The role of the gut-spinal axis in immune-metabolic coupling after spinal cord injury

Spinal cord injury (SCI), representing a devastating trauma to the central nervous system (CNS), is often accompanied by complex immune responses and metabolic dysregulation, significantly affecting patients' functional recovery and quality of life. In recent years, the gut-spinal axis, as an important pathway connecting the gut microbiome and the CNS, has emerged as a pivotal area of investigation regarding the pathological mechanisms of SCI. Changes in the gut microbiome modulate inflammatory responses and tissue repair processes after SCI by regulating immune system activation and metabolic pathways. However, the specific mechanisms by which the gut-spinal axis mediates the interplay between immune and metabolic processes after SCI have not been fully elucidated. This article summarizes the structural and functional characteristics of the gut-spinal axis, as well as the gut microbial imbalance, immune activation, and metabolic regulation induced by SCI. It focuses on how the gut-spinal axis mediates the interaction between immunity and metabolism, thereby influencing the pathological progression and repair potential of SCI. By integrating basic and clinical research findings, it aims to offer a theoretical framework for the comprehensive regulatory mechanisms of immunity and metabolism in SCI and to explore innovative therapeutic strategies targeting the gut-spinal axis.