Cognitive Impairment, Microbiota and Its Transplantation

Álvaro Zamudio-Tiburcio1*, Héctor Bermúdez-Ruiz2, Pedro Antonio Reyes-López3, Silverio Alonso López4

1 Department of Gastroenterology. Intestinal Microbiota Transplantation, Unit. (Medical Specialties Naples). Mexico City. Mexico.

2 Endoscopy Service. Oncology Hospital. National Medical Center., XXI Century. Mexican Social Security Institute. Mexico City, Mexico.

3 Research Department. National Institute of Cardiology "Ignacio Chávez." Mexico City. Mexico.

4 Urologist. Medical Specialties Naples.

*Corresponding Author: Álvaro Zamudio-Tiburcio, Naples Medical Specialties. Pennsylvania 209, corner Kansas. Naples colony. ZIP 03820. City Hall Benito Juárez. Office # 12. Mexico City, Mexico, Tel: 011-52- (55) 2155-3877; E-mail:alzati58@hotmail.com

Citation: Álvaro Zamudio-Tiburcio, Héctor Bermúdez-Ruiz, Pedro Antonio Reyes-López, Silverio Alonso López (2020) Cognitive Impairment, Microbiota and Its Transplantation.Gastroenterol Hepatol J 4: 126.

Copyright: © 2020 Álvaro Zamudio-Tiburcio, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: April 01, 2020; Accepted: April 10, 2020; Published: April 13, 2020.

Abstract

The deterioration of mental function (Cognitive Impairment), is very frequent in older adults, and usually generate countless affectations in close relatives, especially when they are of greater intensity. Many pathologies generate them; However, our approaches must be directed towards prevention, since once the process is established, it is practically impossible to correct it. Although at present, the ever-deepening knowledge of the human Microbiome makes us hopeful, when observing that said super organ performs a good number of functions and modulates the feedback of the brain.

These actions, together with the Mediterranean diet, the use of probiotics, prebiotics and symbiotics, as well as the orientation of stress management, direct us towards a comprehensive tool, which can lessen the impact of cognitive decline if you use Intestinal Microbiota Transplantation, you must be very cautious and strict in the clinical history, as well as determine SARS-CoV2, nasopharyngeal and stool, as recommended by the FDA.

Keywords

Cognitive Impairment (CI), Microbiota. Intestinal Microbiota (IM), Intestinal Microbiota Transplantation (IMT), Probiotics, Mediterranean Diet

Introduction

Cognitive problems (mental function) are very common among older people. This can be mild, without substantially affecting daily activities; however, there are other cases, in which the Cognitive Impairment (CI) is greater and the patient presents manifestations of dementia. There are numerous causes of CI, among which Alzheimer's disease stands out in its initial stage; silent strokes; brain damage; brain tumors; delirium: usually due to illness or medications; major surgeries (Open Heart). Central nervous system infections and drug use.

The search for the diagnosis begins with an excellent medical history, followed by blood tests, lumbar puncture, computed tomography and magnetic resonance imaging. With the support of neuropsychological tests. But the most important thing of all is prevention, in order to prevent CI from occurring, for this, not smoking, contact with family and friends, regular exercise, mental activity, as well as correct treatment of chronic conditions, is appropriate. But above all, try to maintain a healthy Intestinal Microbiota (IM). Mediterranean-ketogenic diet management, personal stress control can be included. The administration of probiotics, pre- or symbiotics, and the use of derivatives of the intestinal microbiota or their transplantation. The warnings issued by the FDA in this regard must be systematically included [1].

All of the latter has been universally considered in the management of cognitive decline. Now, at what stage should microbiota modulation be carried out, we consider that the excellent period is in those children who have a family history of Alzheimer's, or another variety of cognitive impairment and they themselves present severe involvement of the Intestinal Microbiota (IM). Some people will consider that this technique is very aggressive, especially if we are already trying to modulate neurodigestive disorders, why not decrease its future development [2-4].

There are numerous studies that point out the importance of the Microbiome and its qualities, by influencing numerous functions such as Metabolic [5], Immune System [6], Protective Functions [7], Energy Balance [8], Neurological Development [9], Intestinal Homeostasis [10], Control of populations of pathogenic microorganisms [11], Production of vitamins and anti-inflammatory substances [12], Assimilation of nutrients and digestibility of certain compounds of the food [13]. Also, there are only a few genes related to enzymes in our body that allow us to digest complex carbohydrates. The microbiota multiplies this capacity [14]. The microbiota provides substrates for the enterocytes and thereby inhibits diseases caused by opportunistic pathogens [15].

