Multiple sclerosis (MS) patients have lower than usual levels of molecules called bile acids circulating in their blood, a study found. These molecules, produced in the liver to aid fat absorption in the gut, also appear to block inflammation and nerve cell damage in the brain.
Oral treatment with tauroursodeoxycholic acid (TUDCA) — a bile acid now in a clinical trial for progressive MS, detailed below — reduced the number of immune cells infiltrating the brain and demyelination (the loss of myelin, the protective coat of nerve cells) in an animal model of MS, lessening overall disease severity, its researchers reported.
Their study, “Bile acid metabolism is altered in multiple sclerosis and supplementation ameliorates neuroinflammation,” was published in the Journal of Clinical Investigation.
Bile acids, the products of cholesterol metabolism, mainly work in the gut to help absorb lipids (fats). But they may also exert a neuroprotective role by preventing inflammation.
Studies have shown that receptors for these molecules exist on many cells, including those in the brain and the immune system, and that activating these receptors lessens disease severity in animal models of MS.
Whether bile acid metabolism is problematic (abnormal) in MS patients remains unknown.
To address this, a team led by researchers at Johns Hopkins University investigated blood levels of bile acids in 107 MS patients — 56 with relapsing-remitting disease (RRMS) and 51 with progressive MS — and compared their levels to those of 52 healthy people serving as controls.
Levels of 25 metabolites related to bile acid metabolism were tested in all participants, including primary bile acid metabolites (synthesized in the liver), and secondary bile acid metabolites (later modified by enzymes in the gut).
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