Gut Microbiota Dysbiosis in Acute Ischemic Stroke Associated With 3-Month Unfavorable Outcome

Abstract

BackgroundAlterations in the gut microbiota after ischemic stroke have been demonstrated, whereas the effect on stroke outcome remains to be established.MethodsA total of 132 consecutive patients with acute ischemic stroke were prospectively enrolled. Their gut microbiomes within 24 h of admission were profiled using 16S ribosomal RNA (rRNA) gene (V3–V4 region) sequencing. Microbiota comparisons were made between groups with good outcome (n = 105) and poor outcome (n = 27) based on 3-month modified Rankin Scale scores of 0–2 and 3–6. Propensity score-matching (PSM) analysis was conducted to assess the robustness of our findings. The functional potential was predicted using the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt).ResultsPatients in the poor outcome group were characterized by a significant reduction in the alpha diversity (Shannon index, p = 0.025; Simpson index, p = 0.010), an increase in the pathogenic bacteria (e.g., Enterococcaceae and Enterococcus), and a decrease in the short-chain fatty acids (SCFAs)-producing bacteria (e.g., Bacteroidaceae, Ruminococcaceae, and Faecalibacterium) to those with good outcome group (all p < 0.05). Similar results of microbial composition were obtained after PSM. The PICRUSt revealed that the pathway for membrane transport was relatively dominant in patients with poor outcome (p < 0.05).ConclusionThis study demonstrated that stroke patients with 3-month poor outcome had baseline gut microbiota dysbiosis featured by increased pathogenic bacteria and decreased SCFAs-producing bacteria.

Functional recovery outcomes following acute stroke is associated with abundance of gut microbiota related to inflammation, butyrate and secondary bile acid

“…While this inflammatory shift can help to mitigate the acute effects of stroke in the brain, the residual inflammation in the weeks and months following the stroke is likely undermining recovery. Previous studies have also found that butyrate-producing bacteria were significantly reduced in cerebral ischemia patients and that this reduction is associated with poor outcomes (27,88,89). Future studies should explore treatments targeting the composition of microbial communities following stroke as a way to boost recovery from stroke in combination with other rehabilitation therapies.…”

Bone marrow mesenchymal stem cell treatment improves post-stroke cerebral function recovery by regulating gut microbiota in rats

“…Consequently, it appears that beta gut microbiota diversity may provide more information regarding the gut microbiota-stroke link in addition to alpha gut microbiota[ 16 ].…”

Gut microbiome and neurosurgery: Implications for treatment

“… 199 Those with poor post-stroke outcomes were found to have the same three major changes in gut microbiome composition but to a greater extent. 203 Understanding this phenomenon is important, as gut dysbiosis has been associated with diminished survival. Spychala et al used stroke mice models to show that aged mice or those with aged gut microbiota had an elevated Firmicutes to Bacteroidetes (F:B) ratio which was associated with lessened survival and post-stroke recovery.…”

“…The degree of stroke‐related gut dysbiosis has also been shown to be strongly and positively associated with stroke severity based on the National Institute of Health Stroke Score and post‐stroke disability based on the Modified Rankin Scale 199 . Those with poor post‐stroke outcomes were found to have the same three major changes in gut microbiome composition but to a greater extent 203 . Understanding this phenomenon is important, as gut dysbiosis has been associated with diminished survival.…”