Fecal Microbiota Transplantation Role in the Treatment of Alzheimer's Disease: A Systematic Review

Implications of the Gut Microbiome in Alzheimer's Disease: A Narrative Review

Alzheimer's disease (AD) is a progressive neurodegenerative disorder, with its prevalence doubling approximately every decade. It is a significant contributor to disability-adjusted life-years in individuals aged 50 and older, impacting a substantial portion of this population globally. The pathophysiology of AD is primarily explained by two hypotheses: the amyloid cascade hypothesis and the tau hypothesis. While the amyloid cascade hypothesis is widely accepted as the main contributor to AD, both mechanisms promote neuroinflammation by driving the formation of amyloid-beta (Aβ) plaques and tau tangles, which are key features of the neurodegenerative process. Recent studies highlight the critical role of the gut microbiome (GMB) in the progression of AD. Gut dysbiosis has been linked to neuroinflammation, altered Aβ metabolism, blood-brain barrier disruption, and changes in neuroactive metabolites. Targeting the GMB offers potential therapeutic avenues aimed at restoring microbial balance and mitigating the effects of dysbiosis. The gut-brain axis, crucial for neurological health, remains underexplored in AD, especially since current research is limited to animal models and small human studies, leaving uncertainty about specific gut bacteria's roles in AD. Currently, pharmacological treatments for AD include cholinesterase inhibitors and memantine. This review discusses newer and emerging treatments targeting Aβ and tau pathology, alongside microbiome-based interventions. Larger, human-based studies with diverse populations are essential to establish the therapeutic efficacy of these microbiome-targeted treatments and their long-term impact on AD management.

Sex-specific associations between AD genotype and the microbiome of human amyloid beta knock-in (hAβ-KI) mice

INTRODUCTION

Emerging evidence links changes in the gut microbiome to late-onset Alzheimer's disease (LOAD), necessitating examination of AD mouse models with consideration of the microbiome.

METHODS

We used shotgun metagenomics and untargeted metabolomics to study the human amyloid beta knock-in (hAβ-KI) murine model for LOAD compared to both wild-type (WT) mice and a model for early-onset AD (3xTg-AD).

RESULTS

Eighteen-month female (but not male) hAβ-KI microbiomes were distinct from WT microbiomes, with AD genotype accounting for 18% of the variance by permutational multivariate analysis of variance (PERMANOVA). Metabolomic diversity differences were observed in females, however no individual metabolites were differentially abundant. hAβ-KI mice microbiomes were distinguishable from 3xTg-AD animals (81% accuracy by random forest modeling), with separation primarily driven by Romboutsia ilealis and Turicibacter species. Microbiomes were highly cage specific, with cage assignment accounting for more than 40% of the PERMANOVA variance between the groups.

DISCUSSION

These findings highlight a sex-dependent variation in the microbiomes of hAβ-KI mice and underscore the importance of considering the microbiome when designing studies that use murine models for AD.

HIGHLIGHTS

Microbial diversity and the abundance of several species differed in human amyloid beta knock-in (hAβ-KI) females but not males. Correlations to Alzheimer's disease (AD) genotype were stronger for the microbiome than the metabolome. Microbiomes from hAβ-KI mice were distinct from 3xTg-AD mice. Cage effects accounted for most of the variance in the microbiome and metabolome.

The microbiota-gut-brain-immune interface in the pathogenesis of neuroinflammatory diseases: a narrative review of the emerging literature

Importance

Research is beginning to elucidate the sophisticated mechanisms underlying the microbiota-gut-brain-immune interface, moving from primarily animal models to human studies. Findings support the dynamic relationships between the gut microbiota as an ecosystem (microbiome) within an ecosystem (host) and its intersection with the host immune and nervous systems. Adding this to the effects on epigenetic regulation of gene expression further complicates and strengthens the response. At the heart is inflammation, which manifests in a variety of pathologies including neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and Multiple Sclerosis (MS).

Observations

Generally, the research to date is limited and has focused on bacteria, likely due to the simplicity and cost-effectiveness of 16s rRNA sequencing, despite its lower resolution and inability to determine functional ability/alterations. However, this omits all other microbiota including fungi, viruses, and phages, which are emerging as key members of the human microbiome. Much of the research has been done in pre-clinical models and/or in small human studies in more developed parts of the world. The relationships observed are promising but cannot be considered reliable or generalizable at this time. Specifically, causal relationships cannot be determined currently. More research has been done in Alzheimer's disease, followed by Parkinson's disease, and then little in MS. The data for MS is encouraging despite this.

Conclusions and relevance

While the research is still nascent, the microbiota-gut-brain-immune interface may be a missing link, which has hampered our progress on understanding, let alone preventing, managing, or putting into remission neurodegenerative diseases. Relationships must first be established in humans, as animal models have been shown to poorly translate to complex human physiology and environments, especially when investigating the human gut microbiome and its relationships where animal models are often overly simplistic. Only then can robust research be conducted in humans and using mechanistic model systems.