Lipoic acid is a naturally occurring antioxidant molecue. It is being tested for its ability to boost myelin repair in MS. It is taken as a tablet.
Lipoic acid for myelin repair: Phase II
- Lipoic acid is a powerful antioxidant, lowers several markers of inflammation and reduces the number of immune cells that migrate into the brain and spinal cord and damage the myelin coating of nerves. This combination may slow the progression of further nerve damage.
- Animal studies have suggested a role in remyelination and/or neuroprotection. In progressive MS, lipoic acid prevented the loss of brain volume (brain atrophy)
- In early clinical trials, the most common side effects were gastrointestinal upset and rashes.
Lipoic acid is an antioxidant made naturally in the body and found in very small amounts in foods such as spinach and broccoli. It is also available as an over-the-counter dietary supplement. Antioxidants block the action of “free radicals”, which are by-products of biological processes that can cause tissue injury in MS.
In addition to its antioxidant properties, animal studies and data from human trials have shown that lipoic acid lowers several markers of inflammation and reduces the number of inflammatory immune cells that migrate into the brain and spinal cord.
A combination of these mechanisms may slow the progression of further nerve damage.
Lipoic acid is taken as a tablet.
The doses of lipoic acid being used in MS clinical trials (1200mg) are higher than the doses generally used when it is taken as a supplement (100 – 600mg).
Laboratory studies dating back to the 1970s have suggested that lipoic acid might have a role in remyelination and/or neuroprotection.
More recently, lipoic has been studied in clinical trials. In a phase II study, 51 people with secondary progressive MS took lipoic acid or placebo. The aim was to see if lipoic acid could prevent the loss of brain volume (brain atrophy). Over the two years of the study, change in brain volume was less in the group taking lipoic acid compared to those taking placebo. Other measures were not significantly different between the two groups, although people taking lipoic acid were able to do a timed 25-foot walk slightly faster and had fewer falls than those taking placebo. Further analysis of a subgroup of this study suggested that lipoic acid may preserve walking performance in people with secondary progressive MS, particularly in those with less disability.
Lipoic acid for progressive multiple sclerosis (LAPMS)
In this phase II study, 115 participants with progressive MS took either lipoic acid or placebo daily for two years. The main measure of the study will be the difference between the time it takes to walk 25 feet at the beginning of the study and at the end. The study will also monitor other measures of mobility and brain volume change.
Data collection was completed by August 2024. Results have not yet been reported.
Further details of the study
Octopus trial for progressive MS - multi-arm, multi-stage study
The Octopus trial is taking a new approach to testing repurposed treatments (ie treatments already in use for other conditions) which have shown potential to protect nerves in laboratory studies.
Octopus is designed to be a more efficient kind of clinical trial by using the multi-arm, multi-stage (MAMS) approach. In the first stage of the study, new treatments are quickly evaluated using MRI techniques to assess potential for slowing down progression. If a treatment shows promise, it moves on to the second stage of the study which runs for several years, involves more participants and monitors disability progression more directly.
The first two drugs to be tested in Octopus are metformin and lipoic acid.
Further details of the study
The most common side effects in clinical trials have been gastrointestinal upset and rash.
