Out-of-balance bacteria is linked to multiple sclerosis − the ratio can predict severity of disease
Multiple sclerosis is a disease that results when the immune system mistakenly attacks the brain and spinal cord. It affects nearly one million people in the U.S. and over 2.8 million worldwide. While genetics play a role in the risk of developing multiple sclerosis, environmental factors such as diet, infectious disease and gut health are major contributors.
The environment plays a key role in determining who develops multiple sclerosis, and this is evident from twin studies. Among identical twins who share 100% of their genes, one twin has a roughly 25% chance of developing MS if the other twin has the disease. For fraternal twins who share 50% of their genes, this rate drops to around 2%.
Scientists have long suspected that gut bacteria may influence a person's risk of developing multiple sclerosis. But studies so far have had inconsistent findings.
To address these inconsistencies, my colleagues and I used what researchers call a bedside-to-bench-to-bedside approach: starting with samples from patients with multiple sclerosis, conducting lab experiments on these samples, then confirming our findings in patients.
In our newly published research, we found that the ratio of two bacteria in the gut can predict multiple sclerosis severity in patients, highlighting the importance of the microbiome and gut health in this disease.
First, we analyzed the chemical and bacterial gut composition of patients with multiple sclerosis, confirming that they had gut inflammation and different types of gut bacteria compared with people without multiple sclerosis.
Specifically, we showed that a group of bacteria called Blautia was more common in multiple sclerosis patients, while Prevotella, a bacterial species consistently linked to a healthy gut, was found in lower amounts.
In a separate experiment in mice, we observed that the balance between two gut bacteria, Bifidobacterium and Akkermansia, was critical in distinguishing mice with or without multiple sclerosis-like disease. Mice with multiple sclerosis-like symptoms had increased levels of Akkermansia and decreased levels of Bifidobacterium in their stool or gut lining.
To explore this further, we treated mice with antibiotics to remove all their gut bacteria. Then, we gave either Blautia, which was higher in multiple sclerosis patients; Prevotella, which was more common in healthy patients; or a control bacteria, Phocaeicola, which is found in patients with and without multiple sclerosis. We found that mice with Blautia developed more gut inflammation and worse multiple sclerosis-like symptoms.
Even before symptoms appeared, these mice had low levels of Bifidobacterium and high levels of Akkermansia. This suggested that an imbalance between these two bacteria might not just be a sign of disease, but could actually predict how severe it will be.
We then examined whether this same imbalance appeared in people. We measured the ratio of Bifidobacterium adolescentis and Akkermansia muciniphila in samples from multiple sclerosis patients in Iowa and participants in a study spanning the U.S., Latin America and Europe.
Our findings were consistent: Patients with multiple sclerosis had a lower ratio of Bifidobacterium to Akkermansia. This imbalance was not only linked to having multiple sclerosis but also with worse disability, making it a stronger predictor of disease severity than any single type of bacteria alone.
One of the most interesting findings from our study was that normally beneficial bacteria can turn harmful in multiple sclerosis. Akkermansia is usually considered a helpful bacterium, but it became problematic in patients with multiple sclerosis.
A previous study in mice showed a similar pattern: Mice with severe disease had a lower Bifidobacterium-to-Akkermansia ratio. In that study, mice fed a diet rich in phytoestrogens – chemicals structurally similar to human estrogen that need to be broken down by bacteria for beneficial health effects – developed milder disease than those on a diet without phytoestrogens. Previously we have shown that people with multiple sclerosis lack gut bacteria that can metabolize phytoestrogen.
Although the precise mechanisms behind the link between the Bifidobacterium-to- Akkermansia ratio and multiple sclerosis is unknown, researchers have a theory. Both types of bacteria consume mucin, a substance that protects the gut lining. However, Bifidobacterium both eats and produces mucin, while Akkermansia only consumes it. When Bifidobacterium levels drop, such as during inflammation, Akkermansia overconsumes mucin and weakens the gut lining. This process can trigger more inflammation and potentially contribute to the progression of multiple sclerosis.
Our finding that the Bifidobacterium-to-Akkermansia ratio may be a key marker for multiple sclerosis severity could help improve diagnosis and treatment. It also highlights how losing beneficial gut bacteria can allow other gut bacteria to become harmful, though it is unclear whether changing levels of certain microbes can affect multiple sclerosis.
