Focus on the gut-brain axis: Multiple sclerosis, the intestinal barrier and the microbiome

Abstract

The brain-gut axis serves as the bidirectional connection between the gut microbiome, the intestinal barrier and the immune system that might be relevant for the pathophysiology of inflammatory demyelinating diseases. People with multiple sclerosis have been shown to have an altered microbiome, increased intestinal permeability and changes in bile acid metabolism. Experimental evidence suggests that these changes can lead to profound alterations of peripheral and central nervous system immune regulation. Besides being of pathophysiological interest, the brain-gut axis could also open new avenues of therapeutic targets. Modification of the microbiome, the use of probiotics, fecal microbiota transplantation, supplementation with bile acids and intestinal barrier enhancers are all promising candidates. Hopefully, pre-clinical studies and clinical trials will soon yield significant results.

Keywords: Multiple sclerosis; Microbiome; Intestinal barrier; Bile acids; Gut-brain axis

Core tip: Many studies suggest that the brain-gut connection can contribute to our knowledge of the pathophysiology of neurological conditions. Recent evidence suggests that people with multiple sclerosis have changes in their gut microbiome, their intestinal barrier and even in the metabolism of bile acids. All of these represent relevant therapeutic targets that could feasibly be addressed by pre-clinical and clinical studies. This knowledge acquired in the bench might soon be translated to the bedside.