Role of the Gut Microbiota in Stroke Pathogenesis and Potential Therapeutic Implications

Abstract

<b><i>Background:</i></b> Major advances have been made in stroke treatment and prevention in the past decades. However, the burden of stroke remains high. Identification of novel targets and establishment of effective interventions to improve stroke outcomes are, therefore, needed. Recent research highlights the contribution of the gut microbiota to stroke pathogenesis. <b><i>Summary:</i></b> Compositional and functional alterations of the gut microbiota, termed dysbiosis, are linked to stroke risk factors, such as obesity, metabolic diseases, and atherosclerosis. In acute cerebral ischemia, the gut microbiota plays a key role in bidirectional interactions between the gut and brain, referred to as the microbiota-gut-brain axis. Gut dysbiosis prior to ischemic stroke affects outcomes. Additionally, the brain affects the gut microbiota during acute ischemic brain injury, which in turn impacts outcomes. Interactions between the gut microbiota and stroke pathogenesis are mediated by several factors including bacterial components (e.g., lipopolysaccharide), gut microbiota-related metabolites (e.g., short-chain fatty acids and trimethylamine N-oxide), and the immune and nervous systems. Clinical studies have reported that patients with acute ischemic stroke exhibit gut dysbiosis, which is associated with host metabolism and inflammation, as well as functional outcomes. Modulation of the gut microbiota or its metabolites improves conditions related to stroke pathogenesis, including inflammation, cardiometabolic disease, atherosclerosis, and thrombosis. <b><i>Key Messages:</i></b> Accumulating evidence indicates that the gut microbiota plays a possible role in stroke pathogenesis. Modulation of the gut microbiota may provide a novel therapeutic strategy for the treatment and prevention of stroke.

Probiotic as A Potential Gut Microbiome Modifier for Stroke Treatment: A Systematic Scoping Review of <i>in vitro</i> and <i>in vivo</i> Studies

“…Moreover, probiotics have been found to inhibit neuronal apoptosis [30,31,32], which correlates with results from previous studies. Probiotics can also play a role in the immunologic pathway of the brain and decrease changes within the hippocampus [27,29,31].…”

“…Previous associations have also been found to suggest gut dysbiosis or an altered strain of gut microbiota to be preset in stroke patients. [31] Thus, some studies have included probiotic supplementation as a primary form of intervention found probiotic use to improve the neurological outcome by using the bidirectional pathways [32].…”

Relationships Among Gut Microbiota, Ischemic Stroke and Its Risk Factors: Based on Research Evidence

“…In view of the above facts, therapeutic intervention measures for ischemic stroke target on regulating gut microbiota are feasible. 246 By regulating gut microbiota, alleviates inflammation, atherosclerosis and thrombosis, to prevent the occurrence of ischemic stroke. Also, by intervening and regulating gut microbiota, alleviates obesity, diabetes and hypertension to reduce the risk of developing ischemic stroke.…”

The Role of Vitamin D in Stroke Prevention and the Effects of Its Supplementation for Post-Stroke Rehabilitation: A Narrative Review

“…Moreover, it has been shown that disturbances of the intestinal microflora, as the central immune regulator, are associated with a worse prognosis after stroke [104]. Bacterial components (lipopolysaccharides), microflora metabolites such as short-chain fatty acids and trimethylamine N-oxide, and inflammatory cells (T cells) are involved in the gut-brain interaction affecting neuroinflammation and post-stroke outcomes [105].…”