While more research can help clarify the link between the gut microbiome and multiple sclerosis, these findings offer a promising new direction for understanding and treating this disease.
This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Ashutosh Mangalam, University of Iowa
Read more:
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Ashutosh Mangalam received funding from the NIH/NIAID, VA, and the University of Iowa. He holds a patent licensed to Evelo Biosciences by Mayo Clinic on a technology using Prevotella histicola to treat autoimmune diseases. No funds or products from this patent were used in this study.
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Wildfire smoke can harm your brain, not just your lungs
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Demyelinating Diseases Therapeutics Market to Reach USD 45 Billion by 2034, Growing at 6.3% CAGR
Demyelinating Diseases Therapeutics Market Outlook 2025-2034 Luton, Bedfordshire, United Kingdom, June 06, 2025 (GLOBE NEWSWIRE) -- The global market for demyelinating diseases therapeutics is witnessing notable growth and transformation, fueled by the increasing prevalence of neurological disorders and the introduction of innovative treatment solutions. Valued at approximately USD 25 billion in 2024, the market is projected to reach an estimated USD 45 billion by 2034, progressing at a steady Compound Annual Growth Rate (CAGR) of 6.3% during the forecast period from 2025 to 2034. Download PDF Brochure: A major contributor to this expansion is the rising incidence of multiple sclerosis (MS), along with other related disorders such as neuromyelitis optica (NMO), acute disseminated encephalomyelitis (ADEM), and chronic inflammatory demyelinating polyneuropathy (CIDP). The market is undergoing significant advancements through personalized medicine, biologics, and digital health integrations, shaping the way therapies are developed and delivered. Market Segmentation: A Detailed Breakdown The demyelinating diseases therapeutics market is categorized across several parameters including product type, therapeutic application, disease type, route of administration, distribution channels, therapeutic class, and patient demographics. Among product types, monoclonal antibodies, corticosteroids, and immunomodulators dominate due to their high efficacy and role in managing autoimmune responses central to these diseases. Multiple Sclerosis (MS) remains the largest disease segment due to its global prevalence, impacting nearly 2.8 million individuals worldwide. This segment benefits from a strong drug pipeline and sustained investment in research and development. In contrast, diseases like NMO and CIDP, though less prevalent, are becoming more prominent due to improved diagnostic capabilities and novel drug approvals. When it comes to therapeutic applications, Disease-Modifying Therapies (DMTs) are pivotal. These therapies reduce relapse rates and slow disease progression, particularly in MS, capturing the lion's share of the market. Symptomatic treatments, though secondary in market size, are essential for improving patients' quality of life and remain indispensable in overall disease management strategies. Route of Administration and Distribution Channels The preferred routes of administration in this market include injectable, oral, and infusion-based methods. Injectables lead due to their rapid efficacy and widespread use in administering monoclonal antibodies. However, oral therapies are quickly gaining popularity for their convenience and higher patient adherence, which could shift the administration landscape in coming years. 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Browse full Report - Market SegmentationType of Demyelinating Disease - Multiple Sclerosis (MS) - Neuromyelitis Optica (NMO) - Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) - Acute Disseminated Encephalomyelitis (ADEM) Therapeutic Application - Disease-Modifying Therapies (DMTs) - Symptomatic Treatments - Corticosteroids - Monoclonal Antibodies - Other Immunotherapies & Supportive Care Route of Administration - Oral - Injectable (Subcutaneous, Intravenous) - Infusion Distribution Channel - Hospital Pharmacy - Retail Pharmacy - Online Pharmacy Therapeutic Class - Biologics - Small Molecules - Non-Biologics Patient Demographics - Adults - Pediatric - Geriatric Regional Insights and Global Landscape North America currently commands the largest market share, accounting for around 45% of global revenue in 2024. This dominance is underpinned by advanced healthcare systems, widespread access to therapies, and high levels of R&D investment. The U.S., in particular, plays a significant role with supportive regulatory policies and well-established pharmaceutical players. Europe follows closely, contributing approximately 30% to the market. Growth in this region is propelled by increasing awareness, government-supported healthcare systems, and a favorable environment for clinical research. Countries like Germany, France, and the UK are key hubs for drug development and patient care. The Asia-Pacific region is the