Taking supplements of the sugar molecule N-acetylglucosamine, known as GlcNAc, was found to decrease markers of inflammation in people with multiple sclerosis (MS) in a small clinical trial. Moreover, nearly a third of trial participants reported less severe disability following a month of daily GlcNAc supplements. However, because this study was open-label — all of the patients were treated with GlcNAc and there was no control group — researchers called for further placebo-controlled trials to test the effects of GlcNAc in MS treatment. "An unbiased randomized double-blind placebo-controlled trial is required to establish the potential of GlcNAc on chronic active inflammation, myelin repair and neurodegeneration in MS," the scientists wrote. The study, "N-acetylglucosamine inhibits inflammation and neurodegeneration markers in multiple sclerosis: a mechanistic trial," was published in the Journal of Neuroinflammation. Small trial did not include a placebo or control groups. MS is caused by inflammation in the brain and spinal cord, which damages the fatty coating around nerve fibers known as the myelin sheath. Damage to myelin disrupts nerve signaling, which leads to the symptoms of the neurodegenerative disease. GlcNAc is a sugar that naturally occurs in the body and is involved in glycosylation, a molecular process in which sugar molecules are attached to certain proteins. Studies in preclinical models of MS have indicated that GlcNAc supplementation can reduce inflammation and promote myelin repair. "Our previous studies in mice and humans implicated N-acetylglucosamine in suppressing brain inflammation, promoting the re-growth of the myelin sheath and slowing brain degeneration," Michael Demetriou, MD, PhD, a senior author of the study from the University of California Irvine (UCI), said in a press release. To know more about the effects of GlcNAc in people with MS, Demetriou and an international team of scientists conducted a small clinical trial that involved 34 adults. All of the patients were on treatment with glatiramer acetate (sold as Copaxone and generics). The study included people with all types of MS, including relapsing-remitting, primary progressive, and secondary progressive disease, although participants could not have experienced a relapse in the three months prior to enrolling. Most participants were female, and the average age was 54.3 years. The participants first underwent three weeks of screening. Then, for four weeks, they took supplements of GlcNAc at one of two doses (6 or 12 grams per day). The treatment period was then followed by another four weeks of safety screening. Safety data from the trial showed that the GlcNAc supplements were generally well tolerated, with no serious side effects reported. Half of the patients given the higher dose of GlcNAc experienced digestive symptoms like bloating, flatulence, or loose stools, but these were generally mild and didn't stop participants from finishing the trial. Less inflammation, disability seen in MS patients taking GlcNAc. Biomarker data showed that patients given the higher dose of GlcNAc experienced a significant reduction in levels of several pro-inflammatory signaling molecules that have been implicated in driving MS. These signaling molecules included IFN-gamma, IL-6 and IL-17. Levels of IL-10, an anti-inflammatory molecule that's sometimes increased in MS due to the body's attempt to control the disease, also were decreased among patients given the higher dose of GlcNAc. The higher supplement dose also led to reductions in levels of neurofilament light chain (NfL), a marker of nerve damage. Several of the patients experienced a reduction in disability following GlcNAc supplementation, as reflected by a decrease in scores on the Expanded Disability Status Scale (EDSS). Specifically, 28% of patients given the lower dose and 31% of those given the higher dose reported a decrease in EDSS scores, reflecting less severe disability. One patient in each group experienced an increase in EDSS, indicating worse disability. In an analysis that excluded one participant who did not receive treatment according to the pre-established protocol — this patient had a lung infection and a subsequent relapse — a total of 30% of patients had experienced improvements in disability and 3% had worsened. Among the 10 patients with confirmed disability improvements, the average reduction in EDSS scores was 0.52 points. Further, the supplements were seen, in some patients, to have benefits not found with therapies already approved by the U.S. Food and Drug Administration (FDA). "We ... observed a sustained reduction in neurological disability in 30% of the patients, an activity which has not been observed with current FDA approved therapies," said Michael Y. Sy, MD, PhD, a study co-author at UCI, adding, "They at best slow progression, not improve function." The researchers stressed that this was a small, short study with no placebo group, so further research will be needed to confirm whether GlcNAc supplements can in fact provide benefits for people with MS. Added Demetriou: "Future studies demonstrating that N-acetylglucosamine can restore neurological function in MS patients would be a gamechanger and provide something that no other current therapy can do."