Spinal cord injury: pathophysiology, possible treatments and the role of the gut microbiota

Frontiers in Microbiology, 2024 · DOI: 10.3389/fmicb.2024.1490855 · Published: December 18, 2024

Simple Explanation

Spinal Cord Injury (SCI) is a devastating pathological state causing motor, sensory, and autonomic dysfunction. To date, SCI remains without viable treatment for its patients. After trauma, the gut-brain/spinal cord axis promotes the production of pro-inflammatory metabolites that provide a non-permissive environment for cell survival and locomotor recovery. Overall, this review provides valuable insights into the pathophysiology of SCI and the evolving understanding of the role of the gut microbiota in SCI, with implications for future research and clinical practice.

Study Duration

Not specified

Participants

SCI patients and healthy individuals

Evidence Level

Review

Key Findings

1
SCI leads to a decrease in SCFAs-producing bacteria. This reduction has also been observed in other CNS pathologies such as hepatic encephalopathy.
2
Gut microbiota studies after SCI suggest that any treatment to improve behavioral recovery must also reduce dysbiosis caused by the lesion and/or drug treatment.
3
SCI-related dysbiosis can further compromise neuro-recovery by promoting systemic inflammation, which negatively influences spinal cord healing.

Research Summary

Spinal cord injury (SCI) is a devastating pathological state causing motor, sensory, and autonomic dysfunction. To date, SCI remains without viable treatment for its patients. In this review, we highlight recent findings on the pathophysiology of SCI from pre-clinical and clinical trials, how changes in gut microbiome composition affect cell survival, locomotor recovery, drug absorption, and how the possibility of microbiota-targeted therapeutic strategies combined with drugs that show positive outcomes after SCI can be a viable novel therapeutic technique for SCI. Evidence shows that gut microbiota pro-inflammatory metabolites can enter the central nervous system via the blood-spinal cord barrier, resulting in neuroinflammation and contributing to the secondary phase of SCI.

Practical Implications

Therapeutic potential

Pharmacological treatments should improve the environment in the injured area and protect neurons.

Clinical Trials

Neuroprotective and neurodegenerative agents targeting pathological mechanisms are currently undergoing clinical trials.

Future Research

Pre-clinical studies coupling SCI with microbiome and immune responses will certainly help develop novel therapeutic approaches, and more studies are needed.

Study Limitations

1
There is limited data on the therapeutic potential of any pharmacological drug in maintaining a healthy microbiome after SCI.
2
Experimental design differences impact reported microbiome composition after SCI and should be accounted for in assigning pro- and anti-inflammatory roles in the bacterial genera.
3
The effect of possible pharmacological agents on the microbiome is unknown, and the role of drug therapy in dysbiosis has not been investigated and should be established for the benefit of SCI patients.

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