Abstract
The microbiota–gut–brain axis is considered a central regulator of the immune system after acute ischemic stroke (AIS), with a potential role in determining outcome. Several pathways are involved in the evolution of gut microbiota dysbiosis after AIS. Brain–gut and gut–brain signaling pathways involve bidirectional communication between the hypothalamic–pituitary–adrenal axis, the autonomic nervous system, the enteric nervous system, and the immune cells of the gut. Alterations in gut microbiome can be a risk factor and may also lead to AIS. Both risk factors for AIS and gut-microbiome composition are influenced by similar factors, including diabetes, hypertension, hyperlipidemia, obesity, and vascular dysfunction. Furthermore, the systemic inflammatory response after AIS may yield liver, renal, respiratory, gastrointestinal, and cardiovascular impairment, including the multiple organ dysfunction syndrome. This review focus on biochemical, immunological, and neuroanatomical modulation of gut microbiota and its possible systemic harmful effects after AIS, as well as the role of ischemic stroke on microbiota composition. Finally, we highlight the role of gut microbiota as a potential novel therapeutic target in acute ischemic stroke.
Highlights
Acute ischemic stroke (AIS) is the second leading cause of death worldwide, accounting for up to 25% of global lifetime risk [1]
After acute ischemic stroke (AIS), up to 50% of patients develop gastrointestinal complications such as hemorrhage, intestinal paralysis, bowel incontinence, and dysphagia, which are considered partially responsible for poor neurological outcomes and increased mortality [53, 87]
Systemic inflammatory response can result in multiple organ dysfunction syndrome (MODS) in up to 12% of AIS patients, increasing the mortality rate up to 80%. [104] Among risk factors for MODS after AIS, a low Glasgow Coma Score, advanced age, hypoglycemia, hyperglycemia, leukocytosis, and history of chronic organ dysfunction have been identified [104]
Summary
Acute ischemic stroke (AIS) is the second leading cause of death worldwide, accounting for up to 25% of global lifetime risk [1]. Post-AIS infection has been identified as a key cause of death and prolonged hospitalization after stroke [3]. For instance, that peripheral adaptive immunity is activated and recruited into the brain within the first few hours/days after AIS [4], and that its cells might regulate and be regulated by the gut microbiota [5]. Gut Microbiota in Acute Ischemic Stroke of microorganisms within a specific (micro) environment, while the microbiome is the genetic material of these microorganisms [6]. The aim of this review is to highlight the pathophysiology potentially involved in gut microbiota modulation after AIS, and its implication for therapy and outcome
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