Probiotic as a Potential Gut Microbiome Modifier for Stroke Treatment: A Systematic Scoping Review of In Vitro and In Vivo Studies

Abstract

Background: Pharmacologic and non-pharmacologic treatments for stroke are essential but can be costly or harmful, whereas probiotics are a promising alternative. This scoping review aimed to synthesize the in vitro and in vivo evidence of probiotics on stroke-related neurological, biochemical, and histochemical outcomes. Methods: A systematic review was conducted in PubMed, Embase, and Cochrane Central Register of Clinical Trials (CENTRAL) up to 7 May 2021. Titles and abstracts were screened and assessed by two independent reviewers. The initial screening criteria aimed to include studies using probiotics, prebiotics, and symbiotics both in vitro and in vivo for the prevention and/or treatment of stroke. Results: Of 6293 articles, 4990 passed the initial screen after excluding duplication articles, of which 36 theme-related full texts were assessed and 13 were included in this review. No in vitro studies passed the criteria to be included in this review. Probiotics can ameliorate neurological deficits and show their anti-inflammation and anti-oxidative properties. Decreased loss of cerebral volume and inhibition of neuronal apoptosis were revealed in histopathological evidence. Conclusions: There are potential cognitive benefits of probiotic supplementation, especially among animal models, on decreasing cerebral volume, increasing neurological score, and decreasing the inflammatory response. However, further investigation is needed to validate these conclusions in various populations.

Fecal microbiota transplantation unveils sex-specific differences in a controlled cortical impact injury mouse model

“…These findings provide promising avenues for better therapeutic strategies in treating neurological illnesses ( Messaoudi et al, 2011a , b ; Zakostelska et al, 2011 ). As probiotics impose a positive impact on brain functions, they also possess a role in influencing the diversity of the gut microbiota, which is crucial for overall wellbeing ( Bienenstock et al, 2015 ; Sirisinha, 2016 ; Akhoundzadeh et al, 2018 ; Ma et al, 2019 ; Devi et al, 2021 ; Savigamin et al, 2022 ). These preliminary results indicate that the sex-specific restoration of gut microbiota may reverse the CCI-generated neurological complications.…”

“…Moreover, other TBI studies also reported changes in Lactobacillus , Romboutsia, and Turicibacter microbial genera following the injury ( Kang et al, 2019 ; Koopman et al, 2019 ; Li et al, 2019 ; Du et al, 2021 ). Furthermore, probiotic treatment has shown potential benefits in animal models of spinal injuries, TBI, and stroke ( Akhoundzadeh et al, 2018 ; Ma et al, 2019 ; Devi et al, 2021 ; Savigamin et al, 2022 ). In clinical settings, supplementation of Lactobacillus -rich probiotics showed improvement in TBI patients by modifying gut dysfunction ( Tan et al, 2011 ).…”

Microbiome signatures in ischemic stroke: A systematic review

“…Clostridium butyricum has been used to modulate the gut microbiota to improve cognitive function and reduce neuronal damage in mice subjected to ischemia/reperfusion [ 44 ]. Therefore, the use of probiotics to modulate gut microbiota may be a potential treatment for ischemic stroke [ 45 ]. In addition, trimethylamine N-oxide (TMAO) is a microbio-derived metabolite that can be synthesized from dietary choline [ 46 ].…”

Interventional strategies for ischemic stroke based on the modulation of the gut microbiota

“…For stroke patients, early EN combined with probiotics can help in improving the nutritional status, reconstructing the gut microbiota, stabilizing intestinal barrier function, improving immune tolerance, and decreasing the complications of infection and nutritional diarrhea, thus, facilitating a more effective therapeutic intervention (Xu and Shao, 2015;Mao et al, 2022). Furthermore, systematic reviews and meta-analyses of randomized controlled trials have confirmed the efficacy of EN in IS patients (Chen et al, 2022;Savigamin et al, 2022). On the other hand, additional high-quality and welldesigned randomized controlled trials are required to provide more reasonable theoretical guidance for clinical practice (Chen et al, 2022).…”