Gut Microbiota Influence on Ischemic Stroke Outcomes

The community of microorganisms residing in the gut shapes systemic immunity, metabolic homeostasis and neural repair processes following cerebral arterial occlusion. Alterations in microbial composition, termed gut dysbiosis, can exacerbate blood–brain barrier disruption, promote systemic inflammation and modulate immune cell trafficking to the injured brain. Microbial metabolites such as short-chain fatty acids and trimethylamine N-oxide influence endothelial function, cytokine release and neuronal survival pathways. Conversely, the acute neural injury and autonomic imbalance induced by stroke drive changes in intestinal permeability and motility, further reshaping microbial communities. Together, these bidirectional interactions along the gut–brain axis determine the severity of secondary complications—such as infection, immunodepression and delayed recovery—and open avenues for novel prognostic markers and microbiome-targeted therapies.

Research from Nature Portfolio

Recent studies have revealed that stroke induces substantial alterations in the mucosal communities of the gastrointestinal tract within 24 hours of insult. Investigations in murine models demonstrate a significant increase in Akkermansia muciniphila and clostridial species at the intestinal epithelium, accompanied by predicted enhancements in pathways related to infectious disease and membrane transport. These shifts in mucosal microbiota composition have been linked to selective bacterial translocation to peripheral tissues, implicating gut-derived pathogens in post-stroke infections. Functional analysis suggests that modulation of mucosal bacterial populations may represent a therapeutic avenue to reduce infection risk and improve neurological recovery.

Gut Microbiota Influence on Ischemic Stroke Outcomes publication trend

The graph below shows the total number of articles in gut microbiota influence on ischemic stroke outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Gut microbiota: The community of microorganisms inhabiting the gastrointestinal tract.

Ischaemic stroke: Brain injury caused by obstruction of a cerebral artery, leading to reduced blood flow and oxygen deprivation.

Gut dysbiosis: An imbalance in the normal composition or function of the gut microbiota.

Short-chain fatty acids (SCFAs): Metabolic by-products of bacterial fibre fermentation, influencing host immunity and barrier function.

Gut–brain axis: The bidirectional communication network linking the gastrointestinal tract and the central nervous system.

References

1. Gut Microbiota in Acute Ischemic Stroke: From Pathophysiology to Therapeutic Implications. Frontiers in Neurology (2020).
2. Brain injury induces specific changes in the caecal microbiota of mice via altered autonomic activity and mucoprotein production. Brain Behavior and Immunity (2016).
3. Ischemic stroke induces gut permeability and enhances bacterial translocation leading to sepsis in aged mice. Aging (2016).
4. An insight into intestinal mucosal microbiota disruption after stroke. Scientific Reports (2018).
5. Gut microbiota of old mice worsens neurological outcome after brain ischemia via increased valeric acid and IL-17 in the blood. Microbiome (2023).
6. The Role of Gut Microbiota in an Ischemic Stroke. International Journal of Molecular Sciences (2021).
7. Disruptions of Anaerobic Gut Bacteria Are Associated with Stroke and Post-stroke Infection: a Prospective Case–Control Study. Translational Stroke Research (2020).