Fumaric Acid – Function & Diseases
Fumaric acid
The remedy fumaric acid has been known since ancient Greece. The active ingredient occurs in nature and can also be produced synthetically.
It is mainly used in industry and also in medicine. There, fumaric acid is used to treat psoriasis and a certain form of multiple sclerosis . It inhibits special immune cells.
What is fumaric acid?
Fumaric acid is an organic and at the same time chemical substance that belongs to the class of fruit acids and is also called trans-ethylenedicarboxylic acid . The salts of fumaric acid are called fumarates.
The acid is found in plants, fungi and lichens. It can also be made in the lab. As a food additive E 297, it is used to preserve food. Industry uses it to produce the plastic polyester. In the livestock industry it is used as a food additive to prevent infections. The salts of fumaric acid fumaric acid ester, fumaric acid monoethyl ester and fumaric acid dimethyl ester are used to treat patients with skin diseases and multiple sclerosis.
They are applied externally as ointments or administered orally in the form of capsules and tablets, as well as injections. 60% of the active ingredient is later excreted through breathing , the rest through the urine. The side effects, which occur rather rarely, can be reduced if the patient takes the medication with meals.
Function, effect & tasks
Fumaric acid primarily has an immunosuppressive effect. This creates a balance between different groups of immune cells. For example, fumaric acid drugs affect B and T lymphocytes and Th1 cells by inhibiting the action of Th1 cells with the help of Th2 cells.
This is necessary because patients with psoriasis have an excess of Th1 cells. All three fumarates are used in the long-term treatment of psoriasis and, since 2014, also in relapsing remitting multiple sclerosis. Psoriasis is a chronic, non-contagious skin disease. Fumarate ointments, capsules, and tablets reduce the inflammation that causes the scaly rash to form. Fumaderm therapy is successful in about 90 percent of patients.
As early as the 1970s, physicians were treating their psoriasis patients with fumaric acid preparations. Following the positive decision of the European Medicines Agency EMA in 2013, dimethyl fumarate (DMF) was also approved for the treatment of relapsing remitting multiple sclerosis. The drug is administered as capsules and tablets and replaces the previously used beta interferon injection, which many patients found stressful. In this special form of multiple sclerosis, which is based on a disruption of the Th1 cells, it inhibits the inflammation of the nerve fibers in the brain and spinal cord by releasing the cell protection factor Nrf2.
Because it also inhibits cytokine production – it blocks the HCA2 receptors – it reduces the frequency of flare-ups by up to 50%. This delays the progression of the disease. In the treatment of psoriasis, the fumaric acid agents are administered in lower doses than in the special form of multiple sclerosis.
Formation, Occurrence, Properties & Optimal Values
Fumaric acid forms colorless, almost odorless, flammable crystals at room temperature and sublimes at around 299 °C. The fruit acid is highly irritating and dissolves poorly in water. It has been known since ancient times, when it was used in folk medicine, primarily to treat skin diseases. Fumaric acid occurs naturally in some lichens, plants and fungi and is named after fumitory (Fumaria officinalis), a red-flowering weed.
In 1832 it was isolated from the plant for the first time. Naturopathy also calls the plant “grind weed” because it was applied in the form of tea poultices to the body regions affected by the rash. The common fumitory contains a lot of fumaric acid. To produce fumaric acid in the laboratory, maleic acid is heated to at least 150 degrees, irradiated with UV light or dissolved in water. In non-plant organisms, fruit acid is produced, among other things, by the hydrolytic breakdown of the amino acids tyrosine and phenylalanine .
Diseases & Disorders
Especially at the beginning of the treatment, side effects sometimes occur when using fumaric acid preparations. The most commonly observed side effects (more than one in 10 patients) are gastrointestinal problems such as diarrhoea , bloating , flatulence , nausea and abdominal pain and a feeling of excessive heat.
These disturbances also occasionally occur later. In rarer cases, skin allergies associated with itching , flushing (reddening of the skin), increased liver values, drowsiness, tiredness , headaches , a reduced number of lymphocytes in the blood and increased protein excretion in the urine were found. If more proteins are excreted, this indicates the presence of kidney disease and should be examined more closely immediately. Isolated cases of progressive multifocal leukoencephalopathy (a brain disease), Kaposi’s sarcoma and lymphopenia may occur during treatment with fumaric acid.
Doctors assume that the immunosuppressive effect of fumarates is the cause of these diseases. Patients with acute severe infection, severe kidney problems, gastric ulcer , duodenal ulcer, severe liver disease and hypersensitivity to the active ingredient should not consume fumaric acid preparations. This also applies to pregnant and breastfeeding women as well as children and adolescents under the age of 18, as there is still no reliable knowledge of its effects on these patient groups. In addition, fumaric acid medication should not be taken if the patient is also taking medications with similar side effects (ciclosporin, retinoids, etc.), since fumaric acid can impair kidney function .
Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.