Impacto de la inmunonutrición en la evolución de los pacientes con esclerosis múltiple mayores de 20 años de edad: revisión narrativa
DOI:
https://doi.org/10.35454/rncm.v6n3.522Palabras clave:
Dieta de inmunonutricion, Esclerosis múltiple, Dieta, Sistema inmunológico, Suplementos dietéticosResumen
Introducción: la esclerosis múltiple (EM) es una enfermedad inflamatoria crónica ocasionada por múltiples factores que afectan al sistema nervioso central (SNC), lo que conlleva discapacidades, principalmente, en los adultos jóvenes. La nutrición está dentro de estos factores patogénicos y más recientemente se incluye la disfunción inmunitaria, local y sistémica que produce la EM en la microbiota intestinal (MBI), y afecta órganos como el cerebro.
Objetivo: en esta revisión narrativa se analizó el impacto de la terapéutica con nutrientes específicos (inmunonutrientes) en los síntomas y la progresión de la enfermedad en pacientes adultos jóvenes con EM.
Método: se realizó una búsqueda de artículos en las plataformas PubMed y MedLine entre enero de 2012 y diciembre de 2022.
Resultados: la EM destruye la mielina, lo que produce áreas de desmielinización en la sustancia blanca. Teniendo en cuenta este componente inflamatorio, la investigación muestra que nutrientes específicos como probióticos, ácidos grasos omega-3 (ω-3) y la vitamina D, por sus efectos favorables en la modulación de la inflamación, presentan impactos positivos en los síntomas de estos pacientes; no así para frenar su evolución.
Conclusiones: el uso de suplementación con inmunonutrientes reporta efectos favorables en paciente con EM. Ante la escasa evidencia sobre el tema, con esta revisión se pretende seguir aportando a la literatura en desarrollo sobre el uso de estos nutrientes en pacientes adultos jóvenes con EM.
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Qureshi M, Al-Suhaimi EA, Wahid F, Shehzad O, Shehzad A. Therapeutic potential of curcumin for multiple sclerosis. Neurol Sci. 2018;39(2):207-14. doi: 10.1007/s10072-017-3149-5
Martinez-Altarriba MC, Ramos-Campoy O, Luna-Calcaño IM, Arrieta-Antón E. Revisión de la esclerosis múltiple (2). Diagnóstico y tratamiento [A review of multiple sclerosis (2). Diagnosis and treatment]. Semergen. 2015;41(6):324-8. Spanish. doi: 10.1016/j.semerg.2014.07.011
Shah P. Symptomatic management in multiple sclerosis. Ann Indian Acad Neurol. 2015;18(Suppl 1):S35-42. doi: 10.4103/0972-2327.164827
Fox RJ, Thompson A, Baker D, Baneke P, Brown D, Browne P, et al. Setting a research agenda for progressive multiple sclerosis: the International Collaborative on Progressive MS. Mult Scler. 2012;18(11):1534-40. doi: 10.1177/1352458512458169
Storoni M, Plant GT. The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis. Mult Scler Int. 2015;2015:681289. doi: 10.1155/2015/681289
Livingston T, Fay M, Iyer R, Wells W, Pill MW. Quantifying Differences in Health Care Consumption for the Management of Multiple Sclerosis Within Privately and Publicly Insured Health Care Programs. J Manag Care Spec Pharm. 2016;22(12):1385-391. doi: 10.18553/jmcp.2016.22.12.1385
Dos Passos GR, Sato DK, Becker J, Fujihara K. Th17 Cells Pathways in Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders: Pathophysiological and Therapeutic Implications. Mediators Inflamm. 2016;2016:5314541. doi: 10.1155/2016/5314541
