Abstract
Introduction: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease that affects young adults. The etiology of MS is complex, involving various environmental and genetic factors. The gut microbiota plays a central role in the gut-brain axis (GBA). Modulation of the gut microbiota through probiotics and nutrients is considered a fundamental aspect in the treatment of MS. Objective: This study aimed to present the nutritional importance of probiotics and nutrients in immunomodulation in patients with multiple sclerosis. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from March to May 2025 in the Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 154 articles were found. A total of 39 articles were fully evaluated and 14 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 31 studies with a high risk of bias and 24 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=89.5%>50%. It was concluded that interference in the composition of the gut microbiota of patients with multiple sclerosis allows the development of diagnostic tools and personalized adjuvant therapy. Diets rich in fruits, yogurt, and vegetables can reduce the risk of onset and progression of MS. Furthermore, the Mediterranean diet and the ketogenic diet have shown the potential to reduce inflammation, supporting neuroprotection. Tregs can potentially decrease the migratory capacity of effector cells to the central nervous system. These results suggest that Tregs can be used as a therapeutic opportunity. Oral administration of butyrate, propionate, and acetate, individually or in combination, led to an increase in the number of Treg cells in the colon. Also, all-trans retinoic acid (atRA), a bioactive form of vitamin A, stimulates Treg cells in the human gut. Probiotics, together with gut microbiota, have been increasingly proposed for the stimulation of Treg cells.