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多发性硬化症中的肠脑轴。其功能障碍是疾病的病理性触发因素还是后果?

The Gut-Brain Axis in Multiple Sclerosis. Is Its Dysfunction a Pathological Trigger or a Consequence of the Disease?

机构信息

Department of Neurosciences, Rehabilitation, Ophthalmology and Maternal-Fetal Medicine (DINOGMI), University of Genoa, Genoa, Italy.

TomaLab, Institute of Nanotechnology, Consiglio Nazionale delle Ricerche (CNR), Rome, Italy.

出版信息

Front Immunol. 2021 Sep 21;12:718220. doi: 10.3389/fimmu.2021.718220. eCollection 2021.


DOI:10.3389/fimmu.2021.718220
PMID:34621267
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8490747/
Abstract

A large and expending body of evidence indicates that the gut-brain axis likely plays a crucial role in neurological diseases, including multiple sclerosis (MS). As a whole, the gut-brain axis can be considered as a bi-directional multi-crosstalk pathway that governs the interaction between the gut microbiota and the organism. Perturbation in the commensal microbial population, referred to as dysbiosis, is frequently associated with an increased intestinal permeability, or "leaky gut", which allows the entrance of exogeneous molecules, in particular bacterial products and metabolites, that can disrupt tissue homeostasis and induce inflammation, promoting both local and systemic immune responses. An altered gut microbiota could therefore have significant repercussions not only on immune responses in the gut but also in distal effector immune sites such as the CNS. Indeed, the dysregulation of this bi-directional communication as a consequence of dysbiosis has been implicated as playing a possible role in the pathogenesis of neurological diseases. In multiple sclerosis (MS), the gut-brain axis is increasingly being considered as playing a crucial role in its pathogenesis, with a major focus on specific gut microbiota alterations associated with the disease. In both MS and its purported murine model, experimental autoimmune encephalomyelitis (EAE), gastrointestinal symptoms and/or an altered gut microbiota have been reported together with increased intestinal permeability. In both EAE and MS, specific components of the microbiota have been shown to modulate both effector and regulatory T-cell responses and therefore disease progression, and EAE experiments with germ-free and specific pathogen-free mice transferred with microbiota associated or not with disease have clearly demonstrated the possible role of the microbiota in disease pathogenesis and/or progression. Here, we review the evidence that can point to two possible consequences of the gut-brain axis dysfunction in MS and EAE: 1. A pro-inflammatory intestinal environment and "leaky" gut induced by dysbiosis could lead to an altered communication with the CNS through the cholinergic afferent fibers, thereby contributing to CNS inflammation and disease pathogenesis; and 2. Neuroinflammation affecting efferent cholinergic transmission could result in intestinal inflammation as disease progresses.

摘要

大量不断增加的证据表明,肠道-大脑轴可能在神经系统疾病中发挥关键作用,包括多发性硬化症(MS)。总的来说,肠道-大脑轴可以被认为是一个双向的多信号交流途径,它控制着肠道微生物群和机体之间的相互作用。共生微生物种群的紊乱,称为肠道菌群失调,通常与肠道通透性增加(即“漏肠”)有关,这允许外源分子,特别是细菌产物和代谢物的进入,这些物质可以破坏组织平衡并引发炎症,促进局部和全身免疫反应。因此,肠道微生物群的改变不仅会对肠道中的免疫反应产生重大影响,还会对 CNS 等远处效应免疫部位产生重大影响。事实上,由于肠道菌群失调导致这种双向交流的失调被认为在神经系统疾病的发病机制中起着可能的作用。在多发性硬化症(MS)中,肠道-大脑轴越来越被认为在其发病机制中起着关键作用,主要关注与疾病相关的特定肠道微生物群改变。在 MS 和其假定的实验性自身免疫性脑脊髓炎(EAE)模型中,据报道存在胃肠道症状和/或肠道菌群改变以及肠道通透性增加。在 EAE 和 MS 中,已经显示微生物群的特定成分可以调节效应和调节性 T 细胞反应,从而调节疾病进展,并且使用无特定病原体(GF)和特定病原体(SPF)小鼠进行的 EAE 实验,这些小鼠接受了与疾病相关或不相关的微生物群转移,这清楚地表明了微生物群在疾病发病机制和/或进展中的可能作用。在这里,我们回顾了可以指向 MS 和 EAE 中肠道-大脑轴功能障碍的两种可能后果的证据:1. 肠道菌群失调引起的促炎肠道环境和“漏肠”可能导致与 CNS 通过胆碱能传入纤维的交流改变,从而有助于 CNS 炎症和疾病发病机制;2. 影响传出胆碱能传递的神经炎症可能导致疾病进展时的肠道炎症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1339/8490747/70e2bc259886/fimmu-12-718220-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1339/8490747/89a5984a1e04/fimmu-12-718220-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1339/8490747/70e2bc259886/fimmu-12-718220-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1339/8490747/89a5984a1e04/fimmu-12-718220-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1339/8490747/70e2bc259886/fimmu-12-718220-g002.jpg

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本文引用的文献

[1]
Isoflavone diet ameliorates experimental autoimmune encephalomyelitis through modulation of gut bacteria depleted in patients with multiple sclerosis.

Sci Adv. 2021-7

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