La terapia farmacológica integrada y con Omega-3 modula las vías inmunometabólicas y los resultados neuro-oftalmológicos en la esclerosis múltiple remitente-recurrente

AIMS: To investigate the immunometabolic and neuro-ophthalmological effects of combined Fingolimod, Metformin, Fluoxetine, and Omega-3 therapy in patients with relapsing-remitting multiple sclerosis (RRMS). MATERIALS AND METHODS: A total of 80 RRMS patients were analyzed. Peripheral blood mononuclear cells and serum samples were assessed for gene expression of apoptosis- and oxidative stress-related markers (BCL2, BAX, CASP3, NRF2, SOD2, AMPK2), cytokine levels (IL-6, TNF-α, IL-10, IFN-γ), and Th1/Th17 ratio. Optical coherence tomography (OCT) and visual evoked potentials (VEP) were used to evaluate neuro-ophthalmological outcomes. RESULTS: Omega-3 supplementation was associated with reduced pro-inflammatory cytokines (IL-6, TNF-α) and increased IL-10 levels. It was also linked to higher expression of antioxidant-related genes (NRF2, SOD2, AMPK2) and modulation of T-cell balance, reflected by a reduced Th1/Th17 ratio. Integrated analysis showed distinct clustering of treatment groups, with Omega-3-associated profiles linked to anti-inflammatory and antioxidant signatures. These changes were correlated with improved RNFL thickness and VEP parameters. CONCLUSIONS: Omega-3 supplementation was associated with coordinated immunometabolic changes and improved neuro-ophthalmological indicators in RRMS patients, suggesting its potential as an adjunct to standard therapies. Plain Language Summary: Multiple sclerosis (MS) is a long-term disease where the body’s immune system attacks the brain and spinal cord. This leads to inflammation and damage to nerves. Current treatments can reduce inflammation, but they do not fully protect nerve cells. In this study, we looked at whether adding omega-3 (found in fish oil) to common MS medications could help patients. We studied 80 people with relapsing-remitting MS. We tested their blood to check inflammation and how the immune system behaves. We also examined eye health and nerve function using special tests. We found that patients who took omega-3 had lower levels of inflammation and higher levels of protective signals in their bodies. Their immune system also became less harmful. In addition, these patients showed better results in tests related to nerve function and eye health. These results suggest that omega-3 may support MS treatment by helping reduce inflammation and protect nerve cells. However, more research is needed to confirm these findings and understand exactly how omega-3 works. DOI: 10.1080/1750743X.2026.2676451