Gut microbiome in intracranial aneurysm growth, subarachnoid hemorrhage, and cerebral vasospasm: a systematic review with a narrative synthesis

Tomasz Klepinowski; Karolina Skonieczna-Żydecka; Bartłomiej Pala; Ewa Stachowska; Leszek Sagan

doi:10.3389/fnins.2023.1247151

Gut microbiome in intracranial aneurysm growth, subarachnoid hemorrhage, and cerebral vasospasm: a systematic review with a narrative synthesis

Front Neurosci. 2023 Oct 19:17:1247151. doi: 10.3389/fnins.2023.1247151. eCollection 2023.

Authors

Tomasz Klepinowski¹, Karolina Skonieczna-Żydecka², Bartłomiej Pala¹, Ewa Stachowska³, Leszek Sagan¹

Affiliations

¹ Department of Neurosurgery, Pomeranian Medical University, Szczecin, Poland.
² Department of Biochemical Sciences, Pomeranian Medical University, Szczecin, Poland.
³ Department of Human Nutrition and Metabolomics, Pomeranian Medical University, Szczecin, Poland.

Abstract

Intracranial aneurysms (IA) are the most common cerebral vascular pathologies. Their rupture leads to the most dangerous subtype of stroke-aneurysmal subarachnoid hemorrhage (aSAH), which may be followed by cerebral vasospasm and ischemic sequelae. Recently, an imbalance within the intestinal microbiota, referred to as dysbiosis, was suggested to play a role in the formation, progression, and rupture of IA. As no systematic review on this topic exists, considering the significance of this matter and a lack of effective prophylaxis against IA or cerebral vasospasm, we aim to sum up the current knowledge regarding their associations with intestinal microbiome, identify the gaps, and determine future prospects. Scientific databases were systematically and independently searched by two authors from inception to 1st May 2023 for original articles regarding the role of intestinal microbiota in intracranial aneurysmal growth, aSAH occurrence, as well as in cerebral vasospasm following aSAH. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was followed in an abstraction process. The STROBE tool was applied to assess the risk of bias. This research was funded by the National Science Centre, Poland (grant number 2021/41/N/NZ2/00844). Of 302 records, four studies were included that fully met eligibility criteria. Studies reported (1) that the relative abundance of Hungatella hathewayi is a protective factor against aneurysm growth and rupture, resulting from the reduced inflammation and extracellular matrix remodeling in the cerebral arterial wall and from reduced metalloproteinase-mediated degradation of smooth muscle cells in cerebral vessels. (2) Relative abundance of Campylobacter ureolyticus is associated with aSAH. (3) No article has evaluated microbiota in relation to cerebral vasospasm following aSAH although there is an ongoing study. We concluded that intestinal microbiota might be a potential target for diagnostic and therapeutic tools to improve the management of cerebral aneurysms. However, more studies of prospective design are needed.

Keywords: aneurysm; brain; hemorrhage; microbiome; vasospasm.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was partly funded by National Science Centre, Poland (Grant Number 2021/41/N/NZ2/00844 to TK as a principal investigator and LS as a supervisor).