What is the bactericidal principle of dimethyl fumarate (Tecfidera) in the body?

The physiological effects of dimethyl fumarate (Tecfidera) on the body are unknown. It has anti-inflammatory and cytoprotective effects, which may be related to its effects in multiple sclerosis (MS) patients. The active substance dimethyl fumarate is thought to work by activating a protein called NRF2, which regulates certain genes that produce "antioxidants" involved in protecting cells from damage. Case reports of progressive multifocal leukoencephalopathy, severe opportunistic infections, lymphopenia, and liver injury have been reported in patients with multiple sclerosis treated with this drug. Anaphylaxis and angioedema may also occur.