Abstract
Schizophrenia is a chronic, heterogeneous neurodevelopmental disorder that has complex symptoms and uncertain etiology. Mounting evidence indicates the involvement of genetics and epigenetic disturbances, alteration in gut microbiome, immune system abnormalities, and environmental influence in the disease, but a single root cause and mechanism involved has yet to be conclusively determined. Consequently, the identification of diagnostic markers and the development of psychotic drugs for the treatment of schizophrenia faces a high failure rate. This article surveys the etiology of schizophrenia with a particular focus on gut microbiota regulation and the microbial signaling system that correlates with the brain through the vagus nerve, enteric nervous system, immune system, and production of postbiotics. Gut microbially produced molecules may lay the groundwork for further investigations into the role of gut microbiota dysbiosis and the pathophysiology of schizophrenia. Current treatment of schizophrenia is limited to psychotherapy and antipsychotic drugs that have significant side effects. Therefore, alternative therapeutic options merit exploration. The use of psychobiotics alone or in combination with antipsychotics may promote the development of novel therapeutic strategies. In view of the individual gut microbiome structure and personalized response to antipsychotic drugs, a tailored and targeted manipulation of gut microbial diversity naturally by novel prebiotics (non-digestible fiber) may be a successful alternative therapeutic for the treatment of schizophrenia patients.
Highlights
Despite the fact of exploring the genetics, epigenetics, environmental factors, and more recently, dysbiosis of gut microbiome involved in schizophrenia, an incessant effort is required to understand the reason and mechanism of action of this multifactorial disease
The role of gut microbiome-related immune factors has been demonstrated by various experiments in animal models and humans, and many potential pathways have been proposed to explain the gut–brain axis connection in schizophrenia
There are still many questions to answer in this regard: Is the initial alteration in microbiome composition a potent reason or a booster for the manifestation of the disease? Which chemical repertoire of altered microbial species has a strong link to the diseases? Does any interspecies communication play a role in controlling genetics and epigenetics in the illness that makes it complex to understand? Could reprogramming of gut microbiota ecosystem be a good therapeutic strategy? Answering these questions may lead to a meaningful conclusion of the gut–schizophrenia link and medical outcome, including beneficial treatment and personalized medicine
Summary
J.A.; Stroup, T.S.; McEvoy, J.P.; Swartz, M.S.; Rosenheck, R.A.; Perkins, D.O.; Keefe, R.S.; Davis, S.M.; Davis, C.E.; Lebowitz, B.D.; et al Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. S.; Cipriani, A.; Spineli, L.; Mavridis, D.; Orey, D.; Richter, F.; Samara, M.; Barbui, C.; Engel, R.R.; Geddes, J.R.; et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. M.D. Second-Generation Antipsychotic Medications: Pharmacology, Administration, and Side Effects. Available online: https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-andside-effects (accessed on 15 July 2021). S.; Corves, C.; Arbter, D.; Engel, R.R.; Li, C.; Davis, J.M. Second-generation versus first-generation antipsychotic drugs for schizophrenia: A meta-analysis. C.J.; Emge, J.R.; Berzins, K.; Lung, L.; Khamishon, R.; Shah, P.; Rodrigues, D.M.; Sousa, A.J.; Reardon, C.; Sherman, P.M.; et al Probiotics normalize the gut-brain-microbiota axis in immunodeficient mice.
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