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2D Structure
Also known as: 624-49-7, Tecfidera, Dimethylfumarate, Methyl fumarate, (e)-dimethyl fumarate, Fumaderm
Molecular Formula
C6H8O4
Molecular Weight
144.12  g/mol
InChI Key
LDCRTTXIJACKKU-ONEGZZNKSA-N
FDA UNII
FO2303MNI2

A fumarate derivative that is used as a DERMATOLOGIC AGENT in the treatment of PSORIASIS and SKIN DISEASES. It also may be used as an IMMUNOSUPPRESSIVE AGENT in the treatment of MULTIPLE SCLEROSIS.
1 2D Structure

2D Structure

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
dimethyl (E)-but-2-enedioate
2.1.2 InChI
InChI=1S/C6H8O4/c1-9-5(7)3-4-6(8)10-2/h3-4H,1-2H3/b4-3+
2.1.3 InChI Key
LDCRTTXIJACKKU-ONEGZZNKSA-N
2.1.4 Canonical SMILES
COC(=O)C=CC(=O)OC
2.1.5 Isomeric SMILES
COC(=O)/C=C/C(=O)OC
2.2 Other Identifiers
2.2.1 UNII
FO2303MNI2
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 00012, Bg

2. 12 Compound, Bg

3. 2-butenedioic Acid, (2e)-, Dimethyl Ester

4. 201, Fag

5. Bg 00012

6. Bg 12 Compound

7. Bg-00012

8. Bg-12 Compound

9. Bg00012

10. Bg12 Compound

11. Compound, Bg 12

12. Compound, Bg12

13. Dimethylfumarate

14. Fag 201

15. Fag-201

16. Fag201

17. Fumaderm

18. Fumarate, Dimethyl

19. Tecfidera

2.3.2 Depositor-Supplied Synonyms

1. 624-49-7

2. Tecfidera

3. Dimethylfumarate

4. Methyl Fumarate

5. (e)-dimethyl Fumarate

6. Fumaderm

7. Dimethyl (e)-but-2-enedioate

8. Fumaric Acid Dimethyl Ester

9. Fumaric Acid, Dimethyl Ester

10. Bg-12

11. Boletic Acid Dimethyl Ester

12. Dimethyl Trans-ethylenedicarboxylate

13. Bg 12 Compound

14. Trans-butenedioic Acid Dimethyl Ester

15. Panaclar

16. Bg00012

17. 2-butenedioic Acid (e)-, Dimethyl Ester

18. Allomaleic Acid Dimethyl Ester

19. Bg-00012

20. Dimethyl 2-butenedioate

21. Trans-1,2-ethylenedicarboxylic Acid Dimethyl Ester

22. Dimethyl (2e)-but-2-enedioate

23. Fag-201

24. Bg 00012

25. Bis-methyl Ester

26. Dimethyl Fumar

27. Dimethyl Fumarate [usan]

28. Azl O 211089

29. Azl-o-211089

30. Nsc-25942

31. Dimethylester Kyseliny Fumarove

32. Nsc-167432

33. (e)-but-2-enedioic Acid Dimethyl Ester

34. Chebi:76004

35. 2-butenedioic Acid (2e)-, Dimethyl Ester

36. Bg 12

37. Fp187

38. Las41008

39. Fp-187

40. Las-41008

41. Fumaric Acid-dimethyl Ester

42. Azl-0211089

43. 1,2-bis(methoxycarbonyl)-trans-ethylene

44. Dimethyl (2e)-2-butenedioate

45. Fo2303mni2

46. 23055-10-9

47. Dimethyl (~{e})-but-2-enedioate

48. But-2-enedioic Acid, Dimethyl Ester

49. Azl 0 211089

50. Dimethyl Fumarate (usan)

51. 2-butenedioic Acid (2e)-, 1,4-dimethyl Ester

52. Wln: 1ov1u1vo1 -t

53. Fumaric Acid-dimethyl Ester 1000 Microg/ml In Acetonitrile

54. 2-butenedioic Acid, Dimethyl Ester

55. Mfcd00064438

56. Ethylene,2-bis(methoxycarbonyl)-, Trans-

57. Fag201

58. Fag 201

59. Bg 12 [fumarate]

60. Bg-12 [fumarate]

61. Einecs 210-849-0

