Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
J Neurotrauma. 2023 May;40(9-10):793-806. doi: 10.1089/neu.2022.0264. Epub 2023 Mar 10.
Spinal cord injury (SCI) affects ∼1,300,000 people living in the United States. Most research efforts have been focused on reversing paralysis, as this is arguably the most defining feature of SCI. The damage caused by SCI, however, extends past paralysis and includes other debilitating outcomes including immune dysfunction and gut dysbiosis. Recent efforts are now investigating the pathophysiology of and developing therapies for these more distal manifestations of SCI. One exciting avenue is the spinal cord-gut-immune axis, which proposes that gut dysbiosis amplifies lesion inflammation and impairs SCI recovery. This review will highlight the most recent findings regarding gut and immune dysfunction following SCI, and discuss how the central nervous system (CNS), gut, and immune system all coalesce to form a bidirectional axis that can impact SCI recovery. Finally, important considerations regarding how the spinal cord-gut-immune axis fits within the larger framework of therapeutic development (i.e., probiotics, fecal transplants, dietary modifications) will be discussed, emphasizing the lack of interdepartmental investigation and the missed opportunity to maximize therapeutic benefit in SCI.
脊髓损伤 (SCI) 影响着美国约 130 万人的生活。大多数研究都集中在逆转瘫痪上，因为这可以说是 SCI 最具定义性的特征。然而，SCI 造成的损害不仅限于瘫痪，还包括其他使人衰弱的后果，包括免疫功能障碍和肠道菌群失调。最近的研究正在调查这些 SCI 更远处表现的病理生理学，并为其开发治疗方法。一个令人兴奋的途径是脊髓-肠道-免疫轴，该理论提出肠道菌群失调会放大损伤炎症，并损害 SCI 的恢复。本综述将重点介绍 SCI 后肠道和免疫功能障碍的最新发现，并讨论中枢神经系统 (CNS)、肠道和免疫系统如何汇聚形成一个双向轴，从而影响 SCI 的恢复。最后，将讨论关于脊髓-肠道-免疫轴如何在治疗发展的更大框架内（即益生菌、粪便移植、饮食改变）的重要考虑因素，强调缺乏部门间的调查以及错失最大限度提高 SCI 治疗效益的机会。
