Bile Acids: A Novel Multiple Sclerosis Therapy?

Research Summary: Bile acid metabolites predict multiple sclerosis progression and supplementation is safe in progressive disease

Researchers are constantly looking at novel approaches for the treatment of multiple sclerosis.  One potential avenue that has shown promise in a range of neurological conditions is supplementation with bile acids.  This summary will explore recent work on this specifically for MS.

What?

The study looked to better understand the impact of bile acids in people living with multiple sclerosis and provide early stage information about the safety of using them for therapeutic purposes.

Who?

This research was led by a team at the Johns Hopkins School of Medicine in Baltimore, USA.

Where?

The article is currently a pre-print – which means it has been made available online for people to access prior to it being peer reviewed.  It is currently accessible here.  

When?

The study first appeared online in January, 2024.

BACKGROUND #1: Previous work by this research group has shown that bile acids are altered in people living with multiple sclerosis compared to healthy controls.  They also showed, through cell culture and animal model experiments, that supplementation with bile acids could be a potential novel treatment approach.  Our previous summary of this work can be found here.

The current study was split into two arms, as shown in their graphical abstract below:

FINDING #1:  In the observational cohort, it was found that the levels of bile acids in people living with MS were able to predict future disease outcomes.  In particular, it was found that higher levels at baseline were associated with lower levels of brain atrophy.

FINDING #2:  In the clinical trial cohort, 54 people living with progressive MS were randomly assigned to either receive supplementation with tauroursodeoxycholic acid (TUDCA) or placebo.  It was found that the treatment was safe and well-tolerated, other than a slight increase in gastrointestinal symptoms (particularly diarrhoea).  

FINDING #3:  In the clinical trial cohort, it was found that those treated with TUDCA had changes in their gut microbiome and their immune profile.  The trial wasn’t designed to effectively assess any clinical outcomes of these changes.

THOUGHT #1:  This study builds nicely upon the previous research published by this group, extending our knowledge about how bile acid levels appear to link to clinical progression in multiple sclerosis and showing that treatment with them, in a small cohort of people living with progressive MS, is safe and well-tolerated.

THOUGHT #2: As with any early-stage research, we will need to see further studies to completely understand the benefits that this treatment approach might have for people living with multiple sclerosis.  The next steps will likely be to undertake a larger clinical trial that is specifically designed to assess the therapeutic outcomes.

If you have questions on this study, please don’t hesitate to post them under this article or on any of our social media channels.

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