62. Nsc 25942

63. Tl 353

64. Nsc 167432

65. Dimethylester Kyseliny Fumarove [czech]

66. Brn 0774590

67. Unii-fo2303mni2

68. Ai3-07872

69. Dimethyl-fumarate

70. Fumaric Acid Dimethyl Ester (1,1,1,8,8,8-d6)

71. Ethylene, 1,2-bis(methoxycarbonyl)-, Trans-

72. Hsdb 7725

73. Tecfidera (tn)

74. Fumaric Acid Dimethyl

75. 2-butenedioic Acid, (2e)-, Dimethyl Ester

76. Dimethyl Fumarate, 97%

77. (e/z)-dimethyl Fumarate

78. Dimethyl Trans-butenedioate

79. Schembl41835

80. Schembl41836

81. 4-02-00-02205 (beilstein Handbook Reference)

82. Dimethyl Fumarate [mi]

83. Dimethyl Fumarate (jan/usan)

84. Gtpl7045

85. Dimethyl Fumarate [jan]

86. Chembl2107333

87. Dimethyl Fumarate [hsdb]

88. Dtxsid4060787

89. Dimethyl Fumarate [vandf]

90. But-2-enedioic Aciddimethyl Ester

91. Hms3264d14

92. Pharmakon1600-01506154

93. Dimethyl Fumarate [who-dd]

94. Nsc25942

95. Zinc3843378

96. Bdbm50504654

97. Fumaric Acid, Dimethyl Ester (8ci)

98. Nsc167432

99. Nsc760139

100. S2586

101. Stk039379

102. Dimethyl Ester(e)-2-butenedioic Acid

103. (e)-ch3oc(o)ch=chc(o)och3

104. Akos000121333

105. Zinc100509880

106. Ccg-213618

107. Cs-0909

108. Db08908

109. Dimethyl Ester(2e)-2-butenedioic Acid

110. Dimethyl Fumarate [orange Book]

111. Nsc-760139

112. Hy-17363

113. Ls-13141

114. 2(e)-butenedioic Acid 1,4-dimethyl Ester

115. 2-butenedioic Acid, Dimethyl Ester, (2e)-

116. Cs-0369103

117. F0069

118. Sw219154-1

119. D03846

120. H11241

121. Ab00172980_03

122. Ab00172980_04

123. Dimethyl Fumarate, Vetec(tm) Reagent Grade, 97%

124. Q418123

125. Sr-01000944222

126. Sr-01000944222-1

127. Trans-1, 2-ethylenedicarboxylic Acid Dimethyl Ester

128. Brd-k31111078-001-01-8

129. Fumaric Acid Dimethyl Ester 100 Microg/ml In Methanol

130. F0001-1675

131. Dimethyl Fumarate, Certified Reference Material, Tracecert(r)

132. 12287-98-8

133. Eou

2.4 Create Date
2005-03-26
3 Chemical and Physical Properties
Molecular Weight 144.12 g/mol
Molecular Formula C6H8O4
XLogP30.7
Hydrogen Bond Donor Count0
Hydrogen Bond Acceptor Count4
Rotatable Bond Count4
Exact Mass144.04225873 g/mol
Monoisotopic Mass144.04225873 g/mol
Topological Polar Surface Area52.6 Ų
Heavy Atom Count10
Formal Charge0
Complexity141
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count1
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 2  
Drug NameTecfidera
PubMed HealthDimethyl Fumarate (By mouth)
Drug ClassesImmune Modulator
Drug LabelTECFIDERA contains dimethyl fumarate which is also known by its chemical name, dimethyl (E) butenedioate, (C6H8O4). It has the following structure: Dimethyl fumarate is a white to off-white powder that is highly soluble in water with a molecular mass...
Active IngredientDimethyl fumarate
Dosage FormCapsule, delayed release
RouteOral
Strength120mg; 240mg
Market StatusPrescription
CompanyBiogen Idec

