Skip to main content
Top
Published in: Journal of Neuroinflammation 1/2022

Open Access 01-12-2022 | Septicemia | Research

A crosstalk between gut and brain in sepsis-induced cognitive decline

Authors: Vijayasree V. Giridharan, Jaqueline S. Generoso, Leonardo Lence, Gabriela Candiotto, Emílio Streck, Fabricia Petronilho, Anilkumar Pillai, Tarek Sharshar, Felipe Dal-Pizzol, Tatiana Barichello

Published in: Journal of Neuroinflammation | Issue 1/2022

Login to get access

Abstract

Background

Sepsis is a potentially fatal disease characterized by acute organ failure that affects more than 30 million people worldwide. Inflammation is strongly associated with sepsis, and patients can experience impairments in memory, concentration, verbal fluency, and executive functioning after being discharged from the hospital. We hypothesize that sepsis disrupts the microbiota–gut–brain axis homeostasis triggering cognitive impairment. This immune activation persists during treatment, causing neurological dysfunction in sepsis survivors.

Methods

To test our hypothesis, adult Wistar rats were subjected to cecal–ligation and perforation (CLP) or sham (non-CLP) surgeries. The animals were subjected to the [11C]PBR28 positron emission tomography (PET)/computed tomography (CT) imaging at 24 h and 10 days after CLP and non-CLP surgeries. At 24 h and 10 days after surgery, we evaluated the gut microbiome, bacterial metabolites, cytokines, microglia, and astrocyte markers. Ten days after sepsis induction, the animals were subjected to the novel object recognition (NOR) and the Morris water maze (MWM) test to assess their learning and memory.

Results

Compared to the control group, the 24-h and 10-day CLP groups showed increased [11C]PBR28 uptake, glial cells count, and cytokine levels in the brain. Results show that sepsis modulates the gut villus length and crypt depth, alpha and beta microbial diversities, and fecal short-chain fatty acids (SCFAs). In addition, sepsis surviving animals showed a significant cognitive decline compared with the control group.

