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Highly effective and yet non-harmful: Fumaric acid esters to fight MS

Firewall for nerve cells: RUBIN covers research reports Success made in Bochum: Treatment of relapsing-remitting multiple sclerosis

Multiple sclerosis (MS) is a disease for which no cure has yet been found. Its progression may be delayed thanks to new drugs, but the active ingredients in those drugs are either only partially effective or may lead to severe side effects. Recent developments in the field of dermatology have given rise to hope. Researchers in Bochum have discovered that MS symptoms are considerably alleviated through the application of an active pharmaceutical ingredient on the basis of fumaric acid that has long been successfully used against psoriasis.

Patients suffered 50% fewer flare-ups and the number of active inflammatory foci was reduced by up to 90%. Researchers have now discovered in what way fumaric acid esters protect nerve cells. Their report has been published in the international edition of RUBIN, the science magazine issued by the Ruhr University Bochum.

RUBIN online

The complete article with downloadable images may be found online at http://www.ruhr-uni-bochum.de/rubin/rubin-international-2013/beitraege/beitrag1.html

MS: Most common neurological cause of disabilities in young adults.

Multiple sclerosis is the most common neurological cause of disabilities in young adults. In Germany, it currently affects some 130,000 patients. In MS patients, the body's own immune system attacks the nerve fibres' "insulating layer" and destroys it. Typically, all regions of the brain and the spinal cord are affected as the disease progresses. The inflammations result in ataxia, impairment of fine motor skills, as well as concentration loss, bladder function impairment, fatigue and depressive episodes.

Fruit acid approved for use in the food industry

Since the 1990s, various drugs that delay the progression of the disease by altering the immune system have been available. They are not harmful, yet their efficacy is quite limited. Particularly serious cases are treated with chemotherapeutic agent, which, however, may have severe, even life-threatening side effects. Researchers in Bochum have now discovered that an agent long known in the field of dermatology is highly effective in the treatment of MS episodes: fumaric acid ester. Fumaric acid is a fruit acid found in numerous plants and an approved food acidulant that also occurs naturally in the human body. The active agent has been successfully utilised in psoriasis therapy.

50% fewer episodes, 90% fewer inflammation foci

The discovery happened quite by accident: the MS symptoms of patients who suffered from both MS and psoriasis were alleviated following fumaric acid ester treatment. Accordingly, several studies were carried out. Prof Dr Ralf Gold's team of neurologists have now presented the proof of fumaric acid ester's efficacy: it triggers protective metabolic pathways in cells. "Nerve cells are thus protected, as if by a firewall, from inflammatory agents, mainly from free radicals and nitrogen monoxide," explains Prof Gold. A large-scale study with more than 2,400 patients revealed that fumaric acid esters reduce MS episode frequency by up to 50% and the number of inflammatory foci visible in MRI scans by up to 90%. By changing the drug formula, indigestion, a common side effect of fumaric acid ester occurring in some 400 patients treated by the dermatological drug has been considerably reduced to some 3% to 5%. "Highly efficient and yet non-harmful - a wholly new experience in MS therapy!" Prof Gold says happily.

Bibliographic record

Ralf Gold et al.: Placebo-Controlled Phase 3 Study of Oral BG-12 for Relapsing Multiple Sclerosis. In: N Engl J Med 2012; 367:1098-1107, September 20, 2012, DOI: 10.1056/NEJMoa1114287

Further information

Prof Dr med Ralf Gold, Director at the Neurology Clinic of the Ruhr University Bochum at St. Josef-Hospital, phone 0234/509-2410, ralf.gold@rub.de

Editor: Meike Drießen

idw :: 26.03.2013