Advertisement
Research Article| Volume 31, ISSUE 11, 106727, November 2022

The effect of fecal microbiota transplantation on stroke outcomes: A systematic review

      Abstract

      Background and Purpose

      Fecal microbiota transplantation (FMT) is a novel microbiota-based therapeutic method that transfers stool from donor into a recipient and its application is under investigating for neurological disorders such as stroke. In this systematic review, we assessed the effect of FMT in progression and treatment of stroke and recovery of post-stroke complications.

      Methods

      Preliminary studies were searched in MEDLINE via PubMed, Scopus, COCHRANE library and Google Scholar, databases up to February 2022. The search strategy was restricted to articles about FMT in stroke. The initial search yielded 4570 articles, of which 19 publications were included in our systematic review.

      Results

      Based on outcomes transferring microbiome from healthy or ischemic donor to other ischemic recipient can affect brain infarct volume and survival rate, neurological and behavioral outcomes, and inflammatory pathways.

      Conclusions

      Our systematic review on preclinical studies showed that manipulating gut microbiota via FMT can be a possible therapeutic approach for treatment of stroke and recovery of post-stroke complications.

      Keyword

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Feigin VL
        • Norrving B
        • Mensah GA
        Global burden of stroke.
        Circulation research. 2017; 120: 439-448
        • Johnson CO
        • Nguyen M
        • Roth GA
        • et al.
        Regional, and national burden of stroke, 1990–2016: A systematic analysis for the global burden of disease study 2016.
        The Lancet Neurology. 2019; 18: 439-458
        • Katan M
        • Luft A
        Global Burden of Stroke. Seminars in Neurology.
        Thieme Medical Publishers, 2018: 208-211
        • Saini V
        • Guada L
        • Yavagal DR
        Global epidemiology of stroke and access to acute ischemic stroke interventions.
        Neurology. 2021; 97: S6-S16
        • Grotta JC.
        Fifty years of acute ischemic stroke treatment: A personal history.
        Cerebrovascular Diseases. 2021; 50: 666-680
        • Katsanos AH.
        Updates in stroke treatment, diagnostic methods and predictors of outcome.
        Journal of Clinical Medicine. 2020; 9: 2789
        • Patel VP
        • Heit JJ
        Ischemic stroke treatment trials: Neuroimaging advancements and implications.
        Topics in Magnetic Resonance Imaging. 2017; 26: 133-139
        • Durgan DJ
        • Lee J
        • McCullough LD
        • Bryan Jr RM
        Examining the role of the microbiota-gut-brain axis in stroke.
        Stroke. 2019; 50: 2270-2277
        • Arneth BM.
        Gut–brain axis biochemical signalling from the gastrointestinal tract to the central nervous system: Gut dysbiosis and altered brain function.
        Postgraduate medical journal. 2018; 94: 446-452
        • Carabotti M
        • Scirocco A
        • Maselli MA
        • Severi C
        The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems.
        Annals of gastroenterology. 2015; 28: 203
        • Rhee SH
        • Pothoulakis C
        • Mayer EA
        Principles and clinical implications of the brain–gut–enteric microbiota axis.
        Nature reviews Gastroenterology hepatology. 2009; 6: 306-314
        • Bäckhed F
        • Fraser CM
        • Ringel Y
        • et al.
        Defining a healthy human gut microbiome: Current concepts, future directions, and clinical applications.
        Cell host. 2012; 12: 611-622
        • Qin J
        • Li R
        • Raes J
        • et al.
        A human gut microbial gene catalogue established by metagenomic sequencing.
        Nature. 2010; 464: 59-65
        • Huang L
        • Wang T
        • Wu Q
        • et al.
        Analysis of microbiota in elderly patients with acute cerebral infarction.
        PeerJ. 2019; 7: e6928
        • Tan C
        • Wu Q
        • Wang H
        • et al.
        Dysbiosis of gut microbiota and short‐chain fatty acids in acute ischemic stroke and the subsequent risk for poor functional outcomes.
        Journal of Parenteral Enteral Nutrition. 2021; 45: 518-529
        • Yin J
        • Liao SX
        • He Y
        • et al.
        Dysbiosis of gut microbiota with reduced trimethylamine‐n‐oxide level in patients with large‐artery atherosclerotic stroke or transient ischemic attack.
        Journal of the American Heart Association. 2015; 4e002699
        • Ling Y
        • Gong T
        • Zhang J
        • et al.
        Gut microbiome signatures are biomarkers for cognitive impairment in patients with ischemic stroke.
        Frontiers in Aging Neuroscience. 2020; : 297
        • Chen R
        • Wu P
        • Cai Z
        • et al.