Conclusions

Since several pharmacological studies have failed to prevent cognitive impairment in sepsis survivors, a better understanding of the function of glial cells and gut microbiota can provide new avenues for treating sepsis patients.
Appendix
Available only for authorised users
Literature
1.
go back to reference CDC, Data & Reports-Sepsis, C.f.D.C.a. Prevention., Editor. updated 2018. CDC, Data & Reports-Sepsis, C.f.D.C.a. Prevention., Editor. updated 2018.
4.
go back to reference Iwashyna TJ, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA J Am Med Assoc. 2010;304(16):1787–94.CrossRef Iwashyna TJ, et al. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA J Am Med Assoc. 2010;304(16):1787–94.CrossRef
5.
6.
7.
go back to reference Widmann CN, Heneka MT. Long-term cerebral consequences of sepsis. Lancet Neurol. 2014;13(6):630–6.PubMedCrossRef Widmann CN, Heneka MT. Long-term cerebral consequences of sepsis. Lancet Neurol. 2014;13(6):630–6.PubMedCrossRef
8.
go back to reference Barichello T, et al. The blood-brain barrier dysfunction in sepsis. Tissue Barriers. 2021;9(1):1840912.PubMedCrossRef Barichello T, et al. The blood-brain barrier dysfunction in sepsis. Tissue Barriers. 2021;9(1):1840912.PubMedCrossRef
9.
go back to reference Cagnin A, et al. In-vivo measurement of activated microglia in dementia. Lancet. 2001;358(9280):461–7.PubMedCrossRef Cagnin A, et al. In-vivo measurement of activated microglia in dementia. Lancet. 2001;358(9280):461–7.PubMedCrossRef
10.
12.
go back to reference Pascual B, et al. Neuroinflammation is highest in areas of disease progression in semantic dementia. Brain. 2021;144(5):1565–75.PubMedCrossRef Pascual B, et al. Neuroinflammation is highest in areas of disease progression in semantic dementia. Brain. 2021;144(5):1565–75.PubMedCrossRef
13.
go back to reference Semmler A, et al. Systemic inflammation induces apoptosis with variable vulnerability of different brain regions. J Chem Neuroanat. 2005;30(2–3):144–57.PubMedCrossRef Semmler A, et al. Systemic inflammation induces apoptosis with variable vulnerability of different brain regions. J Chem Neuroanat. 2005;30(2–3):144–57.PubMedCrossRef
14.
go back to reference Semmler A, et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry. 2013;84(1):62–9.PubMedCrossRef Semmler A, et al. Persistent cognitive impairment, hippocampal atrophy and EEG changes in sepsis survivors. J Neurol Neurosurg Psychiatry. 2013;84(1):62–9.PubMedCrossRef
16.
go back to reference Wichterman KA, Baue AE, Chaudry IH. Sepsis and septic shock–a review of laboratory models and a proposal. J Surg Res. 1980;29(2):189–201.PubMedCrossRef Wichterman KA, Baue AE, Chaudry IH. Sepsis and septic shock–a review of laboratory models and a proposal. J Surg Res. 1980;29(2):189–201.PubMedCrossRef
17.
18.
go back to reference Toth M, et al. Positron emission tomography studies with [11C]PBR28 in the healthy rodent brain: validating SUV as an outcome measure of neuroinflammation. PLoS ONE. 2015;10(5): e0125917.PubMedPubMedCentralCrossRef Toth M, et al. Positron emission tomography studies with [11C]PBR28 in the healthy rodent brain: validating SUV as an outcome measure of neuroinflammation. PLoS ONE. 2015;10(5): e0125917.PubMedPubMedCentralCrossRef
19.
go back to reference Bhattacharyya S, Bershtein S, Shakhnovich EI. Gene dosage experiments in enterobacteriaceae using arabinose-regulated promoters. Bio Protoc. 7(14). Bhattacharyya S, Bershtein S, Shakhnovich EI. Gene dosage experiments in enterobacteriaceae using arabinose-regulated promoters. Bio Protoc. 7(14).
20.
go back to reference Giridharan VV, et al. Neuroinflammation trajectories precede cognitive impairment after experimental meningitis-evidence from an in vivo PET study. J Neuroinflammation. 2020;17(1):5.PubMedPubMedCentralCrossRef Giridharan VV, et al. Neuroinflammation trajectories precede cognitive impairment after experimental meningitis-evidence from an in vivo PET study. J Neuroinflammation. 2020;17(1):5.PubMedPubMedCentralCrossRef
21.