2 of 2  
Drug NameTecfidera
PubMed HealthDimethyl Fumarate (By mouth)
Drug ClassesImmune Modulator
Drug LabelTECFIDERA contains dimethyl fumarate which is also known by its chemical name, dimethyl (E) butenedioate, (C6H8O4). It has the following structure: Dimethyl fumarate is a white to off-white powder that is highly soluble in water with a molecular mass...
Active IngredientDimethyl fumarate
Dosage FormCapsule, delayed release
RouteOral
Strength120mg; 240mg
Market StatusPrescription
CompanyBiogen Idec

4.2 Therapeutic Uses

Dermatologic Agents; Immunosuppressive Agents; Radiation-Sensitizing Agents

National Library of Medicine's Medical Subject Headings. Dimethyl Fumarate. Online file (MeSH, 2015). Available from, as of May 1, 2015: https://www.nlm.nih.gov/mesh/2014/mesh_browser/MBrowser.html


/CLINICAL TRIALS/ ClinicalTrials.gov is a registry and results database of publicly and privately supported clinical studies of human participants conducted around the world. The Web site is maintained by the National Library of Medicine (NLM) and the National Institutes of Health(NIH). Each ClinicalTrials.gov record presents summary information about a study protocol and includes the following: Disease or condition; Intervention (for example, the medical product, behavior, or procedure being studied); Title, description, and design of the study; Requirements for participation (eligibility criteria); Locations where the study is being conducted; Contact information for the study locations; and Links to relevant information on other health Web sites, such as NLM's MedlinePlus for patient health information and PubMed for citations and abstracts for scholarly articles in the field of medicine. Dimethyl fumarate is included in the database.

NIH/NLM; ClinicalTrials.Gov. Available from, as of July 18, 2015: https://clinicaltrials.gov/search/intervention=Dimethyl+Fumarate


Tecfidera is indicated for the treatment of patients with relapsing forms of multiple sclerosis. /Included in US product label/

NIH; DailyMed. Current Medication Information for Tecfidera (Dimethyl Fumarate) Capsule (Updated: April 2015). Available from, as of June 30, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=665d7e74-036c-5f68-5b67-ab84b9b49151


EXPL THER Mixtures of fumaric acid esters (FAE) are used as an oral systemic treatment for moderate to severe psoriasis. Large clinical studies with dimethylfumarate (DMF) monotherapy are scarce. The objective of this study is to assess the effectiveness and long-term safety of high-dose DMF monotherapy in moderate to severe psoriasis. A prospective single-blinded follow-up study was performed in a cohort of patients treated with DMF. Patients were followed-up at fixed intervals. Assessment of consecutive photographs was performed by two observers. Primary outcome was a change in static physician global assessment (PGA) score. Safety outcome was defined as incidences of (serious) adverse events. A total of 176 patients with moderate to severe psoriasis were treated with DMF for a median duration of 28 months. The median daily maintenance dosage of 480 mg was reached after a median of 8 months. Psoriasis activity decreased significantly by 1.7 out of five points. A total of 152 patients reported one or more adverse events, such as gastrointestinal complaints and flushing. High-dose DMF monotherapy is an effective and safe treatment option in moderate to severe psoriasis. It can be suggested that 50% of all patients may benefit from high-dose DMF monotherapy. KEYWORDS: Dimethylfumurate; high dose; monotherapy; prospective study; psoriasis

PMID:26088405 Lijnen R et al; J Dermatolog Treat. 2015 Jun 19:1-6. (Epub ahead of print)


