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How MS drugs affect the microbiota and whether this is part of their mode of action is yet unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To assess how dimethyl fumarate (DMF) affects the gut microbiota and whether the microbiota is associated with clinical response or adverse events (AEs) to DMF or diet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>An observational cohort study, in which the microbiota from 45 patients with relapsing-remitting MS pre-DMF initiation and following 6\u2009months of DMF therapy, and from 47 matched healthy controls, were compared, and associations with clinical and dietary data assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources and methods:<\/jats:title>\n                    <jats:p>Microbial DNA was sequenced and analyzed using MicrobiomeAnalyst. The clinical response was assessed after 1-year DMF therapy based upon evidence of disease activity (relapse, \u0394EDSS increase &gt;1, or MRI activity compared to pre-treatment). Dietary data were obtained by food questionnaires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Alterations in relative abundance of several microbes were identified post 6-month DMF therapy compared to pre-treatment, including an increase in Firmicutes,\n                      <jats:italic toggle=\"yes\">Lachnospiraceae<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Ruminococcaceae<\/jats:italic>\n                      , while reduction in Bacteroidetes and Proteobacteria. Patients who showed disease activity within 1\u2009year from DMF initiation had pre-treatment higher abundance of Proteobacteria,\n                      <jats:italic toggle=\"yes\">Flavonifractor<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Acidaminococcaceae<\/jats:italic>\n                      , while lower abundance of Firmicutes,\n                      <jats:italic toggle=\"yes\">Ruminococcaceae<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Butyricicoccus<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Massiliprevotella massiliensis<\/jats:italic>\n                      , compared to patients without disease activity. Patients who discontinued DMF therapy due to AEs had pre-treatment higher abundance of Proteobacteria, Bacteroidetes,\n                      <jats:italic toggle=\"yes\">Eggerthella<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Lachnoclostridium<\/jats:italic>\n                      and lower abundance of\n                      <jats:italic toggle=\"yes\">Ruminococcaceae<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">Megamonas<\/jats:italic>\n                      , and\n                      <jats:italic toggle=\"yes\">Holdemanella<\/jats:italic>\n                      , among others. Differentially abundant microbes correlated with intake of several nutrients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>DMF immunotherapy is associated with modifications of the microbiota. The microbiota may affect the severity of AEs and the clinical response to DMF, and is potentially modulated by diet. Microbiota-based, personalized treatment approach, integrating pharmacotherapy with dietary components, carries potential to improved clinical outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562864241306565","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T13:38:25Z","timestamp":1741873105000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["Immunotherapy-mediated modulation of the gut microbiota in multiple sclerosis and associations with diet and clinical response\u2014the effect of dimethyl fumarate therapy"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9620-5255","authenticated-orcid":false,"given":"Elsebeth","family":"Staun-Ram","sequence":"first","affiliation":[{"name":"Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa, Israel"},{"name":"Neuroimmunology Unit and Multiple Sclerosis Center, Lady Davis Carmel Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anat","family":"Volkowich","sequence":"additional","affiliation":[{"name":"Neuroimmunology Unit and Multiple Sclerosis Center, Lady Davis Carmel Medical Center, Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5843-6841","authenticated-orcid":false,"given":"Ariel","family":"Miller","sequence":"additional","affiliation":[{"name":"Neuroimmunology Unit and Multiple Sclerosis Center, Lady Davis Carmel Medical Center, Michal St. 7, Haifa 3436212, Israel"},{"name":"Rappaport Faculty of Medicine, Technion\u2014Israel Institute of Technology, Haifa 31096, Israel"},{"name":"Department of Neurology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11940-015-0344-7"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-017-0598-8"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clim.2017.03.001"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-022-00697-8"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10482-020-01474-7"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep28484"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/JIM.0000000000000192"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-52894-z"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13026"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/ncomms12015"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2019.101427"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms241915024"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26084"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520924594"},{"key":"e_1_3_4_16_2","article-title":"Disease-modifying therapies alter gut microbial composition in MS","volume":"6","author":"Katz Sand I","year":"2018","unstructured":"Katz Sand I, Zhu Y, Ntranos A, et al. 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