        Puerariae lobatae radix with chuanxiong rhizoma for treatment of cerebral ischemic stroke by remodeling gut microbiota to regulate the brain–gut barriers.
        The Journal of Nutritional Biochemistry. 2019; 65: 101-114
        • Ling Y
        • Gu Q
        • Zhang J
        • et al.
        Structural change of gut microbiota in patients with post-stroke comorbid cognitive impairment and depression and its correlation with clinical features.
        Journal of Alzheimer’s Disease. 2020; 77: 1595-1608
        • Roth WH
        • Cai A
        • Zhang C
        • Chen ML
        • Merkler AE
        • Kamel H
        Gastrointestinal disorders and risk of first-ever ischemic stroke.
        Stroke. 2020; 51: 3577-3583
        • Vemuri R
        • Gundamaraju R
        • Shinde T
        • Eri R
        Therapeutic interventions for gut dysbiosis and related disorders in the elderly: Antibiotics, probiotics or faecal microbiota transplantation?.
        Beneficial microbes. 2017; 8: 179-192
        • Meyyappan AC
        • Forth E
        • Wallace CJ
        • Milev R
        Effect of fecal microbiota transplant on symptoms of psychiatric disorders: A systematic review.
        BMC psychiatry. 2020; 20: 1-19
        • Vindigni SM
        • Surawicz CM
        Fecal microbiota transplantation.
        Gastroenterology Clinics. 2017; 46: 171-185
        • Mikolašević I
        • Hauser G
        • Abram M
        • Filipec T
        Fecal microbiota transplantation–where are we?.
        Croatian Medical Journal. 2021; 62: 52
        • Bafeta A
        • Yavchitz A
        • Riveros C
        • Batista R
        • Ravaud P
        Methods and reporting studies assessing fecal microbiota transplantation: A systematic review.
        Annals of Internal Medicine. 2017; 167: 34-39
        • Stalder T
        • Kapel N
        • Diaz S
        • et al.
        A systematic review of economic evaluation in fecal microbiota transplantation.
        Infection Control Hospital Epidemiology. 2020; 41: 458-466
        • Wang S
        • Xu M
        • Wang W
        • et al.
        Systematic review: Adverse events of fecal microbiota transplantation.
        PloS one. 2016; 11e0161174
        • Moher D
        • Liberati A
        • Tetzlaff J
        • Altman DG
        Preferred reporting items for systematic reviews and meta-analyses: The prisma statement.
        International Journal of Surgery. 2010; 8: 336-341
        • Beller EM
        • Glasziou PP
        • Altman DG
        • et al.
        Prisma for abstracts: Reporting systematic reviews in journal and conference abstracts.
        PLoS Medicine. 2013; 10e1001419
        • Macleod MR
        • O’Collins T
        • Howells DW
        • Donnan GA
        Pooling of animal experimental data reveals influence of study design and publication bias.
        Stroke. 2004; 35: 1203-1208
        • Winek K
        • Engel O
        • Koduah P
        • et al.
        Depletion of cultivatable gut microbiota by broad-spectrum antibiotic pretreatment worsens outcome after murine stroke.
        Stroke. 2016; 47: 1354-1363
        • Benakis C
        • Brea D
        • Caballero S
        • et al.
        Commensal microbiota affects ischemic stroke outcome by regulating intestinal γδ t cells.
        Nature medicine. 2016; 22: 516-523
        • Jandzinski M.
        Manipulation of the microbiome and its impact on functional recovery following ischemic stroke. University of Connecticut, 2015
        • Spychala MS
        • Venna VR
        • Jandzinski M
        • et al.
        Age‐related changes in the gut microbiota influence systemic inflammation and stroke outcome.
        Annals of Neurology. 2018; 84: 23-36
        • Park MJ
        • Pilla R
        • Panta A
        • et al.
        Reproductive senescence and ischemic stroke remodel the gut microbiome and modulate the effects of estrogen treatment in female rats.
        Translational Stroke Research. 2020; 11: 812-830
        • Feng Y
        • Zhang D
        • Zhao Y
        • et al.
        Effect of intestinal microbiota transplantation on cerebral ischemia reperfusion injury in aged mice via inhibition of il‐17.
        Neurogastroenterology Motility. 2022; e14313
        • Lee J
        • d’Aigle J
        • Atadja L
        • et al.
        Gut microbiota–derived short-chain fatty acids promote poststroke recovery in aged mice.
        Circulation Research. 2020; 127: 453-465
        • Singh V
        • Roth S
        • Llovera G
        • et al.
        Microbiota dysbiosis controls the neuroinflammatory response after stroke.
        Journal of Neuroscience. 2016; 36: 7428-7440
        • Huang Q
        • Di L
        • Yu F
        • et al.
        Alterations in the gut microbiome with hemorrhagic transformation in experimental stroke.
        CNS Neuroscience Therapeutics. 2022; 28: 77-91
        • Hafez S
        • Hoda MN
        • Guo X