Mokry LE, Ross S, Ahmad OS, Forgetta V, Smith GD, Goltzman D, et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLoS Med. 2015;12(8):e1001866. doi: 10.1371/journal.pmed.1001866
Wu H, Zhao M, Yoshimura A, Chang C, Lu Q. Critical Link Between Epigenetics and Transcription Factors in the Induction of Autoimmunity: a Comprehensive Review. Clin Rev Allergy Immunol. 2016;50(3):333-44. doi: 10.1007/s12016-016-8534-y
Pierrot-Deseilligny C, Souberbielle JC. Vitamin D and multiple sclerosis: An update. Mult Scler Relat Disord. 2017;14:35-45. doi: 10.1016/j.msard.2017.03.014
Penesová A, Dean Z, Kollár B, Havranová A, Imrich R, Vlček M, et al. Nutritional intervention as an essential part of multiple sclerosis treatment? Physiol Res. 2018;67(4):521-33. doi: 10.33549/physiolres.933694
Sintzel MB, Rametta M, Reder AT. Vitamin D and multiple sclerosis: A comprehensive review. Neurol Ther. 2018;7(1):59-85. doi: 10.1007/s40120-017-0086-4
Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. Methodology of an International Study of People with Multiple Sclerosis Recruited through Web 2.0 Platforms: Demographics, Lifestyle, and Disease Characteristics. Neurol Res Int. 2013;2013:580596. doi: 10.1155/2013/580596
El Aidy S, Dinan TG, Cryan JF. Immune modulation of the brain-gut-microbe axis. Front Microbiol. 2014;5:146. doi: 10.3389/fmicb.2014.00146
Sender R, Fuchs S, Milo R. Revised Estimates for the Number of Human and Bacteria Cells in the Body. PLoS Biol. 2016;14(8):e1002533. doi: 10.1371/journal.pbio.1002533
Carding S, Verbeke K, Vipond DT, Corfe BM, Owen LJ. Dysbiosis of the gut microbiota in disease. Microb Ecol Health Dis. 2015;26:26191. doi: 10.3402/mehd.v26.26191
Petersen C, Round JL. Defining dysbiosis and its influence on host immunity and disease. Cell Microbiol. 2014;16(7):1024-33. doi: 10.1111/cmi.12308
Hou K, Wu ZX, Chen XY, Wang JQ, Zhang D, Xiao C, et al. Microbiota in health and diseases. Signal Transduct Target Ther. 2022;7(1):135. doi: 10.1038/s41392-022-00974-4
Shahi SK, Freedman SN, Mangalam AK. Gut microbiome in multiple sclerosis: The players involved and the roles they play. Gut Microbes. 2017;8(6):607-15. doi: 10.1080/19490976.2017.1349041
Picca A, Fanelli F, Calvani R, Mulè G, Pesce V, Sisto A, et al. Gut Dysbiosis and Muscle Aging: Searching for Novel Targets against Sarcopenia. Mediators Inflamm. 2018;2018:7026198. doi: 10.1155/2018/7026198
Blum HE. The human microbiome. Adv Med Sci. 2017;62(2):414-20. doi: 10.1016/j.advms.2017.04.005
Power SE, O’Toole PW, Stanton C, Ross RP, Fitzgerald GF. Intestinal microbiota, diet and health. Br J Nutr. 2014;111(3):387-402. doi: 10.1017/S0007114513002560.
Corrêa-Oliveira R, Fachi JL, Vieira A, Sato FT, Vinolo MA. Regulation of immune cell function by short-chain fatty acids. Clin Transl Immunology. 2016;5(4):e73. doi: 10.1038/cti.2016.17
Chu F, Shi M, Lang Y, Shen D, Jin T, Zhu J, et al. Gut Microbiota in Multiple Sclerosis and Experimental Autoimmune Encephalomyelitis: Current Applications and Future Perspectives. Mediators Inflamm. 2018;2018:8168717. doi: 10.1155/2018/8168717
