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Principles and clinical implications of the brain-gut-enteric
Principles and clinical implications of the brain–gut–enteric
microbiota axis
Sang H. Rhee,
Inflammatory Bowel Disease Center, Division of Digestive Diseases, David Geffen School of
Medicine, UCLA, CA, USA.
Charalabos Pothoulakis, and
Inflammatory Bowel Disease Center, Division of Digestive Diseases, David Geffen School of
Medicine, UCLA, CA, USA.
Emeran A. Mayer
Center for Neurobiology of Stress, Los Angeles, CA, USA
Abstract
While bidirectional brain–gut interactions are well known mechanisms for the regulation of gut
function in both healthy and diseased states, a role of the enteric flora—including both commensal
and pathogenic organisms—in these interactions has only been recognized in the past few years.
The brain can influence commensal organisms (enteric microbiota) indirectly, via changes in
gastrointestinal motility and secretion, and intestinal permeability, or directly, via signaling
molecules released into the gut lumen from cells in the lamina propria (enterochromaffin cells,
neurons, immune cells). Communication from enteric microbiota to the host can occur via
multiple mechanisms, including epithelial-cell, receptor-mediated signaling and, when intestinal
permeability is increased, through direct stimulation of host cells in the lamina propria.
Enterochromaffin cells are important bidirectional transducers that regulate communication
between the gut lumen and the nervous system. Vagal, afferent innervation of enterochromaffin
cells provides a direct pathway for enterochromaffin-cell signaling to neuronal circuits, which may
have an important role in pain and immune-response modulation, control of background emotions
and other homeostatic functions. Disruption of the bidirectional interactions between the enteric
microbiota and the nervous system may be involved in the pathophysiology of acute and chronic
gastrointestinal disease states, including functional and inflammatory bowel disorders.
Introduction
The role of the central nervous system (CNS) in
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