A recent study conducted by the Molecular Neuroimmunoendocrinology research group of the Institute of Biomedicine of Seville (IBiS) and the University of Seville has revealed the potential of melatonin as an adjuvant treatment in relapsing-remitting multiple sclerosis (RR-MS). The article, published in the scientific journal Journal of Autoimmunity , shows how the combined use of melatonin and corticosteroids (methylprednisolone) "protects 90% of the animals studied, notably reducing neuroinflammation and the necessary dose of corticosteroids", as indicated by the first author of the study, Ana Isabel Álvarez López.
Multiple sclerosis is an autoimmune disease characterized by the destruction of myelin, the substance that covers nerve fibers and allows the correct transmission of nerve impulses. This neurodegenerative disease is the leading cause of non-traumatic disability in young adults and affects approximately 50,000 people in Spain. The most common form of multiple sclerosis, RR-MS, presents with acute inflammatory episodes that cause varying degrees of disability, followed by partial or total recovery.
Currently, the first-line treatment for relapsing RR-MS consists of administration of high doses of glucocorticoids, in particular methylprednisolone, for several days. However, this treatment can cause significant side effects and some patients develop hypersensitivity to corticosteroids.
Melatonin: an ally in reducing neuroinflammation
The study by the NeuroImmunoendocrinology Molecular group, led by Professor Antonio Carrillo Vico, has shown that co-administration of melatonin and methylprednisolone protects 90% of the animals studied from developing symptoms of the disease. In addition, co-treatment with melatonin allowed a four-fold reduction in the dose of methylprednisolone, which significantly reduced the side effects associated with the use of corticosteroids.According to Professor Carrillo Vico, "this finding is of great relevance, as we have not only proven the efficacy of melatonin in enhancing the effect of corticosteroids, but also observed that melatonin alone can improve the resolution of a disease flare-up and enhance the effect of corticosteroids in a subsequent relapse."
Melatonin acts by reducing the entry of pathogenic immune cells, such as CD4+ T lymphocytes, B lymphocytes, macrophages and dendritic cells, into the central nervous system, thus limiting neuroinflammation. In addition, melatonin treatment increases the production of anti-inflammatory markers, which contributes to less myelin destruction.
The results of this preclinical study and the group’s previous studies have laid the foundations for the development of a clinical trial in humans, called MELATOMS-1. This trial, coordinated by the IBiS team and with the participation of the Hospital Universitario Virgen del Rocío de Sevilla (HUVR) and the Hospital Universitario Virgen Macarena de Sevilla (HUVM), evaluates the use of melatonin in patients with primary progressive multiple sclerosis (MS-PP), the most aggressive form of the disease, for which there is currently only one drug approved in Spain.
The MELATOMS-1 trial is a multicenter, randomized, double-blind, placebo-controlled study aimed at evaluating the safety and efficacy of melatonin in patients with MS-PP who are already receiving treatment with ocrelizumab.
Antonio Carrillo Vico stresses that "the potential of melatonin to reduce inflammation and corticosteroid dosage in multiple sclerosis could lead to a significant improvement in the quality of life of patients".
This study has been financed by the Consejería de Salud y Consumo de la Junta de Andalucía.
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