Microbiota modulation as preventative and therapeutic approach in Alzheimer's disease

FEBS J. 2021 May;288(9):2836-2855. doi: 10.1111/febs.15571. Epub 2020 Oct 8.


The gut microbiota coevolves with its host, and numerous factors like diet, lifestyle, drug intake and geographical location continuously modify its composition, deeply influencing host health. Recent studies demonstrated that gut dysbiosis can alter normal brain function through the so-called gut-brain axis, a bidirectional communication network between the central nervous system and the gastrointestinal tract, thus playing a key role in the pathogenesis of neurodegenerative disorders, such as Alzheimer's disease (AD). In this perspective, in the constant search for novel treatments in AD, the rational modulation of gut microbiota composition could represent a promising approach to prevent or delay AD onset or to counteract its progression. Preclinical and human studies on microbiota modulation through oral bacteriotherapy and faecal transplantation showed anti-inflammatory and antioxidant effects, upregulation of plasma concentration of neuroprotective hormones, restoration of impaired proteolytic pathways, amelioration of energy homeostasis with consequent decrease of AD molecular hallmarks and improvement of behavioural and cognitive performances. In this review, we dissect the role of gut microbiota in AD and highlight recent advances in the development of new multitarget strategies for microbiota modulation to be used as possible preventative and therapeutic approaches in AD.

Keywords: Alzheimer’s disease; dysbiosis; gut-brain axis; inflammation; microbiota modulation; oxidative stress; prebiotics; probiotics; proteolysis; therapeutic approaches.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Alzheimer Disease / microbiology*
  • Alzheimer Disease / pathology
  • Alzheimer Disease / prevention & control
  • Alzheimer Disease / therapy
  • Antioxidants / therapeutic use
  • Brain / metabolism
  • Brain / pathology
  • Gastrointestinal Microbiome / genetics*
  • Humans
  • Inflammation / drug therapy*
  • Inflammation / genetics
  • Neuroprotective Agents / therapeutic use


  • Antioxidants
  • Neuroprotective Agents