Editing Biotin (section)

===Multiple sclerosis===
High-dose biotin (300&nbsp;mg/day = 10,000 times [[Dietary Reference Intake|adequate intake]]) has been used in [[clinical trial]]s for treatment of [[multiple sclerosis]], a demyelinating autoimmune disease.<ref name=Tryfonow2019/><ref name=Sedel2016/> The hypothesis is that biotin may promote remyelination of the [[myelin]] sheath of nerve cells, slowing or even reversing neurodegeneration. The proposed mechanisms are that biotin activates acetyl-CoA carboxylase, a key rate-limiting enzyme during the synthesis of myelin, and by reducing axonal hypoxia through enhanced energy production.<ref name=Tryfonow2019>{{cite journal |vauthors=Tryfonos C, Mantzorou M, Fotiou D, Vrizas M, Vadikolias K, Pavlidou E, Giaginis C |title=Dietary Supplements on Controlling Multiple Sclerosis Symptoms and Relapses: Current Clinical Evidence and Future Perspectives |journal=Medicines  |volume=6 |issue=3 |date=September 2019 |page=95 |pmid=31547410 |pmc=6789617 |doi=10.3390/medicines6030095 |url=|doi-access=free }}</ref><ref name=Sedel2016>{{cite journal |vauthors=Sedel F, Bernard D, Mock DM, Tourbah A |title=Targeting demyelination and virtual hypoxia with high-dose biotin as a treatment for progressive multiple sclerosis |journal=Neuropharmacology |volume=110 |issue=Pt B |pages=644–53 |date=November 2016 |pmid=26327679 |doi=10.1016/j.neuropharm.2015.08.028 |url=|doi-access=free }}</ref> Clinical trial results are mixed; a 2019 review concluded that a further investigation of the association between multiple sclerosis symptoms and biotin should be undertaken,<ref name=Tryfonow2019/> whereas two 2020 reviews of a larger number of clinical trials reported no consistent evidence for benefits,<ref name=Motte2020>{{cite journal |vauthors=Motte J, Gold R |title=High-dose biotin in multiple sclerosis: the end of the road |journal=Lancet Neurol |volume=19 |issue=12 |pages=965–66 |date=December 2020 |pmid=33222766 |doi=10.1016/S1474-4422(20)30353-7 |s2cid=225049079 |url=}}</ref> and some evidence for increased disease activity and higher risk of relapse.<ref name=Goldschmidt2020>{{cite journal |vauthors=Goldschmidt CH, Cohen JA |title=The Rise and Fall of High-Dose Biotin to Treat Progressive Multiple Sclerosis |journal=Neurotherapeutics |volume=17 |issue=3 |pages=968–70 |date=July 2020 |pmid=32761325 |doi=10.1007/s13311-020-00907-5 |pmc=7609671 |url=|doi-access=free }}</ref>