4.3 Drug Warning

A patient with multiple sclerosis who was being treated with dimethyl fumarate developed progressive multifocal leukoencephalopathy (PML), and later died. The patient who died was not taking any other drugs that affect the immune system or drugs that are thought to be associated with PML. Patients taking dimethyl fumarate should be advised to contact their clinician if they develop any symptoms that may be suggestive of PML. Symptoms of PML are diverse, progress over days to weeks, and include the following: progressive weakness on one side of the body or clumsiness of limbs; disturbance of vision; and changes in thinking, memory and orientation, leading to confusion and personality changes. The progression of deficits can lead to severe disability or death. Dimethyl fumarate should be discontinued immediately at the first sign or symptom suggestive of PML and an appropriate diagnostic evaluation should be performed. Lymphocyte counts should be monitored in dimethyl fumarate-treated patients according to approved labeling.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 3620


Dimethyl fumarate may decrease lymphocyte counts. In placebo-controlled clinical trials, mean lymphocyte counts decreased by approximately 30% during the first year of treatment with the drug and remained stable thereafter. Mean lymphocyte counts improved 4 weeks following discontinuance of the drug, but did not return to baseline values. Dimethyl fumarate has not been studied in patients with preexisting low lymphocyte counts. Prior to initiation of dimethyl fumarate, a recent (i.e., within 6 months) complete blood cell (CBC) count should be available to identify patients with preexisting low lymphocyte counts. A CBC should also be obtained annually during therapy and as clinically indicated. In patients with serious infections, withholding dimethyl fumarate treatment should be considered until the infection has resolved.

American Society of Health-System Pharmacists 2015; Drug Information 2015. Bethesda, MD. 2015, p. 3620


During post marketing experience, hypersensitivity reactions have been reported, including rare reports of anaphylaxis and angioedema in patients treated with Tecfidera. Signs and symptoms have included difficulty breathing, urticaria, and swelling of the throat and tongue.

Health Canada; Product Monograph for Tecfidera (Dimethyl Fumarate) Delayed-release Capsules, Drug Identification Number (DIN): 02404508 p.14 (Date of Revision: January 29, 2015). Available from, as of June 30, 2015: https://webprod5.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng


Treatment with Tecfidera should not be initiated in patients with signs and symptoms of a serious infection. Decreases in lymphocyte counts observed in patients treated with Tecfidera in clinical trials were not associated with increased frequencies of infections. However, due to the potential risk of infections in patients who develop sustained lymphopenia, patients should be instructed to report symptoms of infection to their physician. For patients with signs and symptoms of serious infections, interrupting treatment with Tecfidera should be considered, until the infection(s) resolves.

Health Canada; Product Monograph for Tecfidera (Dimethyl Fumarate) Delayed-release Capsules, Drug Identification Number (DIN): 02404508 p.6 (Date of Revision: January 29, 2015). Available from, as of June 30, 2015: https://webprod5.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng


For more Drug Warnings (Complete) data for DIMETHYL FUMARATE (14 total), please visit the HSDB record page.


4.4 Drug Indication

Used in multiple sclerosis patients with relapsing forms.


FDA Label


Tecfidera is indicated for the treatment of adult and paediatric patients aged 13 years and older with relapsing remitting multiple sclerosis (RRMS).


Skilarence is indicated for the treatment of moderate to severe plaque psoriasis in adults in need of systemic medicinal therapy.


Treatment of psoriasis


Treatment of multiple sclerosis


Dimethyl fumarate Mylan is indicated for the treatment of adult patients with relapsing remitting multiple sclerosis.


Dimethyl fumarate Polpharma is indicated for the treatment of adult patients with relapsing remitting multiple sclerosis.


Dimethyl fumarate Neuraxpharma is indicated for the treatment of adult patients with relapsing remitting multiple sclerosis.


5 Pharmacology and Biochemistry
5.1 Pharmacology

The physiological effects dimethyl fumarate has on the body is not well understood. It is known that dimethyl fumarate has anti-inflammatory and cytoprotective effects, which both are likely involved in its actions in multiple sclerosis patients.


5.2 MeSH Pharmacological Classification

Radiation-Sensitizing Agents

Drugs used to potentiate the effectiveness of radiation therapy in destroying unwanted cells. (See all compounds classified as Radiation-Sensitizing Agents.)


