The over-the-counter supplement lipoic acid may offer some benefits in slowing the loss of gray matter in the brains of individuals with progressive forms of multiple sclerosis (MS). This finding comes from new research conducted by Oregon Health & Science University and the Portland VA Health Care System. However, the study, which was published on December 15 in Neurology, the medical journal of the American Academy of Neurology, revealed that lipoic acid did not improve the primary clinical outcome of walking speed.
The randomized controlled trial involved 54 participants diagnosed with primary progressive and secondary progressive MS. Participants in the experimental group received a daily dose of 1,200 milligrams of lipoic acid over two years. Their outcomes were compared to 61 individuals who were given a placebo. The primary outcome measured was walking speed, while secondary outcomes included brain atrophy assessed via magnetic resonance imaging (MRI), other clinical outcomes, and safety considerations.
Mixed Results in Clinical Outcomes
“It didn’t work clinically in progressive multiple sclerosis the way we hoped,” stated Dr. Rebecca Spain, lead author of the study and associate professor of neurology at the OHSU School of Medicine. Dr. Spain, who also serves as co-director of the VA MS Center of Excellence West, emphasized the potential significance of the findings. “However, the slowing of brain atrophy that we saw in MRI images suggests that we may yet be on the right track, especially if we can find a better way to deliver the beneficial effects of an antioxidant like lipoic acid.”
Multiple sclerosis is a chronic disease that affects the central nervous system, damaging the myelin sheath that covers nerve fibers. This damage disrupts the electrical signals necessary for movement, sensation, and cognition. An estimated 2.8 million people globally are affected by MS.
Understanding Lipoic Acid’s Potential
Researchers hypothesize that lipoic acid may possess both anti-inflammatory and antioxidant properties that could protect damaged myelin and underlying nerves. The challenge lies in ensuring sufficient circulation of the compound in the blood to reach the brain. “Lipoic acid is lipophobic,” Dr. Spain explained. “It does not cross the blood-brain barrier and get into the central nervous system very easily.”
This study builds on a line of research that began with a mouse model, followed by dose-finding studies and a promising pilot study published in 2017. Despite the high dosage used in the trial, which led to some side effects, researchers remain hopeful about lipoic acid’s potential.
“In combination with this Octopus trial, we are going to learn more about whether lipoic acid is worth taking if you have progressive MS,” Dr. Spain said. “I am cautiously optimistic.”
Future Research and Global Collaboration
The findings from this study are being incorporated into a larger research initiative in the United Kingdom known as the Optimal Clinical Trials Platform for Multiple Sclerosis, or Octopus. This multi-arm, multi-stage trial will test lipoic acid and metformin against a placebo in a significantly larger cohort of participants. Dr. Spain is advising this global research effort, which aims to combine OHSU’s findings with other extensive datasets.
The research was supported by several grants, including those from the Department of Veterans Affairs, the National Multiple Sclerosis Society, and the Multiple Sclerosis Society of Canada. Additionally, the National Center for Advancing Translational Sciences of the National Institutes of Health contributed through grant award UL1TR002369.
As the scientific community continues to explore the potential of lipoic acid in treating progressive MS, these findings represent a step forward in understanding the complex mechanisms of the disease and the search for effective treatments.