go back to reference Scaini G, et al. Perturbations in the apoptotic pathway and mitochondrial network dynamics in peripheral blood mononuclear cells from bipolar disorder patients. Transl Psychiatry. 2017;7(5): e1111.PubMedPubMedCentralCrossRef Scaini G, et al. Perturbations in the apoptotic pathway and mitochondrial network dynamics in peripheral blood mononuclear cells from bipolar disorder patients. Transl Psychiatry. 2017;7(5): e1111.PubMedPubMedCentralCrossRef
22.
24.
go back to reference Quast C, et al. The SILVA ribosomal RNA gene database project: improved data processing and web-based tools. Nucleic Acids Res. 2013;41(Database issue):590–6. Quast C, et al. The SILVA ribosomal RNA gene database project: improved data processing and web-based tools. Nucleic Acids Res. 2013;41(Database issue):590–6.
25.
go back to reference Lee J, et al. Young versus aged microbiota transplants to germ-free mice: increased short-chain fatty acids and improved cognitive performance. Gut microbes. 2020;12(1):1–14.PubMed Lee J, et al. Young versus aged microbiota transplants to germ-free mice: increased short-chain fatty acids and improved cognitive performance. Gut microbes. 2020;12(1):1–14.PubMed
26.
go back to reference Zhao G, Nyman M, Jönsson JA. Rapid determination of short-chain fatty acids in colonic contents and faeces of humans and rats by acidified water-extraction and direct-injection gas chromatography. Biomed Chromatogr. 2006;20(8):674–82.PubMedCrossRef Zhao G, Nyman M, Jönsson JA. Rapid determination of short-chain fatty acids in colonic contents and faeces of humans and rats by acidified water-extraction and direct-injection gas chromatography. Biomed Chromatogr. 2006;20(8):674–82.PubMedCrossRef
28.
go back to reference Idris N, et al. Sertindole improves sub-chronic PCP-induced reversal learning and episodic memory deficits in rodents: involvement of 5-HT(6) and 5-HT (2A) receptor mechanisms. Psychopharmacology. 2010;208(1):23–36.PubMedCrossRef Idris N, et al. Sertindole improves sub-chronic PCP-induced reversal learning and episodic memory deficits in rodents: involvement of 5-HT(6) and 5-HT (2A) receptor mechanisms. Psychopharmacology. 2010;208(1):23–36.PubMedCrossRef
29.
go back to reference Morris R. Developments of a water-maze procedure for studying spatial learning in the rat. J Neurosci Methods. 1984;11(1):47–60.PubMedCrossRef Morris R. Developments of a water-maze procedure for studying spatial learning in the rat. J Neurosci Methods. 1984;11(1):47–60.PubMedCrossRef
30.
go back to reference Kim BR, et al. Deciphering diversity indices for a better understanding of microbial communities. J Microbiol Biotechnol. 2017;27(12):2089–93.PubMedCrossRef Kim BR, et al. Deciphering diversity indices for a better understanding of microbial communities. J Microbiol Biotechnol. 2017;27(12):2089–93.PubMedCrossRef
31.
go back to reference Lozupone C, et al. UniFrac: an effective distance metric for microbial community comparison. Isme j. 2011;5(2):169–72.PubMedCrossRef Lozupone C, et al. UniFrac: an effective distance metric for microbial community comparison. Isme j. 2011;5(2):169–72.PubMedCrossRef
32.
go back to reference Chen J, et al. Associating microbiome composition with environmental covariates using generalized UniFrac distances. Bioinformatics. 2012;28(16):2106–13.PubMedPubMedCentralCrossRef Chen J, et al. Associating microbiome composition with environmental covariates using generalized UniFrac distances. Bioinformatics. 2012;28(16):2106–13.PubMedPubMedCentralCrossRef
34.
go back to reference Tóth M, et al. Acute neuroinflammation in a clinically relevant focal cortical ischemic stroke model in rat: longitudinal positron emission tomography and immunofluorescent tracking. Brain Struct Funct. 2016;221(3):1279–90.PubMedCrossRef Tóth M, et al. Acute neuroinflammation in a clinically relevant focal cortical ischemic stroke model in rat: longitudinal positron emission tomography and immunofluorescent tracking. Brain Struct Funct. 2016;221(3):1279–90.PubMedCrossRef
35.