The microbiota keeps the intestinal barrier intact [16]. And finally, it prevents the development of neoplasms or autoimmunity and favors endocrine functions, through the brain-intestine axis [17]. Without the beneficial microorganisms that we carry in our bodies, we would die due to infections in the mucosa, the skin, or pathogens that normally cannot proliferate.

Comments

Now, it´s necessary consider some processes that occur in CI, related to dementia, in order to specify interesting aspects. In the UK it is estimated that 209,600 new cases of dementia will appear per year [18]. What represents everything in challenge in this country. As the foregoing is the main challenge of the 21st century, prevention is an indispensable tool in its impact [19]. In 2015, the global cost of dementia was estimated at US $ 818 billion, and this figure will continue to increase, as the number of people with this disease increases. A new vein emerges, as knowledge of the Intestinal Microbiome develops [20]. This could represent a useful goal in the prevention of dementia.

Differences in the composition of the gut microbiome have been detected in some studies and bacterial populations are shown to be associated with dementia, regardless of traditional dementia biomarkers. Fact, which shows that IM, from healthy individuals, turns out to be an excellent ally in correcting the problem [21]. Likewise, the impact of the microbiome on health and the generation of various diseases is increasingly known. Thus we see that the genesis of CI has a substantial influence [22].

In Alzheimer's disease, in which dementia most frequently appears, changes in the permeability of the intestinal barrier, which translate inflammatory activity, have been detected through the intestine-brain axis [23,24]. Studies have been carried out showing that the obese microbiota translates interesting changes in obesity in mice [25,26]. Likewise, it has been determined that the Microbome modulates neurodevelopmental disorders [27]. Which is very significant, as this can form the basis for the use of Intestinal Microbiota Transplantation [28]. And the above, accompanied by a Mediterranean-ketogenic diet, tends to improve not only the Intestinal Microbiota itself, but also short-chain acids, in carriers of Azheimer, with CI [29].

Bacteroides are found as the main component of the intestinal Microbiota, and it should not be forgotten that they can become pathogens and their main action is the degradation of high molecular weight organic matter, which decreases with processed foods [30]. And in children, what happens? It is the Bifidobacterium longus, subspecies infantis, the most abundant subspecies, which possess enormous capacity to consume and digest any human oligosaccharide [31]. Determining that when there is consumption of probiotics of these bacteria, the possibility of necrotizing colitis decreases [32].

As we observed, our thesis that combined Microbiota transplantation, the use of a Mediterranean-ketogenic diet, the use of pro, pre or symbiotic drugs, as well as stress management, tend to improve CI. As reinforcement to this thesis, some special diets, such as those high in fat, tend to increase CI, as well as brain damage [33]. The same phenomenon occurs in the metabolic syndrome and in the pathological intestinal microbiota [34-36]. The determination of Bio-markers in cerebrospinal fluids, in small centers, are capable of diagnosing Alzheimer's disease in early stages and with this, they can affect CI [37].

Cognitive impairment and Intestinal Microbiota Transplantation:

The determination that abnormal IM is associated with the presence of Alzheimer's and CI has led several authors to seek to alleviate the disorder with IMT. And although there are few studies in this regard, the ones we reviewed contemplate the result in mice, through the sequencing of 16S rRNA and nuclear magnetic resonance, pointing out that indirect determinations improved the process, so IMT may be a therapy of helps in these problems [38]. On the other hand, IMT improves DI and clinical evolution in a European study [39]. The fact that the I MT in rats, with carbon tetrachloride-induced encephalopathy improves, is yet another indicator of what this interesting part of the human Microbiome can do [40]. Finally, if IM supplements improve CI, what will be the use of the total microbiota obtained from excellent donors [41]?

Conclusions

Now what is the challenge? It is undoubtedly the need for increased management in older adults [42].

A) The management of CI with IMT has demonstrated its effectiveness; it is necessary to increase its employment, with the necessary care, so that it is regulated outside the United States of America and can be used, in a more efficient way.

B) As the IMT is used, accompanied by a Mediterranean-ketogenic diet, pre, pro or symbolic and stress management, the scheme will undoubtedly be developed and will be useful in various conditions, including Cognitive Impairment.

C) The scheme we propose has a greater impact on children with severe disorders of IM and a family history of CI.

D) When treating older people, it is preferable to do it in mild Cognitive Impairment, rather than in advanced, since there will be better results and more possibilities of influencing psychological management.

Conflicts of Interest

The authors declare that do NOT have affiliation or participation in organizations with financial interests.

