Can the gut affect how well multiple sclerosis treatment works? New Czech research says yes.

The brain and gut communicate intensively with each other—through the nervous system, the endocrine system, the immune system and the metabolites. This connection is called the microbiota-gut-brain axis. Current research points to the fact that the gut microbiota also plays an important role in the pathogenesis of multiple sclerosis (MS), an autoimmune disease affecting the central nervous system.

In a new study, IMIC researchers found that changes in the gut microbiota appear very early in people with clinically isolated syndrome, i.e., in the early stages before the disease is fully developed. Their aim was to monitor how the gut microbiota is changing during treatment targeting B lymphocytes and, above all, to identify which changes are related to the response to treatment. “After 12 months, we saw a different microbial pattern,” says Štěpán Coufal from the Laboratory of Cellular and Molecular Immunology, adding: ” In patients who responded well to treatment, the gut microbiota began to resemble that of healthy people, while in patients who did not respond, the diversity of the microbiota continued to decline. We were particularly interested in the differences in bacteria that produce molecules that support intestinal barrier function and suppress the pro-inflammatory response—short-chain fatty acids. These bacteria were absent from the gut microbiota of patients who did not respond to treatment.”

The results thus fit into the broader picture of the microbiota-gut-brain axis, where the state of the intestinal barrier itself and the composition of the intestinal microbiota may be related not only to the course of MS, but also to how well the treatment works. In the future, similar monitoring could help move treatment closer to personalized medicine.

Laboratory of Cellular and Molecular Immunology also tested whether manipulation of the intestinal microbiota itself affects the immune system and the course of MS in an experimental animal model of MS, and they succeeded. They are currently continuing the research into the microbiota in the pathogenesis of MS.

PUBLICATION

Ocrelizumab transiently alters microbiota and modulates immune response depending on treatment outcome; Coufal, Stepan et al. iScience, Volume 28, Issue 12, 113872 DOI: 10.1016/j.isci.2025.113872

Graphical abstract