Extracellular Vesicles in the Gut-Vascular-Brain Axis: A Missing Mechanistic Link Between IBD and Stroke Risk

Area of Science:

• Gastroenterology
• Neurology
• Vascular Biology

Background:

• Inflammatory bowel disease (IBD) is a systemic inflammatory condition linked to increased ischemic stroke risk, even in young adults.
• Traditional vascular risk factors do not fully explain the elevated stroke risk in IBD patients.
• Mechanisms connecting intestinal inflammation to cerebrovascular injury require further elucidation.

Purpose of the Study:

• To propose a mechanistic framework for how extracellular vesicles (EVs) mediate the link between intestinal inflammation and cerebrovascular vulnerability.
• To review existing literature on IBD, vascular disease, and EV biology.

Main Methods:

• Literature review integrating epidemiologic, vascular, and EV biology data.
• Focus on the role of EVs as mediators of intercellular communication in inflammatory states.

Main Results:

• Circulating EVs in IBD are enriched with pro-inflammatory molecules.
• These EVs can promote endothelial activation, blood-brain barrier disruption, immune-thrombosis, and neuroinflammation.
• A mechanistic framework is proposed linking gut inflammation to brain vascular injury via the gut-vascular-brain axis.

Conclusions:

• EV-mediated signaling offers a plausible mechanism integrating intestinal inflammation with cerebrovascular vulnerability.
• Further experimental and translational research is needed to confirm causality and explore therapeutic targets.