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AAN 2023 | Update on the role of the microbiome in MS

Anne-Katrin Pröbstel, MD, University Hospital of Basel, University of Basel, Basel, Switzerland, discusses the role of the microbiome in multiple sclerosis (MS). Studies have shown that individuals with MS have different microbiota compared to healthy controls from the same household. It is important for us to understand how these differences translate to neuroinflammation. Several possibilities have been proposed, including translocation, bacterial secretions, and travel through the vagus nerve. Recent work has shown that the microbiota interacts with B-cell in MS via IgA-producing cells in the gut. These cells are important for gut homeostasis but are found in the brain during acute MS flare-ups. Here, IgA-producing cells secrete microbial-reactive antibodies and cytokines to resolve inflammation, suggesting the role of these cells in protecting the brain from microbial translocation. The microbiota has also been linked to inflammatory processes in MS. This may occur due to the microbiota’s balance shifting towards pro-inflammatory or due to molecular mimicry, whereby microbes resemble molecules in the brain and activate immune cells to cross-react. Current research is further investigating this possibility. Experts hope this knowledge will translate to new MS therapies that manipulate the microbiome, such as by eliminating harmful microbes and increasing beneficial microbes. This interview took place at the American Academy of Neurology Annual Meeting 2023 in Boston, MA.

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