Calahorra L, Camacho-Toledano C, Serrano-Regal MP, Ortega MC, Clemente D. Regulatory Cells in Multiple Sclerosis: From Blood to Brain. Biomedicines. 2022;10(2):335. doi: 10.3390/biomedicines10020335
Budhram A, Parvathy S, Kremenchutzky M, Silverman M. Breaking down the gut microbiome composition in multiple sclerosis. Mult Scler. 2017;23(5):628-36. doi: 10.1177/1352458516682105
Parashar A, Udayabanu M. Gut microbiota: Implications in Parkinson’s disease. Parkinsonism Relat Disord. 2017;38:1-7. doi: 10.1016/j.parkreldis.2017.02.002
Dendrou CA, Fugger L, Friese MA. Immunopathology of multiple sclerosis. Nat Rev Immunol. 2015;15(9):545-58. doi: 10.1038/nri3871
Rangachari M, Kerfoot SM, Arbour N, Alvarez JI. Editorial: Lymphocytes in MS and EAE: More Than Just a CD4+ World. Front Immunol. 2017;8:133. doi: 10.3389/fimmu.2017.00133
van Baarlen P, Wells JM, Kleerebezem M. Regulation of intestinal homeostasis and immunity with probiotic lactobacilli. Trends Immunol. 2013;34(5):208-15. doi: 10.1016/j.it.2013.01.005
Antonini M, Lo Conte M, Sorini C, Falcone M. How the Interplay Between the Commensal Microbiota, Gut Barrier Integrity, and Mucosal Immunity Regulates Brain Autoimmunity. Front Immunol. 2019;10:1937. doi: 10.3389/fimmu.2019.01937
Kinashi Y, Hase K. Partners in Leaky Gut Syndrome: Intestinal Dysbiosis and Autoimmunity. Front Immunol. 2021;12:673708. doi: 10.3389/fimmu.2021.673708
Gebrayel P, Nicco C, Al Khodor S, Bilinski J, Caselli E, Comelli EM, et al. Microbiota medicine: towards clinical revolution. J Transl Med. 2022;20(1):111. doi: 10.1186/s12967-022-03296-9
Almeida PP, Tavares-Gomes AL, Stockler-Pinto MB. Relaxing the “second brain”: nutrients and bioactive compounds as a therapeutic and preventive strategy to alleviate oxidative stress in the enteric nervous system. Nutr Rev. 2022;80(11):2206-224. doi: 10.1093/nutrit/nuac030
Hemarajata P, Versalovic J. Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Therap Adv Gastroenterol. 2013;6(1):39-51. doi: 10.1177/1756283X12459294
Pihurov M, Păcularu-Burada B, Cotârleţ M, Vasile MA, Bahrim GE. Novel Insights for Metabiotics Production by Using Artisanal Probiotic Cultures. Microorganisms. 2021;9(11):2184. doi: 10.3390/microorganisms9112184
Durazzo A, Nazhand A, Lucarini M, Atanasov AG, Souto EB, Novellino E, et al. An Updated Overview on Nanonutraceuticals: Focus on Nanoprebiotics and Nanoprobiotics. Int J Mol Sci. 2020;21(7):2285. doi: 10.3390/ijms21072285
Calvo-Barreiro L, Eixarch H, Montalban X, Espejo C. Combined therapies to treat complex diseases: The role of the gut microbiota in multiple sclerosis. Autoimmun Rev. 2018;17(2):165-74. doi: 10.1016/j.autrev.2017.11.019
Ojeda J, Ávila A, Vidal PM. Gut Microbiota Interaction with the Central Nervous System throughout Life. J Clin Med. 2021;10(6):1299. doi: 10.3390/jcm10061299
Tankou SK, Regev K, Healy BC, Tjon E, Laghi L, Cox LM, et al. A probiotic modulates the microbiome and immunity in multiple sclerosis. Ann Neurol. 2018;83(6):1147-161. doi: 10.1002/ana.25244
Kouchaki E, Tamtaji OR, Salami M, Bahmani F, Daneshvar Kakhaki R, Akbari E, et al. Clinical and metabolic response to probiotic supplementation in patients with multiple sclerosis: A randomized, double-blind, placebo-controlled trial. Clin Nutr. 2017;36(5):1245-249. doi: 10.1016/j.clnu.2016.08.015
