Rolle des Darmes bei der Multiplen Sklerose

ZUSAMMENFASSUNG

Die Multiple Sklerose (MS) ist eine autoimmunvermittelte Erkrankung des zentralen Nervensystems (ZNS), die in Deutschland ca. 230000 Menschen betrifft. Bis heute existiert für die MS keine Heilung. Als Ursachen werden genetische und Umwelt-Risikofaktoren angenommen, wobei letztere mit ca. 70 % des Risikos den Hauptanteil einnehmen. In diesem Zusammenhang weisen neuere Studien auf eine wichtige Rolle des Darms, des intestinalen Mikrobioms, d. h. der Gesamtheit aller Darmbakterien, und der Diät zur Erkrankungsmodulation hin. Hierdurch könnten neue Therapieansätze geliefert werden. In dieser Übersichtsarbeit diskutieren wir aktuelle Erkenntnisse zur Bedeutung des Darms und der Ernährung aus präklinischen Modellen der MS sowie aus translationalen Studien mit MS-Patienten. Diese Studien zeigen, dass Darmbakterien eine wichtige Rolle für die Entstehung und Erkrankungsprogression spielen können. Darüber hinaus existiert eine komplexe Interaktion zwischen der Diät und dem Mikrobiom sowie dem Immunsystem, was auf die Möglichkeit einer Modulation der MS auf diesem Wege hinweist. Diätetische Ansätze wie kurzkettige gesättigte Fettsäuren und Fasten können die MS und ihre experimentellen Modelle günstig beeinflussen. Derartige diätetische oder probiotische Ansätze werden in randomisierten klinischen Studien getestet.

ABSTRACT

Multiple sclerosis (MS) is an immune mediated demyelinating disorder affecting more than 230000 patients in Germany. Currently, there is no cure for this devastating disease. MS risk is conferred by a complex interplay of genetic as well as environmental factors. In this context, recent studies demonstrate a critical influence of the gut microbiome and the intestinal immune system on the propagation and development of the disease thus implying new therapeutic avenues. Here we discuss major dietary components and dietary regimens that may be associated with improvement in preclinical models of the disease as well as MS itself. In particular, propionic acid or fasting may beneficially affect the course of the disease via the microbiome and regulatory immune cell responses. New dietary approaches as well as probiotic treatments are currently further validated in randomized clinical trials.

Schlüsselwörter

Multiple Sklerose - Dünndarm/Dickdarm - T-Zelle - Diät - Mikrobiom - Metabolom

Key words

Multiple sclerosis - gut - T cell - diet - microbiome - metabolome

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