        • Johnson MH
        • Fagan SC
        • Ergul A
        Comparative analysis of different methods of ischemia/reperfusion in hyperglycemic stroke outcomes: Interaction with tpa.
        Translational Stroke Research. 2015; 6: 171-180
        • Lee K-E
        • Kim J-K
        • Kim D-H
        Orally administered antibiotics vancomycin and ampicillin cause cognitive impairment with gut dysbiosis in mice with transient global forebrain ischemia.
        Frontiers in Microbiology. 2020; : 2347
        • Wang H
        • Ren S
        • Lv H
        • Cao L
        Gut microbiota from mice with cerebral ischemia-reperfusion injury affects the brain in healthy mice.
        Aging. 2021; 13: 10058
        • Dou Z
        • Rong X
        • Zhao E
        • Zhang L
        • Lv Y
        Neuroprotection of resveratrol against focal cerebral ischemia/reperfusion injury in mice through a mechanism targeting gut-brain axis.
        Molecular Neurobiology. 2019; 39: 883-898
        • Im Jeong S
        • Shin JA
        • Cho S
        • et al.
        Resveratrol attenuates peripheral and brain inflammation and reduces ischemic brain injury in aged female mice.
        Neurobiology of Aging. 2016; 44: 74-84
        • Chen R
        • Xu Y
        • Wu P
        • et al.
        Transplantation of fecal microbiota rich in short chain fatty acids and butyric acid treat cerebral ischemic stroke by regulating gut microbiota.
        Pharmacological Research. 2019; 148: 104403
        • Wang H
        • Song W
        • Wu Q
        • et al.
        Fecal transplantation from db/db mice treated with sodium butyrate attenuates ischemic stroke injury.
        Microbiology Spectrum. 2021; 9: e00042-00021
        • Zhou Z
        • Xu N
        • Matei N
        • et al.
        Sodium butyrate attenuated neuronal apoptosis via gpr41/gβγ/pi3k/akt pathway after mcao in rats.
        Journal of Cerebral Blood Flow Metabolism. 2021; 41: 267-281
        • Zhang F
        • Zhai M
        • Wu Q
        • et al.
        Protective effect of tong-qiao-huo-xue decoction on inflammatory injury caused by intestinal microbial disorders in stroke rats.
        Biological Pharmaceutical Bulletin. 2020; 43: 788-800
        • Li L
        • Wang N
        • Jin Q
        • et al.
        Protection of tong-qiao-huo-xue decoction against cerebral ischemic injury through reduction blood–brain barrier permeability.
        Chemical Pharmaceutical Bulletin. 2017; 65: 1004-1010
        • Zhang P
        • Zhang X
        • Huang Y
        • et al.
        Atorvastatin alleviates microglia-mediated neuroinflammation via modulating the microbial composition and the intestinal barrier function in ischemic stroke mice.
        Free Radical Biology Medicine. 2021; 162: 104-117
        • Wang L
        • Zhang X
        • Liu L
        • Yang R
        • Cui L
        • Li M
        Atorvastatin protects rat brains against permanent focal ischemia and downregulates hmgb1, hmgb1 receptors (rage and tlr4), nf-κb expression.
        Neuroscience letters. 2010; 471: 152-156
        • Huang J-T
        • Mao Y-Q
        • Han B
        • et al.
        Calorie restriction conferred improvement effect on long-term rehabilitation of ischemic stroke via gut microbiota.
        Pharmacological Research. 2021; 170: 105726
        • de Carvalho TS.
        Calorie restriction or dietary restriction: How far they can protect the brain against neurodegenerative diseases?.
        Neural Regeneration Research. 2022; 17: 1640
        • Zhu W
        • Romano KA
        • Li L
        • et al.
        Gut microbes impact stroke severity via the trimethylamine n-oxide pathway.
        Cell Host. 2021; 29: 1199-1208
        • Haghikia A
        • Li X
        • Liman T
        • et al.
        Gut microbiota-dependent tmao predicts risk of cardiovascular events in patients with stroke and is related to proinflammatory monocytes. Arteriosclerosis, Thrombosis, and Vascular.
        Biology. 2018; 38: 2225-2235
        • Zhai Q
        • Wang X
        • Chen C
        • et al.
        Prognostic value of plasma trimethylamine n-oxide levels in patients with acute ischemic stroke.
        Molecular Neurobiology. 2019; 39: 1201-1206
        • Rexidamu M
        • Li H
        • Jin H
        • Huang J
        Serum levels of trimethylamine-n-oxide in patients with ischemic stroke.
        Bioscience Reports. 2019; 39
        • Schneider C
        • Okun J
        • Schwarz K
        • et al.
        Trimethylamine‐n‐oxide is elevated in the acute phase after ischaemic stroke and decreases within the first days.
        European Journal of Neurology. 2020; 27: 1596-1603
        • Xia G-H
        • You C
        • Gao X-X
        • et al.
        Stroke dysbiosis index (sdi) in gut microbiome are associated with brain injury and prognosis of stroke.
        Frontiers in Neurology. 2019; 10: 397