Tamtaji OR, Kouchaki E, Salami M, Aghadavod E, Akbari E, Tajabadi-Ebrahimi M, et al. The Effects of Probiotic Supplementation on Gene Expression Related to Inflammation, Insulin, and Lipids in Patients With Multiple Sclerosis: A Randomized, Double-Blind, Placebo-Controlled Trial. J Am Coll Nutr. 2017;36(8):660-65. doi: 10.1080/07315724.2017.1347074
Rahimlou M, Hosseini SA, Majdinasab N, Haghighizadeh MH, Husain D. Effects of long-term administration of Multi-Strain Probiotic on circulating levels of BDNF, NGF, IL-6 and mental health in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled trial. Nutr Neurosci. 2022;25(2):411-22. doi: 10.1080/1028415X.2020.1758887
Zheng D, Liwinski T, Elinav E. Interaction between microbiota and immunity in health and disease. Cell Res. 2020;30(6):492-506. doi: 10.1038/s41422-020-0332-7
Dopkins N, Nagarkatti PS, Nagarkatti M. The role of gut microbiome and associated metabolome in the regulation of neuroinflammation in multiple sclerosis and its implications in attenuating chronic inflammation in other inflammatory and autoimmune disorders. Immunology. 2018;154(2):178-85. doi: 10.1111/imm.12903
Munger K, Åivo J, Hongell K, Soilu-Hänninen M, Surcel H, Ascherio A. Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the Finnish maternity cohort. JAMA Neurol. 2016;73(5):515. doi: 10.1001/jamaneurol.2015.4800
Wacker M, Holick M. Vitamin D—effects on skeletal and extraskeletal health and the need for supplementation. Nutrients. 2013;5(1):111-48. doi: 10.3390/nu5010111
Jelinek GA, Marck CH, Weiland TJ, Pereira N, van der Meer DM, Hadgkiss EJ. Latitude, sun exposure and vitamin D supplementation: associations with quality of life and disease outcomes in a large international cohort of people with multiple sclerosis. BMC Neurol. 2015;15:132. doi: 10.1186/s12883-015-0394-1
Hossein-nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proc. 2013;88(7):720-55. doi: 10.1016/j.mayocp.2013.05.011
Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12(7):2097. doi: 10.3390/nu12072097
Feng X, Wang Z, Howlett-Prieto Q, Einhorn N, Causevic S, Reder AT. Vitamin D enhances responses to interferon-β in MS. Neurol Neuroimmunol Neuroinflamm. 2019;6(6):e622. doi: 10.1212/NXI.0000000000000622
Ascherio A, Munger KL, White R, Köchert K, Simon KC, Polman CH, et al. Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol. 2014;71(3):306-14. doi: 10.1001/jamaneurol.2013.5993
Hanaei S, Sahraian MA, Mohammadifar M, Ramagopalan SV, Ghajarzadeh M. Effect of Vitamin D Supplements on Relapse Rate and Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis. Int J Prev Med. 2021;12:42. doi: 10.4103/ijpvm.IJPVM_208_20
Tredinnik AR, Probst YC. Evaluating the Effects of Dietary Interventions on Disease Progression and Symptoms of Adults with Multiple Sclerosis: An Umbrella Review. Adv Nutr. 2020;11(6):1603-615. doi: 10.1093/advances/nmaa063
Kouchaki E, Afarini M, Abolhassani J, Mirhosseini N, Bahmani F, Masoud SA, et al. High-dose ω-3 Fatty Acid Plus Vitamin D3 Supplementation Affects Clinical Symptoms and Metabolic Status of Patients with Multiple Sclerosis: A Randomized Controlled Clinical Trial. J Nutr. 2018;148(8):1380-386. doi: 10.1093/jn/nxy116. Retraction in: J Nutr. 2021;151(5):1362.