Dermatologic Agents

Drugs used to treat or prevent skin disorders or for the routine care of skin. (See all compounds classified as Dermatologic Agents.)


Immunosuppressive Agents

Agents that suppress immune function by one of several mechanisms of action. Classical cytotoxic immunosuppressants act by inhibiting DNA synthesis. Others may act through activation of T-CELLS or by inhibiting the activation of HELPER CELLS. While immunosuppression has been brought about in the past primarily to prevent rejection of transplanted organs, new applications involving mediation of the effects of INTERLEUKINS and other CYTOKINES are emerging. (See all compounds classified as Immunosuppressive Agents.)


5.3 ATC Code

L04AX07


L04AX07


L04AX07


L04AX07


L04AX07


L - Antineoplastic and immunomodulating agents

L04 - Immunosuppressants

L04A - Immunosuppressants

L04AX - Other immunosuppressants

L04AX07 - Dimethyl fumarate


5.4 Absorption, Distribution and Excretion

Absorption

Once ingested, dimethyl fumarate is rapidly hydroylyzed by esterases to MMF. Thus there is negligible amount of dimethyl fumarate in the body, and all pharmacokinetic information is quantified with MMF. In multiple sclerosis patients, the time to maximum concentration of MMF is 2 to 2.5 hours and the maximum concentration is 1.87 mg/L.


Route of Elimination

The main route of elimination is by CO2 exhalation that accounts for 60% of the dose. The other minor routes are through the kidney (16% metabolites and trace amounts of unchanged MMF) and the feces (1%).


Volume of Distribution

In healthy people, MMF has a variable volume of distribution of 53 to 73 litres.


Clearance

MMF clearance was not quantified.


After oral administration of Tecfidera, dimethyl fumarate undergoes rapid presystemic hydrolysis by esterases and is converted to its active metabolite, monomethyl fumarate (MMF). Dimethyl fumarate is not quantifiable in plasma following oral administration of Tecfidera. Therefore all pharmacokinetic analyses related to Tecfidera were performed with plasma MMF concentrations. ... The median Tmax of MMF is 2-2.5 hours. The peak plasma concentration (Cmax) and overall exposure (AUC) increased approximately dose proportionally in the dose range studied (120 mg to 360 mg). Following administration of Tecfidera 240 mg twice a day with food, the mean Cmax of MMF was 1.87 mg/L and AUC was 8.21 mg.hr/L in MS patients.

NIH; DailyMed. Current Medication Information for Tecfidera (Dimethyl Fumarate) Capsule (Updated: April 2015). Available from, as of June 30, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=665d7e74-036c-5f68-5b67-ab84b9b49151


Exhalation of CO2 is the primary route of elimination, accounting for approximately 60% of the Tecfidera dose. Renal and fecal elimination are minor routes of elimination, accounting for 16% and 1% of the dose respectively. Trace amounts of unchanged monomethyl fumarate (MMF) were present in urine.

NIH; DailyMed. Current Medication Information for Tecfidera (Dimethyl Fumarate) Capsule (Updated: April 2015). Available from, as of June 30, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=665d7e74-036c-5f68-5b67-ab84b9b49151


The apparent volume of distribution of monomethyl fumarate (MMF) varies between 53 and 73 L in healthy subjects. Human plasma protein binding of MMF is 27-45% and independent of concentration. /Monomethyl fumarate, active metabolite/

NIH; DailyMed. Current Medication Information for Tecfidera (Dimethyl Fumarate) Capsule (Updated: April 2015). Available from, as of June 30, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=665d7e74-036c-5f68-5b67-ab84b9b49151


5.5 Metabolism/Metabolites

Dimethly fumarate is hydrozlied to its metabolite MMF in the GIT, tissues, and blood by esterases. MMF then undergoes subsequent metabolism in the tricarboxylic acid (TCA) cycle. Altogether the main metabolites formed are MMF, glucose, citric acid, and fumaric.


