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• MS is the most common inflammatory disease of the central nervous system. Among many other factors, microorganisms in the gut are suspected of contributing to the onset of the disease.
• To obtain meaningful results, researchers* examined stool samples and microorganisms directly from the small intestine of identical twins, where only one twin had MS.
• Using a mouse model of the disease, they identified Lachnoclostridium and Eisenbergiella tayi for the first time as potential disease-causing bacteria in the intestinal samples of twins with MS.
• The study demonstrates ways to identify disease-causing bacteria and could eventually result in new therapeutic approaches for humans.
More than 280,000 people in Germany have multiple sclerosis (MS) and approximately 15,000 new cases are diagnosed each year. This makes MS the most common inflammatory disease of the central nervous system. In MS, the body's own immune cells attack the insulating layer surrounding nerve fibers, damaging their function. Depending on where attacks occur, a wide variety of symptoms can arise, which is why MS is also known as the disease of a thousand faces. Impaired vision, other sensory disturbances, and paralysis are just some of the symptoms that people living with MS must contend with.
Interaction of several factors
Exactly how MS causes immune cells to become dysfunctional is still largely unclear. MS is a multifactorial disease—there is no single trigger, but rather several factors must come together for the disease to develop. In addition to genetic components, various environmental factors such as smoking, vitamin D deficiency, certain infectious diseases, and especially microorganisms in the gut have all been linked to the development of MS.
Previous studies have identified numerous bacterial strains that distinguish the intestinal flora of MS patients from that of healthy individuals. However, the significance of these differences for the course of the disease remained unclear. In addition, it was often difficult to interpret the results, as genetic differences or differing eating habits among the test subjects can have a major influence on the results.
Twin study reduces confounding factors
To minimize these confounding factors, a team from several research institutions* launched a major collaborative project—with the help of twins. Although identical twins share nearly the same genetic makeup, in some MS cases one twin may develop the disease while the other remains symptom-free—known as an MS-discordant pair.
Around 100 such twin pairs are currently taking part in the MS TWIN STUDY at the Institute of Clinical Neuroimmunology at the University Hospital of the LMU Munich, enabling the disease to be studied under more comparable conditions. In addition to their minimal genetic differences, the twins lived together until early adulthood, meaning they were exposed to many of the same environmental factors.
Comparing the gut flora
The researchers examined stool samples from 81 pairs of twins enrolled in the MS TWIN STUDY, and compared their composition between siblings. They identified 51 taxa—groups of microorganisms—that differed in abundance between twins with and without MS symptoms.
In addition, the researchers went one step further in this study: Four of the twin pairs also agreed to have samples taken from their small intestines using enteroscopy. The disease-causing interactions between microorganisms and the body's own immune cells are believed to occur there. However, most previous studies have relied exclusively on stool samples, which provide only limited information about the microorganisms in the small intestine.
Transfer of samples from the small intestine into a mouse model
To test whether the samples from the small intestine contain disease-causing organisms, the researchers used special transgenic mice. These live a healthy life under germ-free conditions, however after colonization with gut bacteria, they can develop a MS-like disease.
As part of the study, the mice were given samples from a twin with or without MS in parallel. Symptoms were mainly observed in mice that had been colonized with MS samples, indicating the presence of disease-causing microorganisms in the small intestines of people with MS.
Disease-causing bacteria
The researchers then examined the feces of the diseased mice and identified two members of the family of Lachnospiraceae (Lachnoclostridium sp. and Eisenbergiella tayi) as potential disease-causing factors. Due to their low abundance in the intestine, these bacteria had previously only been associated with MS in large and well-controlled studies. However, with their innovative experimental strategy, the researchers were able for the first time to functionally characterize these bacteria and provide evidence for their pathogenicity.
The scientists emphasize that there may be other microorganisms with the potential to trigger MS. Further studies are needed to obtain a more comprehensive picture and to examine the pathogenicity of the two candidates identified so far in detail—initially in a mouse model of the disease and later also regarding the transferability of the results to humans. However, if it turns out that only a small number of microorganisms trigger the disease, this could open up new therapeutic options. Strikingly, the study demonstrates the role that lifestyle habits play in the development of MS and provides new experimental strategies to further investigate their effects.
*This study was conducted in collaboration with scientists from the Max Planck Institute for Biological Intelligence, the Biomedical Center (LMU München), the University Hospital (LMU München), the Weill Institute for Neurosciences (University of California San Francisco), the Institute of Neuropathology (University Hospital Münster) and ZIEL - Institute for Food and Health (Technical University of Munich).
Prof. Dr. Dr. (h.c.) Hartmut Wekerle
Emeritus Director
Max Planck Institute for Biological Intelligence
hartmut.wekerle@bi.mpg.de
Dr. Anneli Peters
Group Leader
Biomedical Center, LMU Munich
Anneli.Peters@med.uni-muenchen.de
Multiple sclerosis and gut microbiota: Lachnospiraceae from the ileum of MS twins trigger MS-like disease in germfree transgenic mice—An unbiased functional study
Hongsup Yoon$, Lisa Ann Gerdes$, Florian Beigel$, Yihui Sun, Janine Kövilein, Jiancheng Wang, Tanja Kuhlmann, Andrea Flierl-Hecht, Dirk Haller, Reinhard Hohlfeld, Sergio E. Baranzini*, Hartmut Wekerle*, and Anneli Peters*
$,* these authors contributed equally
PNAS, online 21. April 2025
DOI-Link: https://doi.org/10.1073/pnas.2419689122
https://www.bi.mpg.de/Wekerle
https://www.med.lmu.de/bmc/de/forschung/forschungsgruppen/peters-lab/
In a twin study, researchers successfully characterized gut bacteria involved in multiple sclerosis ...
@ MPI for Biological Intelligence / Julia Kuhl
Using the experimental strategy shown here, the scientists were able to functionally analyze the mic ...
© MPI for Biological Intelligence / Annika Schneitz
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In a twin study, researchers successfully characterized gut bacteria involved in multiple sclerosis ...
@ MPI for Biological Intelligence / Julia Kuhl
Using the experimental strategy shown here, the scientists were able to functionally analyze the mic ...
© MPI for Biological Intelligence / Annika Schneitz
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