed/unexposed (p > 0.05). One study observed a difference in beta-diversity between interferon-beta users/DMT non-users (weighted UniFrac, p = 0.006). All studies examined taxa-level differences, but most (6) combined different DMTs. Two or more studies reported eight genera (Actinomyces, Bacteroides, Clostridium sensu stricto 1, Haemophilus, Megasphaera, Pseudomonas, Ruminiclostridium 5, Turicibacter) and one species (Ruthenibacterium lactatiformans) differing in the same direction between DMT exposed/unexposed. DMT users had lower relative abundances of carbohydrate degradation and reductive tricarboxylic acid cycle I pathway than non-users (p < 0.05), but findings could not be attributed to a specific DMT.
Discussion:
While DMT use (versus no use) was not associated with gut microbiota diversity differences, taxa-level differences were observed. Further work is warranted, as most studies were cross-sectional, few examined functionality, and DMTs were combined.
Insights
Disease-modifying therapies (DMTs) for multiple sclerosis (MS) did not alter gut microbiota diversity. However, specific gut bacteria and functional pathways differed between DMT-exposed and unexposed persons with MS (pwMS).
Area of Science:
- Microbiology
- Neuroimmunology
- Pharmacology
Background:
- The gut microbiome's role in multiple sclerosis (MS) is increasingly recognized, but its interaction with disease-modifying therapies (DMTs) remains poorly understood.
- This systematic review investigates the relationship between DMT use and the gut microbiota composition and function in persons with MS (pwMS).
Approach:
- A comprehensive literature search of MEDLINE, EMBASE, Web of Science, and Scopus (2007-2022) was conducted.
- Studies comparing gut microbiota diversity, taxonomic abundances, and functional capacity between DMT-exposed/unexposed pwMS or before/after DMT initiation were included.
- All US FDA-approved MS DMTs and rituximab were considered.
Key Points:
- No significant differences in gut microbiota alpha-diversity were found between DMT-exposed and unexposed pwMS.
- One study noted a beta-diversity difference in interferon-beta users compared to non-users.
- Specific bacterial genera and functional pathways (carbohydrate degradation, TCA cycle) showed altered relative abundances in DMT users, though not attributable to a single DMT.
Conclusions:
- DMT use in MS is not associated with changes in overall gut microbiota diversity.
- Taxa-level and functional differences in the gut microbiome exist between DMT-exposed and unexposed pwMS.
- Further research is needed due to the cross-sectional nature of most studies and the combined analysis of various DMTs.
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