Attenuation of immune activation in patients with multiple sclerosis on a wheat-reduced diet: a pilot crossover trial.

Background: Western lifestyle has been associated with an increase in relapsing-remitting multiple sclerosis (RRMS). In mice, dietary wheat amylase-trypsin inhibitors (ATIs) activate intestinal myeloid cells and augment T cell-mediated systemic inflammation.
Objective: The aim of this study was to assess whether a wheat- and thus ATI-reduced diet might exert beneficial effects in RRMS patients with modest disease activity.
Methods: In this 6-month, crossover, open-label, bicentric proof-of-concept trial, 16 RRMS patients with stable disease course were randomized to either 3 months of a standard wheat-containing diet with consecutive switch to a > 90% wheat-reduced diet, or vice versa.
Results: The primary endpoint was negative, as the frequency of circulating pro-inflammatory T cells did not decrease during the ATI-reduced diet. We did, however, observe decreased frequencies of CD14 ⁺ CD16 ⁺⁺ monocytes and a concomitant increase in CD14 ⁺⁺ CD16 ^- monocytes during the wheat-reduced diet interval. This was accompanied by an improvement in pain-related quality of life in health-related quality of life assessed (SF-36).
Conclusion: Our results suggest that the wheat- and thus ATI-reduced diet was associated with changes in monocyte subsets and improved pain-related quality of life in RRMS patients. Thus, a wheat (ATI)-reduced diet might be a complementary approach accompanying immunotherapy for some patients.
Registration: German Clinical Trial Register (No. DRKS00027967).
Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: LK received honoraria for lecturing and travel expenses for attending meetings from Alexion, Biogen, Janssen, Merck, Sanofi Genzyme, Novartis, Teva, Viatris, and Roche; her research is funded by the Deutsche Forschungsgemeinschaft (DFG), Interdisciplinary Center for Clinical Studies (IZKF) Muenster, Biogen, Merck, and Novartis. ME received speaker honoraria and travel support from Sanofi Genzyme; she received research support from the Deutsche Multiple Sklerose Gesellschaft (DMSG) Landesverband, Nordrhein-Westfalen (NRW), and the Innovative Medical Research (IMF) program of the University Münster. SB has received honoraria and compensation for travel from Biogen Idec, Merck Serono, Novartis, Sanofi Genzyme, and Roche. FZ has recently received research grants and consultation funds from DFG, BMBF, PMSA, MPG, Genzyme, Merck Serono, Roche, Novartis, Sanofi-Aventis, Celgene, ONO, and Octapharma. DS consults for, advises for, received grants from, and holds intellectual property rights with NorthSea; he consults for, advises for, and received grants from Boehringer Ingelheim; and consults for and advises for Pliant, UCB, Inversago, and Prometik. FL received consultancy fees from Roche and support with travel cost from Teva Pharma. The remaining authors have nothing to disclose.
(© The Author(s), 2023.)