Black LJ, Zhao Y, Peng YC, Sherriff JL, Lucas RM, van der Mei I, et al. Higher fish consumption and lower risk of central nervous system demyelination. Eur J Clin Nutr. 2020;74(5):818-24. doi: 10.1038/s41430-019-0476-z
Pommerich UM, Brincks J, Christensen ME. Is there an effect of dietary intake on MS-related fatigue? - A systematic literature review. Mult Scler Relat Disord. 2018;25:282-91. doi: 10.1016/j.msard.2018.08.017
Zostawa J, Adamczyk J, Sowa P, Adamczyk-Sowa M. The influence of sodium on pathophysiology of multiple sclerosis. Neurol Sci. 2017;38(3):389-98. doi: 10.1007/s10072-016-2802-8
Hucke S, Wiendl H, Klotz L. Implications of dietary salt intake for multiple sclerosis pathogenesis. Mult Scler. 2016;22(2):133-9. doi: 10.1177/1352458515609431
Jörg S, Grohme DA, Erzler M, Binsfeld M, Haghikia A, Müller DN, et al. Environmental factors in autoimmune diseases and their role in multiple sclerosis. Cell Mol Life Sci. 2016;73(24):4611-622. doi: 10.1007/s00018-016-2311-1
Colpitts SL, Kasper EJ, Keever A, Liljenberg C, Kirby T, Magori K, et al. A bidirectional association between the gut microbiota and CNS disease in a biphasic murine model of multiple sclerosis. Gut Microbes. 2017;8(6):561-73. doi: 10.1080/19490976.2017.1353843
Sato W, Yamamura T. Multiple sclerosis: Possibility of a gut environment-induced disease. Neurochem Int. 2019;130:104475. doi: 10.1016/j.neuint.2019.104475
Jangi S, Gandhi R, Cox LM, Li N, Von Glehn F, Yan R, et al. Alterations of the human gut microbiome in multiple sclerosis. Nat. Commun. 2016;7:12015. doi: 10.1038/ncomms12015
Horton MK, McCauley K, Fadrosh D, Fujimura K, Graves J, Ness J, et al. Gut microbiome is associated with multiple sclerosis activity in children. Ann Clin Transl Neurol. 2021;8(9):1867-883. doi: 10.1002/acn3.51441
Varela-Trinidad GU, Domínguez-Díaz C, Solórzano-Castanedo K, Íñiguez-Gutiérrez L, Hernández-Flores TJ, Fafutis-Morris M. Probiotics: Protecting Our Health from the Gut. Microorganisms. 2022;10(7):1428. doi: 10.3390/microorganisms10071428
Bagur MJ, Murcia MA, Jiménez-Monreal AM, Tur JA, Bibiloni MM, Alonso GL, et al. Influence of Diet in Multiple Sclerosis: A Systematic Review. Adv Nutr. 2017;8(3):463-72. doi: 10.3945/an.116.014191
Cantorna MT, Zhao J, Yang L. Vitamin D, invariant natural killer T-cells and experimental autoimmune disease. Proc Nutr Soc. 2012;71(1):62-6. doi: 10.1017/S0029665111003193
Skrobot A, Demkow U, Wachowska M. Immunomodulatory Role of Vitamin D: A Review. Adv Exp Med Biol. 2018;1108:13-23. doi: 10.1007/5584_2018_246
Fatima M, Lamis A, Siddiqui SW, Ashok T, Patni N, Fadiora OE. Therapeutic Role of Vitamin D in Multiple Sclerosis: An Essentially Contested Concept. Cureus. 2022;14(6):e26186. doi: 10.7759/cureus.26186
McLaughlin L, Clarke L, Khalilidehkordi E, Butzkueven H, Taylor B, Broadley SA. Vitamin D for the treatment of multiple sclerosis: a meta-analysis. J Neurol. 2018;265(12):2893-905. doi: 10.1007/s00415-018-9074-6
Jelinek GA, Hadgkiss EJ, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. Association of fish consumption and Ω 3 supplementation with quality of life, disability and disease activity in an international cohort of people with multiple sclerosis. Int J Neurosci. 2013;123(11):792-800. doi: 10.3109/00207454.2013.803104
Mische LJ, Mowry EM. The Evidence for Dietary Interventions and Nutritional Supplements as Treatment Options in Multiple Sclerosis: a Review. Curr Treat Options Neurol. 2018;20(4):8. doi: 10.1007/s11940-018-0494-5
Crabtree-Hartman E. Advanced Symptom Management in Multiple Sclerosis. Neurol Clin. 2018;36(1):197-18. doi: 10.1016/j.ncl.2017.08.015
Altowaijri G, Fryman A, Yadav V. Dietary Interventions and Multiple Sclerosis. Curr Neurol Neurosci Rep. 2017;17(3):28. doi: 10.1007/s11910-017-0732-3
Claflin SB, van der Mei IAF, Taylor BV. Complementary and alternative treatments of multiple sclerosis: a review of the evidence from 2001 to 2016. J Neurol Neurosurg Psychiatry. 2018;89(1):34-41. doi: 10.1136/jnnp-2016-314490
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