Therapeutic Effect of Enteral Nutrition Supplemented with Probiotics in the Treatment of Severe Craniocerebral Injury: A Systematic Review and Meta-Analysis

Du, Tianjiao; Jing, Xiyue; Song, Sirong; Lu, Shan; Xu, Lixia; Tong, Xiaoguang; Yan, Hua

doi:10.1016/j.wneu.2020.04.083

Cited by 15 publications

(11 citation statements)

References 16 publications

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“…Extensive clinical data show that the mortality rate of sTBI is extremely high 27 . Even if the patient survives, he often suffers from memory loss, limb hemiplegia, and other severe neurological dysfunction 28 .…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, many researchers have reported that non-coding RNAs play an important role in maintaining stable and normal NVU function. MicroRNAs (miRNAs) are short (19)(20)(21)(22)(23)(24)(25)(26)(27)(28) nucleotides) endogenous non-coding RNAs that regulate protein synthesis at the post-transcriptional level 16 . Previous studies have verified that the levels of various miRNAs are significantly changed in brain tissues after TBI, which can restore the normal function of the NVU by inhibiting the apoptosis of neurons and reducing the destruction of the BBB.…”

Section: Introductionmentioning

confidence: 99%

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Downregulation of microRNA-9-5p promotes synaptic remodeling in the chronic phase after traumatic brain injury

et al. 2021

Cell Death Dis

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The level of microRNA-9-5p (miRNA-9-5p) in brain tissues is significantly changed in the chronic phase after traumatic brain injury (TBI). However, the effect of miRNA-9-5p on brain function after TBI has not been elucidated. In this study, we used a controlled cortical impact (CCI) model to induce TBI in Sprague–Dawley rats. Brain microvascular endothelial cells (BMECs), astrocytes, and neurons were extracted from immature Sprague–Dawley rats and cocultured to reconstruct the neurovascular unit (NVU) in vitro. The results showed that downregulation of miRNA-9-5p in the chronic phase contributed to neurological function recovery by promoting astrocyte proliferation and increasing the release of astrocyte-derived neurotrophic factors around injured brain tissues after TBI. A dual-luciferase reporter assay validated that miRNA-9-5p was a post-transcriptional modulator of thrombospondin 2 (Thbs-2), and downregulation of miRNA-9-5p promoted Thbs-2 expression in astrocytes. Furthermore, we verified that Thbs-2 can promote Notch pathway activation by directly binding to Jagged and Notch. Through in vitro experiments, we found that the expression of synaptic proteins and the number of synaptic bodies were increased in neurons in the NVU, which was constructed using astrocytes pretreated with miRNA-9-5p inhibitor. Moreover, we also found that downregulation of miRNA-9-5p promoted Thbs-2 expression in astrocytes, which activated the Notch/cylindromatosis/transforming growth factor-β-activated kinase 1 pathway in neurons and promoted the expression of synaptic proteins, including post-synaptic density protein 95 and synaptotagmin. Based on these results, miRNA-9-5p may be a new promising prognostic marker and treatment target for TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Downregulation of microRNA-9-5p promotes synaptic remodeling in the chronic phase after traumatic brain injury

et al. 2021

Cell Death Dis

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“…The metabolism and decomposition rates in the body of a patient with TBI are 1.4 times faster than those of a normal person (10,12). The body's systemic metabolism is disrupted, the body's energy consumption increases, protein decomposition accelerates, and the patient develops traumatic hypoproteinemia, which escalates the process of brain damage and increases the mortality rate (17). Therefore, timely and effective nutritional support is particularly important.…”

Section: Discussionmentioning

confidence: 99%

“…Intensified nutritional supplementation can be used to provide adequate dietary needs for patients with TBI. The use of nutritional support combined with early enteral nutrition in treating patients with TBI can effectively improve the nutritional status of the body after surgery, enhance nutritional support, and have a significant effect on the recovery of the patient's condition (2,17,18). Nutritional therapy is an integral part of the clinical treatment of patients with TBI and can promote postoperative recovery and reduce the occurrence of related complications (19,20).…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of the effect of nutritional support on the clinical outcome of patients with traumatic brain injury

