Using fecal microbiota transplantation to treat multiple sclerosis
Some of the most exciting work in multiple sclerosis (MS) research is being conducted by researchers at Western University in London, Ontario. Indeed, at London Health Sciences Centre’s University Hospital, Drs. Marcelo Kremenchutzky and Ana Cristina Wing have begun the first fecal microbiota transplantation (FMT) study on humans to investigate gut bacteria as a potential therapy for MS.
MS is a potentially disabling immune-mediated neurodegenerative disease of the central nervous system (CNS). Its signs and symptoms are often unpredictable given that lesions (damage to tissue) may occur anywhere in the CNS, and the disease most often affects young adults. Canadians have among the highest rates of MS in the world.
There was a time when a diagnosis of MS was catastrophic. This is no longer necessarily the case. Although there is currently no cure, many treatments have been developed over the past several decades. These therapies have been able to significantly improve the quality of life for patients and slow the overall progression of the disease.
In his twenty years as a lead neurologist in the field, Dr. Kremenchutzky has contributed to some of the earliest treatments of MS. Today, in collaboration with research fellow Dr. Wing, they are conducting pioneering research of the microbiome in relation to MS. They hope to find out if FMT is a viable treatment for MS patients.
The relationship between the gut and various neurological diseases is an interesting one. Recently, some have argued that the manipulation of the human gut microbiome has therapeutic potential. When interviewed for this piece, Dr. Wing said: “We already have a lot of research showing that [the gut microbiome of MS patients] seems to be different compared to the gut of people that do not have MS”. And we don’t exactly know why and how these differences relate to the disease.” This is what they have set out to determine.
Currently, they are in the process of conducting a crossover phase II clinical trial. Two groups, an early intervention group and a late intervention group, are administered an FMT followed by monthly checkups for a year. “Since this is a phase II study, we are only looking for inflammation”, said Dr. Wing. “So, basically, we are going to measure the cytokine levels in the serum to see if they change somehow in a more anti-inflammatory pattern.” In collaboration with laboratories studying immunology, the microbiome, and infectious disease, the work of Drs. Kremenchutzky and Wing could serve as a potential proof of concept.
Their efforts build from past research that has established the therapeutic potential of FMT for other conditions. It has been shown that the colitis caused by antibiotic resistant Clostridium difficile infection (CDI) can be treated with FMT. What would be the ideal outcome for this study with MS patients? Dr. Wing believes that this exploratory study will help addresses preliminary questions about the viability of such a treatment. “When we do this transfer successfully, we are able to restore a healthy composition in the gut … if we transplant healthy bacteria from an individual that does not have MS into a patient that does have MS, are we able to change the microbiome? How will this influence inflammation?” Answering these questions will open the opportunity for future studies that ask more specific questions regarding FMT as a therapy for MS. “I think it is a very innovative and bold project. Because it has never been done before in MS,” said Wing.
Despite the promise of this endeavor, Dr. Wing noted that the wider research community was initially reluctant to accept the idea of treating MS patients with FMT. “We do see some skepticism from people … and some believe that we need more information before trying FMT with MS.” Fortunately, the early results have been promising. The patients have been responding well to the treatment. In Dr. Ana Wing’s view, the value of research is not predicated on obtaining the expected results. Rather, she believes any research is helpful regardless of whether the outcome is positive or negative. Ultimately, all pursuits of knowledge contribute to building a foundation for future studies. “We are going to learn something from this experience, I have no doubt of that … whatever works, or does not work, we will improve on it for next time.”
For a disease that affects 2.3 million people worldwide, the importance of Drs. Kremenchutzky and Wing’s research cannot be overstated. Such developments in therapies for MS makes one hopeful for the future of battling with a condition whose progression can be so unforgiving.
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Shortly after writing this article, it was discovered, with great sadness, the passing of Dr. Kremenchutzky on Monday, October 1st, 2018. A memorial service was held in London, ON, on Saturday, October 13th, 2018 at 1:00 p.m.
Those wishing to make a donation in Dr. Kremenchutzky’s memory are asked to consider Lung Cancer Canada. The family wishes to extend a special ‘thank you’ to Dr. Mark Vincent, the London Regional Cancer Program and the Stroke Unit at University Hospital.
This article was written by Ramtin Hakimjavadi, an undergraduate “Science Writer in Residence” from David Smith’s Lab at the University of Western Ontario.
