The spinal cord-gut-immune axis as a master regulator of health and neurological function after spinal cord injury

Exp Neurol, 2020 · DOI: 10.1016/j.expneurol.2019.113085 · Published: January 1, 2020

Spinal Cord Injury Immunology Gastroenterology

Simple Explanation

This review explores the interconnectedness of the spinal cord, gut, and immune system following a spinal cord injury (SCI). It highlights how SCI disrupts the normal communication between these systems, leading to various health complications. A key focus is on the gut microbiota, the community of microorganisms in the gut, and how SCI can cause an imbalance in this community, known as gut dysbiosis. This dysbiosis is believed to contribute to several pathological issues after SCI. The review also discusses how advanced sequencing technologies can provide a more comprehensive understanding of the gut ecosystem and how changes in microbial populations can affect metabolic disease, immune dysfunction, and affective disorders after SCI.

Study Duration

Not specified

Participants

SCI patients and animal models

Evidence Level

Review

Key Findings

1
SCI leads to gut dysbiosis, characterized by changes in the composition and abundance of gut bacteria, such as a decrease in Bacteroidales and an increase in Clostridiales.
2
SCI disrupts the normal sympathetic nervous system control of major immune organs, leading to SCI-induced immune depression syndrome (SCI-IDS), which increases the risk of infections.
3
SCI can cause trauma-induced autoimmunity (TIA), where the immune system recognizes and mounts a response against self-antigens, which may be related to gut dysbiosis and bacterial translocation.

Research Summary

This review addresses how SCI changes the physiological interplay between the spinal cord, the gut and the immune system. A suspected culprit in causing many of the pathological manifestations of impaired spinal cord- gut-immune axis homeostasis is the gut microbiota. As new tools and approaches become more readily available to the broader research community, the “ecogenomic” toolbox described above will enable a more wholistic, Eco-Systems Biology approach to study SCI that should help unravel the complex interplay along the virus/microbe-gut-brain axis.

Practical Implications

Targeted Therapies for SCI Comorbidities

Understanding the causal relationships between gut dysbiosis and comorbidities in SCI patients can lead to targeted therapies by modifying the gut microbiota or their metabolites.

Improved Diagnostic and Therapeutic Strategies

The urinary microbiome's diagnostic value in differentiating between asymptomatic bacteriuria and urinary tract infection (UTI) after SCI suggests potential for improved diagnostic and therapeutic strategies.

Holistic Treatment Approaches

Adopting an Eco-Systems Biology approach can unravel the interplay along the virus/microbe-gut-brain axis, promoting more holistic treatment approaches for SCI individuals.

Study Limitations

1
The functional consequences of SCI-induced dysbiosis are currently unknown.
2
Precisely how gut dysbiosis develops after SCI, whether it persists indefinitely, is unknown.
3
The human virome in SCI remains unexplored.

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