Researchers at the Experimental and Clinical Research Center and the Max Delbrück Center for Molecular Medicine in the Helmholtz Association – as well as from Berlin, UC Irvine, Calif., and Toronto – report in a new study that the simple sugar N-acetylglucosamine, or GlcNAc for short, could play a key role in the development of progressive multiple sclerosis. This opens up potential new avenues for identifying, at an early stage, which patients are at higher risk of progressive MS and adjusting their treatment accordingly.

Inside an organism, GlcNAc and other sugar molecules attach to proteins on the cell surface in the form of chains. This mechanism controls various cell functions by forming branched structures from these sugar chains. Researchers studied 120 subjects from Irvine and were able to show that, in this particularly severe form of the disease, there are significantly lower concentrations of N-acetylglucosamine in the blood serum than there are in healthy people or patients with relapsing-remitting MS. In another study of 180 patients from Berlin with relapsing-remitting or progressive MS, researchers also found that low serum levels of GlcNAc are linked to the development of the progressive form of the disease, clinical disability, and neurodegeneration. 

In autumn 2020 researchers gave GlcNAc to lactating mice and found the animals passed on this simple sugar – which, incidentally, is also contained in human breast milk – to their offspring. This stimulated primary myelination of the neuronal axons in the young animals. They also observed in the mouse experiments that N-acetylglucosamine activates myelin progenitor cells, thus promoting both primary myelination and the repair of damaged myelin.

The study’s authors hope GlcNAc not only has potential as a suitable biomarker for progressive MS, but it could also pave the way for new therapeutic strategies. An initial, as-yet-unpublished phase I trial has just been completed with around 30 subjects, where the scientists investigated the safety of taking GlcNAc in certain doses. If it is shown to be safe, the scientists hope to be able to conduct further studies into this simple sugar's possible efficacy as an MS therapy.

The study was published in the journal JAMA Neurology.