go back to reference Forsberg A, et al. The immune response of the human brain to abdominal surgery. Ann Neurol. 2017;81(4):572–82.PubMedCrossRef Forsberg A, et al. The immune response of the human brain to abdominal surgery. Ann Neurol. 2017;81(4):572–82.PubMedCrossRef
37.
go back to reference Warford J, et al. Human brain chemokine and cytokine expression in sepsis: a report of three cases. Can J Neurol Sci Le Journal Canadien Des Sciences Neurologiques. 2017;44(1):96–104.CrossRef Warford J, et al. Human brain chemokine and cytokine expression in sepsis: a report of three cases. Can J Neurol Sci Le Journal Canadien Des Sciences Neurologiques. 2017;44(1):96–104.CrossRef
39.
go back to reference Zrzavy T, et al. Pro-inflammatory activation of microglia in the brain of patients with sepsis. Neuropathol Appl Neurobiol. 2019;45(3):278–90.PubMedCrossRef Zrzavy T, et al. Pro-inflammatory activation of microglia in the brain of patients with sepsis. Neuropathol Appl Neurobiol. 2019;45(3):278–90.PubMedCrossRef
40.
go back to reference Barichello T et al. Postmortem evidence of brain inflammatory markers and injury in septic patients: a systematic review. Crit Care Med. 2021. Barichello T et al. Postmortem evidence of brain inflammatory markers and injury in septic patients: a systematic review. Crit Care Med. 2021.
41.
go back to reference Cohen SJ, Stackman RW Jr. Assessing rodent hippocampal involvement in the novel object recognition task, a review. Behav Brain Res. 2015;285:105–17.PubMedCrossRef Cohen SJ, Stackman RW Jr. Assessing rodent hippocampal involvement in the novel object recognition task, a review. Behav Brain Res. 2015;285:105–17.PubMedCrossRef
42.
go back to reference Warford J, et al. Human brain chemokine and cytokine expression in sepsis: a report of three cases. Can J Neurol Sci. 2017;44(1):96–104.PubMedCrossRef Warford J, et al. Human brain chemokine and cytokine expression in sepsis: a report of three cases. Can J Neurol Sci. 2017;44(1):96–104.PubMedCrossRef
43.
go back to reference Sharshar T, et al. Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock. Lancet. 2003;362(9398):1799–805.PubMedCrossRef Sharshar T, et al. Apoptosis of neurons in cardiovascular autonomic centres triggered by inducible nitric oxide synthase after death from septic shock. Lancet. 2003;362(9398):1799–805.PubMedCrossRef
44.
go back to reference Dominguini D, et al. The protective effect of PK-11195 on cognitive impairment in rats survived of polymicrobial sepsis. Mol Neurobiol. 2021;58(6):2724–33.PubMedCrossRef Dominguini D, et al. The protective effect of PK-11195 on cognitive impairment in rats survived of polymicrobial sepsis. Mol Neurobiol. 2021;58(6):2724–33.PubMedCrossRef
45.
go back to reference Barichello T, et al. The translocator protein (18kDa) and its role in neuropsychiatric disorders. Neurosci Biobehav Rev. 2017;83:183–99.PubMedCrossRef Barichello T, et al. The translocator protein (18kDa) and its role in neuropsychiatric disorders. Neurosci Biobehav Rev. 2017;83:183–99.PubMedCrossRef
46.
47.
go back to reference Gerhard A, et al. In vivo imaging of microglial activation with [11C](R)-PK11195 PET in idiopathic Parkinson’s disease. Neurobiol Dis. 2006;21(2):404–12.PubMedCrossRef Gerhard A, et al. In vivo imaging of microglial activation with [11C](R)-PK11195 PET in idiopathic Parkinson’s disease. Neurobiol Dis. 2006;21(2):404–12.PubMedCrossRef
48.
go back to reference Kumar A, Williams MT, Chugani HT. Evaluation of basal ganglia and thalamic inflammation in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection and tourette syndrome: a positron emission tomographic (PET) study using 11C-[R]-PK11195. J Child Neurol. 2015;30(6):749–56.PubMedCrossRef Kumar A, Williams MT, Chugani HT. Evaluation of basal ganglia and thalamic inflammation in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection and tourette syndrome: a positron emission tomographic (PET) study using 11C-[R]-PK11195. J Child Neurol. 2015;30(6):749–56.PubMedCrossRef
49.