Lü¹,

Liao²,

Hou³

et al. 2021

Ann Palliat Med

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Background: It remains unclear whether nutritional support can reduce the mortality and infection rate of patients with traumatic brain injury (TBI), improve their gastrointestinal function, and shorten the length of stay in the intensive care unit (ICU). The purpose of this study is to evaluate the effect of nutritional support on the clinical outcome of TBI patients. Methods: A computer search was conducted of the PubMed, Cochrane Library, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trials investigating the impact of nutritional support on the clinical outcomes of patients with TBI. The search included the period from the establishment of the database to July 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias in the included studies. RevMan 5.3 statistical software (Cochrane Collaboration) was used to analyze the effect size, and a funnel plot was used to detect publication bias.Results: Seven articles reporting on 260 patients receiving nutritional support therapy compared with 252 standard nutrition control patients were included in the study. Meta-analysis showed that there was no significant difference in mortality between the nutritional support and standard nutrition treatments (RR =0.74; 95% CI: 0.34-1.60; P=0.44). However, there were significant differences in total serum protein levels

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“…We continuously explored various immune tolerance pathways for craniocerebral trauma, screened out the most suitable cost, promoted the pathway of the orally administered brain protein, and applied it in the clinic, which was recognized by the academic community ( 25 – 30 ). In response to the individual differences in efficacy in some patients, we recognized the key organ for generating immune tolerance, the intestine, which has a dysbiosis problem, and added probiotics to the process followed by orally administered brain protein and achieved considerably satisfactory results ( 31 ).…”

Section: Introductionmentioning

confidence: 99%

Orally Administered Brain Protein Combined With Probiotics Increases Treg Differentiation to Reduce Secondary Inflammatory Damage Following Craniocerebral Trauma

Cui

Wang

et al. 2022

Front. Immunol.

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Craniocerebral trauma is caused by external forces that can have detrimental effects on the vasculature and adjacent nerve cells at the site. After the mechanical and structural primary injury, a complex series of secondary cascades of injury exacerbates brain damage and cognitive dysfunction following mechanical and structural primary injury. Disruption of the blood-brain barrier and exposure of brain proteins following craniocerebral trauma, recognition by the immune system triggering autoimmune attack, and excessive secondary inflammatory responses causing malignant brain swelling, cerebral edema, and subsequent brain cell apoptosis provide a new direction for the suppression of brain inflammatory responses in the treatment of craniocerebral trauma. We observed that CD4+T/CD8+T in peripheral blood T cells of craniocerebral trauma rats were significantly higher than those of normal rats, and the ratio of CD4+CD25+Foxp3 (Foxp3)+Regulatory T cell (Treg) was significantly lower than that of normal rats and caused increased secondary inflammation. We constructed a rat model of post-surgical brain injury and orally administered brain protein combined with probiotics, which was observed to significantly reduce CD4+T/CD8+T and induce T-cell differentiation into CD4+CD25+Foxp3+Treg, thus, reducing secondary inflammatory responses following craniocerebral trauma. However, collecting intestinal stool and small intestinal tissues for broad target metabolomics, 16s rRNA bacteriomics, and the combined analysis of intestinal tissue proteomics revealed that oral administration of brain protein combined with probiotics activates glycerophospholipid and vitamin B6 metabolic pathways to promote the production of CD4+CD25+Foxp3+Treg. Therefore, we propose the novel idea that oral administration of brain protein combined with probiotics can induce immune tolerance by increasing Treg differentiation, thus, reducing secondary inflammatory injury following craniocerebral trauma.

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Therapeutic Effect of Enteral Nutrition Supplemented with Probiotics in the Treatment of Severe Craniocerebral Injury: A Systematic Review and Meta-Analysis

Cited by 15 publications

References 16 publications

Downregulation of microRNA-9-5p promotes synaptic remodeling in the chronic phase after traumatic brain injury

Downregulation of microRNA-9-5p promotes synaptic remodeling in the chronic phase after traumatic brain injury

Systematic review and meta-analysis of the effect of nutritional support on the clinical outcome of patients with traumatic brain injury

Orally Administered Brain Protein Combined With Probiotics Increases Treg Differentiation to Reduce Secondary Inflammatory Damage Following Craniocerebral Trauma

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