HFP (High-Fiber Supplement) in MS (Multiple Sclerosis)

It has been suggested that dysbiosis of gut commensal bacteria increases the risk of autoimmune diseases including MS. However, there is no viable intervention available to correct dysbiosis. Since high-fiber supplement can promote the growth of healthy bacteria in the gut, the investigators propose to examine the effect of specially designed high-fiber supplement on the growth of short-chain fatty acid-producing gut bacteria and development of regulatory immune cells. Although dysbiosis is an alteration of microbial composition, enteric bacteria involved in gut dysbiosis of MS are different in ethnic groups due to difference in genetics, diet, and environmental exposures. Therefore, it is important to determine the intestinal bacterial composition involved in the MS dysbiosis in each ethnicity and geographical location. Additionally, it is necessary to find a non-invasive biomarker for gut dysbiosis-mediated CNS autoimmunity in MS. Since the investigators found that fecal Lipocalin 2 (Lcn-2) is a biomarker of gut dysbiosis-mediated CNS autoimmunity in MS animal models, the investigators will examine the association of fecal Lcn-2 levels with disease activation in MS.

Effect of high-fiber supplement (HFS) on (1) composition of gut microbiota and (2)production of short-chain fatty acids (SCFAs) and Foxp3 regulatory T cells (Tregs).

(1) The fecal sample will be collected from MS patients with/without high-fiber supplement (HFS) and composition of gut microbiota will be examined. (2) The blood cells will be isolated from MS patients with/without HFS-treatment and production of SCFAs such as acetate, propionate, and butyrate, and development of Foxp3 Tregs will be examined.

Inclusion Criteria: Patients with first demyelinating event who meet the McDonald criteria for definite MS or established relapsing remitting MS patients. We will recruit Caucasian due to reports suggesting higher incidence of MS in Caucasian. Also, western diet which is common among Caucasian can promote MS. MS patients treated with either Glatiramer acetate or Fingolimod for at least 6 months prior to enrollment. Exclusion Criteria: Primary or secondary progressive MS. Patients with autoimmune comorbidities. Having received prior chemotherapy. Having received Dimethylfumarate (DMF). Pregnant women. Cognitively impaired. Antibiotic use within last 6 months. Probiotic use within 2 months. Self-reported allergy or intolerance to any ingredients in the fiber supplement Self-reported or diagnosed gastrointestinal symptoms, disorders or adenomas Active or history of malignant tumors