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Review
. 2021 Sep 21:12:718220.
doi: 10.3389/fimmu.2021.718220. eCollection 2021.

The Gut-Brain Axis in Multiple Sclerosis. Is Its Dysfunction a Pathological Trigger or a Consequence of the Disease?

Affiliations
Review

The Gut-Brain Axis in Multiple Sclerosis. Is Its Dysfunction a Pathological Trigger or a Consequence of the Disease?

Benedetta Parodi et al. Front Immunol. .

Abstract

A large and expending body of evidence indicates that the gut-brain axis likely plays a crucial role in neurological diseases, including multiple sclerosis (MS). As a whole, the gut-brain axis can be considered as a bi-directional multi-crosstalk pathway that governs the interaction between the gut microbiota and the organism. Perturbation in the commensal microbial population, referred to as dysbiosis, is frequently associated with an increased intestinal permeability, or "leaky gut", which allows the entrance of exogeneous molecules, in particular bacterial products and metabolites, that can disrupt tissue homeostasis and induce inflammation, promoting both local and systemic immune responses. An altered gut microbiota could therefore have significant repercussions not only on immune responses in the gut but also in distal effector immune sites such as the CNS. Indeed, the dysregulation of this bi-directional communication as a consequence of dysbiosis has been implicated as playing a possible role in the pathogenesis of neurological diseases. In multiple sclerosis (MS), the gut-brain axis is increasingly being considered as playing a crucial role in its pathogenesis, with a major focus on specific gut microbiota alterations associated with the disease. In both MS and its purported murine model, experimental autoimmune encephalomyelitis (EAE), gastrointestinal symptoms and/or an altered gut microbiota have been reported together with increased intestinal permeability. In both EAE and MS, specific components of the microbiota have been shown to modulate both effector and regulatory T-cell responses and therefore disease progression, and EAE experiments with germ-free and specific pathogen-free mice transferred with microbiota associated or not with disease have clearly demonstrated the possible role of the microbiota in disease pathogenesis and/or progression. Here, we review the evidence that can point to two possible consequences of the gut-brain axis dysfunction in MS and EAE: 1. A pro-inflammatory intestinal environment and "leaky" gut induced by dysbiosis could lead to an altered communication with the CNS through the cholinergic afferent fibers, thereby contributing to CNS inflammation and disease pathogenesis; and 2. Neuroinflammation affecting efferent cholinergic transmission could result in intestinal inflammation as disease progresses.

Keywords: dysbiosis; enteric nervous system; experimental autoimmune encephalomyelitis; intestinal permeability; neuroinflammation; probiotics; short-chain fatty acids (SCFA); vagus nerve.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the intestinal wall in homeostatic and inflammatory conditions. The intestinal barrier is composed of mucus, which acts as physical and biochemical barrier, of a continuous monolayer of intestinal epithelial cells (including enterocytes, goblet cells, Paneth cells, and enteroendocrine cells), and of the lamina propria, which is densely populated by immune cells (such as DC, macrophages, ILC, and T cells). The intestinal barrier is directly exposed to the gut microbiota that has an important role in the maintenance of barrier integrity and in the regulation of the immune system. The lamina propria is innervated by enteric nerve fibres, which originate in the myenteric and submucosal plexi and are in contact with EGC. The left panel shows the intestinal wall under homeostatic conditions; in the right panel, under inflammatory conditions, the composition of the gut microbiota is altered (a), the intestinal epithelial barrier is impaired (b), enabling translocation of microbes (or their products) (c), and resulting in an increase in Th17 cells (d) and enteric axonal loss and gliosis (e).
Figure 2
Figure 2
What comes first in MS, gut or CNS inflammation? Gut environment drives MS/EAE pathogenesis. In MS/EAE, dysbiosis together with an increased intestinal permeability, possibly due to alterations in intestinal epithelial barrier morphology, have been demonstrated. These alterations allow the translocation of microbes or their products from the gut lumen into the lamina propria, thereby promoting inflammation. Inflammation in the gut can result in activation of encephalitogenic T cells that can travel to the CNS where they can induce inflammatory damage with subsequent demyelination and axonal loss. CNS inflammation is the trigger for MS/EAE. Neuroinflammation in MS/EAE could be the consequence of an altered vascular permeability of BBB. The leakage of plasma components, such as fibrinogen, leads to rapid activation of microglia that might be the trigger of the disease, with ensuing infiltration of homing inflammatory cells and signal transmission to the gut resulting in intestinal barrier permeability thereby propagating the brain-gut inflammation loop.

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