Cited by 121Gut microbiota and healthAlzheimer's disease research and treatmentsDementia and Cognitive Impairment Research

A peripheral signature of Alzheimer’s disease featuring microbiota-gut-brain axis markers

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Marizzoni, Moira, Mirabelli, Peppino, Mombelli, Elisa, Coppola, Luigi, Festari, Cristina, Lopizzo, Nicola, Luongo, Delia, Mazzelli, Monica +7 more·2023·Alzheimer's Research & Therapy

Abstract

Background: Increasing evidence links the gut microbiota (GM) to Alzheimer’s disease (AD) but the mechanisms through which gut bacteria influence the brain are still unclear. This study tests the hypothesis that GM and mediators of the microbiota-gut-brain axis (MGBA) are associated with the amyloid cascade in sporadic AD. Methods: We included 34 patients with cognitive impairment due to AD (CI-AD), 37 patients with cognitive impairment not due to AD (CI-NAD), and 13 cognitively unimpaired persons (CU). We studied the following systems: (1) fecal GM, with 16S rRNA sequencing; (2) a panel of putative MGBA mediators in the blood including immune and endothelial markers as bacterial products (i.e., lipopolysaccharide, LPS), cell adhesion molecules (CAMs) indicative of endothelial dysfunction (VCAM-1, PECAM-1), vascular changes (P-, E-Selectin), and upregulated after infections (NCAM, ICAM-1), as well as pro- (IL1β, IL6, TNFα, IL18) and anti- (IL10) inflammatory cytokines; (3) the amyloid cascade with amyloid PET, plasma phosphorylated tau (pTau-181, for tau pathology), neurofilament light chain (NfL, for neurodegeneration), and global cognition measured using MMSE and ADAScog. We performed 3-group comparisons of markers in the 3 systems and calculated correlation matrices for the pooled group of CI-AD and CU as well as CI-NAD and CU. Patterns of associations based on Spearman’s rho were used to validate the study hypothesis. Results: CI-AD were characterized by (1) higher abundance of Clostridia_UCG-014 and decreased abundance of Moryella and Blautia ( p < .04); (2) elevated levels of LPS ( p < .03), upregulation of CAMs, Il1β, IL6, and TNFα, and downregulation of IL10 ( p < .05); (3) increased brain amyloid, plasma pTau-181, and NfL ( p < 0.004) compared with the other groups. CI-NAD showed (1) higher abundance of [Eubacterium] coprostanoligenes group and Collinsella and decreased abundance of Lachnospiraceae_ND3007_group , [Ruminococcus]_gnavus_group and Oscillibacter ( p < .03); (2) upregulation of PECAM-1 and TNFα ( p < .03); (4) increased plasma levels of NfL ( p < .02) compared with CU. Different GM genera were associated with immune and endothelial markers in both CI-NAD and CI-AD but these mediators were widely related to amyloid cascade markers only in CI-AD. Conclusions: Specific bacterial genera are associated with immune and endothelial MGBA mediators, and these are associated with amyloid cascade markers in sporadic AD. The physiological mechanisms linking the GM to the amyloid cascade should be further investigated to elucidate their potential therapeutic implications.

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Crossref · 10.1186/s13195-023-01218-5

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  • LPS is elevated in both the blood and brain of AD patients.

    “LPS is elevated in both the blood and brain of AD patients.25–29”

    From TET2-mutant myeloid cells mitigate Alzheimer’s disease progression via CNS infiltration and enhanced phagocytosis in mice (2025) · cites this paper as [28]

    The Results (Immune and endothelial microbiota-gut-brain axis mediators; page unavailable) report high LPS levels in patients with cognitive impairment due to AD, and the Methods specify that LPS was measured in plasma. The paper does not report elevated LPS levels in those patients’ brains; the Discussion mentions possible co-localization with amyloid plaques, not a brain-level comparison. (LLM, conf=0.89)

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  • Beneficial taxa such as Bifidobacterium and Lactobacillus are typically decreased, while proinflammatory bacteria including Escherichia/Shigella, Enterobacteriaceae, and Clostridium species are enriched in AD.

    “For instance, beneficial taxa such as Bifidobacterium and Lactobacillus are typically decreased, while proinflammatory bacteria, including Escherichia/Shigella, Enterobacteriaceae, and Clostridium species are enriched [124].”

    From Toward a Unified Framework in Molecular Neurobiology of Alzheimer’s Disease: Revisiting the Pathophysiological Hypotheses (2026) · cites this paper as [124]

    The Results section (Gut microbial communities; page unavailable) reports higher Clostridia_UCG-014 in the AD group, supporting that part of the claim. But it reports higher—not lower—Bifidobacterium, and the Discussion describes published Bifidobacterium findings as conflicting rather than typically decreased. The cited passages do not establish the claimed changes in Lactobacillus, Escherichia/Shigella, or Enterobacteriaceae. (LLM, conf=0.88)

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Authors
Marizzoni, M., Mirabelli, P., Mombelli, E., Coppola, L., Festari, C., Lopizzo, N., Luongo, D., Mazzelli, M., Naviglio, D., Blouin, J.-L., Abramowicz, M., Salvatore, M., Pievani, M., Cattaneo, A., & Frisoni, G. B.
Affiliations
  • Centro San Giovanni di Dio Fatebenefratelli (IT)
  • University of Milan (IT)
  • Institute of Biostructure and Bioimaging (IT)
  • University of Naples Federico II (IT)
  • University of Geneva (CH)
Corresponding author
Marizzoni, Moira
Venue
Alzheimer's Research & Therapy
Published
2023-05-31
Volume
15
Issue
1
Pages
101-101
ISSN
1758-9193 (ISSN-L)
OpenAlex
W4378781690
Cited by
121
References
69
Citations by year
2026: 24 · 2025: 64 · 2024: 27 · 2023: 6
FWCI
10.78
Type
journal article
Language
en
Open access
Locations
  • Alzheimer s Research & Therapy (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Science Foundation
  • Alzheimer's Association
  • Biogen
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
  • Ministero della Salute
  • Eisai
  • Hôpitaux Universitaires de Genève
  • Fondation Segré
  • Horizon 2020 Framework Programme
  • Avid Radiopharmaceuticals
  • Faculté de Médecine, Université de Genève
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
Alzheimer's disease, gut microbiota, microbiota-gut-brain axis, amyloid hypothesis, lipopolysaccharide, adhesion molecules, endothelial dysfunction, inflammatory cytokines, Clostridia_UCG-014, Blautia, Eubacterium coprostanoligenes, Collinsella, phosphorylated tau, neurofilament light chain, amyloid PET, cognitive impairment
MeSH terms
Brain-Gut Axis, Alzheimer Disease, Humans, Lipopolysaccharides, Mitoguazone, NAD, RNA, Ribosomal, 16S, Tumor Necrosis Factor-alpha, Biomarkers, Interleukin-6, Amyloid beta-Peptides, Interleukin-10, Platelet Endothelial Cell Adhesion Molecule-1

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