Advancements in the investigation of gut microbiota-based strategies for stroke prevention and treatment

Abstract

Stroke represents a predominant cause of mortality and disability on a global scale, impacting millions annually and exerting a considerable strain on healthcare systems. The incidence of stroke exhibits regional variability, with ischemic stroke accounting for the majority of occurrences. Post-stroke complications, such as cognitive impairment, motor dysfunction, and recurrent stroke, profoundly affect patients' quality of life. Recent advancements have elucidated the microbiota-gut-brain axis (MGBA), underscoring the complex interplay between gut health and brain function. Dysbiosis, characterized by an imbalance in gut microbiota, is significantly linked to an elevated risk of stroke and unfavorable outcomes. The MGBA plays a crucial role in modulating immune function, neurotransmitter levels, and metabolic byproducts, which may intensify neuroinflammation and impair cerebral health. This review elucidates the role of MGBA in stroke pathophysiology and explores potential gut-targeted therapeutic strategies to reduce stroke risk and promote recovery, including probiotics, prebiotics, pharmacological interventions, and dietary modifications. However, the current prevention and treatment strategies based on intestinal flora still face many problems, such as the large difference of individual intestinal flora, the stability of efficacy, and the long-term safety need to be considered. Further research needs to be strengthened to promote its better application in clinical practice.

Keywords: FMT; MGBA; SCFAs; TMAO; immunity; neurotransmitter; probiotics; stroke.

Figure 1

The microbial-gut-brain axis communicates primarily through neural, endocrine, and immune pathways. The abnormality of gut microbiota may be related to the occurrence and development of nervous system diseases and some immune system diseases. At the same time, the abnormal function of the brain may also affect the function of the digestive system.

Figure 2

Gut microbiota can affect the brain through neural, endocrine, immune and other pathways. Gut microbiota can stimulate gut neurons, which transmit signals to the brain through the vagus nerve. Meanwhile, vagus nerve stimulation can not only promote nerve repair, but also promote the regulation of gut microbiota. In addition, we can affect brain health by regulating the metabolites of gut microbiota and the synthesis and metabolism of neurotransmitters, and stimulate the immune system to release cytokines to affect the functions of the gut and brain through immune pathways. The brain affects the physiological function of the gut through the hypothalamic-pituitary-adrenal axis, and indirectly regulates the microbial community.

Figure 3

The regulation of gut microbiota can be achieved in many ways. Supplementation of probiotics and prebiotics, fecal microbiota transplantation, dietary intervention, rational use of antibiotics and traditional Chinese medicine can increase the abundance of beneficial bacteria, reduce the abundance of opportunistic bacteria, maintain the balance of intestinal flora and promote health.