fastest-growing market with a projected CAGR of 8% through 2034. Factors such as economic development, expanding healthcare infrastructure, and rising disease prevalence contribute to this rapid growth. Nations like China, India, and Japan are investing heavily in healthcare, which supports both access and innovation in therapeutic offerings. Latin America and the Middle East & Africa are also emerging as regions with untapped market potential. While they currently hold smaller shares, their projected CAGRs of 7% and 6% respectively reflect strong future growth, particularly in urban centers with improving access to care. Key Market Drivers The momentum in this market is largely attributed to scientific and technological advancements, including the development of next-generation therapies like monoclonal antibodies and targeted biologics. The rise of personalized medicine, where treatments are tailored based on patient-specific genetic and biomarker profiles, is reshaping therapeutic strategies. Regulatory developments are also influential. Accelerated approval pathways, especially for orphan and breakthrough therapies, have reduced time-to-market for promising treatments. In tandem, increased global healthcare spending, particularly in neurological and autoimmune sectors, is bolstering the adoption of advanced therapies. Challenges and Restraints Despite promising growth, the market faces a number of hurdles. 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Janssen Pharmaceuticals (a Johnson & Johnson Company) Horizon Therapeutics plc Recent Strategic Developments Company Name: Biogen Inc. Month & Year: August 2023 Type of Development: Product Launch Detailed Analysis: Biogen launched its latest multiple sclerosis (MS) therapy, an oral medication named Alectinib, in August 2023. This drug represents a significant advancement in the treatment landscape for MS, targeting a previously underserved patient demographic. The launch is crucial as the MS market increasingly shifts toward oral therapies that offer improved safety and convenience over traditional injections. Biogen's investment in clinical studies demonstrates their commitment to addressing unmet clinical needs. The release not only strengthens Biogen's portfolio but also rekindles competitive dynamics in the MS therapeutics market. Other companies may need to accelerate their research and focus on innovative delivery mechanisms to retain market share, indicating a potential uptick in R&D spending across the industry. Company Name: Novartis International AG Month & Year: July 2023 Type of Development: Regulatory Approval Detailed Analysis: In July 2023, Novartis received expedited approval from the FDA for its drug ofatumumab aimed at treating neuromyelitis optica spectrum disorder (NMOSD). NMOSD is a rare, debilitating condition, and this regulatory advancement opens new pathways for patients who have historically faced limited treatment options. This approval underlines a broader trend in the industry towards personalized medicine and targeted therapies. The positive regulatory news also strengthens Novartis's position in the demyelinating diseases market, compelling competitors to prioritize novel therapeutic approaches. 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Industry observers anticipate that this will prompt increased mergers and acquisitions in the sector as firms seek similar synergies to expedite drug development processes. Company Name: Sanofi S.A. Month & Year: October 2023 Type of Development: Product Launch Detailed Analysis: Sanofi unveiled a new monoclonal antibody therapy for treating relapsing forms of MS in October 2023, expanding its treatment arsenal significantly in this field. The introduction of this therapy reflects a commitment to advancing treatment modalities through innovative science. Furthermore, the development showcases a broader industry trend toward biologics and targeted therapies for demyelinating diseases. Market responses indicate that healthcare professionals and payers are eager for alternatives that provide safety and efficacy. This influx of new treatment options may fuel competitive pressure on existing therapies, leading to potential price adjustments and altering market dynamics. Company Name: Teva Pharmaceutical Industries Ltd. Month & Year: November 2023 Type of Development: Partnership Detailed Analysis: Teva announced a strategic partnership with a technology firm to collaborate on AI-driven approaches to MS treatment and patient management in November 2023. This partnership underscores a growing trend of incorporating technology into healthcare to enhance drug discovery and patient outcomes. By utilizing AI, Teva aims to streamline clinical research and tailor therapies to individual patient needs, thereby enhancing therapeutic efficacy. The collaboration could reshape how the pharmaceutical industry conducts research and develops therapies for demyelinating diseases, prompting competitors to explore similar integrations of advanced technologies, ultimately driving innovation in the market. 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