White Matter Injury in Preterm Infants: Pathogenesis and Potential Therapy From the Aspect of the Gut-Brain Axis

Area of Science:

• Neonatal neurology
• Microbiology
• Neuroimmunology

Background:

• Very preterm infants face high risks of white matter injury (WMI).
• The gut microbiota's role in WMI pathogenesis is gaining attention.
• The gut-brain axis provides a framework for understanding gut-brain communication.

Purpose of the Study:

• To review mechanisms linking gut bacteria to the immature brain via the gut-brain axis.
• To explore how microbial metabolites influence neuroinflammation and oligodendrocyte development.
• To assess the potential of probiotics and prebiotics in managing WMI.

Main Methods:

• Literature review of studies on gut microbiota, gut-brain axis, and white matter injury.
• Analysis of proposed signaling pathways involving microbial metabolites, microglial activation, and oligodendrocyte differentiation.
• Evaluation of current evidence on probiotic and prebiotic interventions.

Main Results:

• Gut microbiota metabolites can modulate inflammatory and immune responses.
• Microglial activation, influenced by microbial signals, impacts pre-myelinating oligodendrocyte differentiation.
• This process can lead to white matter injury (WMI) in vulnerable infants.
• Probiotics and prebiotics show potential for improving neurodevelopmental outcomes.

Conclusions:

• The gut microbiota communicates with the immature brain, influencing WMI development through the gut-brain axis.
• Microbial metabolites play a key role in regulating neuroinflammation and oligodendrocyte maturation.
• While promising, probiotics and prebiotics require further research for optimal use in WMI treatment.