The following article is part of conference coverage from the Americas Committee for Treatment and Research in Multiple Sclerosis 2020 Forum in West Palm Beach, Florida. Neurology Advisor‘s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from the ACTRIMS 2020 Forum.

WEST PALM BEACH, FL — Pediatric patients with multiple sclerosis (MS) and a high relative abundance of Pasteurellales or Enterobacteriales in their gut microbiota have a lower relapse risk, according to research results presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) 2020 Forum held from February 27 to 29, 2020, in West Palm Beach, Florida. Further, results also found that given that the gut microbiome is potentially modifiable through diet or fecal transplant, investigators of this study determined this may lead to novel MS treatment strategies and targets.

Although recent research has suggested that the composition of the gut microbiome contributes to both adult and pediatric MS, less is known about how microbiota contributes to disease progression and activity. Researchers designed a study to investigate associations between gut microbiota profiles and subsequent disease activity among patients with pediatric MS from the US Network of Pediatric Multiple Sclerosis Centers. At baseline, stool samples were collected from patients with symptom onset before age 18 years, and samples were profiled using 16S rRNA sequencing.

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At least 20% of stool samples were dichotomized on the basis of the presence vs absence and high vs low relative abundance distribution of bacterial orders in the gut microbiome. Relative abundance of bacterial orders were used individually as predictors in Cox proportional hazard models of first relapse after baseline. These models were adjusted for sex, age, and disease-modifying therapy and corticosteroid use in the past 30 days.

Among a total of 47 participants with pediatric MS, 74.5% were girls, and the median age at symptom onset was 14.9 years (range 8.6-17.9 years). Median baseline disease duration was 1.0 year (range 0.1-4.1 years), median baseline Expanded Disability Status Scale was 1.0 (range 0-3.5), and 59.6% of participants had been exposed to a disease-modifying therapy within the past 30 days.

During a median 1.30-year follow-up, 22 participants (46.8%) experienced a relapse, with the median time to relapse being 114 days after collection of stool samples (range 14-954). Of the 18 bacterial orders included in the analyses, 2 orders (Pasteurellales and Enterobacteriales) were associated with a reduction in the hazard for relapse (adjusted hazard ratio [aHR], 0.25; 95% CI, 0.10-0.61 and aHR, 0.34; 95% CI, 0.12-0.95, respectively). Continued analyses are investigating the effects of individual amplicon sequence variants and the use of magnetic resonance imaging data to model time to new enhancing lesions.

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The investigators concluded, “The microbiome is a potentially modifiable risk factor through diet or fecal microbiota transplant, and findings could offer new strategies and targets to alter MS disease course.”

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Horton M, Graves J, Benson L, et al. Gut microbiota composition and risk of relapse in pediatric-onset multiple sclerosis. Presented at: ACTRIMS Forum 2020; February 27-29, 2020; West Palm Beach, FL. Abstract P187.