Short-chain fatty acid producers in the gut are associated with pediatric multiple sclerosis onset

Objective: The relationship between multiple sclerosis and the gut microbiome has been supported by animal models in which commensal microbes are required for the development of experimental autoimmune encephalomyelitis. However, observational study findings in humans have only occasionally con-verged when comparing multiple sclerosis cases and controls which may in part reflect confounding by comorbidities and disease duration. The study of micro-biome in pediatric-onset multiple sclerosis offers unique opportunities as it is closer to biological disease onset and minimizes confounding by comorbidities and environmental exposures. Methods: A multicenter case-control study in which 35 pediatric-onset multiple sclerosis cases were 1:1 matched to healthy controls on age, sex, self-reported race, ethnicity, and recruiting site. Linear mixed effects models, weighted correlation network analyses, and PICRUSt2 were used to identify microbial co-occurrence networks and for predicting functional abundances based on marker gene sequences. Results: Two microbial co-occurrence networks (one reaching significance after adjustment for multiple comparisons; q < 0.2) were identified, suggesting interdependent bacterial taxa that exhibited association with disease status. Both networks indicated a poten-tially protective effect of higher relative abundance of bacteria observed in these clusters. Functional predictions from the significant network suggested a contri-bution of short-chain fatty acid producers through anaerobic fermentation pathways in healthy controls. Consistent family-level findings from an indepen-dent Canadian-US study (19 case/control pairs) included Ruminococaccaeae and Lachnospiraceae (p < 0.05). Macronutrient intake was not significantly different between cases and controls, minimizing the potential for dietary confounding. Interpretation: Our results suggest that short-chain fatty acid producers may be important contributors to multiple sclerosis onset.