Let's talk about oral tolerance and microbiome. You pioneered this concept. You also extensively wrote on the subject of oral immune tolerance for several decades. What is oral tolerance? Dr. Anton Titov, MD. How oral tolerance can be used to treat autoimmune disease? Dr. Anton Titov, MD. Which patients benefit most from the oral tolerance treatments? Dr. Anton Titov, MD. Oral tolerance refers to the fact that we tolerate food that comes into our gut. The gut immune system is very important. There has been a renaissance or resurgence in studying the gut. Especially there is a renewed interest in studying the microbiome. Because that is part of the various bacteria in our gut that relates to immune tolerance. There is a lot of clinical trials going on now. They show that what happens in the gut can be related to how patients do with their Multiple Sclerosis. There are not any specific oral tolerance or microbiome medications yet. But they are being studied. Dr. Howard Weiner, MD. We are studying the microbiome. Many researchers are studying it. Dr. Howard Weiner, MD. We are also studying monoclonal antibody called Anti-CD3. Dr. Howard Weiner, MD. We can give it orally or nasally. This antibody Anti-CD3 stimulates the mucosal immune system. How far in the development of the anti-CD3 antibody are you in? Dr. Anton Titov, MD. Because you have been working on it for a while. Anti-CD3 antibody has a lot of promises for diseases, not only for multiple sclerosis, but for other autoimmune diseases. Dr. Howard Weiner, MD. We are now in initial clinical trials in some diseases. Dr. Howard Weiner, MD. We hope to be trying this antibody in progressive types of multiple sclerosis. Anti-CD3 antibody is given nasally. On the subject of oral tolerance. Dr. Howard Weiner, MD. I spoke to Dr. Simon Robson of Beth Israel Deaconess Hospital. Dr. Howard Weiner, MD. We discussed that gut microbiome has its own cyclical circadian clock. It is very complex. Gut microbiome is larger than the number of cells of the body. This is very important. What do your clinical trials show? Dr. Anton Titov, MD. What is the importance of gut microbiome for the general autoimmune diseases? Dr. Anton Titov, MD. How can it potentially be influenced? Dr. Anton Titov, MD. The microbiome is important for all autoimmune diseases. Dr. Howard Weiner, MD. We need to understand gut microbiome more. Dr. Howard Weiner, MD. We need to understand how you can manipulate it to help patients. Fecal transplant is the word that patients hear a lot. Could fecal transplant potentially be used for the multiple sclerosis treatment? Dr. Anton Titov, MD. Dr. Howard Weiner, MD. I wouldn't use the word "fecal transplants". Dr. Howard Weiner, MD. I would use the word "microbiome reconstitution". One day we will use fecal transplants and microbiome reconstitution for treatment of multiple sclerosis. Dr. Howard Weiner, MD. We will reconstitute gut microbiome or do transplants of the microbiome to help patients suffering from multiple sclerosis. Are there any people with certain gut microbiomes that are resistant to multiple sclerosis? Dr. Anton Titov, MD. Is that something that has been studied? Dr. Anton Titov, MD. Dr. Howard Weiner, MD. We are studying it now. Dr. Howard Weiner, MD. We know that the gut microbiome in multiple sclerosis patient is not normal. As we define this, then we will figure out how to make gut microbiome normal. Potentially you can have a certain bacteria that you can inject, infuse into the patient's gut? Dr. Anton Titov, MD. That is correct. It will cure multiple sclerosis? Dr. Anton Titov, MD. That is correct, yes. That would be a non-pharmacological Multiple Sclerosis treatment! Yes, well, it is a true vaccine. Remember vaccines are using bacteria and viruses in special ways. That would be a vaccine for Multiple Sclerosis. Fecal transplant / microbiome reconstitution is investigated for multiple sclerosis treatment. Nasal vaccines based on growing knowledge of immune tolerance development are also being developed as multiple sclerosis therapy. There is a lot of progress in the microbiome and multiple sclerosis research. Leading multiple sclerosis expert.