Multiple sclerosis treatment is entering a new era, with researchers pursuing three fundamentally different approaches to stop disease progression and potentially repair nerve damage. Rather than simply suppressing the immune system like traditional MS drugs, these emerging strategies aim to reset immune function, harness beneficial gut bacteria, or restore cellular energy pathways that have gone awry in MS patients (Source 1, 2, 3).

What Is CAR T Cell Therapy and How Could It Transform MS Treatment?

One of the most promising developments comes from an international clinical trial testing CAR T cell therapy, a treatment originally developed for blood cancers. The approach works by extracting a patient's own immune cells, called T cells, and genetically modifying them in a laboratory to become what researchers call "living drugs".

These engineered cells are then reinfused into the patient's body, where they seek out and destroy the specific immune cells causing damage in MS. Unlike ongoing medications, CAR T offers a one-time immune system reset designed to halt disease progression at its source.

Numan Unees, a 40-year-old from Rotherham, England, became the first patient in Sheffield and the seventh globally to receive this experimental treatment. Diagnosed with MS six years ago and unable to walk unaided, Unees described the potential impact as "like starting a new life" if the therapy restores his mobility.

Unees

"This represents a significant moment for MS patients, as by targeting and eliminating disease-causing cells in the tissues of the nervous system, CAR T offers a one-off immune system reset that could stop disability progression in this disease," said Prof. Basil Sharrack, consultant neurologist at Sheffield Teaching Hospitals NHS Foundation Trust.

Prof. Basil Sharrack, Consultant Neurologist at Sheffield Teaching Hospitals NHS Foundation Trust

The trial is currently recruiting up to 18 patients globally and focuses on people aged 18 to 60 with progressive MS who have not responded well to existing medications. The first phase prioritizes testing safety, with researchers closely monitoring Unees and other early participants.

Can Gut Bacteria Help Reduce MS Severity?

A separate line of research suggests that a specific type of gut bacteria called Veillonella ratti may reduce MS severity by increasing anti-inflammatory signaling in the brain and spinal cord. In a mouse model of MS, researchers found that this bacterium works by changing the activity of other gut bacteria, ultimately boosting levels of a protective molecule called DOPE (dioleoyl phosphatidylethanolamine).

The study, published in the journal Experimental and Molecular Pathology, revealed that mice treated with V. ratti showed significantly less severe disease and experienced less damage to myelin, the fatty coating that protects nerve fibers. Notably, MS patients tend to have lower than normal levels of V. ratti in their gut microbiome compared to healthy individuals.

When researchers gave mice daily oral V. ratti supplements starting one week before disease was induced, the bacteria reduced the abundance of other gut microbes that break down DOPE. With less DOPE being destroyed, more of this protective molecule remained available to travel to the brain and spinal cord, where it dampened the inflammatory immune cells driving MS damage.

To confirm DOPE's role, scientists also treated mice directly with purified DOPE and observed similar reductions in disease severity, suggesting the molecule is a key mediator of V. ratti's protective effects.

How Does NAD+ Metabolism Connect to MS Progression?

A third emerging area of research focuses on NAD+ (nicotinamide adenine dinucleotide), a coenzyme essential for cellular energy production and immune regulation. Researchers have observed that disruptions in NAD+ metabolism occur across multiple autoimmune diseases, including MS.

Immune cells require substantial energy to activate, communicate, and carry out their functions, and NAD+ is central to these energetic processes. When chronic inflammation persists, it increases NAD+ consumption, depleting cellular NAD+ pools and altering immune cell function over time.

This depletion can contribute to elevated inflammatory signaling, impaired immune regulation, and ongoing tissue damage. NAD+ precursors such as nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN) are currently being investigated for their ability to restore NAD+ levels and potentially modulate these pathways.

What Are the Key Differences Between These Three Approaches?

These three strategies represent distinct mechanisms for addressing MS:

• CAR T Cell Therapy: A one-time treatment that genetically engineers a patient's own immune cells to eliminate disease-causing cells, offering a potential permanent immune system reset rather than ongoing medication.
• Gut Bacteria Supplementation: A microbiome-based approach that leverages beneficial bacteria to increase anti-inflammatory signaling in the brain and spinal cord, potentially preventing immune-mediated nerve damage.
• NAD+ Restoration: A metabolic approach that aims to restore cellular energy pathways in immune cells, reducing chronic inflammation and supporting immune regulation through precursor compounds.

What Stage Are These Treatments At?

It is important to note that these approaches are at different stages of development. CAR T cell therapy is in early-stage human trials, with safety as the primary focus. The gut bacteria research remains in animal models, with researchers emphasizing that additional studies will be needed to determine if similar approaches might benefit people with MS.

NAD+ precursor research is primarily focused on understanding how NAD+ availability influences autoimmune disease processes, rather than establishing these compounds as proven treatments. Much of the available evidence comes from preclinical models and a limited number of early-stage human studies.

"Existing treatments don't work for everyone. It's early days but, if trial results prove successful, CAR T cell therapy could be a gamechanger for how we treat the condition," said Caitlin Astbury from the MS Society charity.

Caitlin Astbury, MS Society Charity

The MS Society and other patient advocacy organizations are following these developments closely. With approximately 150,000 people living with MS in the United Kingdom, and many diagnosed in their 30s and 40s, the potential for treatments that address the root cause of the disease rather than simply managing symptoms represents a significant shift in how the condition might be approached.

While these three approaches differ in mechanism and timeline, they share a common goal: moving beyond immune suppression toward treatments that either reset immune function, harness the body's natural protective mechanisms, or restore the cellular energy systems that support healthy immune regulation.