Ethical approval

This report does not contain any study with human or animal subjects carried out by the authors.

Informed Consent

The authors obtained informed written consent from the patients, in order to develop this article.

References

  1. FDA Issues Alert on Potential Risk of SARS-CoV-2 Transmission Trought FMT. Contagion Live. Infectious Diseases Today. Mar 24, 2020.
  2. Petersson J, Schreiber O, Hansson GC, Gendler SJ, Velcich A, et al. (2011) Importance and regulation of the colonic Mucus barrier in a mouse model of colitis. Am J Physiol. Gastrointest Liver Physiol. 300. : G327- G333.
  3. Brandt LJ (2013) American Journal of Gastroenterology Lecture: intestinal microbiota and the role of fecal microbiota transplant (FMT) in treatment of C. difficile infection. Am J Gastroenterol108: 177- 185.
  4. Sekirov I, Russell SL, Antunes LC, Finlay BB (2010) Gut microbiota in health and disease. Physiol Rev90: 859-904.
  5. Owyang C, Wu GD (2014) The gut microbiome in health and disease. Gastroenterology 146: 1433-1436.
  6. Chung H, Pamp SJ, Hill JA, Surana NK, Edelman SM, et al. (2012) Gut immune maturation depends on colonization with a host-specific microbiota. Cell. 149: 1578-93.
  7. Bernstein H, Bernstein C, Payne CM, Dvorakova K, Garewal H, et al. (2005) Bile acids as carcinogens in human gastrointestinal cancers. Mutat Res 589: 47-65.
  8. Bernstein C, Holubec H, Bhattacharyya AK, Nguyen H, Payne CM, et al. (2011) Carcinogenicity of deoxycholate, a secondary bile acid. Arch Toxicol 85: 863-871.
  9. Lu J, Claud EC (2019) Connection between gut microbiome and brain development in preterm infants. Dev Psychobiol. 61: 739-751.
  10. Sun X, Jia Z (2018) Microbiome modulates intestinal homeostasis against inflammatory diseases. Veterinary immunology and immunopathology. 205: 97-105.
  11. Pickard JM, Zeng MY, Caruso R, Núñez H (2017) Gut Microbiota: Role in Pathogen Colonization, Immune Responses and Inflammatory Disease. Immunol Rev279: 70-89.
  12. Rowland I, Gibson G, Heinken A, Scott K, Swann J, et al. (2018) Gut microbiota functions: metabolism of nutrients and other food components. Eur J Nutr57: 1-24.
  13. Krajmalnik-Brown R, Ilhan ZE, Dae-Wook K, DiBaise JK (2012) Effects of Gut Microbes on Nutrient Absorption and Energy Regulation. Nutr Clin Pract. 27: 201-214.
  14. Vinke PC, El Aidy S, van Dijk G (2017) The Role of Supplemental Complex Dietary Carbohydrates and Gut Microbiota in Promoting Cardiometabolic and Immunological Health in Obesity: Lessons from Healthy Non-Obese Individuals. Front Nutr. 4:34.
  15. Hillman ET, Lu H, Yao T, Nakatsu CH (2017) Microbial Ecology along the Gastrointestinal Tract. Microbes Environ. 32: 300-313.
  16. Jalili-Firoozinezhad S, Gazzaniga FS, Calamari EL, Camacho DM, Fadel CW, et al.  (2019) A complex human gut microbiome cultured in an anaerobic intestine-on-a-chip. Nat Biomed Eng. 3: 520-531.
  17. Carabotti M. Scirocco A, Maselli MA, Severi C (2015) The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 28: 203–209.
  18. Matthews FE, Stephan BC, Robinson L, Jagger C, Barnes LE, et al. (2016) A two decade dementia incidende comparision from the Cognitive Function and Ageing Studies I ad II. Nat Commun. 7: 11398.
  19. Livingston G, Sommerland A, Orgeta V, Costafreda SG, Huntley J, et al. (2017) Dementia prevention, intervention, and care. Lancet. 390: 2673-734.
  20. Saji N, Niida S, Murotani K, Hisada T, Tsuduki T, et al. Analysis of the relationship between the gut microbiome and dementia: a cross-sectional study conducted in Japan. Sci Rep 9: 1008.
  21. Alkasir R, Li J, Li X, Jin M, Zhu B (2017) Human gut microbiota: the links with dementia development. Protein Cell. 8: 90-102.
  22. Novotný M, Klimova B, Valis M (2019) Microbiome and Cognitive Impairment: Can Any Diets Infuence Learning Processes in a Positive Way? Front. Aging Neurosci.