In humans, Tecfidera is extensively metabolized by esterases, which are ubiquitous in the gastrointestinal tract, blood and tissues, before it reaches the systemic circulation. Further metabolism occurs through the tricarboxylic acid (TCA) cycle, with no involvement of the cytochrome P450 (CYP) system. A single 240 mg (14)C-dimethyl fumarate dose study identified monomethyl fumarate, fumaric and citric acid, and glucose as the major metabolites in plasma. The downstream metabolism of fumaric and citric acid occurs through the TCA cycle, with exhalation of CO2 serving as a primary route of elimination. Less than 0.1% of the dose is excreted as unchanged dimethyl fumarate in urine.

Health Canada; Product Monograph for Tecfidera (Dimethyl Fumarate) Delayed-release Capsules, Drug Identification Number (DIN): 02404508 p.18 (Date of Revision: January 29, 2015). Available from, as of June 30, 2015: https://webprod5.hc-sc.gc.ca/dpd-bdpp/start-debuter.do?lang=eng


In humans, dimethyl fumarate is extensively metabolized by esterases, which are ubiquitous in the gastrointestinal tract, blood, and tissues, before it reaches the systemic circulation. Further metabolism of monomethyl fumarate (MMF) occurs through the tricarboxylic acid (TCA) cycle, with no involvement of the cytochrome P450 (CYP) system. MMF, fumaric and citric acid, and glucose are the major metabolites in plasma.

NIH; DailyMed. Current Medication Information for Tecfidera (Dimethyl Fumarate) Capsule (Updated: April 2015). Available from, as of June 30, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=665d7e74-036c-5f68-5b67-ab84b9b49151


5.6 Biological Half-Life

MMF has a short half life of about 1 hour, and MMF does not accumulate after repeated doses of dimethyl fumarate.


The terminal half-life of monomethyl fumarate (MMF) is approximately 1 hour and no circulating MMF is present at 24 hours in the majority of individuals. /Monomethyl fumarate, active metabolite/

NIH; DailyMed. Current Medication Information for Tecfidera (Dimethyl Fumarate) Capsule (Updated: April 2015). Available from, as of June 30, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=665d7e74-036c-5f68-5b67-ab84b9b49151


5.7 Mechanism of Action

The mechanism of action of dimethyl fumarate in multiple sclerosis is not well understood. It is thought to involve dimethyl fumarate degradation to its active metabolite monomethyl fumarate (MMF). MMF up-regulates the Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway that is activated in response to oxidative stress. As well MMF is an agonist at the nicotinic acid receptor, but the relevance of this is not known.


Dimethyl fumarate (DMF) is a fumaric acid ester that is used to treat psoriasis and multiple sclerosis. Recently, DMF was found to exhibit anti-tumor effects. However, the molecular mechanisms underlying these effects have not been elucidated. In this study, we investigated the mechanism of DMF-induced apoptosis in different human hematopoietic tumor cell lines. We found that DMF induced apoptosis in different human hematopoietic tumor cell lines but it did not affect the normal human B lymphocyte cell line RPMI 1788. We also observed a concurrent increase in caspase-3 activity and in the number of Annexin-V-positive cells. Furthermore, an examination of the survival signals, which are activated by apoptotic stimuli, revealed that DMF significantly inhibited nuclear factor-kB (NF-kB) p65 nuclear translocation. In addition, DMF suppressed B-cell lymphoma extra-large (Bcl-xL) and X-linked inhibitor of apoptosis (XIAP) expression whereas Bcl-2, survivin, Bcl-2-associated X protein (Bax), and Bim levels did not change. These results indicated that DMF induced apoptosis by suppressing NF-kB activation, and Bcl-xL and XIAP expression. These findings suggested that DMF might have potential as an anticancer agent that could be used in combination therapy with other anticancer drugs for the treatment of human hematopoietic tumors.