go back to reference Valdés-Ferrer SI, et al. HMGB1 mediates splenomegaly and expansion of splenic CD11b+ Ly-6C(high) inflammatory monocytes in murine sepsis survivors. J Intern Med. 2013;274(4):381–90.PubMedPubMedCentralCrossRef Valdés-Ferrer SI, et al. HMGB1 mediates splenomegaly and expansion of splenic CD11b+ Ly-6C(high) inflammatory monocytes in murine sepsis survivors. J Intern Med. 2013;274(4):381–90.PubMedPubMedCentralCrossRef
52.
go back to reference Barichella M, et al. Unraveling gut microbiota in Parkinson’s disease and atypical parkinsonism. Mov Disord. 2019;34(3):396–405.PubMedCrossRef Barichella M, et al. Unraveling gut microbiota in Parkinson’s disease and atypical parkinsonism. Mov Disord. 2019;34(3):396–405.PubMedCrossRef
53.
go back to reference Ling Y, et al. Gut microbiome signatures are biomarkers for cognitive impairment in patients with ischemic stroke. Front Aging Neurosci. 2020;12: 511562.PubMedPubMedCentralCrossRef Ling Y, et al. Gut microbiome signatures are biomarkers for cognitive impairment in patients with ischemic stroke. Front Aging Neurosci. 2020;12: 511562.PubMedPubMedCentralCrossRef
54.
go back to reference Myers SA, et al. Following spinal cord injury, PDE4B drives an acute, local inflammatory response and a chronic, systemic response exacerbated by gut dysbiosis and endotoxemia. Neurobiol Dis. 2019;124:353–63.PubMedCrossRef Myers SA, et al. Following spinal cord injury, PDE4B drives an acute, local inflammatory response and a chronic, systemic response exacerbated by gut dysbiosis and endotoxemia. Neurobiol Dis. 2019;124:353–63.PubMedCrossRef
55.
56.
go back to reference Zwielehner J, et al. Combined PCR-DGGE fingerprinting and quantitative-PCR indicates shifts in fecal population sizes and diversity of Bacteroides, bifidobacteria and Clostridium cluster IV in institutionalized elderly. Exp Gerontol. 2009;44(6–7):440–6.PubMedCrossRef Zwielehner J, et al. Combined PCR-DGGE fingerprinting and quantitative-PCR indicates shifts in fecal population sizes and diversity of Bacteroides, bifidobacteria and Clostridium cluster IV in institutionalized elderly. Exp Gerontol. 2009;44(6–7):440–6.PubMedCrossRef
57.
go back to reference Liu P, et al. Gut microbiota interacts with intrinsic brain activity of patients with amnestic mild cognitive impairment. CNS Neurosci Ther. 2021;27(2):163–73.PubMedCrossRef Liu P, et al. Gut microbiota interacts with intrinsic brain activity of patients with amnestic mild cognitive impairment. CNS Neurosci Ther. 2021;27(2):163–73.PubMedCrossRef
58.
go back to reference Li H, et al. Clostridium butyricum exerts a neuroprotective effect in a mouse model of traumatic brain injury via the gut-brain axis. Neurogastroenterol Motil. 2018;30(5): e13260.PubMedCrossRef Li H, et al. Clostridium butyricum exerts a neuroprotective effect in a mouse model of traumatic brain injury via the gut-brain axis. Neurogastroenterol Motil. 2018;30(5): e13260.PubMedCrossRef
61.
go back to reference Rothhammer V, Quintana FJ. The aryl hydrocarbon receptor: an environmental sensor integrating immune responses in health and disease. Nat Rev Immunol. 2019;19(3):184–97.PubMedCrossRef Rothhammer V, Quintana FJ. The aryl hydrocarbon receptor: an environmental sensor integrating immune responses in health and disease. Nat Rev Immunol. 2019;19(3):184–97.PubMedCrossRef
62.
go back to reference Steckert AV, et al. Effects of sodium butyrate on aversive memory in rats submitted to sepsis. Neurosci Lett. 2015;595:134–8.PubMedCrossRef Steckert AV, et al. Effects of sodium butyrate on aversive memory in rats submitted to sepsis. Neurosci Lett. 2015;595:134–8.PubMedCrossRef
63.
Metadata
Title
A crosstalk between gut and brain in sepsis-induced cognitive decline
Authors
Vijayasree V. Giridharan
Jaqueline S. Generoso
Leonardo Lence
Gabriela Candiotto
Emílio Streck
Fabricia Petronilho
Anilkumar Pillai
Tarek Sharshar
Felipe Dal-Pizzol
Tatiana Barichello
Publication date
01-12-2022
Publisher
BioMed Central
Published in
Journal of Neuroinflammation / Issue 1/2022
Electronic ISSN: 1742-2094
DOI
https://doi.org/10.1186/s12974-022-02472-4

Other articles of this Issue 1/2022

Journal of Neuroinflammation 1/2022 Go to the issue