  23. Li Z, Zhu L, Zhang L, Qin C (2018) The intestinal microbiome and Alzheimer's disease: A review. Animal Model Exp Med. 1: 180-188.
  24. Kowaski K, Mulak A (2019) Brain-Gut Microbiota Axis in Alzheimer´s Disease. Neurogastroenterol Motil. 25: 48-60.
  25. Bruce-Keller AJ, Salbaum JM, Luo M, Blanchard E, Taylor CM, et al. (2015) Obese-type gut microbiota induce neurobehavioral changes in the absence of obesity. Biol Psychiatry. 77: 607-615.
  26. Agusti A, García-Pardo MP, López-Almela I, Campillo I, Maes M, et al. (2018) Interplay between the gut-brain axis, obesity and cognitive function. Front Neurosci. 12: 155.
  27. Hsiao EY, McBride SW, Hsien S, Sahron G, Hyde ER, et al. (2013) Microbiota Modulate behavioral and physiological abnormalities associated with nurodevelopment disorders. Cell. 155: 1451-1463.
  28. Bajaj JS, Kassam A, Fagan A, Gavis EA, Liu E, et al. (2017) Fecal microbiota transplant using a precision medicine approach is safe, Associated with lower hospitalization risk and improved cognitive function in recurrent hepatic encephalopathy. Journal of Hepatology. 66 Supplement, Page S49.
  29. Nagpal R, Neth BJ, Craft S, Yaday H (2019) Modified Mediterranean-ketogenic diet modulates gut microbiome and short-chain fatty acids in association with Alzheimer's disease markers in subjects with mild cognitive impairment. EBioMedicine. 47: 529-542.
  30. Thomas F, Hehemann JH, Rebuffet E, Czjzek M, Michel G, et al. (2011) Enviromental and Gut Bacteroidetes: The Food Connection. Front Microbiol. 2: 93.
  31. Underwood MA, German JB, Lebrilla CB, Mills DA (2015) Bifidobacterium longum subspecies infantis: champion colonizer of the infant gut. Pediatr Res.77: 229-235.
  32. Kim CS, Claud EC (2019) Necrotizing Enterocolitis Pathophysiology: How Microbiome Data Alter Our Understanding. Clin Perinatol. 46: 29-38.
  33. Freeman LR, Haley Z, Rosenberger DS, Granhom AC (2014) Damaging effects of a high-fat diet to the brain and cognition: a review of proposed mechanisms. Nutr Neurosci. 17: 241-251.
  34. Kim B, Feldman EL (2015) Insulin resistance as a key link for the increased Risk of cognitive impairment in the metabolic syndrome. Exp Mol Med. 47: e149.
  35. Zhan G, Yang N, Li S, Huang N, Fang X, et al. (2018) Abnormal gut microbiota composition contributes to cognitive Dysfunction in SAMP8 mice. Aging (Albany NY). 10: 1257-1267.
  36. De Felice FG, Lourenco MV, Ferreira ST (2014) How does brain insulin resistance develop in Alzheimer’s disease? Alzheimer’s Dement. 9: S26-32.
  37. Mattsson N, Zetterberg H, Hannson O, Andreasen N, Parnetti L, et al. (2009) CSF Biomarkes and incipient Alzheimer Diseases in Patients with Mild Cognitive impairment. JAMA 302: 385-393.
  38. Sun J, Xu J, Ling Y, Wang F, Gong T, et al. (2019) Fecal microbiota transplantation alleviated Alzheimer´s disease-like pathogenesis in APP/PS1 transgenic mice. Transl Psuchiatry. 9: 189.
  39. European Association for the Study of the Liver. Fecal Microbiota Transplantation Produces Sustained Improvements in Cognitive and Clinical Outcomes. 2018. Apr 14.
  40. Wang WW, Zhag Ym Huang XB, You N, Zhg L, et al. (2017) Fecal microbiota transplantation prevents hepatic encephalopathy in rats with carbon tetrachloride-induced acute hepatic dysfunction. World J Gastroenterol. 23: 6983-6994.
  41. Shi H, Wang Q, Zheng M, Hao S, Lum JS, et al. (2020) Supplement of microbiota-accessible carbohydrates prevents neuroinflammation and cognitive decline by improving the gut microbiota-brain axis in diet-induced obese mice. Journal of Neuroinflammation. 17: 77.
  42. Pérez-Martínez VT (2005) El deterioro cognitivo: una mirada previsora. Rev Cubana Med Gen Integr. 2005 ene.-abrl 21. 1-2. Ciudad de la Habana.