PMID:25443417 Tsubaki M et al; Biomed Pharmacother 68 (8): 999-1005 (2014)


Oxidative stress plays a crucial role in many neurodegenerative conditions such as Alzheimer's disease, amyotrophic lateral sclerosis and Parkinson's as well as Huntington's disease. Inflammation and oxidative stress are also thought to promote tissue damage in multiple sclerosis (MS). Recent data point at an important role of anti-oxidative pathways for tissue protection in chronic-progressive MS, particularly involving the transcription factor nuclear factor (erythroid-derived 2)-related factor 2 (Nrf2). ... In vitro, application of dimethylfumarate (DMF) leads to stabilization of Nrf2, activation of Nrf2-dependent transcriptional activity and abundant synthesis of detoxifying proteins. Furthermore, application of FAE involves direct modification of the inhibitor of Nrf2, Kelch-like ECH-associated protein 1. On cellular levels, the application of FAE enhances neuronal survival and protects astrocytes against oxidative stress. Increased levels of Nrf2 are detected in the central nervous system of DMF treated mice suffering from experimental autoimmune encephalomyelitis (EAE), an animal model of MS. In EAE, DMF ameliorates the disease course and improves preservation of myelin, axons and neurons. Finally, Nrf2 is also up-regulated in the spinal cord of autopsy specimens from untreated patients with MS, probably as part of a naturally occurring anti-oxidative response. In summary, oxidative stress and anti-oxidative pathways are important players in MS pathophysiology and constitute a promising target for future MS therapies like FAE.

PMID:23109883 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472775 Lee DH et al; Int J Mol Sci 13 (9): 11783-803 (2012)


Multiple sclerosis (MS) is the most common multifocal inflammatory demyelinating disease of the central nervous system (CNS). Due to the progressive neurodegenerative nature of MS, developing treatments that exhibit direct neuroprotective effects are needed. Tecfidera (BG-12) is an oral formulation of the fumaric acid esters (FAE), containing the active metabolite dimethyl fumarate (DMF). Although BG-12 showed remarkable efficacy in lowering relapse rates in clinical trials, its mechanism of action in MS is not yet well understood. In this study, we reported the potential neuroprotective effects of dimethyl fumarate (DMF) on mouse and rat neural stem/progenitor cells (NPCs) and neurons. We found that DMF increased the frequency of the multipotent neurospheres and the survival of NPCs following oxidative stress with hydrogen peroxide (H2O2) treatment. In addition, utilizing the reactive oxygen species (ROS) assay, we showed that DMF reduced ROS production induced by H2O2. DMF also decreased oxidative stress-induced apoptosis. Using motor neuron survival assay, DMF significantly promoted survival of motor neurons under oxidative stress. We further analyzed the expression of oxidative stress-induced genes in the NPC cultures and showed that DMF increased the expression of transcription factor nuclear factor-erythroid 2-related factor 2 (Nrf2) at both levels of RNA and protein. Furthermore, we demonstrated the involvement of Nrf2-ERK1/2 MAPK pathway in DMF-mediated neuroprotection. Finally, we utilized SuperArray gene screen technology to identify additional anti-oxidative stress genes (Gstp1, Sod2, Nqo1, Srxn1, Fth1). Our data suggests that analysis of anti-oxidative stress mechanisms may yield further insights into new targets for treatment of multiple sclerosis (MS).

PMID:26090715 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490529 Wang Q et al; Int J Mol Sci 16 (6): 13885-13907 (2015)


The mechanism by which dimethyl fumarate (DMF) exerts its therapeutic effect in multiple sclerosis is unknown. DMF and the metabolite, monomethyl fumarate (MMF), have been shown to activate the Nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway in vitro and in vivo in animals and humans. The Nrf2 pathway is involved in the cellular response to oxidative stress. MMF has been identified as a nicotinic acid receptor agonist in vitro.

NIH; DailyMed. Current Medication Information for Tecfidera (Dimethyl Fumarate) Capsule (Updated: April 2015). Available from, as of June 30, 2015: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=665d7e74-036c-5f68-5b67-ab84b9b49151


For more Mechanism of Action (Complete) data for DIMETHYL FUMARATE (14 total), please visit the HSDB record page.