AAN 2023 | Next steps in treating MS through gut microbiota

Anne-Katrin Pröbstel, MD, University Hospital of Basel, University of Basel, Basel, Switzerland, discusses the next steps to translate our knowledge of the gut microbiota in multiple sclerosis (MS) into therapeutic interventions. The microbiota is a complex ecosystem that is difficult to alter, and this needs to be considered when designing therapies as it may not be as simple as ‘good’ and ‘bad’ bacteria. For MS treatment, the two most likely interventions would be to remove pro-inflammatory bacteria or to supplement bacteria that benefit the immune response. We then need to ensure that these actions can change the effect of the microbiome on the immune system. It is important to consider the risks of these therapies, and as MS is not a deadly disease, therapies should have a low level of adverse effects. There are currently no approved therapies that alter the microbiome, but experts recommend a Mediterranean diet and high levels of vitamin D to positively affect the immune and cardiovascular systems. Intermittent fasting is also currently being researched for its effects on the microbiota, as is propionate for its beneficial effects on immune cells. This interview took place at the American Academy of Neurology Annual Meeting 2023 in Boston, MA.

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