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ABSTRACT
Introduction
The associations between multiple sclerosis (MS) and altered intestinal microbiomes have clinicians considering the use of fecal microbiota transplantation (FMT). Animal data suggests that administering FMT from people with MS into healthy mice results in a microbiome with decreased abundance of Sutterella, reduced anti-inflammatory signals, increase in inflammation and experimental autoimmune encephalomyelitis (EAE). Animal studies that administered FMT (from normal healthy donors) into mice resulted in slowing down EAE development relieving symptoms, improving BBB integrity and restoration of microbiota diversity. Human studies indicated clinical benefits of FMT (from healthy donors) in people with MS including: improved intestinal motility and motor ability which lasted at least for the duration of the studies, ranging from 2 to 15 years.
Areas covered
The authors discuss the efficacy and safety of FMT in treatment of experimental MS in animals and humans with MS. A literature search was performed via PubMed (up to July 2023), using the key words: multiple sclerosis, fecal microbiota transplantation, microbiome.
Expert opinion
Limited associative data do not provide an understanding of role of FMT in the treatment for MS. Until appropriately designed randomized comparative trials which are underway, are completed, we cannot recommend routine use of FMT in people with MS.
Article highlights
Multiple sclerosis (MS) is an immune-mediated neurodegenerative disease affecting the central nervous system (CNS); pathologically it is characterized by demyelination and axonal injury.
Multiple MS affects approximately 2.5–2.8 million people worldwide.
Given reported associations between MS and altered intestinal microbiomes, clinicians have considered the use of fecal microbiota transplantation (FMT) from healthy donors to potentially reestablish the gut microbiome and decrease relapse rates.
Limited animal data suggests that administering FMT from people with MS into healthy mice results in a microbiome with decreased abundance of Sutterella, reduced anti-inflammatory signals, increase in inflammation and experimental autoimmune encephalomyelitis (EAE).
Animal studies that administered FMT (from normal healthy donors) into mice resulted in slowing down EAE development and relieving EAE symptoms, improving BBB integrity and restoration of microbiota diversity.
Human studies indicated clinical benefits of FMT (from healthy donors) in people with MS such as: improved intestinal motility and motor ability which lasted at least for the duration of the studies, which ranged from 2 to 15 years.
Although promising, the clinical findings from such limited data are only associative and do not provide an understanding of role of FMT in the treatment for MS.
Randomized comparative trials are required to fully assess the safety and efficacy of FMT in people with MS.
Abbreviations
| ANS | = | autonomic nervous system |
| BBB | = | blood brain barrier |
| CDI-Clostridium difficile | = | infection |
| CNS-central | = | nervous system |
| EAE-experimental | = | autoimmune encephalomyelitis |
| ENS-enteric | = | nervous system |
| (FMT) | = | FMT-fecal microbiota transplantation |
| axis | = | GBA-gut-brain |
| axis | = | MGBA-microbiota-gut-brain |
| (MS) | = | MS-multiple sclerosis |
| MBP-myelin | = | basic protein |
| light chain protein | = | NF-L-neurofilament |
| killer | = | NK-natural |
| RCTs-randomized | = | comparative clinical trials |
| rCDI-recurrent | = | Clostridium difficile infection |
| RRMS-relapsing | = | remitting multiple sclerosis |
| fatty acids | = | SCFAs-short-chain |
| nerve | = | VN-vagus |
Declaration of interest
GG Zhanel has received research funding from Avir, Iterum, Merck & Co, Paladin labs, Pfizer Inc, Sandoz, Venatorx Pharmaceuticals, Verity and Zambon. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.