Integrated pharmacological and Omega-3 therapy modulates immunometabolic pathways and neuro-ophthalmological outcomes in relapsing-remitting multiple sclerosis

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.